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Background: Medicare Advantage (MA) penetration rates have shown an increase in rural areas in the past decade, increasing the bargaining power of MA plans relative to rural hospitals. We study the effect that this increase has had in the revenue of rural hospitals through reductions in the number of inpatient days paid by the plans, which has been reported to be part of the financial bargaining between the two parties. Methods: We use 2014–2020 hospital level data from the American Hospital Association's annual survey and county-level MA penetration rates. We estimate the correlation between MA penetration rates and Medicare and non-Medicare inpatient days using multivariate regressions with hospital and year fixed effects. We use results for urban areas where competition among multiple MA sponsors reduces their individual bargaining power as a falsification test. Results: We find that a 10 percentage points increase in the county-level MA penetration rate is associated with a decrease of 0.87% inpatient days paid to rural hospitals, which unveils a new main factor affecting the fragile finances of rural hospitals. Consistent with our hypothesis, urban hospitals do not exhibit similar effects, underscoring the role of MA plans in rural areas. Conclusions: As MA plans increase their penetration in rural areas, their bargaining power increases relative to rural hospitals. MA plans use this increased bargaining power to reduce the number of paid inpatient days, which creates adverse financial conditions for rural hospitals. Policymakers can safeguard rural hospitals by modifying the fee-for-service prices received by rural hospitals or strengthening the network adequacy criteria of MA plans for rural areas. [ABSTRACT FROM AUTHOR]

Background: Traumatic injuries are a leading cause of morbidity and mortality globally, with a disproportionate impact on populations in low- and middle-income countries (LMICs). The Kampala Trauma Score (KTS) is frequently used for triage in these settings, though its predictive accuracy remains under debate. This study evaluates the effectiveness of machine learning (ML) models in predicting triage decisions and compares their performance to the KTS. Methods: Data from 4,109 trauma patients at Soroti Regional Referral Hospital, a rural hospital in Uganda, were used to train and evaluate four ML models: Logistic Regression (LR), Random Forest (RF), Gradient Boosting (GB), and Support Vector Machine (SVM). The models were assessed in regard to accuracy, precision, recall, F1-score, and AUC-ROC (Area Under the Curve of the Receiver Operating Characteristic curve). Additionally, a multinomial logistic regression model using the KTS was developed as a benchmark for the ML models. Results: All four ML models outperformed the KTS model, with the RF and GB both achieving AUC-ROC values of 0.91, compared to 0.62 (95% CI: 0.61–0.63) for the KTS (p < 0.01). The RF model demonstrated the highest accuracy at 0.69 (95% CI: 0.68–0.70), while the KTS-based model showed an accuracy of 0.54 (95% CI: 0.52–0.55). Sex, hours to hospital, and age were identified as the most significant predictors in both ML models. Conclusion: ML models demonstrated superior predictive capabilities over the KTS in predicting triage decisions, even when utilising a limited set of injury information about the patients. These findings suggest a promising opportunity to advance trauma care in LMICs by integrating ML into triage decision-making. By leveraging basic demographic and clinical data, these models could provide a foundation for improved resource allocation and patient outcomes, addressing the unique challenges of resource-limited settings. However, further validation is essential to ensure their reliability and integration into clinical practice. [ABSTRACT FROM AUTHOR]

Background: The diagnosis and treatment of cancer are associated with substantial physical, psychological, and social morbidity for most patients. Distress can be seen as an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. Purpose: The aim was to understand patients' experiences of distress in their context and to analyze and interpret the findings. Method: An explorative, descriptive qualitative study was conducted among cancer patients receiving treatment and care at rural hospitals in Limpopo. A face-to-face individual interview was conducted to determine the participants' cancer-related experiences and quality of life. Thematic analysis was conducted following Tesch's method, and the themes developed were subjected to a triangulation process to ensure the validity and rigor of the findings. Findings: The participants revealed experiences of symptomatic distress resulting in biopsychosocial distress such as pain, fatigue, emotional distress related to prognosis and uncertainty about the future, psychosocial distress related to a lack or absence of support, financial instability, and poor self-esteem. Conclusions: Cancer patients face many challenges during their treatment journey. Participants were drained by anxiety and uncertainty of the cancer trajectory and required psychosocial support. The oncology team must provide supportive preventive measures for side effects management and culture-sensitive psychotherapy at an early stage to improve their quality of life. [ABSTRACT FROM AUTHOR]

Aims: To explore the perspectives of people who worked at Whakatāne Hospital during and following a mass casualty event from the Whakaari/White Island eruption in New Zealand. Background: The eruption of Whakaari / White Island on December 09th, 2019, significantly impacted many people in New Zealand and internationally. Whakatāne Hospital, a rural hospital in New Zealand, received a mass casualty alert in response to this event. Whakaari holds genealogical significance for Māori (Indigenous) people of the Mataatua region, the Eastern Bay of Plenty. Many local stories and waiata (songs) about this ancestral volcano are still told today. Design: A research protocol for conducting a grounded theory study in the wake of a traumatic event. Methods: Grounded theory (GT), a structured yet flexible methodology, is ideal for understanding a phenomenon in a research area where evidence is limited. It asserts that reality is constructed by those who experience it. In this context, recognising cultural knowledge (Mātauranga Māori) is crucial to ensure the validity of cultural inclusivity and equity in the research process and generation of data. Conclusion: The GT developed from this study will be based on the experiences of selected participants and will also explore the importance of cultural factors, such as indigenous knowledge, in conducting research on traumatic events. Implications for the Profession and for Patient Care: The results from this grounded theory research will provide data for healthcare practitioners in developing resources and policies to enhance health system preparedness and responsiveness to disasters, improving future crisis management protocols. Reporting Method: EQUATOR guidelines have been adhered to Consolidated criteria for reporting qualitative research COREQ. Public Contribution: Mr Arona Smith and Mrs TeReinga.Kingi-Chase were actively involved in the design of this study, contributing their expertise in Mātauranga Māori. [ABSTRACT FROM AUTHOR]

Abstract Background Medicare Advantage (MA) penetration rates have shown an increase in rural areas in the past decade, increasing the bargaining power of MA plans relative to rural hospitals. We study the effect that this increase has had in the revenue of rural hospitals through reductions in the number of inpatient days paid by the plans, which has been reported to be part of the financial bargaining between the two parties. Methods We use 2014–2020 hospital level data from the American Hospital Association’s annual survey and county-level MA penetration rates. We estimate the correlation between MA penetration rates and Medicare and non-Medicare inpatient days using multivariate regressions with hospital and year fixed effects. We use results for urban areas where competition among multiple MA sponsors reduces their individual bargaining power as a falsification test. Results We find that a 10 percentage points increase in the county-level MA penetration rate is associated with a decrease of 0.87% inpatient days paid to rural hospitals, which unveils a new main factor affecting the fragile finances of rural hospitals. Consistent with our hypothesis, urban hospitals do not exhibit similar effects, underscoring the role of MA plans in rural areas. Conclusions As MA plans increase their penetration in rural areas, their bargaining power increases relative to rural hospitals. MA plans use this increased bargaining power to reduce the number of paid inpatient days, which creates adverse financial conditions for rural hospitals. Policymakers can safeguard rural hospitals by modifying the fee-for-service prices received by rural hospitals or strengthening the network adequacy criteria of MA plans for rural areas.

Background: Prostate cancer is the most frequently diagnosed cancer among men in the world. Uganda and Zimbabwe have been reported to have highest incidence rates of prostate cancer in sub-Saharan Africa. There are no urologists and no prostate cancer diagnostic facilities in rural communities in south western Uganda. Men with lower urinary tract symptoms are treated with prostatectomy by midlevel healthcare workers and general surgeons without prior prostate cancer screening. Histological diagnosis relies on the prostate tissue retrieved during surgery and the results may take several months. Prostate cancer care in southwestern Uganda remains uncoordinated and has not been documented before. This study aimed to establish and document the burden of prostate cancer in rural southwestern Uganda as a basis for further research. Methods: This was a retrospective study conducted in hospitals in rural southwestern Uganda. We used hospital records as primary source of data. Histology results of patients treated with prostatectomy during the five-year period (2019–2023) were retrieved and data extracted for analysis. 1013 patients were included in the study. Univariate data analysis was done with STATA version 17.0. The study received ethics clearance for Kabale university REC and Uganda National council of Science and Technology. Results: The average age of patients in this study was 70.6 year (range 54–102 years). Prostate cancer was present in 232 (22.9%) patients. Seventeen (7.3%) patients with prostate cancer were below sixty years. Most (75.4%) of the patients with prostate cancer in this study had low to intermediate risk disease. Perineural tumor infiltration was present in 28.9% of prostate cancer patients. Conclusion: More than 1 in 5 men (22.9%) with lower urinary tract symptoms treated with prostatectomy in the study period in southwestern Uganda had prostate cancer. Majority of patients (75.4%) had low to intermediate risk disease. These findings highlight the urgent need for systematic improvements in prostate cancer care, including sensitization of both health workers and the general population, establishment of early screening and regional diagnostic and treatment facilities to enhance patient outcomes in resource -limited rural communities in Uganda. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Diabetic macular edema (DME) is the most common cause of decreased visual acuity in diabetic patients. Diabetic Macular edema is detected clinically only after its characteristic features which could damage the visual status of the patients. OCT (Optical coherence tomography) offers a non-invasive imaging technique that provides high-resolution cross-sectional images of the macula which can be helpful in early detection of Diabetic Macular Edema. Methods: Hospital-based observational, descriptive, cross-sectional study, carried out from October 2016 to October 2018 in the Ophthalmology Department of Pravara Rural Hospital, a rural-based tertiary-level hospital. A total number of 130 cases with DRs fulfilling inclusion and exclusion criteria were included. The age and gender of the patient, duration of DM, medication for DM, stage of DR, and visual acuity were recorded and assessed for DME with the help of OCT. Results: Out of 130 DR cases, the maximum number of cases was in the age group of 60- 70 years (50.77%). The prevalence of OCT-proven DME in cases with DR in the present study was 29.23%. 95.38% of cases had NPDR changes and 4.62% PDR changes. A higher (76.93%) number of DR cases were involved having a duration of DM up to 5 years. DR cases having a duration of DM up to 5 years had a prevalence of DME (57.90%). Early PDR changes had a maximum prevalence of DME (100%), followed by Severe (87.5%) and Very Severe NPDR (81.81%) respectively. The percentage of DR cases on Insulin was higher (66.66%) than cases not on Insulin (13.19%) showing a preponderance of cases on Insulin. Central macular thickness showed a signifiicant increase in thickness with the progression of DR. Conclusion: From the observations and results of the present study it is evident that the prevalence of OCT-proven DME is 29.23% in cases with DR. Prevalence of DME in PDR cases is more than with NPDR cases. Our study shows a higher percentage of DME with a duration of up to 5 years of DR. [ABSTRACT FROM AUTHOR]

