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Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults. We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such as death, fracture, and population-based clinical measures where available.

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.

Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50 years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57–93] years), most (83%) published in the past 3 years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32 weeks) for older adults living in the community seems feasible, accepted, and can improve physical function. [ABSTRACT FROM AUTHOR]

Background: Approximately 3 million people in the United Kingdom are currently living with or beyond cancer. People undergoing treatment for cancer are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) in enhancing psychological and physical well-being in patients with cancer and improving outcomes. Active Together is an evidence-based, multimodal rehabilitation service for patients with cancer, providing support to help patients prepare for and recover from treatment. This paper presents the evaluation protocol for the Active Together service, aiming to determine its impact on patient-reported outcomes and clinical endpoints, as well as understand processes and mechanisms that influence its delivery and outcomes. Methods: This evaluation comprises an outcome and process evaluation, with service implementation data integrated into the analysis of outcome measures. The outcome evaluation will assess changes in outcomes of patients that attend the service and compare health care resource use against historical data. The process evaluation will use performance indicators, semistructured interviews, and focus groups to explore mechanisms of action and contextual factors influencing delivery and outcomes. Integrating psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service. Conclusions: Evidence to support the role of multimodal rehabilitation before, during, and after cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world impact of cancer rehabilitation and strengthen the case for widespread adoption of rehabilitation into routine care for people with cancer. [ABSTRACT FROM AUTHOR]

Help Chain (HC) is a problem-solving practice underpinned by lean manufacturing principles and also adopted for health services, which have different complexity characteristics in relation to manufacturing. This study is based on the premise that Social Network Analysis (SNA) might be an effective analytical approach to account for the complexity of HCs in healthcare. Hence, two research questions are addressed: how to model and interpret HCs in health services as a social network and how SNA can either challenge or add to the lean assumptions of HC design. The use of SNA to model HCs was tested in a maternity hospital, where HCs related to five problems were analyzed, concerning the supply of instruments from the centre of sterilised materials to the surgical and obstetrics units. We analyzed the HCs of single problems and then combined the five problem-solving networks to produce a multilayered network that accounted for their interactions. The patterns of social interactions varied according to the problem and three dimensions of actors' performance (i.e. availability, reliability, and agility). SNA unveiled the complexity of HCs and provided guidance for revising the lean assumptions in their design, matching the realities of health services. [ABSTRACT FROM AUTHOR]

Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semistructured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFCs enable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community. [ABSTRACT FROM AUTHOR]

This systematic review synthesized the literature on digital health interventions for the promotion of physical activity (PA) among people with intellectual disabilities and/or autism. From an initial screening of 553 records, 10 studies underwent full-text review. Data were extracted relating to study, intervention, and sample characteristics and PA-related findings. Methodological quality was evaluated using the Crowe Critical Appraisal Tool. There were mixed findings pertaining to the effectiveness of digital health interventions for promoting PA among these populations. Positive results were reported for three of five active-video-game interventions, two of three social-media-based interventions, and one of two e-learning/multicomponent interventions. Digital health interventions can potentially be effective for promoting PA among people with intellectual disabilities and/or autism. However, the large variation in the samples and intervention types and a reliance on pre- and quasi-experimental research designs suggest that inferences should be made with caution and additional research is needed. [ABSTRACT FROM AUTHOR]

The article discusses the importance of physical activity promotion by health professionals in increasing population physical activity levels. It highlights the World Health Organization's Global Action Plan on Physical Activity and the International Society for Physical Activity and Health's Eight investments that work for physical activity as key strategies. The article emphasizes the need to strengthen the training of health professionals to increase their knowledge and skills for promoting physical activity. It also provides physical activity guidelines for different populations and discusses the effectiveness of physical activity advice in various healthcare settings. The article proposes a continuum of physical activity advice that can be tailored to different time constraints and settings. Overall, the article emphasizes the role of all health professionals in promoting physical activity and the potential impact on population health. [Extracted from the article]

The historiography of the American effort in World War I describes an American unwillingness to learn from the Allies. However true that may be for the combat arms, it was untrue for the Army Medical Department (AMEDD). The AMEDD sought a wide range of information from the beginning of the war, and through multiple channels that expand substantially and systematically once the U.S. entered the war. The information was also disseminated through multiple channels and made significant impacts on medical care in the American Expeditionary Force (AEF) during the Great War. Historians should be more cautious about assuming that all parts of the AEF were resistant to foreign information. [ABSTRACT FROM AUTHOR]

Despite considerable investment, health outcomes for First Nations people are well below those of the rest of the population in several countries, including Canada, the United States, and Australia. In this article, the authors draw on actor-network theory and the case of Birthing on Country, a successful policy initiative led by First Nations Australians, to explore the decolonization of health services. Using publicly available archival data and the theoretical guidance of actor-network theory, the analysis offers insight into how marketing techniques and technologies can be deployed to achieve improved health outcomes and implement decolonized approaches. The insights provided have theoretical implications for marketing scholarship, social implications for understanding and implementing an agenda of decolonization, and practical implications for health care marketing. [ABSTRACT FROM AUTHOR]

