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The trickle‐down effect has been proposed as one means to address women's continued underrepresentation in leadership positions globally. While earlier research supported the trickle‐down effect's prediction that increasing women's representation at higher managerial levels will positively impact women's careers at lower managerial levels, recent studies provide inconsistent evidence, leading to claims that it may be spurious. Due to data limitation, most prior trickle‐down research has explored just two managerial levels—board and executives—making it difficult to separate a trickle‐down effect from external pressures (e.g., shareholders, law) or internal factors (e.g., organizational culture) that may cause it. Furthermore, prior research does not adequately account for women's representation in managerial pipelines, a crucial source of potential managerial talent. To address these concerns, we analyze Australian workplace panel data (2014–2020) that allow for a more robust test of the trickle‐down effect than previously examined. Our results support the trickle‐down effect across multiple managerial levels below the board level, independent of managerial pipeline effects. The trickle‐down and pipeline effects were only observed for positions immediately above and below each managerial level. This highlights the proximity of positions within management hierarchies where the in‐group preference and women's direct advocacy for other women are most likely to occur. Our study suggests that simply appointing more women to top positions, such as boards, while beneficial, is not enough to address gender inequality in management meaningfully. We recommend that rather than focusing on gender representation at the top, organizations should set gender diversity goals and monitor progress at all managerial levels. We conclude with implications for theory, practice, and future research. [ABSTRACT FROM AUTHOR]

Despite extensive developments in the field of Human Resource Management, we still have limited and fragmented knowledge of how the external and internal environment of an organization influences direct employee voice. In this conceptual paper, we draw on signaling theory and theorize on whether and, if so, how direct employee voice and organizational voice climate are shaped at times of macro and organizational turbulence. Specifically, we introduce the concepts of solidary, utilitarian, and opportunistic crisis‐related Human Resource (HR) practices and propose that they send different signals to employees, influencing their voice perceptions in distinctive ways. We also theorize that employees interpret these signals vis‐à‐vis the experienced meso‐ and macroturbulence, a process that affects HR system strength and the subsequent formulation of voice perceptions and voice climate emergence. With this work, we contribute to the voice and strategic HR literature by offering an integrated and multilayered understanding of how top‐down processes at turbulent times such as crisis‐related HR practices can influence bottom‐up emergent phenomena. [ABSTRACT FROM AUTHOR]

The study proposes and tests a self‐concept‐based perspective for the effects of formal mentoring support on affective organizational commitment (AOC) via multiple mediators. Using time‐lagged multi‐source dyadic data (n = 203), we demonstrate that formal mentoring support significantly influences newcomer–protégés' AOC through an underlying self‐evaluative mechanism indicated by organization‐based self‐esteem (OBSE), even in the presence of a well‐established alternative mediator (perceived organizational support; POS). Moreover, we further demonstrate when or under what circumstances such effects might be attenuated or exaggerated by introducing a salient boundary condition to such a process (i.e., perceived mentor organizational prototypicality). As the findings reveal, by making newcomer–protégés feel good about themselves in the workplace (i.e., perceive self‐value) formal mentoring support can also promote organizational commitment, effects that are likely to be amplified when the formal mentor is perceived to be prototypical of the organization. Thus, bridging the mentoring and socialization literatures, the inclusion of our proposed mediators and moderator and testing their relationships simultaneously not only provides a more nuanced view of the underlying mechanisms through which the effects of formal mentoring support are channeled to influence newcomer–protégés' work attitudes but it offers new theoretical elaboration and contextual understanding that we hope will prompt future research and be of benefit to human resource practitioners. Implications to theory, practice and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Using an institutional lens, we investigate the isomorphic effects of both external and internal contexts on human resource management (HRM) systems. Our analysis uses data from 4768 organizations across 34 countries to focus on the similarities in HRM systems. By employing distance matrices, a commonly adopted method in geographic science, we find that both external and internal contexts affect (dis)similarities in HRM systems. Organizations in similar environments exhibit more similar HRM systems. Furthermore, we find that the devolvement of HRM activities from HRM to line management reduces the similarity of HRM systems across organizations. By contrast, a strong strategic position of HRM does not yield a comparable effect. Our study's main contributions include elucidating the multifaceted relationship between context and HRM, highlighting the HRM department's role in this relationship, clarifying the context–HRM connection via the concept of isomorphic pressures, and illustrating the use of distance matrices as tool with great explanatory power for the analysis of similarities among HRM phenomena. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To assess the effectiveness of evidence‐based quality improvement (EBQI) as an implementation strategy to expand the use of medications for opioid use disorder (MOUD) within nonspecialty settings.We studied eight facilities in one Veteran Health Administration (VHA) region from October 2015 to September 2022 using administrative data.Initially a pilot, we sequentially engaged seven of eight facilities from April 2018 to September 2022 using EBQI, consisting of multilevel stakeholder engagement, technical support, practice facilitation, and data feedback. We established facility‐level interdisciplinary quality improvement (QI) teams and a regional‐level cross‐facility collaborative. We used a nonrandomized stepped wedge design with repeated cross sections to accommodate the phased implementation. Using aggregate facility‐level data from October 2015 to September 2022, we analyzed changes in patients receiving MOUD using hierarchical multiple logistic regression.Eligible patients had an opioid use disorder (OUD) diagnosis from an outpatient or inpatient visit in the previous year. Receiving MOUD was defined as having been prescribed an opioid agonist or antagonist treatment or a visit to an opioid substitution clinic.The probability of patients with OUD receiving MOUD improved significantly over time for all eight facilities (average marginal effect [AME]: 0.0057, 95% CI: 0.0044, 0.0070) due to ongoing VHA initiatives, with the probability of receiving MOUD increasing by 0.577 percentage points, on average, each quarter, totaling 16 percentage points during the evaluation period. The seven facilities engaging in EBQI experienced, on average, an additional 5.25 percentage point increase in the probability of receiving MOUD (AME: 0.0525, 95%CI: 0.0280, 0.0769). EBQI duration was not associated with changes.EBQI was effective for expanding access to MOUD in nonspecialty settings, resulting in increases in patients receiving MOUD exceeding those associated with temporal trends. Additional research is needed due to recent MOUD expansion legislation. [ABSTRACT FROM AUTHOR]

