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Background: Specialist care units cater to targeted cohorts of patients, applying evidence-based practice to people with a specific condition (e.g., dementia) or meeting other specific criteria (e.g., children). This paper aimed to collate perceptions of local consumers and health providers around specialist care units, as a model of care that may be considered for a new local healthcare facility. Methods: This was a qualitative study using two-hour workshops and interviews to collect data. Participants were consumers and health providers in the planned facility's catchment: 49 suburbs in metropolitan Australia. Consumers and health providers were recruited through advertisements and emails. An initial survey collected demographic details. Consumers and health providers participated in separate two-hour workshops in which a scenario around the specialist unit model was presented and discussion on benefits, barriers and enablers of the model was led by researchers. Detailed notes were taken for analysis. Results: Five consumer workshops (n = 22 participants) and five health provider workshops (n = 42) were conducted. Participants were representative of this culturally diverse region. Factors identified by participants as relevant to the specialist unit model of care included: accessibility; a perceived narrow scope of practice; coordination with other services; resources and infrastructure; and awareness and expectations of the units. Some factors identified as risks or barriers when absent were identified as strengths and enablers when present by both groups of participants. Conclusions: Positive views of the model centred on the higher perceived quality of care received in the units. Negative views centred on a perceived narrow scope of care and lack of flexibility. Consumers hinted, and providers stated explicitly, that the model needed to be complemented by an integrated model of care model to enable continuity of care and easy transfer of patients into and out of the specialist unit. [ABSTRACT FROM AUTHOR]

The delivery of acute health care has changed with the adoption of new technologies to meet changing community needs. In response to this, hospital systems and governments have invested in alternative models of care, including hospital in the home (HITH), where acute care that would typically require inpatient treatment is provided in the patient's home. The academic literature presents evidence for comparable or improved patient outcomes associated with HITH interventions. However, it is currently unknown how consumers and providers view the model in the context of a new healthcare facility. This study aimed to elicit consumer and provider views about HITH and how the implementation of a HITH model of care in a new hospital could meet their healthcare needs. We adopted a qualitative approach for this research. Semistructured workshops and interviews were conducted via Zoom, where we presented patient vignettes of different models of care to consumers and providers and recorded their responses using scribes. Qualitative data were independently coded by pairs of researchers to identify themes and subthemes, and demographic data were aggregated. A total of 51 consumers and 35 providers attended the workshops. Consumers and providers frequently described similar themes, particularly accessibility, patient factors, and the health system consequences of HITH. However, the importance and focus of these topics varied across participants. Participants endorsed HITH as a flexible, patient-centred model with potential for wellbeing benefits. However, they noted the potential need for additional resources and increased anxiety among patients with lower health literacy. To address this, participants described the need for clear escalation protocols, communication channels, and expectations around HITH care. In conclusion, HITH is an established model that brings acute care into the homes of patients. The findings of this study support the provision of flexible acute care delivery to meet consumer needs and address the challenges encountered during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Innovative models of health care that involve advanced technology in the form of a digital hospital are emerging globally. Models include technology such as machine learning and smart wearables, that can be used to integrate patient data and improve continuity of care. This model may have benefits in situations where patient deterioration must be detected quickly so that a rapid response can occur such as cardiopulmonary settings. The purpose of this scoping review was to examine the evidence for a digital hospital model of care, in the context of cardiac and pulmonary settings. Scoping review. Databases searched were using PsycInfo, Ovid MEDLINE, and CINAHL. Studies written in English and containing key terms related to digital hospital and cardiopulmonary care were included. The Joanna Briggs Institute methodology for systematic reviews was used to assess the risk of bias. Thirteen (13) studies fulfilled the inclusion criteria. For cardiac conditions, a deep-learning-based rapid response system warning system for predicting patient deterioration leading to cardiac arrest had up to 257% higher sensitivity than conventional methods. There was also a reduction in the number of patients who needed to be examined by a physician. Using continuous telemonitoring with a wireless real-time electrocardiogram compared with non-monitoring, there was improved initial resuscitation and 24-hour post-event survival for high-risk patients. However, there were no benefits for survival to discharge. For pulmonary conditions, a natural language processing algorithm reduced the time to asthma diagnosis, demonstrating high predictive values. Virtual inhaler education was found to be as effective as in-person education, and prescription error was reduced following the implementation of computer-based physician order entry electronic medical records and a clinical decision support tool. While we currently have only a brief glimpse at the impact of technology care delivery for cardiac and respiratory conditions, technology presents an opportunity to improve quality and safety in care, but only with the support of adequate infrastructure and processes. Open Science Framework (OSF: DOI 10.17605/OSF.IO/PS6ZU). [ABSTRACT FROM AUTHOR]

