Search

Pharma 4.0, a technology ecosystem in drug development analogous to Industry 4.0 in healthcare, is transforming the traditional approach to drug discovery and development, aligning product quality with less time to market, and creating intelligent stakeholder networks through effective collaborations. The wide range of potential Pharma 4.0 networks have produced several conceptualizations, which have led to a lack of clarity and definition. The main emphasis of this paper is on the clinical trial stage of drug development in the Pharma 4.0 era. It highlights the merged computerized technologies that are currently used in clinical research, and proposes a framework for integrating Pharma 4.0 technologies. The impact of and barriers to employing the proposed framework are discussed, highlighting its potential and some future research applications.

Introduction While there has been strong emphasis on enhancing interprofessional education and interprofessional care in the published literature, there is relatively little literature focused on advancing interprofessional research. In extrapolating from the current frameworks of interprofessional collaboration (IPC), it becomes clear that the core competencies of IPC are transferable to research teams. The aim of this paper is to present our experience of an international research team framed within core competencies for IPC. Methods A simplified narrative inquiry approach was used to share the experience of an international research team framed within six core competencies of IPC. Results and discussion By way of our international research collaboration, we demonstrate the translation of key core competencies for IPC. We share key learnings and mitigation strategies for the successful outcomes of the research team. Conclusion To embark on a successful international research collaboration requires integrating IPC core competencies across the entire research continuum. In addition to the core competencies of collaboration, enablers to success also include digital collaborative forums, existing professional relationships and research projects that offer global meaning and value.

The purpose of this study was to clarify the current status of collaboration between nurses and community pharmacists as well as the requests and expectations that community pharmacists have of nurses in community-based comprehensive care systems. Questionnaires requiring open-ended responses were sent to 867 pharmacies throughout Fukushima prefecture (excluding four suspended pharmacies). We asked one pharmacist at each facility to answer the questions. We then analyzed the collected questionnaires using descriptive statistics, including the current status of nurse cooperation and the basic information about the pharmacies. Additionally, the open-ended descriptions of nurses' requests and expectations were analyzed quantitatively and qualitatively. The questionnaire collection rate was 32% (278 cases), and the breakdown of pharmacies that responded was 68.0% for facilities with 1 or 2 full-time pharmacists and 27.0% for facilities with 3 to 5 pharmacists. About 30% of respondents reported contact with the nursing profession at least once a week, while about 50% reported no contact at all or several times a year. The types of nurses collaborating with the pharmacies were clinic nurses (54.6%) and visiting nurses (43.4%). Some pharmacists had expected nurses to work cooperatively and rely on pharmacists. These results indicate that only about half of the pharmacists had opportunities to cooperate with nurses. For trust to be established between nurses and pharmacists, it is necessary for nurses to ask the pharmacists about medication and consult with them about patient medication management.

A palliative approach to care aims to meet the needs of patients and caregivers throughout a chronic disease trajectory and can be delivered by non-palliative specialists. There is an important gap in understanding the perspectives and experiences of primary care providers on an integrated palliative approach in dementia care and the impact of existing programs and models to this end. To address these, we undertook a scoping review. We searched five databases; and used descriptive numerical summary and narrative synthesizing approaches for data analysis. We found that: (1) difficulty with prognostication and a lack of interdisciplinary and intersectoral collaboration are obstacles to using a palliative approach in primary care; and (2) a palliative approach results in statistically and clinically significant impacts on community-dwelling individuals, specifically those with later stages of dementia. There is a need for high-quality research studies examining the integrated palliative approach models and initiation of these models sooner in the care trajectory for persons living with mild and moderate stages of dementia in the community.

Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998–2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with

Supplemental Digital Content is available in the text., The COVID-19 pandemic caused substantial disruptions in medical education. The University of British Columbia (UBC) MD Undergraduate Program (MDUP) is the sixth-largest medical school in North America. MDUP students and faculty developed a joint response to these disruptions to address the curriculum and public health challenges that the pandemic posed. After clinical activities were suspended in March 2020, third- and fourth-year MDUP students formed a COVID-19 Medical Student Response Team (MSRT) to support frontline physicians, public health agencies, and community members affected by the pandemic. A nimble organizational structure was developed across 4 UBC campuses to ensure a rapid response to meet physician and community needs. Support from the faculty ensured the activities were safe for the public, patients, and students and facilitated the provision of curricular credit for volunteer activities meeting academic criteria. As of June 19, 2020, more than 700 medical students had signed up to participate in 68 projects. The majority of students participated in projects supporting the health care system, including performing contact tracing, staffing public COVID-19 call centers, distributing personal protective equipment, and creating educational multimedia products. Many initiatives have been integrated into the MDUP curriculum as scholarly activities or paraclinical electives for which academic credit is awarded. This was made possible by the inherent flexibility of the MDUP curriculum and a strong existing partnership between students and faculty. Through this process, medical students were able to develop fundamental leadership, advocacy, communication, and collaboration skills, essential competencies for graduating physicians. In developing a transparent, accountable, and inclusive organization, students were able to effectively meet community needs during a crisis and create a sustainable and democratic structure capable of responding to future emergencies. Open dialogue between the MSRT and the faculty allowed for collaborative problem solving and the opportunity to transform disruption into academic innovation.

Problem American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. Approach Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. Outcomes Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. Next steps During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings, and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.

