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Background: Indigenous people are often neglected in eye health research and service delivery programs, despite having a greater burden of vision loss, most of which is avoidable. The objective of this work was to improve access to specialist eye care for Indigenous Australians living in rural and remote areas, by providing direct access to expert diagnostic services based in metropolitan areas through a tele-ophthalmology system. Methods: Over a four-year study period, 13 remote communities in Queensland and the Northern Territory were identified that had limited or no access to eye screening services. Relationships with health service providers in the communities were established to codesign a sustainable model of service delivery and referral pathways to ensure that patients identified with eye issues received appropriate treatment. Results: Over the course of the study, screening records from 378 patients were uploaded to a web-based telehealth system and diagnosed by ophthalmologists. From these examinations, 64 new cases of diabetic retinopathy (DR) were identified (including 2 cases of proliferative DR and 4 cases of severe nonproliferative DR), and diabetic macular edema was noted in 18 patients. The majority of participants screened had no eye problems, which enables the removal of these patients from the queues of overwhelmed specialist lists, improving service efficiency. The study also demonstrates capacity building of healthcare workers to perform eye screening and improved patient health awareness where the retinal cameras were used as an educational tool. Conclusions: A valuable screening service has been established in the target areas, where access to ophthalmic services has been improved for residents of the study screening locations. Routine eye examination (instead of opportunistic eye examination) is feasible for early detection of some eye diseases for remote and rural patients. [ABSTRACT FROM AUTHOR]

Background: Indigenous knowledge healers (IKHs) provide alternative healthcare to formal health services in rural South Africa, but there is a gap in knowledge regarding their treatment of surgical conditions. This study evaluated IKH surgical care and described their perspective of the dual health system. Methods: A cross sectional survey of IKHs in the Madwaleni Hospital catchment of the Eastern Cape, South Africa was conducted. Topics included the training and experience of IKHs, treatment of nine common surgical conditions, referral patterns, disease origin beliefs, benefits and limitations of care, and collaborative opportunities between the two health systems. Results: Thirty‐five IKHs completed the survey. IKHs were consulted by persons with all nine surgical conditions. The most common forms of treatment were application of an ointment on the affected site (88%) and oral medication (82%). Operative treatment was only done for abscess. Referrals to the formal healthcare sector were made for all surgical conditions. IKHs reported that they were limited by their lack of training and resources to perform operations. On the other hand, they perceived the treatment of the spiritual aspect of surgical disease as a benefit of their care. Thirty‐five (100%) IKHs were interested in closer collaboration with the formal health sector. Conclusion: IKHs treat surgical conditions but refer to the formal health sector when diagnostic and operative services are needed. More research is needed to determine the potential advantages and disadvantages between the formal health sector and IKH collaboration. [ABSTRACT FROM AUTHOR]

In the field of healthcare, quality and efficiency are of paramount importance to ensure the provision of safe and reliable diagnostic services. Blood screening laboratories play a critical role in detecting and preventing the spread of infectious diseases, ensuring the safety of blood transfusions, and supporting medical diagnoses. To enhance the quality of processes in such laboratories, the Six Sigma methodology has gained significant recognition for its ability to systematically identify and minimize variations, thereby improving overall efficiency and reducing errors. This retrospective study aims to explore the application of Six Sigma metrics in the context of blood screening laboratories, providing an in-depth analysis of its implementation, benefits, and challenges. The performance of three serology assays, i.e., anti-HCV, HIV Ag/Ab combo, and HBsAg, using internal quality control (IQC) daily data extracted from six Alinity i instruments (Abbott GmbH, Germany), from February to April 2023, was evaluated. Mean, standard deviation (SD), and coefficient of variation (CV%) was calculated for positive controls. Bias was calculated using peer group data. Sigma metrics were calculated using allowable total error (TEa %) based on difference between the observed mean of the positive control and the s/co cut-off of assay. The observed CV% for positive controls was ≤10%. The TEa% ranged from 66% to 79% for the analytes using the observed mean. All the assays showed Six Sigma performance (σ>6) with and without bias. The study observed that the serology assays showed very high sigma values (σ>6) and thus, simplified statistical quality control (SQC) design based on Westgard Sigma rules could be implemented without compromising blood safety. [ABSTRACT FROM AUTHOR]

Introduction: The Medication Review in the Pharmacotherapeutic Follow-up Service (PFS) seems to be an effective method to study long-term drug safety in the outpatient setting. The adverse drug reactions (ADRs) that are not immediately obvious are difficult to identify and sometimes can be confused with a more common condition. Misdiagnosis by not associating the symptoms of AMR to its pharmacological cause causes its masking and hinders its detection. Objective: Detect in the SFT service the diagnostic errors related to the non-detection of adverse reactions to statins. Material and Method: The data obtained from the medication review at the Pharmacotherapeutic Follow-up Service (PFS) were pooled for analysis. The patients who received the service were selected with the "DLGM screening" tool, an acronym "Diagnosis load Generated by Medications", that allows us to describe adverse drug reactions (ADRs), when their symptoms are attributed to a pathology, without considering medication as a possible underlying cause. Only the results of patients over 60 years of age, who after a prolonged period of statin use gradually presented musculoskeletal disorders (MSD) and other symptoms theoretically described as possible ADRs, are shown. Results: In 66 % of the cases, corresponding to 14 patients out of a total of 21 studied, the physician modified the treatment and in 92% of these cases there was improvement and a decrease of the consumption of analgesics drug, anti-inflammatory and other drugs used to treat ADR symptoms. Conclusion: DLGM screening identified hidden AMRs in 62 % of patients. [ABSTRACT FROM AUTHOR]

During infectious disease epidemics, accurate diagnostic testing is key to rapidly identify and treat cases, and mitigate transmission. When a novel pathogen is involved, building testing capacity and scaling testing services at the local level can present major challenges to healthcare systems, public health agencies, and laboratories. This mixed methods study examined lessons learned from the scale-up of SARS-CoV-2 testing services in New York City (NYC), as a core part of NYC's Test & Trace program. Using quantitative and geospatial analyses, the authors assessed program success at maximizing reach, equity, and timeliness of SARS-CoV-2 diagnostic testing services across NYC neighborhoods. Qualitative analysis of key informant interviews elucidated key decisions, facilitators, and barriers involved in the scale-up of SARS-CoV-2 testing services. A major early facilitator was the ability to establish working relationships with private sector vendors and contractors to rapidly procure and manufacture necessary supplies locally. NYC residents were, on average, less than 25 min away from free SARS-CoV-2 diagnostic testing services by public transport, and services were successfully directed to most neighborhoods with the highest transmission rates, with only one notable exception. A key feature was to direct mobile testing vans and rapid antigen testing services to areas based on real-time neighborhood transmission data. Municipal leaders should prioritize fortifying supply chains, establish cross-sectoral partnerships to support and extend testing services, plan for continuous testing and validation of assays, ensure open communication feedback loops with CBO partners, and maintain infrastructure to support mobile services during infectious disease emergencies. [ABSTRACT FROM AUTHOR]

