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Background: Unplanned extubations (UEs) continue to be one of the most common adverse events in the neonatal intensive care unit (NICU). Management of endotracheal tubes (ETTs) can be particularly challenging in neonates due to the unique needs and physical characteristics of this patient population. Purpose: The purpose of this quality improvement project was to decrease the rate of UEs from 0.76 to less than 0.5 per 100 ventilator days in an urban level III NICU in the Midwest, United States. Methods: A newly formed interprofessional team created an evidence-based, standardized, bedside nurse-led care bundle for intubations and ETT care in the NICU. This project also created standardized, clear, closed-loop communication for the transition of bedside staff at shift change. Results: The UE rate decreased from 0.76 to 0 per 100 ventilator days, reaching the goal of less than 0.5 per 100 ventilator days, during the 10-week project implementation period from December 2021 to February 2022. Implications for Practice and Research: Many NICUs focus on reducing UEs due to the impact on healthcare resource utilization, acute complications, and long-term outcomes for infants. The development of a standardized, nurse-led care bundle for ETTs decreased the rate of UEs. Future research is needed to study the potential for generalization to different units and beyond the scope of the neonatal population. [ABSTRACT FROM AUTHOR]

Musculoskeletal conditions in children frequently lead to referrals to paediatric orthopaedic clinics, driven by anxiety among parents and primary care providers. Normal variants, which represent a substantial proportion of these referrals, require thorough understanding to distinguish them from pathologic conditions and provide appropriate reassurance. This review outlines common normal variants and disorders of growth, categorized by presenting complaints, anatomical location, and age group. Effective management often involves parental reassurance, observation, and conservative measures such as physiotherapy and activity modification. Surgical interventions are rarely required. Emphasizing the importance of collaboration between paediatric orthopaedic surgeons and primary care providers, this review highlights the importance of musculoskeletal education to reduce unnecessary referrals and optimize patient care. [ABSTRACT FROM AUTHOR]

This pilot study explored the feasibility of a Forever Heart Program and the impact it has on oncology nurses' perception of the dying experience and their own compassion competence. Guided by Kubler-Ross's framework, the Forever Heart Program consists of a gemstone keepsake offered to patients and families during end-of-life care to support the grieving process. A mixed-methods approach utilized pretest/posttest design in a convenience sample of oncology nurses in an academic medical center over a 3-month period. The study collected demographics, Compassion Competence Scale scores, and qualitative responses via survey and an optional focus group. Twenty-five nurses participated in the presurvey, and 14 participated in the postsurvey. Seven nurses attended the focus groups. Overall, compassion competence scores were high, both pre and post. Qualitative themes included appreciation, connection, positive nursing, patient and family experience/relationships, grieving guidance, program benefits, and process opportunities. Although the study did not show statistically significant differences in compassion, it did show program feasibility and the potential positive impact that keepsakes like the Forever Heart Program can have on nurses and their role in the dying experience. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction.: Musculoskeletal pain and opioid misuse frequently co-occur. Review of the Literature.: The US Preventive Services Task Force calls for all health care providers to be trained to screen for misuse and/or opioid use disorder. The purpose of this study was to develop and implement an opioid misuse training program that could be used by physical therapists. Subjects.: Thirteen practicing physical therapists were invited to participate in a curriculum development project. Methods.: Using the Curriculum Framework, a collaborative learning approach was used to develop an opioid misuse training program and training manual for physical therapists. Four training sessions were provided virtually every 2 weeks. Topics included an introduction to the opioid crisis, screening, assessing, and communicating with patients and with the health care team about opioid misuse. Each didactic session was followed by a participant feedback session where participants provided recommendations on improving the training content and their impressions on the barriers and facilitators to incorporating the training into practice. A companion training manual was created and sent to participants for comment. Participants were asked over email to describe whether and how they incorporated training materials into clinical practice during the training curriculum. Results.: All participants attended sessions 1–3. Twelve (92.3%) attended the fourth session. Based on the participants' feedback, training sessions were edited, and a companion training manual was finalized and distributed to each participant. After the fourth session, 9 participants (69.2%) reported using what they learned in the training. During the participant feedback sessions, participants regarded the training as important. Some participants expressed barriers to discussing opioids with patients and concerns about whether the training was within physical therapists' scope of practice. Discussion and Conclusion.: An iteratively developed training program for physical therapists to address opioid misuse was acceptable, feasible, and provided immediate practice change by most participants. [ABSTRACT FROM AUTHOR]

A confluence of research and current events in the United States has brought guardianship for people with disabilities into focus in recent years. In the process, the field of special education has been confronted with an unpleasant reality. In their action or inaction, special education professionals may play a role in parents of students with disabilities pursuing undue and overbroad guardianship. The purpose of this study was to work with researchers and practitioners supporting alternatives to guardianship to gather their foremost recommendations for the field of special education on addressing the use of undue guardianship. To this end, the researchers conducted a three-round Delphi study with these established professionals to solicit, rate, and revise their ratings of related recommendations toward achieving consensus. The 30 top recommendations they offered have been collected here and discussed in terms of their relevance for policy, practice, and research in the field. [ABSTRACT FROM AUTHOR]

Lung cancer, the leading cause of cancer-related deaths globally, remains a pressing health issue despite significant medical advances. The New York Lung Cancer Foundation brought together experts from academia, the pharmaceutical and biotech industries as well as organizational leaders and patient advocates, to thoroughly examine the current state of lung cancer diagnosis, treatment, and research. The goal was to identify areas where our understanding is incomplete and to develop collaborative public health and scientific strategies to generate better patient outcomes, as highlighted in our "Calls to Action." The consortium prioritized 8 different calls to action. These include (1) develop strategies to cure more patients with early-stage lung cancer, (2) investigate carcinogenesis leading to lung cancers in patients without a history of smoking, (3) harness precision medicine for disease interception and prevention, (4) implement solutions to deliver prevention measures and effective therapies to individuals in under-resourced countries, (5) facilitate collaborations with industry to collect and share data and samples, (6) create and maintain open access to big data repositories, (7) develop new immunotherapeutic agents for lung cancer treatment and prevention, and (8) invest in research in both the academic and community settings. These calls to action provide guidance to representatives from academia, the pharmaceutical and biotech industries, organizational and regulatory leaders, and patient advocates to guide ongoing and planned initiatives. [ABSTRACT FROM AUTHOR]

