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Objectives: Multiple barriers limit access to the full range of contraceptive options. The purpose of this quality improvement initiative was to increase single-visit access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings in New York City (NYC).Study Design: From 2015 to 2018 we convened 2 learning collaboratives, named the Quality Improvement Network for Contraceptive Access, with 17 teams (representing 40 sites) from New York City-based hospitals and health centers using an adaptation of the Institute for Healthcare Improvement's Breakthrough Series Learning Collaborative model. Participating teams sought to implement evidence-informed recommendations to increase access. The goal was to increase the patient-centeredness of services by reducing barriers. In the absence of a way to directly measure access, we measured progress toward implementation of the 4 recommendations and contraceptive care utilization measures as proxies for access, and asked teams to describe facilitating factors.Results: Learning collaborative teams successfully implemented all 4 of the recommendations in 95% of the participating sites. Patients who chose and received a most or moderately effective method increased from 22% to 38% in primary care, and from 0% to 17% in the immediate postpartum period. Patients who chose and received a long-acting-reversible contraceptive increased from 5% to 11% in primary care, and from 0% to 3% in immediate postpartum. Facilitating factors included the involvement of interdisciplinary teams, consideration of costs, utilization of peers to demonstrate change, and champions to drive change.Conclusions: The application of evidence-informed recommendations using a structured quality improvement initiative increases contraceptive access.Implications: This paper identifies key facilitators and factors that influenced the successful implementation of evidence-based recommendations for access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings. Findings can inform future initiatives that seek to increase contraceptive access at the service delivery level, as a component of reproductive autonomy, and contraceptive equity. [ABSTRACT FROM AUTHOR]

The growing interest in developing sustainable healthcare materials from natural biomass to replace synthetic healthcare materials derived from non-renewable sources has focused on lignin–carbohydrate complexes (LCCs). These LCCs are formed by combining hydrophobic/rigid lignin and hydrophilic/flexible polysaccharide segments from plant tissues found in nature. While LCCs inherit the broad composition and features of biomass relevant for use in healthcare, the role of LCCs in healthcare materials has not been fully studied and is not well understood. Indeed, the specific features of LCCs according to their manufacturing method and composition remain vaguely defined. In this paper, the fractionation, characterization, and applications of LCCs in healthcare materials are therefore reviewed with emphasis on their biocompatible, immunostimulant, oxidation-resistant, anticancer/antitumor, antiviral, and ultraviolet-resistant properties. The information compiled in this review can encourage the increased development of advanced healthcare materials through LCC-based innovations. • Summarized the use of lignin–carbohydrate complexes (LCCs) in healthcare materials • Discussed the challenges and opportunities associated with such LCC applications • This review promotes the development of LCC-based healthcare materials. [ABSTRACT FROM AUTHOR]

The introduction of the Human papillomavirus (HPV) vaccine has shown potential to not only prevent cervical cancer but also drive adolescents' access to other health care services, even in low-income countries. Few studies have been conducted to date to identify best practices and estimate the acceptance, operational challenges and benefits of including broader adolescent health interventions into immunization efforts, knowledge which is essential to supporting widespread integration. In this paper we review the efforts undertaken by the government of Togo to integrate adolescent health programming with the HPV vaccination roll out. With the support of partners (GAVI, WHO, UNFPA and UNICEF), the country successfully completed, in 2017, two years of an HPV vaccine demonstration project, which entailed vaccinating 10-year-old girls against HPV in two selected districts of the country and integrating a health education component focused on puberty education / menstrual hygiene and hand washing practice. Our study is a post-implementation program evaluation, using mixed methods to assess key questions of feasibility and acceptability of an integrated adolescent package of care. It showed that the HPV vaccination in conjunction with the health education sessions was well received by the majority of health care providers, teachers and parents. Our study confirmed that in Togo it proved feasible to combine education and HPV vaccination in school-based service delivery. However, more operational research is neded to understand how to increase the impact and sustainability of the co-delivery of interventions. We did not analyze the health impact and cost implications of the intervention, which will be an important consideration for scaling up such integration efforts alongside routine immunization. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused huge and disruptive technological changes in the healthcare sector, transforming the way businesses and societies function. To respond to the global health crisis, there have been numerous innovation projects in the healthcare sector, including the fast design and manufacturing of personal protective equipment (PPE) and medical devices, and testing, treatment, and vaccine technologies. Many of these innovative activities happen beyond organizational boundaries with collaboration and open innovation. In this paper, we review the current literature on open innovation strategy during the pandemic and adopt the co-evolution view of business ecosystems to address the context of change. Based on a detailed exploration of the COVID-19-related technologies in the UK and global healthcare sectors, we identify the key emerging themes of open innovation in crisis. Further discussions are conducted in relation to each theme. Our results and analysis can help provide policy recommendations for the healthcare sector, businesses, and society to recover from the crisis. [ABSTRACT FROM AUTHOR]

Purpose: The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions.Methods: Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3-5 years.Results: Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status.Conclusions: The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts. [ABSTRACT FROM AUTHOR]

Paediatric sepsis remains a leading cause of childhood death. Morbidity is high, with up to one third of children affected developing ongoing, sometimes lifelong sequelae. To address the major burden of sepsis on child health, there is need for a unified approach to care, as outlined in the Australian National Action Plan for sepsis. While the Surviving Sepsis Campaign 2020 guidelines provided evidence-based recommendations for sepsis management in hospital, additional emphasis on families, pre-hospital recognition and post-sepsis care incorporating the multidisciplinary team is paramount to achieve quality patient outcomes. The role of families, paramedics and nurses in recognising and managing paediatric sepsis remains an under-represented area in current literature. The aim of this paper is to critically discuss key challenges surrounding the journey of paediatric sepsis, drawing on contemporary literature to highlight key areas pertinent to recognition and management of sepsis in children. Application of a holistic, patient-centred focus will provide an overview of paediatric sepsis, aiming to inform future development for enhanced healthcare delivery and identify critical areas for further research. [ABSTRACT FROM AUTHOR]

