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Intensive care unit (ICU) strain, characterized by a discrepancy between perceived or actual intensive care resources and demand, significantly impacts patient outcomes and healthcare worker well-being. The coronavirus disease (COVID-19) pandemic exacerbated ICU strain, leading to increased mortality and extended hospital stays, affecting both critically ill patients with and without COVID-19. A systematic review identified 16 leading and lagging indicators of ICU capacity strain, including queuing, premature and after-hours ICU discharge, use of temporary space, length of stay, burnout, staffing and nurse-to-patient ratio, ICU census, acuity and turnover, standardized mortality ratio, readmissions, availability of critical supplies, ventilator use, and surgery cancellation. However, variability in operational definitions and limited evidence regarding the reliability, validity, usability, and feasibility limit the value of single indicators for informed strategic planning and policy guidance. Regional and national policies and programs are essential to enhance real-time monitoring for effective management of critical care resources, and they mitigate the impact of ICU strain, facilitating complex interhospital transfers to reduce strain and ensuring comprehensive strategies for enhancing ICU resilience. Proactive regional cooperation is advocated for policy formulation, knowledge exchange, and resource allocation to anticipate and mitigate ICU strain, ensuring equitable healthcare access during global health crises. The policy implications for future preparedness emphasize the importance of evidence-based triage and adaptable patient management strategies alongside ethical considerations in resource allocation and the role of behavioral economic insights in optimizing resource utilization and collaborative healthcare practices. This multifaceted approach for addressing ICU strain comprehensively and effectively during a pandemic would promote health equity and enhance healthcare system resilience under both routine operations and crisis conditions. [ABSTRACT FROM AUTHOR]

In the context of a global nursing shortage, this paper explores the concept of resilience within the nursing profession, highlighting its implications for practice and policy on an international level. Although resilience is a vital concept for coping with stressors, we argue that placing the burden of resilience on individual nurses may obscure systemic issues that contribute to burnout and attrition. Resilience in nursing is a multifaceted concept that should be examined critically. Relying heavily on individual resilience may inadvertently perpetuate systemic issues and risk internalization of blame by nurses. Upon critical analysis of recent global statistics, this paper advocates for a shift toward collective resilience strategies, specifically, nurse participation in policy‐making. This approach not only addresses immediate workforce challenges but also reinforces the essential role of the nursing profession in shaping health and social policies, ensuring sustainable healthcare systems worldwide. [ABSTRACT FROM AUTHOR]

This study aims to establish a cost basis for biologics manufacturers and policymakers by quantifying the price and time required to bring a biosimilar from the lab to market. For efficient implementation of a cost‐based policy, especially for life‐saving medicines like biosimilars, it is imperative to establish a benchmark for the cost involved in biosimilar development. In this holistic and multiple‐case study, stage‐wise cost estimates of biosimilar development were obtained for microbial and mammalian systems. The investigation of six biopharmaceutical companies based in India concluded that biosimilar development through the microbial system costs ∼18 million USD and ∼21 million USD for the mammalian system. Additionally, 45–50 million USD is required as a one‐time capital investment. Further, US/EU authorization can cost ∼25 million USD per product. Clinical studies are the most expensive and account for 60%–70% of total development cost. The presented information can serve as a basis for implementing cost‐based pricing in countries like India and reimbursement policies for biosimilars under Medicare Part B in the United States. [ABSTRACT FROM AUTHOR]

Introduction: Given the increase in the primary care nursing workforce and the need to further grow nursing roles in the community understanding how this is included in undergraduate education is important. This study aimed to explore the inclusion of primary care in the undergraduate nursing education curriculum of four countries. Method: A mixed‐method design was employed to obtain a broader context of primary care nursing in nursing education and teaching approaches relating to primary care nursing. Subsequently, Australia, Canada, Spain, and Ireland were selected for this study because primary healthcare systems are established as a part of their healthcare system. Results: In total, 136 nursing faculties (40 in Australia, 35 in Canada, 46 in Spain, and 15 in Ireland) were invited to participate in this study. Of these, 27 responses were obtained (19.8% response rate). Following the survey phase, in‐depth interviews were conducted with 13 participants. The results indicated that the highest number was coded within the theme of "Understanding of PHC in the curriculum" (n = 108). The second highest number (n = 87) was within the theme of "Interpretation differences of PHC in curriculum," and the third highest (n = 31) was coded within "Policy impact on health by national government and others." Conclusion: The results emphasized the ambiguity of primary care within the undergraduate nursing curriculum and that interpretation and implementation into the curriculum largely depended on the school's intentions. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate opinions of healthcare personnel about the City Hospitals (CHs) which have been established in Turkey through public-private partnership. Method: The study is a cross-sectional survey carried out between June-September 2019 on physicians, nurses, and other health personnel working in three CHs. As a result of the exploratory factor analysis, a structure was reached that measures the opinions of the participants about CHs in 7 and their solution proposals in two dimensions. The reliability coefficients of the dimensions were found to be between 0.56 and 0.94, and the general reliability coefficient was found to be 0.95. Results: While the participants stated that CHs generally positively affected quality & productivity, access to health services, and opportunities, they negatively affected risks, employees, transparency, and management dimensions. The opinions of the participants differed significantly according to their occupations but did not differ whether they had previously worked in the public or private sector. Conclusion: Physicians and nurses generally evaluated the impact of CHs on the health sector more negatively than others. The study suggested that there could be significant clues for managers and policymakers to eliminating problems that have emerged in CHs practices and for developing their implementation. [ABSTRACT FROM AUTHOR]

Background: Postpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS. Methods: Four focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis. Results: Analysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety. Conclusions: Findings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication. [ABSTRACT FROM AUTHOR]