Outcomes among acute kidney injury (AKI) patients are poor in United Kingdom (UK) hospitals, and electronic alerts and care bundles may improve them. We implemented such a system at West Suffolk Hospital (WSH) called the 'AKI order set'. We aimed to assess its impact on all-cause mortality, length of stay (LOS) and renal function among AKI patients, and its utilization. Retrospective, single-center cohort study of patients ≥ 18 years old with AKI at WSH, a 430-bed general hospital serving a rural UK population of approximately 280,000. 7243 unique AKI events representing 5728 patients with full data were identified automatically from our electronic health record (EHR) between 02 September 2018 and 1 July 2021 (median age 78 years, 51% male). All-cause mortality, LOS and improvement in AKI stage, demographic and comorbidity data, medications and AKI order set use were automatically collected from the EHR. The AKI order set was used in 9.8% of AKI events and was associated with 28% lower odds of all-cause mortality (multivariable odds ratio [OR] 0.72, 95% confidence interval [CI] 0.57–0.91). Median LOS was longer when the AKI order set was utilized than when not (11.8 versus 8.8 days, p <.001), but was independently associated with improvement in the AKI stage (28.9% versus 8.7%, p <.001; univariable OR 4.25, 95% CI 3.53–5.10, multivariable OR 4.27, 95% CI 3.54–5.14). AKI order set use led to improvements in all-cause mortality and renal function, but longer LOS, among AKI patients at WSH. [ABSTRACT FROM AUTHOR]

Background: Acute lower respiratory tract infections (ALRIs) remain the leading infectious cause of death among children < 5 years, with viruses contributing to a large proportion of cases. Little is known about the epidemiology and etiology of viral ALRI in rural Bangladesh. Methods: We enrolled 3‐ to 23‐month‐old children with ALRIs attending a subdistrict hospital outpatient clinic in Sylhet district in Bangladesh. Trained study physicians ascertained the cases and obtained nasopharyngeal swabs to detect 19 respiratory viruses by multiplex PCR using the Luminex Integrated System NxTAG Respiratory pathogen panel. Results: Between August 2016 and September 2017, we enrolled 1477 children. Median age was 10 months; 58.1% were male. Forty‐seven percent presented during autumn (mid‐June to mid‐October). About a third had temperature ≥ 101°F, 95.4% had cough in the previous 3 days, 72.0% had fast breathing, and 80.0% had chest indrawing. Alveolar consolidation occurred in 23.9%, and 4.4% were hypoxemic (saturation < 90% on room air). Nineteen percent required hospitalization; 79.1% of them were discharged within 48 h. A respiratory virus was identified in 81.8%, majority (75.8%) with single virus isolation. Rhinoenterovirus was most commonly identified (HRV/HEV, 37.9%), followed by respiratory syncytial virus (RSV, 20.2%) and human metapneumovirus (hMPV, 11.7%). Rhinoenterovirus was detected year‐round; RSV was detected during August–November and hMPV during December–March. Conclusions: Respiratory viruses were identified in a majority (82%) of children under 2 years of age presenting with ALRI in rural hospitals of Bangladesh. These findings have implications for future study and potentially for surveillance, antimicrobial stewardship, vaccine program planning, and policy. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: A ten-group classification system of caesarean section was proposed by Michael Robson in 2001. It is helpful in comparing the rates of caesarean section between hospitals. The objective of this study was to determine the caesarean section rates to analyse trends of caesarean section and classify according to Robson's categories. Methods: This cross-sectional study was conducted from 2016 to 2022. A total of 3176 women who underwent caesarean section were grouped under Robson's ten-group classification system. Results: The most common group was Group 5 (All multiparous women with at least one previous uterine scar, with single cephalic pregnancy, ≥37 weeks gestation) followed by Group 2 (Nulliparous women, with single cephalic pregnancy, >37 weeks gestation who either had labour induced or were delivered by caesarean section before labour). Results were obtained for the specified period (from 2016 to 2022), and Group 5 contributes more to the total CS rates (45% in 2016, 46% in 2017, 46% in 2018, 57% in 2019, 49% in 2020, 52% in 2021, 54% in 2022), followed by Group 2 (20% in 2016, 17% in 2017, 18% in 2018, 19% in 2019, 26% in 2020, 24% in 2021, 24% in 2022). Conclusion: Pregnant women with prior uterine scars contribute more to caesarean section rates according to Robson's categories. Hence, strategies must be implemented to lower the primary caesarean section rates. [ABSTRACT FROM AUTHOR]

Background: A small number of post-cholecystectomy syndrome cases result from residual stones in a lengthy cystic duct or recurrence of lithiasis in a remaining gallbladder (GB) tissue. In laparoscopic procedures, up to 13.3% may involve incomplete GB removal due to surgical complexities and anatomical variations such as adhesions or challenging morphology. Aims and Objectives: (1) To assess the incidence of retained stones in patients undergoing cholecystectomy, (2) to compare incidences among open and laparoscopic cholecystectomies, (3) to study various presenting ways and different investigational methods helping in early diagnosis and proper management, and (4) to study different operative interventions for different cases. Materials and Methods: This was a prospective and retrospective observational study. After getting ethical committee approval and informed consent, 35 patients were included in the study. The study was carried out in the Department of General Surgery at I.P.G.M.E.R./S.S.K.M. Hospital, Kolkata. Results: Most patients were post-open cholecystectomy cases. The incidence of retained GB stones was 4.48%, with females affected 2.8 times more than males. Common symptoms were pain abdomen (80%) and fever (25%). Ultrasonography diagnosed stump calculi in 85.71% of cases; magnetic resonance cholangiopancreatography (MRCP) was preferred when ultrasound was inconclusive. Conclusion: Cases underwent subtotal cholecystectomy or had long cystic duct stumps in rural hospitals, referred to tertiary hospital for further management. Symptoms included pain abdomen, fever, and sometimes jaundice. MRCP confirmed diagnoses before open re-exploration; completion cholecystectomy addressed residual stones for symptom relief and cure. [ABSTRACT FROM AUTHOR]

Background: Research aimed to see if minimally invasive percutaneous pedicle screw fixation (MIPPS)or open pedicle screw fixation (OPS) worked effectively for geriatric osteoporotic fractures (#) of the spine. Methods: In the department of neurosurgery at the tertiary care centre, 60 cases of geriatric osteoporotic vertebral # were divided into a MIPPS set (n=30 MIPPS) and an OPS set (n=30, conventional OPS). Results: The experimental set surgical time, surgical bleeding, incision size, days of hospital stay, and incidence of postoperative complications were smaller than those in the control set (all P <0.05). Both sets' Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) improved 6 months following surgery, with the experimental set showing the most improvement (all P<0.05). Conclusions: Both sets of MIPPS and OPS may accomplish adequate internal fixation, with the former having reduced trauma, a less surgical duration, a quicker recovery, fewer postsurgical problems, and less post-surgical discomfort. [ABSTRACT FROM AUTHOR]

Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby's admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD. [ABSTRACT FROM AUTHOR]