Saudi Arabia embarked on transforming its primary health care system in 2016 to meet international standards, gain the people's trust and respond to the growing burden of noncommunicable diseases, as proposed in the Saudi Vision 2030.This review aims to highlight the progress, identify challenges and prospects for Saudi Arabia's PHC reform process in order to make recommendations to facilitate strengthening of the PHC system.A review of previous studies and governmental reports was undertaken to extract, analyse, synthesize and report the findings.The review has indicated that by mid-2019, the reform has contributed to an increase of 37.5% in the rate of PHC visits and 4.7% increase in patient satisfaction, enhanced coverage of rural communities (from 78% to 83%), and contributed to increasing the screening rate for prevalent chronic diseases. However, the country still faces gaps and challenges pertaining to human resources issues, cultural and lifestyle behaviour, geography, intersectoral collaboration and PHC infrastructure.PHC reform process in Saudi Arabia has demonstrated that positive change is achievable. This has been aided by building on previous accomplishments and the wealth of experience gained throughout the PHC journey in Saudi Arabia. However, despite improvement in the quality of services, continuous improvement is required to meet the rising expectations of the population.إصلاح نظام الرعاية الصحية الأولية في المملكة العربية السعودية: التقدم المُحرَز، والتحديات الماثلة، والآفاق المستقبلية.هشام الخشان، فؤاد أبو غزالة، شاكر العمري، محمود النحاس، علي الوادعي، بسمه الخضير، فهد العمري، نوف العيسى، نجلاء محمود، مصطفى حسنين.شرعت المملكة العربية السعودية في تحويل نظام الرعاية الصحية الأولية في عام 2016 لتلبية المعايير الدولية لكسب ثقة الناس والاستجابة للعبء المتزايد للأمراض غير المعدية ، كما هو مقترح في رؤية المملكة العربية السعودية 2030.هدفت هذه الدراسة إلى تسليط الضوء على التقدم المحرز وتحديد التحديات والآفاق لعملية إصلاح الرعاية الصحية الأولية في المملكة العربية السعودية من أجل تقديم توصيات لتسهيل تعزيز نظام الرعاية الصحية الأولية.تم إجراء مراجعة للدراسات السابقة والتقارير الحكومية لاستخراج وتحليل وتوليف وتقرير النتائج.أشارت المراجعة إلى أنه بحلول منتصف عام 2019 ، ساهم الإصلاح بنسبة 37.5٪ في زيادة معدل الرعاية الصحية الأولية و4.7٪ زيادة في رضا المرضى ، وتحسين تغطية المجتمعات الريفية (من 78٪ إلى 83٪) ، والمساهمة لزيادة معدل فحص الأمراض المزمنة السائدة. ومع ذلك ، لا تزال البلاد تواجه فجوات وتحديات تتعلق بقضايا الموارد البشرية والسلوك الثقافي ونمط الحياة والجغرافيا والتعاون بين القطاعات والرعاية الصحية الأولية للبنية الأساسية.أظهرت عملية إصلاح الرعاية الصحية الأولية في المملكة العربية السعودية أن التغيير الإيجابي قابل للتحقيق. وقد ساعد هذا من خلال البناء على الإنجازات السابقة والثروة من الخبرة المكتسبة خلال رحلة الرعاية الصحية الأولية في المملكة العربية السعودية بشبه الجزيرة العربية. ومع ذلك ، على الرغم من التحسن في جودة الخدمات ، فإن التحسين المستمر مطلوب لمواجهة الارتفاع بتوقعات السكان.Réforme des soins de santé primaires en Arabie saoudite : progrès, défis et perspectives.En 2016, l'Arabie saoudite s’est engagée dans la transformation de son système de soins de santé primaires pour se conformer aux normes internationales, obtenir la confiance de la population et faire face à la charge de plus en plus lourde des maladies non transmissibles, conformément à la Vision saoudienne à l’horizon 2030.La présente analyse vise à mettre en évidence les progrès réalisés, à identifier les défis et les perspectives du processus de réforme des soins de santé primaires (SSP) en Arabie saoudite afin de formuler des recommandations pour faciliter le renforcement du système SSP.Une analyse des études et des rapports gouvernementaux précédents a été réalisée afin d’extraire, d’analyser, de synthétiser les résultats et d’en rendre compte.L’analyse a indiqué qu’à la mi-2019, la réforme avait contribué à une augmentation de 37,5 % du taux de consultation pour les soins de santé primaires et de 4,7 % pour la satisfaction des patients, à une meilleure couverture des communautés rurales (passant de 78 % à 83 %) et à l’augmentation du taux de dépistage des maladies chroniques prévalentes. Cependant, le pays est toujours confronté à des lacunes et à des défis concernant les ressources humaines, les comportements liés à la culture et au mode de vie, la géographie, la collaboration intersectorielle et les infrastructures de soins de santé primaires.Le processus de réforme des soins de santé primaires en Arabie saoudite a démontré qu’un changement positif était possible. Cela a été facilité par le recours aux réalisations antérieures et à la richesse de l’expérience acquise tout au long de la mise en œuvre des soins de santé primaires en Arabie saoudite. Toutefois, malgré l’amélioration de la qualité des services, une amélioration continue est nécessaire pour répondre aux attentes grandissantes de la population.

Background The Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany. Methods Communities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach. Discussion This is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach. Trial registration This study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.

Supplemental Digital Content is available in the text., Longer time in target range (TTR) for systolic blood pressure (SBP) is associated with a lower risk of cardiovascular events. Team-based care improves SBP control but its effect on the consistency of SBP control over time is unknown. This post hoc analysis used data from a cluster-randomized trial of a physician/pharmacist collaborative model that randomized medical offices to either a 9- or 24-month pharmacist intervention or control group. TTR for SBP was calculated using linear interpolation and an SBP range of 110 to 130 mm Hg. TTR is reported as median values and group comparisons assessed using the Kruskal-Wallis test. Of the 625 participants enrolled, 524 had 9-month and 366 had 24-month SBP data. Participants were a median 59 years old, 59% female, and 52% minority. After 24 months, the median TTR for SBP was 31.9% and 29.8% for the 9- and 24-month intervention groups, respectively, compared with 19% in the control group (P=0.0068). This observation persisted in the subgroup of participants with diabetes or chronic kidney disease and minorities. A longer TTR was not associated with an increased risk of adverse drug events. Time to first observed SBP in the target range was shorter in the intervention group compared with control (270 versus 365 days; P=0.0047). A physician/pharmacist collaborative care model achieved longer TTR for SBP compared with control (usual care).

Background: Parity of esteem means that end-of-life care for people with severe mental illness should be of equal quality to that experienced by all. Aim: To synthesise international, English language, research and UK policy and guidance relating to the organisation, provision, and receipt of end-of-life care for people with severe mental illness. Design: A mixed methods systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach and informed by a stakeholder group. We employed thematic synthesis to bring together data from both qualitative and quantitative studies, and from non-research material. We assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches. Data sources: Ten electronic databases were searched from inception to December 2019, along with 62 organisational websites. Quality appraisal was conducted using Critical Appraisal Skills Programme checklists or other study design-specific alternatives as necessary. Results: Of the 11,904 citations retrieved, 34 research publications were included plus 28 non-research items. The majority of research was of high or acceptable quality. An overarching synthesis including 52 summary statements, with assessments of confidence in the underpinning evidence, was produced using four themes: Structure of the system; Professional issues; Contexts of care; and Living with severe mental illness. Conclusions: Implications for services and practice reflect evidence in which there is a high degree of confidence. Partnership should be developed across the mental health and end-of-life systems, and ways found to support people to die where they choose. Staff caring for people with severe mental illness at the end-of-life need education, support and supervision. End-of-life care for people with severe mental illness requires a team approach, including advocacy. Proactive physical health care for people with severe mental illness is needed to tackle problems of delayed diagnosis.