Background: To explore the design, delivery models and identify good and innovative practices in Memory Assessment Services (MAS) in England and Wales. Methods: A two-stage service evaluation comprising (1) on-line survey of MAS providers to identify features of the commissioning models, service design, delivery, and challenges alongside examples of good/innovative practice; (2) qualitative case studies using video/telephone interviews with key staff and people who had used the service. Results: The 49 respondents to the survey reported a shift in delivery of MAS post COVID and identified key areas for improvement, including a need for specialist staff, support for MCI and rarer dementias, and capacity for post diagnostic support. The 15 case studies illustrated good practice and innovation focusing on post diagnostic support, equity of access, working with external services/service location, MCI and rarer dementia and involving specialist staff. Conclusions: The evaluation speaks to the importance of (re)evaluation of services to identify local need and the importance of commissioning based on local need and innovative approaches that my sit outside of 'typical' MAS pathways. [ABSTRACT FROM AUTHOR]

Background: Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia. Methods: Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action. Results: The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members. Conclusion: This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens). [ABSTRACT FROM AUTHOR]

Background: Despite Africa's significant infectious disease burden, it is underrepresented in global vaccine clinical trials. While this trend is slowly reversing, it is important to recognize and mitigate the challenges that arise when conducting vaccine clinical trials in this environment. These challenges stem from a variety of factors peculiar to the population and may negatively impact adverse event collection and reporting if not properly addressed. Methods: As a team of clinical researchers working within the MRCG (Medical Research Council Unit The Gambia), we have conducted 12 phase 1 to 3 vaccine trials over the past 10 years. In this article, we discuss the challenges we face and the strategies we have developed to improve the collection and reporting of adverse events in low-income settings. Outcome. Healthcare-seeking behaviors in the Gambia are influenced by spiritual and cultural beliefs as well as barriers to accessing orthodox healthcare; participants in trials may resort to non-orthodox care, reducing the accuracy of reported adverse events. To address this, trial eligibility criteria prohibit self-treatment and herbal product use during trials. Instead, round-the-clock care is provided to trial participants, facilitating safety follow-up. Constraints in the healthcare system in the Gambia such as limitations in diagnostic tools limit the specificity of diagnosis when reporting adverse events. To overcome these challenges, the Medical Research Council Unit maintains a Clinical Services Department, offering medical care and diagnostic services to study participants. Sociocultural factors, including low literacy rates and social influences, impact adverse event collection. Solicited adverse events are collected during home visits on paper-based or electronic report forms. Community engagement meetings are held before each study starts to inform community stakeholders about the study and answer any questions they may have. These meetings ensure that influential members of the community understand the purpose of the study and the risks and benefits of participating in the trial. This understanding makes them more likely to support participation within their communities. Conclusion: Conducting ethical vaccine clinical trials in resource-limited settings requires strategies to accurately collect and report adverse events. Our experiences from the Gambia offer insights into adverse event collection in these settings. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is a global pandemic that has highly impacted the healthcare system and patients, especially patients with epilepsy, due to the fact that the success of their treatment depends on obtaining sustainable access to medical professions, diagnostic services, facilities, and medications. The epidemiology and presence of neuro-pediatric emergencies in the setting of COVID-19 in XXX have not been thoroughly described. This is a barrier to planning and providing quality emergency care within the local health systems. The objective of this study is to provide a comprehensive description of the epidemiology of neurological cases encountered in the pediatric emergency unit. Methods: This is a retrospective study to analyze the flow pattern of Emergency Department (ED) visits among pediatric patients with neuro-related complaints. Participants were filtered, and a total of 108,000 visits were reduced to 960 patients with a neurological provisional diagnosis. Patients were grouped into pre- and post-pandemic visits according to their age group. We identified demographic and clinical variables. Results: The study included 960 patients with a provisional neurological diagnosis, consisting of 542 (56.5%) males and 418 (43.5%) females. The mean age of admission was 5.29 ± 4.19 years. The majority of patients were triaged as "priority 1—resuscitation" (n = 332, 34.6%), and seizures were the most frequent chief complaint (n = 317, 33.0%). Statistical significance was observed for patients with vascular issues (p = 0.013) during the pre-COVID-19 period after adjusting for odds ratio. The most common outcome was discharge (n = 558, 58.1%). The mean length of stay during the pre-COVID-19 pandemic was 16.48 ± 33.53 h, which was significantly longer compared to a mean length of stay of 7.76 ± 7.27 h during the COVID-19 pandemic (P < 0.001). Conclusion: We presented a new epidemiology of pediatric patients with neuro-related ED visits. An increase in seizure diagnosis was observed, as were significant shifts in the length of stay. Demographic changes were less evident in the two periods. Understanding such variation aids in managing this vulnerable population during critical periods. [ABSTRACT FROM AUTHOR]

The use of technological means in the process of neuropsychological assessment has been proposed as a technique with promising results in the field of detection of neurocognitive disorders for community-dwelling older adults. Especially during the pandemic period due to COVID-19, telemedicine assumed to be vital in the field of early diagnosis of cognitive disorders and highlighted the clinical utility of remote methods of neuropsychological assessmentby video-conference. This descriptive study presents the development of a remote neuropsychological assessment protocol by selecting appropriate validated tests as part of a more comprehensive evaluation for older adults dwelling in the community. We recruited participants from the Athens Alzheimer's Association center in collaboration with the Hellenic Neuropsychological Society, in Athens, Greece, regarding the period between April 2020 and October 2021. 90 individuals, tested for the first time, were categorized into three groups according to their diagnosis which included: (a) Mild Cognitive Impairment (MCI), (b) Alzheimer's disease, (c) cognitively healthy older adults. The presented protocol outlines the main considerations of a framework about remote neuropsychological assessment, which can maximize the effectiveness of interventions and continuity regarding the care of older adults. The recommendations outlined in the presented protocol highlight strengths and limitations that should be taken into account in remote control procedures. Although the protocol was created in response to pandemic restrictions, tele-neuropsychology shows promise as a way to improve access opportunity to neurodiagnostic services for rural aging and underserved populations, which lack specialized healthcare services. Further application to different populations will add validity to the presented descriptive protocol. [ABSTRACT FROM AUTHOR]