Introduction: Although the importance of leader–member relationships in teamwork is acknowledged in literature, a deeper understanding of this relationship is lacking, especially in rural areas. The impact of leader–member relationships on team outcomes is especially important in rural Chinese hospitals as improving teamwork forms a national health reform priority in these hospitals. This study investigates how leader-member relationships (ie leader-member perceived similarity and power distance orientation) influence team outcomes (ie perceived quality of care and job satisfaction) via speaking up and silence. Methods: An online questionnaire was completed by 1017 team members (ie doctors, nurses and other healthcare professionals) of 300 teams in four rural Chinese hospitals in October 2022. The questionnaire measured leader-member perceived similarity, power distance orientation, speaking up, silence, perceived quality of care, job satisfaction and control variables. Multilevel mediation analysis was conducted to test the hypotheses. Results: Leader–member perceived similarity and power distance orientation are positively related to speaking up (β=0.61, p< 0.01; β=0.17, p< 0.01 respectively) and to silence (β=0.41, p< 0.01; β=0.63, p< 0.01 respectively). Speaking up is positively related to the perceived quality of care (β=0.24, p< 0.01; β=0.46, p< 0.01) and job satisfaction (β=0.30, p< 0.01; β=0.54, p< 0.01), while the impact of silence is not significant. Finally, speaking up mediates the associations of both leader-member perceived similarity and power distance orientation with perceived quality of care (β=0.15, p< 0.01; β=0.08, p< 0.01 respectively) and job satisfaction (β=0.30, p< 0.01; β=0.54, p< 0.01 respectively). Conclusion: Speaking up, rather than silence, contributes to team functioning by mediating the impact of leader–member relationships to team outcomes. Hospital management may therefore seek to stimulate speaking up by focussing on leader-member relationships: increasing leader-member similarity and promoting members' power distance orientation. However, any unintended effect of increased silence through these leader–member relationships is an important area of future research, which can adopt multidimensional models of speaking up and silence. [ABSTRACT FROM AUTHOR]

Hospital plate waste poses a major challenge facing the present food systems, as providing meals that meet the nutritional requirements and expectations of the patients remains complex for hospital food services. This study aimed to assess the magnitude of plate waste in Lebanese hospitals, evaluate the patients' satisfaction levels, and identify the determinants of plate waste in participating hospitals. A cross-sectional study was conducted between April 2023 and September 2023, involving 155 in-patients from cardiovascular, gastrointestinal, obstetrics-gynecology, and surgical wards across 16 hospitals in different Lebanese governorates. Plate waste was measured, and patient satisfaction was assessed using a questionnaire. Plate waste represented 31.4% of the total food served, equivalent to 366 tonnes annually in the 16 participating hospitals. Waste was higher in hospitals located in rural areas (p-value = 0.771). The highest waste levels were observed in the obstetrics-gynecology ward and during lunchtime. Vegetables were the most wasted food group. The majority of participants were satisfied with the food service, and low appetite was the main reason for not consuming hospital meals. Food quality (β= −0.17, p-value = 0.049) and governorate (β= −0.18, p-value = 0.019) were determinants of plate waste. The hospital sector is as unique and challenging as other sectors regarding plate waste, which warrants further research to gain deeper insights into waste generation. [ABSTRACT FROM AUTHOR]

Background: Despite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS). Methods: A stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level. Results: Compared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p < 0.001) in models adjusted for the study period. A similar improvement was observed for discharge medication reconciliation completion (OR 4.07, CI 2.38–6.95, p < 0.001), whereas a 33-fold improvement was seen in Best Possible Medication History completion (OR 33.27, CI 17.53–63.14, p < 0.001). The VCPS documented 879 medication related problems, with 61% of patients having at least one medication-related problem documented by a pharmacist. There was no change in length of stay, falls, readmission rates or reported medication error rates; however, the study was not powered to detect these changes. Patient feedback was positive and comparable to in-person care, with 95% (179/189) reporting their overall experience as 'good' or 'very good.' No unintended harms were reported. Conclusions: The VCPS improved compliance with national standards for medication safety, had high patient acceptability and resulted in the detection of clinically relevant medication-related issues in rural and remote settings. The applicability of virtual pharmacy should be explored in further rural and remote locations in addition to other settings such as metropolitan locations with no onsite clinical pharmacists. Ethics number: GWHREC 2019/ETH13355. Trial registration: ANZCTR registration number ACTRN12619001757101. Registered on 11/12/2019. Published trial protocol: A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Globally, breast cancer is the most common malignant tumor in both developed and developing nations, with an incidence of 2 million cases every year and around 6 lakh deaths. Even after the availability of healthcare facilities, delays in the management of breast cancer are seen in both developed and developing countries. Objectives: To assess the patient and system-level delays and to determine the factors that cause the identified delays in women with breast cancer from central rural India. Methodology: The present Mixed-method study was conducted in a tertiary care hospital in central rural India among 128 female breast cancer patients. Socio-demographic and clinical information of the patients was summarized using frequency and proportions. Delays were reported using a median number of days and interquartile range. To assess the factors associated with the delays, we used Negative log-binomial regression analysis. Qualitative data analysis was done by manual thematic analysis. Results: The mean age of the study participants was 50.54, SD was 10.46, Median was 50, and the Interquartile range (IQR) was 43-58 years. A median patient delay of 45 days, and IQR was 15-120. A median system delay of 19 days and IQR was 7-35 days. We identified seven themes addressing the factors influencing delays at various levels by thematic analysis. Negative log-binomial regression models were built for the association of the socio- demographic and clinical variables with patient and system delays. Conclusion: Our study concludes that there is a substantial delay at patient level reporting to healthcare care providers, which needs an increase in awareness levels in the community through dedicated Behavior Change Communication strategies along with addressing identified socio-cultural and economic determinants influencing delay at various levels. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: Klebsiella pneumoniae commonly causes healthcare-associated infections and shows multidrug resistance. K. pneumoniae can produce biofilm. Carbapenem resistance in K. pneumoniae is due to the production of carbapenemases mainly. This study was done to evaluate the formation of biofilm and carbapenemase resistance in K. pneumoniae isolates. Material and Methods: A total of 110 K. pneumoniae isolated from various clinical samples were taken, the antibiotic susceptibility test was done by the Kirby disk diffusion method, and biofilm detection was done by the tissue culture plate method. All the carbapenem-resistant isolates were confirmed by multiplex real-time PCR (mPCR). Those found positive for any of the carbapenemase genes were tested by the modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and ethylenediamine tetraacetic acid (EDTA)-modified carbapenem inactivation method (eCIM). Results: Out of 110 isolates, 66% (72/110) were carbapenem-resistant (suggestive of carbapenemase producers) by Kirby-Bauer disk diffusion but 58% (42/72) of Klebsiella isolates were confirmed for carbapenemase production by mPCR. Maximum number of carbapenemase gene were New Delhi metallo-β-lactamase (NDM) 52% (N = 22), 29% (N = 12) coproducers (NDM+OXA-48), and lowest in oxacillinase (OXA-48), 19% (N = 8). The overall sensitivity of MHT and mCIM+eCIM was 62% and 93%, and specificity was 88% and 97%, respectively. Our study showed that moderate biofilm producers were 51% (N = 56) K. pneumoniae isolates, strong biofilm producers 27% (N = 30), and 22% (N = 30) were weak/non-biofilm producers. We also found the correlation between biofilm formation and carbapenem-resistant K. pneumoniae (CR-KP) genes was statistically significant with a P value of 0.01*<0.05. Conclusion: Most isolates of K. pneumoniae demonstrated a wide range of antibiotic resistance and were biofilm producers. Our results indicated that the combination of mCIM with eCIM showed high sensitivity and specificity to detect CR-KP compared with MHT. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis and antibiotic therapy in patients with sepsis reduce morbidity and mortality, thus pre-hospital management is likely to affect patient outcomes. Pre-hospital administration may increase the risk of unnecessary use of broad-spectrum antibiotics, but identification of an infectious focus enables more targeted antibiotic therapy. The aim of this study was to investigate how paramedics, with or without the assistance of general practitioners, can administer empiric intravenous antibiotic treatment against sepsis in a timely manner. Methods: Cohort study of patients with suspected sepsis that received pre-hospital intravenous antibiotics and were transported to hospital. The setting was mainly rural with long average distance to hospital. Patients received targeted antibiotic treatment after an assessment based on clinical work-up supported by scoring systems. Patients were prospectively included from May 2018 to August 2022. Results are presented as median or absolute values, and chi-square tests were used to compare categorical data. Results: We included 328 patients. Median age was 76 years (IQR 64, 83) and 48.5% of patients were female. 30-days all-cause mortality was 10.4%. In cases where a suspected infectious focus was determined, the hospital discharge papers confirmed the pre-hospital diagnosis focus in 195 cases (79.3%). The presence of a general practitioner during the pre-hospital assessment increased the rate of correctly identified infectious focus from 72.6% to 86.1% (p = 0.009). Concordance between pre-hospital identification of a tentative focus and discharge diagnosis was highest for lower respiratory tract (p = 0.02) and urinary tract infections (p = 0.03). Antibiotic treatment was initiated 44 min (median) after arrival of ambulance, and median transportation time to hospital was 69 min. Antibiotic therapy was started 76 min (median) before arrival at hospital. Conclusions: Pre-hospital identification of infectious focus in suspected sepsis was feasible, and collaboration with primary care physicians increased level of diagnostic accuracy. This allowed initiation of intravenous focus-directed antibiotics more than one hour before arrival in hospital in a rural setting. The effect of pre-hospital therapy on timing was much stronger than in previous studies from more urban areas. [ABSTRACT FROM AUTHOR]