Kasiye Shiferaw,1 Bezatu Mengistie,2 Tesfaye Gobena,3 Merga Dheresa,1 Assefa Seme4 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 4School of Public Health, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Kasiye Shiferaw Tel +251256662517Email sifkas.gem2@gmail.comPurpose: This study aimed to identify the extent of antenatal care content received and associated factors among Ethiopian women.Methods: A nationally representative Performance Monitoring for Action 2020 Ethiopian data were used. A multistage cluster sampling design was used to select 2855 pregnant or recently postpartum women nested within 217 enumeration areas. Female resident enumerators collected the data using a semi-structured questionnaire. Researchers dichotomized the number of ANC content received greater than or equal to 75 percentiles as adequate. Otherwise, it was considered inadequate. A multilevel Poisson regression was fitted. The result was reported using an incidence rate ratio with a 95% confidence interval and a p-value less than 0.05 was considered for statistical significance.Results: The study revealed more than a quarter of pregnant women received adequate ANC content (27.8%; 95% CI: 23.8%, 32.2%). Multivariable analysis revealed urban residence (IRR = 1.09, 95% CI: 1.01, 1.21), attending secondary and above formal education (IRR = 1.08, 95% CI: 1.01, 1.16), maternal age 20– 24 years (IRR = 1.10, 95% CI: 1.02, 1.19), and partner’s encouragement to attend clinic for antenatal care (IRR = 1.14, 95% CI: 1.05, 1.24) was significantly associated with receiving higher numbers of antenatal care content.Conclusion: The proportion of women who received adequate antenatal care content in Ethiopia was low. Despite Ethiopia’s effort to improve maternal health services utilization, disparities among regions and between rural and urban exist. This study highlights the importance of ensuring high received antenatal care content, which is crucial for reducing pregnancy-related morbidity and mortality. This implies prompt intersectoral collaboration to promote female education, target older aged women, and rural resident women, encourage partner involvements during the antenatal care process, minimize regional variation, and strengthen the implementation of received ANC content policies and programs with the active participation of the stakeholders are priority issues.Keywords: received, ANC contents, associated factors, Ethiopia

Introduction: According to the World Health Organization (WHO) global estimates for 2017, 9.6% of children under 5 years old are stunted. Worldwide evidence shows that actions for preventing stunting and catching-up growth are relevant if addressed by all the sectors involved. Therefore, there is a need to identify 'intersectoral actions' to address the risk of stunting during pregnancy and the first 2 years of life. Objective: To identify and describe worldwide evidence for prevention, nutritional interventions, and 'intersectoral collaboration' efforts against stunting in infants. Materials and methods: We conducted a systematic review in 2019 (PROSPERO CRD42019134431). The search included PubMed, OVID, and Web of Science, as well as WHO and the Food and Agriculture Organization of the United Nations (FAO) official documents and expert recommendations. Results: We selected 231 studies: 86.1% described prevention-related factors, 30.7%, nutritional interventions, and 52.8% intersectoral collaboration efforts; 36.4% of the studies were conducted in multiple regions; 61% of the studies described the importance of interventions during pregnancy, 71.9% from birth up to 6 months old, and 84.8% from 6 months up to 2 years old. The most frequent variables described were antenatal care, nutritional counseling for the mother and the newborn, and counseling on micronutrient supplementation. Conclusions: Evidence-based understanding of actions geared towards monitoring the risk of stunting-associated factors from pregnancy up to 2 years old is critical. Resumen Introducción. Según estimaciones mundiales de la Organización Mundial de la Salud (OMS) para el 2017, el 9,6 % de los niños menores de cinco años padecen retraso del crecimiento. La evidencia mundial ha demostrado que las acciones para prevenir el retardo del crecimiento o para tratarlo adquieren relevancia si las abordan todos los sectores involucrados. Por lo tanto, es necesario determinar las acciones intersectoriales para atender el riesgo de retraso del crecimiento durante el embarazo y los dos primeros años de vida. Objetivo. Rastrear y describir la evidencia mundial para la prevención, las intervenciones nutricionales y los esfuerzos de colaboración intersectorial contra el retraso del crecimiento en los lactantes. Materiales y métodos: Se hizo una revisión sistemática en el 2019 (PROSPERO CRD42019134431). La búsqueda incluyó PubMed, OVID y Web of Science, así como documentos oficiales de la OMS y la Organización para la Agricultura y la Alimentación de Naciones Unidas (FAO) y recomendaciones de expertos. Resultados. Se seleccionó un total de 231 estudios: 86,1 % describían factores relacionados con la prevención, 30,7 %, intervenciones nutricionales, y 52,8 %, esfuerzos de colaboración intersectorial; 36,4 % de ellos se llevaron a cabo en múltiples regiones. Del total, el 61 % de los estudios se enfocaba en la importancia de las intervenciones durante el embarazo, el 71,9 % desde el nacimiento hasta los seis meses y el 84,8 % desde los seis meses hasta los dos años. Las variables descritas con mayor frecuencia fueron la atención prenatal, el asesoramiento nutricional para la madre y el recién nacido, y el asesoramiento sobre la suplementación con micronutrientes. Conclusiones. La comprensión basada en la evidencia de las acciones orientadas a monitorear el riesgo de factores asociados al retraso del crecimiento desde el embarazo hasta los dos años, es fundamental.

PURPOSE OF REVIEW Most of the world's children and adolescents live in low and middle-income countries (LMICs) where mental health services are very limited. Here, we reviewed literature over the last 18 months describing the current landscape of child and adolescent mental health services and systems (CAMHSS) in LMICs, and present findings from systems strengthening research. RECENT FINDINGS The challenges in CAMHSS are well described with little change over the last two decades. Fortunately, research has started to move from 'mapping' towards systems 'strengthening'. Using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) framework, we reviewed recent CAMHSS innovations. Clinical care and human resource innovations focused on primary care with validation of screening tools, training and task-sharing for capacity-building. Intersectoral collaboration emerged as a priority domain for strengthening, alongside a theme around the importance of participatory research to inform policy reforms. The potential role of digital technology to strengthen CAMHSS was identified as an emerging theme. SUMMARY There is an urgent need to increase the priority of CAMHSS in LMICs. This will require innovations at multiple levels aimed at all CAMHSS domains, with active participation of all relevant local stakeholders to ensure the translation of research into policy and practice.

The Complementarity of Public Health and Medicine The approaches and achievements of public health and clinical medicine are often framed as dichotomies — “prevention versus cure” or “individual ve...