This paper focuses on the estimation of efficiency within the medical laboratories industry, a sector of vital importance in healthcare due to its provision of essential diagnostic services. To this end, we employ three distinct stochastic frontier models to evaluate the technical efficiency of the medical laboratory industry. Our benchmark model stands out by considering the presence of heterogeneity, leading to robust findings compared to alternative models. The mean efficiency estimate is determined to be 70.6%, while the median efficiency estimate stands at 70.0%. Remarkably, our results highlight that the production technology employed in US medical laboratories demonstrates constant returns to scale. Moreover, our study delves into the intricate relationship between firm efficiency and market valuation. Our findings reveal a positive and statistically significant correlation between efficiency and market valuation. More specifically, a 1% increase in efficiency corresponds to a 1.08% increase in market valuation. [ABSTRACT FROM AUTHOR]

Objective: To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden. Methods: Data were retrieved from the National Quality Register for Breast Cancer for 2008–2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis. Results: In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40–74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40–49 deviated most from the other age groups. Conclusions: Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40–49 age group compared to the other age groups, except for ER and PgR. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultConclusionSpeech-language pathologists (SLPs) are often the first point of contact for families of children with autism. Despite this, little is known about SLPs’ understanding of autism and its early indicators. This study sought to investigate what Australian SLPs know about autism, the early indicators, and the actions they take when they identify these characteristics.A 34 question cross-sectional online survey was distributed through professional networks, social media channels, and industry contacts to Australian SLPs. Quantitative and qualitative data were analysed.The 70 participants worked in various contexts around the country. The majority of participants demonstrated sound knowledge of the main characteristics of autism, and some early indicators. Quantitative analysis identified a significant correlation between participant age and confidence talking to parents about possible autism. Overarching themes were identified: (a) caution may delay or prevent SLPs from taking action, (b) some factors may influence SLPs’ action, and (c) SLPs take action.Australian SLPs working with children have the knowledge and understanding of the main characteristics of autism and some early indicators. However, they demonstrate a cautious approach around the subject of autism, and this caution may cause delays for children requiring diagnostic services. [ABSTRACT FROM AUTHOR]

Background: Due to the high prevalence of multimorbidity and realistic health service demands for fall prevention, there is growing interest in the association between multimorbidity and falls. Our study aimed to identify multimorbidity patterns among Chinese older adults and explore the association between multimorbidity patterns and falls. Methods: Data from 4,579 Chinese community-dwelling older adults was included in this analysis. Information regarding falls and 10 chronic conditions was collected. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of individual chronic disease or multimorbidity patterns with falls. Results: Among 4,579 participants, 368 (8.0%) were defined as fallers, including 92 (2.0%) frequent fallers, and multimorbidity affected 2,503 (54.7%) participants. Older adults with multimorbidity were more likely to be fallers [odds ratio (OR) = 1.3, P = 0.02] and frequent fallers (OR = 1.7, P = 0.04). Three multimorbidity patterns were identified (i.e., cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases), and the associations between psycho-cognitive diseases/organic diseases and prevalent falls or frequent falls were found to be significant. Conclusions: The psycho-cognitive disease pattern and organic disease pattern are significantly associated with falls. Therefore, more attention should be paid to patients with psycho-cognitive diseases and timely, targeted diagnostic and treatment services should be provided in fall prevention. [ABSTRACT FROM AUTHOR]

Primary care physicians played an important role in the global response during the COVID-19 pandemic, but with the absence of laboratory and diagnostics services, the move to telehealth and the focus on respiratory assessment, they faced increased uncertainty when making clinical decisions. This paper aims to examine the impact of the pandemic on decisions made by primary care physicians, as measured by referrals to chest X-ray and laboratory tests and by prescriptions of antibiotics. We conducted a retrospective study of all visits recorded with fever or cough, presenting to 209 community clinics in Southern Israel during the years 2018–2022. We describe changes in outcome rates across time and use multivariate generalised linear mixed effects model to compare the odds of referrals and prescriptions between periods, while accounting for gender, age, clinic sector, visit type, diagnosis, and season. In total, 609,823 visits to primary care physicians complied with the cohort definitions. Social restrictions were associated with a decline in all measured outcomes for primary care physician decisions, most prominently among ages 20-59, for throat culture referral during the first lockdown (OR = 0.46) and for cephalosporine prescription during the second lockdown (OR = 0.55). This trend persisted following the cancellation of the restrictions. Despite higher uncertainty during the COVID-19 social restrictions, the overall course of clinical decision-making processes was maintained, and was associated with a reduction in the use of auxiliary resources, which can improve the quality of patient care by lowering costs and supporting prevention of future antibiotics resistance. [ABSTRACT FROM AUTHOR]

Hearing loss is an important health care concern. Pure Tone Audiometry (PTA) is considered Gold Standard for audiometric evaluations though, there exist a huge variance between the demand and the actual services available. As smartphones are mobile, applications are upgradable, results are reproducible, the mobile applications may offer a good screening tool, especially in remote areas. There are many smartphone-based hearing applications which are already in use. However, effectiveness of such applications needs to be validated. To evaluate the reliability of 'Hearing Test' a phone application against PTA for assessment of hearing thresholds in adults. We conducted a diagnostic study on a heterogenous group of 250 individuals irrespective of their hearing levels. The hearing thresholds for both ears were measured by PTA and phone app and then compared statistically. The agreement between the methods were statistically significant with respect to diagnosing hearing loss and the degree of hearing loss. Though, PTA remains Gold Standard for hearing evaluation but freely available, highly reproducible & specific 'Hearing Test' application could be used as a screening tool in remote areas and may help bridging the gap between the requirement and availability of diagnostic audiometric services. [ABSTRACT FROM AUTHOR]

Introduction: To contribute to addressing diagnostic health inequalities in the United Kingdom, this review aimed to investigate determinants of diagnostic service use amongst people experiencing high deprivation in the United Kingdom. Methods: A systematic review was conducted using three databases (EBSCO, Web of Science and SCOPUS) to search studies pertaining to diagnostic service use amongst people experiencing high deprivation. Search terms related to diagnostics, barriers and facilitators to access and deprivation. Articles were included if they discussed facilitators and/or barriers to diagnostic service access, contained participants' direct perspectives and focussed on individuals experiencing high deprivation in the United Kingdom. Articles were excluded if the full text was unretrievable, only abstracts were available, the research did not focus on adults experiencing high deprivation in the United Kingdom, those not including participants' direct perspectives (e.g., quantitative studies) and papers unavailable in English. Results: Of 14,717 initial papers, 18 were included in the final review. Determinants were grouped into three themes (Beliefs and Behaviours, Emotional and Psychological Factors and Practical Factors), made up of 15 sub‐themes. These were mapped to a conceptual model, which illustrates that Beliefs and Behaviours interact with Emotional and Psychological Factors to influence Motivation to access diagnostic services. Motivation then influences and is influenced by Practical Factors, resulting in a Decision to Access or Not. This decision influences Beliefs and Behaviours and/or Emotional and Psychological Factors such that the cycle begins again. Conclusion: Decision‐making regarding diagnostic service use for people experiencing high deprivation in the United Kingdom is complex. The conceptual model illustrates this complexity, as well as the mediative, interactive and iterative nature of the process. The model should be applied in policy and practice to enable understanding of the factors influencing access to diagnostic services and to design interventions that address identified determinants. Patient or Public Contribution: Consulting lived experience experts was imperative in understanding whether and how the existing literature captures the lived experience of those experiencing high deprivation in South England. The model was presented to lived experience experts, who corroborated findings, highlighted significant factors for them and introduced issues that were not identified in the review. [ABSTRACT FROM AUTHOR]

