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Introduction: Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of noncommunicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods: We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results: Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of personcentred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions: Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings. [ABSTRACT FROM AUTHOR]

Objective: Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes. Methods: Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus. Results: The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education. Conclusion: The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research. [ABSTRACT FROM AUTHOR]

IntroductionRehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing.MethodsWe searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models.ResultsOut of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent.ConclusionsFocusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.

Background: Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. Objective: To better understand the relationship between hospice and PC and factors that influence this relationship. Methods: A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.S. Veterans Health Administration (VA) from 2007 to 2013 with follow-up through 2017 (n = 22,907). Mixed logistic regression models with a random effect for site, adjustment for patient variables, and propensity score weighting were used to examine whether the association between PC and hospice use varied by U.S. region and PC team characteristics. Results: Overall, 57% of patients with lung cancer received PC, 69% received hospice, and 16% received neither. Of those who received hospice, 60% were already enrolled in PC. Patients who received PC had higher odds of hospice enrollment than patients who did not receive PC (adjusted odds ratio = 3.25, 95% confidence interval: 2.43–4.36). There were regional differences among patients who received PC; the predicted probability of hospice enrollment was 85% and 73% in the Southeast and Northeast, respectively. PC team and facility characteristics influenced hospice use in addition to PC; teams with the shortest duration of existence, with formal team training, and at lower hospital complexity were more likely to use hospice (all p < 0.05). Conclusions: Among patients with advanced lung cancer, PC was associated with hospice enrollment. However, this relationship varied by geographic region, and PC team and facility characteristics. Our findings suggest that regional PC resource availability may contribute to substitution effects between PC and hospice for end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with non-clinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success.

Purpose: This paper aims to explore challenges and opportunities of shifting from physical to virtual employment support delivery prompted by the Covid-19 pandemic. It investigates associated changes in the nature and balance of support and implications for beneficiary engagement with programmes and job search. Design/methodology/approach: The study draws on longitudinal interviews conducted with beneficiaries and delivery providers from a neighbourhood-based employment support initiative in an English region with a strong manufacturing heritage between 2019 and 2021. The initiative established prior to the Covid-19 pandemic involved a strong physical presence locally but switched to virtual delivery during Covid-19 lockdowns. Findings: Moving long-term to an entirely virtual model would likely benefit some beneficiaries closer to or already in employment. Conversely, others, particularly lone parents, those further from employment, some older people and those without computer/Internet access and/or digital skills are likely to struggle to navigate virtual systems. The study emphasises the importance of blending the benefits of virtual delivery with aspects of place-based physical support. Originality/value: Previous studies of neighbourhood-based employment policies indicate the benefits of localised face-to-face support for transforming communities. These were conducted prior to the Covid-19 pandemic and the more widespread growth of virtual employment support. This study fills a gap regarding understanding the challenges and opportunities for different groups of beneficiaries when opportunities for physical encounters decline abruptly and support moves virtually. [ABSTRACT FROM AUTHOR]

Extending last-mile delivery services to individuals—crowdshippers who pick up or deliver a shipment as part of their daily activities—has sustainable benefits, but also risks (damaged parcels, late deliveries, increased emissions) for various stakeholders. So far, developed crowdshipping models have only addressed one or two risks at a time. No model promotes environmental goals separately or together with other goals. This study proposes a crowdshipping model that consists of three stakeholders (the owner of a crowdshipping platform, crowdshippers and parcel providers) and with various incentives aims to maximise the profitability of the platform and the compensation of crowdshippers, the quality of delivery, and to minimise environmental externalities. A two-level leader–follower game and the concept of Shapley value, from cooperative flow games at the follower level, are used to define the optimal strategy that provides sustainable delivery with a good balance between costs and profits. The game behaviour was explained on a crowdshipping platform provider (leader) and two coalitions: individual crowdshippers and parcel logistics providers. The aim of the example is to explain the strategy of promoting environmentally friendly parcel delivery. The results show satisfactory economic, social and environmental performance. [ABSTRACT FROM AUTHOR]