Background: Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited. Our aim was to synthesise the evidence for transition models and their components, examine the health related and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care. Method: We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included. Results: Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6 studies), multidisciplinary team transition support (5 studies) and telehealth/virtual care (3 studies). Compared with usual practice, three of the six structured transition education programs led to improvements in maintenance of glycaemic control, psychological well-being, and engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but did not change health outcomes. Conclusions: Although some health and psychosocial benefits are reported, the results were mixed. No studies reported on T1D transition model implementation outcomes such as acceptability, adoption, and appropriateness among clinicians or managers implementing these models. This gap needs to be addressed to support future adoption of successful models. [ABSTRACT FROM AUTHOR]

Background: Integrated care is a model recognised internationally, however, there is limited evidence about its usability in the community. This study aimed to elicit community and provider views about integrated care and how implementation could meet their healthcare needs in a new hospital. Methods: Using a qualitative approach, consumer and provider views on the strengths, barriers and enablers for integrated care were collected via a series of online workshops and supplementary interviews. Results: A total of 22 consumers and 49 providers participated in 11 focus groups; all perceived integrated care to be an accessible and efficient model that offers a high level of care which enhanced staff and patient well-being. Providers expressed concerns about longer waiting times and safety risks associated with communication gaps and insufficient staff. Enablers include supporting consumers in navigating the integrated care process, co-ordinating and integrating primary care into the model as well as centralising patient electronic medical records. Discussion: Primary, tertiary and community linkages are key for integrated care. Successful interoperability of services and networks requires an investment in resources and infrastructure to build the capability for providers to seamlessly access information at all points along the patient pathway. Conclusion: Integrated care is perceived by consumers and providers to be a flexible and patient-focused model of healthcare that offers benefits for a hospital of the future. [ABSTRACT FROM AUTHOR]

Objective: This research was designed to test whether behavioral indicators of pathology-related cue utilization were associated with performance on a diagnostic task. Background: Across many domains, including pathology, successful diagnosis depends on pattern recognition that is supported by associations in memory in the form of cues. Previous studies have focused on the specific information or knowledge on which medical image expertise relies. The target in this study is the more general ability to identify and interpret relevant information. Method: Data were collected from 54 histopathologists in both conference and online settings. The participants completed a pathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of context-related cue utilization. They also completed a separate diagnostic task designed to examine related diagnostic skills. Results: Behavioral indicators of higher or lower cue utilization were based on the participants' performance across five tasks. Accounting for the number of cases reported per year, higher cue utilization was associated with greater accuracy on the diagnostic task. A post hoc analysis suggested that higher cue utilization may be associated with a greater capacity to recognize low prevalence cases. Conclusion: This study provides support for the role of cue utilization in the development and maintenance of skilled diagnosis amongst pathologists. Application: Pathologist training needs to be structured to ensure that learners have the opportunity to form cue-based strategies and associations in memory, especially for less commonly seen diseases. [ABSTRACT FROM AUTHOR]

Summary: Driving is a high‐risk and cognitively demanding activity that requires the efficient use of cognitive resources to inhibit responses when necessary to avoid accidents. Cue utilization, via an inherent capacity for pattern recognition, is one strategy that may be applied while driving to reduce cognitive load allowing for the allocation of resources to other demanding tasks. The present study was designed to measure the contribution of cue utilization in a driving context on performance in a response inhibition task. Undergraduate students (N = 105) completed the driving edition of EXPERTise 2.0 as an online assessment of cue utilization and a measure of response inhibition, the Stop‐Signal Task. The results indicated that participants with relatively higher cue utilization were more accurate at inhibiting responses, but there was no difference in their response times. These findings provide support for cue utilization as one strategy that may improve response inhibition through the acquisition and recognition of patterns, thereby decreasing cognitive load. The practical implications for drivers will be discussed. [ABSTRACT FROM AUTHOR]

Summary: Echocardiographers can detect abnormalities accurately and rapidly from dynamic images. This is likely due to the application of cue‐based associations resident in memory, a process known as cue utilization. This study investigated whether cue utilization is associated with the ability to apply within‐domain capabilities (dynamic) to more degraded images (static). Fifty‐eight echocardiographers completed the echocardiography edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of within‐domain cue utilization. They also completed an abnormality detection and categorization task that comprised briefly presented static and moving images (50% abnormal). Behaviors consistent with higher cue utilization were associated with greater accuracy in detecting both static and dynamic images but not for categorization. This study provides important information about how experts who have the capacity to utilize cue‐based strategies can rapidly and accurately detect abnormalities from domain‐specific stimuli and generalize their skills to more challenging stimuli. [ABSTRACT FROM AUTHOR]