BACKGROUND In 2015, the Ontario Surgical Quality Improvement Network was established to create a community of practice for Ontario hospitals to improve surgical quality. A provincial campaign to decrease postsurgical infections was launched in 2017. STUDY DESIGN Thirty hospitals implemented activities related to the campaign from April 2018 to March 2019. The community of practice was used to disseminate suggested change ideas in each area. Self-reported data from participating hospitals and collaborative-wide aggregate risk-adjusted data from the American College of Surgeons NSQIP were reviewed to determine the impact of the campaign on the rates of postoperative surgical site infections (SSIs), urinary tract infections (UTIs), and pneumonia. RESULTS A total of 24, 8, and 2 hospitals selected SSIs, UTIs, and pneumonia, respectively, as their targets for improvement. Three hospitals selected both SSIs and UTIs, 1 hospital selected SSIs and pneumonia, and 1 hospital selected all 3 indicators as targets. Self-reported data demonstrated that the rates of SSIs and UTIs decreased significantly post campaign from 4.87% to 3.99% (p < 0.0001) and from 3.65% to 1.25% (p = 0.007), respectively. Pneumonia rates also decreased from 1.27% to 1.05%. Overall rates of SSIs, UTIs, and pneumonia across all Ontario Surgical Quality Improvement Network hospitals were reduced from 3.4%, 1.29%, and 0.88% to 3.37%, 1.14%, and 0.84%, respectively. CONCLUSIONS The 1-year campaign resulted in a clinically significant reduction in the rates of SSIs and UTIs, as well as a trend for decrease in pneumonia incidence among participating hospitals. Using a flexible approach with priority setting and leveraging the community of practice for dissemination of change ideas is an effective way of sustaining quality improvement activities.

A stratified medicine approach for the treatment of psoriasis promises greater certainty of clinical decision making through prediction of response on the basis of clinical, pharmacological, and -omics data from an individual patient. As yet, there is no predictive model for treatment response in routine clinical use for psoriasis. The Psoriasis Stratification to Optimise Relevant Therapy (PSORT) Consortium is a United Kingdom Medical Research Council‒funded, academic‒industrial stratified medicine consortium established with the objective of discovering the predictors and stratifiers of response of psoriasis to biologic therapies. A showcase meeting was convened and attended by 80 stakeholders at the Royal College of Physicians, London, United Kingdom on 18 November 2019. The purpose was to disseminate the research findings from the PSORT consortium discovered thus far. This report summarizes the presentations made on the day and the significant advances made by PSORT toward a stratified medicine approach to the management of psoriasis.

We investigated whether Peace4Tarpon's trauma-responsive community capacity activities led to greater collaboration among community partners. We conducted longitudinal social network analysis (SNA) among organizations within Peace4Tarpon's network in 2016 and 2018 to capture cooperation around adverse childhood experiences-related topics. We examined network structure, cohesion, organizational collaboration, and associations between centrality and organizational practices. Peace4Tarpon's network included diverse sectors, with a group of organizations forming the network core and collaborating over time. The network displayed a small increase in cohesion, more cross-sector collaboration, and less heterophily over time. We found a significant difference between the mean betweenness centralities of organizations who assessed resilience and those who did not in the 2018 average union network. This is one of the first studies using SNA to investigate a trauma-informed community network. Findings from this type of analysis may assist community organizations in strengthening outreach and strategically engaging organizations within a trauma-informed network.

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

Japanese pharmaceutical products continue to experience a trade deficit, since import values exceed export values. In drug discovery development, given the pace of technological innovations, there has been a major shift from low-molecular-weight compounds to biomedicine. It is anticipated that industry, academia and government will work more closely together in support of the pharmaceutical industry. Drug discovery requires much time and vast resources before the results can be put to practical use, and evidence suggests that many newly approved drugs derive from university-sourced technology. Pharmaceutical companies keep a close eye on technology evolving in universities. However, some reports state that there is a substantial difference compared to the development costs of the major Japanese pharmaceutical companies. Therefore, the authors hypothesized that there may be some issues hindering industrial-academic partnerships in drug discovery. In order to understand the actual situation and barriers to promoting industrial-academic collaboration, the Japan Pharmaceutical Manufacturers Association (JPMA), Japan Agency for Medical Research and Development (AMED), and the Medical Industry-Academia Collaboration Network (medU-net) Council will work together in issuing questionnaires and conducting an awareness survey. This survey sought the personal opinions of individuals belonging to JPMA and medU-net. Based on the results of this survey, we will introduce the issues related to industrial-academic collaboration and partnerships, and any gaps between industry and academia. Furthermore, we suggest solutions to promoting drug discovery innovation in Japan.

Objective Data-informed decision making is valued among school districts, but challenges remain for local health departments to provide data, especially during a pandemic. We describe the rapid planning and deployment of a school-based COVID-19 surveillance system in a metropolitan US county. Methods In 2020, we used several data sources to construct disease- and school-based indicators for COVID-19 surveillance in Franklin County, an urban county in central Ohio. We collected, processed, analyzed, and visualized data in the COVID-19 Analytics and Targeted Surveillance System for Schools (CATS). CATS included web-based applications (public and secure versions), automated alerts, and weekly reports for the general public and decision makers, including school administrators, school boards, and local health departments. Results We deployed a pilot version of CATS in less than 2 months (August–September 2020) and added 21 school districts in central Ohio (15 in Franklin County and 6 outside the county) into CATS during the subsequent months. Public-facing web-based applications provided parents and students with local information for data-informed decision making. We created an algorithm to enable local health departments to precisely identify school districts and school buildings at high risk of an outbreak and active SARS-CoV-2 transmission in school settings. Practice Implications Piloting a surveillance system with diverse school districts helps scale up to other districts. Leveraging past relationships and identifying emerging partner needs were critical to rapid and sustainable collaboration. Valuing diverse skill sets is key to rapid deployment of proactive and innovative public health practices during a global pandemic.

Background Military nurse scientists are embedded in service-affiliated branches (Army, Navy, Air Force) with different missions, but with the singular purpose of generating and disseminating research impacting the health and well-being of DoD beneficiaries. Purpose This project examines collaboration among TriService Nursing Research Program (TSNRP) members, seeking opportunities to strengthen, diversify, and expand research collaboration. Method Social network analysis (SNA) is the empirical inquiry of relations among social actors at different levels of analysis. An electronic SNA assessment and total enumerative sampling were used to explore current collaborations among PhD-prepared military nurse scientists (N = 136). Findings The TSNRP collaboration network has a complex service-driven structure with high status actors whose advice, knowledge, or skills are sought by others, and who function as connectors or bridges across service branches. Discussion For military scientists, SNA is instrumental in identifying influential individuals, visualizing opportunities for intraservice mentoring, designing responsive policy, and directing career opportunities for novice scientists.