Background: The considered shift from individual blame and sanctions towards a commitment to system-wide learning from incidents in healthcare has led to increased understanding of both the moral and epistemic importance of involving those affected. It is important to understand whether and how local policy describes and prompts involvement with a view to understanding the policy landscape for serious incident investigations in healthcare. This study aimed to explore the way in which involvement of those affected by serious incidents is represented in incident investigation policy documents across acute and mental health services in the English NHS, and to identify guidance for more effective construction of policy for meaningful involvement. Methods: We conducted a documentary analysis of 43 local serious incident investigation policies to explore the way in which involvement in serious incident investigations is represented in policy documents across acute and mental health services in the NHS in England. Results: Three headline findings were generated. First, we identified involvement as a concept was conspicuous by its absence in policy documents. Direct reference to support or involvement of those affected by serious incidents was lacking. Even where involvement and support were recognised as important, this was described as a passive process rather than there being moral or epistemic justification for more active contribution to learning. Second, learning from serious incidents was typically described as a high priority but the language used was unclear and ‘learning’ was more often positioned as construction of an arbitrary set of recommendations rather than a participatory process of deconstruction and reconstruction of specific systems and processes. Third, there was an emphasis placed on a just and open culture but paradoxically this was reinforced by expected compliance, positioning investigations as a tool through which action is governed rather than an opportunity to learn from and with the experiences and expertise of those affected. Conclusions: More effective representation in policy of the moral and epistemic reasons for stakeholder involvement in serious incident investigations may lead to better understanding of its importance, thus increasing potential for organisational learning and reducing the potential for compounded harm. Moreover, understanding how structural elements of policy documents were central to the way in which the document is framed and received is significant for both local and national policy makers to enable more effective construction of healthcare policy documents to prompt meaningful action. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis. In Korea, ESD was included in the National Health Insurance (NHI) coverage in 2011, which was expanded in 2018. In the present study, we investigated the status and trends of ESD for EGC over the past decade since its incorporation into the NHI system. Materials and Methods: We analyzed the data from the National Health Insurance Service (NHIS) database from 2011 to 2021, focusing on patient characteristics, number of ESD procedures, in-hospital length of stay (LOS), and total medical cost (TMC) per admission. In addition, we conducted an interrupted time series analysis to assess the impact of changes in insurance coverage on these variables. Results: Overall, 95,348 cases of ESD for EGC were identified. A consistent annual increase in ESD procedures was observed, particularly in tertiary care hospitals and among patients aged >60 years. The overall median LOS and TMC were 4 days and 2,123,000 KRW, respectively. The 2018 insurance coverage expansion did not significantly affect the number of ESD procedures or LOS; however, the TMC increased significantly. Conclusions: Our study illustrates decade-long trends in the ESD for EGC in Korea. The policy needs to be revised continuously to optimize ESD use and improve resource allocation within healthcare systems. [ABSTRACT FROM AUTHOR]

Abstract Introduction Given the increase in the primary care nursing workforce and the need to further grow nursing roles in the community understanding how this is included in undergraduate education is important. This study aimed to explore the inclusion of primary care in the undergraduate nursing education curriculum of four countries. Method A mixed‐method design was employed to obtain a broader context of primary care nursing in nursing education and teaching approaches relating to primary care nursing. Subsequently, Australia, Canada, Spain, and Ireland were selected for this study because primary healthcare systems are established as a part of their healthcare system. Results In total, 136 nursing faculties (40 in Australia, 35 in Canada, 46 in Spain, and 15 in Ireland) were invited to participate in this study. Of these, 27 responses were obtained (19.8% response rate). Following the survey phase, in‐depth interviews were conducted with 13 participants. The results indicated that the highest number was coded within the theme of “Understanding of PHC in the curriculum” (n = 108). The second highest number (n = 87) was within the theme of “Interpretation differences of PHC in curriculum,” and the third highest (n = 31) was coded within “Policy impact on health by national government and others.” Conclusion The results emphasized the ambiguity of primary care within the undergraduate nursing curriculum and that interpretation and implementation into the curriculum largely depended on the school's intentions.

Korakot Apiratwarakul,1 Lap Woon Cheung,2,3 Chatkhane Pearkao,4 Kamonwon Ienghong1 1Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong; 3Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; 4Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Kamonwon Ienghong, Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Mueang Khon Kaen District, Khon Kaen, 40002, Thailand, Tel +66 46 366 869, Fax +66 43 366 870, Email Kamonwan@kku.ac.thPurpose: Global warming is one of the critical problems affecting health, society, and the economy. High temperatures are linked to an increase in heat-related illnesses, which have significantly impacted the public health system, particularly emergency medical services (EMS). Analyzing the pattern of heat-related illness cases in EMS can improve resource utilization and preparedness within the public health system.Patients and Methods: A retrospective study was conducted on EMS data from Srinagarind Hospital, Thailand, covering the summer months (February to May) from 2020 to 2024. Patients with heat-related illnesses were identified in the EMS database using the 10th revision of the International Classification of Diseases (ICD-10) version 2019, specifically codes under “T67 Effects of Heat and Light”, which include heat stroke, heat syncope, heat cramps, heat exhaustion, and heat fatigue.Results: A total of 136 EMS operations from the hospital’s database were analyzed. In the summer 2024 group, 95.7% (N=44) of the patients were male. The majority of EMS triage cases required resuscitation (P = 0.020). Outdoor activity was identified as a significant factor related to heat illness, with rates of 83.3%, 92.9%, 93.3%, 97.1%, and 93.5% over the five years of the study. The activation time was 1.30 minutes for the summer of 2024 and 1.24 minutes for the summer of 2023. Notably, the average scene time in the summer 2024 group was significantly longer at 25.2 minutes, compared to 12.0 minutes in the summer 2020 group (P< 0.001).Conclusion: Outdoor activity was the most significant risk factor associated with increased heat-related illnesses. Other contributing factors included male gender, age between 20– 40 years, scene temperatures above 35°C, and prolonged scene times exceeding 15 minutes.Keywords: global warming, healthcare policy, heat illness, prehospital emergency care

Man Teng Iong Faculty of Law, University of Macau, Macao, People’s Republic of ChinaCorrespondence: Man Teng Iong, Faculty of Law (FLL), University of Macau, E32, Avenida da Universidade, Taipa, Macau, People’s Republic of China, Email mantengiong@um.edu.moAbstract: Governments worldwide have made significant efforts to combat the COVID-19 pandemic. Nonetheless, measures against the COVID-19 outbreak have raised concerns relating to the measures that can affect health and endanger the lives of patients not related to COVID-19 but needing emergency treatments. For instance, ambulances were sometimes unable to access restricted zones for patients in urgent situations, and emergency departments were closed or refused urgent cases due to healthcare policies during the pandemic. To prevent such issues in future public health emergencies, changes to existing pandemic prevention measures are necessary. This article, through narrative review, intends to find a better healthcare policy during pandemic to protect proportionally public health and simultaneously guarantee the health and lives of non-COVID-19 patients needing emergency care. For this purpose, it provides three suggestions: ensuring ambulance access to confined areas, strengthening emergency department capabilities, and finding a balance between pandemic control and respect for patient rights. These suggestions are paramount to safeguard public health while securing the health and living for those needing urgent medical care.Keywords: healthcare policy, pandemic, COVID-19, individual rights, public health