Purpose: To describe the use of work process modelling to optimise the organisation of the demand for oral health treatment in primary care units in Brazil. Materials and Methods: The oral health care routine was at first described as the “AS IS” model, which was evaluated by the oral team professionals, rearranged, and further described as the “TO BE” model described using a business process management modelling tool. The significant increase in the demand of patients due to restrictions offered by the dental service in addition to non-urgent treatments being avoided by patients during COVID-19 pandemic was also considered. Results: Structuring the work processes in a visual way using modelling tools was useful to picture the entire treatment process and adjust when needed. The use of the managerial tool was useful to understand and reorganise the workflow of organising the demand and ultimately improve the efficiency of the resources. The use of such managerial tools helped oral health professionals to efficiently rearrange their tasks and set priorities to meet their needs. Conclusions: With the use of management tools, each unit can readjust its structures and ways of working, aiming to improve the quality of public health care services provided to patients. [ABSTRACT FROM AUTHOR]

Chatbots are "computer agents that can interact with the user" in a way that feels like human-to-human conversation.1 While the use of chatbots for reference service in academic libraries is a topic of interest for both library professionals and researchers, little is known about how they are used in library reference service, especially in academic libraries in Canada. This article aims to fill this gap by conducting a web-based survey of 106 academic library websites in Canada and analyzing the prevalence and characteristics of chatbot and live chat services offered by these libraries. The authors found that only two libraries were using chatbots for reference service. For live chat services, the authors found that 78 libraries provided this service. The article discusses possible reasons for the low adoption of chatbots in academic libraries, such as accessibility, privacy, cost, and professional identity issues. The article also provides a case study of the authors' institution, the University of Calgary, which integrated a chatbot service in 2021. The article concludes with suggestions for future research on chatbot use in libraries. [ABSTRACT FROM AUTHOR]

The onset of retirement and children leaving the family home may offer a "window of opportunity" for individuals to influence regular moderate- to vigorous-intensity physical activity; therefore, this study examines the feasibility of a moderate- to vigorous-intensity physical activity intervention among recently retired participants (RET) and parents (P) with children who recently left the family home. A total of 46 inactive RET and nine inactive P were randomized to a 10-week web intervention (n = RET = 25/P = 4) or waitlist control (n = RET = 21/P = 5). Intervention techniques followed the multiprocess action control framework. Enrollment (37.5% for P; 40% for RET), retention (89% for P; 83% for RET), and satisfaction were high. One hundred percent of intervention-sectioned participation increased moderate- to vigorous-intensity physical activity compared with 52% of controls; large effect size differences were observed for key multiprocess action control constructs. Participants were highly satisfied with the intervention; however, recruitment challenges of P support moving to a randomized controlled trial for only the RET group. [ABSTRACT FROM AUTHOR]

In this study, we examine how organizational rules source knowledge. By knowledge sourcing of a rule, we mean the formation of reference ties from the rule to knowledge sources located outside of the focal rule. Rules can source knowledge from sources within the organization (e.g., other rules) and outside (e.g., research publications, policies, standards, etc.). Our theoretical model proposes that knowledge sourcing of rules is driven by inherent incompleteness of rules as a result of bounded rationality of rule makers and rule making process. Incomplete rules can lead to experiences of insufficient rule knowledge, termed "knowledge gaps," which are shaped by rule dynamics at the levels of individual rules, the rule system, and rule networks. Our theoretical model leads to several hypotheses that we test with longitudinal archival data of clinical practice guideline (CPG) changes in a Canadian healthcare organization. The findings support our theoretical model of incomplete organizational rules which encounter knowledge gaps and close them through internal and external knowledge sourcing. The theoretical and practical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

This retrospective clinical study compared two different professional maintenance therapy (MT) approaches (with and without periodic removal and decontamination of prosthetic components) on peri-implant inflammatory clinical and biochemical parameters after 5 years of implant function. A retrospective analysis based on patient records was used to assess inflammatory clinical and biochemical parameters around dental implants placed by the same clinician in a private practice. The Plaque Index (PI), peri-implant probing depth (PPD), mucosal recession (REC), bleeding on probing (BOP), and radiographic marginal bone level were determined at baseline and at each follow-up year. Moreover, at the last follow-up visit, the peri-implant intrasulcular levels of active metalloproteinasis 8 (aMMP-8) were also assessed. All participants were under MT with a 6-month recall interval. A total of 92 patients with 132 implants were selected. At the end of the study period, 12 patients with 12 implants were classified as dropouts. The remaining 80 patients and 120 implants were classified into two groups: Group 1 (42 patients, 62 implants) received MT with periodic removal and decontamination of prosthetic components; Group 2 (38 patients, 58 implants) received MT without periodic removal and decontamination of prosthetic components. No statistical differences were found between the groups regarding PI, PPD, and REC. Group 1 presented a statistically significant higher number of sites with BOP (12.4% vs 6.2%). Marginal bone loss was statistically higher in Group 2 than in Group 1 (0.23 ± 0.6 mm vs 0.78 ± 0.3 mm). Intrasulcular levels of aMMP-8 were statistically higher in Group 1 than in Group 2. The supplemental application of periodic removal and decontamination of prosthetic components during MT had a significantly positive effect on the inflammatory status of periimplant tissues. [ABSTRACT FROM AUTHOR]

There is a powerful global trend toward deeper integration of digital twins into modern life driven by Industry 4.0 and 5.0. Defense, agriculture, engineering, manufacturing, and urban planning sectors have thoroughly incorporated digital twins to great benefit across their respective product lifecycles. Despite clear benefits, a digital twin framework for health and medical sectors is yet to emerge. This paper proposes a digital twin framework for precision neuromusculoskeletal health care. We build upon the International Standards Organization framework for digital twins for manufacturing by presenting best available computational models within a digital twin framework for clinical application. We map a use case for modeling Achilles tendon mechanobiology, highlighting how current modeling practices align with our proposed digital twin framework. Similarly, we map a use case for advanced neurorehabilitation technology, highlighting the role of a digital twin in control of systems where human and machine are interfaced. Future work must now focus on creating an informatic representation to govern how digital data are passed to, from, and within the digital twin, as well as specific standards to declare which measurement systems and modeling methods are acceptable to move toward widespread use of the digital twin framework for precision neuromusculoskeletal health care. [ABSTRACT FROM AUTHOR]