According to the World Health Organization, discrepancies in health statistics reflect unequal access to resources. The Truth and Reconciliation Commission of Canada calls for an increase in the number of Indigenous workers within health and social services. The involvement of local community workers is essential to ensure the cultural security of care and the decolonization of services. This article presents the role played by these workers in the expansion of mental health services and social interventions in Nunavik, the contextual considerations that influence their practice and their place within professional teams.A thematic analysis was conducted on semi-structured interviews done in 2016 with 60 Inuit and non-Inuit individuals working in the broad field of health and social services in Nunavik.The integration of local community workers is perceived to bring several benefits, including the improvement of interventions and unique learning opportunities. However, several factors hinder this collaboration, such as clarity of mandates, access to pre-requisite training and diplomas, recognition of local knowledge, and staff turnover. More flexibility and support after hiring would allow for the service structure to be adapted to the complex reality of Nunavik.This article adds to the body of literature highlighting the importance of collaboration with local community workers. The decolonization of services necessarily involves redesigning structures in order to recognize their contribution and to give a place to local knowledge.RéSUMé: OBJECTIFS: Selon l’Organisation mondiale de la santé, les écarts dans les statistiques de santé reflètent un accès inégal aux ressources. La Commission de vérité et de réconciliation du Canada appelle à l’accroissement du nombre de travailleurs autochtones dans le domaine des soins de santé et services sociaux. L’implication des travailleurs communautaires locaux est essentielle à la sécurisation culturelle des soins et la décolonisation des services. Cet article décrit le rôle de ces travailleurs dans l’extension des services de santé mentale et des interventions sociales au Nunavik et explore les considérations contextuelles qui influencent leur pratique et leur place au sein des équipes professionnelles. MéTHODE: Les résultats ont été obtenus par l’entremise d’une analyse thématique d’entrevues semi-structurées effectuées en 2016 auprès de 60 individus inuit et non-inuit travaillant dans le système de la santé et des services sociaux au Nunavik. RéSULTATS: L’intégration des travailleurs communautaires locaux est perçue comme apportant plusieurs bénéfices, notamment une amélioration des interventions. Cependant, plusieurs facteurs entravent cette collaboration tels que la clarté dans les mandats, l’accès aux formations et diplômes pré-requis, la reconnaissance du savoir local ainsi que le roulement de personnel. Plus de flexibilité et de soutien après l’embauche permettrait d’adapter la structure des services à la réalité complexe du Nunavik. CONCLUSION: Cet article s’ajoute au corpus de littérature qui met de l’avant l’importance de la collaboration avec les travailleurs locaux. La décolonisation des services passe nécessairement par le remaniement des structures afin de reconnaitre l’apport des travailleurs locaux.

Surgical quality improvement efforts are challenging due to the multidisciplinary nature of care, difficulties obtaining reliable data, and variability in quality metrics. The objective of this analysis was to assess whether participation in a regional collaborative quality initiative was associated with decreased in-hospital surgical complication in South Carolina.In-hospital surgical complication rates were determined using a statewide all-payer claims data set. Retrospective, univariate, and longitudinal multivariable analyses were performed and adjustments were made to account for aggregated hospital-level patient characteristics.The analysis included 275,387 general surgery cases performed in South Carolina hospitals between January 2016 and December 2018. Eight hospitals involved in the South Carolina Surgical Quality Collaborative (SCSQC) performed 56,179 cases and 51 non-SCSQC hospitals performed 219,208 cases. Univariate analysis revealed SCSQC hospitals performed operations in older patients (p0.0001) and patients with higher mean Charlson Comorbidity Index scores (p0.0001). SCSQC hospitals had higher mean in-hospital surgical complication rates at the surgery level compared with non-SCSQC hospitals (8.3% vs 7.0%; p0.0001). However, in multivariable analyses, the rate ratio for in-hospital surgical complication in SCSQC hospitals was 0.994 (95% CI, 0.989 to 0.998; p = 0.008) per month compared with non-SCSQC hospitals. This suggests a 21.6% (95% CI, 7.2% to 39.6%) proportional decrease in the rate of in-hospital surgical complication during 3 years associated with participation in the regional collaborative quality initiative.Structured collaboration between facilities, reliable data abstraction support, timely data review, and active member participation resulted in outcomes improvements for participating hospitals compared with hospitals that did not participate in a regional collaborative quality initiative.

Justification The unprecedented COVID-19 pandemic has had a formidable impact on Indian health care. With no sight of its end as yet, various establishments including the smaller clinics and nursing homes are restarting full operations. Hence, there is the need for recommendations to allow safe practice ensuring the safety of both the heath care worker (HCW) and patients. Process Indian Academy of Pediatrics organized an online meeting of subject experts on 27 July, 2020. A committee was formed comprising of pediatricians, pediatric and neonatal intensivists, and hospital administrators. The committee held deliberations (online and via emails) and a final consensus was reached by November, 2020. Objectives To develop recommendations to provide a safe and practical healthcare facility at clinics and small establishments during COVID times. Recommendations The key recommendation to practise safely in this setting are enumerated. Firstly, organizing the out-patient department (OPD). Secondly, appropriate personal protective equipment (PPE) to provide protection to the individual. Thirdly, decontamination/disinfection of various common surfaces and equipment to prevent transmission of infection from fomites. Next, maintaining the heating ventilation and air conditioning (HVAC) to provide a stress-free, comfortable, and safe environment for patients and HCWs. Finally, steps to effectively manage COVID-19 exposures in a non-COVID-19 facility. All these measures will ensure safe practice during these unprecedent times in clinics and smaller establishments.

With the onset of the COVID-19 pandemic, researchers have been faced with challenges in maintaining interdisciplinary research collaborations. The purpose of this article is to apply and expand a previously introduced model to sustaining new interdisciplinary research collaborations: Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR). FAIRR is a logic model that can be used as a guide to create interdisciplinary rehabilitation research teams. In this article, the authors propose expanding FAIRR by including strategies for sustaining interdisciplinary rehabilitation research collaborations: modifying inputs (resources needed to assemble a team and to conduct research activities), shifting activities (steps taken to move the interdisciplinary collaboration forward), and examining what impacts the fit between inputs and activities. Two examples are used to highlight the application of the FAIRR model to interdisciplinary collaborations during COVID-19.

Fragmentation of social service and healthcare services has been given attention in many countries and a variety of strategies and models are used in attempts to remedy the problem. In a parallel development, demands have been made that users/patients should have more influence over their own care, and research has shown that user involvement can support the recovery process. This article focuses on how professionals view user involvement in collaborative efforts in care planning, using the Coordinated Individual Plan (CIP) in Sweden as an example. Since 2009, social service and healthcare agencies are required to draw up CIPs when they are judged to be needed, with the purpose of improving the care process. An additional purpose is to increase users' involvement in their own care. Semi-structured interviews were conducted in 2019 with 20 professionals working within social service and healthcare agencies for people with mental health and/or substance abuse problems in the Stockholm region. Analysis was by qualitative content analysis. Findings show that professionals study experience ambivalence concerning user involvement in care planning. On the one hand, they support the user´s own demands of services and, on the other hand, they correct the user´s demands to fit the range of services and organisation of care. The user/patient's position is expressed as vulnerable, caught between caregivers who often safeguard their organisational duties and economical restrictions. These findings reflect the conflict predicted by Lipsky's theory of street-level bureaucracy. Professionals are expected to act as advocates for the user/patient, while at the same time exercising a controlling and gatekeeping function. The question is raised whether a model such as CIP provides sufficiently for factors which can counterbalance the power of the professionals relative to the user/patient in care planning.