Objective: This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology.Background: Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance.Method: Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance.Results: Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization (p = .01).Conclusion: This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task.Application: Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature-event relationships and internalize these associations in the form of cues in memory. [ABSTRACT FROM AUTHOR]

Retrospectively obvious events are frequently missed when attention is engaged in another task—a phenomenon known as inattentional blindness. Although the task characteristics that predict inattentional blindness rates are relatively well understood, the observer characteristics that predict inattentional blindness rates are largely unknown. Previously, expert radiologists showed a surprising rate of inattentional blindness to a gorilla photoshopped into a CT scan during lung-cancer screening. However, inattentional blindness rates were higher for a group of naïve observers performing the same task, suggesting that perceptual expertise may provide protection against inattentional blindness. Here, we tested whether expertise in radiology predicts inattentional blindness rates for unexpected abnormalities that were clinically relevant. Fifty radiologists evaluated CT scans for lung cancer. The final case contained a large (9.1 cm) breast mass and lymphadenopathy. When their attention was focused on searching for lung nodules, 66% of radiologists did not detect breast cancer and 30% did not detect lymphadenopathy. In contrast, only 3% and 10% of radiologists (N = 30), respectively, missed these abnormalities in a follow-up study when searching for a broader range of abnormalities. Neither experience, primary task performance, nor search behavior predicted which radiologists missed the unexpected abnormalities. These findings suggest perceptual expertise does not protect against inattentional blindness, even for unexpected stimuli that are within the domain of expertise. [ABSTRACT FROM AUTHOR]

Summary: Echocardiographers are highly specialised, skilled practitioners who play a critical role in medical imaging diagnostics. Yet, little is known about the cognitive and perceptual attributes of experts within this domain. This study was designed to examine the role of individual differences in expertise. Specifically, the contribution of a domain general visual expertise and pattern recognition, or cue utilization. Data were collected from 42 echocardiographers and 43 naïve participants. All of the participants competed the Novel Object Memory Test (NOMT). When compared, the echocardiographers were more accurate than the naïve participants. The echocardiographers also completed an echocardiography edition of the Expert Intensive Skills Evaluation 2.0, to establish behavioral indicators of context‐related cue utilization. Those with relatively higher cue utilization performed more accurately on the NOMT, controlling for exposure. These results suggest that a general perceptual ability contributes to echocardiography potential and a sensitivity to cue‐based learning may contribute to expertise. [ABSTRACT FROM AUTHOR]

The human visual system is capable of processing an enormous amount of information in a short time. Although rapid target detection has been explored extensively, less is known about target localization. Here we used natural scenes and explored the relationship between being able to detect a target (present vs. absent) and being able to localize it. Across four presentation durations (~ 33–199 ms), participants viewed scenes taken from two superordinate categories (natural and manmade), each containing exemplars from four basic scene categories. In a two-interval forced choice task, observers were asked to detect a Gabor target inserted in one of the two scenes. This was followed by one of two different localization tasks. Participants were asked either to discriminate whether the target was on the left or the right side of the display or to click on the exact location where they had seen the target. Targets could be detected and localized at our shortest exposure duration (~ 33 ms), with a predictable improvement in performance with increasing exposure duration. We saw some evidence at this shortest duration of detection without localization, but further analyses demonstrated that these trials typically reflected coarse or imprecise localization information, rather than its complete absence. Experiment 2 replicated our main findings while exploring the effect of the level of "openness" in the scene. Our results are consistent with the notion that when we are able to extract what objects are present in a scene, we also have information about where each object is, which provides crucial guidance for our goal-directed actions. [ABSTRACT FROM AUTHOR]

Radiologists make critical decisions based on searching and interpreting medical images. The probability of a lung nodule differs across anatomical regions within the chest, raising the possibility that radiologists might have a prior expectation that creates an attentional bias. The development of expertise is also thought to cause "tuning" to relevant features, allowing radiologists to become faster and more accurate at detecting potential masses within their domain of expertise. Here, we tested both radiologists and control participants with a novel attentional-cueing paradigm to investigate whether the deployment of attention was affected (1) by a context that might invoke prior knowledge for experts, (2) by a nodule localized either on the same or on opposite sides as a subsequent target, and (3) by inversion of the nodule-present chest radiographs, to assess the orientation specificity of any effects. The participants also performed a nodule detection task to verify that our presentation duration was sufficient to extract diagnostic information. We saw no evidence of priors triggered by a normal chest radiograph cue affecting attention. When the cue was an upright abnormal chest radiograph, radiologists were faster when the lateralised nodule and the subsequent target appeared at the same rather than at opposite locations, suggesting attention was captured by the nodule. The opposite pattern was present for inverted images. We saw no evidence of cueing for control participants in any condition, which suggests that radiologists are indeed more sensitive to visual features that are not perceived as salient by naïve observers. [ABSTRACT FROM AUTHOR]