The primary purpose of the paper is to identify the level of organisation's readiness for change in order to improve change in health organizations. The current research is focused to establish an evaluation model for organizational readiness. Fuzzy methods offer a streamlined and analytical environment, which enables to design, analyse or test models in a reasonable shorter time compared to other approaches. Development of conceptual framework through defining enablers, criteria and attributes based on literature review and expert opinion. Four enablers are defined for the development of a conceptual model along with 12 criteria and 38 attributes. Fuzzy logic approach is performed by two levels of analysis. In order to determine the organizational readiness level of the hospital, the Fuzzy Organizational Readiness Index (FORI) and Fuzzy Performance Importance Index (FPII) were calculated. The FORI can be estimated as the "Averaged Ready" (3.48, 5.21, 6.95) and FPII is calculated to identify eighteen weaker attributes that necessities management attention to prepare a hospital for the process of change. The suggested structure strengthens the ability of administrators to effectively incorporate improvements in their organizations. [ABSTRACT FROM AUTHOR]

If Europe's health systems make a conscious decision to increase their utilization of technology and techniques that can enhance prevention and expedite early-stage diagnosis, they can effectively address the growing challenges of disease. By embracing these advancements, these health systems can significantly improve their response to emerging health issues.However, at present the effective integration and exploitation of these opportunities remains hesitant and suboptimal, and health and health services underperform accordingly, with patients suffering from the continuing variations in diagnosis and access to innovation. This paper presents a comprehensive study that examines the current state of various influential disciplines and factors in European countries. It specifically focuses on the adoption of Next Generation Screening technologies and the development stage of Public Health Genomics. The assessment of these areas is presented in the context of a rapidly changing policy environment, which provides an opportunity for a fundamental reconsideration of how and where new tools can be integrated into healthcare systems and routine practices. Top of Form [Display omitted] • NGS Adoption: European nations differ in NGS tech adoption, with disparities between leaders and laggards. • Policy Impact: Strong policies enhance NGS tech integration in healthcare. • Collaboration: Unified data standards, legal frameworks, and training are essential for Europe-wide NGS integration. • Benefits: NGS integration improves healthcare services, research, diagnostics, and treatments. • Conditions: Progress requires better workforce capacity, data sharing, collaboration, and policy leadership. [ABSTRACT FROM AUTHOR]

The human vestibular system is adversely affected by the aging process. Recent evidence indicates that vestibular information and cognitive functions are related, suggesting that age-related vestibular loss may contribute to cognitive impairment. In this study, we aimed to investigate the effects of repetitive, home-based galvanic vestibular stimulation (GVS) on cognitive functions in healthy older adults. Twenty-one participants (age = 64.66 ± 2.97 years, 12 females) were randomly allocated to either a home-based GVS or an active control group. The GVS intervention lasted 20 min per session, five times a week, for two weeks (10 sessions). Cognitive functions were assessed before and after the intervention using the Stroop Test, Trail Making Test A&B, and Dual-Task (digit recall and paper-pencil tracking test). Our findings revealed a significant group-by-time interaction effect for the tracking accuracy (F (1,18) = 7.713, p = 0.012, η p 2 = 0.30), with only the home-based GVS group showing significant improvement (t = −2.544, p = 0.029). The proposed home-based GVS protocol offers a promising non-pharmacological avenue for enhancing visuospatial ability in healthy older adults. Further research is needed to investigate the effects of different GVS protocols on various cognitive functions, particularly in older individuals with different health conditions. • Home-based GVS is feasible for older adults. • Repetitive GVS improves visuospatial ability in healthy older adults. • GVS is a promising non-pharmacological tool for improving cognition. [ABSTRACT FROM AUTHOR]

Background and Objective Health Information Exchange (HIE) is known as a technology that electronically shares all clinical and administrative data throughout healthcare settings. Despite this technology has a great potential in the healthcare industry, there is a limited and sparse evidence of articles which illustrated the impact of HIE on quality of care and cost-effectiveness. This work presents a systematic review that evaluates the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation in healthcare organizations. Methods We systematically searched all English papers that were indexed in four major databases (Science Direct, PubMed, IEEE and Web of Science) between 2005 and 2016. Consequently, 32 identified papers appeared in 21 international journals and conferences. Eligible studies independently were critically appraised, collected within data extraction form and then thematically analyzed by two reviewers and if necessary, the third author. The selected papers have been classified based on 11 main categories including publication year, journal and conference names, country and study design, types of data exchanged, healthcare levels, disease or disorder, participants in organizations and individuals, settings characteristics and HIE types, the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation. Results Of the 32 articles, 25 studies investigated the financial and clinical impact of HIE. Overwhelmingly, HIE studies have reported positive findings for quality and cost-effectiveness of care. 15 of HIE studies (60%) demonstrated positive financial effects and 16 studies (64%) reported positive effects on quality improvement of patient care. However, the overall quality of the evidences was low. In this regard, cohort study (59.38%) was the most common used study design. Nine studies presented the rates of HIE adoption and participation. The lowest and highest participation rates were 15.7% and 79%, respectively. Conclusions HIE can be considered as a superior potential for healthcare information system, resulting to promote patient care quality and reduce costs related to resource utilization. However, further researches are needed in order to provide a better understanding of this domain and accordingly attain new opportunities to increase users’ participation and motivation for successfully adopting this technology. [ABSTRACT FROM AUTHOR]

The 16th World Congress on Medical and Health Informatics (MedInfo 2017) was held August 21–25, 2017, in Hangzhou, China. It provided a valuable platform for sharing the latest medical and health informatics research and related applications to the scientists, medical practitioners, entrepreneurs, and educators as well as students. During this event, on August 23, 2017, an important related topic was presented in a panel discussion entitled “Wearable technologies: Advancing the healthcare in ageing population” by panelists Shabbir Syed-Abdul, Panagiotis Bamidis, Chun-Por Wong, and Xinxin Zhu. Recent advances in health technologies, focusing on the aging population, their benefits and challenges were discussed, and these topics are summarized in this paper. The need for technology to improve of the life of older population, influential and beneficial technologies, for delivering these technologies to patients are described in this paper. [ABSTRACT FROM AUTHOR]

Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January–September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes. [ABSTRACT FROM AUTHOR]