Hussam M Alsaleh,1,2 Saad M Alsaad,3 Sami S Alabdulwahab,1 Vishal Vennu,1 Saad M Bindawas1,4 1Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 3Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4King Salman Center for Disability Research, Riyadh, Saudi ArabiaCorrespondence: Saad M Bindawas, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, 10219, Riyadh, 11433, Saudi Arabia, Tel +966114696226, Email sbindawas@ksu.edu.saPurpose: Falls among older adults are a growing public health concern in Saudi Arabia. The Otago Exercise Program (OEP) is an evidence-based intervention aimed at reducing fall risk in this population. This study assessed the knowledge and attitudes of Saudi Arabian physical therapists toward the OEP and examined potential gender-based differences.Patients and Methods: A cross-sectional survey was conducted between November 2023 and April 2024, involving 120 licensed physical therapists from Saudi Arabia, recruited via Email and social media. The survey captured sociodemographic data, knowledge, and attitudes regarding the OEP. Responses were analyzed using descriptive statistics, chi-square tests, and Cramér’s V to assess the strength of associations, with a significance level set at p < 0.05.Results: Most physical therapists reported knowledge of the OEP’s clinical effectiveness (36.7%), cultural compatibility (35.0%), and fall prevention benefits (28.3%). Gender was not significantly associated with knowledge of clinical effectiveness (χ² = 3.84, p = 0.57), contraindications (χ² = 4.44, p = 0.48), cost-effectiveness (χ² = 4.15, p = 0.52), or fall prevention in older adults (χ² = 2.44, p = 0.78), with moderate effect sizes observed (Cramer’s V = 0.233 to 0.467). Attitudes toward the OEP were generally positive, with 51.7% supporting its use in regular aging care and 45.0% expressing confidence in delivering the program. There were no significant gender differences in understanding the OEP’s recommendations (χ² = 7.45, p = 0.11) or confidence in program delivery (χ² = 7.62, p = 0.10), although strong association effects were noted (Cramer’s V = 0.696 and 0.680, respectively).Conclusion: This study highlights the strong knowledge and positive attitudes of Saudi physical therapists toward the OEP, underscoring its potential for integration into national healthcare strategies to improve geriatric care and reduce fall-related risks. The findings emphasize the importance of continuous professional development to address knowledge gaps and optimize the implementation of evidence-based fall prevention programs.Keywords: healthcare policy, risk reduction, fall prevention, physical therapists, older adults, Saudi Arabia

Abstract Background The considered shift from individual blame and sanctions towards a commitment to system-wide learning from incidents in healthcare has led to increased understanding of both the moral and epistemic importance of involving those affected. It is important to understand whether and how local policy describes and prompts involvement with a view to understanding the policy landscape for serious incident investigations in healthcare. This study aimed to explore the way in which involvement of those affected by serious incidents is represented in incident investigation policy documents across acute and mental health services in the English NHS, and to identify guidance for more effective construction of policy for meaningful involvement. Methods We conducted a documentary analysis of 43 local serious incident investigation policies to explore the way in which involvement in serious incident investigations is represented in policy documents across acute and mental health services in the NHS in England. Results Three headline findings were generated. First, we identified involvement as a concept was conspicuous by its absence in policy documents. Direct reference to support or involvement of those affected by serious incidents was lacking. Even where involvement and support were recognised as important, this was described as a passive process rather than there being moral or epistemic justification for more active contribution to learning. Second, learning from serious incidents was typically described as a high priority but the language used was unclear and ‘learning’ was more often positioned as construction of an arbitrary set of recommendations rather than a participatory process of deconstruction and reconstruction of specific systems and processes. Third, there was an emphasis placed on a just and open culture but paradoxically this was reinforced by expected compliance, positioning investigations as a tool through which action is governed rather than an opportunity to learn from and with the experiences and expertise of those affected. Conclusions More effective representation in policy of the moral and epistemic reasons for stakeholder involvement in serious incident investigations may lead to better understanding of its importance, thus increasing potential for organisational learning and reducing the potential for compounded harm. Moreover, understanding how structural elements of policy documents were central to the way in which the document is framed and received is significant for both local and national policy makers to enable more effective construction of healthcare policy documents to prompt meaningful action.

Abstract Background Postpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS. Methods Four focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis. Results Analysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety. Conclusions Findings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication.

This manuscript explores the historical development and significance of geriatric and anti-aging research in Ukraine, emphasizing its vital role in advancing global gerontology and geriatrics.The manuscript highlights the multidisciplinary aims of Ukrainian gerontological research, including understanding the biological mechanisms of aging, developing medical treatments for chronic diseases prevalent in older populations, and addressing the social and psychological aspects of aging. It also discusses the challenges of Ukraine’s aging population, such as healthcare policy reform, improved geriatric care integration, and increased funding for aging research. A significant emphasis is placed on incorporating anti-aging studies into medical education. By updating medical curricula to include comprehensive anti-aging education, Ukraine can better prepare future healthcare professionals to meet the evolving needs of its aging population. The manuscript concludes that such educational reforms are crucial for enhancing the effectiveness and sustainability of Ukraine’s healthcare system, ultimately improving the quality of life for older adults and aligning with global trends in aging research.

Background: The 2018 UNOS allocation policy change deprioritized geographic boundaries to organ distribution, and the effects of this change have been widespread. The aim of this investigation was to analyze changes in donor transplant center distance for organ travel and corresponding outcomes before and after the allocation policy change. Methods: The UNOS database was utilized to identify all adult patients waitlisted for heart transplants from 2016 to 2021. Transplant centers were grouped by average donor heart travel distance based on whether they received more or less than 50% of organs from >250 miles away. Descriptive statistics were provided for waitlisted and transplanted patients. Regression analyses modeled waitlist mortality, incidence of transplant, overall survival, and graft survival. Results: Centers with a longer average travel distance had a higher mean annual transplant volume with a reduction in total days on a waitlist (86.6 vs. 149.2 days), an increased cold ischemic time (3.6 vs. 3.2 h), with no significant difference in post‐transplant overall survival or graft survival. Conclusions: The benefits of reducing waitlist time while preserving post‐transplant outcomes extend broadly. The trends observed in this investigation will be useful as we revise organ transplant policy in the era of new organ procurement and preservation techniques. [ABSTRACT FROM AUTHOR]