Neutrosophic environments have gained significant relevance across diverse disciplines. Neutrosophic Over Supra Exterior Modal Topological Structure is introduced, demonstrating the generation of two distinct structures through traditional Neutrosophic Over supra topological operations, denoted as ... (closure) and ... (interior), along with novel Neutrosophic Over Supra Exterior Modal Operations, expressed as ... (modal closure) and ... (modal interior). This exploration delves into the essential properties and characteristics of these structures, illuminating their behavior and implications. To illustrate the practical relevance, a numerical example is presented, demonstrating the identification of disease types using a score function. The study conclusively shows that the Neutrosophic Over Supra Exterior Modal Topological Structure effectively classifies diseases such as tuberculosis (bacterial), malaria (parasitic), swine flu (viral), and ringworm (fungal). This dual approach ensures a holistic understanding of the topic, appealing to both theoretical and practitioners seeking practical solutions in the neutrosophic over environment. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Our objective was to explore how women living with HIV aged ≥40 years perceive their care in relation to their HIV infection, comorbidities, and menopausal health and to evaluate the extent to which the care they receive meets their expectations, comparatively across World Health Organization (WHO) European regions.We conducted a cross‐sectional survey (May–December 2023) among women living with HIV aged ≥40 years from the WHO European region. Five dimensions of care were assessed: content of care, information, relationship with caregiver, organization of care, and patients' rights and privacy, in addition to management of non‐HIV comorbidities and menopause.In total, 600 women completed the survey; they were predominantly from the Western European region (70.2%), followed by the Eastern (20.2%) and Central (9.6%) regions. The majority of women (46.5%–95.1%) described positive experiences, responding that they were ‘always’ or ‘usually’ satisfied with the five dimensions of HIV care. The concordance between perceptions and experiences of HIV care ranged from 49.4% to 96.1% and was lower in the Eastern region. Among menopausal women, 58.5% were ‘very satisfied’ or ‘satisfied’ with the care they received; satisfaction was significantly lower in Eastern European countries than in Western countries.Our results highlighted a generally high concordance between respondents' expectations and the services provided, including both HIV and non‐HIV care. Women aged ≥40 years living with HIV face several challenges that should be addressed. These findings inform stakeholders and decision‐makers about the need to adopt a more inclusive and sensitive approach in healthcare systems. [ABSTRACT FROM AUTHOR]

Study Design.: Retrospective longitudinal study. Objective.: This study aims to investigate the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on the development of low back pain requiring hospitalization or surgery. Background.: The baseline data were surveys gathered biennially in 1981–1997 (the Adolescent Health and Lifestyle Survey) and individually linked with outcome data, degenerative low back pain hospitalizations, and spine surgeries retrieved from the Care Register for Health Care. A total of 47,724 participants were included. Explanatory variables included physical activity, high BMI, smoking, monthly drunkenness, chronic diseases, and family SES. Materials and Methods.: A logistic regression model was used to analyze the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low SES on degenerative low back pain hospitalization, lumbar disc herniation (LDH) hospitalization, and/or spine surgery. Covariates were selected using directed acyclic graphs (DAGs). Results.: A total of 5538 participants had degenerative low back pain hospitalizations, 2104 had LDH hospitalizations, and 913 had spinal surgery over an average of 27-year follow-up. High BMI [adjusted odds ratio (aOR): 1.25, CI: 1.12–1.38], smoking (aOR: 1.53, CI: 1.43–1.62), monthly drunkenness (aOR: 1.17, CI: 1.10–1.26), and chronic diseases (aOR: 1.47, CI: 1.35–1.61) in adolescence increased the odds of hospitalizations during follow-up. In addition, high BMI (aOR: 1.37, CI: 1.09–1.72), smoking (aOR: 1.40, CI: 1.21–1.61), and monthly drunkenness (aOR: 1.19, CI: 1.01–1.39) increased the odds of spine surgeries. Conclusions.: We found that smoking, high BMI, monthly drunkenness, chronic diseases, and low family SES in adolescence increased the likelihood of degenerative low back pain hospitalizations in adulthood. In addition, high BMI, smoking, and monthly drunkenness in adolescence increased the odds of spinal surgeries. [ABSTRACT FROM AUTHOR]

Comprehensive biomarker testing is a crucial requirement for the optimal treatment of advanced‐stage non–small cell lung cancer (NSCLC), with emerging relevance in the adjuvant treatment setting. To advance its goal of ensuring optimal therapy for persons diagnosed with lung cancer, the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) held The Summit on Optimizing Lung Cancer Biomarkers in Practice in September 2020 to align its partners toward the goal of ensuring comprehensive biomarker testing for all eligible patients with NSCLC. The ACS NLCRT's Strategic Plan for Advancing Comprehensive Biomarker Testing in NSCLC, a product of the summit, comprises actions to promote comprehensive biomarker testing for all eligible patients. The approach is multifaceted, including policy‐level advocacy and the development and dissemination of targeted educational materials, clinical decision tools, and guides to patients, physicians, and payers aimed at ameliorating barriers to testing experienced by each of these groups. Plain language summary: The ACS NLCRT works to improve care for patients with lung cancer.The ACS NLCRT supports comprehensive biomarker testing as essential to determine treatment options for all eligible patients with non–small cell lung cancer.Many factors lead to some patients not receiving optimal biomarker testing.The ACS NLCRT held a collaborative summit and developed a strategic plan to achieve and promote comprehensive biomarker testing for all patients.These plans include developing educational materials and physician tools and advocating for national policies in support of biomarker testing. Comprehensive biomarker testing is a crucial component of care for patients with non–small cell lung cancer, informing treatment decisions regarding targeted therapies and immunotherapies. The National Lung Cancer Roundtable's Strategic Plan to Optimize Biomarker Testing aims to reduce barriers to testing with a goal of universal comprehensive testing for eligible patients. [ABSTRACT FROM AUTHOR]