Aim Design, setting and participants Measurements Findings Conclusion This study: (1) estimated the effect of early discontinuation of medication for opioid use disorder (MOUD) on overdose probability and (2) measured the relationship between patient characteristics and early discontinuation probability for each MOUD type.This was a retrospective cohort using electronic health record data from the US Veterans Healthcare Administration. Participants were veterans initiating MOUD with buprenorphine (BUP), methadone (MET) or extended‐release naltrexone (XR‐NTX) from fiscal years 2012–19. A total of 39 284 veterans met eligibility with 22 721 (57.8%) initiating BUP, 12 652 (32.2%) initiating MET and 3911 (10.0%) initiating XR‐NTX.Measurements (1) determined whether the veteran experienced an overdose in the 365 days after MOUD initiation (primary) and (2) early discontinuation of MOUD, defined as discontinuation before 180 days (secondary). We assumed that unobserved patient characteristics would jointly influence the probability of discontinuation and overdose. and estimated the joint distribution with a bivariate probit model.We found that 9.0% of BUP initiators who experienced an overdose above the predicted 3.9% had no veteran‐discontinued BUP early; findings for XR‐NTX were similar, with 12.2% of initiators overdosing above the predicted 4.5%, but this was statistically inconclusive. We found no relationship between early discontinuation and overdose for MET initiators, probably due to the high risk of both events. The patient characteristics included in our post‐estimation exploratory analysis of early discontinuation varied by MOUD type, with between 14 (XR‐NTX) and 25 (BUP) tested. The only characteristics with at least one level showing a statistically significant change in probability of early discontinuation for all three MOUD types were geography and prior‐year exposure to psychotherapy, although direction and magnitude varied.Early discontinuation of buprenorphine, and probably extended‐release naltrexone, appears to be associated with a greater probability of experiencing a fatal or non‐fatal overdose among US veterans receiving medication for opioid use disorder (MOUD); methadone does not show the same association. There is no consistent set of characteristics among early discontinuers by MOUD type. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is one of the main causes of hospitalization for lower respiratory tract infection in children under five years of age globally. Maternal vaccines and monoclonal antibodies for RSV prevention among infants are approved for use in high income countries. However, data are limited on the economic burden of RSV disease from low- and middle-income countries (LMIC) to inform decision making on prioritization and introduction of such interventions. This study aimed to estimate household and health system costs associated with childhood RSV in Kenya. Methods: A structured questionnaire was administered to caregivers of children aged < 5 years admitted to referral hospitals in Kilifi (coastal Kenya) and Siaya (western Kenya) with symptoms of acute lower respiratory tract infection (LRTI) during the 2019–2021 RSV seasons. These children had been enrolled in ongoing in-patient surveillance for respiratory viruses. Household expenditures on direct and indirect medical costs were collected 10 days prior to, during, and two weeks post hospitalization. Aggregated health system costs were acquired from the hospital administration and were included to calculate the cost per episode of hospitalized RSV illness. Results: We enrolled a total of 241 and 184 participants from Kilifi and Siaya hospitals, respectively. Out of these, 79 (32.9%) in Kilifi and 21(11.4%) in Siaya, tested positive for RSV infection. The total (health system and household) mean costs per episode of severe RSV illness was USD 329 (95% confidence interval (95% CI): 251–408) in Kilifi and USD 527 (95% CI: 405– 649) in Siaya. Household costs were USD 67 (95% CI: 54–80) and USD 172 (95% CI: 131– 214) in Kilifi and Siaya, respectively. Mean direct medical costs to the household during hospitalization were USD 11 (95% CI: 10–12) and USD 67 (95% CI: 51–83) among Kilifi and Siaya participants, respectively. Observed costs were lower in Kilifi due to differences in healthcare administration. Conclusions: RSV-associated disease among young children leads to a substantial economic burden to both families and the health system in Kenya. This burden may differ between Counties in Kenya and similar multi-site studies are advised to support cost-effectiveness analyses. [ABSTRACT FROM AUTHOR]

If we assume that nonhuman animals experience pain or distress, then ethically justifying human-centered research with only nonhuman animals as subjects likely requires that the research's benefits to humans must, at least, outweigh harms suffered by the nonhuman animals. Yet this reasoning does not seem to account well for the ethical view that nonhuman animals are morally valuable in their own right. This commentary on a case considers this ethical tension and discusses how clinician-researchers should navigate it. This commentary also suggests why clinician-researchers' reasoning about the nature and scope of their obligations to nonhuman animals extends beyond governing regulations and federal oversight, which is silent on or ambiguous about nonhuman animals as morally valuable in their own right. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of chronic pain of service members (SMs) in the U.S. is estimated to be higher (roughly 31-44%) compared to that of civilian population (26%). This higher prevalence is likely due to the high physical demands related combat and training injuries that are not immediately resolved and worsen over time. Mental Health America reports that chronic pain can lead to other mental health conditions such as severe anxiety, depression, bipolar disorder, and post-traumatic stress disorder. Such mental health conditions can negatively affect job performance, reduce readiness for military duties, and often lead to patterns of misuse of opioid after SMs entering civilian life. The primary objective of this narrative review is to present a summarized guideline for the treatment of two types of pain that likely affect SMs, namely nociceptive somatic pain and neuropathic pain. This review focused on a stepwise approach starting with nonopioid interventions prior to opioid therapy. The secondary objective of this review is to elucidate the primary mechanisms of action and pathways associated with these two types of pain. Methods We followed the Scale for Assessment of Narrative Review Articles when transcribing this narrative review article to enhance the quality and brevity of this review. This Scale has 0.77% an intra-class coefficient of correlation, 95% confidence interval and 0.88 inter-rater reliability. We searched PubMed, Google Scholar, WorldCAT, and the Cochrane Library for the primary and secondary articles that targeted mechanisms of action, pathways, and pharmacological modalities for nociceptive somatic and neuropathic pain that were published from 2011 to 2022. We excluded articles related to pediatric, some specific pain conditions such as cancer-related pain, palliative care, end-of-life care, and articles that were not written in English language. For pharmacologic selection, we adopted the guidelines from the Policy for Implementation of a Comprehensive Policy on Pain Management by the Military Health Care system for the Fiscal Year 2021; the Clinical Practice Guidance for Opioid Therapy for Chronic Pain by the Department of Defense/Veterans Health Administration (2022); the (2021) Implementation of a Comprehensive Policy on Pain Management by the Military Health Care System; and the (2022) Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control. Discussion From the knowledge of the mechanisms of action and pathways, we can be more likely to identify the causative origins of pain. As a result, we can correctly diagnose the type of pain, properly develop an efficient and personalized treatment plan, minimize adverse effects, and optimize clinical outcomes. The guideline, however, does not serve as a substitute for clinical judgment in patient-centered decision-making. Medication choices should be individualized judiciously based on the patient's comorbid conditions, available social and economic resources, and the patient's preferences to balance the benefits and risks associated with various pain medications and to achieve optimal pain relief and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40–60 were the most common demographic group in the cohort (48% of all patients), and men made up a higher proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion that is somewhat smaller than what has been reported at non-VHA facilities, despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits. • From 2010 to 2019, there were 251,300 Veterans Health Administration emergency department visits for alcohol intoxication. • The annual rate of visits increased during the study period. • The majority of visits (68%) resulted in medical or psychiatric admission. • Visits for intoxication accounted for 1.3% of patients volume in the system, which is lower than other US health systems. [ABSTRACT FROM AUTHOR]