Background Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery. Objective Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture. Methods Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis. Results Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01–0.39, I 2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I 2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24–1.05, I 2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements. Conclusions Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture. [ABSTRACT FROM AUTHOR]

Background: A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. Methods: We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. Results: Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. Conclusions: Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake. [ABSTRACT FROM AUTHOR]

Introduction: Eye-tracking research has been widely used in radiology applications. Prior studies exclusively analysed either temporal or spatial eye-tracking features, both of which alone do not completely characterise the spatiotemporal dynamics of radiologists' gaze features. Purpose: Our research aims to quantify human visual search dynamics in both domains during brain stimuli screening to explore the relationship between reader characteristics and stimuli complexity. The methodology can be used to discover strategies to aid trainee radiologists in identifying pathology, and to select regions of interest for machine vision applications. Method: The study was performed using eye-tracking data 5 seconds in duration from 57 readers (15 Brain-experts, 11 Other-experts, 5 Registrars and 26 Naïves) for 40 neuroradiological images as stimuli (i.e., 20 normal and 20 pathological brain MRIs). The visual scanning patterns were analysed by calculating the fractal dimension (FD) and Hurst exponent (HE) using re-scaled range (R/S) and detrended fluctuation analysis (DFA) methods. The FD was used to measure the spatial geometrical complexity of the gaze patterns, and the HE analysis was used to measure participants' focusing skill. The focusing skill is referred to persistence/anti-persistence of the participants' gaze on the stimulus over time. Pathological and normal stimuli were analysed separately both at the "First Second" and full "Five Seconds" viewing duration. Results: All experts were more focused and a had higher visual search complexity compared to Registrars and Naïves. This was seen in both the pathological and normal stimuli in the first and five second analyses. The Brain-experts subgroup was shown to achieve better focusing skill than Other-experts due to their domain specific expertise. Indeed, the FDs found when viewing pathological stimuli were higher than those in normal ones. Viewing normal stimuli resulted in an increase of FD found in five second data, unlike pathological stimuli, which did not change. In contrast to the FDs, the scanpath HEs of pathological and normal stimuli were similar. However, participants' gaze was more focused for "Five Seconds" than "First Second" data. Conclusions: The HE analysis of the scanpaths belonging to all experts showed that they have greater focus than Registrars and Naïves. This may be related to their higher visual search complexity than non-experts due to their training and expertise. [ABSTRACT FROM AUTHOR]

Background: The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. Methods: A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. Results: Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. Conclusion: It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication. [ABSTRACT FROM AUTHOR]

Background: The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. Methods: A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. Results: Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. Conclusion: It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. Data sources and study setting: Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability. Study design: A systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker's Quality Assessment Tool. Data collection/extraction methods: A team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies. Results: Of the 124 studies included in this review, almost half utilised qualitative designs (n = 52; 41.9%) and roughly one third were conducted in the USA (n = 43; 34.7%). Few studies (n = 29; 23.4%) reported on program sustainability beyond 5 years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting (n = 99; 79.8%), process (n = 99; 79.8%) and intervention characteristics (n = 72; 58.1%) were most frequently reported. Leadership/support (n = 61; 49.2%), training/support/supervision (n = 54; 43.5%) and staffing/turnover (n = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding (n = 26; 56.5%), external leadership by stakeholders (n = 16; 34.8%), and socio-political context (n = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation. Conclusions: This review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area. Trial registration: https://bmjopen.bmj.com/content/7/11/e018568. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research; synthesise findings on capacities that develop RHC across system levels (micro, meso, macro); and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients). Methods: Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts; healthcare and healthcare settings; and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis. Results: Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care. Conclusions: This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events. [ABSTRACT FROM AUTHOR]