In many developing countries, populations rely on traditional medicine for primary health care, which have infiltrated commercial markets globally as natural remedies are generally regarded as safe. Traditional and natural remedies are adapted and expanded in commercial products and product ranges to provide alternatives for various diseases and illnesses. These products resemble very little of the traditional use and application and adverse effects are observed in several cases. Some of the herbs and botanical formulations therefore, are not as safe as are commonly contemplated. This paper discusses some plants that are used as food or medicine. These plants are known to contain chemical components that have been identified as genotoxic carcinogens. Often contradictory results are obtained with beneficial and adverse effects reported. The concentration, biotransformation and metabolism of these compounds, as well as the matrix effect, affect the outcome of these results, therefore not providing a clear picture of the risk associated with the use and consumption of these plants. This paper focuses on plants that are accepted as healthy, however contain compounds that are genotoxic and carcinogenic. We further highlight the risks in use of these plants where thorough studies have been conducted in various food and plant products. [ABSTRACT FROM AUTHOR]

This paper seeks to theorize the mechanism by which socially responsible innovation can provide high quality care for patients within the U.S. health care system. By analyzing three exemplary case studies of health care innovation using content analysis, we reveal the mechanism for socially responsible innovation and also suggest places for future implementation. Socially responsible innovation has already taken place in India through design problem solving (at Aravind Eye Care System), and in the United States through both the Chronic Care Model (across hundreds of hospitals), and Lean Management™ principles (at ThedaCare in Wisconsin). Unlike previous theories of organizational learning such as incrementalism and design problem solving, socially responsible innovation puts the patient at the center of systemic health care solutions. Also unlike previous definitions of socially responsible innovation, our conceptualization provides a mechanism for practical application. When analyzing the three exemplary cases of socially responsible innovation, we drew out elements of previous mechanisms of organizational learning (e.g., psychological safety, trial and error, and positive applied theory, etc.) to create a novel reflective mechanism: cycles of actualization. This new reflective mechanism promotes continuous development and implementation of ideal models of practice. Finally, this paper suggests that medical waste management could benefit from socially responsible innovation. If the U.S. health care system adopted socially responsible innovation, facilities could think more holistically about their duties, enacting patient-centered change, and creating a culture of medicine that promotes learning, reflection, and action. [ABSTRACT FROM AUTHOR]

Green Public Procurement (GPP) is an increasingly debated “demand side” environmental policy instrument. The aim of this paper is to take stock of the related literature, with the twofold aim of developing a conceptual model of the relevant phases of GPP and to identify the related research gaps in detail. The literature analyzed here comprises English language papers, which are focused on GPP during the time period from 2000 to 2016. By means of a systematic literature review and content analysis, we provide both a quantitative and qualitative viewpoint. As our analysis reveals, GPP discussion has mostly focused so far on the specific impacts of GPP implementation, while the discussion on GPP as compared to other environmental policy tools, in terms of efficiency and innovation, is still lagging behind; this is coupled with a limited geographical coverage. Finally, by disaggregating the 17 years period under scrutiny into four sub-periods allows us to outline the changes in research trends over time. [ABSTRACT FROM AUTHOR]

This paper investigates the healthcare needs, access to healthcare, and healthcare strategies of Ethiopian migrant domestic workers (MDWs) in Lebanon, drawing on qualitative empirical research. The analysis focusses on four types of health care needs: minor illnesses, pregnancies, serious illnesses (such as cancer, tuberculosis or heart problems), and emergencies (due to accidents, suicide attempts or assaults). Predictably, access to healthcare is distinctly differentiated according to an MDW's status as a documented, freelancer, or undocumented worker. Drawing on the concepts of systemic health inequities and inter-personal racial discrimination, the paper provides evidence for inequitable access to healthcare experienced by Ethiopian women in Lebanon. I identify the specific forms of exclusion they experience and develop a matrix for analysis of systemic inequities in access to healthcare differentiated by migrant status. [ABSTRACT FROM AUTHOR]

Background: Patient portals are considered valuable conduits for supporting patients' self-management. However, it is unknown why they often fail to impact on health care processes and outcomes. This may be due to a scarcity of robust studies focusing on the steps that are required to induce improvement: users need to effectively interact with the portal (step 1) in order to receive information (step 2), which might influence their decision-making (step 3). We aimed to explore this potential knowledge gap by investigating to what extent each step has been investigated for patient portals, and explore the methodological approaches used.Methods: We performed a systematic literature review using Coiera's information value chain as a guiding theoretical framework. We searched MEDLINE and Scopus by combining terms related to patient portals and evaluation methodologies. Two reviewers selected relevant papers through duplicate screening, and one extracted data from the included papers.Results: We included 115 articles. The large majority (n = 104) evaluated aspects related to interaction with patient portals (step 1). Usage was most often assessed (n = 61), mainly by analysing system interaction data (n = 50), with most authors considering participants as active users if they logged in at least once. Overall usability (n = 57) was commonly assessed through non-validated questionnaires (n = 44). Step 2 (information received) was investigated in 58 studies, primarily by analysing interaction data to evaluate usage of specific system functionalities (n = 34). Eleven studies explicitly assessed the influence of patient portals on patients' and clinicians' decisions (step 3).Conclusions: Whereas interaction with patient portals has been extensively studied, their influence on users' decision-making remains under-investigated. Methodological approaches to evaluating usage and usability of portals showed room for improvement. To unlock the potential of patient portals, more (robust) research should focus on better understanding the complex process of how portals lead to improved health and care. [ABSTRACT FROM AUTHOR]

There is a growing trend towards data mining applications in medicine. Different algorithms have been explored by medical practitioners in an attempt to assist their work; the diagnosis of breast cancer is one of those applications. Machine learning algorithms are of vital importance to many medical problems, they can help to diagnose a disease, to detect its causes, to predict the outcome of a treatment, etc. K-Nearest Neighbors algorithm (KNN) is one of the simplest algorithms; it is widely used in predictive analysis. To optimize its performance and to accelerate its process, this paper proposes a new solution to speed up KNN algorithm based on clustering and attributes filtering. It also includes another improvement based on reliability coefficients which insures a more accurate classification. Thus, the contributions of this paper are three-fold: (i) the clustering of class instances, (ii) the selection of most significant attributes, and (iii) the ponderation of similarities by reliability coefficients. Results of the proposed approach exceeded most known classification techniques with an average f-measure exceeding 94% on the considered breast-cancer Dataset. [ABSTRACT FROM AUTHOR]