Public Health Consortiums (PHC) in Brazil represent a strategy to enhance regionalization in the Public Health Care System (SUS in Portuguese) and State/interstate/intermunicipal cooperation. The establishment of regional polyclinics aims to improve access to services with greater technological concentration and closer to users’ homes. This study specifically aims to analyze the process of creating PHC and regional polyclinics in Bahia State, based on documental analysis, identifying aspects related to entering the political agenda that facilitate and hinder, the role of state administration, specificities of the composition of these PHC and regional polyclinics. A documental analysis was carried out of the minutes of the Comissão Intergestores Bipartite (CIB-BA) [Bipartite Administrative Commission] from 2015 to 2018 and of constitutive documents of the consortiums established in this state. The Ceará State experience inspired the creation of consortiums in Bahia, especially the structuring of polyclinics. Municipal administrators demonstrated a favorable position regarding the potential of consortiums with cooperation among municipalities. The role of the state government proved to be a facilitating condition, whereas the maintenance of the municipal counterpart in finance constituted a hindering element. The consortiums contributed to the regionalization of health in the state as well as expansion of access to specialized care. [ABSTRACT FROM AUTHOR]

The article offers a perspective on principles and care pathways for caries management in children. Topics discussed include advances in the science of cariology, evidence-based care pathway for caries management, prevention and restorative strategies, caries risk/susceptibility assessment, shared decision-making in oral healthcare, and active surveillance as part of restorative dental care, advances in clinical caries management for children, improvements for oral health systems.

This article presents the concept and results of a study on the effects of organizational trust on the safety level in an enterprise. The research results presented provide valid and reliable statistical evidence that employees' trust in management is an important factor that significantly affects safety in a company. In particular, the research findings prove that employees' trust in management affects safety outcomes indirectly (full mediation), due to the improvement in their engagement in safety citizenship behaviour (SCB); but also that better engagement in SCB should directly or indirectly contribute to the reduction of accident event occurrence through improvement in employees' health and safety (H&S) regulation compliance (partial mediation). Moreover, the research findings prove that improvement in perceived management commitment in H&S will additionally strengthen positive relationships between trust in management and SCB engagement (interaction effect). [ABSTRACT FROM AUTHOR]

Regulatory frameworks for artificial intelligence (AI) are needed to mitigate risks while ensuring the ethical, secure, and effective implementation of AI technology in healthcare and population health. In this article, we present a synthesis of 141 binding policies applicable to AI in healthcare and population health in the EU and 10 European countries. The EU AI Act sets the overall regulatory framework for AI, while other legislations set social, health, and human rights standards, address the safety of technologies and the implementation of innovation, and ensure the protection and safe use of data. Regulation specifically pertaining to AI is still nascent and scarce, though a combination of data, technology, innovation, and health and human rights policy has already formed a baseline regulatory framework for AI in health. Future work should explore specific regulatory challenges, especially with respect to AI medical devices, data protection, and data enablement. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic, drought and internal conflict have worsened Ethiopia's already weak healthcare system. Antenatal and intrapartum care are especially prone to interruption under these circumstances. Objective: To explore women's experiences receiving antenatal and intrapartum care during the pandemic. Design: A descriptive qualitative approach was utilised. Methods: We conducted in-depth interviews with 17 women and held 4 focus group discussions with women who gave birth at 4 public hospitals during the pandemic. A study was conducted at four public hospitals in the Sidama region of Ethiopia, during which data were collected from 14 February to 10 May 2022. Thematic analysis was performed to generate themes. Results: The peak of the COVID-19 pandemic in Ethiopia presented several barriers to access and uptake of antenatal and intrapartum care at public hospitals. Four themes and 10 subthemes emerged from the thematic analysis. The themes were 'Barriers to maternity care uptake during COVID-19', 'Shortage of resources during COVID-19', 'Delays in maternity care uptake during COVID-19' and 'Mistreatment of women during maternity care during COVID-19'. The subthemes included 'Fear of contracting COVID-19', 'People in the hospital neglecting COVID-19 prevention', 'Women losing their job during COVID-19', 'Shortage of beds in the labour ward', 'Shortage of medical supplies', 'Delays in seeking care', 'Delays in receiving care', 'Complications during childbirth', 'disrespectful' and 'suboptimal care'. Conclusion: The findings of this study underscore the impact of COVID-19 on antenatal and intrapartum care, leading to delays in seeking and receiving care due to reduced rapport, resource shortages, companion restrictions, disrespectful care and suboptimal care. These factors contribute to increased obstetric complications during COVID-19. It is imperative for policymakers to prioritise essential resources for antenatal and intrapartum care in the present and future pandemics. Moreover, healthcare providers should maintain respectful and optimal care even amid challenges. Plain Language Summary: Women's experiences in receiving antenatal and intrapartum care during COVID-19 The COVID-19 pandemic has posed a significant challenge in seeking and receiving care of antenatal care and institutional childbirth. Women could experience delays in booking antenatal care appointments, postponing antenatal care visits, and facing delays in receiving care at hospitals, which has disrupted their access to routine antenatal care and institutional birth during the pandemic. This study highlights a range of barriers that hinder access to and utilisation of antenatal care and institutional birth, including lack of transport, shortage of resources, fear of contracting the virus, companion restrictions, disrespectful care and suboptimal care that leads to increased obstetric complications during COVID-19. This study provides recommendations for policymakers to prioritise resources and enhance respectful and optimal care for pregnancy and institutional birth to lessen the indirect impact of present and future pandemics on pregnant women and their unborn babies. [ABSTRACT FROM AUTHOR]