Background: The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Clinical relevance: Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement coding. Technological advancement: The tissue-sparing posterior cervical fusion procedure was approved by the US Food and Drug Administration (FDA) in 2018 (CORUS™ Spinal System and CAVUX® Facet Fixation System (CORUS/CAVUX); Providence™ Medical Technology). This technique addresses the concerns with traditional spine fusion methods by achieving the stability and outcomes of posterior cervical fusion without the morbidity associated with significant muscle stripping in the traditional approach. This technology uses specialized implants and instrumentation to perform all of the steps required to facilitate bone fusion and provide stability while minimizing tissue disruption. The technique involves extensive bone preparation for fusion and placement of specialized stabilization implants that span the facet joint, promoting natural bone growth and fusion while reducing the need for extensive exposure. This procedure provides an effective, less invasive solution for patients with cervical degenerative disc disease. Reimbursement and coding clarity: The article provides a comprehensive rationale for appropriate reimbursement coding for tissue-sparing posterior cervical fusion. This is a critical aspect for the adoption and accessibility of medical technologies. This information is crucial for practitioners and healthcare administrators, ensuring that innovative procedures are accurately coded and reimbursed. Procedural details and clinical evidence: By detailing the procedural steps, instruments used and the physiological basis for the procedure, this article serves as a valuable educational resource for spine surgeons and payers to appropriately code for this procedure. Conclusions: The description of work for CORUS/CAVUX is equivalent to the current surgical standard of lateral mass screw fixation with decortication and onlay posterior grafting to facilitate posterior fusion. Thus, it is recommended that CPT codes 22600/22840 be used, as they best reflect the surgical approach, instrumentation, decortication, posterior cervical fusion and bone grafting procedures. [ABSTRACT FROM AUTHOR]

Background: Over the past decades, US Congress enabled the US Food and Drug Administration (FDA) to facilitate and expedite drug development for serious conditions filling unmet medical needs with five special designations and review pathways: orphan, fast track, accelerated approval, priority review, and breakthrough therapy. Objectives: This study reviews the FDA's five special designations for drug development regarding their safety, efficacy/clinical benefit, clinical trials, innovation, economic incentives, development timelines, and price. Methods: We conducted a keyword search to identify studies analyzing the impact of the FDA's special designations (orphan, fast track, accelerated approval, priority review, and breakthrough therapy) on the safety, efficacy/clinical benefit, trials, innovativeness, economic incentives, development times, and pricing of new drugs. Results were summarized in a narrative overview. Results: Expedited approval reduces new drugs' time to market. However, faster drug development and regulatory review are associated with more unrecognized adverse events and post-marketing safety revisions. Clinical trials supporting special FDA approvals frequently use small, non-randomized, open-label designs. Required post-approval trials to monitor unknown adverse events are often delayed or not even initiated. Evidence suggests that drugs approved under special review pathways, marketed as "breakthroughs", are more innovative and deliver a higher clinical benefit than those receiving standard FDA approval. Special designations are an economically viable strategy for investors and pharmaceutical companies to develop drugs for rare diseases with unmet medical needs, due to financial incentives, expedited development timelines, higher clinical trial success rates, alongside greater prices. Nonetheless, patients, physicians, and insurers are concerned about spending money on drugs without a proven benefit or even on drugs that turn out to be ineffective. While European countries established performance- and financial-based managed entry agreements to account for this uncertainty in clinical trial evidence and cost-effectiveness, the pricing and reimbursement of these drugs remain largely unregulated in the US. Conclusion: Special FDA designations shorten clinical development and FDA approval times for new drugs treating rare and severe diseases with unmet medical needs. Special-designated drugs offer a greater clinical benefit to patients. However, physicians, patients, and insurers must be aware that special-designated drugs are often approved based on non-robust trials, associated with more unrecognized side effects, and sold for higher prices. [ABSTRACT FROM AUTHOR]

The potential adverse consequences associated with poor concussion management highlights the need to improve the translation of concussion guidelines into consistent use in real-world sport settings. To facilitate this process, New Zealand Rugby developed a community concussion management pathway to support concussion recognition, diagnosis, and management. This study adopted a pragmatic, descriptive qualitative approach to explore key stakeholders' perceptions of the concussion management pathway, with the aim to inform policy and practice. Interviews were conducted with 123 participants, including players, parents, coaches, healthcare professionals, and school and provincial union representatives. The framework method was used to analyze data. Themes were organized according to the principles of realist process evaluation that considers contextual factors and mechanisms influencing a program's operation to produce specific outcomes. Contextual factors influencing the concussion management pathway's implementation included governing bodies' support, existing local resources, general concussion attitudes, or concussion severity. The optimal functioning of the concussion management pathway (mechanism) was influenced by (i) pathway resources, (ii) roles and relationships, (iii) buy-in and support towards the concussion management pathway, and (iv) diligence and communication. Outcomes identified included (i) hitting the target (optimally managed and enhanced awareness) or (ii) missing the mark (dissatisfaction or management gaps). Overall, participants found the concussion management pathway valuable. However, the acceptability of certain policy-related aspects and the underlying attitudes associated with these perceptions, are some areas requiring further investigation and support. Tailoring programs according to end-users' perceptions is crucial in developing context-sensitive interventions appropriate for a specific setting. These findings may act as a foundation for investigations of concussion management in other settings. [ABSTRACT FROM AUTHOR]

This study examines the impact of public policy, specifically health policy, on sports promotion and support. This analysis explores the impact of healthcare policies on sports activities and the significance of public policy in enhancing population health. It evaluates policies across different countries and sectors to determine their effectiveness. The study employs various research methods, including policy analysis, case studies, and secondary data analysis, to offer a comprehensive view of policy effects. The findings indicate that healthcare policies play a vital role in promoting sports. Health insurance, healthcare promotional campaigns, and the construction of appropriate sports facilities all have a significant impact on sports participation levels. Through the implementation of comprehensive sports promotion policies, there was a notable 7.3 percentage point increase observed over a span of five years. The study also emphasises the secondary impacts, such as a slight decrease in healthcare expenses and enhanced approaches to tackling chronic illnesses and mental health concerns. The study highlights the effectiveness of policy interventions, such as the national fitness policy in Nordic countries and South Korea, which emphasise the use of multidisciplinary approaches. Implications: The outcomes provide guidelines for developing and implementing healthcare policies, suggestions for improving long-term Integrated Health Care Policy, and proposals for targeted solutions that address diverse populations. [ABSTRACT FROM AUTHOR]

U.S. health agencies periodically evaluate transplant programs based on their patients' posttransplant survival outcomes, and a program is flagged for review if the number of unsuccessful transplants far exceeds what would be expected based on national averages. Some researchers have expressed concerns that these regulations might cause programs to reject high-risk patients, whereas others have questioned if such a response would be rational. In "Characterizing Rational Transplant Program Response to Outcome-Based Regulation," Mildebrath et al. use chance-constrained optimization to demonstrate that it may, in fact, be rational for a transplant program to become more selective when evaluating transplant candidates for admittance to the waitlist. They also demonstrate that the regulations may unfairly penalize medium-sized programs. Moreover, their model quantifies which patients may be most at risk for adverse selection by programs. Their results provide insights to policymakers by quantitatively characterizing the response of rational programs to outcome-based regulations. Organ transplantation is an increasingly common therapy for many types of end-stage organ failure, including lungs, hearts, kidneys, and livers. The last 20 years have seen increased scrutiny of posttransplant outcomes in the United States to ensure the efficient utilization of the scarce organ supply. Under regulations by the Organ Procurement Transplantation Network (OPTN) and Centers for Medicare and Medicaid Services (CMS), the United States has seen a rise in risk-averse patient selection among transplant programs, resulting in decreased transplantation volume for some programs. Despite this observed decrease, the response of transplant programs to OPTN/CMS regulations remains poorly understood. In this work, we consider the perspective of a transplant program that seeks to simultaneously maximize transplant volume and control the risk of OPTN/CMS penalization. Using a chance-constrained mixed-integer programming model, we demonstrate that under certain conditions, it may be rational for a transplant program to curtail its transplant volume to avoid penalization under OPTN/CMS regulations. This finding, which confirms empirical results observed in the clinical literature, suggests that such regulations may be inherently unsuitable for use in incentivizing improved program performance. We also highlight other structural shortcomings of OPTN/CMS regulations that have not been observed previously in the literature. Funding: This work was supported by the U.S. Department of Defense and the National Science Foundation [Grants CMMI-1826144, CMMI-1826297, and CMMI-1826323]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/opre.2018.0721. [ABSTRACT FROM AUTHOR]