The strongest economic crisis ever known, started in 2008, destroyed much of the social achievements. Although the European Union had to deal with this situation by designing common policies, the member states have handled this crisis in many different ways. Nevertheless, not all the countries had the same possibilities for manage their economic policies inside a common currency area. These states involved in the EuroZone have faced some restrictions due to their belonging to a currency area, so they have had to design alternative economic policies to the monetary one. The main objective of this paper is to assess the acceptance of the restrictive policies on public health expenses due to economic crisis and the implemented economic policy, from the point of view of citizens. This paper hypothesized that this acceptance or not depends on citizens perception of adequate use of the public health care system. A survey was conducted among the main social actors involved on healthcare system: the general population and health professionals. And for testing the hypotheses a means comparison ( t -test and ANOVA) and Structural Equation Modeling (SEM) has been developed using data from that survey. Outcomes from those econometric exercises show a general disagreement with the cuts in health expenses, but in a level very related with citizen’s perceptions of overuse of public health services. [ABSTRACT FROM AUTHOR]

To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access. We theorise our data by bringing together traditional candidacy theory (in particular, concepts of self-assessment, help-seeking, adjudication and negotiation) and socio-technical and technology structuration theories (in particular, concepts of user configuration, articulation, distanciation, disembedding, and recursivity), thus producing a novel theory of digital candidacy. We propose that both human and technological actors (in different ways) embody social structures which affect how they 'act' in social situations. Digital technologies contain inbuilt assumptions about users' capabilities, needs, rights, and skills. Patients' ability to self-assess as sick, access digital platforms, self-advocate, and navigate multiple stages in the pathway, including adapting to and compensating for limitations in the technology, vary widely and are markedly patterned by disadvantage. Not every patient can craft an accurate digital facsimile on which the subsequent adjudication decision will be made; those who create incomplete, flawed or unpersuasive digital facsimiles may be deprioritised or misdirected. Staff who know about such patients may use articulation measures to ensure a personalised and appropriate access package, but they cannot identify or fully mitigate all such cases. The decisions and actions of human and technological agents at the time of an attempt to access care can significantly influence, disrupt, and reconstitute candidacy both immediately and recursively over time, and also recursively shape the system itself. These findings underscore the need for services to be (co-)designed with attention to the exclusionary tendencies of digital technologies and technology-supported processes and pathways. • Digital access and triage involves a network of technological and human agents. • Digitalised systems exacerbate existing inequities, and create new ones. • Technologies are encoded with assumptions, limiting their use and accessibility. • These assumptions lock out some users, recursively affecting health service usage. • Individual practices' digital options must depend on local staff and patient needs. [ABSTRACT FROM AUTHOR]

The characteristic features of 21st-century corporate capitalism – monopoly and financialization – are increasingly being recognized by public health scholars as undermining the foundations of human health. While the "vectors" through which this is occurring are well known – poverty, inequality, climate change among others – locating the root cause of this process in the nature and institutions of contemporary capitalism is relatively new. Researchers have been somewhat slow to study the relationship between contemporary capitalism and human health. In this paper, we focus on one of the leading causes of death in the United States; cancer, and empirically estimate the relationship between various measures of financialization and monopoly in the US healthcare system and cancer mortality. The measures we focus on are for the hospital industry, the health insurance industry, and the pharmaceutical industry. Using a fixed effects model with different specifications and control variables, our analysis is at the state level for the years 2012–2019. These variables include data on population demographic controls, social and economic factors, and health behavior and clinical care. We compare Medicaid expansion states with non-Medicaid expansion states to investigate variations in state-level funded health insurance coverage. The results show a statistically significant positive correlation between the HHI index in the individual healthcare market and cancer mortality and the opioid dispensing rate and cancer mortality. • We analyze how corporate capitalism is related to cancer mortality. • Recently, corporate capitalism has become more common in the healthcare industry. • We find a correlation between hospital net revenue, profit, and cancer mortality. • There is a link between the HHI index in insurance markets and cancer mortality. [ABSTRACT FROM AUTHOR]

The cognitive load experienced by humans is an important factor affecting their performance. Cognitive overload or underload may result in suboptimal human performance and may compromise safety in emerging human-in-the-loop systems. In driving, cognitive overload, due to various secondary tasks, such as texting, results in driver distraction. On the other hand, cognitive underload may result in fatigue. In automated manufacturing systems, a distracted operator may be prone to muscle injuries. Similar outcomes are possible in many other fields of human performance such as aviation, healthcare, and learning environments. The challenge with such human-centred applications is that the cognitive load is not directly measurable. Only the change in cognitive load is measured indirectly through various physiological, behavioural, performance-based and subjective means. A method to objectively assess the performance of such diverse measures of cognitive load is lacking in the literature. In this paper, a performance metric for the comparison of different measures to determine the cognitive workload is proposed in terms of the signal-to-noise ratio. Using this performance metric, several measures of cognitive load, that fall under the four broad groups were compared on the same scale for their ability to measure changes in cognitive load. Using the proposed metrics, the cognitive load measures were compared based on data collected from 28 participants while they underwent n -back tasks of varying difficulty. The results show that the proposed performance evaluation method can be useful to individually assess different measures of cognitive load. [ABSTRACT FROM AUTHOR]

• Trauma-informed practice is being trialled in response to extra-familial risks and harms. • An institutional ethnography found sources of knowledge impact this innovation. • Professionals may say young people are 'known-to-services' but be distant from them. • Being proximal to young people and advocating for their needs helps to know them. • To be trauma-informed, professionals must relationally know those they support. Efforts to shift from criminal justice to welfare-based responses to exploitation and other forms of extra-familial risks and harms, have centred relational approaches. In particular, the role that relationships between professionals and young people can play in providing a sense of safety as well as a route to wider support services when young people come to harm beyond their families is under consideration. In parallel, trauma-informed practice is increasingly promoted as a tool for creating service conditions in which relational practice can thrive. In this paper we present data from an institutional ethnography of two social care organisations in the UK which are endeavouring to adopt trauma-informed responses to extra-familial risks and harms. We use observation, focus group, and case file data collected in two time periods, to illustrate a relationship we identified between the nature and source of knowledge that guided professional responses, the ability of professionals to form relationships with young people affected by extra-familial risks and harms, and the capacity for their organisations to be trauma-informed. In doing so we trouble an established discourse in many social care organisations, that young people subject to intervention are 'known-to-services' and call for more responses in which young people are 'known-by-professionals' who are supporting them. Far from being a matter of semantics, we discuss how these two ways of knowing about young people, and the situations they face, potentially facilitate or undermine key pillars of trauma-informed practice, and the relational approaches that make such practice possible. [ABSTRACT FROM AUTHOR]