INTRODUCTION: COVID-19 represents an unprecedented challenge to policy makers as well as those entrusted with capturing, monitoring, and analyzing COVID-19 data. Effective public policy is data-informed policy. This requires a liaison between public health scientists and public officials. OBJECTIVE: This article details the experience, challenges, and lessons learned advising public officials in a large metropolitan area from March to October 2020. METHODS: To effectively do this, an R Markdown report was created to iteratively monitor the number of COVID-19 tests performed, positive tests obtained, COVID-19 hospitalization census, intensive care unit census, the number of patients with COVID-19 on ventilators, and the number of deaths due to COVID-19. RESULTS: These reports were presented and discussed at meetings with policy makers to further comprehension. DISCUSSION: To facilitate the fullest understanding by both the general public and policy makers alike, we advocate for greater centralization of public health surveillance data, objective operational definitions of metrics, and greater interagency communication to best guide and inform policy makers. Through consistent data reporting methods, parsimonious and consistent analytic methods, a clear line of communication with policy makers, transparency, and the ability to navigate unforeseen externalities such as "data dumps" and reporting delays, scientists can use information to best support policy makers in times of crises.

The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium-with diverse expertise and representation-representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens' values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource's varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes.

The purpose of this article is to demonstrate how a new cross-community leadership team came together, collaborated, coordinated across academic units with external community partners, and executed a joint mission to address the unmet clinical need for medical face shields during these unprecedented times. Key aspects of this success include the ability to forge and leverage new opportunities, overcome challenges, adapt to changing constraints, and serve the significant need across the Philadelphia region and healthcare systems. We teamed to design-build durable face shields (AJFlex Shields). This was accomplished by high-volume manufacturing via injection molding and by 3-D printing the key headband component that supports the protective shield. Partnering with industry collaborators and civic-minded community allies proved to be essential to bolster production and deliver approximately 33,000 face shields to more than 100 organizations in the region. Our interdisciplinary team of engineers, clinicians, product designers, manufacturers, distributors, and dedicated volunteers is committed to continuing the design-build effort and providing Drexel AJFlex Shields to our communities.

HIV/AIDS and child malnutrition are pervasive in eastern and southern Africa. This paper employs cross‐country panel data on 20 countries from 1991 to 2017 to explore the macro‐level relationship between HIV/AIDS and child malnutrition. Using instrumental variables (IV) regression, we find that HIV/AIDS is a robust predictor of long‐term and chronic malnutrition. Conditional on various controls, the results demonstrate a positive empirical association between HIV/AIDS and stunting. Moreover, increased access to improved water, female education, and food availability are critical for reducing stunting. These findings underscore the need for an integrated national policy on nutrition and HIV/AIDS and intersectoral collaboration between government agencies responsible for managing nutrition and HIV/AIDS programs.

PurposeSchool principals are presumed to be pillars of school health promotion implementation. Their understanding of their role could enhance school health promotion. This study aims to investigate how principals understood their role in school health promotion.Design/methodology/approachIn this study, semi-structured interviews were conducted with six school principals who participated and completed the first cycle of the Continuous Professional Teacher Development programme that was offered by the South African Council of Educators. Snowball sampling was used to sample participants.FindingsThe findings of this study showed that principals did not differentiate between concepts of health-promoting schools and school health promotion, the meaning was the same for them. They focused on any health improvement within the schools, regardless of its conceptual nature. The second finding pertains to the role of the principal as a manager, while the third was on expedition of collaborations and partnerships.Research limitations/implicationsThis research was limited to school principals who completed the Continuous Professional Teacher Development programme. It, therefore, does not include perceptions of other principals.Originality/valueThe study findings suggest that despite inability of schools in poor communities to implement effective school health programmes, the principals of the sampled schools were aware of their roles. This is positive, as the efforts to enhance health promotion initiatives would focus on developing and empowering principals to improve their performance.

The response to the coronavirus disease 2019 (COVID-19) pandemic in the United States has resulted in rapid modifications in the delivery of health care. Key among them has been surge preparation to increase both acute care hospital availability and staffing while using state and federal waivers to provide appropriate and efficient delivery of care. As a large health system in New York City, the epicenter of the pandemic in the United States, we were faced with these challenges early on, including the need to rapidly transition patients from acute care beds to provide bed capacity for the acute care hospitals. Rehabilitation medicine has always played an essential role in the continuum of care, establishing functional goals while identifying patients for postacute care planning. During this crisis, this expertise and the overwhelming need to adapt and facilitate patient transitions resulted in a collaborative process to efficiently assess patients for postacute care needs. We worked closely with our skilled nursing facility, home care partners, and an acute inpatient rehabilitation hospital to adapt their admissions processes to the patient population with COVID-19, all the while grappling with varying access to vital supplies, testing, and manpower. As the patient criteria were established, rapid pathways were created to postacute care, and we were able to create much needed bed capacity in our acute care hospitals.