The '5 Moments' approach is a time–space framework that delineates when hand hygiene should be performed and provides a resource for educators and auditors. It has become the dominant paradigm for organisations, practice, policy, and research in relation to hand hygiene. It is a concept that adopts the 'precautionary principle' that if the relative risk of a specific care task is unknown, a safe system must be to treat them on an equal level. However, a literal interpretation will frequently result in an extraordinary, implausible number of hand-hygiene opportunities and if this then becomes the standard to audit practice, within a policy document that espouses zero tolerance, it is likely to generate inauthentic data. If used effectively the 5 Moments concept provides an opportunity to enhance practice and reduce healthcare-associated infections but the healthcare provider organisation must embody a 'just culture' and collect the data in a climate of openness, transparency, and learning. [ABSTRACT FROM AUTHOR]

The purpose of this article is to identify the ways to minimize such a socially dangerous act as improper performance of professional duties by a medical professional, and also to study the legitimacy of bringing doctors to liability for failure to perform or improper performance of professional duties, to find out the reasons which cause this type of criminal offenses to be committed, and also to address the issue of the investigation process of bringing a medical professional to criminal liability, which is quite time-consuming given that it takes a long time taking into account the tasks assigned to the pretrial investigation bodies, accompanied by a set of measures defined by the Criminal Procedure Code of Ukraine, such as assessing the correctness of the manipulations of a medical specialist with the involvement of experts of appropriate qualifications and the seizure of medical records, comparing the protocol tactics of medical treatment and preventive measures by a medical professional with the actions that should have been taken in a given situation). At the same time, the pre-trial investigation authorities are deprived of the opportunity to summon a doctor to testify regarding information constituting medical secrecy, which complicates the conduct of investigative (detective) actions. However, in each case, in order to prove the guilt of a healthcare professional, it is necessary to establish which professional duties were assigned to the person and were not fulfilled at all, which is an absolute inaction of a healthcare professional in a real opportunity to act, and which of such duties were improperly performed, with significant violations of direct duties regulated by job descriptions, qualification requirements and treatment protocols with a clear algorithm of actions, orders and instructions of the Ministry of Health and SES of Ukraine, and WHO recommendations. Clarification of the specifics of the subject matter of proving improper performance of professional duties by a medical or pharmaceutical worker (Article 140 of the Criminal Code of Ukraine) is necessary both in theory and practice. Given the inestimable importance of human health and life as the highest social value, harm caused to them as a result of improperly performed medical intervention is extremely dangerous to society, and therefore requires specific criminal law means of regulation. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of the Veterans Health Administration (VHA) as a learning health system over 25 years through the Quality Enhancement Research Initiative (QUERI) program. QUERI focuses on translating research into patient care and health systems improvement, initially targeting prevalent conditions among veterans. The program has expanded to address broader health system issues, implement evidence-based programs, and support evidence-based policymaking. QUERI's infrastructure has evolved to support rapid translation of research into practice, aligning with the VA's Strategic Plan and focusing on improving care access, quality, costs, equity, and experience. [Extracted from the article]

Objective: To examine the relationship between site‐level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medical centers. Data Sources and Study Setting: We enrolled and evaluated 25 VA medical centers (VAMCs). Along with administrative data on site characteristics, we examined site‐reported data on adaptations and intervention adoption, defined as ≥4 training classes delivered to ≥5 caregivers at 6 months from April through October 2022. Study Design: A type III hybrid implementation‐effectiveness cluster randomized controlled trial, randomized VAMCs 1:1 to receive foundational (low‐touch) implementation support (n = 12) or the addition of enhanced (high‐touch) implementation support (n = 13). Data Collection/Extraction Methods: At key implementation phases, VAMCs were asked to report adaptations including content, contextual modifications (format, setting, personnel, and population), and training of providers. We describe site‐level adaptations by arm and by organizational characteristics that included VAMC complexity level, staffing, rurality, and organizational readiness to change. We used qualitative comparative analysis to identify unique adaptations that contributed to intervention adoption at 6 months. Principal Finding s : VAMCs randomized to receive enhanced support reported slightly more adaptations than those randomized to foundational support. At 6 months, VAMCs with two or more adaptations adopted Caregivers FIRST at a higher rate than those with fewer adaptations (90% vs. 44%). Staffing adaptations (e.g., who delivered the intervention), format and content (e.g., modified delivery pace), and referring provider training were unique adaptations to adopting sites. Conclusions: Site‐level adaptations were diverse and occurred more frequently in sites with early adoption of Caregivers FIRST. Future research should identify best practices of supporting and monitoring intervention adaptation. Understanding the role of adaptation in early adoption success could assist other healthcare systems in implementing interventions for caregivers. [ABSTRACT FROM AUTHOR]