Arctium lappa L. root is a well-known Chinese medicine with high medicinal and food values. Arctium lappa L. root polysaccharide (ALP), as the main component and bioactive substance, has a variety of biological activities, including anti-inflammatory, antioxidant, hypoglycemic, hypolipidemic, antithrombotic, immunomodulatory activity and improvement of intestinal flora. The biological activities of polysaccharides are closely related to their structures, and different extraction and purification methods will yield different polysaccharide structures. As a kind of natural polysaccharide, ALP has a broad application prospect in drug carrier. In this paper, we reviewed the research progress on the extraction, purification, structural characterization, biological activities, structure-activity relationship and drug carrier application of ALP, in order to provide basic reference for the development and application of medical and health care value. At the same time, the shortcomings of ALP research are discussed in depth, and the potential development prospect and future research direction are prospected. [ABSTRACT FROM AUTHOR]

Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups' institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned. • Physicians depend on other hospital actors for pursuing value-based payment reform. • Payment reform prompts actors to assess flaws of current payment practices. • Current payment practices persist due to perceived lack of payment reform necessity. • It is important to look beyond the insurer–provider nexus during payment reform. [ABSTRACT FROM AUTHOR]

Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services. • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands. • Latinx children in colonias are disproportionately exposed to environmental toxins. • Geography acts as a structural determinant of health for Latinx families in colonias. • A binational approach to health services should be prioritized for families in the borderlands. [ABSTRACT FROM AUTHOR]

Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD – is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care. This paper employs a qualitative approach to the analysis of provider-based stigma among professionals involved in the treatment or supervision of individuals with OUD. We conducted and analyzed interviews with 19 professionals as part of a larger mixed methods study on stigma among substance use treatment providers and court personnel in Pennsylvania. Beyond capturing providers' perceptions of PWUO and MOUD, the authors asked participants to describe barriers to recovery, and the effective delivery of care within this population. Interviewees enumerated multiple entrenched barriers that sometimes operated at different levels, such as criminal-legal involvement, which weakened PWUO's social networks and employment prospects, while undermining providers' attempts at continuity of care; moreover, participants cited the "War on Drugs" as an overarching impediment to effective substance use treatment, not least for its role in perpetuating stigma against PWUO. Interestingly, while an overwhelming majority of participants named stigma as a barrier to treatment at every level, most also articulated stigmatizing beliefs around PWUO. Namely, providers evoked one element of stigma – blameworthiness – in their contention that many PWUO are inadequately motivated to recover. In addition to adding further complexity to MOUD barriers research, this study troubles the notion that professional training and education on the disease model of addiction serve to eradicate stigma. • Uptake of medications for opioid use disorder remains low despite efforts to expand access. • Individual, institutional, and systemic barriers to MOUD interact to reduce usage. • Treatment providers identify stigma as a primary barrier to MOUD effectiveness at all levels. • Many treatment providers also express conceptions of people who use opioids as "blameworthy." [ABSTRACT FROM AUTHOR]

Personal health records (PHR) offer significant benefit for patients, such as reducing medical cost and improving the quality of medical care. Majority of the current schemes lack provisions for tracking and revoking malicious doctors. The explicit access policies are prone to leaking patient private information. What is more, owning to the uneven distribution of medical supplies, shocking computational overhead during decryption is a burden that cannot be ignored for busy medical workers. This paper proposed a patient-centric medical service matching scheme that supports policy hiding, attribute matching, fine-grained access control, and user dynamic management. The scheme uses ciphertext policy-based attribute encryption (CP-ABE) to achieve fine-grained access control and supports policy hiding. It utilizes white-box tracking technology and binary tree structure to achieve malicious doctor tracking. Revocation information is ciphertext to achieve dynamic management of doctors. From the experimental results, it can be concluded that our protocol achieves both patient-centric security and performance advantages. • A secure patient-centric medical service matching scheme with policy hiding. • Achieve fine-grained access control and withdraw untrustworthy doctors. • Low computational and communication overhead. [ABSTRACT FROM AUTHOR]

This paper proposes a 4th-order class-AB low-pass filter (LPF) for wearable biological healthcare applications designed by cascading two 2nd-order LPFs. The proposed class-AB LPF uses quasi-floating gate (QFG), flipped source follower (FSF) and level-shifter (LS) techniques to boost its performance. The LPF is designed and validated in CMOS 180 nm technology which emulates the post-layout gain of −0.212 dB, bandwidth of 100 Hz, dynamic range (DR) of 50.26 dB, total harmonic distortion (THD) of −52.5 dB and figure of merit (FOM) of 1.71 × 10-15 J. The class-AB QFG FSF LPF consumes power and area of 0.224 nW and 0.0196 mm2, respectively. Furthermore, the statistically determined coefficient of variation for proposed LPF with 1000 iterations for gain is −0.035, THD is −0.172 and DR is 0.04, respectively. The class-AB QFG FSF LPF is compared with other LPFs which establishes its advantage in terms of low-power consumption and least figure of merit thus confirming its suitability for wearable healthcare applications. [ABSTRACT FROM AUTHOR]

Supplier selection is critical to the healthcare industry, especially in emergencies. Accurate and timely supply of healthcare resources can reduce economic cost and ensure the safety of people's lives. However, the healthcare supplier market is enormous and complex; making accurate evaluations of different suppliers and helping managers choose the most suitable one when considering many factors is becoming an important task. Many multicriteria decision-making (MCDM) methods have been applied to supplier selection in existing literature. However, the research on healthcare supplier selection still needs to be completed. In this paper, to deal with healthcare supplier selection problems when there is no sufficient time and information to decide with uncertainty, the stochastic multicriteria acceptability analysis (SMAA) method and multi-attributive border approximation area comparison (MABAC) method are first combined by taking both the advantages of SMAA and MABAC methods when the assessments are expressed by belief distributions (BDs). In the SMAA-MABAC method, the global ignorance in BDs and the uncertain criteria weights are considered by judging the feasible space to derive the final rank of healthcare suppliers with the most possible. The more straightforward calculation process of SMAA-MABAC makes it faster to make an accurate choice among various suppliers. Moreover, it is flexible to generate different recommended suggestions when diverse preference information is added in SMAA-MABAC. Finally, a case study of healthcare supplier selection is examined for managers based on distributed reviews, and targeted selection advice is given concerning different demands. Besides, the sensitive analysis is provided to better understand the influence of the criteria weights on the proposed model. The results of the comparative analysis also show the effectiveness and rationality of the proposed method. [ABSTRACT FROM AUTHOR]