Background: Production of extended-spectrum β-lactamases (ESBLs) is a common resistance mechanism in Enterobacteriaceae, leading to serious hospital-acquired infections. This study aimed to assess phenotypic, phylogenetic, and antibiotic resistance patterns among ESBL-producing Escherichia coli isolates recovered from two rural tertiary hospitals in Thailand. Results: Among 467 Enterobacteriaceae isolates, E. coli was the most prevalent 356 (76.2%) followed by K. pneumoniae 88 (18.8%), K. aerogenes 8 (1.7%), K. variicola 3 (0.6%), K. quasipneumoniae 1 (0.2%%), K. oxytoca 1 (0.2%), and unidentified 9 (1.9%). Of the 202 cephalosporin-resistant E. coli isolates, 195 (96.5%) were ESBL-producing and 7 (3.5%) were non-ESBL-producing. Clermont typing revealed that phylogroup B2 was predominant (43.3%), followed by phylogroups F (11.3%), D (10.3%), C (9.7%), and A (8.7%). Among the beta-lactamase-encoding genes, blaCTX−M (83.6%) and blaTEM (81.0%) were widely found among the isolates, and blaCTX−M−1 (60.7%) was the most common among the five blaCTX−M subgroups detected. The predominant ESBL was blaCTX−M−15 (58.3%). All isolates were resistant to cefotaxime (100%) and ampicillin (100%), followed by ciprofloxacin (91.3 %), ceftazidime (72.8 %), and tetracycline (64.1%). Conclusion: Our findings show that phylogroup B2 was the most prevalent phylogroup among ESBL-producing E. coli isolates in northeastern Thailand. Notably, the isolates mostly carried the blaCTX−M gene(s). [ABSTRACT FROM AUTHOR]

Background: Worldwide about 2.3 million newborns still die in the neonatal period and the majority occurs in low- and middle-income countries (LMICs). Intrapartum-related events account for 24% of neonatal mortality. Of these events, intrapartum birth asphyxia with subsequent neonatal encephalopathy is the main cause of child disabilities in LMICs. Data on neurodevelopmental outcome and early risk factors are still missing in LMICs. This study aimed at investigating the factors associated with mortality, risk of neurodevelopmental impairment and adherence to follow-up among asphyxiated newborns in rural Tanzania. Methods: This retrospective observational cohort study investigated mortality, neurodevelopmental risk and adherence to follow-up among asphyxiated newborns who were admitted to Tosamaganga Hospital (Tanzania) from January 2019 to June 2022. Neurodevelopmental impairment was assessed using standardized Hammersmith neurologic examination. Admission criteria were Apgar score < 7 at 5 min of life and birth weight > 1500 g. Babies with clinically visible congenital malformations were excluded. Comparisons between groups were performed using the Mann-Whitney test, the Chi-square test, and the Fisher test. Results: Mortality was 19.1% (57/298 newborns) and was associated with outborn (p < 0.0001), age at admission (p = 0.02), lower Apgar score at 5 min (p = 0.003), convulsions (p < 0.0001) and intravenous fluids (IV) (p = 0.003). Most patients (85.6%) were lost to follow-up after a median of 1 visit (IQR 0–2). Low adherence to follow-up was associated with female sex (p = 0.005). The risk of neurodevelopmental impairment at the last visit was associated with longer travel time between household and hospital (p = 0.03), female sex (p = 0.04), convulsions (p = 0.007), respiratory distress (p = 0.01), administration of IV fluids (p = 0.04), prolonged oxygen therapy (p = 0.004), prolonged hospital stay (p = 0.0007) and inappropriate growth during follow-up (p = 0.0002). Conclusions: Our findings demonstrated that mortality among asphyxiated newborns in a rural hospital in Tanzania remains high. Additionally, distance from home to hospital and sex of the newborn correlated to higher risks of neurodevelopmental impairment. Educational interventions among the population about the importance of regular health assessment are needed to improve adherence to follow-up and for preventive purposes. Future studies should investigate the role of factors affecting the adherence to follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Oral Submucous Fibrosis (OSMF) is a longterm condition characterised by the gradual buildup of fibrous tissue in the oral cavity, often extending to the throat and upper oesophagus. The primary symptoms include progressive limitation in mouth opening due to the formation of stiff fibrous bands in the oral mucosa, accompanied by muscle atrophy. However, the most concerning aspect of this restriction, known as trismus, is its hindrance to effective cancer monitoring. Surgical approaches typically aim to release these fibrotic bands, while medical interventions focus on managing inflammation and preventing further fibrosis. Need of the Study: A modification of the nasolabial flap has been suggested for the reconstruction of intraoral defects following ablative surgery for OSMF. The study will assess its merits in comparison to the conventional nasolabial flap. Aim: To evaluate and compare the aesthetic and functional outcomes of the rima oris between the Conventional Nasolabial Flap and the Nasolabial Flap with Fishtail Modification in patients undergoing surgical intervention for OSMF. Materials and Methods: A prospective, double-blinded, randomised controlled trial will be conducted in the Department of Oral and Maxillofacial Surgery at Acharya Vinoba Bhave Rural Hospital, associated with Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, from November 2023 to November 2024. Patients older than 18 years of age diagnosed with OSMF, without any superimposing cancerous lesions, will be included in the study. They will be divided into two groups: Group A will be treated with bilateral fibrotomy, coronoidotomy and reconstruction with the conventional nasolabial flap, while Group B will undergo the same surgical intervention, except that the reconstruction will be performed using the fishtail modification of the nasolabial flap. The parameters that will be compared include interincisal mouth opening, intercommissural width, dehiscence and flap necrosis. The analysis will be conducted using the Chi-square test and Fisher's-exact test for categorical data and the independent t-test for continuous data that follow a normal distribution. These statistical tests will help evaluate the association between different demographic, clinical and etiological factors and the outcomes under consideration. A p-value of <0.05 will be considered statistically significant. [ABSTRACT FROM AUTHOR]

Introduction: Cancer rates are rising in low- and middle-income countries. While point-of- care ultrasound is now available globally and could serve to mitigate against this rise, its use in diagnosing cancers is inconsistent in lower-resourced healthcare contexts. This proof-of-concept study investigates the feasibility of an ultrasound training concept in a low-resource setting. It evaluates whether this educational concept led to improved knowledge and application of ultrasound diagnostics, cancer screening and staging and patient care. Material and methods: The curriculum was developed through expert exchange and is based on the World Health Organisation's Manual of Diagnostic Ultrasound. It consisted of two didactic components: an on-site training phase across 5 days for a total of 24 hours, and a digital follow-up phase involving the meeting of a bi-weekly tumor board online. The learning objectives of the on-site training were normal imaging and recognition of common pathologies of the abdominal organs, vessels, lymph nodes, female breasts and lungs. The virtual tumour boards met to discuss cases and ultrasound findings, thus aiding continuing professional development after the training sessions had concluded. The face-to-face course component was accompanied by tests given before and after training as well as an evaluation sheet (Likert-scale with 1 = 'completely/very good' and 7 'not at all/very poor'). Results: Of 20 participants from a rural hospital in Tanzania, a total of 16 were included in the analysis (clinical officers n = 6; medical officers n = 10). A significant increase in knowledge (p < 0.01) was measured both in the subjective self-assessment and in the theoretical competence tests. In multivariate linear regression, the status 'medical officers yes' (β = 5.4; p = 0.04) had a significant influence on theory test results at T2. During the 24 virtual tumour board meetings, 28 cases were discussed and a continuous improvement in image acquisition quality was observed. Conclusion: The ultrasound education concept comes with a sustainable increase in clinical competence and improved oncological ultrasound screening locally. There is potential for the transfer of the concept to other locations, which can be explored in the future. [ABSTRACT FROM AUTHOR]

Introduction: We sought to determine the difference between Canadian CT Head Rule (CCHR) indicated imaging rates and actual imaging rates for patients with mild traumatic brain injuries (mTBIs) at a rural emergency department (ED) without in-house computed tomography (CT). In addition, we compared CCHR adherence at a hospital without CT to previous publications from centres with CT to determine if rural populations receive less CT imaging for minor head traumas when indicated by the CCHR. Methods: This retrospective chart review explored individuals who presented to a rural ED (no in-house CT scanner) with a primary diagnosis of mild head injury or concussion between 1 January 2017 and 31 December 2021. Information regarding CCHR criteria, transfer status and patient demographics was collected. Descriptive analyses were completed to determine the percentage of patients who received appropriate transfer for imaging, did not receive transfer for imaging when indicated and received unnecessary transfer. Results: A total of 124 charts met our inclusion criteria (17 [12.1%] charts excluded), with 25.8% transferred to the nearest hospital for CT imaging. After applying the CCHR criteria to our charts, 62.1% were indicated for CT. Of the 62.1%, only 35.1% were transferred for imaging (51.2% of high-risk and 16.7% of medium-risk). Conclusion: By exploring CT rates for mTBIs in a rural Canadian ED, we found low transfer rates (35.1%) of CCHR-indicated patients for imaging needed to guide further healthcare decisions. This work highlights a discrepancy within the Canadian healthcare system between rural and urban centres and allows for opportunities to help narrow the gap in health care. Introduction: Nous avons cherché à déterminer la différence entre les taux d'imagerie indiqués par le Canadian CT Head Rule (CCHR, règlement canadien relatif à la tomodensitométrie de la tête) et les taux d'imagerie réels pour les patients souffrant de traumatismes craniocérébraux légers (TCCL) dans un service d'urgence rural ne disposant pas d'une tomographie par ordinateur interne. En outre, nous avons comparé l'adhésion au CCHR dans un hôpital sans tomographie par ordinateur à des publications antérieures provenant de centres avec tomographie par ordinateur afin de déterminer si les populations rurales reçoivent moins d'imagerie par tomodensitométrie pour les traumatismes crâniens mineurs lorsque le CCHR l'indique. Méthodes: Cette étude rétrospective des dossiers a exploré les personnes qui SE sont présentées à une urgence rurale (sans tomodensitomètre interne) avec un diagnostic primaire de traumatisme crânien léger ou de commotion cérébrale entre le 1er janvier 2017 et le 31 décembre 2021. Les informations concernant les critères du CCHR, l'état de transfert et les données démographiques des patients ont été recueillies. Des analyses descriptives ont été réalisées pour déterminer le pourcentage de patients ayant reçu un transfert approprié pour l'imagerie, n'ayant pas reçu de transfert pour l'imagerie quand c'était indiqué et ayant reçu un transfert inutile. Résultats: Au total, 124 dossiers répondaient à nos critères d'inclusion [17 (12,1%) dossiers exclus], dont 25,8% ont été transférés à l'hôpital le plus proche pour une imagerie par tomodensitométrie. Après avoir appliqué les critères du CCHR à nos dossiers, 62,1% d'entre eux étaient indiqués pour une tomodensitométrie. Sur ces 62,1%, seuls 35,1% ont été transférés pour imagerie (51,2% de haut risque, 16,7% de risque moyen). Conclusion: En explorant les taux de tomodensitométrie pour les TCCL dans un service d'urgence rural canadien, nous avons constaté de faibles taux de transfert (35,1%) des patients recommandés par le CCRH pour une imagerie nécessaire dans le but de guider les décisions de soins de santé ultérieures. Ce travail met en évidence un écart dans le système de santé canadien entre les centres ruraux et urbains et offre des opportunités pour aider à réduire l'écart dans les soins de santé. [ABSTRACT FROM AUTHOR]