Abstract Background Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area. Methods We identify social entrepreneurs working to deliver primary health care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al. framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories. Results Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing and cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under 10 years old. Conclusions Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

Context: Smallholder pig production systems in the north-eastern region of India are characterised by inefficiency due to use of unselected local pigs, and multiple breeding constraints such as paucity of superior germplasm, high mating costs, and poor access to artificial insemination (AI). Effective AI is the most viable option for genetic improvement and enhancing pig productivity. Aim: The study was designed to assess the success rate and economic efficacy of four AI delivery models (Models I–IV): (I) AI at farmer's doorstep through direct linkage to tribal farmers; (II) AI at farmer's doorstep through trained, educated youth; (III) oestrus synchronisation and fixed-time AI; and (IV) mobile van-based AI delivery system. The study also sought to ascertain the benefits of adopting a crossbreeding program through AI over the existing use of local pigs for smallholder systems. Methods: Semen collected from nine Hampshire boars was routinely utilised for AI after processing as per standard protocols. For Models I–IV, respectively, 259, 154, 183 and 284 sows from 75 villages/clusters were inseminated. Reproductive and litter performance as well as insemination cost were evaluated for each model. Growth performance of crossbred pigs obtained through AI was compared with that of local pigs in the smallholder production system. Key results: Farrowing rate and mean litter size at birth were 74.90% and 8.57 ± 0.52 for Model I, 68.83% and 8.08 ± 0.37 for Model II, 80.87% and 9.31 ± 0.41 for Model III, 75.00% and 8.54 ± 0.64 for Model IV, and 81.58% and 6.81 ± 0.29 for natural service. Farrowing rate, litter size at birth and at weaning, and litter weight at weaning were significantly (P < 0.05) affected by AI delivery model in the order: Model III > Model I = Model IV > Model II. Litter weight at birth was significantly (P < 0.05) affected by AI delivery model in the order: Model III > Model I = Model II = Model IV. Lowest cost per insemination was found for Model IV (INR 319.00) followed by Model II (INR 449.00), Model III (INR 629) and Model I (INR 899). All models had lower cost than the natural service system (INR 2200). The growth performance of crossbred pigs obtained through AI was significantly (P < 0.01) higher than of the local pigs reared in the same production system. Conclusion: The present study justifies the accessibility, feasibility and potential benefit of AI delivery models in smallholder/backyard pig production systems in the north-eastern region of India. Use of these AI delivery models will overcome the breeding constraints and reward farmers with more rapid genetic improvement in productivity with lower production costs. Model III (oestrus synchronisation and fixed time AI) shows best productivity and Model IV (mobile van-based AI delivery system) has lowest cost. Implications: These AI delivery models will be effective for sustainable and economic piggery development and improve the socioeconomic livelihood of pig farmers in South Asian countries. Artificial insemination (AI) is an important tool for commercial pig farming in developed countries; however, it is rarely used in smallholder/backyard pig production systems in other countries due to the lack of a proper channel for effective AI in pigs. This study developed different cost-effective AI delivery models for smallholder/backyard pig farmers to enhance productivity of existing nondescript pigs as well as overcoming the breeding constraints. The study demonstrated the benefits of crossbred pigs obtained through AI over the existing pigs in smallholder production system and suggests that wider implementation of these models would reward sustainable, economic and profitable piggery development in these systems. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorder (OUD) is a major public health issue in the United States. Medications for OUD (MOUD), which combines the use of approved medications with counseling and behavioral therapies, represents an evidence-based approach to treat individuals living with an OUD. However, MOUD has not kept up with increased demand and new treatment approaches are needed. One approach is injectable naltrexone, an approved and effective MOUD treatment, provided by pharmacists, who are more geographically accessible and have legal authority to administer it in some states.Objectives: To explore how different community pharmacists provide injectable naltrexone treatment and identify best practices.Methods: An exploratory sequential mixed-methods design was used to investigate pharmacy-based naltrexone injection practices, involving a pharmacist questionnaire and interviews with pharmacists, prescribers, and community stakeholders. An inductive/iterative content analysis approach, guided by an initial straw model, was used to identify and explore conceptual categories for the interviews.Results: The final sample included 68 pharmacy surveys and 14 total interviews with pharmacists (n = 9), prescribers (n = 3), and community stakeholders (n = 2). Pharmacies providing naltrexone injections reported administering over 700 injections in the past year. Interviews revealed benefits and barriers to pharmacist-provided injections and the importance of the prescriber-pharmacist relationship in OUD treatment. Three pharmacy treatment delivery models were identified, compared to the initial straw model, and informed development of a best practices checklist for community pharmacies interested in establishing or expanding a naltrexone injection service.Conclusions: The study demonstrates how community pharmacies developed and implemented a naltrexone injection service. Pharmacists' and prescribers' feedback clearly suggests an untapped interest, as well as resources, in realizing pharmacists' roles as providers of injectable naltrexone treatment. Implementation research could inform the development and evaluation of an intervention based on these best practices to further explore the utility of community pharmacy-based naltrexone injection services. [ABSTRACT FROM AUTHOR]

Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary health care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al. framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing and cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under 10 years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems. [ABSTRACT FROM AUTHOR]

Home delivery, as a flow of goods between the company and the consumer (B2C) at the end of the supply chain ("last mile"), can be realized by the manufacturer, retailer or third party (logistics provider, crowd-worker). The growth of home delivery services in recent decades has been predominantly stimulated by the development of online ordering, i.e. e-commerce. Delivery characteristics depend on the characteristics of the environment and a number of factors related to stakeholders (customers, companies, governments). In order to improve the quality of service and customer satisfaction, company profitability and (or) reduce the negative effects of deliveries on the environment, area and community functionality, various delivery models are designed and implemented in terms of need for ordering, frequency, ordering and payment system, starting and end points, executors, reception method, security, delivery area, speed and time of realization, return flows, etc. This paper proposes a framework for a comprehensive structuring and classification of home delivery models according to the stated characteristics/criteria. Also, the advantages, disadvantages, interdependence and applicability of different delivery models in changing circumstances are described. In this way, a comprehensive review of home delivery flows was performed, the literature that deals with this area in a similar way was supplemented, but the basis for future research was also created. [ABSTRACT FROM AUTHOR]

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with nonclinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success. [ABSTRACT FROM AUTHOR]

This paper defines eCooking Delivery Models (eCDMs) as the activities, resources and actors needed to deliver modern electric cooking (eCooking) appliances to end-users in need of innovative clean cooking solutions in the Global South. We define the eCooking Market System (socio-economic and cultural context, the enabling environment, market chains, support services) which conceptualizes the real-world market factors and surrounding context related to enabling the uptake and sustained use of eCooking appliances by end-users. We also describe an approach to design eCDMs and identify the support services required to start and sustain the market delivery infrastructure. The eCDM concept and approach are demonstrated through designing eCDMs and support services for electric pressure cookers (EPCs) for two end-user segments in Tanzania: rural and peri-urban/urban customer segments. Research methods included: focus groups and workshops (12), household surveys (51), cooking demonstrations (11), offering end-users the chance to purchase EPCs through various financing mechanisms, and interviews (eight with market actors, 18 with enabling environment stakeholders). This led to stakeholder mapping, understanding end-users, market chains, and enabling environment, and identification of eCDMs and support services to reach the focus customer segments. The case study outcome was a plan to implement support services, which is being carried out by a Tanzanian NGO, and we reflect on progress thus far in supporting the eCooking market in Tanzania. The concept and approach can support similar action research in other contexts to accelerate the transition to modern energy cooking services.