Purpose: Inclusive recruitment and employment of autistic adults has garnered recent attention in research and policy. To address a need to better understand the experiences of autistic adults in relation to paid employment, we asked the literature, what are the experiences of autistic individuals (from their perspectives) in competitive employment? Methods: A scoping review was conducted to summarize and consolidate the findings across research to date. A systematic search and screen of the literature resulted in 32 relevant studies. Findings: Key study characteristics, participant demographics, and thematic findings are shared, along with considerations and recommendations for future research and practice. Six key themes were described by autistic participants across the 32 studies: (1) accessibility of employment, (2) workplace relationships and communication, (3) role alignment, (4) sensory needs and/or mental health, (5) colleagues' knowledge and beliefs about autism, and (6) family and community context. Conclusion: It is anticipated that the results of this review will be beneficial for stakeholders engaging in discussions and decision-making across research and employment contexts. [ABSTRACT FROM AUTHOR]

Asthma is one of the most prevalent lung conditions in the UK. Around eight in 100 people are diagnosed with it (Asthma + Lung UK, 2024). However, according to the British Thoracic Society (BTS, 2024), asthma affects around 12% of the UK population, with 160,000 people being newly diagnosed each year. This article focuses on the importance of finding the right inhaler to meet patient needs and lifestyle, while exploring the concepts of shared decision-making within respiratory reviews. [ABSTRACT FROM AUTHOR]

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Industry 4.0 technology is promoted as improving manufacturing flexibility, and competitiveness; though Australia has been slow to adopt. The Australian Navy shipbuilding program provides opportunities for accelerating technology adoption, revitalising manufacturing productivity and competitiveness. Adopting a sociotechnical systems lens, our research sought to identify usability, workload, and user experience of an augmented reality head-mounted display (AR-HMD) deployed to complete multiple work tasks in a workflow (electrical assembly, collaborative robot (cobot) mediated inspection, and remote troubleshooting using video call). Usability was rated 'average' (System Usability Scale mean = 69.8) and workload 'acceptable' (NASA Task Load Index mean = 25.8) for the AR-HMD alone, with usability of the integrated work system (IWS) rated 'good' (SUS mean = 79.2). Results suggest software interfaces, tracking, and gesturing methods for the AR-HMD require improvement. This trial shows the AR-HMD provides a versatile platform for integrating multiple digital technologies without hindering effectiveness of end-user performance, potentially benefiting productivity and quality. PRACTITIONER SUMMARY: Using an augmented reality head-mounted display (AR-HMD) to reduce and correct errors in electrical assembly identified factors influencing technology adoption in shipbuilding. Mental workload, interface design, tracking, and gesturing most hindered successful performance. AR-HMDs can facilitate the use of more complex integrated technologies (i.e. cobot), improving usability and acceptance. [ABSTRACT FROM AUTHOR]

Purpose: Children who utilise augmentative and alternative communication (AAC) have difficulty participating in interactions with peers and speech-language pathologists (SLPs) lack training in the development of activities to specifically target participation. The purpose of the current study was to explore a pilot online training program designed to provide information about the development of collaborative learning (CL) activities to support participation. Method: A single-subject, multiple baseline across six participants in an initial group and a replication group was completed to assess the number of CL elements included in probe responses during baseline, intervention, and maintenance phases. Result: SLPs were highly accurate in their ability to answer multiple choice questions about CL elements (80%–90%); however, the overall effect of the intervention was weak with a Tau-U of 0.48 for the initial group and 0.53 for the replication group. Conclusion: SLPs can begin to develop skills in designing CL activities for children who utilise AAC as a means to support participation and foster social interaction. Future research is necessary to design efficient and effective online training for SLPs. [ABSTRACT FROM AUTHOR]

Surely a leader should know what to do? But what happens when complexity means they cannot know which path to take? We answer this question with an ethnographic study of distributed leadership (DL) in an organisation grappling with inherent tensions within its mission. The article makes a counter-intuitive argument for the value and utility of unknowingness, defined as a state of awareness of both an absence of knowing and one's inability to know. Three inter-related aspects to unknowingness are developed – acceptance of not knowing, tolerance of the discomfort of not knowing, and distribution of unknowingness – leading to an innovative theory of unknowingness. We reveal how unknowingness and DL are bound with each other in the sense that not knowing can enable distribution of leadership within the organisation, whilst DL addresses challenges in complex organisations associated with not knowing. We thereby provide an illustration of the interplay between those with hierarchical authority and others dispersed throughout an organisation. In sum, we provide an alternative perspective to the heroic, all-knowing individual leader. [ABSTRACT FROM AUTHOR]

Background: With the rising incidence of inflammatory bowel disease (IBD) in pediatric populations, school nurses are increasingly called on to care for and support these students. Method: The research team surveyed Connecticut school nurses about their experiences, knowledge, and confidence in addressing IBD in the school setting. The team also developed and implemented an online education intervention to improve knowledge and confidence gaps during the 2022–2023 academic year. Results: Most participants have cared for one to two (46%, n = 66) or several (30%, n = 44) students with IBD. However, 24% (n = 35) have not cared for any students with IBD. School nurses shared their perspectives with three themes identified from the qualitative feedback: (a) limited knowledge and experience with IBD, (b) importance of support at school, and (c) need for interprofessional collaborative practice. Conclusion: The online education significantly improved school nurses' knowledge (p <.001) and confidence scores (p <.001). Participants found this intervention beneficial to their work. [J Contin Educ Nurs. 2024;55(12):589–595.] [ABSTRACT FROM AUTHOR]

Background: For many patients, cannulation ('needling') is essential for haemodialysis. It is associated with anxiety and fear and contributes to the overall burden of treatment. Limited research exists on patient experience of needling and how this might vary by individual and clinical characteristics. Objectives: To explore and identify key aspects of needling impacting patients' experiences. Design: Qualitative, multicentre, cross‐sectional, co‐produced. Participants: Adults on haemodialysis with working fistulae or grafts (n = 41). Approach: We used interviews to explore patients' experiences of needling and key aspects contributing to this. Interviews were conducted in two sets: unstructured (n = 24, broadly investigated needling experience) and semistructured (n = 17, refined themes and assessed cultural relevance). Thematic analysis was used to identify themes driving experience and examine variation. A Patient Steering Group comprising people with lived experience of needling was integral to the study. Findings: A thematic framework capturing patients' view of needling was developed. It defined a core theme (The Nature of needling) and five foundational aspects of needling (Health of the fistula or graft, Steps in needling, The needler, The patient, Organisational context). We identified two further themes important to overall experience, Learning from needling experience and Reciprocity (the two‐way interaction between patient and needler). Both interrelated across themes, highlighting the complexity of needling and junctures where patient experience can be influenced. Conclusions: Needling is shaped by multiple psychological and relational influences. These findings provide healthcare professionals with a basis to improve patient experience as part of a broader drive to enhance quality in healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: Individuals who experience childhood trauma may be more likely to misuse substances. The influence of social risk factors increases the frequency of opioid use. Understanding the linkages between childhood trauma, opioid use disorder, and social risk factors has the potential of improving poor health outcomes. The performance of specific role groups on office-based addition teams in documenting social risk factors in the electronic medical record had not been studied. Methods: This retrospective chart review was conducted across three primary care practices at an urban academic medical center. Results: The majority of our sample reported at least one social risk factor. Those patients with an advanced practice nurse and/or navigator on their team were more likely to report food insecurity and to have documentation related to involvement with the legal system. Recovery coaches were most likely to document the lack of housing stability as compared to other members of the team. Conclusions: The incidence of documentation related to housing stability, food insecurity, and involvement with the legal system for patient's engaged in an OBAT program should alert interprofessional clinicians on the team to assess for a history of adverse childhood experiences. [ABSTRACT FROM AUTHOR]