Background: Rifampicin resistant tuberculosis (RR-TB) poses a growing threat to individuals and communities. This study utilized a seasonal autoregressive integrated moving average (SARIMA) model to quantitatively predict the monthly incidence of RR-TB in Yunnan Province which could guide government health administration departments and the centers for disease control and prevention (CDC) in preventing and controlling the RR-TB epidemic. Methods: The study utilized routine surveillance reporting data from the infectious Disease Network Surveillance and Reporting System. Monthly incidence rates of RR-TB were collected from January 2019 to December 2022. A time series SARIMA model was used to predict the number of monthly RR-TB cases in Yunnan Province in 2023, and the model was validated using time series plots, seasonal and non-seasonal differencing, autocorrelation and partial autocorrelation analysis, and white noise tests. Results: From 2019 to 2022, the incidence of RR-TB decreases as the incidence of all TB decreases (P < 0.05). There was no significant change in the proportion of RR-TB among all TB cases, which remained within 2.5% (P>0.05). The time series decomposition shows that it presented obvious seasonality, periodicity and randomness after being decomposed. Time series analysis was performed on the original series after 1 non-seasonal difference and 1 seasonal difference, the ADF test showed P < 0.05. According to ACF and PACF, the SARIMA (1, 1, 1) (1, 1, 0)12 model was chosen and statistically significant model parameter estimates (P < 0.05). The predicted seasonal trend of RR-TB incidence in 2019 to 2023 was similar to the actual data. The percentage accuracy in the prediction excesses 80% in 2019 to 2022 and is all within 95% CI. However there was a certain gap between the actual incidence and the predicted value in 2023, and the acutual incidence had increased by 12.4% compared to 2022. The percentage of accuracy in the prediction was only 70% in 2023. Conclusions: We found the incidence of RR-TB was based on that of all TB in Yunnan. The SARIMA model successfully predicted the seasonal incidence trend of RR-TB in Yunnan Province in 2019 to 2023, but the prediction precision could be influenced by factors such as new infectious disease outbreaks or pandemics, social issues, environmental challenges or other unknown risks. Hence CDCs should pay special attention to the post epidemic effects of new infectious disease outbreaks or pandemics, carry out monitoring and early warning, and better optimize disease prediction models. [ABSTRACT FROM AUTHOR]

Simple Summary: As the complexity of medical data and the specificity of cancer treatments increase, the role of Molecular Tumor Boards (MTBs) becomes ever more crucial. These boards expertly utilize detailed patient data to tailor personalized cancer therapies, significantly enhancing treatment outcomes. However, the operational framework for MTBs lacks clarity and uniformity, which challenges their effectiveness on a global scale. To address this, in early 2023, a group of leading experts convened to establish a comprehensive framework designed to optimize MTB functionality locally, nationally, and internationally. This framework outlines ten essential elements for the success of MTBs, including advanced data management, rigorous testing protocols, and effective leadership across all levels of healthcare. Importantly, it emphasizes the necessity of integrating MTBs within both academic and community healthcare settings, as well as into national health systems, to ensure sustainable operations and widespread access to the most advanced care. This initiative promises to equip MTBs with the necessary tools to adapt and thrive in diverse health systems, ensuring that every patient receives the best possible care based on cutting-edge medical data. The increasing volume of information for cancer care, and the evolution of molecularly guided therapies, have increased the need for molecular tumor boards (MTBs), which can integrate such data into personalized treatment plans to improve patient outcomes. However, recommendations for improving the sustainability of MTBs are lacking. A diverse committee of MTB experts was assembled (February–March 2023), with extensive experience in sustainability in healthcare ecosystems. The aim was to identify MTB-related hurdles throughout the patient journey and develop a general framework for MTBs to operate on larger scales locally, nationally, and internationally. The committee identified ten key pillars for sustainable and scalable MTBs, including technical solutions for data integration and visualization, interoperability, learning loops, clinical trial access, legal considerations, criteria for patient testing, decision standardization, making MTBs official bodies for treatment decisions, local leaders, and international networks. The need for scalable frameworks at academic and community levels was recognized, along with integrating MTBs into national health systems to enhance sustainability and ensure optimal treatment decisions. Irrespective of the health ecosystem, the sustainability and scalability of MTBs are essential. Our framework provides guidelines to address this and to help MTBs evolve towards integrated, essential components of the oncology healthcare system. [ABSTRACT FROM AUTHOR]

Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers. [ABSTRACT FROM AUTHOR]

The UK government's recent announcement that the highly controversial Work Capability Assessment (WCA) will likely be abolished leaves questions of what precisely will emerge in its place. This commentary revisits a construct central to the attempted justification of the WCA, that of 'common health problems', which may well continue to leave a legacy in delineating purported 'deserving' and 'undeserving' impairment, ill-health and related disability. After outlining the politically strategic application of this construct in social policy, concerns are raised for long Covid. In particular, the risk of long Covid following the trajectory of another post-infection diagnosis, myalgic encephalomyelitis / chronic fatigue syndrome, is discussed. [ABSTRACT FROM AUTHOR]

This document contains summaries of various research studies related to urology and oncology. The studies cover topics such as kidney stone management, bladder cancer, prostate cancer, and renal cell carcinoma. The findings provide valuable insights into the diagnosis, treatment, and prognosis of these conditions. The studies utilize various methods, including bioinformatics analysis, molecular analysis, and patient surveys. The results contribute to the existing knowledge in the field and may have implications for future research and clinical practice. [Extracted from the article]

To describe the incidence and victim demographics of Welsh hospital admissions due to dog bites and strikes from 2014 to 2022. Descriptive analysis of Welsh hospital admissions data. Residents of Wales admitted to a Welsh National Health Service (NHS) hospital for a dog bite or strike, were identified using ICD-10 codes. The annual incidence of dog bite and strike admissions between 2014 and 2022 was calculated and stratified by child–adult status, sex, and Local Health Boards. Trends over time were analysed using the Chi-square test for trends. Hospital admissions due to dog bites and strikes have significantly increased from 16.3 per 100,000 to 23.7 per 100,000 population in 2022. This was driven by an increase in non-geriatric adults and an increase in three Local Health Boards. The Swansea Bay area has the highest incidence in Wales (56.1 admissions per 100,000). Wales has a higher incidence of dog bites and strikes than England or the Republic of Ireland. Work in the communities where incidence is exceptionally high is needed to understand the reasons behind having the highest incidence of dog bites in the British Isles and to establish the most efficacious methods for bite prevention. [ABSTRACT FROM AUTHOR]

This position paper of the International Osteoporosis Foundation reports the findings of an IOF Commission to consider to recommend rules of partnership with scientists belonging to a country which is currently responsible for an armed conflict, anywhere in the world. The findings and recommendations have been adopted unanimously by the Board of IOF. [ABSTRACT FROM AUTHOR]

The CMS Home Health Quality Reporting Program (HH QRP) requires home health agencies (HHAs) to report quality data to measure their performance. This study aimed to assess the relationship between voluntary accreditation with The Joint Commission (TJC) and the ability of HHAs to sustain higher performance over multiple years compared to non-TJC-accredited HHAs. This was a multi-year observational study that analyzed CMS HHA performance data for each year, 2013 to 2019. Measures of interest were the star ratings and 8 quality measures in the HHC dataset with enough variability where a difference between the top and bottom quartile would be meaningful. Close to half of HHAs did not attain the top quartile for any of the study years, but TJC-accredited HHAs generally have a lower proportion of HHAs with 0 year and a higher proportion with 4 to 7 years with top-quartile performance for all measures except the 2 immunization measures. Given a HHA was in the top quartile on a measure the previous year, TJC-accredited HHAs were significantly more likely to remain in the top quartile the year following compared to non-TJC-accredited HHAs. These findings demonstrate better sustained performance among TJC-accredited HHAs compared to non-TJC-accredited agencies. These findings suggest that accreditation requirements may address some of the factors that can threaten the sustainability of positive performance in HHAs. Further research is needed to explore these factors more closely. [ABSTRACT FROM AUTHOR]