The most widespread healthcare reimbursement models, including diagnostic laboratory services, are Fee-for-Service, Reference Pricing and Diagnosis-Related Groups. Within these models healthcare providers are remunerated for each specific service or procedure they operate. Healthcare payers are increasingly exploring alternative models, such as bundled payments or value-based reimbursement to encourage value of patient care rather than the simple amount of delivered services. These alternative models are advised, as they are more efficient in promoting cost-effective, high-quality laboratory testing, thereby improving patient health outcomes. If outcomes-based evaluation is a pillar in a new vision of "Value-Based Healthcare", an active policy of Value-Based Reimbursement in laboratory medicine will assure both an efficiency-based sustainability and a high-quality effectiveness-based diagnostic activity. This review aims to evaluate current and alternative reimbursement models, to support a wider agenda in encouraging more Value-Based Healthcare and Value-Based Reimbursement in laboratory medicine. [ABSTRACT FROM AUTHOR]

PURPOSE: Patients living in rural communities have greater barriers to cancer care and poorer outcomes. We hypothesized that rural patients with prostate cancer have less access and receive different treatments compared with urban patients. METHODS: We used a population-based prospective cohort, the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, to compare differences in prostate cancer diagnosis, access to care, and treatment in patients by geographic residence. The 2013 rural-urban continuum code (RUCC) was used to determine urban (RUCC 1-3) versus rural (RUCC 4-9) location of residence. RESULTS: Patients with rural residence comprised 25% of the cohort (364 of 1,444); they were less likely to be White race and had lower income and educational attainment. Rural patients were more likely to have <12 cores on biopsy (47.1% v 35.7%; P <.001) and less likely (40.8% v 47.6%; P =.04) to receive multidisciplinary consultation. We observed significant differences in treatment between urban and rural patients, including rural patients receiving less active surveillance or observation (22.6% v 28.7%), especially in low-risk cancer (33.2% v 40.7%). On multivariable analysis that adjusted for patient and diagnostic factors, rural residence was associated with less use of active surveillance or observation over radical treatment (ie, surgery or radiation therapy; odds ratio, 0.49 v urban; P <.001) in patients with low-risk cancer. CONCLUSION: Patients with prostate cancer who live in rural versus urban areas experience several differences in care that are likely clinically meaningful, including fewer cores in the diagnostic biopsy, less utilization of multidisciplinary consultation, less use of active surveillance, or observation for low-risk disease. Future studies are needed to assess the efficacy of interventions in mitigating these disparities. We observed meaningful disparities in rural versus urban prostate cancer diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objectives: To improve healthcare access for rural cisgender women and gender diverse Veterans, we created the "Boost Team," a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services. Methods: Between 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022. Results: The needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics. Discussion: Data from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program. [ABSTRACT FROM AUTHOR]

This research proposes an innovative, intelligent hand-assisted diagnostic system aiming to achieve a comprehensive assessment of hand function through information fusion technology. Based on the single-vision algorithm we designed, the system can perceive and analyze the morphology and motion posture of the patient's hands in real time. This visual perception can provide an objective data foundation and capture the continuous changes in the patient's hand movement, thereby providing more detailed information for the assessment and providing a scientific basis for subsequent treatment plans. By introducing medical knowledge graph technology, the system integrates and analyzes medical knowledge information and combines it with a voice question-answering system, allowing patients to communicate and obtain information effectively even with limited hand function. Voice question-answering, as a subjective and convenient interaction method, greatly improves the interactivity and communication efficiency between patients and the system. In conclusion, this system holds immense potential as a highly efficient and accurate hand-assisted assessment tool, delivering enhanced diagnostic services and rehabilitation support for patients. [ABSTRACT FROM AUTHOR]

Background: Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing diagnostic audiology services following a refer screen result. Methods: This study aimed to assess the opinions of families who had experienced infant diagnostic audiology assessments regarding a telehealth option for these appointments within Victoria, Australia. Families who attended in-person infant diagnostic audiology appointments were sent a questionnaire exploring their experiences of the service and their opinion regarding a proposed telehealth option for infant diagnostic audiology (50 responses received). These results were also compared to those of families who were surveyed following testing in 2020, where the audiologist conducted the appointment remotely to comply with COVID-19-related social distancing recommendations at the time (10 responses received). Results: There were not significant differences between the duration or number of appointments, perceived understanding of results, or concerns regarding a tele-audiology model between families who experienced face-to-face and tele-audiology infant diagnostic audiology appointments. Opinions of infant diagnostic audiology appointments utilizing telehealth technology were largely positive, and minimal technological difficulties were identified. Conclusion: Overall positive attitudes of many families with infant diagnostic appointment experiences toward a tele-audiology option of this service suggest that offering a telehealth model of appointments may be an appropriate model to improve service access for families requiring infant diagnostic audiology in Victoria. [ABSTRACT FROM AUTHOR]

A 5-year retrospective study published in the British Journal of Haematology examined changes in practice within a haematological malignancy diagnostic service. The study found that there has been an increase in the use of ancillary immunophenotypic, molecular, and cytogenetic assays to supplement morphological assessment in order to improve diagnostic accuracy and treatment options. The study also observed an increase in the number of testing modalities per specimen, particularly in genomic testing, which has led to more confident diagnoses of chronic myeloid disease. The findings highlight the need for increased scientific capacity and training within laboratories to support the analysis of these complex assays. [Extracted from the article]

India published its first edition of the National Essential Diagnostics List in 2019. The list depicts the list of diagnostic tests that can ensure affordable and quality healthcare delivery by removing barriers toward accessibility and reducing out-of-pocket expenditure. In 2024, the Indian Council of Medical Research has invited suggestions for revision of the list. Therapeutic drug monitoring (TDM) has been a promising modality and has been useful for a range of indications like monitoring medication adherence, diagnosing suboptimal treatment, detecting drug interactions, and guiding initiation or withdrawal of therapy. In this article, the authors make a case for inclusion of TDM for certain psychotropic drugs like lithium, sodium valproate, carbamazepine, and clozapine at the district hospital level. The authors have tried to justify the inclusion backed by recent evolving evidence. [ABSTRACT FROM AUTHOR]