Running is a popular form of physical activity yet discontinuation is common. Interventions targeting physical activity adoption have shown modest effects, often with little translation into long-term participation, which may limit the health benefits available to the wider community. This paper details the development of a new online running intervention (Just Run) aimed at improving continuation of running activity in new runners through a motivational and psychological lens, including aspects of design, content, refinement, and usability testing. A six-step intervention mapping process was used to develop a theory-based online intervention using a mix of research designs. Key stakeholders including runners, coaches and relevant experts in physical activity and behavior change provided valuable insight, feedback and refinement of the education to be delivered. The final Just Run intervention included ten modules delivered online over twelve weeks to promote ongoing running participation through videos, testimonials, and activities. Key themes identified through the literature and stakeholder engagement process related to goal setting, self-efficacy, intrinsic motivation, social support and overcoming barriers to running participation. Usability testing confirmed the quality and suitability of the education to the target population. Just Run has been developed with a range of stakeholders to address an area of unmet need in the adoption and promotion of running. Just Run is a robust online intervention that has been designed and pre-tested with positive feedback and unique insights from key stakeholders. Further investigation is required to support its implementation to the wider community. • A six-step intervention mapping process informed the design of Just Run. • Key stakeholders contributed to the design of this motivational running intervention. • Goal setting and social support were key topics included in the designed material. • Positive usability testing confirmed the aptness of the education to runners. [ABSTRACT FROM AUTHOR]

Patients are continually being put at risk of harm, and health care organisations are struggling to learn effectively from past experiences in order to improve the safe delivery and management of care. Learning from incidents in health care is based on the traditional safety-engineering paradigm, where safety is defined by the absence of negative events (Safety-I). In this paper we make suggestions for the policy and practice of learning from incidents in health care by offering a critique based on a Safety-II perspective. In Safety-II thinking safety is defined as an ability - to make dynamic trade-offs and to adjust performance in order to meet changing demands and to deal with disturbances and surprises. The paper argues that health care organisations might improve their ability to learn from past experience by studying not only what goes wrong (i.e. incidents), but also by considering what goes right, i.e. by learning from everyday clinical work. [ABSTRACT FROM AUTHOR]

Background Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children’s to adult services. This has proved a challenging process for both young adults and service providers, with complex transition interventions interacting in unpredictable ways with local contexts. Objectives To explain how intervention processes interact with contextual factors to help transition from children’s to adult services for young adults with life-limiting conditions. Design Systematic realist review of the literature. Data sources Literature was sourced from four electronic databases: Embase, MEDLINE, Science Direct and Cochrane Library from January 1995 to April 2016. This was supplemented with a search in Google Scholar and articles sourced from reference lists of included papers. Review methods Data were extracted using an adapted standardised data extraction tool which included identifying information related to interventions, mechanisms, contextual influences and outcomes. Two reviewers assessed the relevance of papers based on the inclusion criteria. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tools. Results 78 articles were included in the review. Six interventions were identified related to an effective transition to adult services. Contextual factors include the need for children’s service providers to collaborate with adult service providers to prepare an environment with knowledgeable staff and adequate resources. Mechanisms triggered by the interventions include a sense of empowerment and agency amongst all stakeholders. Conclusions Early planning, collaboration between children’s and adult service providers, and a focus on increasing the young adults’ confidence in decision-making and engaging with adult services, are vital to a successful transition. Interventions should be tailored to their context and focused not only on organisational procedures but on equipping young adults, parents/carers and staff to engage with each other effectively. [ABSTRACT FROM AUTHOR]

Health Information Systems (HIS) helps in coordinating various activities within hospital through effective and efficient services. Malaysian Government began to introduce HIS in 1999 to cover both clinical and non-clinical information systems. Since then hospitals have been facing challenges to achieve the objectives of its introduction. Thus, it is important to understand determinants for successful implementation in order to ensure sustainable HIS. Various determinants render successful implementation, such as human factors, technology factors as well as organizational factors. However, understanding organizational factors becomes important, since the systems runs within the organization itself. The other two factors; human and technology factors have been discussed elsewhere by the authors. Any issues pertaining to the organization if identified earlier will prevent implementation failure. Hence, this paper aims to provide a review of barriers associated with organization factors hindering the sustainability of HIS, and propose strategies required to minimize the issues discussed. Based on our review, this paper highlighted four main challenges from an organization perspective; high adoption cost, top management support, adequate infrastructure and security and privacy issues. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the effect of social trust on the willingness to pay more taxes to improve public healthcare in post-communist countries. The well-documented association between higher levels of social trust and better health has traditionally been assumed to reflect the notion that social trust is positively associated with support for public healthcare system through its encouragement of cooperative behaviour, social cohesion, social solidarity, and collective action. Hence, in this paper, we have explicitly tested the notion that social trust contributes to an increase in willingness to financially support public healthcare. We use micro data from the 2010 Life-in-Transition survey (N = 29,526). Classic binomial probit and instrumental variables ivprobit regressions are estimated to model the relationship between social trust and paying more taxes to improve public healthcare. We found that an increase in social trust is associated with a greater willingness to pay more taxes to improve public healthcare. From the perspective of policy-making, healthcare administrators, policy-makers, and international donors should be aware that social trust is an important factor in determining the willingness of the population to provide much-needed financial resources to supporting public healthcare. From a theoretical perspective, we found that estimating the effect of trust on support for healthcare without taking confounding and measurement error problems into consideration will likely lead to an underestimation of the true effect of trust. [ABSTRACT FROM AUTHOR]

The virtualization and the digital environments are common learning platforms in several different domains, such as in flying airplanes or controlling nuclear power plants. However, virtual reality is no longer expensive special hardware; the basic installations for virtual and augmented reality can be done within household budgets and with common customer products. In this paper, we study the aspect of usability issues in a scenario, where a new virtual learning environment is built to teach correct prevention mechanics and strategies against common physical and cybersecurity threats in healthcare, namely in a hospital. Our proof-of-concept studies indicate that the concept is functional and that on hardware level components exist. The problems are in the usability and user immersion aspects, which are discussed in this paper and further studied in the proposed research setting. [ABSTRACT FROM AUTHOR]