The corporatization of health care in the United States has forced us to confront society's moral expectations of the industry, which serves uniquely vulnerable consumers. Health care has become increasingly more lucrative, attracting private equity ("PE") investment, specifically in private physicians' practices. Physicians find PE transactions appealing because physicians have difficulty competing with large hospital systems and complying with expansive regulatory requirements. The attention given by PE to health care has raised concerns regarding the tension between the expected priorities of PE firms and health care. Additionally, the nature of PE investments through roll-ups of smaller companies has regulators worried that they cannot control PE's involvement in the industry. The Federal Trade Commission ('FTC') is one regulatory agency that has explicitly addressed PE investments through revisions to its Merger Guidelines to ensure PE does not slip through its grasp. As PE roll-ups are a type of health care consolidation, this Comment will compare the FTC's past efforts to regulate hospital mergers with its potential future efforts to regulate PE investment in health care under the 2023 Merger Guidelines. The Comment also states how the 2023 Merger Guidelines still fall short of effectively regulating PE investment in health care and how healthcare-specific guidelines could improve their effectiveness. It additionally argues that it may be best to let PE investment continue until the market self-corrects. The Comment provides supplementary methods to undermine the attractiveness of PE investment for physicians, which would decrease the frequency of these transactions and speed up the economic self-correcting process. The various paths forward further support the Comments overarching argument that, as it currently stands, the FTC's antitrust laws are not effective in regulating PE investment in health care. [ABSTRACT FROM AUTHOR]

Introduction: PrEP, a highly effective HIV prevention measure, provides autonomy to individuals in managing their HIV acquisition vulnerability. Despite its availability in tenofovir-based oral pills and injectable cabotegravir formulations, PrEP uptake among Black cisgender women in the U.S. South, a region with a high HIV burden, remains critically low. This demographic faces a disproportionately high rate of new HIV diagnoses, yet fewer than 10% of women in the US who could benefit from PrEP are currently receiving it. Methods: Utilizing a critical realism interpretative framework, this narrative review employed a tri-level analysis strategy to examine the empirical, actual, and real domains influencing PrEP implementation among Black women in the Southern U.S. The empirical level refers to observable events and data (e.g., PrEP uptake rates), the actual level encompasses experiences and actions that may not always be directly observed (e.g., healthcare interactions and community engagement), and the real level involves the deeper structures and mechanisms (e.g., systemic racism and cultural narratives) that shape these outcomes. A comprehensive search of peer-reviewed literature from PubMed and other sources was conducted to identify barriers and facilitators to PrEP uptake in this population. Results: The analysis revealed significant barriers, including structural violence, socioeconomic disparities, medical mistrust, stigma, and inadequate healthcare policies. Empirical data showed variability in PrEP awareness and interest among Black women, while actual experiences highlighted misaligned marketing strategies, financial constraints, and interpersonal dynamics. At the real level, underlying mechanisms such as systemic racism and cultural narratives were identified as critical impediments to PrEP uptake. Discussion: Addressing these multifaceted barriers requires a comprehensive, multi-level approach that integrates personalized, community-centric strategies. Emphasizing the need for healthcare providers, community leaders, researchers, and policymakers to collaborate, the review proposes actionable strategies to enhance PrEP implementation, focusing on education, structural reforms, and policy changes to improve access and acceptability among Black women in the South. [ABSTRACT FROM AUTHOR]

Background: Demographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care. Methods: In this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology. Discussion: Demographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies. Trial registration: German Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set. [ABSTRACT FROM AUTHOR]

This paper argues that accepting incommensurability can be a useful step for developing attractive hybrid theories to how to distribute scarce health-related resources. If one provides opportunity for distributive options to be incommensurable with respect to substantive criteria, one can hold on to substantive criteria while also providing room for decision processes to play a significant role. The paper also argues that the strategy of accepting incommensurability is preferable to the strategy of having substantive criteria establish sets of options that are equally, explains why incommensurability gives us reason to go hybrid, and argues that reasons grounded in decision processes have properties that make them appropriate as "tiebreakers" in choice situations characterized by incommensurability. [ABSTRACT FROM AUTHOR]

The novel Coronavirus (COVID-19) is caused by the newly identified strain of the coronavirus family severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), whose target organ is the lungs. It has become a global pandemic, and COVID-19 poses so far unprecedented challenges to healthcare systems around the globe, particularly to those with weakened immune systems. Effective methods for managing, diagnosing, and lessening the effects of COVID-19 are critical because, by 2024, the virus has already caused over 7 million deaths. In this study, we anatomize the impacts of the latest COVID-19 virus on patients with the help of computational intelligence, like Machine learning, artificial intelligence, and IoT-enabled technologies for managing, analyzing, diagnosing, and predicting COVID-19. With tools for early identification, risk assessment, and therapy optimization, machine learning and artificial intelligence have shown tremendous promise in the healthcare industry. These tools can examine big datasets to find patterns and trends that might not be noticeable to human observers. Additionally, IoT will enable healthcare firms to monitor patient scenarios properly and reduce the readmission of COVID-19 patients. Wearable sensors and remote monitoring systems are two examples of IoT-enabled gadgets that are vital for tracking the COVID-19 virus's spread and keeping an eye on its sufferers. These gadgets can gather data in real-time on environmental variables, symptoms, and vital signs, giving medical professionals important insights into the state of their patients' health and the course of their diseases. This study will play a vital role in competing for safety considerations of reducing SARS-CoV-2, COVID-19, and exposure with the assistance of smart technology and provide much-needed information regarding the impact of COVID-19 on patients that will benefit globally. [ABSTRACT FROM AUTHOR]