Our Coagulation Disorders Unit in Helsinki, Finland, provides 24/7 services for local and national hospitals and colleagues upon requests regarding bleeding and thrombosis diagnostics and management, including follow-up. The unit has a tight connection between the clinic and laboratory, and its maintenance and sharing knowledge and observations have been priorities, already for over 20 years and will continue to be of major importance. The consultation service is provided by phone during daytime and on-call hours, and in written form sent electronically to the consulting stakeholders. Thrombosis and hemostasis-targeted outpatient clinics are also available for the patients referred to the center. Writing local guidance and official guidelines, Nordic, European and international collaboration, and educational activities including social communication are critical elements for the Coagulation Disorders Unit. Alertness to acute coagulation abnormalities, such as occurred during COVID-19 and vaccine-induced thrombosis and thrombocytopenia, and development of strategies to manage cross-disciplinary problems are topics which call upon broad networking. The Nordic community has an ongoing historical meeting, which has been circulating among coagulation centers for the past 56 years. At the European level, the European Association of Haemophilia and Allied Disorders focuses on bleeding disorders and their management, including safety surveillance. The International Society of Thrombosis and Haemostasis offers excellent basic and clinical benchmarks for any Coagulation Disorders Unit. We hope that the description of the development and implementation of our Coagulation Disorders Unit in Helsinki achieves international interest and broadens international collaboration. Finally, we congratulate STH on its great contributions around the globe and for providing a vivid forum to foster the discipline of thrombosis and hemostasis. [ABSTRACT FROM AUTHOR]

Background: Understanding the factors that contribute to diagnostic errors is critical if we are to correct or prevent them. Some scholars influenced by the default interventionist dual‐process theory of cognition (dual‐process theory) emphasise a narrow focus on individual clinician's faulty reasoning as a significant contributor. In this paper, we examine the validity of claims that dual process theory is a key to error reduction. Methods: We examined the relationship between a clinical experience (staff and resident physicians) and viewing time on accuracy for categorising chest X‐rays (CXRs) and electrocardiograms (ECGs). In two studies, participants categorised images as normal or abnormal, presented at viewing times of 175, 250, 500 and 1000 ms, to encourage System 1 processing. Study 2 extended viewing times to 1, 5, 10 and 20 s to allow time for System 2 processing and a diagnosis. Descriptives and repeated measures analysis of variance were used to analyse the proportion of true and false positive rates (TP and FP) as well as correct diagnoses. Results: In Study 1, physicians were able to detect abnormal CXRs (0.78) and ECGs (0.67) with relatively high accuracy. The effect of experience was found for ECGs only, as staff physicians (0.71, 95% CI = 0.66–0.75) had higher ECG TP than resident physicians (0.63, 95% CI = 0.58–0.68) in Study 1, and staff had lower ECG FP (0.10, 95% CI = 0.03–0.18) than resident physicians (0.27, 95% CI = 0.20–0.33) in Study 2. In other comparisons, experience was equivocal for ECG FPs and CXR TPs and FPs. In Study 2, overall diagnostic accuracy was similar for both ECGs and CXRs, (0.74). There were small interactions between experience and time for TP in ECGs and FP in CXRs, which are discussed further in the discussion and offer insights into the relationship between processing and experience. Conclusion: Overall, our findings raise concerns about the practical application of models that link processing type to diagnostic error, or to specific diagnostic error reduction strategies. Recommendations to employ self‐directed strategies to slow down, take a diagnostic time out, or reflect, are reported as not being reliable means for reducing diagnostic error; in fact, these strategies may increase error. [ABSTRACT FROM AUTHOR]

An automatic medical diagnosis service based on deep learning has been introduced in e-healthcare, bringing great convenience to human life. However, due to privacy regulations, insufficient data sharing among medical centers has led to many severe challenges for automated medical diagnostic services, including diagnostic accuracy. To solve such problems, swarm learning (SL), a blockchain-based federated learning (BCFL), has been proposed. Although SL avoids single-point-of-failure attacks and offers an incentive mechanism, it still faces privacy breaches and poisoning attacks. In this paper, we propose a new privacy-preserving Byzantine-resilient swarm learning (PBSL) that is resistant to poisoning attacks while protecting data privacy. Specifically, we adopt threshold fully homomorphic encryption (TFHE) to protect data privacy and provide secure aggregation. And the cosine similarity is used to judge the malicious gradient uploaded by malicious medical centers. Through security analysis, PBSL is able to defend against a variety of known security attacks. Finally, PBSL is implemented by uniting deep learning with blockchain-based smart contract platforms. Experiments based on different datasets show that the PBSL algorithm is practical and efficient. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to map place of cancer diagnosis in relation to Human Immunodeficiency Virus (HIV) care centre among people living with HIV (PLHIV) within South Africa (SA) using national laboratory database. Design: We linked HIV and cancer laboratory data from 2004–2014 using supervised machine-learning algorithms. We performed a cross-sectional analysis comparing province where individuals accessed their HIV care versus where they had their cancer diagnosis. Setting: We used laboratory test records related to HIV diagnostics and care, such as CD4 cell counts and percentages, rapid tests, qualitative Polymerase Chain Reaction (PCR), antibody and antigen tests for HIV data that was documented as HIV positive and laboratory diagnosed cancer records from SA. Study population: Our study population consisted of HIV records from the National Health Laboratory Service (NHLS) that linked to cancer record at the National Cancer Registry (NCR) between 2004–2014. Primary and secondary outcomes: We linked HIV records from NHLS to cancer records at NCR in order to study the inherent characteristics of the population with both HIV and cancer. Results: The study population was 68,284 individuals with cancer and documented HIV related laboratory test. The median age at cancer diagnosis was 40 [IQR, 33–48] years for the study population with most cancers in PLHIV diagnosed in females 70.9% [n = 46,313]. Of all the PLHIV and cancer, 25% (n = 16,364 p < 0.001) sought treatment outside their province of residence with 60.7% (n = 10,235) travelling to Gauteng. KZN had 46.6% (n = 4,107) of its PLHIV getting cancer diagnosis in Gauteng. Western Cape had 95% (n = 6,200) of PLHIV getting cancer diagnosis within the province. Conclusions: Our results showed health systems inequalities across provinces in SA with respect to cancer diagnosis. KZN for example had nearly half of the PLHIV getting cancer diagnosis outside the province while Western Cape is able to offer cancer diagnostic services to most of the PLHIV in the province. Gauteng is getting over burdened with referral for cancer diagnosis from other provinces. More effort is required to ensure equitable access to cancer diagnostic services within the country. [ABSTRACT FROM AUTHOR]