Accreditation evaluates healthcare organization quality of care and patient safety processes, but the influence of this activity on the patient experience is not well understood. This study was designed to explore the relationship between accreditation survey scoring and patient experience of care using a subset of The Joint Commission (TJC) accreditation standards that are conceptually aligned with the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Special Care Issues composite. This was an observational study that used 2018 to 2019 CMS HHCAHPS data and TJC survey findings for 1464 accredited HHAs. The presence or absence of Requirements for Improvement (RFIs) indicating observed noncompliance and the Survey Analysis for Evaluating Risk (SAFER) score were used as independent variables in the analysis. Dependent variables included 3 HHCAHPS composite measures and 2 global rating measures. Data were analyzed using 2 sets of random effects logistic regression models. We found that an increase in RFIs scored on an HHA survey was associated with lower HHCAHPS score on all measures. When the frequency of RFIs and SAFER scores increased, there was a corresponding decline in HHCAHPS ratings, suggesting that patient experience ratings can potentially identify quality of care issues, when experience questions and quality concepts are sufficiently aligned. Adherence to Joint Commission accreditation standards may positively influence some aspects of the patient experience of care. While causality remains uncertain, accreditation appears to play a role in contributing to these outcomes. [ABSTRACT FROM AUTHOR]

Institutions of higher education have faced increasing pressure to comply with federal regulations and reform their response to campus sexual assault. This study explores institutions of higher education employees' perceptions on whether decoupling, or organizational resistance to change, is associated with the number and timing of campus sexual assault reforms adopted. Early captured reforms instituted before the "Dear Colleague Letter" in 2011, mid included reforms instituted after the Dear Colleague Letter in 2011 but before the 2015–2016 academic year and during the period of heightened attention to campus sexual assault, and late which included reforms instituted during or after the 2015–2016 academic year. A web‐based survey of institutions of higher education employees familiar with sexual assault policy implementation on their campuses asked about types of reforms, timing, decoupling, and campus characteristics. Correlations and t‐tests were run to examine the types of reforms across time periods, and regression assessed the degree to which decoupling was associated with the number and timing of reforms. Higher decoupling was associated with fewer reforms in the early period and more in the late period, though not with the overall number of reforms adopted. Findings highlight the importance of understanding factors that influence change on campuses. [ABSTRACT FROM AUTHOR]

Background: Brain drain is an issue of concern in developing countries. Many factors are involved in this issue, and their identification can be a good guide for decision-makers at different management levels. Therefore, the present study was carried out to identify the factors affecting brain drain and solutions to reduce it in Iran's health system. Methods: The data for this qualitative study was collected in 2023 through 15 semi-structured interviews with Iranian health experts and emigrant elites. Interviews were collected both face-to-face and virtually (on Skype and Google Meet) and analyzed using the thematic content analysis method. Results: Data analysis of the factors affecting brain drain in Iran's health system yielded seven main categories and 45 subcategories. The main categories were "individual factors," "economic factors," "social and cultural factors," "organizational and administrative factors," "political factors," "attraction factors for destination countries," and "attraction factors of destination countries for elites." Also, the solutions were divided into four categories of "economic," "social," "organizational and scientific," and "political" factors and 19 subcategories. Conclusion: Due to the increase in brain drain in recent years, it is necessary to make a serious decision in dealing with this issue. Solutions such as creating stable economic conditions, creating an atmosphere of hope, increasing respect and dignity for elite students by politicians, using the elites in macro-decisions, and creating the job rank for honorary professors can lead to reducing brain drain and decreasing the costs of the health system. [ABSTRACT FROM AUTHOR]

This research aimed to use a computational approach to aid infection prevention strategies during the predesign phase of healthcare environment planning. The objective of this study was to decompose and analyze health system catchment area 'outside design basis factors' such as demographic, public health, and environmental characteristics that may contribute to infection causing pathogen spread in healthcare environments using state of Florida data as a context for analysis. Supervised Machine Learning methodologies were used to determine relationships between Socioecological System (SES) factors and observed incidence rates of specific Hospital Acquired Infections (HAI). Results of the analysis suggest that relevant regional population SES factors, when included as independent variables, can forecast the potential co-occurrence of specific types of HAI in regional health system service areas. Outcomes of the analysis suggest that demographic and regional characteristics are significantly related to the predictive incidence of Antimicrobial-resistant infections in healthcare settings in Florida Agency for Healthcare Administration (ACHA) regions. The outcomes of this research suggest the benefit of using SES computational modeling for decision-making in health system Architectural Programming and predesign. This process allows for manifesting meaningful patterns by applying quantitative methods to analyze patient population characteristics that may influence the prevalence of pathogen spread within the interior environments of healthcare inpatient settings. This information contributes to a deeper understanding of context-specific priorities for operationalizing human-centered Infection Prevention through Design (PtD) infrastructure and planning. [ABSTRACT FROM AUTHOR]

We examine how the authority of investors to speak about climate change with corporations is established. Leveraging the 'communication as constitutive of organisations' (CCO) perspective, we analyse who speaks on behalf of whom (or what) in shareholder engagement on corporate carbon emissions. Based on access to private dialogues between an engager acting on behalf of a pool of investors with 20 utility corporations, we identify how three authoritative personae—that of diplomat, advocate, and coach—convey climate change concerns. We find that the mirroring of these authoritative personae by corporations may lead to deliberation, evasion, or rejection of the suggested courses of action. We theorise how relational authority is communicatively constituted in shareholder engagement through a process of mirroring and switching between authoritative personae. Our framework contributes to the study of CCO and relational authority by highlighting how meta-figures are used by external actors in an attempt to author appropriate corporate actions. We discuss the implications of our framework for the role of shareholder engagement in current attempts at greening financial capitalism. [ABSTRACT FROM AUTHOR]