Background and Objectives In conversations about expanding age-friendly ecosystems, the concept of "age-friendliness" has not been explored in relation to residential settings. Research Design and Methods This multiple-case study compared four residents' perspectives on the age-friendliness of a retirement and assisted living community, combining individual semi-structured interviews with observational data and organizational document analyses in a contextualist thematic examination. Results Three themes depict (A) existing experiences of the setting as "age-friendly" and the tension of the built design vs. identity; (B) resident-to-resident microaggressions, delineated into 4 subthemes including identity-related, intergenerational, condition-related microaggressions, and their influence on social isolation; and (C) desired experiences of the setting as "age-friendly" reflecting the social design. In cases of visibly perceptible diversity (white cane, darker skin tone), residents fared worse in experiencing microaggressions stemming from ableism, racism, and age differences. Conversely, in cases of visibly imperceptible diversity, residents had more positive or entirely positive experiences. Although the setting met many environmental and healthcare needs, it lacked design factors prioritizing meaningful social relationships among residents, affecting social isolation. Discussion and Implications Resident-to-resident social relationships were key in the experience of a retirement and assisted living community as age-friendly. Resident-to-resident microaggressions undermined perceptions of the community as age-friendly, and influenced social isolation. We reflect on the organizational role in mitigating against negative social relationships and social isolation to maximize dignity. [ABSTRACT FROM AUTHOR]

The article describes the work of the American Association of Critical Care Nurses (AACN) Clinical Scene Investigator (CSI) team in the cardiovascular intensive care unit (ICU) at Methodist Hospital in San Antonio, Texas. It discusses the development of a clinical nurse coordinators schedule, introduction of the Healthy Work Environment Assessment Tool (HWEAT) tool, use of a recognition board to celebrate team-based accomplishments, and fostering of collaboration among physicians and staff.

Background: LGBTQ+ young people have elevated rates of poor mental health in comparison to their cisgender heterosexual peers. School environment is a key risk factor and consistently associated with negative mental health outcomes for LGBTQ+ adolescents. Aims: To examine how, why, for whom and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ adolescents. Methods: A realist review methodology was utilised and focused on all types of school-based interventions and study designs. A Youth Advisory Group were part of the research team. Multiple search strategies were used to locate relevant evidence. Studies were subject to inclusion criteria and quality appraisal, and included studies were synthesised to produce a programme theory. Seventeen studies were included in the review. Results: Eight intervention components were necessary to address LGBTQ+ pupils mental health: affirmative visual displays; external signposting to LGBTQ+ support; stand-alone input; school-based LGBTQ support groups; curriculum-based delivery; staff training; inclusion policies; trusted adult. Few school-based interventions for this population group were identified. Conclusions: The programme theory indicates that "to work" school-based interventions must have a "whole-school" approach that addresses specifically the dominant cis-heteronormative school environment and hence the marginalisation, silence, and victimisation that LGBTQ+ pupils can experience. [ABSTRACT FROM AUTHOR]

Purpose: Tinnitus is a common health condition in the general population, with increased prevalence among military Veterans. Tinnitus is, in fact, the most prevalent military service--connected disability. There is no cure for tinnitus, but interventions are available to help patients manage their reactions to tinnitus and reduce its functional impact. Progressive tinnitus management (PTM) is a stepped-care protocol that involves coordinated audiological and behavioral health clinical services. PTM was endorsed by national Veterans Affairs (VA) audiology leadership in 2009. Given new clinical insights and research findings since the initial rollout of PTM, it remains necessary to improve and update the protocol in response to feedback from clinicians and patients. Method: This two-phase quality improvement project captured quantitative and qualitative feedback from VA and Department of Defense (DOD) clinicians and patients concerning PTM materials. A convergent parallel mixed-methods design was used to integrate the quantitative and qualitative data, and a consensus method was used to adjudicate any discrepant findings. Results: In Phase 1, 21 VAs and DOD clinicians and patients completed semi-structured interviews and quantitative measures on the PTM handbook and workbook revisions. Phase 1 findings were recommendations to modify content, format, and adaptations of content (e.g., electronic formats with a clickable index). In Phase 2, six non-Veteran patients assisted in pilot testing PTM PowerPoint slides used by clinicians for PTM skills education sessions. Phase 2 findings indicated that the revised PTM PowerPoint slides were useful and clinically acceptable. Conclusions: Findings from this study are being used to revise and update materials in the PTM skills education sessions. More generally, the study demonstrates the necessity of end-user input to inform and implement clinical updates. [ABSTRACT FROM AUTHOR]

The worldwide population of migrant families is on the rise, and there is growing acknowledgement of the significance of supporting parental mental health within these families. However, understanding of the experiences of migrant fathers during the perinatal period remains incomplete. The objective of this review is to provide an overview of existing research on perinatal migrant fathers' experiences in different cultures. Multiple searches were conducted in April 2023 for quantitative, qualitative, and mixed-methods studies across six electronic databases: Medline, CINAHL, Embase, PsycINFO, Web of Science, and Scopus. Fourteen eligible articles were identified, including nine qualitative studies, five quantitative studies, and no mixed-methods studies. The Mixed-methods Appraisal Tool was used to assess the quality of these studies. The quantitative findings were transformed into narrative summaries to be analysed thematically along with the qualitative data. Three themes were identified: (1) Cultural competence (dealing with cultural differences, needs related to original country); (2) Parenthood in a new country (challenges and adaptation to fatherhood, challenging traditional gender norms, lack of extended family and building new support networks, being the main supporter for the family); (3) Needs of the fathers and their personal difficulties. The findings of this review suggest a direction for future research in perinatal psychology. The review also provides insights into the need for social and community support for migrant fathers and how healthcare services can support this group during the perinatal period. [ABSTRACT FROM AUTHOR]