Since December 2019, there has been a global explosion of research on COVID-19. In Canada, the six National Collaborating Centres (NCCs) for Public Health form one of the central pillars supporting evidence-informed decision making by gathering, synthesizing and translating emerging findings. Funded by the Public Health Agency of Canada and located across Canada, the six NCCs promote and support the use of scientific research and other knowledges to strengthen public health practice, programs and policies. This paper offers an overview of the NCCs as an example of public health knowledge mobilization in Canada and showcases the NCCs' contribution to the COVID-19 response while reflecting on the numerous challenges encountered.Depuis décembre 2019, on assiste à une explosion mondiale de la recherche sur la COVID-19. Au Canada, les six Centres de collaboration nationale (CCN) en santé publique constituent l’un des piliers de la prise de décisions informées par les données probantes, car ils recueillent, résument et traduisent les connaissances émergentes. Financés par l’Agence de la santé publique du Canada et répartis sur le territoire, ils favorisent et soutiennent l’utilisation des résultats de la recherche scientifique et d’autres connaissances pour renforcer les pratiques, les programmes et les politiques en santé publique. Cet article fournit un aperçu de la manière dont les CCN participent à la mobilisation des connaissances en santé publique au Canada, met en évidence leur contribution à la lutte contre la COVID-19 et décrit les nombreuses difficultés rencontrées.The explosion of research on COVID-19 in Canada and around the world called for an improved capacity to support evidence-informed decision making (EIDM). Canada is fostering various mechanisms to achieve this goal; the National Collaborating Centres (NCCs) for Public Health are central to supporting EIDM during the pandemic. The NCCs, a network of networks anchored on six unique knowledge hubs, are well connected to provincial, territorial, local and international partners. In response to COVID-19, the NCCs are making an important contribution to building knowledge, skills and capacity in the public health sector, and to supporting public health professionals in synthesizing and using evidence-informed knowledge in policy and practice.L’explosion de la recherche menée sur la COVID-19 au Canada et ailleurs dans le monde a nécessité une augmentation de la capacité à soutenir la prise de décisions informées par les données probantes. Parmi les divers mécanismes préconisés par le Canada pour atteindre cet objectif, les Centres de collaboration nationale (CCN) en santé publique jouent un rôle essentiel pendant la pandémie pour soutenir la prise de décisions informées par les données probantes. Les CCN, qui constituent un réseau de réseaux s’appuyant sur six centres de connaissances, ont des liens étroits avec plusieurs partenaires provinciaux, territoriaux, locaux et internationaux. Pour lutter contre la COVID-19, les CCN renforcent de façon significative les connaissances, les compétences et les capacités en santé publique et soutiennent les professionnels en santé publique en synthétisant des connaissances fondées sur des données probantes pour leur intégration aux politiques et aux pratiques.

Background: Disease prevention and prediction have led to the generation of phenotypically based methods for deriving the limits of safety across toxicological disciplines. In the ionizing radiation field, human data has formed the basis of the linear-no-threshold (LNT) model for risk estimates. However, uncertainties around its accuracy at low doses and low dose-rates have led to passionate debates on its effectiveness to derive radiation risk estimates under these conditions. Concerns arise from the linear extrapolation of data from high doses to low doses, below 0.1 Gy where there is considerable variability in the scientific literature. Efforts to address these controversies have led to a mountain of mechanistic data to improve the understanding of molecular and cellular effects related to phenotypic changes. These data provide fragments of information that have yet to be combined and used effectively to improve modeling, reduce uncertainties, and update radiation protection approaches. This paper suggests a better consolidation of mechanistic research may serve to guide priority research and facilitate translation to risk assessment. An effective approach that may be implemented is the organization of data using the adverse outcome pathway (AOP) framework, a programme that has been launched by the Organisation for Economic Cooperation and Development in the chemical toxicology field. The AOP concept has proved beneficial to human health and ecological toxicological fields, demonstrating possibilities for better linkages of mechanistic data to phenotypic effects. A similar approach may be beneficial to the field of radiation research. However, for this to work effectively, collaborative efforts are needed among the scientific communities in the area of AOP development and documentation. Studies will need to be evaluated, re-organized and integrated into AOPs. Here, details of the AOP approach and areas it could support in the radiation field are discussed. In addition, challenges are highlighted and steps to integration are outlined. Organizing studies in this manner will facilitate a better understanding of our current knowledge in the radiation field and help identify areas where more focused work can be undertaken. This will, in turn, allow for improved linkage of mechanistic data to human relevance and better support radiation risk assessments.

At the start of the COVID-19 pandemic, the Mountain Area Health Education Center formed a response team with the goal of building capacity across Western North Carolina health systems to collectively identify needs, coordinate resources to fill gaps, and strategically manage the regional threats of the pandemic. The library team collaborated on interprofessional projects by gathering information and using LibGuides to quickly and easily organize and share resources. The team met challenges, including moving to telecommuting, balancing a growing workload, and navigating a changing information landscape, and in doing so, strengthened relationships across the organization and the region.

The implementation of adult education in Ethiopia is the responsibility of different sectors. Studies indicated that the collaboration among these sectors is unsatisfactory, but the main factors th...

SUMMARY: While the term systemness has been used in the healthcare sector for decades, its definition varies from organization to organization. Still, the goals are consistent: to improve patient experience, lower costs, reduce risk, and provide insights into a wide range of care and management issues. Most health systems face similar challenges, such as margin enhancement, quality improvement, increased access, and fending off disruptive competition. Systemness is a way to address these challenges while improving the overall interdependence of the organization. Although embraced by and advantageous to healthcare organizations, systemness efforts often fail. The obstacles are surmountable when organizations thoroughly analyze the achievable scale of systemness, community resources, and current mindset regarding the good of the whole. Leaders must play a vital role in promoting systemness by providing education and a routine review of day-to-day organizational activities. Sometimes, systemness requires a change in leadership or an updating of leadership skills.Organizations must recognize and assess their culture as it relates to principles of independence versus interdependence, and refocus clinical standardization through best-practice protocols and policies as COVID-19 affects the already-fractured healthcare sector. Fortunately, current and developing artificial intelligence, wearables, at-home testing, and improved technologies promise to provide a needed break for a contracting physician field and fatigued front line, and they present an opportunity for those organizations poised to meet the systemness challenge.

Background: In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration. Methods: This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest. Results: 52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators. Conclusion: The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.

Sports ultrasound (US) is a rapidly advancing and expanding field, where "hands-on" education and real-time instructor feedback are paramount in developing this skill. In light of a global pandemic and limited access to instructors and educational conferences, sports US education must adapt to continue to teach future ultrasonographers. Virtual US education, conducted using various virtual meeting platforms not only allows for continued didactic education but also can virtually recreate the "hands-on" training sessions with live, immediate instructor feedback that is necessary for acquiring competence. Additionally, using these methods, sports US conferences can continue in a virtual manner, sports US education can expand remote areas, and collaboration among distant experts may increase, all without the cost of travel and extended time away from work. While immediately relevant because of the COVID-19 pandemic, virtual US methods may continue to be beneficial as sports US education and collaboration continue to expand.

Objective: The social component of health plays a significant role in improving the mental health of the people of a district. A national program on providing comprehensive social and mental health services, entitled “SERAJ”, was developed and piloted in three districts of Iran. The present study aims to determine its model for improving the indicators of the social component of mental health. Method: This study is a system design for which a literature review, interviews with experts, and focused group discussions with stakeholders were used. Results: Community action in promoting the mental health of the districts has three main components: strengthening intersectoral collaboration through the memorandum of understandings (MoU), increasing people's participation by establishing People’s Participation House (PPH) with the presence of the representative of current People’s network, and social protection of people suffering from mental disorders by establishing the Social Support Unit (SSU) for self-reliance activity. All three components are controlled by the governor and with supervision and technical consult of the health network of the district and stakeholder participation Conclusion: The model uses the inner capacities of the city instead of creating new structures. The prerequisites for the effective function of the main three components are educating departments, educating members of the PPH, and hiring a social worker at the SSU. The effective measures taken by the departments to reduce the risk factors for mental disorders are dependent on the technical and financial support of relevant organizations at the provincial and national levels.