Introduction: Consumer contribution to occupational therapy student learning is mandated for Australian educational programs. However, there is limited research about how consumers contribute to student learning during practice placements. A scoping review was completed to explore the concepts of existing feedback systems for consumers to authentically contribute to student learning during practice placements. Methods: Five databases were searched for all articles up to and including July 2023. All publications were included if they described and investigated authentic contribution to student learning during a practice placement experience. Data from the results and discussion sections of the papers were transformed into qualitative data and thematically analysed to develop a conceptual understanding of consumer feedback systems. Results: Forty‐six papers met the eligibility criteria. Most articles originated from Medicine (30%) and Nursing (45%) education. Feedback systems were primarily designed to critique student communication and professional behaviours using a variety of standardised and non‐standardised methods. Five interconnected themes were created that addressed the concepts of consumer feedback systems. The themes were (1) creating value specific for each stakeholder is essential, (2) preparation is required and nuanced; (3) consumers do engage and provide critical feedback when the system is supportive of all stakeholders; (4) gathering approaches need to be responsive to the diversity of practice and learning; (5) processing feedback with a trusted mentor is critical for learning. Conclusions: Consumers, academics, practice educators, and students recognised that consumers have an important role in contributing to student learning during practice placements. Future consumer feedback systems need to be co‐produced to create an optimal mode for consumers to authentically contribute to student learning constructively and safely. Consumer and community involvement: A consumer consultant was a member of the advisory panel for the larger research project that this review is part of and provided advice to the research team at all stages of the project. PLAIN LANGUAGE SUMMARY: In Australia, occupational therapy training programs require input from consumers to help students learn. However, there is not much research on how consumers help occupational therapy students during their practical training. We did a review to see how existing feedback systems let consumers genuinely help students during their training. We searched five databases for research up to July 2023. We included research that talked about how consumers help all health students learn during practical training. We found 46 articles, mostly from Medicine and Nursing education. We analysed them to understand how consumer feedback systems work and found five main themes: (1) making sure everyone involved gets value out of it, (2) being prepared is important, (3) consumers give useful feedback when the system supports everyone involved, (4) different approaches are needed because practices and learning vary, and (5) discussing feedback with other people helps students learn. Current feedback systems mostly focused on how students communicate and behave professionally. Consumers, educators, and students all agree that consumers play a vital role in helping students learn during practical training. In the future, we need to work together to make feedback systems that let consumers help students in the best way possible, making sure it is constructive and safe for everyone. [ABSTRACT FROM AUTHOR]

Introduction: Autistic children commonly receive simultaneous services from various health‐care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health‐care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children. Methods: This study employed an exploratory qualitative descriptive design. Semi‐structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data. Consumer and Community Consultation: This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines. Findings: Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism‐related frames of reference were perceived to influence interprofessional collaboration. Conclusion: Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model. PLAIN LANGUAGE SUMMARY: This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful. [ABSTRACT FROM AUTHOR]

Introduction: A peer‐mediated, play‐based intervention has been developed to address social participation challenges experienced by children with ADHD. To facilitate implementation into clinical practice, interventions should be evaluated for appropriateness to the end‐user, as well as effectiveness. Previous research demonstrated the approach is effective for improving children's social play skills. This study aimed to evaluate the appropriateness of the intervention for children with ADHD and their families. Methods: Parents of children with ADHD who participated in the play‐based intervention were interviewed 1 month after completion. Parents were asked about their perspective of parent and children's experiences of the intervention, the perceived benefits for children and parents, the logistics of participating, and recommended adaptations to the intervention. Interviews were analysed thematically, and themes were mapped to the elements of the adopted definition of appropriateness to understand whether parents supported the appropriateness of the intervention for their families. Consumer and Community Involvement: Consumers were not directly involved in the decisions made about this study. Findings: One core theme, 'collaborative efforts', emerged from the data. Major themes comprising the core theme were 'on the same page', 'therapeutic relationship', and 'getting the job done'. Three sub‐themes of 'engagement and motivation', 'the effort was worth it for the reward', and 'Rome wasn't built in a day' were nested within the major themes. Conclusion: Parents largely supported the appropriateness of the intervention, indicating it addressed an important goal for their child, participation was a positive experience, and they perceived the intervention to be beneficial. Future adaptions of the intervention are needed to increase its ecological validity and to generalise the strategies to other social environments and playmates, such as peers at school. PLAIN LANGUAGE SUMMARY This study looked at an intervention that uses play with peers to help children with ADHD develop their play skills. The researchers wanted to know if parents thought the intervention was a good fit for their families and if it helped their children. Parents gave an interview a month after the intervention ended. They were asked about their thoughts on the intervention, how it helped their children and themselves, how easy it was to take part, and what changes could be made to make the intervention better. After analysing parents' answers, the researchers found parents mostly agreed that the intervention was a good fit. They said it helped their children to play with their peers, and they had a good time doing it. Parents thought the intervention was helpful, they liked that it was a joint effort between them and the occupational therapist, and they felt it was worth the effort. However, they also suggested some changes. They wanted the intervention to fit into other real‐life social situations, such as school, so their children could use the skills they learned in other places. Overall, parents thought the intervention was helpful and suitable for their children and themselves, but some changes might make it more helpful. [ABSTRACT FROM AUTHOR]

The authors discuss the meeting by Childhood Sjöogren's Disease (cSjD) Workgroup during the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Annual Scientific Meeting to review the current state of cSjD and identify opportunities to prioritize this rare and understudied disease. Topics include domains identified by the core members of the workgroup prior to the meeting and key themes and research questions that emerged from the domains.