Immigrants from Asian countries are the fastest-growing undocumented population in the United States (U.S.), yet not much is known about their health. This scoping review identifies the nature and extent of scientific literature on the health of undocumented Asian immigrants in the U.S. We conducted a comprehensive search of six electronic databases in 2024. Inclusion criteria were empirical articles written in English, published in peer-reviewed scientific journals from 2010 to 2024, and focused on a health outcome or health-related issue involving undocumented Asian immigrants. Results are summarized narratively. We identified 13 peer-reviewed publications. Nine studies were quantitative, and four were qualitative. Eight studies were conducted in California; two studies used national secondary data sources. Studies were mixed in their research focus. They covered a range of health outcomes and issues, such as mental health (n = 4), health services and access (n = 2), contraceptive use (n = 1), COVID-19 (n = 2), and HIV (n = 1). Three studies measured self-rated health alongside other conditions, such as disability, health insurance coverage, chronic health conditions, and obesity. Scholarship on the health of undocumented Asian immigrants is a growing research area. Given the small number of studies identified, future research with larger diverse samples, more robust methodology, and greater topical variety are warranted to understand the health of this population better and reduce potential inequities. [ABSTRACT FROM AUTHOR]

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. In the United States, drowning is the leading cause of death in children 1 to 4 years of age and second leading cause of death due to unintentional injury in those aged 5 to 14 years. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest due to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Academy of Pediatrics and the American Heart Association. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Academy of Pediatrics and the American Heart Association. The writing group used these reviews to update its recommendations aimed at resuscitation from cardiac arrest following drowning in children. [ABSTRACT FROM AUTHOR]

Contrary to common belief, effective communication is not only achieved via verbal exchanges of information. It requires a thoughtful combination of verbal and non-verbal cues since, in some circumstances, verbal communication in healthcare may be impossible, unfavourable or ineffective. The semiotics literature suggests that effective non-verbal communication goes beyond body language and gestures. It also includes the use of objects (i.e. traces) to transmit a message. We call this trace-based communication (TBC). In this perspective paper, we offer some reflections from our experience researching and using trace-based communication for training purposes. Our intention was to bring further awareness to the opportunities that trace-based communication might enable, including opportunities to enhance trainee-supervisor interactions, and consequently inform curriculum design. [ABSTRACT FROM AUTHOR]

Introduction: Changing health care requires changing medical education. In this position paper it is suggested that subsequent innovations in medical education each had their specific strengths and shortcomings. What they have, however, in common is that they place the medical student and their competencies at their center. Innovation in medical education is inward looking. Discussion: The authors propose a perspective on the medical curriculum in which the patient, their family, and the surrounding community take center stage. They argue that present medical education cannot adequately respond to the great challenges to population health: an aging population, the obesity epidemic, and future pandemics of new diseases due to population growth, urbanization, and antimicrobial resistance, particularly because these challenges cannot be dealt with by the medical sciences alone but need deep understanding of the social sciences as well. In addition, the practice of health care is changing: effective health care demands a close partnership between the health care system and the medical school which is mostly lacking, cooperation with other health professions is becoming more and more necessary in response to the increasing complexity of health care, patients and their families are required to play a more active role in their health, medical error threatening patient safety is becoming to be seen as a huge problem, and the emergence of artificial intelligence in education and practice, all requiring transformation of medical education. Conclusion: The present contribution suggests eight such transformations necessary to create a truly patient- and population-centered medical curriculum. [ABSTRACT FROM AUTHOR]

Singapore, located strategically at the meeting point of the Malacca Strait and the South China Sea, has established itself as a global financial and economic hub. Despite its small geographical size, Singapore is home to over 5 million people from diverse cultural backgrounds. The city-state's medical education landscape has evolved significantly over the past century. Originally, Singapore had only one undergraduate medical school, the NUS Yong Loo Lin School of Medicine, established in 1905. Over time, this institution has grown into Singapore's largest and oldest medical school. NUS Medicine's vision centres on developing highly competent, values-driven, and inspired healthcare professionals to transform the practice of medicine and improve health worldwide. A curriculum overhaul in 2020 introduced new educational components to prepare future healthcare professionals for the challenges of Singapore's resilient healthcare system. This includes proficiency in integrated care, collaboration across disciplines, and leveraging AI and data science in clinical decision-making. The introduction of a common curriculum in August 2023 for Medicine, Nursing, Dentistry, and Pharmacy undergraduates further aligns with Singapore's 'Healthier SG' vision, ensuring that graduates are well-equipped to meet the evolving needs of the healthcare landscape. The common curriculum aims to address professional hierarchies and foster interprofessional collaboration among students from diverse academic backgrounds. By promoting frequent interaction and a team-oriented mindset, the curriculum seeks to instil a collective approach to healthcare, emphasising the importance of interprofessional practice in achieving the broader goals of healthcare delivery. This paper describes the reforms that took place and how the challenges were mitigated in a research-intensive top-ranked academic medical institution. This strategic alignment of medical education with national healthcare priorities underscores NUS Medicine's commitment to transforming medical practice and improving health outcomes in Singapore and beyond. [ABSTRACT FROM AUTHOR]