Introduction: We sought to streamline cataract surgery post-operative care when COVID-19 hit by discontinuing the 1-day post-operative visit. We wanted to know if this change was safe and beneficial to our patients by reducing patients' time and transportation burden, opening appointment slots allowing providers to see more patients and reducing greenhouse gas emissions. By minimising intraoperative use of dispersive viscoelastic, increasing irrigation/aspiration time at the end of the surgery and using intraocular pressure (IOP) lowering medications such as carbachol, brimonidine and acetazolamide routinely, we posit that post-operative day 1 IOP spikes can be avoided, thereby eliminating the need for the 1st post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1st day. Methods: We retrospectively reviewed cataract surgeries performed before COVID-19 to determine the incidence of serious pathology discovered at the post-operative day 1 visit. Subsequently, we examined all the cataract surgeries performed in 2023 by our practice. Results: One hundred and ninety-three cataract surgeries performed before COVID-19 and 832 performed in 2023 were reviewed. We found that the post-operative day 1 visit after cataract surgery is unnecessary in most routine uncomplicated cases. Conclusion: By eliminating hundreds of post-operative day 1 visits for a busy rural practice annually, patients, their friends and relatives are spared an extra trip to the office (that can be 100 km each way), the office schedule is open to accommodate more patients, and the patients' carbon footprint of travel to the office is reduced. Introduction: Nous avons cherché à rationaliser les soins postopératoires de la chirurgie de la cataracte lors de l'arrivée de la Covid en supprimant la visite postopératoire d'un jour. Nous voulions savoir si ce changement était sécuritaire et bénéfique pour nos patients en réduisant le temps et la charge de transport des patients, en ouvrant des créneaux de rendez-vous permettant aux prestataires de voir plus de patients et en réduisant les émissions de gaz à effet de serre. En minimisant l'utilisation peropératoire de viscoélastique dispersif, en augmentant le temps d'irrigation/aspiration à la fin de l'opération et en utilisant systématiquement des médicaments abaissant la PIO, tels que le carbachol, la brimonidine et l'acétazolamide, nous pensons que les PIO postopératoire du premier jour peuvent être évitées, éliminant ainsi la nécessité d'une première visite de jour postopératoire. Nous avons également cherché à démontrer l'impact environnemental positif de l'élimination de ce premier jour. Méthodes: Nous avons examiné rétrospectivement opérations de la cataracte réalisées avant la Covid afin de déterminer l'incidence des pathologies graves découvertes lors de la visite postopératoire du premier jour. Par la suite, nous avons examiné toutes les opérations de la cataracte réalisées en 2023 par notre cabinet. Résultats: 193 opérations de la cataracte réalisées avant la Covid et 832 réalisées en 2023 ont été examinées. Nous avons constaté que la visite postopératoire du premier jour après la chirurgie de la cataracte n'est pas nécessaire dans la plupart des cas de routine sans complications. Conclusion: En éliminant des centaines de visites postopératoires du premier jour dans une région rural, les patients, leurs amis et leurs proches n'ont pas à SE rendre au cabinet (ce qui peut représenter des centaines de kilomètres aller-retour). L'emploi du temps du cabinet est libéré pour accueillir davantage de patients et l'empreinte carbone des patients liée à leur déplacement au cabinet est réduite. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol dependence syndrome (ADS) is a significant health problem all over the world. Alcohol-dependent individuals have a high prevalence of psychiatric comorbidities and nonadaptive personality traits that may influence the pathogenesis, treatment outcome, clinical course, and relapse of ADS. Aim: The aim of this study was to assess the personality traits and psychiatric comorbidities of alcohol-dependent patients and to determine the association of personality traits with psychiatric comorbidities in ADS. Methodology: An observational study was conducted on 100 patients of ADS from Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha, Maharashtra. They were assessed through semi-structured sociodemographic pro forma, Mini-International Neuropsychiatric Interview PLUS, and 16 Personality Factor Inventory. Results: Most of the patients scored high on personality traits such as dominance (67%), warmth (56%), sensitivity (70%), social boldness (56%), openness to change (65%), vigilance (77%), and perfectionism (52%) while they scored low on factors privateness (50%) and liveliness (35%). The prevalence of psychiatric comorbidity was found to be 49%, with mood disorders (21%) being the most common diagnosis. Personality factors dominance (0.0001) and social boldness (0.042) were significantly associated with psychiatric comorbidities with P < 0.05. Conclusion: The personality traits and psychiatric comorbidity need to be addressed at the time of management to improve outcome. [ABSTRACT FROM AUTHOR]

Introduction: As the rural–urban cancer mortality gap widens, centering care around the needs of rural patients presents an opportunity to advance equity. One barrier to delivering patient‐centered care at rural hospitals stems from limited analytic capacity to leverage data and monitor patient outcomes. This case study describes the experience of a public health cancer surveillance system aiming to fill this gap within the context of a rural cancer network. Methods: To support the implementation of a novel network model intervention in Iowa, the Iowa Cancer Registry began generating hospital‐specific and catchment area reports. Then, the Iowa Cancer Registry supported adapting the network model to fit the context of Iowa's cancer care delivery system by performing data monitoring and reporting functions. Informed by a gap analysis, the Iowa Cancer Registry then identified which quality accreditation standards could be achieved with public health surveillance data and analytic support. Results: The network intervention in Iowa supported 5 rural cancer centers across the state, each concurrently pursuing quality accreditation standards. The Iowa Cancer Registry's hospital and catchment‐specific reports illuminated the cancer burden and needs of rural cancer centers within the network. Our team identified 19 (of the 36 total) quality standards that can be supported by public health surveillance functions typically performed by the registry. These standards encompassed data‐driven quality improvement, patient monitoring, and reporting guideline‐concordant care standards. Conclusions: As rural hospitals continue to face resource constraints, multisectoral efforts informed by data from centralized public health surveillance systems can promote quality improvement initiatives across rural communities. While our work remains preliminary, we predict that analytic support provided by the Iowa Cancer Registry will enable the rural network hospitals to focus their capacity toward developing the infrastructure necessary to deliver high‐quality care and serve the unique needs of rural cancer patients. [ABSTRACT FROM AUTHOR]