How does female board membership affect firm stakeholder strategy? With the large increase in pressure to add more women to boards, it is especially important to understand how they influence firm strategy. Moreover, despite the growing importance of firm stakeholder strategy, key stakeholders continue to criticize firms for failing to keep their commitments. Here, we expect that owing to their long-term nature, consistency is particularly important for stakeholder investments, and that owing to their greater interest in stakeholder issues and their effect on board monitoring, female board members can be a key driver of stakeholder strategy consistency. Specifically, we develop and test hypotheses that increasing architectural complexity and uncertainty make stakeholder investments more difficult or costly, leading to a reduction in such investments. However, female board membership increases firm stakeholder consistency and counteracts these negative effects. Using a sample of 1755 S&P 1500 firms for the period 2000–2013, we provide robust support for our hypotheses. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disrupted everything that people had taken for granted, specifically the freedom through which they could interact and engage with others. The COVID-19 vaccines provided the means to earn back the normalcy that people had lost. However not everyone was willing to receive the vaccine. Some wanted to take a chance on their health to wait and see. Others had other ways to defer the vaccine. One of the main reasons they credited for their hesitation was the communication process invoked by authorities at the onset of the pandemic and the uncertainty about the safety and effectiveness of the vaccines. The purpose of this information systems applied research paper is to conduct a phenomenological study and answer a research question that is geared toward understanding what vaccine hesitancy looks like in people with certain behavioral traits; some of these are established components of vaccine hesitancy and were known to underpin vaccine uptake during the 2009 H1N1 epidemic. Through the interview process and the ensuing thematic analysis, this paper hones into six themes with the intent to aid healthcare administrators and policy makers with a clearer understanding in planning effective campaigns against epidemics and pandemics in the future. [ABSTRACT FROM AUTHOR]

The nurses' quality of work life (QWL) is critical for a sustainable nursing workforce and effective healthcare delivery. As nurses make up the majority of the healthcare workforce, their QWL is an important issue for both nurses and nurse managers. Therefore, nurse managers need to assess, monitor, and improve the QWL of their nurses. This study aimed to determine the impact of the nursing work environment on nurses' QWL. This descriptive and cross-sectional study was conducted among 330 nurses working in a private university hospital. A healthy nursing work environment and individual and institutional factors positively influence nurses' QWL. This study showed that nurses' participation in hospital affairs, satisfaction with the institution, satisfaction with the social facilities, ability to meet the institution's career goals, work unit, and perceived salary were all factors that influenced nurses' QWL. This study contributes to the understanding of the impact of nurses' work environment and individual and institutional variables on their QWL. Healthcare administration and nurse managers can help improve the quality of nurses' working lives by developing strategies to create healthy work environments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Strengthening safety compliance behaviour can reduce the organizations' unexpected financial losses and prevent employees from continuous COVID-19. It drives this study to create a research framework involved by organizational, individual and social factors to predict employees' safety compliance behaviour. OBJECTIVE: This study examines how risk perceptions of COVID-19, employee well-being, workplace health and safety training, safety motivation and safety related stigma impact safety compliance behavior in times COVID-19 pandemic. METHODS: A self-administered questionnaire was disseminated to healthcare workers. In all, 344 acceptable questionnaires were derived for further analysis. RESULTS: The results revealed that the risk perception of COVID-19 and employee well-being has no significant relationship with safety compliance behavior. Similarly, safety related stigma also has no moderating effect on safety motivation and safety compliance behavior. However, workplace health and safety training and safety motivation have significant relationships with safety compliance behavior. CONCLUSION: This study contributes to the literature by illuminating on the importance of organizational, individual, social factors and how they can interact with safety compliance behaviour. Additionally, knowing the unique function of safety related stigma in building safety compliance behaviour may help guide future efforts and training initiatives to enhance workplace safety. [ABSTRACT FROM AUTHOR]

Background: Maternal and Perinatal Death Surveillance and Response (MPDSR) systems provide an opportunity for health systems to understand the determinants of maternal and perinatal deaths in order to improve quality of care and prevent future deaths from occurring. While there has been broad uptake and learning from low- and middle-income countries, little is known on how to effectively implement MPDSR within humanitarian contexts – where disruptions in health service delivery are common, infrastructural damage and insecurity impact the accessibility of care, and severe financial and human resource shortages limit the quality and capacity to provide services to the most vulnerable. This study aimed to understand how contextual factors influence facility-based MPDSR interventions within five humanitarian contexts. Methods: Descriptive case studies were conducted on the implementation of MPDSR in Cox's Bazar refugee camps in Bangladesh, refugee settlements in Uganda, South Sudan, Palestine, and Yemen. Desk reviews of case-specific MPDSR documentation and in-depth key informant interviews with 76 stakeholders supporting or directly implementing mortality surveillance interventions were conducted between December 2021 and July 2022. Interviews were recorded, transcribed, and analyzed using Dedoose software. Thematic content analysis was employed to understand the adoption, penetration, sustainability, and fidelity of MPDSR interventions and to facilitate cross-case synthesis of implementation complexities. Results: Implementation of MPDSR interventions in the five humanitarian settings varied in scope, scale, and approach. Adoption of the interventions and fidelity to established protocols were influenced by availability of financial and human resources, the implementation climate (leadership engagement, health administration and provider buy-in, and community involvement), and complex humanitarian-health system dynamics. Blame culture was pervasive in all contexts, with health providers often facing punishment or criminalization for negligence, threats, and violence. Across contexts, successful implementation was driven by integrating MPDSR within quality improvement efforts, improving community involvement, and adapting programming fit-for-context. Conclusions: The unique contextual considerations of humanitarian settings call for a customized approach to implementing MPDSR that best serves the immediate needs of the crisis, aligns with stakeholder priorities, and supports health workers and humanitarian responders in providing care to the most vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: Patients with significant multimorbidity and other factors that make healthcare challenging to access and coordinate are at high risk for poor health outcomes. Although most (93%) of Veterans' Health Administration (VHA) patients at high risk for hospitalization or death ("high-risk Veterans") are primarily managed by primary care teams, few of these teams have implemented evidence-based practices (EBPs) known to improve outcomes for the high-risk patient population's complex healthcare issues. Effective implementation strategies could increase adoption of these EBPs in primary care; however, the most effective implementation strategies to increase evidence-based care for high-risk patients are unknown. The high-RIsk VETerans (RIVET) Quality Enhancement Research Initiative (QUERI) will compare two variants of Evidence-Based Quality Improvement (EBQI) strategies to implement two distinct EBPs for high-risk Veterans: individual coaching (EBQI-IC; tailored training with individual implementation sites to meet site-specific needs) versus learning collaborative (EBQI-LC; implementation sites trained in groups to encourage collaboration among sites). One EBP, Comprehensive Assessment and Care Planning (CACP), guides teams in addressing patients' cognitive, functional, and social needs through a comprehensive care plan. The other EBP, Medication Adherence Assessment (MAA), addresses common challenges to medication adherence using a patient-centered approach. Methods: We will recruit and randomize 16 sites to either EBQI-IC or EBQI-LC to implement one of the EBPs, chosen by the site. Each site will have a site champion (front-line staff) who will participate in 18 months of EBQI facilitation. Analysis: We will use a mixed-methods type 3 hybrid Effectiveness-Implementation trial to test EBQI-IC versus EBQI-LC versus usual care using a Concurrent Stepped Wedge design. We will use the Practical, Robust Implementation and Sustainability Model (PRISM) framework to compare and evaluate Reach, Effectiveness, Adoption, Implementation, and costs. We will then assess the maintenance/sustainment and spread of both EBPs in primary care after the 18-month implementation period. Our primary outcome will be Reach, measured by the percentage of eligible high-risk patients who received the EBP. Discussion: Our study will identify which implementation strategy is most effective overall, and under various contexts, accounting for unique barriers, facilitators, EBP characteristics, and adaptations. Ultimately this study will identify ways for primary care clinics and teams to choose implementation strategies that can improve care and outcomes for patients with complex healthcare needs. Trial registration: ClinicalTrials.gov, NCT05050643. Registered September 9th, 2021, https://clinicaltrials.gov/study/NCT05050643 Protocol version: This protocol is Version 1.0 which was created on 6/3/2020. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this review is to summarize the impact of the multidisciplinary tumor board as a tool or mechanism for orthopedic oncology care, to highlight its evolution and changing role over time, to assess its strengths and weaknesses, and to report our institutional experience as an NCI-Designated Comprehensive Cancer Center. Methods: We reviewed the relevant literature about multidisciplinary tumor boards in orthopedic oncology, and summarized the articles to provide a summary of the topic. Additionally, we retrospectively reviewed our electronic medical records to analyze the distribution, characteristics, and numbers of the cases that were discussed. Results: Our retrospective institutional review revealed a total of 1178 individual patients discussed between August 2018 and August 2023. There was an even distribution of patients by sex, with 549 female (50.2%) patients and 544 male (49.8%). Diagnoses peaked in the second and sixth decades of life (189 and 175 patients, respectively). The majority of patients were discussed once (55%) or twice (21%). The most common neoplastic diagnosis that was presented in these meetings was giant cell tumor of bone (n = 51). Osteosarcoma (n = 41) was the most common diagnosis among the primary malignant bone tumors, and liposarcomas (n = 41) were the most frequently discussed soft tissue sarcoma histology. Conclusion: Tumor boards have played a central role in cancer care for almost a century. Our experience at an NCI-designated comprehensive cancer center has yielded a review of over a thousand individual cases in only a 5-year span of time. [ABSTRACT FROM AUTHOR]