This article analyzes the relevance of the comprehensive definition of sexual and reproductive health and rights (SRHR) to adolescents and identifies adolescent-specific implications for the implementation of an essential package of SRHR interventions. The delivery of a comprehensive approach to SRHR targeting adolescents is underpinned by five principles—equity, quality, accountability, multisectorality, and meaningful engagement. All SRHR interventions included in the package are relevant to adolescents, given the diversity of adolescents' SRHR needs and considering their specific attributes, circumstances, and experiences. Ensuring that this package is available, accessible, and acceptable to adolescents requires an approach that looks at adolescents as being biologically and socially distinct from other age groups and acknowledges that they face some specific barriers when accessing SRHR services. This article provides cross-cutting strategies for the implementation of a comprehensive approach to SRHR for adolescents and specific considerations in delivering each intervention in the package of essential SRHR interventions. To further implement the International Conference on Population and Development Programme of Action, a prerequisite for achieving the Sustainable Development Goals, SRHR interventions must be adolescent responsive, delivered through multiple platforms, leveraging multisectoral collaboration, and strengthening accountability and participation. [ABSTRACT FROM AUTHOR]

Solar photovoltaic (PV) will play the leading role in addressing off‐grid electricity access; it can be applied almost anywhere and used in a wide range of applications for households, businesses, institutions and communities. However, to fully exploit this opportunity, off‐grid markets that need these solutions need to be effectively penetrated. This article focuses on delivery models for off‐grid solar PV solutions and how they address barriers such as awareness, acceptance, access and affordability. It is based on a survey of 13 solar PV businesses in East Africa, supported by the Energy and Environment Partnership Programme and implementing the following delivery models: Retail, Pay‐As‐You‐Go (PAYG), Consumer financing, Mini‐grid and Fee‐for‐service. The survey is complemented by supporting literature and incorporates experiences from a University of Oslo research project on a village scale energy access model in Kenya and case studies of solar PV mini‐grids in Senegal and India. Experiences from implementation of the different models are analyzed and generic descriptions provided. The models are compared to illustrate their suitability and effectiveness for delivering different levels of energy access. Retail and PAYG models are identified as effective at reaching scale, while the mini‐grid and fee‐for‐service models demonstrate good potential to affordably and sustainably deliver a wider range of electricity access. The limitations of conventional rural electrification strategies are also discussed and the potential to incorporate some delivery models into electrification programs assessed. This article is categorized under: Photovoltaics > Economics and Policy Photovoltaics > Systems and Infrastructure Energy and Development > Economics and Policy Solar Heating and Cooling > Economics and Policy [ABSTRACT FROM AUTHOR]

A persistent problem in the field of gifted education has been the lack of categorization and delineation of gifted programming options. To address this issue, we propose Unified Program Design as a structural framework for gifted program models. This framework defines gifted programs as the combination of delivery methods and curriculum models. By considering both the delivery methods and the curriculum, coordinators and teachers will be able to visualize the available options that address each component, making designing and describing gifted programs more consistent. Implications for research, evaluation, and program practice are also discussed. [ABSTRACT FROM AUTHOR]

Objective: Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes., Methods: Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus., Results: The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education., Conclusion: The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Richard M. Rosenfeld, MD, MPH, MBA, DipABLM (Methodologist): Director of Guidelines and Quality, ACLM; prior Chief Medical Officer, ABLM. Jonathan P. Bonnet, MD, MPH, FAAFP, FACLM, CAQSM, DipABOM, DipABLM (Panel Member): Consultant to AAFP's Lifestyle Medicine Tool Kit (Ardmore Institute of Health Grant)—Consultant to Emory Lifestyle Medicine and Wellness for Teaching Kitchen (Ardmore Institute of Health Grant)—Co-chair of ACLM Board Review Course—Advisory Board of Forfend Health—ABLM Board Member—Co-author of Lifestyle Medicine Handbook: The Power of Healthy Habits—AJLM CME Question Writer. David Bowman, MD, DipABLM (Panel Member): Board of Directors for ACLM. Amy R. Mechley, MD, FAAFP, FACCLM, Dip ABLM, DipABFM (Panel Member): Investor in Poplar Health-ABLM Board member and ABLM Chair-elect. Rajiv K. Misquitta, MD, FACP, Dipl. ABLM (Panel Member): Co-author of a book on plant-based eating called “Healthy Heart healthy Planet.” Michael D. Parkinson, MD, MPH, FACPM (Panel Member) Advisor to employers, health care organizations, numerous startups and Pivio (formerly CHIP - Complete Health Improvement Program). Padmaja M. Patel, MD, FACLM, DipABLM (Panel Member): Investor in Poplar Health and Nudj Health. Advisory board of member of Nudj Health. Karen R. Studer, MD, MBA, MPH, FACPM, DipABOM, DipABLM, Lifestyle Medicine Intensivist (Panel Member):10% FTE for Lifestyle Medicine Residency Curriculum (LMRC) work, a joint product by (LLUH) and ACLM., (Copyright © 2023 The Author(s).)