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Background: In the United States, the scheduling system for controlled substances was established by the Controlled Substance Act of 1970. In 2009, Parker et al. published the study “Physicians' knowledge and attitudes toward scheduling.” Since 2009, the opioid epidemic has gathered national attention from social and scientific perspectives as the number of drug overdose deaths in the United States has nearly tripled. Objective: To follow up on a 2009 survey by Parker, et al. to determine prescribers' knowledge and attitudes regarding the controlled substance scheduling system and assess the impact of the controlled substance scheduling system on providing optimal patient care. Methods: The cross-sectional survey was designed to assess prescribers' attitudes and mailed to 400 randomly selected physicians and 400 randomly selected nurse practitioners. Results: Prescribers across all groups provided consistent responses suggesting an overall lack of understanding of controlled substance regulations, a negative attitude towards the controlled substance scheduling system, and a detrimental effect on providing optimal patient care. Responses from nurse practitioners differed significantly from physicians in 75 % (3 of the 4) questions regarding regulations, suggesting nurse practitioners possess a greater understanding of pharmaceutical regulations. Specialists' responses demonstrated an enhanced level of dissatisfaction regarding the controlled substance scheduling system compared to primary care providers in 75 % (3 of the 4) questions. Questions regarding the impact of the scheduling system on prescribing patterns differed significantly across multiple demographic groups, notably between physicians and nurse practitioners, differences in practice setting, and primary state of practice for 75 % (3 of the 4) questions. Conclusions: The results of this survey confirm the findings of Parker, et al., and further display the need for investigation into how to improve the controlled substance scheduling system in the United States.

Introduction: Deprescribing serves as a pivotal measure to mitigate the drug-related problem due to polypharmacy. This study aimed to map the factors influencing healthcare providers’ deprescribing decision using the Behaviour Change Wheel framework and develop an innovative conceptual model to support deprescribing practice.Methods: A cross-sectional online survey targeting doctors and pharmacists was conducted to assess the influence of various factors on healthcare providers’ comfort in recommending deprescribing. The conceptual model was formulated, based on the existing deprescribing framework and the Behaviour Change Wheel. The model’s robustness was scrutinised through Partial Least Squares Structural Equation Modeling (PLS-SEM), and model-fitting indices were employed to obtain the best-fit model.Results: A total of 736 responses were analysed with the final best-fit model consisting of 24 items in 5 constructs (R2: 0.163; SRMR: 0.064; rho_c: 0.750–0.862; AVE: 0.509–0.627) and three independent factors. Based on the results, we proposed that deprescribing could be promoted through strategies aimed at enhancing healthcare providers internal capabilities such as knowledge levels, when patients’ condition deteriorated and previous experiences with adverse events of drugs. Organisational support in providing such educational opportunities is important, with the empowerment of patient and healthcare providers through policy enhancements, guideline development, and effective communication.Conclusion: The deprescribing behaviours of healthcare professionals are influenced by an intricate interplay of patient, prescriber, and system factors. Enhancing deprescribing practices necessitates a comprehensive strategy that encompasses providers and patients’ education, the development of structured deprescribing guidelines, the implementation of deprescribing support tools, and the enhancement of communication between healthcare providers.

Attending the Michigan State Medical Society House of Delegates (MSMS HOD) meeting was a transformative experience that deepened my understanding of the vital role organized medicine plays in shaping healthcare. The meeting's diverse and passionate discussions on critical issues highlighted the profound impact of collective advocacy. Networking with experienced physicians underscored the value of involvement in medical societies for career enrichment and mentorship. This experience inspired me to actively participate in organized medicine to advocate for meaningful changes in healthcare. I urge fellow medical students to engage in similar experiences to gain insights into healthcare policy, develop leadership skills, and contribute to the future of our profession.

Background: A decrease in populations could affect healthcare access and systems, particularly in medically underserved areas (MUAs) where depopulation is becoming more prevalent. This study aimed to simulate the future population and land areas of MUAs in Japan. Methods: This study covered 380,948 1 km meshes, 87,942 clinics, and 8354 hospitals throughout Japan as of 2020. The areas outside a 4 km radius of medical institutions were considered as MUAs, based on the measure of areas in the current Japanese Medical Care Act. Based on the population estimate for a 1 km mesh, the population of mesh numbers of MUAs was predicted for every 10 years from 2020 to 2050 using geographic information system analysis. If the population within a 4 km radius from a medical institution fell below 1000, the institution was operationally assumed to be closed. Results: The number of MUAs was predicted to decrease from 964,310 (0.77% of the total Japanese population) in 2020 to 763,410 (0.75%) by 2050. By 2050, 48,105 meshes (13% of the total meshes in Japan) were predicted to be new MUAs, indicating a 31% increase in MUAs from 2020 to 2050. By 2050, 1601 medical institutions were tentatively estimated to be in close proximity. Conclusions: In Japan, the population of MUAs will decrease, while the land area of MUAs will increase. Such changes may reform rural healthcare policy and systems.

Aims: Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria. Methods: Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated. Results: The 30-day and one-year readmission rates due to any complication were 15% and 47%, respectively. The 30-day readmission rate (p = 0.001) was higher in endoprosthesis than osteosynthesis patients; this was not the case for the one-year readmission rate (p = 0.138). Internal medicine- (n = 2,273 (20%)) and surgery/injury-associated complications (n = 1,612 (14%)) were the most common reason for one-year readmission. Regardless of the surgical procedure, male sex was significantly associated with higher readmission risk due to any, as well as internal medicine-associated, complication. Advanced age was significantly associated with higher readmission risk after osteosynthesis. In both cohorts, treatment at mid-sized hospitals was significantly associated with lower readmission risk due to any complication, while prolonged length of stay was associated with higher one-year readmission risks due to any complication, as well as internal-medicine associated complications. Conclusion: Future health policy decisions in Austria should focus on optimization of perioperative and post-discharge management of this vulnerable patient population. Cite this article: Bone Jt Open 2024;5(4):294–303.