Background Chemical eye injuries are a critical ophthalmic emergency requiring urgent treatment. This study aims to examine the demographic and clinical profile and evaluate the visual outcomes of patients with ocular chemical injuries in a rural medical setting. Methods A hospital-based cross-sectional observational study was conducted at a tertiary rural medical hospital from June 2022 to May 2023. The study included 24 patients with chemical ocular injuries. Data were collected on demographics, clinical presentation, type of chemical involved, and visual outcomes. Injuries were classified using the Roper-Hall classification system. Statistical analysis was performed using SPSS 17.0. Results Of the 24 patients, 71% were males, with a mean age of 40.29 years. The majority of injuries were unilateral (71%) and occurred at home (41.66%) and construction sites (33.33%). Alkali injuries were the most common (58.33%), followed by acid injuries (33.33%). According to the Roper-Hall classification, 50% of injuries were Grade I, 38% were Grade II, 8% were Grade III, and 4% were Grade IV. At presentation, 29% of patients had mild or no visual impairment, 54% had moderate impairment, 13% had severe impairment, and 4% were blind. Post-treatment, 88% of patients achieved mild or no impairment, 8% had moderate impairment, 4% had severe impairment, and none remained blind. Conclusion Chemical ocular injuries pose a major risk of visual impairment, particularly in occupational settings. Early intervention and preventive measures are crucial for improving visual outcomes and reducing the incidence of these injuries. Public health initiatives focusing on safety protocols and awareness campaigns are essential to mitigate the risks associated with chemical eye injuries. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this research is to present some estimates regarding the size of rural tourism in Romania based on the existing data from official tourism statistics provided by the National Institute of Statistics (INS). Design/Methodology/approach A bottom-up approach was used by aggregating INS data from more than 1,000 - 1,200 rural localities (ro. comune) in Romania that have tourism statistics in the period 2019-2023. Based on the assumption that rural tourism occurs in these rural localities, some statistical indicators were calculated for the rural area of Romania: accommodation capacities (existing capacity and functioning capacity), arrivals, overnight stays, length of stay and bed-places occupancy. However, as a limitation, due to the fact that in Romania some urban localities comprise also villages where rural tourism might occur, some adjustments are possible to be made in the estimates to include agro-tourism boarding houses (ro. pensiuni agroturistice) of the urban localities. Main findings The results show that even rural area concentrates half of the accommodation establishments and over 30% of the accommodation capacity in Romania it attracts only 21-22% of total tourists registered in accommodation establishments. This illustrates a lower capacity of the rural area to constitute a real driver to boost Romanian tourism. Originality/value This paper proposed a new method to unveil statistics on rural tourism in Romania based on data aggregation from Local Administrative Units (LAUs) in a pragmatic approach to defi ne rural space based on the classification of localities (ro. UAT-uri -- comune, orașe, municipii) as used in the official statistics in Romania. Conclusions/Recommendation Within accommodation statistics, National Institute of Statistics might start publish data with the breakdown Rural vs. Urban localities (out of which, agritourist boarding houses from urban localities). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy and validity of ocular trauma scores (OTS) among patients with open globe injury (OGI) in rural hospital settings and to identify the determinants predicting poor visual outcomes. Materials and Methods: A single-center retrospective cohort study was conducted through a chart review of OGI patients between July 2018 and June 2023 at Bueng Kan Hospital. Demographic and preoperative factors affecting the final visual outcome were evaluated. OTS score for each patient was calculated and categorized. Final visual acuity (VA) after 6 months was compared to the predicted VA from OTS study. Poor visual outcome was defined as legal blindness after 6 months of treatment. Results: Thirty-nine eyes from patients with a mean age of 44.05 years were evaluated. Most subjects were male (94.87%), and workplace injuries were the most common (78.38%). Compared to the OTS study, patients in OTS category 2 achieved a significantly higher percentage of better final VA, while categories 3 and 4 showed similar outcomes. OTS category 1 patients had a lower proportion of no light perception (NLP) outcomes, though the difference was not significant. Poor visual outcomes were predicted by initial VA (OR=4.64), wound extension ≥10 mm (OR=20.66), and lens injury (OR=7.44). Conclusion: OTS is beneficial for predicting final vision in patients with OGI, particularly with less severe trauma. Severe cases can sometimes result in better-than-expected visual outcomes, emphasizing the need for cautious management and counseling by ophthalmologists. Factors that estimate poor visual outcomes involve poor initial VA, wound extension ≥10 mm, and lens damage. [ABSTRACT FROM AUTHOR]

UNLABELLED: Policy Points Policymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures. Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities. Black and Latinx rural residents contend with inequities in spatial access to hospital care, which arise from fundamental structural inequities in spatial allocation of economic opportunity in rural communities of color. Long-term policy solutions including reparations are needed to address these underlying processes. CONTEXT: The growing rate of rural hospital closures elicits concerns about declining access to hospital-based care. Our research objectives were as follows: 1) characterize the change in rural hospital supply in the US South between 2007 and 2018, accounting for health system closures, mergers, and conversions; 2) quantify spatial accessibility (in 2018) for populations most at risk for adverse outcomes following hospital closure-Black and Latinx rural communities; and 3) use multilevel modeling to examine relationships between structural factors and disparities in spatial access to care. METHODS: To calculate spatial access, we estimated the network travel distance and time between the census tract-level population-weighted centroids to the nearest and second nearest operating hospital in the years 2007 and 2018. Thereafter, to describe the demographic and health system characteristics of places in relation to spatial accessibility to hospital-based care in 2018, we estimated three-level (tract, county, state-level) generalized linear models. FINDINGS: We found that 72 (10%) rural counties in the South had ≥1 hospital closure between 2007 and 2018, and nearly half of closure counties (33) lost their last remaining hospital to closure. Net of closures, mergers, and conversions meant hospital supply declined from 783 to 653. Overall, 49.1% of rural tracts experienced worsened spatial access to their nearest hospital, whereas smaller proportions experienced improved (32.4%) or unchanged (18.5%) access between 2007 and 2018. Tracts located within closure counties had longer travel times to the nearest acute care hospital compared with tracts in nonclosure counties. Moreover, rural tracts within Southern states with more concentrated commercial health insurance markets had shorter travel times to access the second nearest hospital. CONCLUSIONS: Rural places affected by rural hospital closures have greater travel burdens for acute care. Across the rural South, racial/ethnic inequities in spatial access to acute care are most pronounced when travel times to the second nearest open acute care hospital are accounted for.

Abstract Ensuring workplace safety for healthcare workers is vital considering the important role they play in various societies which is to save life. Healthcare workers face different risks when performing tasks in various departments within hospitals, hence there is a need to assess work safety analysis procedures among healthcare workers. As a result, this study aims to assess the effectiveness of work safety analysis procedures among healthcare workers at Muvonde and Driefontein Sanatorium rural hospitals in Chirumanzu district. The research applied the descriptive cross-sectional design, combining quantitative and qualitative data collection methods. A questionnaire with both closed and open ended questionnaire was used for data collection among 109 healthcare workers at Muvonde hospital and 68 healthcare workers at Driefontein Sanatorium hospital. Secondary data sources, observations and interviews were also included as data collection methods. Quantitative data collected during the study was analysed using SPSS version 25. Braun and Clarke (2006)’s six phase framework was applied for qualitative data analysis. Ethical approval form was obtained from the District Medical Officer and Midlands State University. Findings of the study indicated that risks identified at Muvonde and Driefontein Sanatorium rural hospitals are classified as ergonomic, physical, chemical, psychosocial and biological risks. Respondents specified that these risks occur as a result of inadequate equipment, poor training, negative safety behaviour, poor management and pressure due to high workload. Safety inspection, safety workshops and monitoring of worker’s safety behaviour were mentioned as measures to manage risks. However, the strengths and weaknesses of the current safety procedures need to be assessed to highlight areas for improvement to reduce occurrence of risks within the hospitals.

Objective Data Sources/Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To develop a method of consistently identifying interfacility transfers (IFTs) in Medicare Claims using patients with ST‐Elevation Myocardial Infarction (STEMI) as an example.100% Medicare inpatient and outpatient Standard Analytic Files and 5% Carrier Files, 2011–2020.Observational, cross‐sectional comparison of patient characteristics between proposed and existing methods.We limited to patients aged 65+ with STEMI diagnosis using both proposed and existing methods.We identified 62,668 more IFTs using the proposed method (86,128 versus 23,460). A separately billable interfacility ambulance trip was found for more IFTs using the proposed than existing method (86% vs. 79%). Compared with the existing method, transferred patients under the proposed method were more likely to live in rural (p < 0.001) and lower income (p < 0.001) counties and were located farther away from emergency departments, trauma centers, and intensive care units (p < 0.001).Identifying transferred patients based on two consecutive inpatient claims results in an undercount of IFTs and under‐represents rural and low‐income patients. [ABSTRACT FROM AUTHOR]

Background: In Japan, local governments have rural clinics designated for areas without physicians (RCDA) to secure physicians for rural medical care. Moreover, a medical policy of dispatching physicians between the RCDA and core hospitals for rural areas (CHRA) exists. This study aimed to assess the actual situation of physician migration from RCDAs and those who migrated, and examine the factors associated with their migration. Methods: This retrospective cohort study used biennial national physicians' survey data from 2012 to 2018. It targeted physicians who worked at RCDAs in 2012 and participated in all four surveys (n = 510). The physicians were divided into two groups. One group consisted of physicians who worked continuously at the RCDA over the four study periods (retained physicians, n = 278), and the other included physicians who migrated to other institutions midway through the study period (migrated physicians, n = 232). We tracked the types of facilities where RCDA physicians worked from 2012 to 2018, also examined the factors associated with their migration. Results: Among physicians from RCDAs who migrated to other institutions (n = 151) between 2012 and 2014, many migrated to hospitals (n = 87/151, 57.6%), and some migrated to CHRA (n = 35/87, 40.2%). Physicians in their 40s (Hazard ratio 0.32 [95% CI 0.19–0.55]), 50s (0.20 [0.11–0.35]), and over 60 years (0.33 [0.20–0.56]) were more likely to remain at RCDAs. Changes in their area of practice (1.82 [1.34–2.45]) and an increase in the number of board certifications held by physicians between 2012 and 2018 (1.50 [1.09–2.06]) were associated with migration. Conclusions: Many migrating physicians choose to work at hospitals after migrating from RCDAs. It was seemed that the physician dispatch system between RCDA and CHRA has been a measure to secure physicians in rural areas. Young age, obtaining board certification, and changes in areas of practice were associated with physician migration from RCDAs. [ABSTRACT FROM AUTHOR]

Objective: Fatal overdoses are the third leading cause of death in the pediatric population. Substance use disorders (SUD) screening is not routinely done in primary care practices. Early screening and intervention for adolescent SUD could mitigate future harm. Methods: We conducted a 3-month pilot adapting universal screening using the CRAFFT tool in patients aged 12 to 17 presenting to an urban and a rural primary care practice during well-child and acute/sick-child visits. We collaborated with our pediatric addiction service to ensure access availability for further assessment and treatment for all positively screened patients; this was broadly communicated to primary care providers. Results: There was a higher CRAFFT completion rate in the urban site (90%, vs 52.6% in our rural site). The majority of CRAFFT questionnaires were completed during acute/sick-child visits in both study sites. Moreover, we found a higher positive screen rate in our rural practice (14.6%, vs 2.4% in our urban practice). Only 27% of positively screened patients had substance use addressed by their providers. No pediatric addiction referrals were made. Conclusions: Findings suggest provider-level barriers exist despite having adequate specialty referral sources and institutional encouragement. Future work is needed to explore these barriers. [ABSTRACT FROM AUTHOR]