This paper uses a neo-institutional perspective to examine possibilities and obstacles for participation in coordinated individual planning (CIP) for people with intellectual disabilities. CIP is a tool for interprofessional and interorganizational coordination with the objective of creating a joint plan for a person needing cohesive care. Participation by the service-user is considered important for effective coordination but involving someone with an intellectual disability may require special adaptations. A thematic analysis of interviews with 17 professionals from different organizations in Sweden reveals that service user participation is considered an important goal by professionals, but also that it is difficult to put into practice. The results indicate that CIP is characterized by tensions and policy-practice decoupling that limit the service-users' possibilities for participation. Points of interest: Different organisations and professionals sometimes give support to one individual. They need to coordinate this support. It is necessary for service-users to be involved in coordinated planning of the support and care they need. The study analyses how professionals experience participation in coordinated planning when the service-user has an intellectual disability. The study found that coordinated planning can be difficult to adapt for service-user participation. The study found a gap between ideals and practice caused by the organizations' rules, norms, and structures. The findings reveal a risk of focusing on changing the service-user's behaviour or situation rather than addressing problems within the organizations. [ABSTRACT FROM AUTHOR]

Background: The economic sanctions imposed on Iran have had a significant impact on the country's healthcare system. The sanctions have affected the availability and affordability of cancer diagnosis and treatment services, leading to a range of challenges for patients with cancer. This study aimed to explore these challenges and gain a deeper understanding of the impact of economic sanctions on cancer care in Iran. Methods: The research method involved qualitative in-depth interviews with 53 experts, including clinical and basic sciences specialists, who were selected through purposeful sampling. The data were analyzed through qualitative content analysis using MAXQDA 2020. Results: A total of 900 codes were identified, categorized into three primary groups—input, process, and output—and further divided into 13 subcategories. Within the input category related to health systems providing cancer care to patients, several critical issues emerged. These included instability in financing mechanisms and regulations, shortages of materials, low-quality imported materials, high material prices, and loss of human resources. Meanwhile, in the process of delivering diagnostic and treatment procedures to cancer patients, concerns centered around delayed and inadequate care, non-adherence to guidelines, limited international collaborations, and reduced provider satisfaction. Finally, during the output phase, the main subcategories extracted were lower effectiveness, increased adverse events, and increased equity gaps. Conclusions: Although economic sanctions against Iran have not officially targeted healthcare and access to drugs, they have restricted access to standard equipment and modern technologies, leading to increased delays, misdiagnosis, and diagnostic and therapeutic side effects in cancer patients to the point of death. [ABSTRACT FROM AUTHOR]

Background: Equitable access to vaccination remains a concern, particularly among population groups made structurally vulnerable. These population groups reflect the diversity of communities that are confronted with structural barriers caused by systemic racism and oppression and result in them experiencing suffer disadvantage and discrimination based on citizenship, race, ethnicity, ancestry, religion, spiritual beliefs, and/or gender identity. In Canada, Ontario public health units (PHUs) engage with faith-based organizations (FBOs) to improve vaccine confidence among populations made structurally vulnerable. This study explores the factors that facilitate and hinder engagement in the implementation of vaccine confidence promoting interventions, and challenges associated with working with FBOs. Methods: In-depth interviews were conducted with 18 of the 34 Ontario PHUs who expressed an interest. Braun and Clarke's "experiential" approach was used to explore the realities of PHUs' contextual experiences and perspectives. Results: The results showed that receptivity and openness of PHUs to learn from FBOs, previous experience working with religious communities and FBOs, ongoing relations based on respect of different beliefs and opinions on the vaccines, leveraging the support of trusted faith leaders among communities and communications strategy adapted and sensitive to the needs of the community was facilitators to community involvement in the prevention and control of COVID-19. On the other hand, factors both internal and external to the PHUs have often posed challenges to collaboration with the FBOs. Internal factors include low operational capacity of PHU like insufficient human and financial resources, weak analytical capacity, ambiguity in the roles and responsibilities of the different actors. Some external challenges issues were related to the provincial level and the Ministry of Health, while others were related to FBOs. For example, faith-based and collective beliefs promoting vaccine hesitancy have resulted in resistance from some religious communities when PHUs have reached out to collaborate. Conclusions: Engaging with faith-based communities is an ongoing process that requires time, flexibility, and patience, but it is necessary to improve vaccine confidence and equity access among population groups made structurally vulnerable. Lessons learned from this research can guide the implementation of future vaccination programs. [ABSTRACT FROM AUTHOR]

The impact of Human Immunodeficiency Virus (HIV) on neurocognition in Africa is a pressing public health issue, with profound implications for both individual well-being and healthcare systems across the continent. This narrative review aims to elucidate the intricate relationship between HIV infection and neurocognitive function, particularly focusing on HIV-associated neurocognitive disorders (HAND), the effects of antiretroviral therapy (ART), and neuropathological changes. Evidence from Africa emphasizes the variability in the prevalence of neurocognitive impairment among people living with HIV. For instance, a meta-analysis showed that Central and South Africa had the highest pooled prevalence of neurocognitive impairment (NCI) (49.33%), followed by East Africa (45.04%) and West Africa (42.40%). These differences may reflect varying ART coverage, healthcare infrastructure, and the prevalence of co-infections like tuberculosis highlighting the importance of region-specific interventions and support services tailored to local contexts. Furthermore, challenges such as late diagnosis, methodological variations, treatment non-adherence, and limited access to specialized care exacerbate the burden of neurocognitive impairment in this setting. Addressing the complex intersection of HIV and neurocognition in Africa requires a multifaceted approach involving various stakeholders, including healthcare providers, policymakers, researchers, and community organizations. Enhancing awareness, education, and capacity- building initiatives can improve early detection and management of neurocognitive disorders among individuals living with HIV. Moreover, investment in infrastructure and resources for neurocognitive care, including diagnostic tools and rehabilitation services, is essential to meet the growing needs of this population. Additionally, promoting research collaboration and knowledge exchange is important for advancing our understanding of HIV-related neurocognitive impairment and developing evidence-based interventions. By fostering partnerships between academia, healthcare institutions, and governmental agencies, we can facilitate the translation of research findings into policy and practice, ultimately improving outcomes and quality of life for individuals affected by HAND in Africa. [ABSTRACT FROM AUTHOR]

Clinicians face increasing workloads in medical imaging interpretation, and artificial intelligence (AI) offers potential relief. This meta-analysis evaluates the impact of human-AI collaboration on image interpretation workload. Four databases were searched for studies comparing reading time or quantity for image-based disease detection before and after AI integration. The Quality Assessment of Studies of Diagnostic Accuracy was modified to assess risk of bias. Workload reduction and relative diagnostic performance were pooled using random-effects model. Thirty-six studies were included. AI concurrent assistance reduced reading time by 27.20% (95% confidence interval, 18.22%–36.18%). The reading quantity decreased by 44.47% (40.68%–48.26%) and 61.72% (47.92%–75.52%) when AI served as the second reader and pre-screening, respectively. Overall relative sensitivity and specificity are 1.12 (1.09, 1.14) and 1.00 (1.00, 1.01), respectively. Despite these promising results, caution is warranted due to significant heterogeneity and uneven study quality. [ABSTRACT FROM AUTHOR]