Background: A pilot project for telemedicine has been underway since June 2023. However, ongoing issues have persisted since its implementation. This study aimed to review the current status and challenges of this project and recommend necessary improvements. Current Concepts: The following challenges were observed. First, the primary and incidental effects of this pilot project were not presented. It is not a small-scale project as it targets the entire population without a strict predesign. Its evaluation must have a defined implementation period. Currently, an indefinite implementation period has been proposed until the medical law is revised. Second, safety measures were found to be inadequate. Lastly, from an industrial standpoint, the government unilaterally promoted telemedicine policies. Discussion and Conclusion: Enhancements should be implemented in this telemedicine pilot project to ensure safety. First, the project objectives were clearly defined. Clear policy effects and evaluation criteria should be presented, and the project should be implemented through a rigorous policy design to verify them. Second, policy measures should be established to ensure safety. Lastly, administrative and legal improvements related to telemedicine should be implemented simultaneously. [ABSTRACT FROM AUTHOR]

Background: A decrease in populations could affect healthcare access and systems, particularly in medically underserved areas (MUAs) where depopulation is becoming more prevalent. This study aimed to simulate the future population and land areas of MUAs in Japan. Methods: This study covered 380,948 1 km meshes, 87,942 clinics, and 8354 hospitals throughout Japan as of 2020. The areas outside a 4 km radius of medical institutions were considered as MUAs, based on the measure of areas in the current Japanese Medical Care Act. Based on the population estimate for a 1 km mesh, the population of mesh numbers of MUAs was predicted for every 10 years from 2020 to 2050 using geographic information system analysis. If the population within a 4 km radius from a medical institution fell below 1000, the institution was operationally assumed to be closed. Results: The number of MUAs was predicted to decrease from 964,310 (0.77% of the total Japanese population) in 2020 to 763,410 (0.75%) by 2050. By 2050, 48,105 meshes (13% of the total meshes in Japan) were predicted to be new MUAs, indicating a 31% increase in MUAs from 2020 to 2050. By 2050, 1601 medical institutions were tentatively estimated to be in close proximity. Conclusions: In Japan, the population of MUAs will decrease, while the land area of MUAs will increase. Such changes may reform rural healthcare policy and systems. [ABSTRACT FROM AUTHOR]

In Germany, a comprehensive reimbursement policy for extracorporeal membrane oxygenation (ECMO) results in the highest per capita use worldwide, although benefits remain controversial. Public ECMO data is unstructured and poorly accessible to healthcare professionals, researchers, and policymakers. In addition, there are no uniform policies for ECMO allocation which confronts medical personnel with ethical considerations during health crises such as respiratory virus outbreaks.Retrospective information on adult and pediatric ECMO support performed in German hospitals was extracted from publicly available reimbursement data and hospital quality reports and processed to create the web-based ECMO Dashboard built on Open-Source software. Patient-level and hospital-level data were merged resulting in a solid base for ECMO use analysis and ECMO demand forecasting with high spatial granularity at the level of 413 county and city districts in Germany.The ECMO Dashboard (https://www.ecmo-dash.de/), an innovative visual platform, presents the retrospective utilization patterns of ECMO support in Germany. It features interactive maps, comprehensive charts, and tables, providing insights at the hospital, district, and national levels. This tool also highlights the high prevalence of ECMO support in Germany and emphasizes districts with ECMO surplus – where patients from other regions are treated, or deficit – origins from which ECMO patients are transferred to other regions. The dashboard will evolve iteratively to provide stakeholders with vital information for informed and transparent resource allocation and decision-making.Accessible public routine data could support evidence-informed, forward-looking resource management policies, which are urgently needed to increase the quality and prepare the critical care infrastructure for future pandemics. [ABSTRACT FROM AUTHOR]

In the transformative landscape of healthcare, personalized medicine emerges as a pivotal shift, harnessing genetic, environmental and lifestyle data to tailor medical treatments for enhanced outcomes and cost efficiency. Central to its success is public engagement and consent to share health data amidst rising data privacy concerns. To investigate European public opinion on this paradigm, we executed a comprehensive cross-sectional survey to capture the general public's views on personalized medicine and data-sharing modalities, including digital tools and electronic records. The survey was distributed in eight major European Union countries and the results aim at guiding future policymaking and trust-building measures for secure health data exchange. This article delineates our methodological approach, whereby survey findings will be expounded in subsequent publications. Executive summary A collaborative cross-sectional online survey was developed by researchers from Università Cattolica del Sacro Cuore and Amsterdam UMC to assess European Union (EU) citizens' attitudes toward personalized medicine and genomic data sharing. Structured into four thematic modules comprising 37 questions in total, the survey comprehensively addressed individuals' knowledge, attitudes towards data sharing, governance issues and perceived personal needs related to personalized medicine. Translations into eight European languages were undertaken to ensure broad accessibility, with distribution managed by a private company, ensuring high-quality research standards and privacy compliance. The survey aims to inform and shape policy on personalized medicine by capturing a snapshot of current EU views, with an outlook on enhancing healthcare through data-driven and patient-tailored approaches. While providing valuable insights for EU policymaking in healthcare, the survey acknowledges limitations such as potential online user bias, language restrictions and self-reported data accuracy. [ABSTRACT FROM AUTHOR]

Introduction: The governance of healthcare systems plays a pivotal role in shaping global healthcare outcomes by influencing factors such as power dynamics, accountability, transparency, participation, and policy consistency. To drive transformative changes in healthcare, it can be necessary to modify the rules and processes that determine authority and accountability in health policies, organizations, products, and professionals. Crucially, stakeholder engagement throughout change processes is paramount to effectively mitigate resistance when introducing innovative changes within the healthcare system. At each stage of healthcare policy development, stakeholder participation is vital to ensure the attainment of desired goals. Ineffective involvement of stakeholders can result in suboptimal policy formulation and unfavourable outcomes. While Nurses form the largest part of the healthcare workforce globally, current evidence suggests poor involvement in healthcare policymaking. Objectives: This review protocol aims to provide a procedure for investigating the extent of nurses' involvement in healthcare policy, explore the research evidence concerning barriers and facilitators of nurses' involvement in policymaking, and identify interventions and strategies that promote nurses' engagement in healthcare policy. Methods: Primary studies that utilize qualitative, quantitative, or mixed research methods will be sourced from the following databases: MEDLINE, CINAHL Plus with Full Text and CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, PubMed, PsychINFO, and Google Scholar. The PRISMA-ScR guidelines will be followed to ensure systematic review and data management. The results will be presented in a tabular or diagrammatic format, depending on the results, summarizing the available evidence on nurses' involvement in the policy- making process. Expected Outcome: Overall, the final scoping review intends to contribute to the understanding of nurses' participation in healthcare policymaking, shedding light on effective strategies and interventions to enhance their involvement. By exploring this vital aspect, we aim to map evidence around the concept of nurses' involvement in strategic healthcare policy within healthcare systems. Registration: This protocol has been registered with the Centre for Open Science at https://osf.io/cnh4a including protocol metadata. [ABSTRACT FROM AUTHOR]