Background: Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list. Methods: Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members. Results: The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care). Conclusion: The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice. [ABSTRACT FROM AUTHOR]

Background: Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula. Methods: Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members. Results: The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A). Conclusion: All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums. [ABSTRACT FROM AUTHOR]

Background: The central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes. Methods: We included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted. Results: Thirty-one publications were eligible for the analysis: case series (n = 27), mixed methods studies (n = 3) and quasi-experimental studies (n = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders' views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses' performance, organizational outcomes, and clinical outcomes. Economic data were not available. Conclusions: This is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses' performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed. Trail registration: The study was registered (PROSPERO CRD42021259624). [ABSTRACT FROM AUTHOR]

The article discusses how the Medical Library Association (MLA) is adapting and navigating to changes and innovations. Topics discussed include the role of the board of directors in leading the direction of MLA, the strategies of MLA to grow the organization, address its financial challenges and achieve long-term sustainability, and its strategic goals from 2015 to 2024.

The article focuses on identifying and ranking the functions of Web 2.0 technologies for physicians in Iran. It explores how these technologies can enhance access to current health knowledge, improve communication, and support public education. It aims to provide solutions for better communication and networking among physicians by leveraging Web 2.0 tools, highlighting their potential to address challenges in health service management and information sharing.

The number of patients with congenital disease living to adulthood continues to grow. Often undergoing surgical correction in infancy, they continue to require lifelong care. Their numbers are largely unknown. We sought to evaluate hospital admissions of adult patients with esophageal atresia with tracheoesophageal fistula (EA/TEF), congenital diaphragmatic hernia (CDH), and Hirschsprung disease (HD). The Florida Agency for Healthcare Administration inpatient database was merged with the Distressed Communities Index and Centers for Medicare and Medicaid Services Hospital and Physician Compare datasets. The dataset was queried for adult patients (≥18 y, born after 1970) with EA/TEF, CDH, and HD in their problem list from 2010 to 2020. Patient demographics, hospitalization characteristics, and discharge information were obtained. In total, 1140 admissions were identified (266 EA/TEF, 135 CDH, 739 HD). Patients were mostly female (53%), had a mean age of 31.6 y, and often admitted to an adult internist in a general hospital under emergency. Principal diagnoses and procedures (when performed) varied with diagnosis and age at admission. EA patients were admitted with dysphagia and foregut symptoms and often underwent upper endoscopy with dilation. CDH patients were often admitted for diaphragmatic hernias and underwent adult diaphragm repair. Hirschsprung patients were often admitted for intestinal obstructive issues and frequently underwent colonoscopy but trended toward operative intervention with increasing age. Adults with congenital disease continue to require hospital admission and invasive procedures. As age increases, diagnoses and performed procedures for each diagnoses evolve. These data could guide the formulation of multispecialty disease-specific follow-up programs for these patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: The effectiveness of a quality management system consistent with the ISO 9001 standard depends on how quality objectives are established and pursued. The aims of this article are to identify quality objectives in selected certified organizations providing medical services, assess their compliance with the requirements of the ISO 9001 standard, and determine factors influencing such objectives. Methods: The first theoretical part of the article is based on a systematic literature review. The empirical part contains an analysis of documentation related to quality management systems and conducted audits. The data were collected during 42 quality management system audits conducted in 16 health care organizations in the years 2015-2020. Uncategorized interviews were conducted with quality management system representatives. The data were verified by interviews with 6 management system auditors having at least 15 years’ experience in auditing health care organizations. The assessment of the methodological correctness is based on the ISO 9001:2015 standard criteria. Results: The most frequently formulated quality objectives include improving customer satisfaction, task-based objectives related to planned works, improvements, and development of new medical services. The quality objectives fulfill the requirements of the ISO 9001 standard. However, they are not ambitious. The most significant factors influencing the processes of goal setting are economic (financial incentives, available resources for modernization), social (community needs), and managerial (the scope of performed analyses, the quality of the audit process, and the calculation of necessary effort). Conclusions: Health care organizations need to pursue more ambitious objectives, intensify the use of performed medical analyses, and integrate quality objectives into management remuneration systems. [ABSTRACT FROM AUTHOR]