The University of California Los Angeles (UCLA) and University of California San Francisco (UCSF) codeveloped 68Ga-PSMA-11 by conducting a bicentric pivotal phase 3 clinical trial for PET imaging for prostate cancer. On December 1, 2020, 2 separate new drug applications (NDAs) submitted by each institution (NDA 212642 for UCLA and NDA 212643 for UCSF) were approved by the Food and Drug Administration as the first drug for PET imaging of prostate-specific membrane antigen (PSMA)-positive lesions in men with prostate cancer. This article briefly describes the background, clinical development, regulatory approach, and regulatory process for NDA filing and approval. In the second part of this article, key chemistry, manufacturing, and controls (CMC) information is provided to facilitate abbreviated new drug application (ANDA) submission.

Children and adolescents in rural Australia experience poorer health and educational outcomes than those in urban areas. This paper presents findings from a qualitative study exploring the role of primary health care registered nurses (RNs) working in the School-Based Primary Health Care Service in Broken Hill, far west New South Wales. The Service integrates health district-employed RNs with school learning and support teams to increase service access and improve health and education outcomes for students. The findings show that RNs used care navigation to reduce barriers to care by addressing healthcare candidacy with students and families. The RNs also linked schools, families and health and social care services, and facilitated intersectoral collaboration to improve the support provided to students experiencing health and developmental issues. Integrating health district-employed RNs with existing student support services is a promising approach to improving the health and education of disadvantaged students. This study provides individual- and system-level explanations of the role of the school-based primary health care RN and can inform the development of similar services elsewhere.

BACKGROUND AND PURPOSE Leptomeningeal metastases (LMs) carry a poor prognosis. Existing LM scoring systems show limited reproducibility. We assessed the contribution of education level on the reproducibility of LM scoring using structured planning and implementation of new experiments (SPINE), a novel web-based platform. METHODS Stringent radiological definitions of LM and a customized interactive scoring system were implemented in SPINE. Five patients with brain LM and 3 patients with spine, but no brain LM, were selected. Each patient's baseline post-contrast T1-weighted brain MRI was analyzed by three attending neuroradiologists, two neuroradiology fellows, and two radiology residents. Raters identified and characterized all LMs based on: (1) location (cerebrum, cerebellum, brainstem, ventricle, and/or cranial nerves); (2) shape (nodular and/or linear/curvilinear); (3) size (≥ or

The coronavirus pandemic has had significant effects on individuals, healthcare systems and governments. In the UK, whilst routine dentistry was suspended, an urgent dental care system was required to support urgent patient need. Using an adapted model of Donabedians’ framework, a critical evaluation of the services developed and implemented is provided and the various innovative approaches involved in this work are discussed. The three domains of the framework are structure, process and outcome. Structure: We present the principles for selecting and initiating hubs, the integration with secondary care services and the supply of personal protective equipment. Process: The main elements are communication, the development of referral processes to manage complex cases and data collection. Outcome: Through work with local dental stakeholders, 23 clusters and 36 hubs were set up covering a large geographical area. The integrated network of hubs and clusters has strengthened collaboration between providers and policy makers. Various leadership approaches facilitated the readiness for the transition to recovery. The new local collaborative structures could be used to support local programmes such as flexible commissioning, peer-led learning and integration with primary care networks.

The purpose of this study was to conduct a factual survey to evaluate the type of clinical research support offered by service providers (supporters) in Japanese academic research organizations (AROs). From September to October 2018, we conducted an online questionnaire targeting researchers and supporters of AROs, including individuals supporting research and development (R&D) planning, as well as those involved in study management, biostatistics, coordination, data management, monitoring, and auditing. The number of responses was tabulated for each survey item. For items with written descriptions, we compiled summaries using the inductive regression method of qualitative research. Responses were obtained from 124 researchers, 258 supporters, and 40 AROs. None of the institutions responded that they had a performance index for all types of service providers, whereas 47% of institutions had an index for 1–3 types of service providers, and 40% of institutions had no index. Many institutions responded that they had a performance index for coordinators and data management, but few responded that there was a performance index for individuals engaged in R&D and study management. Furthermore, for all evaluations of AROs and researchers, the level of supporter satisfaction was low at only 20%. There was a discrepancy between the levels of researcher expectations and the actual contribution of R&D in the process of research planning. Our survey revealed that there is currently no performance index for services supporting clinical research. In future studies, we need to examine a performance index that accurately reflects the researcher attitudes revealed in this study.

BACKGROUND: Clinical services provided by pharmacists embedded in practices can improve patient outcomes within the primary care setting. Little is known about whether physician organizations (POs) will retain the services of clinical pharmacists after outside funding for a statewide implementation program is ended. OBJECTIVE: To evaluate a statewide program, Michigan Pharmacists Transforming Care and Quality (MPTCQ), that incorporated pharmacists within 17 POs. METHODS: A descriptive study was conducted using data collected from June 2016 to September 2018 from primary care clinical pharmacist encounters in POs participating in MPTCQ. Process outcomes included the number of participating POs, patient encounters, and average visits per patient. Analyses at the encounter level were stratified by 2 encounter types: disease state management (DSM) or comprehensive medication review (CMR). Separately by encounter type, pharmacist effect was described by the number, type, and reasons for medication changes, as well as medication adherence and cost barriers found and addressed. Clinical outcomes included hemoglobin A1c and blood pressure change. Sustainability and patient satisfaction of pharmacists providing clinical services are reported. RESULTS: Across 17 POs, 27 pharmacists participated in the MPTCQ program. Pharmacists completed 24,523 patient encounters for DSM with 5,942 patients, with an average of 5 visits per patient with diabetes and 2 visits for hypertension. Pharmacists made 15,153 therapeutic medication changes during visits for diabetes and hypertension, with approximately 70% related to efficacy. Pharmacists completed 4,203 CMR visits for 3,092 patients. During CMR visits, 1,296 therapeutic medication changes were recommended. Problems with medication cost were identified in 13% of CMR visits. Blood pressure and A1c levels decreased in patients managed by pharmacists. In 157 patients surveyed, 87% rated their pharmacists' care as excellent. Sixteen POs retained their pharmacists at the end of funding. CONCLUSIONS: A statewide provider-payer partnership successfully integrated and retained primary care pharmacists within POs. Pharmacists in the MPTCQ program contributed to improvements in disease control by changing medications to improve patient clinical outcomes. DISCLOSURES: Support for MPTCQ was provided by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. Coe was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR002241. Although BCBSM and MPTCQ work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to report.