Background: Perhaps nowhere else in the healthcare system than in the intensive care unit environment are the challenges to create useful models with direct time-critical clinical applications more relevant and the obstacles to achieving those goals more massive. Machine learning-based artificial intelligence (AI) techniques to define states and predict future events are commonplace activities of modern life. However, their penetration into acute care medicine has been slow, stuttering and uneven. Major obstacles to widespread effective application of AI approaches to the real-time care of the critically ill patient exist and need to be addressed. Main body: Clinical decision support systems (CDSSs) in acute and critical care environments support clinicians, not replace them at the bedside. As will be discussed in this review, the reasons are many and include the immaturity of AI-based systems to have situational awareness, the fundamental bias in many large databases that do not reflect the target population of patient being treated making fairness an important issue to address and technical barriers to the timely access to valid data and its display in a fashion useful for clinical workflow. The inherent "black-box" nature of many predictive algorithms and CDSS makes trustworthiness and acceptance by the medical community difficult. Logistically, collating and curating in real-time multidimensional data streams of various sources needed to inform the algorithms and ultimately display relevant clinical decisions support format that adapt to individual patient responses and signatures represent the efferent limb of these systems and is often ignored during initial validation efforts. Similarly, legal and commercial barriers to the access to many existing clinical databases limit studies to address fairness and generalizability of predictive models and management tools. Conclusions: AI-based CDSS are evolving and are here to stay. It is our obligation to be good shepherds of their use and further development. [ABSTRACT FROM AUTHOR]

The objective was to understand experiences of double motherhood during antenatal, childbirth and postpartum healthcare, using a qualitative method involving individual online interviews and asynchronous, online focus groups of cisgender women, mostly in same-sex relationships. The results revealed how these women’s experiences of parenting were marginalised, highlighting institutional violence in Brazilian healthcare services, which are presented here in two thematic dimensions: 1) Cisheteronormativity and its impact on experiences of double motherhood; and 2) Institutional violence in healthcare services: from curiosity to LGBTQIA+phobia. It was concluded that cisheteronormativity hinders healthcare for these experiences, especially by rendering the non-gestational mother invisible. This underscores the urgent need to train healthcare personnel, rethink and challenge cisgender and heterosexual norms and promote inclusive policies to ensure equitable care and combat institutional violence. [ABSTRACT FROM AUTHOR]

ImportanceSocial media platforms have allowed the formation of informal professional healthcare networks. Transparency in funding, membership requirements, financial conflicts of interest (FCOI), and messaging are necessary to ensure best practices for similar networks in the future.ObjectiveTo analyze the FCOIs of US-based physician members of the OncoAlert Network and appraise the content of their public Twitter account.Design, setting, participantsThis cross-sectional study assessed the FCOIs among US-based physician members of the OncoAlert Network between 2015 and 2020. FCOI data were obtained through the Open Payments Database. Additionally, tweets were examined for content analysis.Main outcomes and measuresThe number of US-based physician members with FCOIs with the pharmaceutical industry; the amount of general, research, and associated research payments; and the perceived attitude of tweet content from the OncoAlert Network Twitter account.ResultsOf 34 US physician members of the OncoAlert Network, 31 (91.2%) received general payments from pharmaceutical companies according to the Open Payments Database. Between 2015 and 2020, US physician members of the OncoAlert Network received a median of $83,600 in general payments (interquartile range [IRQ], $7,200-$221,500). Fourteen members (41.1%) received more than $100,000 in general payments. Additionally, 480 (15.7 %) of 3064 tweets retrieved from the OncoAlert Twitter account mentioned a drug or clinical trial. Of these, 31.6 % (n = 152) had a positive disposition and 3.3 % (n = 16) were negative or critical.Conclusions and relevanceOver 90% of US physician members of the OncoAlert Network had FCOIs between 2015 and 2020. Despite the network's non-profit status, FCOIs amongst its members may influence content produced on the network's social media platforms, such as Twitter, where content discussing drugs and clinical trials are often positive and seldom negative or critical. For future informal professional networks, further research is required to establish best practices for issues such as membership requirements, funding, and FCOI disclosure.

Yousra Odeh,1 Mahmoud Al-Balas2 1Software Engineering Department, Faculty of Science and Information Technology, Al Zaytoonah University of Jordan, Amman, 11733, Jordan; 2Department of General Surgery, Anesthesia and Urology, Faculty of Medicine, The Hashemite University, Zarqa, 13133 JordanCorrespondence: Yousra Odeh, Software Engineering Department, Faculty of Science and Information Technology, Al Zaytoonah University of Jordan, Amman, 11733, Jordan, Tel +9626-429151100962, Fax +9626- 4291432, Email y.odeh@zuj.edu.jo; yousraodeh.odeh@gmail.comPurpose: The complex nature of breast cancer demands flexible and adaptable principles that can account for the diverse characteristics and evolving conditions of each patient. However, there are no common breast cancer treatment agility principles that can influence policies and direct breast cancer professionals and healthcare providers into enhancing the delivery of health outcomes to patients under these conditions along with continuous rapid improvements in breast cancer treatment plan design. The incorporation of agile principles from software engineering offers a promising avenue for enhancing patient care. This research is conducted to identify breast cancer treatment agility principles adopted from the software engineering field and to validate their conformance to agility through work reported from literature in breast cancer treatment context.Material and Methods: The authors applied a structured research methodology that involved interviews for eliciting and validating twelve agility principles from oncologists. Discussion of each principle is reflected using work reported from literature as a form of validation. Finally, a domain expert reviewed the literature-driven validation for each of the twelve identified breast cancer treatment agile principle to finally validate their conformance to agility and provide results.Results: This work resulted twelve validated agility principles for breast cancer treatment and classified whether they are meeting, partially-(hybrid), or not meeting agility. Seven out of the twelve agile principles resulted as meeting agility, where the remaining five principles resulted as partially meeting agility. None of them is recorded as not meeting agility.Conclusion: The work contributes to forming an agile mindset that can empower breast cancer professionals to optimize treatment plans, enhance patient experiences, and continuously improve the quality of care. The twelve identified agile principles are anticipated to contribute to driving more efficient oncology practices, policies, and protocols. It is concluded that the breast cancer treatment agility principles are not limited to twelve.Keywords: agile breast cancer, breast cancer, breast cancer treatment, agile, oncology, agile software engineering, agile healthcare, agile principles, multidisciplinary research, healthcare policy