Background: Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activation among people drawn from general populations. We used the Patient Activation Measure (PAM) to address this knowledge gap. Methods: A representative, population‐based survey of Australian adults was conducted in October 2021 during the Delta strain outbreak of the COVID‐19 pandemic. Comprehensive demographic information was collected, and the participants completed the Kessler‐6 psychological distress scale (K6) and PAM. Multinomial and binomial logistic regression analyses were performed to determine the effect of demographic factors on PAM scores, which are categorised into four levels: 1—participants disengaged with their health; 2—becoming aware of how to manage their health; 3—acting on their health; and 4—engaging with preventative healthcare and advocating for themselves. Results: Of 5100 participants, 7.8% scored at PAM level 1; 13.7% level 2, 45.3% level 3, and 33.2% level 4. The mean score was 66.1, corresponding to PAM level 3. More than half of the participants (59.2%) reported having one or more chronic conditions. Respondents aged 18 to 24 years old were twice as likely to score PAM level 1 compared with people aged 25–44 (p <.001) or people aged over 65 years (p <.05). Speaking a language other than English at home was significantly associated with having low PAM (p <.05). Greater psychological distress scores (K6) were significantly predictive of low PAM scores (p <.001). Conclusion: Overall, Australian adults showed high levels of patient activation in 2021. People with lower incomes, of younger age, and those experiencing psychological distress were more likely to have low activation. Understanding the level of activation enables targeting sociodemographic groups for extra support to increase the capacity to engage in prevention activities. Conducted during the COVID‐19 pandemic, our study provides a baseline for comparison as we move out of the pandemic and associated restrictions and lockdowns. Patient or Public Contribution: The study and survey questions were co‐designed with consumer researchers from the Consumers Health Forum of Australia (CHF) as equal partners. Researchers from CHF were involved in the analysis of data and production of all publications using data from the consumer sentiment survey. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. Methods: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems. Results: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. Conclusion: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Strategies to improve care for older adults who present to the emergency department: a systematic review." The correction addresses an error in the author's name, which was incorrectly written as Felicity Bleckley instead of Felicity Bleckly. The correction has been made to the original article, and the author group has been updated accordingly. The publisher, Springer Nature, maintains a neutral stance on jurisdictional claims and institutional affiliations. The article was authored by Luke Testa, Lieke Richardson, Colleen Cheek, Theresa Hensel, Elizabeth Austin, Mariam Safi, Natália Ransolin, Ann Carrigan, Janet Long, Karen Hutchinson, Magali Goirand, Mia Bierbaum, Felicity Bleckly, Peter Hibbert, Kate Churruca, and Robyn Clay-Williams. [Extracted from the article]

This document is a correction notice for an article titled "Strategies to improve care for older adults who present to the emergency department: a systematic review." The correction addresses an error in the author's name, which was incorrectly written as Felicity Bleckley instead of Felicity Bleckly. The correction has been made to the original article. The publisher, Springer Nature, remains neutral in terms of jurisdictional claims and institutional affiliations. The article was authored by Luke Testa, Lieke Richardson, Colleen Cheek, Theresa Hensel, Elizabeth Austin, Mariam Safi, Natália Ransolin, Ann Carrigan, Janet Long, Karen Hutchinson, Magali Goirand, Mia Bierbaum, Felicity Bleckly, Peter Hibbert, Kate Churruca, and Robyn Clay-Williams. [Extracted from the article]

• The mere presence of a mobile phone while driving is distracting. • Phone presence is distracting regardless of its proximity to the driver or whether it is on or off. • Highly phone dependent individuals are more susceptible to distraction by phone presence. The ubiquity of mobile phones has led to a rapid increase in its presence and use in vehicles, especially among young adults (up to 25 years), who are generally the least experienced group of drivers. The potential for phones to draw attention away from the main driving task has significant consequences for road safety. Previous studies have found that the mere presence of a mobile phone can be distracting by impairing attention in experimental non-driving contexts. However, the effect of phone presence, independent to usage, has not yet been examined in the context of driving. As such, the present study examined whether the mere presence of a mobile phone, its proximity to the driver, and power status (on/off) influenced the driving performance of young drivers. Additionally, this study assessed whether the effects of phone presence and proximity were moderated by an individual's level of dependence on, or emotional attachment to, their phone. A sample of 127 undergraduate psychology students (M = 19.76, SD = 1.63) were randomly assigned to one of four conditions: (1) phone absent (control), (2) phone on, in holder, (3) phone off, in holder, and (4) phone on, in pocket. They all completed the same simulated drive, and were measured for degree of phone dependence and phone emotional attachment. Overall, drivers in all the phone present conditions made significantly more driving errors (speeding and collision) compared to those in the phone absent (control) condition, irrespective of proximity to the phone and whether it was on or off. Phone dependence, but not phone emotional attachment, moderated the effect of phone presence on speeding behaviour. These findings suggest that the mere presence of a phone is distracting for drivers, especially so for those who are highly dependent on their phone, which may place them at a greater risk of a distraction induced crash. [ABSTRACT FROM AUTHOR]