The research aimed to determine the level of knowledge of the respondents about comprehensive quality standards in health units, the level of Implementation of these standards by the respondents, and to determine the significance of the relationship between the independent variables studied by the respondents and the degree of their knowledge of comprehensive quality standards in health units, and the degree of Implementation of these standards, and to identify the obstacles that limit the Implementation Comprehensive quality standards in health units and their Suggestions to solve them. This research was conducted at the Minya Al-Qamh District, Sharkia Governorate, on a sample of 250 respondents from health unit workers, and data was collected using a questionnaire during the months of February and March 2024 AD. The most important results were : 1. Nearly half of the respondents (48.4%) came in the high-level category in terms of their knowledge of comprehensive quality standards in health units in general. 2. The level of respondents' Implementation of comprehensive quality standards in health units as a whole increased by 46%. 3. There is a correlation between the variables of age and achievement motivation and the overall degree of knowledge of comprehensive quality standards in health units as a whole. 4. There is a correlation between the variables of age and achievement motivation and the respondents' opinion on the degree of Implementation of comprehensive quality standards in health units as a whole. 5. There is a significant relationship between the job position and the level of opinion of the respondents regarding the degree of Implementation of comprehensive quality standards in health units. 6. The most important obstacles to implementing comprehensive quality in health units: continuous changes in senior management managers related to health management, the absence of a law or instructions from higher authorities directing the Implementation of comprehensive quality management standards in the health unit. 7. The most important proposals: Requesting higher authorities to legislate laws and instructions that support the Implementation of comprehensive quality management standards in health administration, encouraging and stimulating creativity and innovation among workers in health administration. [ABSTRACT FROM AUTHOR]

Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy. This study examines women prescribed metformin before pregnancy and estimates the risk of continuing metformin and adding insulin versus starting insulin but discontinuing metformin in early pregnancy on outcomes of congenital malformations and nonlive births. Visual Abstract. Metformin Use in the First Trimester of Pregnancy and Risk for Nonlive Birth and Congenital Malformations: Emulating a Target Trial Using Real-World Data Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy. This study examines women prescribed metformin before pregnancy and estimates the risk of continuing metformin and adding insulin versus starting insulin but discontinuing metformin in early pregnancy on outcomes of congenital malformations and nonlive births. Background: Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy. Objective: To evaluate the teratogenicity of metformin use in the first trimester of pregnancy. Design: In an observational cohort of pregnant women with pregestational type 2 diabetes receiving metformin monotherapy before the last menstrual period (LMP), a target trial with 2 treatment strategies was emulated: insulin monotherapy (discontinue metformin treatment and initiate insulin within 90 days of LMP) or insulin plus metformin (continue metformin and initiate insulin within 90 days of LMP). Setting: U.S. Medicaid health care administration database (2000 to 2018). Participants: 12 489 pregnant women who met the eligibility criteria. Measurements: The risk and risk ratio of nonlive births, live births with congenital malformations, and congenital malformations among live births were estimated using standardization to adjust for covariates. Results: A total of 850 women were in the insulin monotherapy group and 1557 in the insulin plus metformin group. The estimated risk for nonlive birth was 32.7% under insulin monotherapy (reference) and 34.3% under insulin plus metformin (risk ratio, 1.02 [95% CI, 1.01 to 1.04]). The estimated risk for live birth with congenital malformations was 8.0% (CI, 5.7% to 10.2%) under insulin monotherapy and 5.7% (CI, 4.5% to 7.3%) under insulin plus metformin (risk ratio, 0.72 [CI, 0.51 to 1.09]). Limitation: Possible residual confounding by glycemic control and body mass index. Conclusion: Compared with switching to insulin monotherapy, continuing metformin and adding insulin in early pregnancy resulted in little to no increased risk for nonlive birth among women receiving metformin before pregnancy. Under conventional statistical criteria, anything between a 49% decrease and a 9% increase in risk for congenital malformations was highly compatible with our data. Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

The Environmental Protection Agency (EPA)'s Worker Protection Standards is the primary set of legislation aimed at protecting farmworkers from occupational pesticide exposure in the United States. Previous studies suggest that worker adoption of Pesticide Protective Behaviors (PPBs) promoted by WPS is associated with lower urinary pesticide concentrations. However, adoption of PPBs is often outside of the control of individual farmworkers and dependent on workplace factors such as employer provisioning of Personal Protective Equipment (PPE) and access to trainings/resources. We conducted a mixed-method study including urinary pesticide biomonitoring, surveys, and interviews with 62 Latinx farmworkers in southwestern Idaho from April to July 2022. We integrated findings across the various data sources to identify emergent themes relating to farmworkers' perceptions of workplace compliance with WPS and potential implications for their pesticide risk perceptions, protective behaviors, and urinary pesticide concentrations. Participants reported some indications of poor workplace compliance with WPS regulations, notably inconsistent access to clean handwashing stations and notification of pesticide applications. Some farmworkers, particularly pesticide applicators, viewed herbicides to be categorically safer than other classes of pesticides such as insecticides; these perceptions appeared to influence protective behaviors, such as the relatively low use of PPE while applying herbicides. These findings are underscored by the higher concentrations of biomarkers of herbicides, but not insecticides, among pesticide applicators compared with non-applicators (e.g. median 2,4-D concentrations = 1.40 µg/L among applicators and 0.69 µg/L among non-applicators). Participants further reported concerns regarding the inadequacy of pesticide safety training, pesticide drift, and the lack of communication regarding pesticide applications on and near fields where they are working. Participants' perceptions that herbicides are categorically safer than other pesticide classes is in direct conflict with WPS training, raising concerns about discrepancies between WPS instruction and other on-the-job training, as well as the inadequate provisioning of PPE during the application of certain pesticides. Our findings also suggest that current WPS regulations may not sufficiently address farmworkers' concerns, particularly in regard to pesticide drift. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage (PPH) is a leading cause of maternity mortality in the United States. The Code Crimson project aimed to enhance PPH management by implementing a standardized intervention bundle to mitigate morbidity and mortality associated with PPH. Local Problem: At a large Philadelphia tertiary hospital, health disparities existed for severe maternal morbidity and mortality, and PPH was a significant factor. Methods: A quality improvement design, using Plan-Do-Study-Act cycles and interrupted time series analysis, was undertaken. Interventions: The Code Crimson project implemented a standardized bundle to manage PPH, including blood product administration and massive transfusion protocol activation. Results: After implementing the Code Crimson bundle, there was a significant decrease in blood product use (P < .001), with minor reductions in packed red blood cell administration over 4 units and mean blood loss. Conclusions: The Code Crimson bundle effectively reduced blood product utilization for PPH treatment. [ABSTRACT FROM AUTHOR]