Background: Pneumonia stands as a significant global contributor to mortality, particularly in South Africa, where it ranks as the second leading cause of death. The country's high prevalence of HIV infection compounds this issue, significantly increasing mortality rates associated with community-acquired pneumonia (CAP). Objective: This study aimed to audit CAP patient management at a regional rural hospital in KwaZulu-Natal. Method: A retrospective review of patient files from September to December 2016 was undertaken. Data extraction from clinical files, conducted according to inclusion criteria, was transferred to a data collection sheet and analyzed using SPSS version 21. Results: The review encompassed 124 patient files over four months, revealing that 117 (94.4%) patients were not managed by the Standard Treatment Guidelines and Essential Medicines List for South Africa. Of the patients admitted with CAP, 54% were HIV positive, and 49 (39.5%) patients succumbed to the illness. Notably, none of the patients underwent assessment using a severity score. Conclusion: The findings underscore a need for more adherence to South African guidelines for managing CAP among staff at the rural regional hospital. This leads to severe consequences, exemplified by the high mortality rate. Urgent intervention is required to incorporate severity assessment scores into pneumonia evaluations, thus enabling appropriate clinical management. Contribution: This study sheds light on the significant impact of CAP within the South African hospital context, delineating critical gaps in clinical care and emphasizing the imperative to address clinical inertia. [ABSTRACT FROM AUTHOR]

Objective: Identify factors relevant to the implementation of nasal high flow for infants with bronchiolitis in rural and remote contexts. Background: Healthcare services in rural and remote Australia must be resilient in responding to paediatric respiratory illness and provide equitable access of care to the tertiary contexts. Retrievals cannot be the only option to provide equitable care, particularly in examples of cyclones reducing aeromedical retrieval services. Nasal high flow (NHF) therapy is available for use in tertiary contexts for treating infants with respiratory illness. However, its use in rural and remote services is inconsistent and implementations to support routine implementation into this context are unknown. Study design and methods: An integrative review was completed using an adapted implementation science framework. The COM-B (Capability, Opportunity, Motivation -- Behaviour) framework was used to structure and analyse the results in alignment with translatable clinical care setting implementations. Seven databases were searched using specified search terms such as nasal high flow therapy, bronchiolitis, and implementation. Results: The original search terms 'rural' and/or 'remote' yielded zero results and were therefore removed from the search criteria. Sixteen publications were included in the final analysis that yielded 73 implementation factors. Eight related to capability, 61 were opportunity factors and four were motivation factors. Many of the factors were relating to the local context level, such as using observation regimes. One study (two publications) explicitly reported using an implementation framework where context was considered as an important component in identifying implementation strategies. Discussion: Implementation strategies included staff training (capability). The opportunity for staff to use NHF was the most common factor with using guidelines. The least represented motivation strategies focused on the clinician's confidence to use NHF therapy. Conclusion: The lack of reported NHF studies in rural and remote hospitals highlights a knowledge gap. Implementation science is recommended for use in contexts such as the rural/remote setting where the context is unique and requires targeted implementation strategies. Implications for research, policy, and practice: Research exploring the use of NHF therapy should consider the unique rural and remote context using appropriate implementation strategies. Implementation science has shown that factors such as local champions, guidelines, use of observational data, and having locally tailored training and supportive approaches does improve the implementation of NHF therapy. The authors recommend these strategies be applied in rural and remote contexts to inform future research, policies, procedures, and practices that will promote and support clinicians' confidence and ability to implement NHF therapy. What is already known on the subject: • NHF therapy is used for infants with bronchiolitis within the tertiary environment. • NHF is used outside of paediatric intensive care units. • Implementation science frameworks hasten evidence-based clinical practice routine uptake. What this paper adds: • Identifies a gap in the literature reporting implementation factors relevant for NHF therapy. • Identifies no published literature reporting NHF use in rural and remote contexts. • Describes, using an implementation framework, relevant factors for the use of NHF therapy in rural and remote hospitals. [ABSTRACT FROM AUTHOR]

Time off work after traumatic hand injury not only affects individuals but also has socioeconomic repercussions, becoming a serious problem from the viewpoint of labor shortages. In depopulated rural areas, the impact of labor shortages due to time off work is more serious than in urban areas; however, few studies have examined return to original work in rural areas. The purpose of this study was to investigate the patient demographics at the time of hand injury that affect return to original work in a rural area of Japan. We retrospectively examined 246 patients with traumatic hand and/or forearm injuries who were working at the time of injury, and who underwent surgical operations and postoperative rehabilitation in a level II hospital in a rural agricultural area. We examined patients' initial demographic data, including gender, age, occupation (white or blue collar), employment status (self-employed, full-time, or part-time workers), complications other than hand injury, workers' compensation, dominant hand injury, and injury severity as determined using the modified Hand Injury Severity Score. Multivariate logistic regression analysis examined the association between initial patient demographics and return to original work within 150 days after injury. In total, 186 patients (76 %) were able to return to original work within 150 days. A multivariate logistic regression analysis showed that three explanatory variables (i.e., severity of injury, complications other than hand injury, and female gender) significantly compromised return to original work. In the treatment of traumatic hand injury, intensive support should be provided for return to original work for patients who are expected to have difficulty returning to work quickly. In addition, labor shortages can be mitigated by sharing information with the workplace about patients' prospects of return to original work. [ABSTRACT FROM AUTHOR]

The research team assessed community acceptability of prehospital stroke telemedicine services in rural O‘ahu communities. Tools were developed to evaluate patient-centered goals about implementing ambulance-based telemedicine which aimed to retain appropriate patients in community hospitals and improve thrombolytic treatment times. Using a mixed methods approach, the team surveyed well-appearing adults (ie, able to complete survey and interview) at O‘ahu community events. Participants were asked to complete a short Likert-scale questionnaire (n=263) followed by a semi-structured interview (n=29). Data were summarized by descriptive and inferential statistics. Comparisons between rural and urban groups were made by chi-square analysis and Wilcoxon rank-sum 2-tailed test. Interviews were transcribed, coded, and analyzed using inductive and deductive methods. The findings suggest that use of prehospital telemedicine for specialty care is viewed favorably by both rural and urban respondents. Additionally, most respondents felt comfortable staying at their local hospital if they had access to a specialist by telemedicine. However, mistrust in rural hospitals may be a potential barrier to implementation. Compared to urban respondents, rural respondents were less confident in their local hospital’s resources and capabilities for stroke care. The findings identified a potential misalignment of the project’s goal with some patients’ goal to use emergency medical services (EMS) to bypass rural hospitals for stroke care. Future community outreach efforts are needed to encourage activation of EMS and highlight the advantages of utilizing prehospital telemedicine for accessing specialty care thereby improving treatment times. [ABSTRACT FROM AUTHOR]

Introduction. Rural hospitals provide secondary care for much of the rural New Zealand population. Little is known about community perspectives of the health and social contribution. Aim. This descriptive qualitative study aimed to explore community views on the role of their rural hospital in a low socioeconomic rural district with a high Māori and Pacific population. Methods. Semi-structured individual and focus group interviews were conducted with rural community members about the perceived role of their rural hospital. Iterative thematic analysis was undertaken. Results. In total, 22 participants were interviewed. Thematic analysis yielded four themes: (i) rural hospitals as a safety net – providing access to emergency care and mitigating limited primary care access; (ii) providing personalised, culturally aware care; (iii) facilitating family/whanau support; and (iv) doing the best with limited resources. The latter included pragmatism about resource constraints, but a preference for the hospital to remain open. Discussion. Rural hospitals contribute to community safety by enhancing access to emergency care and mitigating difficulties in access to primary care. The local contextual knowledge of rural hospital providers allows personalised, family-centred and culturally-responsive care. Despite service centralisation, rural hospitals are wanted by their communities. Rural health planners should consider how to maximise the breadth of locally-provided services to reduce the impacts of travel and transfer for care [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effect of psychological well-being on job performance among nurses and midwives in rural and urban hospitals in Ghana amidst COVID-19. The study adopted a purely quantitative approach, using the explanatory research design. Data were collected from 262 nurses and midwives in two selected hospitals in the Central Region of Ghana. The Structural Equation Modelling was used to analyze the data collected. The results revealed that the levels of psychological well-being and job performance were high in both hospitals amidst the pandemic. Further, it was observed that although psychological well- being had significant influence on job performance among the nurses and midwives in both rural and urban communities, the effect was more significant in the urban settlements. Given these findings, the study recommended that in order to effectively improve the job performance of nurses and midwives, management must adopt policies such as, flexible work arrangements, leave policy, and counselling services to support their psychological well-being. [ABSTRACT FROM AUTHOR]