In the field of healthcare, the intersection of Artificial Intelligence (AI) and Public Health has emerged as an essential component, presenting numerous opportunities for innovation that are one of a kind. The purpose of this research paper is to investigate the historical development, current patterns, and global repercussions of incorporating AI into healthcare systems. The paper provides a comprehensive analysis of the application of AI in the field of public health. It covers the progression of the field, beginning with the initial efforts to automate diagnostic procedures and ending with the most recent developments in predictive modeling and precision medicine. The research investigates the degree to which various nations have adopted AI, highlighting both successful implementations and ongoing challenges in the framework of the global landscape. The intentional incorporation of AI is presented as a driving force for the transformation of healthcare provision. This transformation has the potential to provide potential benefits such as improved precision in diagnosis, effectiveness in treatment, and efficient utilization of treatment resources. In addition, the paper places an emphasis on the proactive role that AI plays in identifying and mitigating emerging health risks. Providing useful information about the policies, practices, and frameworks that enable the efficient incorporation of AI into public health is the primary objective of this research. The purpose of this paper is to provide policymakers, healthcare practitioners, and researchers with suggestions that can be put into practice today by combining historical perspectives and analyzing patterns that are currently occurring. The purpose of this action is to have an impact on the conversation that is taking place about the future of healthcare delivery, with the intention of highlighting the significant impact that AI can have on improving the circumstances of public health.

M Zaenul Muttaqin,1,&ast; Yansen Alberth Reba,2,&ast; Yovian Yustiko Prasetya3,&ast; 1Department of State Administration, Universitas Cenderawasih, Papua, Indonesia; 2Department of Guidance and Counseling, Universitas Cenderawasih, Papua, Indonesia; 3Department of Guidance and Counseling, Universitas Pancasakti Tegal, Tegal, Indonesia&ast;These authors contributed equally to this workCorrespondence: M Zaenul Muttaqin, Department of State Administration, Universitas Cenderawasih, Papua, Indonesia, Email mzaenul69@gmail.com

The aim of this study is to understand the problems of managing psychological disorders in migrant populations, based on the experience of general practitioners. A qualitative study was carried out with general practitioners interviewed in a semi-directive mode. We chose the continuous comparison method and Peirce's pragmatic phenomenological approach to explore the lived experience. Thirteen interviews revealed four phenomenological categories: (1) Immigration was an experience of mental suffering from beginning to end at the source of psychological disorder migrant population (PDMPs) with the need for specialized follow-up. (2) Inadequate support on arrival, with complicated administrative procedures and insecure societal and environmental conditions, exacerbated the precariousness of migrants, making follow-up difficult. (3) Immigration was a transcultural journey in which the language, attitudes and perceptions of each individual blurred understanding of symptoms and care, and thus professional communication. (4) Unprepared general practitioners found counselling migrants to be difficult, time-consuming and complex. They pointed to the need for a coordinated system with comprehensive multidisciplinary care. Data saturation was reached. Three researchers were brought together. This study highlights the difficulties encountered by general practitioner (GPs) dealing with migrant patients in France. They feel helpless in the face of the nature of the disorders encountered and experience a disparity between the connections that are difficult to establish and those in their usual practice, even when professional experience with this population is acquired. They point to the need for coordinated models of care, financed by public policy. [ABSTRACT FROM AUTHOR]

Industry-funded religious liberty legal groups have sought to undermine healthcare policy and law while simultaneously attacking the rights of sexual and gender minorities. Whereas past scholarship has tracked religiously-affiliated healthcare providers' growing political power and attendant transformations to legal doctrine, our account emphasizes the political donors and visionaries who have leveraged religious providers and the U.S. healthcare system's delegated structure to transform social policy and bureaucratic agencies more generally. [ABSTRACT FROM AUTHOR]

People with intellectual disability experience some of the greatest health disparities in Australia. Individuals are expected to access mainstream health services that are ill equipped to meet their needs. The Australian government has made recent commitments to improve the healthcare of people with intellectual disability. This article describes the Australian health system and how it responds to the needs of people with intellectual disability. It draws on examples of advances in policy, inclusion, and service development, achieved through concrete and persistent systemic advocacy, to discuss emerging evidence on the delivery of healthcare to people with intellectual disability in Australia. The article also highlights immediate priorities including increasing the uptake of health assessments, building the capacity of our health workforce, and responding to the needs of people with intellectual disability in COVID‐19 outbreaks or other natural disasters. Intellectual disability healthcare is at a dynamic point in Australia with commitment and funding from government to lead to change. It is critical that momentum in health services development is maintained to enable improved health outcomes for people with intellectual disability. [ABSTRACT FROM AUTHOR]

This essay argues for two conclusions. First, clinical decision-making is not best thought of as analogous to the purchase of other services, such as car repair. Health-care decision-making is far more difficult, collaborative, emotionally fraught, and subject to cognitive distortions. Second, the provision of health care should not be delegated to unregulated markets. Unlike other markets, there is no reason to expect health-care market outcomes to be efficient or fair or to promote individual freedom, properly conceived. Markets may play an important role in implementing an allocation of healthcare, but they are not an ethically acceptable alternative to determining what that allocation should be. [ABSTRACT FROM AUTHOR]

Background: Individuals living with human immunodeficiency virus (HIV) encounter challenges throughout the care continuum, right from the time of diagnosis to the culmination of the treatment process. Current Concepts: The Republic of Korea, like many other countries, has been addressing the needs of people living with HIV (PLWH) by providing financial support for medical expenditures. Currently, HIV counseling specialist nurses offer psychological support at 28 institutions, assisting patients in maintaining viral suppression state and adhering to antiretroviral therapy. Care and welfare services are also provided by non-governmental organizations funded by the Korean Disease Control and Prevention Agency (KDCA). The accessibility of medical institutions for PLWH has seen gradual improvement, with KDCA issuing guidelines for healthcare facilities catering to this population. In addition, the legal and medical insurance coverage issues related to long-term care institutionalization have been addressed. However, PLWH continues to face challenges in treatment and hospitalization, especially with a recent increase in immigrant PLWH, highlighting a lack of support for undocumented immigrants seeking treatment. Discussion and Conclusion: Healthcare policies are shifting from merely managing, isolating, and treating PLWH to prioritizing their human rights. Going forward, it is imperative to empower PLWH and support their self-care efforts. [ABSTRACT FROM AUTHOR]