Translating innovation, such as contemporary research evidence, into policy and practice is a challenge, not just in substance misuse treatment programs, but across all spheres of healthcare. Organizational readiness to change (ORC) has been described as a fundamental concept, and an important determinant of the process of innovation adoption. The aim of this review was to describe the relationship between staff perceptions of ORC and the process of innovation adoption: exposure, adoption, implementation and integration into practice, in substance misuse treatment programs. This systematic review was conducted in accordance with PRISMA guidelines and fourteen papers were identified as being eligible for inclusion. This review was designed to include all constructs of ORC, but only one tool was used in all of the included papers. Despite this, the heterogeneity of studies in this review made a direct comparison of ORC related variables challenging. None of the included papers clearly related to one stage of the process of innovation adoption, and all of the included papers related to the early stages of the process. Only one paper attempted to measure the sustained integration of an innovation into practice. Overall, the papers were assessed as being low in terms of evidential hierarchy and the quality of the papers was assessed as being on average fair. ORC measurements provide us with a measure of organizational functioning which can be important in terms of predicting how successfully new innovations are adopted. Motivation for change was high in programs where staff identified more program deficits and these staff could also identify more specific needs, but were less likely to have exposure to new innovations. Better program resources and specific staff attributes, increase the likely hood of successful innovation adoption. A good organizational climate is potentially the strongest predictor for the adoption of new practices. It may be beneficial to measure ORC in conjunction with other variables such as program size, location, staff workloads and financial resources. More evidence is required on how to address ORC deficits once they are identified in practice. [ABSTRACT FROM AUTHOR]

Although Healthcare Analytics (HA) plays a critical role to uncover the link between data and discover novel and actionable information, the level that each analytics influences clinical decision-making is different. This paper aims to highlight the role of each HA in respect to Precision Medicine (PM). Where, PM is defined as a new approach in medical decision-making that takes into account individual differences in genetic, environmental, and lifestyle indicators. Besides, Simon's model in decision-making assesses the performance of clinical decision-making followed by HA. In addition, SOAP framework is discussed as an example under the influence of HA for adopting PM. [ABSTRACT FROM AUTHOR]

Data visualization is key in the Big Data context, enabling different cognitive perspectives over large datasets. These visual perspectives can prompt relevant advantages with regard to healthcare records, because they may contribute to a faster, more understandable, and adequate way to capture patients' health history and overall condition, thus improving healthcare quality. Timelines are well-known visual artifacts that help healthcare professionals to visualize patients' electronic health records (EHR) over a time period. As data stored in EHR tend to quickly grow with each interaction between patient and healthcare system both number and size, traditional linear timelines are can increasingly become more difficult to manage visually, as they often span over different screens. Considering that a holistic analysis is desirable to provide proper and quality health services, data visualization should enable a seamless understanding of patients' health history and overall condition. When dealing with critical episodes - such as an emergency - where time is an important factor, this is even more decisive. Furthermore, traditional timelines do not support multidimensional data representation. This paper presents a new visual model of time-dependent EHR based on radial models. It is capable of simultaneously displaying several data categories that characterize patients' medical history, enabling medical professionals to be aware of different data categories over time in a single display, without the need to scroll between screens. [ABSTRACT FROM AUTHOR]

The effect of introducing or increasing user fees for health services in low- and middle-income countries is controversial. While user fees are advocated as an effective means of generating revenue and enabling health service quality improvement, they constitute a financial barrier to access health services for the poorer. This paper contributes to the literature on the demand-side financing in health by providing evidence on the medium-term effects of introducing user fees on the utilisation of family planning, antenatal care, and delivery care services, women's access to health care, and child health status in a middle-income country setting. Using a difference-in-differences identification strategy to establish causality, we find that the introduction of user fees in Egypt had no negative effect on the utilisation of family planning and delivery care services. Further, fees did not hinder women's access to care and did not harm child health outcomes. Positive effects were even observed with respect to the utilisation of antenatal care services. Our findings are compatible with the hypothesis that the potential decrease in demand due to the user fee imposition might have been offset by an increased willingness to pay for a quality of health care that could be, at least partly, perceived as higher. • User fees do not necessarily deter utilisation of and access to health services. • Positive effects of user fees on antenatal care utilisation are observed. • Services with fees may be perceived of higher quality, raising willingness to pay. [ABSTRACT FROM AUTHOR]

The use of artificial intelligence (AI) in medicine is beginning to alter current procedures in prevention, diagnosis, treatment, amelioration, cure of disease and other physical and mental impairments. In addition to raising concerns about public trust and ethics, advancements in this new emerging technology have also led to a lot of debate around its integration into healthcare. The objective of this work is to introduce researchers to AI and its medical applications, along with their potential pitfalls, in a comprehensive manner. This paper provides a review of current studies that have investigated how to apply AI methodologies to create a smart predictive maintenance model for the industries of the future. We begin with a brief introduction to AI and a decade's worth of its advancements across a variety of industries, including smart grids, train transportation, etc., and most recently, healthcare. In this paper, we explore the various applications of AI across various medical specialties, including radiology, dermatology, haematology, ophthalmology, etc. along with the comparative study by employing several key criteria. Finally, it highlights the challenges for large-scale integration of AI in medical systems along with a summary of the ethical, legal, trust, and future implications of AI in healthcare. [ABSTRACT FROM AUTHOR]