Cardiovascular disease (CVD) is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be efficacious and cost-effective for secondary prevention in high-income countries. Given its affordability, CR should be more broadly implemented in middle-income countries as well. Hence, the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) convened a writing panel to recommend strategies to deliver all core CR components in low-resource settings, namely: (1) initial assessment, (2) lifestyle risk factor management (i.e., diet, tobacco, mental health), (3) medical risk factor management (lipids, blood pressure), (4) education for self-management; (5) return to work; and (6) outcome evaluation. Approaches to delivering these components in alternative, arguably lower-cost settings, such as the home, community and primary care, are provided. Recommendations on delivering each of these components where the most-responsible CR provider is a non-physician, such as an allied healthcare professional or community health care worker, are also provided. [ABSTRACT FROM AUTHOR]

The paper analyses if the collaborative networked organisations (CNO) concept can bring advantages in organising the international outbound logistics for SMEs. In the manufacturing domain, the European CNO research has identified benefits from using the concept in traditional supply chains, collaboration in various inbound networks and business ecosystems. Less focus has been on outbound logistics for delivering products and related service to customers at remote locations. The analysis is based on conducted company interviews. The interviewed companies have a good record of successful international operations. The used international delivery models are mapped into taxonomy of well-known outbound logistics models. The paper proposes a customer interface network model, based on the CNO concept to tackle problems encountered.

Many countries implement micronutrient powder (MNP) programmes to improve the nutritional status of young children. Little is known about the predictors of MNP coverage for different delivery models. We describe MNP coverage of an infant and young child feeding and MNP intervention for children aged 6–23 months comparing two delivery models piloted in rural Nepal: distributing MNPs either by female community health volunteers (FCHVs) or at health facilities (HFs). Cross‐sectional household cluster surveys were conducted in four pilot districts among mothers of children 6–23 months after starting MNP distribution. FCHVs in each cluster were also surveyed. We used logistic regression to describe predictors of initial coverage (obtaining a batch of 60 MNP sachets) at 3 months and repeat coverage (≥2 times coverage among eligible children) at 15 months after project launch. At 15 months, initial and repeat coverage were higher in the FCHV model, although no differences were observed at 3 months. Attending an FCHV‐led mothers' group meeting where MNP was discussed increased odds of any coverage in both models at 3 months and of repeat coverage in the HF model at 15 months. Perceiving ≥1 positive effects in the child increased odds of repeat coverage in both delivery models. A greater portion of FCHV volunteers from the FCHV model vs. the HF model reported increased burden at 3 and 15 months (not statistically significant). Designing MNP programmes that maximise coverage without overburdening the system can be challenging and more than one delivery model may be needed. [ABSTRACT FROM AUTHOR]