Aim: Some concerns exist that diagnosis of gestational diabetes mellitus (GDM) may be missed when the simplified diagnostic criteria of the Japanese Society of Diabetes and Pregnancy (JSDP) for GDM (published during the COVID‐19 pandemic) are used. Moreover, limited data is available regarding how widespread these diagnostic criteria are used when managing GDM during the COVID‐19 pandemic. Therefore, this study aimed to determine how GDM diagnosis has changed during the COVID‐19 pandemic in Japan. Methods: The changes in GDM diagnosis during the COVID‐19 pandemic were investigated using an online questionnaire to 2159 obstetric facilities in Japan. The questionnaire collected data on facility type, awareness of Japanese GDM diagnostic strategies, modifications to diagnostic methods for early and late GDM, and opinions on GDM management, with the pandemic divided into seven periods. Results: We received responses from 593 facilities (27%). Approximately 90% of the facilities did not change their diagnostic process for early GDM or late GDM (occurring after 24 weeks gestation). However, during the COVID‐19 pandemic, 19 facilities discontinued the use of 75‐g oral glucose tolerance tests before 24 weeks of gestation, and 17 facilities discontinued it after 24 weeks of gestation, instead using the aforementioned Japanese GDM diagnostic strategy. Conclusions: Although a limited number of facilities modified their diagnostic method in response to the COVID‐19 pandemic, this study demonstrated that those that adjusted their diagnostic method primarily used the Japanese COVID‐19 GDM strategy by the JSDP. [ABSTRACT FROM AUTHOR]

Introduction: To achieve epidemic control of infectious diseases, engaging higher‐burden populations with accessible diagnostic services is critical. HIV self‐testing (HIVST) is a promising option. Methods: We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self‐reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre‐determined pick‐up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow‐up services. Follow‐up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients. Results: Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options. Conclusions: Web‐based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder‐to‐reach populations across India. Assistance from a community‐oriented counsellor proved important to overcome literacy barriers and mistrust in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases. [ABSTRACT FROM AUTHOR]

TB diagnosis has been simplified in India following advances in available diagnostic tools. This facilitates private doctors' "patient first" approach toward early diagnosis; however, costs remain high. India's NTEP established a TB diagnostic network, which is free for patients and incentivizes private doctors to participate. Drawing from this context led to the design and implementation of the One-Stop TB Diagnostic Solution model, which was conducted in the Hisar district, Haryana, allowing specimens from presumptive TB patients from private doctors to be collected and tested as per NTEPs diagnostic algorithm. A subset of data pertaining to private doctors was analyzed for the project period. Qualitative data were also collected by interviewing doctors using a snowball method to capture doctors' perception about the model. Out of 1159 specimens collected from 60 facilities, MTB was detected in 32% and rifampicin resistance was detected in 7% specimens. All specimens went through the diagnostic algorithm. Thirty doctors interviewed were satisfied with the services offered and were appreciative of the program that implements this "patient centric" model. Results from implementation indicate the need to strengthen private diagnostics through a certification process to ensure provision of quality TB diagnostic services. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is a major problem which has a significant health, social, and economic impact. Particularly, pediatric trauma carries substantial mortality and morbidity. This is a great concern for subspecialized general and pediatric surgeons. Therefore, a global initiative for pediatric trauma care is warranted and should be initiated. Aim: The international association "Global Initiative for Children's Surgery" (GICS) would like to propose and organize a children's trauma care (CTC) initiative. This initiative should comprehensively address pediatric trauma management globally, especially in low- and middle-income countries (LMICs). The initiative seeks to achieve a structured cooperation and collaboration with respective sister organizations and local stakeholders. Methods: The initiative will address these relevant aspects: 1. first aid; 2. prehospital primary trauma care; 3. hospital primary trauma care; 4. advanced care (ATLS); 5. diagnostic facilities; 6. operation room (OR) equipment; 7. specialized surgical services; 8. rehabilitation; 9. registry, research, and auditing; 10. specialization in pediatric trauma; 11. capacity and confidence building in pediatric trauma; 12. prevention. The GICS CTC provided activities have been recorded and evaluated in a structured manner. This statement paper is based on data of a narrative review as well as expert opinions. Results: The Trauma Working Group of GICS provided specialized trauma prevention leaflets available for translation to different languages. A one-day children's primary trauma course has been designed to be delivered at the physical GICS meetings. Exercising advocacy, the group addressed several meetings on prevention of pediatric trauma, which included the 75th United Nations General Assembly (UNGA) (2020), GICS IVth meeting in Johannesburg (2020), Norwich (UK) Joint SPRINT Symposium on Pediatric Surgery for Pediatricians (2021), the second online Pan African Pediatric Surgical Association (PAPSA) meeting (2021), the seventh World Congress of the World Federation of Associations of Pediatric Surgeons (WOFAPS) in Prague (2022), and GICS pediatric trauma webinar (2023). Additionally, the working group participated in the preparations of a pediatric trauma module for the World Health Organization (WHO) and published several related studies. The contents of the selected articles added relevant information to the categories stated above. Conclusions: The CTC initiative of GICS is proposed as a mean to address pediatric trauma comprehensively through a process of collaboration and advocacy with existing organizations to achieve awareness, health education, prevention, health, and training. Further, it will support the provision of suitable facilities to health institutions. The establishment of a specialization in pediatric trauma is encouraged. GICS CTC initiative aims to improve pediatric trauma care in LMICs by developing injury prevention strategies; optimizing the use of locally available resources; obtaining commitment by LMICs governments; improvement in all fields of hospital care; improvements in infrastructure, education and training, and attention to data registry and research. [ABSTRACT FROM AUTHOR]

Objective: This study aims to establish the frequency of Down’s syndrome which will enhance the knowledge of our local population as well to understand our genotypic patterns and variations. Methods: Electronic Medical Records of inborn babies at the Department of Neonatology, Sheikh Saeed Memorial Campus of The Indus Hospital Karachi during the study period from 1st January 2021 to 31st December 2022 were retrieved. Chromosomal karyotyping was done for all babies with suspicious clinical features identified on routine new born examination by consultant neonatologists, trainee doctors and experienced nurses. Result: There was a total of 7,433 live births during the study period, out of which 14 babies had features suggestive of DS. repetition of sentence. What about karyotyping result?? Conclusion: The frequency of DS in our study is slightly higher than the incidence reported within South East Asia. It is high time to perform effective antenatal screening and efficient prenatal diagnostic services for early detection of chromosomal numerical aberration such as Down syndrome for better management of upcoming pregnancies. [ABSTRACT FROM AUTHOR]