This report presents a comprehensive case study for the responsible integration of artificial intelligence (AI) into healthcare settings. Recognizing the rapid advancement of AI technologies and their potential to transform healthcare delivery, we propose a set of guidelines emphasizing fairness, robustness, privacy, safety, transparency, explainability, accountability, and benefit. Through a multidisciplinary collaboration, we developed and operationalized these guidelines within a healthcare system, highlighting a case study on ambient documentation to demonstrate the practical application and challenges of implementing generative AI in clinical environments. Our proposed framework ensures continuous monitoring, evaluation, and adaptation of AI technologies, addressing ethical considerations and enhancing patient care. This work contributes to the discourse on responsible AI use in healthcare, offering a blueprint for institutions to navigate the complexities of AI integration responsibly and effectively, thus promoting better, more equitable healthcare outcomes. [ABSTRACT FROM AUTHOR]

Background: The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience. Objectives: (1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices. Methods: We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors' knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities. Results: The key moments where participants felt they needed the most support were "treatment", "report of findings", "informed consent", "physical examination", and "before the appointment". All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals. Conclusion: Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada. [ABSTRACT FROM AUTHOR]

Most direct residential aged care is provided by personal care assistants (PCAs), with western societies increasingly relying on culturally diverse aged care workers. In Australia and internationally, studies have reported that the level of training in both instrumental and relational care for PCAs is insufficient and inconsistent. This study evaluated the impact of The Little Things training program, designed for culturally diverse PCAs and students training to become PCAs. A modified Most Significant Change process, comprising a group-based qualitative analysis of narratives, was used to gain a rich understanding of the impacts and outcomes of the training. Narratives supplied by 29 PCAs and students were reviewed with aged care and training organization managers, who identified six themes: Increased confidence; Taking time; Building rapport and collaboration; Awareness of new skills; Seeing the whole person; and Positive impact on the resident. These themes reflected two key aims of The Little Things training: improving PCAs' communication with residents and increasing PCAs' confidence in communicating with residents. The study findings showed that The Little Things training program can improve the confidence of PCAs to communicate with aged care residents and may improve their capacity to form relationships. [ABSTRACT FROM AUTHOR]

Background: Researchers and participants who are members of minoritized populations experience negative psychosocial and wellness outcomes like burnout. Burnout may manifest uniquely for Black women in academia conducting research with Black women participants navigating similar sociocultural contexts. Objectives: This article qualitatively interprets our experiences as 15 Black women scholar-practitioners at a midwestern university conducting community-engaged research. We discuss our experiences of care and burnout while working to reduce opioid use disparities among Black women community members as we simultaneously navigate multilevel challenges in academia. Design: We employ collaborative autoethnography, an autobiographical writing method, using a Black feminist framework and intersectionality methodology. Methods: We are 15 Black women researcher-subjects on the REFOCUS study—a mixed-methods National Institute on Health-funded project examining nonmedical prescription opioid misuse among Black Kentuckians. We examined a series of multigenerational sista circles and individual journal entries we completed to understand the multilevel power dynamics impacting our individual and collective work, burnout, and care. Results: Themes were: (1) "I see me in you": Research with Black Women, (2) "Pervasive, cellular, and epigenetic": Burnout Experiences; (3) "Taxing but rewarding": The Price We Pay to See an Outcome, and (4) "Thank God for the collective": Complexities of Caring Through the Process. Conclusion: We highlight the importance of continued efforts to address workload inequities among Black women in academia, particularly for those working to combat health disparities among Black women or within Black communities. We make recommendations for structural, institutional, and interpersonal steps to improve the support of Black women across career stages. Plain language summary: We discuss our experiences as a multigenerational collective of Black women researchers conducting substance use research among Black women reporting opioid misuse. We conducted a Black feminist collaborative autoethnography, which allowed us to become "researcher-subjects." As researcher-subjects, we examined our burnout and care reflections from multigenerational conversations and individual reflections. We make several recommendations across structural, institutional, and interpersonal levels to better support Black women working to reduce health disparities in Black communities. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally, with increasing rates in low- and low-middle-income countries (LMICs), particularly sub-Saharan Africa (SSA). These occur due to exposure to various risk factors, such as tobacco smoking, physical inactivity, hypertension, and diabetes. There are unique features in LMICs that contribute to the risk factor profile and quality of care offered in these countries. These include cultural influences on diet (carbohydrate-dense diet, use of salt-based spices and preservatives), the lack of dedicated spaces for physical activity, and perceptions of desirable body sizes. The attendant complications affect individuals, families and the community at large. Furthermore, there is a dearth of research to inform change at both the individual and policy level in LMICs. Lifestyle modification is the cornerstone of risk factor control and requires engaging relevant stakeholders in healthcare to enforce sustainable behaviour change among individuals. This includes measures from the individual level to national leadership and requires multisectoral collaboration to ensure sustainability. Such methods include building health worker capacity through a task shifting approach, strengthening the health worker-patient relationship, employing digital/technological applications, and engaging families and communities to serve as accountability partners in the management of CVD and related risk factors. There is a need for increased contextually relevant research output to inform contemporary methods to improve CVD and risk factor control in LMICs. [ABSTRACT FROM AUTHOR]

Vaccination is a crucial tool for the primary prevention of infectious diseases. Thanks to the widespread of vaccinations it has been possible to eradicate very serious diseases. Unfortunately, vaccination coverage in Italy has been decreasing starting from 2015, getting worse during COVID-19. Nowadays, very few Italian regions have achieved the goal of 95% coverage. In this study we present a vaccination recovery model proposed by Local Health Department "Napoli 3 Sud" in Campania. An evaluation of the vaccination coverage from January 2019 to December 2021 of the 13 Districts of the Local Health Department "Napoli 3 Sud" in Campania was carried out, by extraction from the regional computerized platform "GE.VA" Regional Vaccine Registry and from Sinfonia Vaccini Soresa platform. Vaccination coverage of the Local Health Department "Napoli 3 Sud" for the cohorts of newborns in the year 2019–2021 improved to an average of 96.29% for Pneumococco, of 84.78% for Meningococcal, of 94.3% for Measles, Mumps and Rubella, 91.4% for chickenpox. This study highlights how the collaboration between family pediatricians and the Local Health Department, with the help of a regional computerized platform GE.VA, is effective in improving vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: In paediatric palliative care, children with life-threatening and life-limiting conditions, their families, and their health care professionals often face difficult decisions about treatment, goals of care, and delivery of care. Advance care planning and shared decision-making are strategies that can improve quality of care by discussing goals and preferences on future care. In this paper, we provide recommendations that aim to optimise advance care planning and shared decision-making in paediatric palliative care in the Netherlands. Methods: A multidisciplinary guideline panel of 20 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on advance care planning and shared decision-making. We performed systematic literature searches to identify quantitative and qualitative evidence and used the GRADE (CERQual) methodology for appraisal of evidence. Recommendations were formulated based on quantitative and qualitative evidence, clinical expertise, and patient and family experiences. Results: We identified 4 RCTs that reported on the effect of advance care planning interventions in paediatric palliative care and 33 qualitative studies on barriers and facilitators to advance care planning and shared decision-making. We formulated 28 strong recommendations in close collaboration with a multidisciplinary guideline panel that provide guidance to offer advance care planning and shared decision-making, involve children and their family, and communicate information about care and treatment. Conclusion: The identified evidence and recommendations support the use of advance care planning and shared decision-making in paediatric palliative care. However, we found several knowledge gaps that should be addressed. As advance care planning and shared decision-making require specific skills and can be time-consuming, we emphasise the importance of education, adequate staffing and sufficient funding to improve integration in clinical practice. We do believe that our recommendations can be used as a starting point to develop recommendations in other countries. However, country-specific factors should be very carefully considered before applying any recommendations in other countries. [ABSTRACT FROM AUTHOR]