Objective. Health service managers and policy makers are increasingly concerned about the sustainability of innovations implemented in health care settings. The increasing demand on health services requires that innovations are both effective and sustainable; however, research in this field is limited, with multiple disciplines, approaches and paradigms influencing the field. These variations prevent a cohesive approach, and therefore the accumulation of research findings, in the development of a body of knowledge. The purpose of this paper is to provide a thorough examination of the research findings and provide an appropriate theoretical framework to examine sustainability of health service innovation. Methods. This paper presents an integrative review of the literature available in relation to sustainability of health service innovation and provides the development of a theoretical framework based on integration and synthesis of the literature. Results. A theoretical framework serves to guide research, determine variables, influence data analysis and is central to the quest for ongoing knowledge development. This research outlines the sustainability of innovation framework; a theoretical framework suitable for examining the sustainability of health service innovation. Conclusion. If left unaddressed, health services research will continue in an ad hoc manner, preventing full utilisation of outcomes, recommendations and knowledge for effective provision of health services. The sustainability of innovation theoretical framework provides an operational basis upon which reliable future research can be conducted. What is known about the topic? Providers of health services are rapidly implementing innovations in an effort to provide effective health care. Little research has been conducted to evaluate the sustainability of these health service innovations. What does this paper add? This paper aims presents an integration and synthesis of the current body of knowledge to provide a theoretical framework to evaluate the sustainability of health service innovation. What are the implications for the practitioner? An improved body of knowledge surrounding the sustainability of health service innovations generated from research will consequently result in more appropriate use of resources and improved provision of health services. [ABSTRACT FROM AUTHOR]

Objectives To provide an overview of the four major palliative care delivery models: ambulatory clinics, home-based programs, inpatient palliative care units, and inpatient consultation services. The advantages and disadvantages of each model and the generalist and specialist roles in palliative care will be discussed. Data Sources Literature review. Conclusion The discipline of palliative care continues to experience growth in the number of programs and in types of delivery models. Ambulatory- and home-based models are the newest on the scene. Implications for Nursing Practice Nurses caring for oncology patients with life-limiting disease should be informed about these models for optimal impact on patient care outcomes. Oncology nurses should demonstrate generalist skills in the care of the seriously ill and access specialist palliative care providers as warranted by the patient's condition. [ABSTRACT FROM AUTHOR]

Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach. [ABSTRACT FROM AUTHOR]

The maritime domain plays a decisive role in the modern worldwide digital economy and collaborative environments. In addition, emerging technologies such as cloud computing provide holistic frameworks for generating and delivering a plethora of interoperable, cost-effective, and scalable e-services that efficiently manage information and data stored inside large-scale datacenters. Driven by this motivation, this article presents a perspective beyond traditional IT utilization over the maritime domain: a roadmap to the Maritime Cloud. The authors define the Maritime Cloud stack and architecture in detail and describe the Maritime Cloud delivery and deployment models as an integral process for transitioning to the Maritime Cloud. The authors evaluate advantages and challenges and present future research directions. [ABSTRACT FROM AUTHOR]

Current research suggests that hourly rounds on hospitalized patients may be associated with improvements in care delivery and in the patients' perception of care, as well as a reduction in patient safety events. Implementing an hourly rounding protocol involves a major change in nursing staff workflow and a substantial training and education program to ensure the success of the program. This quasi-experimental study aimed to determine if a standardized hourly rounding process (SHaRP), implemented through a formal education program, would result in improved efficiency, quality, safety, and patient satisfaction metrics when compared to a less standardized process introduced through the traditional train-the-trainer method. Data were collected over a 6-month period and results were trended for an additional 6 months later to determine if significant gains were sustained over time. Significant reductions in call light use during the study period ( p = .001) and the number of steps taken by the day-shift staff ( p = .02) were seen on the intervention unit. Differences in the number of patient falls, 30-day readmission rates, and patients' perception of care were not statistically significant. [ABSTRACT FROM AUTHOR]

The Distance Education Project for Rural Schools (DEPRS) was implemented by the Chinese government between 2003 and 2007 to improve the quality of basic education in rural areas of China, especially in the poorer western provinces. It has been referred to as “the largest ICT project in the world up to now” because “it serves a larger population than any other similar projects and therefore will likely start a far-reaching information revolution in China.” This paper offers a descriptive analysis of the effectiveness and impact of DEPRS, explaining how and why it was implemented as a solution to close the wide gaps in access to high quality basic education. Focusing on the initial achievements of DEPRS, this paper explores if, how, and to what extent the three learning tools employed in DEPRS have improved basic education in remote rural areas.