• A comprehensive systematic review on healthcare recommender systems is provided. • The main ideas, methods, tools, advantages, disadvantages, evaluation parameters, and evaluation methods are discussed and summarized. • A scientific taxonomy of healthcare recommender systems is presented. • A detailed list of challenges, open issues, and future research directions is outlined. The maintenance of health through prevention, diagnosis, and treatment of illnesses, injuries, and other mental and physical impairments in people is called healthcare that is performed by professionals in health fields. All activities performed in providing primary, secondary, and tertiary care, as well as in public health, are components of healthcare systems that are required to analyze massive amounts of patients' data to gain insights and aid in disease prediction. The healthcare recommender system (HRS) is a growing and robust platform for healthcare services. The purpose of this paper is to identify , taxonomically classify , and compare current HRS researches in a systematic way. This study presents a systematic literature review (SLR) method for HRSs regarding 41 papers published between 2010 and 2021; the selected articles fall into five classes: collaborative-based, content-based, knowledge-based, context-based, and hybrid. Seventeen essential factors are identified to examine the selected HRSs, and each of the papers were studied to find advantages, disadvantages, evaluation types, and tools. In addition, we address a discussion of challenges, future directions, and open issues. This paper demonstrates that HRSs are still in their early stages of maturity, but they are developing. It identifies the need for a scalable, confidential, and reliable framework to aid in the improvement of both patients' and health professionals' trust in HRSs. This research reveals a lack of standardization of medical codes across various healthcare systems. In addition, this review identifies the need for novel patterns to address cold start problems. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The present study was performed to determine the standard functions of electronic clinical pathways (eCP) embedded in electronic medical records with regard to demand definition. Methods: The standard functions of eCP were decided by the required functions determined from interviews with hospital staff, those derived from the implementation of paper-based clinical pathways (CPs), and additional functions generated through the shift from a paper-based to an electronic system. Moreover, the proposed standard functions and those of eCP embedded in electronic medical records for large hospitals were compared by interviews with five vendors. Results: Seventeen functions were deemed necessary for eCP, and these were classified into six categories: displaying, recording, ordering, editing, variance, and statistics. Although most of these functions are already included in eCP products, their implementations differ between products. Conclusions: We propose 17 standard functions required for eCP embedded in electronic medical records. The functions for editing patient checklists, checking the occurrence of variance, and statistics are especially important and should be implemented as standard functions. This study will aid in the future development of eCP embedded in electronic medical records. [Copyright &y& Elsevier]

Underrepresented in medicine (URiM) are individuals from racial and ethnic populations that are underrepresented in the medical field relative to their numbers in the general population. International medical graduates (IMGs) compose a significant percentage of URiM individuals, with a meaningful role in the current US health care workforce. Currently, there is limited data on IMGs in dermatology. In this paper, we wish to showcase reliable data about the IMG pool and highlight their value in diversifying dermatology in order to better serve our patients and provide culturally competent care. [ABSTRACT FROM AUTHOR]

Introduction: Evidence regarding the impact of prophylactic implantation of Extracorporeal Membrane Oxygenation (ECMO) during coronary or structural procedures is limited. The purpose of this paper is to evaluate the in-hospital and medium term outcomes of ECMO support in complex percutaneous coronary or structural intervention.Methods: The present is an observational prospective study including consecutive patients who underwent to prophylactic ECMO implantation for percutaneous coronary intervention (PCI), structural or combined interventions between July 2018 and July 2020 in Maria Pia Hospital GVM Care & Research, Turin, Italy. Primary endpoints were in-hospital and medium term all-cause death. Secondary endpoints were vascular complication, bleeding and procedural success.Results: 27 patients were included with a mean age of 80 ± 6 years, 10 (37%) being diabetics and 19 (70%) with severe left ventricle dysfunction. Mean Logistic Euroscore was 28.7 ± 18.7. Seven patients (26%) underwent complex coronary revascularization, 7 (26%) combined PCI + TAVI, 5 (19%) combined PCI + Mitraclip, 5 (19%) TAVI alone and finally 3 (11%) combined TAVI + Mitraclip. The procedural success was 96%, with only one in-hospital death due to major vascular complication at the ECMO vascular access. At a mean follow-up of 11 ± 6.8 months 4 deaths were recorded (3 from not cardiovascular causes).Conclusions: Prophylactic use of ECMO may be beneficial for high risk patients undergoing complex combined coronary/structural percutaneous interventions with good in-hospital and mid-term outcomes in term of safety and procedural success. [ABSTRACT FROM AUTHOR]

• Rapid adoption and implementation of group teletherapy in the context of COVID-19 is feasible. • Behavioral health organizations should utilize available guidelines and frameworks to support successful teletherapy implementation. • Teletherapy is a promising solution to provide access to behavioral services during COVID-19. Behavioral health services have been tasked with rapidly adopting and implementing teletherapy during the SARS-CoV-2/COVID-19 pandemic to assure patient and staff safety. Existing teletherapy guidelines were developed prior to the pandemic and do not capture the nuances of rapidly transitioning in-person individual and group-based treatments to a teletherapy format. In this paper, we describe our approach to quickly adapting to a teletherapy technology platform for an intensive outpatient program (IOP) guided by cognitive and behavioral modular principles for adults with serious mental illness. A review of existing guidelines was conducted and the staged approach for teletherapy implementation (Muir et al., 2020) was selected as the most appropriate model for our organizational context. We describe the most pertinent implementation strategies and report our preliminary findings detailing the feasibility of IOPs delivered via telehealth. This model of rapid teletherapy implementation offers practical clinical guidelines for administrators and clinicians seeking to transition traditional in-person behavioral health services to a teletherapy format. [ABSTRACT FROM AUTHOR]

Space agencies use terrestrial-based analog missions to reduce risk and cost of spaceflight operations. This paper explains how research simulations differ from more traditional spaceflight analogs, and describes medical mishaps that may occur. Suggested paths to improved safety standards will better prepare health and safety officers to address healthcare gaps. • Analog space missions use terrestrial environments to simulate aspects of real space. • They vary significantly in fidelity, funding, resources, and organization. • A safety focused risk assessment should be conducted regardless of analog type. • The roles and responsibilities of health and safety officers are many and diverse. • Reporting significant adverse events is encouraged. [ABSTRACT FROM AUTHOR]

Cancer mortality rates in low-income and middle-income countries (LMICs) are unacceptably high, requiring both collaborative global effort and in-country solutions. Experience has shown that working together in policy, clinical practice, education, training, and research leads to bidirectional benefit for LMICs and high-income countries. For over 60 years, the UK National Health Service has benefited from recruitment from LMICs, providing the UK with a rich diaspora of trained health-care professionals with links to LMICs. A grassroots drive to engage with partners in LMICs within the UK has grown from the National Health Service, UK academia, and other organisations. This drive has generated a model that rests on two structures: London Global Cancer Week and the UK Global Cancer Network, providing a high-value foundation for international discussion and collaboration. Starting with a historical perspective, this Series paper describes the UK landscape and offers a potential plan for the future UK's contribution to global cancer control. We also discuss the opportunities and challenges facing UK partnerships with LMICs in cancer control. The UK should harness the skills, insights, and political will from all partners to make real progress. [ABSTRACT FROM AUTHOR]

Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states—Michigan and Connecticut—to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority. [ABSTRACT FROM AUTHOR]