Background. Paediatric patients in Australia experience lengthy wait times for Primary and Allied Healthcare Service (PAHCS) appointments. This results in a lack of satisfaction and adverse health outcomes. However, very few studies have explored wait times for appointments with PAHCSs in Australia. This study explored the length of wait time and associated barriers to timely access to paediatric PAHCSs in Australia. Methods. The scoping review followed PRISMA‐ScR guidelines for Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. We comprehensively searched for relevant studies from five databases, including Scopus, Emcare, Medline (via Ovid), CINAHL, and Google Scholar in August 2023 without any time limitations. Studies that reported qualitative findings on the wait times and associated barriers to timely accessing to PAHCSs were selected in this scoping review. We performed a reflexive thematic analysis using NVivo software in this review. Results. A total of seven studies out of ninety‐one retrieved records were eligible to be included in this review. Studies show that Australian children, in general, had to wait more than one year for health assessments and interventions in PAHCSs. The long waiting times were perceived as frustrating and worrying by caregivers of children. Several overarching themes related to the barriers of timely accessing to paediatric PAHCSs in Australia were identified, such as strict appointment criteria for children, disparity between demand and provision, parental unawareness, and inadequate public funding in rural PAHCSs. Conclusion. Australian paediatric patients are severely burdened with long wait times for appointments with PAHCSs, primarily, due to the poor government initiatives in rural PAHCSs. This study suggested that the criteria for booking an appointment in PAHCSs need to be simplified. Besides, adequate public health funding and the provision of resources are required in rural PAHCSs. [ABSTRACT FROM AUTHOR]

Background. Previous research suggests that patients from rural areas who are critically ill with complex medical needs or require time‐sensitive subspecialty interventions face worse healthcare outcomes and delays in care when compared to those from urban areas. The critical care resuscitation unit (CCRU) at our quaternary care center was established to expedite the transfer of critically ill patients or those who need time‐sensitive intervention. This study investigates if disparities exist in treatments and outcomes among patients transferred to the CCRU from rural versus urban hospitals. Methods. This is a retrospective study of adult, nontrauma patients admitted to the CCRU via interhospital transfer from outside facilities from January 1 to December 31, 2018. Patients transferred from within our institution or with missing clinical data were excluded. Multivariable logistic regressions were performed to measure the association between patients' demographic and clinical factors with in‐hospital mortality. Results. We analyzed 1381 nontrauma patients, and 484 (35%) were from rural areas. Median age was 59 [47–69], and 629 (46%) were female. Median sequential organ failure assessment was 3 ([1–6], p = 0.062) for both patients transferred from urban and rural hospitals. There was no significant difference between groups with respect to most demographic and clinical factors, as well as types of interventions after CCRU arrival, including emergent surgical interventions within 12 hours of arrival at the CCRU. Rural patients were more likely to be transferred for care by the acute care emergency surgery service than were patients from urban areas and were transferred over a significantly greater distance (difference of 53 kilometers (km), 95% CI: –58.9–51.7 km, P < 0.001). Transfer from rural areas was not associated with increased odds of in‐hospital mortality (OR: 0.90, 95% CI: 0.60, 1.36; P = 0.63). Conclusion. Thirty‐five percent of patients transferred to the CCRU came from rural areas, which house 25% of the state population of Maryland. Patients transferred from rural counties to the CCRU faced greater transport distances, but they received the same level of care upon arrival at the CCRU and had the same odds of in‐hospital mortality as patients transferred from urban hospitals. [ABSTRACT FROM AUTHOR]

Ensuring workplace safety for healthcare workers is vital considering the important role they play in various societies which is to save life. Healthcare workers face different risks when performing tasks in various departments within hospitals, hence there is a need to assess work safety analysis procedures among healthcare workers. As a result, this study aims to assess the effectiveness of work safety analysis procedures among healthcare workers at Muvonde and Driefontein Sanatorium rural hospitals in Chirumanzu district. The research applied the descriptive cross-sectional design, combining quantitative and qualitative data collection methods. A questionnaire with both closed and open ended questionnaire was used for data collection among 109 healthcare workers at Muvonde hospital and 68 healthcare workers at Driefontein Sanatorium hospital. Secondary data sources, observations and interviews were also included as data collection methods. Quantitative data collected during the study was analysed using SPSS version 25. Braun and Clarke (2006)'s six phase framework was applied for qualitative data analysis. Ethical approval form was obtained from the District Medical Officer and Midlands State University. Findings of the study indicated that risks identified at Muvonde and Driefontein Sanatorium rural hospitals are classified as ergonomic, physical, chemical, psychosocial and biological risks. Respondents specified that these risks occur as a result of inadequate equipment, poor training, negative safety behaviour, poor management and pressure due to high workload. Safety inspection, safety workshops and monitoring of worker's safety behaviour were mentioned as measures to manage risks. However, the strengths and weaknesses of the current safety procedures need to be assessed to highlight areas for improvement to reduce occurrence of risks within the hospitals. [ABSTRACT FROM AUTHOR]

Background: The association between rurality of patients' residence and hospital experience is incompletely described. The objective of the study was to compare hospital experience by rurality of patients' residence. Methods: From a US Midwest institution's 17 hospitals, we included 56,685 patients who returned a post-hospital Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We defined rurality using rural-urban commuting area codes (metropolitan, micropolitan, small town, rural). We evaluated the association of patient characteristics with top-box score (favorable response) for 10 HCAHPS items (six composite, two individual, two global). We obtained adjusted odds ratios (aOR [95% CI]) from logistic regression models including patient characteristics. We used key driver analysis to identify associations between HCAHPS items and global rating (combined overall rating of hospital and recommend hospital). Results: Of all items, overall rating of hospital had lower odds of favorable response for patients from metropolitan (0.88 [0.81–0.94]), micropolitan (0.86 [0.79–0.94]), and small towns (0.90 [0.82–0.98]) compared with rural areas (global test, P =.003). For five items, lower odds of favorable response was observed for select areas compared with rural; for example, recommend hospital for patients from micropolitan (0.88 [0.81–0.97]) but not metropolitan (0.97 [0.89–1.05]) or small towns (0.93 [0.85–1.02]). For four items, rurality showed no association. In metropolitan, micropolitan, and small towns, men vs. women had higher odds of favorable response to most items, whereas in rural areas, sex-based differences were largely absent. Key driver analysis identified care transition, communication about medicines and environment as drivers of global rating, independent of rurality. Conclusions: Rural patients reported similar or modestly more favorable hospital experience. Determinants of favorable experience across rurality categories may inform system-wide and targeted improvement. [ABSTRACT FROM AUTHOR]

The world experienced an unprecedented health shock (COVID-19) which caught everyone by surprise, and destabilized many sectors, especially the agri-food sector. This unpleasant situation caused upset in the food production and distribution chain, and continues to threaten the attainment of Sustainable Development Goal 2 which underscores zero hunger in society. Many people in South Africa were disproportionately affected with severe consequences on their livelihood activities, food security status, health status, and general welfare conditions; and as a result, social relief intervention was put in place or expanded. This study examined the factors influencing rural households’ food security status among the recipients of social relief grants in rural areas of South Africa. The study used a secondary dataset from Wave 5 of National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM). The research applied descriptive statistics to describe the respondents’ socio-economic characteristics, and pattern of income flow. Food Insecurity Access Scale was employed to investigate the respondents’ food security status, while multinomial logistic regression was used to explore the determinants of food security. The results showed that the majority of the respondents were black (99%), female-headed (54.15%), dwelling in flats (74.01%), with secondary education (88.6%), and heavily dependent on government grants (58.61%). Also, most households were food secure (71.69%) during the pandemic. Moreover, households headed by men were more food secure (62.84%) compared to the ones headed by the female counterparts (37.08). Multinomial regression estimates revealed that formal education (p<0.1), employment status (p<0.05), dwelling type (p<0.01), as well as household size (p<0.01) significantly determined rural households’ food security status. The study concluded that social relief grants significantly reduced the food insecurity situation among the rural households in South Africa, and recommended that the government should ensure the continuation of the social relief of distress grant to the vulnerable people who are mostly domiciled in the rural areas, especially women who are disproportionately affected by these health shocks. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic condition affecting approximately 10% of women of reproductive age, leading to significant physical and emotional stress. Treatments include medical management and surgical interventions, with laparoscopic surgery being the gold standard for removing endometrial tissue. The advent of robotic-assisted laparoscopic surgery (RALS) has enabled more complex procedures to be performed minimally invasively, increasing its use in high-difficulty surgeries. Developed in the late 20th century, systems like the Da Vinci Surgical System have revolutionized surgery by enhancing precision, dexterity, and visualization. The latest models, including the Da Vinci Xi and SP, offer advanced features such as enhanced arm mobility, fluorescence imaging, and single-port capabilities. Comparative studies of RALS and conventional laparoscopy (LPS) for endometriosis show mixed results. While some studies indicate no significant differences in complications or recovery outcomes, others highlight longer operative times and hospital stays for RALS. Despite these drawbacks, RALS is not inferior to LPS overall. The clinical benefits of RALS include greater precision and accuracy, reduced surgeon fatigue, and a faster learning curve, facilitated by advanced ergonomic and control systems. However, the high costs and extensive infrastructure requirements limit the accessibility and availability of robotic surgery, particularly in smaller or rural hospitals. The absence of tactile feedback remains a challenge, though upcoming advancements aim to address this. Continued research and development are essential to make robotic surgery more cost-effective and broadly accessible, ensuring its benefits can reach a wider patient population. This abstract encapsulates the key aspects of robotic surgery's development, comparative studies with conventional methods, and its clinical benefits and limitations, highlighting the need for ongoing improvements and research. [ABSTRACT FROM AUTHOR]