This article takes up some interesting developments on public services reform in a rural context in England. It considers: (1) current issues in public service delivery in rural areas; (2) the opportunities and barriers around changing delivery models, using the example of community-led asset transfer – Jubilee Park in Lincolnshire; and (3) whether other communities are capable of filling gaps in provision left by public sector service deliverers. [ABSTRACT FROM PUBLISHER]

The paper analyses if the collaborative networked organisations (CNO) concept can bring advantages in organising the international outbound logistics for SMEs. In the manufacturing domain, the European CNO research has identified benefits from using the concept in traditional supply chains, collaboration in various inbound networks and business ecosystems. Less focus has been on outbound logistics for delivering products and related service to customers at remote locations. The analysis is based on conducted company interviews. The interviewed companies have a good record of successful international operations. The used international delivery models are mapped into taxonomy of well-known outbound logistics models. The paper proposes a customer interface network model, based on the CNO concept to tackle problems encountered. [ABSTRACT FROM AUTHOR]

One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services. [ABSTRACT FROM AUTHOR]

Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services (Wiselka and Nicholson, 1997). Now almost 70% of those treated with intravenous antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). In total, 38-53% percent of those requiring OPAT are able to self-administer (Hills et al, 2012). The demand for intravenous antimicrobial therapy is increasing and the way it is being delivered is changing. This article examines service models, setting up services and developing staff to enable them to deliver OPAT services. [ABSTRACT FROM AUTHOR]

Most healthcare quality improvement and cost reduction efforts currently focus on care processes, or transitions-for example, the hospital discharge process. While identification and adoption of best practices to address these aspects of healthcare are essential, more is needed for systems that serve vulnerable populations: to account for social factors that often inhibit patients' ability to take full advantage of available healthcare. Our urban safety net healthcare system developed and implemented an innovative quality improvement approach. The programs, Guided Chronic CareTM, and Passport to Wellness, use Assertive Care and provide social support for patients between medical encounters, enabling patients to make better use of the healthcare system and empowering them to better manage their conditions. Results: The majority of patients reported problems with mobility and nearly half reported anxiety or depression. Early indications show improved quality of care and significant reduction in costs. Challenges encountered and lessons learned in implementing the programs are described, to assist others developing similar interventions. [ABSTRACT FROM AUTHOR]

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This paper defines eCooking Delivery Models (eCDMs) as the activities, resources and actors needed to deliver modern electric cooking (eCooking) appliances to end-users in need of innovative clean cooking solutions in the Global South. We define the eCooking Market System (socio-economic and cultural context, the enabling environment, market chains, support services) which conceptualizes the real-world market factors and surrounding context related to enabling the uptake and sustained use of eCooking appliances by end-users. We also describe an approach to design eCDMs and identify the support services required to start and sustain the market delivery infrastructure. The eCDM concept and approach are demonstrated through designing eCDMs and support services for electric pressure cookers (EPCs) for two end-user segments in Tanzania: rural and peri-urban/urban customer segments. Research methods included: focus groups and workshops (12), household surveys (51), cooking demonstrations (11), offering end-users the chance to purchase EPCs through various financing mechanisms, and interviews (eight with market actors, 18 with enabling environment stakeholders). This led to stakeholder mapping, understanding end-users, market chains, and enabling environment, and identification of eCDMs and support services to reach the focus customer segments. The case study outcome was a plan to implement support services, which is being carried out by a Tanzanian NGO, and we reflect on progress thus far in supporting the eCooking market in Tanzania. The concept and approach can support similar action research in other contexts to accelerate the transition to modern energy cooking services. [ABSTRACT FROM AUTHOR]