The National Association of Epilepsy Centers (NAEC) recently published their updated guidelines for specialized epilepsy centers. The first NAEC guidelines provided basic expectations for in-patient care, with the goal of makingan accurate diagnosis and choose the best intervention- medical or surgical. With the 2001 report, the emphasis was for epilepsy centers to be able to provide comprehensive diagnostic and treatment services. The NAEC 2010 guidelines further delineated the essential elements of level 3 and 4 specialized epilepsy centers.The goal of the 2023 guidelines is not only to provide optimal standards of care, but also to "elevate evidence-based science into standard practice."4 Therefore, these are the first NAEC guidelines that are solely funded by NAEC and also the first founded on an evidence-informed, consensus-based process. The 2023 guidelines now include 52 recommendations across the following domains: Inpatient Services/EMU, Surgery, Diagnostic Evaluation, and Outpatient Services. The guidelines provide us with the recommendations when creating new centers or ways to improve our current centers. Well- documented guidelines such as these provide us with support when seeking additional financial and personnel resources. Put simply, these guidelines have provided us with the recipe for ideal comprehensive epilepsy care for PWE. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) causes over 1 million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil. Methods: We obtained data on individuals treated for TB between 2015 and 2018 from Brazil's National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with unsuccessful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment. Results: Among 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful treatment were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62–3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25–1.32], vs. female sex), Black race (aOR 1.23 [1.19–1.28], vs. White race), no education (aOR 2.03 [1.91–2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63–2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88–2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41–1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16–1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95–3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11–1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14–2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29–2.41], vs. receiving DOT). Conclusion: The risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil. [ABSTRACT FROM AUTHOR]

Background: India accounts for about one-quarter of people contracting tuberculosis (TB) disease annually and nearly one-third of TB deaths globally. Many Indians do not navigate all care cascade stages to receive TB treatment and achieve recurrence-free survival. Guided by a population/exposure/comparison/outcomes (PECO) framework, we report findings of a systematic review to identify factors contributing to unfavorable outcomes across each care cascade gap for TB disease in India. Methods and findings: We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches of PubMed, Embase, and Web of Science from January 1, 2000 to August 14, 2023 were conducted. We identified articles evaluating factors associated with unfavorable outcomes for each gap (reported as adjusted odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons for these outcomes (reported as proportions), with specific quality or risk of bias criteria for each gap. Findings were organized into person-, family-, and society-, or health system-related factors, using a social-ecological framework. Factors associated with unfavorable outcomes across multiple cascade stages included: male sex, older age, poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) health services. People previously treated for TB were more likely to seek care and engage in the diagnostic workup (Gaps 1 and 2) but more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable treatment outcomes (Gap 4), especially those who were lost to follow-up during their prior treatment. For individual care cascade gaps, multiple studies highlighted lack of TB knowledge and structural barriers (e.g., transportation challenges) as contributing to lack of care-seeking for TB symptoms (Gap 1, 14 studies); lack of access to diagnostics (e.g., X-ray), non-identification of eligible people for testing, and failure of providers to communicate concern for TB as contributing to non-completion of the diagnostic workup (Gap 2, 17 studies); stigma, poor recording of patient contact information by providers, and early death from diagnostic delays as contributing to pretreatment loss to follow-up (Gap 3, 15 studies); and lack of TB knowledge, stigma, depression, and medication adverse effects as contributing to unfavorable treatment outcomes (Gap 4, 86 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and TB recurrence (Gap 5, 14 studies). Limitations include lack of meta-analyses due to the heterogeneity of findings and limited generalizability to some Indian regions, given the country's diverse population. Conclusions: This systematic review illuminates common patterns of risk that shape outcomes for Indians with TB, while highlighting knowledge gaps—particularly regarding TB care for children or in the private sector—to guide future research. Findings may inform targeting of support services to people with TB who have higher risk of poor outcomes and inform multicomponent interventions to close gaps in the care cascade. Tulip A. Jhaveri and team report findings of a systematic review to identify factors contributing to unfavorable outcomes across each care cascade gap for tuberculosis disease in India. Author summary: Why was this study done?: India has the highest tuberculosis (TB) incidence, accounting for about one-quarter of people with TB disease and nearly one-third of TB deaths globally. Many Indians with TB do not traverse all care stages needed to receive treatment and achieve an optimal long-term outcome, with serial losses of people across these stages referred to as the "care cascade." Understanding why losses of people with TB disease occur across the care cascade is crucial to inform interventions to prevent unfavorable outcomes. What did the researchers do and find?: We conducted 3 systematic searches to identify papers published from 2000 to 2023. We extracted information from these studies on risk factors for unfavorable outcomes for each care cascade gap, as well as reasons reported by people with TB who experienced unfavorable outcomes and were surveyed by researchers. Some factors contributed to losses at multiple care cascade stages, including male sex, older age, poverty-related factors, history of prior TB treatment, lower symptom severity or duration, undernutrition, alcohol use, smoking, and dissatisfaction with health services. Other barriers included: lack of TB knowledge and transportation barriers to clinic contributing to lack of care-seeking (Gap 1), poor accessibility of testing and failure to identify people eligible for testing contributing to non-completion of the diagnostic workup (Gap 2), early deaths from diagnostic delays and poor recording of contact information contributing to losses of people before treatment (Gap 3), lack of TB knowledge and depression contributing to unfavorable treatment outcomes (Gap 4), and medication nonadherence contributing to unfavorable treatment outcomes and TB recurrence (Gaps 4 and 5). What do these findings mean?: Reasons for losses of people with TB disease across the care cascade are complex, vary by care cascade gap, and involve patient- and health system-related barriers. India's TB program should target additional services to people with higher risk of poor outcomes and develop multicomponent interventions to address the diverse challenges faced by people with TB. Study limitations include lack of meta-analyses (i.e., estimation of the average effect of each risk factor by combining findings across studies), and caution is required when applying findings across India's diverse population. [ABSTRACT FROM AUTHOR]

Background: A sustainable point-of-care (POC) diagnostic testing implementation in low-resourced facilities enhances quick diagnostic investigation and halts unnecessary referrals. This study identified the barriers impeding the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana; as well as explored potential solutions that could enhance the accessibility and effectiveness of POC diagnostic testing, ultimately improving the quality of healthcare delivery. Methods: A total of twenty-eight participants were purposively selected from health facilities in low-resourced settings in the Bono Region for a descriptive qualitative study. Of the twenty-eight participants, seventeen including ten healthcare providers from CHPS facilities, six district health depot managers, and one regional depot manager were engaged in in-depth interviews. Additional eleven including nine healthcare providers and two district depot managers were also engaged in focus group discussions. NVivo version 12 software was employed for condensation, labelling, and grouping of themes. Data was analysed narratively. Results: Work overloads, limited POC testing services, stock-outs of POC tests at the facilities, and supply-related challenges of POC test kits were identified as major barriers to POC testing services. To solve these barriers, adequate funding, an effective delivery system, stakeholders' engagement and advocacy, and in-service and refresher training courses were suggested as potential solutions to POC diagnostic testing services implementation by the stakeholders. Conclusions: This study's findings emphasize the need to address the barriers hindering the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana. The suggested solutions provide a roadmap for improving the accessibility and effectiveness of POC testing, which has the potential to enhance the quality of healthcare delivery, reduce unnecessary referrals, and ultimately improve patient health outcomes in underserved settings. [ABSTRACT FROM AUTHOR]