Background: Every healthcare professional (HCP) in the Netherlands is expected to provide palliative care based on their initial education. This requires national consensus and clarity on the quality and goals of palliative care education and accessible education opportunities nationwide. These requirements were not met in the Netherlands, posing a major obstacle to improving the organization and delivery of palliative care. Therefore, a program, Optimizing Education and Training in Palliative Care (O2PZ), was established to improve palliative care education on a national level. Objectives: The main task of the O2PZ program from 2018 to 2021 was to implement and improve palliative care education in initial education for nursing and medical professionals. The program's ultimate goal was that every HCP be sufficiently educated to provide high-quality generalist palliative care. Design: The O2PZ program consists of four projects to improve and consolidate generalist palliative care education nationwide. Methods: All projects used a participatory approach, that is, participatory development, implementation, and co-creation with stakeholders, mainly HCPs and education developers. Appreciative inquiry was used to assess, improve, and integrate existing local palliative care education initiatives. Results: (1) Establishment of an Education Framework for palliative care for all HCPs, including an interprofessional collaboration model; (2) optimization of palliative care education in the (initial) curricula of vocational education institutions and (applied) universities; (3) establishment of an online platform to disseminate materials to improve palliative care education; and (4) installment of seven regional palliative care education hubs, of which one hub was devoted to pediatric palliative care, as well as one national hub. Discussion: We discuss some lessons learned and challenges in accomplishing the goals of the O2PZ program in 2018–2021 and address how these challenges were dealt with. We maintain that co-creation with stakeholders at policy, organizational, and operational levels, as well as ongoing communication and collaboration, is essential to consolidating and implementing results. Conclusion: Over the past 4 years, we have improved generalist palliative care education nationwide for all HCPs through four projects in which we collaborated closely with stakeholders. This has resulted in more attention to and implementation of palliative care in education, a national Education Framework for palliative care, including an interprofessional collaboration model, an online platform for palliative care education, and palliative care education hubs covering all regions of the Netherlands. Plain language summary: Optimizing palliative care education in The Netherlands The innovative aspect of this article is that we explored how a national program called "Optimizing Education and Training in Palliative Care" (O2PZ), which was funded by the Dutch government, was installed. The program was led by an interdisciplinary and interprofessional group of educators, HCPs, and researchers from several institutions in the Netherlands. The encompassing aim of the O2PZ program is that every HCP in the Netherlands has the right competencies to provide high-quality palliative care and that there will be more regional and national direction with regard to providing good palliative care education for all healthcare professionals. Our article will address several interconnected projects and results from the O2PZ program in 2018–2021. This includes (1) A comprehensive national Education Framework for Palliative Care (with a model of interprofessional collaboration), (2) Optimizing Palliative Care education, (3) An online education platform, and (4) A network of regional "education hubs" with nationwide coverage. Several lessons can be learned from these efforts to develop, implement, and consolidate palliative care education nationwide. We will also discuss some significant challenges and how they were dealt with effectively. This may be useful to others who seek to improve palliative care education in their country. Finally, we will address current follow-up studies to elaborate on and consolidate the results and impact of the 2018–2021 program. [ABSTRACT FROM AUTHOR]

Background: Osteoporotic pelvic fractures in the elderly lead to pain and immobility resulting in decreased quality of life and worsening frailty. Teriparatide has been shown to shorten time to fracture union, diminish pain, and improve mobilization. At our hospital, this medication is prescribed by an outpatient endocrinologist or geriatrician. We hypothesize that elderly female patients sustaining low energy lateral compression (LC) pelvic fractures are not given Teriparatide. This study reports rates of successful Teriparatide initiation and looks for areas of improvement. Materials and Methods: A retrospective chart review of stable LC pelvic fractures admitted to a single urban academic level 1 trauma center from January 2012 to February 2021 was conducted. Females over 60 years old with stable LC pelvic fractures were included. Males and those aged less than 60 were excluded. Results: 118 females with mean age of 79.1 ± 10.5 were included. Fourteen patients were not eligible for Teriparatide due to medical history, leaving 104 eligible patients. Twenty-eight patients (23.7%) had previous dual energy X-ray absorptiometry (DEXA) scans with mean T-scores of −3.14 ± 1.1 and 61% had Medicare insurance. Orthopaedic services recommended Teriparatide in 100% of cases. Geriatricians or endocrinologists documented evaluations for Teriparatide in 18 (17%), prescribed in 10 (9.6%), and initiated in 7 (6.7%) patients. Insurance type did not significantly differ among those that initiated Teriparatide and those that did not (p- 0.10). Insurance did not approve the medication in 2 instances and in 1 instance it was discontinued at follow-up. Conclusion: Despite level 1 evidence of Teriparatide's benefit for elderly osteoporotic women with low energy LC pelvic fractures, we failed to initiate treatment in 93% of eligible patients. Barriers to initiation included low rates of medical evaluation for its use and failure of insurance coverage. There are opportunities for multidisciplinary collaboration to increase evaluation for and initiation of Teriparatide. Level of Evidence: Cohort Retrospective (level III evidence). [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) has the potential to revolutionize medical training, diagnostics, treatment planning, and healthcare delivery while also bringing challenges such as data privacy, the risk of technological overreliance, and the preservation of critical thinking. This manuscript explores the impact of AI and Machine Learning (ML) on healthcare interactions, focusing on faculty, students, clinicians, and patients. AI and ML's early inclusion in the medical curriculum will support student-centered learning; however, all stakeholders will require specialized training to bridge the gap between medical practice and technological innovation. This underscores the importance of education in the ethical and responsible use of AI and emphasizing collaboration to maximize its benefits. This manuscript calls for a re-evaluation of interpersonal relationships within healthcare to improve the overall quality of care and safeguard the welfare of all stakeholders by leveraging AI's strengths and managing its risks. [ABSTRACT FROM AUTHOR]