Background: The content and delivery of a health professions' curriculum is often regarded as 'intuitive' and 'self-defining', based on commonly encountered professional roles, detailed knowledge of human structure, function and pathology, and opportunities to acquire necessary clinical and communication skills. However, a curriculum tends to develop, sometimes in unexpected ways, due to scientific advances, changes in teaching faculty and variations in clinical placement experience. Trends come and go, often without careful scrutiny and evaluation. A common result is curriculum 'creep', where learning may drift away from the original plan. Methods: A review of available curriculum models produced several descriptions that appear to be based primarily on professional norms and traditions and not linked strongly to learning theories or expectations of employers and the community. Regulators accept variety in curriculua so long as agreed outcomes are achieved. Unless planned and maintained carefully, a curriculum may not necessarily prepare graduates well for a Results and discussion: Health professions curricula are required to produce graduates not only with higher education qualifications but also capable of providing healthcare services needed by regulators, employers and their communities. The design includes curriculum content, curriculum delivery and assessment of learning, topics often listed separately in standards but in fact closely intertwined, ideally demonstrating constructive alignment that sends consistent messages and facilitates achievement of graduate outcomes. Purposeful design is a systematic approach to defining, developing, and assessing learning that produces competent graduates who will maintain currency throughout their careers. Just as with the human body, everything is connected so a change anywhere is likely to have implications for other parts of the curriculum ecosystem. The role of clinical cases, level of integration, balance of assessment tasks, use of technology, on-site or remote delivery, and choice of assessment methods are important considerations in curriculum design. Any changes should be strategic and aligned with vision, mission, and graduate outcomes. This paper provides a framework analogous to the human body that may facilitate purposeful design of health professions curricula. [ABSTRACT FROM AUTHOR]

During the COVID-19 public health emergency, we previously identified decreased rates of radiotherapy (RT) peer review (PR) discussion and plan changes in virtual versus in-person PR conferences. To expand on these findings, we continued to prospectively collect data on all PR conferences from 2021 to 2023 and performed a follow-up analysis before and after the transition back to in-person PR. A prospectively maintained database of weekly PR cases was queried for consecutive cases reviewed before and after the transition from virtual to in-person conferences. Rates of PR discussion and change recommendations were summarized and compared between the virtual and in-person groups. A survey was developed and administered to assess participants' perceived levels of engagement, opinions on optimal PR format, and preferences for future meetings before and 3 months after the transition back to in-person PR. In total, 2,103 RT plans were reviewed: 1,590 virtually and 513 after the transition back to in-person. There was no difference in faculty attendance between groups. The proportion of cases with PR discussion increased from virtual (9.8%) to in-person (25.5%) format (p < 0.001). In the virtual group, 8.1% of cases had 1 topic and 1.7% had 2+ topics discussed. This increased to 15.8% and 9.7% during in-person PR, respectively (p < 0.001). The rate of change recommendation also increased from 1.5% (virtual) to 3.3% (in-person, p = 0.016). Among cases with at least 1 topic discussed, there was no difference in changes. Survey-reported distraction significantly decreased from virtual to in-person PR (p < 0.001). Upon returning to in-person PR conferences, peer discussion and plan change recommendations significantly increased and returned to pre-pandemic levels, and participants' perceived levels of distraction were reduced. In an increasingly virtual world, additional efforts to develop best practices that maximize PR discussion and minimize distraction outside virtual conferences are warranted. • The case discussion increased with transition from virtual to in-person radiation oncology peer review. • The plan changes were more frequent with in-person versus virtual format. • For cases with any discussion, change rates were similar between virtual and in-person. • Self-reported distraction was decreased in-person and other survey measures of engagement did not change. [ABSTRACT FROM AUTHOR]

When built environments in health care result from an evidence-based design (EBD) process, they are interventions that can improve patients' health outcomes. This commentary on a case discusses which ethical values should guide organizations' capital expenditure decisions about retrofits, which might be more costly than the original budget. This discussion urges reevaluation of the common assumption that capital improvements are "sunk costs," since such improvements can promote long-term positive health outcomes for an organization's patients, thereby advancing both financial value and ethical values. This commentary also suggests that EBD offers key interventions that are clinically and ethically relevant. [ABSTRACT FROM AUTHOR]

Background: Evidence from cohort studies indicates that a healthy lifestyle can improve cancer survival but evidence from randomised controlled trials (RCT) is lacking. Thus, this study tested the feasibility of conducting a lifestyle intervention in patients after colorectal cancer (CRC) treatment. Methods: An intervention was developed based on World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) recommendations, the Health Action Process Approach, Motivational Interviewing and tested a feasibility, mixed-methods RCT. Participants were allocated to a three-month telephone-based intervention versus standard care control group. The follow up period was six months. Data on feasibility and secondary outcomes were collected and analysed using Stata (V15, StataCorp LLC) and NVivo 12 (QSR International Pty Ltd., Doncaster, VIC). Results: Recruitment was challenging (31 ineligible, 37 declined; recruitment rate = 48.6%.). In total, 34/35 participants completed the intervention, and 31 (89%) completed follow up; all 31 completers participated in six telephone calls during intervention and six months follow up. Study retention was 97% (34/35) and 89% (31/35) at three and six months, respectively. Data completion rates were high (>90%). Intervention was acceptable to participants, met their needs and kept them accountable towards their goals. Participants in the intervention group showed significant improvement in WCRF/AICR, Diet Quality Index-International score and a 10% reduction in ultra-processed food consumption. Conclusions: The HEAL ABC intervention was feasible for 87% of intervention participants, supporting them in healthy lifestyle changes. However, alternative recruitment strategies are needed for a fully powered RCT to determine the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]