Background: Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA). Maintaining adherence to CPAP in the long term is a clinical problem, and numerous factors have been identified that impact adherence. Although fully remote diagnostic and CPAP services were frequently utilised during the COVID-19 pandemic for patients with OSA, long-term adherence data have not been published. The aim of this service evaluation project was to describe the long-term adherence to CPAP. We also analysed factors that are associated with it. Methods: two-hundred and eighty patients diagnosed with OSA and set up on CPAP remotely during the first wave of the COVID-19 pandemic as part of routine clinical practice were analysed. Results: One-hundred and seven patients (38%) were fully adherent to CPAP at 24 months, determined by at least 4 h of usage on at least 70% of the days. Of the factors analysed, body mass index, disease severity, driving status and the presence of depression were related to long-term adherence (all p < 0.05). Conclusions: with the likelihood of future pandemics similar to COVID-19, our data provide evidence that fully remote pathways for management of patients with OSA can be designed and be sustainable with good long-term adherence. [ABSTRACT FROM AUTHOR]

Introduction: Reducing waiting times is a major policy objective in publicly-funded healthcare systems. However, reductions in waiting times can produce a demand response, which may offset increases in capacity. Early detection and diagnosis of cancer is a policy focus in many OECD countries, but prolonged waiting periods for specialist confirmation of diagnosis could impede this goal. We examine whether urgent GP referrals for suspected cancer patients are responsive to local hospital waiting times. Method: We used annual counts of referrals from all 6,667 general practices to all 185 hospital Trusts in England between April 2012 and March 2018. Using a practice-level measure of local hospital waiting times based on breaches of the two-week maximum waiting time target, we examined the relationship between waiting times and urgent GP referrals for suspected cancer. To identify whether the relationship is driven by differences between practices or changes over time, we estimated three regression models: pooled linear regression, a between-practice estimator, and a within-practice estimator. Results: Ten percent higher rates of patients breaching the two-week wait target in local hospitals were associated with higher volumes of referrals in the pooled linear model (4.4%; CI 2.4% to 6.4%) and the between-practice estimator (12.0%; CI 5.5% to 18.5%). The relationship was not statistically significant using the within-practice estimator (1.0%; CI -0.4% to 2.5%). Conclusion: The positive association between local hospital waiting times and GP demand for specialist diagnosis was caused by practices with higher levels of referrals facing longer local waiting times. Temporal changes in waiting times faced by individual practices were not related to changes in their referral volumes. GP referrals for diagnostic cancer services were not found to respond to waiting times in the short-term. In this setting, it may therefore be possible to reduce waiting times by increasing supply without consequently increasing demand. [ABSTRACT FROM AUTHOR]

Background/Objectives: Older patients are subject to a high number of Emergency Department (ED) visits and hospitalizations. Innovative strategies to manage geriatric urgencies in the community are thus needed. Methods: In this prospective observational study, we examined the case mix of a hospital-based domiciliary urgent care service tailored to older patients, called Multidisciplinary Mobile Unit (MMU), from January to September 2023. The service, activated by general practitioners or territorial specialists during workdays, provided domiciliary geriatric assessment, point-of-care diagnostics, including multi-site ultrasound and lab tests, and therapeutical measures, including intravenous treatment and insertion of invasive devices, with the goal of reaching on-site stabilization and avoiding ED referral. We collected data regarding multimorbidity, polypharmacy, and frailty according to the Clinical Frailty Scale (CFS), reasons for MMU activation, and diagnostic and therapeutical services provided. The assessed outcomes were immediate hospitalization after a visit, 30-day admission, and 30-day mortality. Results: Participants (n = 205, 102 M) were mostly aged (median age 83 years old), with multimorbidity and frailty (CFS median 6). The most frequent reasons for MMU activation were dyspnea (49%), cough (34%), and musculoskeletal pain (17%), while the commonest diagnostic test provided was thoracic ultrasound (81%). Only five patients (2.4%) were hospitalized immediately after MMU visit. The 30-day rate of hospitalization was 10.2%, with age, cancer, and abdominal pain as independent predictors on a stepwise binary logistic regression model. 30-day mortality was 4.9%. Conclusions: The MMU model is a feasible strategy to manage geriatric urgencies, especially involving the cardiorespiratory system, is associated with good outcomes and may prevent ED visits. [ABSTRACT FROM AUTHOR]

Macadamia cultivation plays significant role in the economy of South Africa. Despite its importance, the industry grapples with disease‐related challenges, notably flower blight, which threatens substantial economic losses by affecting yield and nut quality. In 2022, diagnostic services at the Agricultural Research Council and the Forestry and Agricultural Biotechnology Institute received macadamia flowers displaying blight symptoms. Employing two methods for fungal isolation, 25 isolates were obtained which were classified into one group based on morphological characteristics. DNA analysis identified the isolates as Botrytis cinerea. The pathogenicity testing was conducted on macadamia flowers to confirm Koch's postulates. This is the first report of B. cinerea affecting Macadamia integrifolia Maiden & Betche in South Africa, underlining its potential threat to the industry. [ABSTRACT FROM AUTHOR]

The article focuses on a spirometry service established by the Northwest Surrey Integrated Care Service (NICS). During the COVID-19 pandemic, spirometry testing was halted, leading to missed diagnoses of respiratory conditions and highlighting funding issues in general practice. NICS addressed this by establishing a spirometry service for 37 practices. The service adapted infection control measures and used trained staff. This model serves as an exemplar for post-pandemic healthcare innovation.

The aim of the conducted research was to assess the attitude of the Polish society towards the use of artificial intelligence in medical diagnostics. In the research process, we sought answers to three research questions: how trust in the use of AI for medical diagnostics can be measured; if societal openness to technology determines trust in the use of AI for medical diagnostics purposes; and if a higher level of trust in the use of AI for medical diagnostics influences the potential improvement in the quality of medical diagnostics as perceived by Poles. The authors' particular focus was on the following three constructs and the relationships between them: openness to new technologies (OP), willingness to trust AI in medical diagnostics (T), and perceived impact of AI application on the quality of medical diagnostic services (PI). A survey was conducted on a representative sample of 1063 Polish respondents to seek answers to the above questions. The survey was conducted using the CATI technique. [ABSTRACT FROM AUTHOR]