Background: This study aims to describe the main type 2 diabetes mellitus (T2DM) quality improvement (QI) challenges identified by primary care teams in the province of Quebec who participated in the COMPAS + QI collaborative. Methods: A qualitative descriptive design was used to analyse the results of 8 COMPAS + workshops conducted in 4 regions of the province between 2016 and 2020. Deductive content analysis was performed to classify the reported QI priorities under the Consolidated Framework for Implementation Research domains; and proposed change strategies under the Behavior Change Wheel (BCW) intervention functions. Results: A total of 177 participants attended the T2DM COMPAS + workshops. Three QI priorities were identified: (1) lack of coordination and integration of T2DM care and services; (2) lack of preventive services for pre-diabetes and T2DM; and (3) lack of integration of the patients-as-partners approach to support T2DM self-management. The proposed QI strategies to address those priorities were classified under the education, training, persuasion, habilitation and restructuring BCW intervention functions. Conclusion: This study provides insights on how QI collaboratives can support the identification of QI priorities and strategies to improve T2DM management in primary care. [ABSTRACT FROM AUTHOR]

Simple Summary: Carcinoid syndrome in patients with neuroendocrine tumors is a challenging condition that requires accurate diagnostic and therapeutic management by a multidisciplinary team. Therefore, this review intends to detail all clinical aspects of carcinoid syndrome in order to provide clinicians with a definite overview of the effective approach to carcinoid syndrome. In this way, the review aims to improve patient care and treatment outcomes in this patient population. Carcinoid syndrome (CS) is a rare condition associated with neuroendocrine tumors (NETs), particularly those originating in the gastrointestinal tract, which secrete bioactive substances like serotonin. The management of CS requires a multidisciplinary approach due to its complex clinical manifestations, including flushing, diarrhea, bronchospasm, and carcinoid heart disease. Optimal care involves collaboration between several professional figures like oncologists, endocrinologists, gastroenterologists, surgeons, and dietitians. Currently, a wide range of treatments are available, focused on both symptom control and tumor burden reduction. Somatostatin analogs (SSAs) are the first-line therapy for symptom relief. Still, in patients with progressive disease or refractory CS, other options include targeted therapies, peptide receptor radionuclide therapy (PRRT), liver-directed therapies, and surgical resection, when feasible. Furthermore, management of complications related to prolonged serotonin release and malnutrition as a result of exocrine pancreatic insufficiency, post-surgical conditions, vitamin deficit, and chronic diarrhea often requires early detection to mitigate symptoms and improve the quality of life in these patients. The complexity of CS necessitates individualized care and continuous coordination among specialists to optimize outcomes and enhance patient well-being. [ABSTRACT FROM AUTHOR]

Simple Summary: Accurate detection of HER2 status in breast cancer is vital for effective diagnosis and treatment. While traditional fluorescence in situ hybridization (FISH) is the standard for assessing HER2, it has limitations, such as the need for expert handling and potential signal fading. Silver-enhanced in situ hybridization (SISH) offers a more stable alternative for analysis using conventional bright-field microscopy. This study explores an innovative deep-learning approach to automatically classify Normal, Amplified, and Non-Amplified regions in HER2-SISH images. Our two-stage process trains and evaluates models on annotated patches and applies the most effective model to entire slide images, generating region-specific visualizations. This method not only reduces manual workload but also shows strong potential for aiding pathologists in identifying HER2-amplified areas, thereby supporting precise breast cancer treatment. Statistical evaluations, including k-fold cross-validation and confidence intervals, further validate the robustness of our approach. Fluorescence in situ hybridization (FISH) is widely regarded as the gold standard for evaluating human epidermal growth factor receptor 2 (HER2) status in breast cancer; however, it poses challenges such as the need for specialized training and issues related to signal degradation from dye quenching. Silver-enhanced in situ hybridization (SISH) serves as an automated alternative, employing permanent staining suitable for bright-field microscopy. Determining HER2 status involves distinguishing between "Amplified" and "Non-Amplified" regions by assessing HER2 and centromere 17 (CEN17) signals in SISH-stained slides. This study is the first to leverage deep learning for classifying Normal, Amplified, and Non-Amplified regions within HER2-SISH whole slide images (WSIs), which are notably more complex to analyze compared to hematoxylin and eosin (H&E)-stained slides. Our proposed approach consists of a two-stage process: first, we evaluate deep-learning models on annotated image regions, and then we apply the most effective model to WSIs for regional identification and localization. Subsequently, pseudo-color maps representing each class are overlaid, and the WSIs are reconstructed with these mapped regions. Using a private dataset of HER2-SISH breast cancer slides digitized at 40× magnification, we achieved a patch-level classification accuracy of 99.9 % and a generalization accuracy of 78.8 % by applying transfer learning with a Vision Transformer (ViT) model. The robustness of the model was further evaluated through k-fold cross-validation, yielding an average performance accuracy of 98 % , with metrics reported alongside 95 % confidence intervals to ensure statistical reliability. This method shows significant promise for clinical applications, particularly in assessing HER2 expression status in HER2-SISH histopathology images. It provides an automated solution that can aid pathologists in efficiently identifying HER2-amplified regions, thus enhancing diagnostic outcomes for breast cancer treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Therapeutic decisions made during the treatment of patients with oral squamous cell carcinomas (OSCCs) significantly impact the overall course of the disease. A critical stage in the treatment process is the accurate histopathological assessment of excised tumors. The precision of the specimen description and the comprehensiveness of the information provided to the pathologist are of paramount importance. To address this, a multidisciplinary team comprising a maxillofacial surgeon, a pathologist, and an engineer was assembled. The team's objective was to devise a user-friendly protocol for virtual communication between the surgeon and the pathologist. Leveraging available software and a 3D scanner, a virtual communication protocol was formulated, enabling the generation of virtual images of excised tumors. Moreover, a methodology for applying annotations and marking specific areas (e.g., margins) directly on the tumor surfaces was developed. Consequently, this approach has afforded the team extensive capabilities for effectively conveying and archiving precise information. Background: The histopathological assessment is critical in the comprehensive treatment process for patients diagnosed with oral squamous cell carcinoma (OSCC). A detailed and precise specimen characterization is essential to facilitate effective surgeon–pathologist communication. Methods: In response to this need, a user-friendly virtual communication protocol utilizing a 3D scanner has been developed. This study involved 50 patients with OSCC, whose resected tumors were directly scanned in the operating room and subsequently annotated and characterized using available software. Results: The direct application of annotations and descriptions onto the virtual tumor specimens significantly enhanced the quantity and accuracy of information conveyed to the pathologist. Conclusions: The proposed solution's repeatability and standardized approach make integration into routine clinical practice feasible, thereby establishing a potential new standard in the field. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs. Methods: This study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs. Results: Primary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs' use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14). Conclusions: Digital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies. [ABSTRACT FROM AUTHOR]

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

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

Polio vaccine hesitancy remains high in Pakistan due to various socio-political, religious, and economic factors. To address this, the government of Pakistan and its international partners such as UNICEF have devised a multipronged communication strategy to counter resistance to polio vaccine in hard-to-reach areas of the country. In this strategy, mainstream news media has been identified as a key stakeholder, as they have the potential to reach a wide range of population and disseminate easy to understand messages including both visuals and text. However, less scholarly attention has been paid to how mainstream news media in Pakistan frame polio and polio vaccine in their visuals. This study aims to fill this gap. Using visual framing as a theoretical framework, we analyzed 115 images from three selected newspapers published from 2010 to 2022. Our results suggest that the newspapers depicted hard-to-reach areas in Khyber Pakhtunkhwa (KP) province which were more affected by polio and highlighted the criminality and securitization of polio vaccine in the country. In addition, female polio healthcare workers, who are instrumental in eradicating the disease, have been given marginal coverage, reflecting the importance of gender sensitivity in the region. Overall, this study contributes to the fields of visual communication, health communication, and international communication, particularly related to the Global South. [ABSTRACT FROM AUTHOR]

The article presents information on a pilot program which aims to assess the feasibility of employing and expanding remote physiologic monitoring (RPM) services at an academic medical center. Topics discussed include the overall flow of the project, patients eligible for enrollment in the program, and pharmacist intervention.

Complex contextual factors hinder the optimal delivery of recommended vaccines to target populations in the World Health Organization (WHO) African Region. As a consequence, vaccination coverage for multiple antigens continues to fall short of the recommended benchmark for herd immunity across countries. This is precipitating frequent outbreaks of vaccine-preventable diseases with concomitant morbidity and mortality. If this problem is allowed to continue unchecked, it will delay progress toward achieving the child survival targets of the sustainable development goals for both individual countries and the entire region. Implementation science offer tools that country immunization programmes can leverage to address challenges with vaccine delivery. It has frameworks that can enable better understanding of the contextual barriers that affect effective vaccine delivery. It provides models that can foster the use of tailored interventions and strategies to address identified barriers of effective vaccine delivery while generating evidence on real-world effectiveness. There are also models for facilitating adaptation and spread of context-relevant best practices for enhancing vaccine delivery across diverse settings (whether in health facilities or communities) to improve vaccine uptake. In this opinion article, we reflexively outlined some key recommendations to spur greater use of implementation science in addressing challenges with vaccine delivery that are faced by immunisation programmes in the WHO African Region and beyond. [ABSTRACT FROM AUTHOR]

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

Introduction: The translational gap from the discovery of evidence-based solutions to their implementation in healthcare delivery organizations derives from an incorrect assumption that the need for change among executive, administrative, or clinical personnel is the same as the demand for change. For sickle cell disease (SCD), implementation of evidence-based guidelines is often delayed or obstructed due to lack of demand. This challenge allows for the persistence of resource limitations and care delivery models that do not meet the community's unique needs. Agile Storytelling is a process built on the scientific foundations of behavioral economics, complexity science, and network science to create local demand for the implementation of evidence-based solutions. Methods: Agile Storytelling includes a design phase and a testing phase. The design phase converts the evidence-based solution into a minimally viable story of a hero, a villain, struggle, drama, and a resolution. The testing phase evaluates the effectiveness of the story via a series of storytelling sprints in the target local healthcare delivery organization. The efficacy of Agile Storytelling was tested in an iterative n -of-1 case study design. Results: Agile Storytelling was used in a large, urban, healthcare system within the United States to facilitate implementation of national SCD best-practice guidelines. After repeated failures attempting to use national and local data regarding the high societal need to hire a SCD-specific social worker, an Agile change conductor using Agile Storytelling was able to create demand for the new position within a week. This decision has ultimately improved patient outcomes and led to the adoption of a specialized collaborative care team for SCD within the health network. Discussion: Agile Storytelling can lead to structured, effective, and informed storytelling to create local demand within healthcare delivery organizations. [ABSTRACT FROM AUTHOR]

Background/Objectives: Spinal cord injury (SCI) is a disabling condition prevalent worldwide, requiring rehabilitation services from injury through community living. This study, conducted by representatives of the World Rehabilitation Alliance (WRA), aims to identify strategies for strengthening SCI rehabilitation services globally, with particular attention to settings where resources are limited. Methods: Three focus groups were held between 2023 and 2024 with WRA representatives specializing in SCI rehabilitation. Discussions focused on four key areas: workforce and education, health policy and systems research, primary care, and emergency response. Perspectives were developed taking into account frameworks from the World Health Organization (WHO). Results: Key insights into SCI rehabilitation services emphasize workforce and education as critical areas, underscoring the importance of specialized training, certification, and ongoing support to build capacity. In health systems and policy research, significant gaps in evidence-based practices were highlighted, emphasizing the need for comprehensive data collection and national registries to guide policy and align SCI care with global standards. The integration into primary care systems is recommended to improve access and address common complications in low- and middle-income countries (LMICs). For emergency response, this study stresses the importance of preparedness and establishing multi-disciplinary teams capable of managing SCI cases in resource-limited settings, reducing preventable complications, and improving patient outcomes. Conclusions: SCI rehabilitation services are essential to global health, with a need for workforce development, research, national registries, and integration into primary and emergency care. Such efforts should improve accessibility and align with global best practices, ensuring comprehensive and accessible rehabilitation for all. [ABSTRACT FROM AUTHOR]

Background: Indonesia's stunting prevention programs have shown limited effectiveness and scalability. Interprofessional collaboration (IPC) is crucial for preventing and treating pediatric stunting. This study aimed to investigate the roles of primary health centers and IPC in addressing stunting in Indonesia. Methods: A systematic review was conducted, searching PubMed, EMBASE, Web of Science, ProQuest, and Google Scholar for studies up to November 2023. Two reviewers independently screened and included full-text articles that examined IPC and stunting, focusing on prevalence, policy implications, healthcare roles, community roles, preventive measures, and challenges. Results: The review included 52 articles. IPC was found to be critical in reducing stunting prevalence. Training improved the knowledge of health cadres, aiding in the early detection and prevention of stunting. The studies emphasized IPC's positive impact on stunting reduction across various regions. Policymakers are encouraged to adopt a comprehensive strategy involving collaboration, financial support, and effective program implementation. Conclusions: This study highlights IPC as essential in reducing stunting in Indonesia. Integrating stunting management into primary healthcare is recommended, with a call for developing guidelines to standardize and optimize the approach to this public health issue. [ABSTRACT FROM AUTHOR]

Background: Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care. Methods: To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research. Results: Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes. Conclusion: Key policy, training and practice implications are discussed. [ABSTRACT FROM AUTHOR]