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Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults. We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such as death, fracture, and population-based clinical measures where available.

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.

Help Chain (HC) is a problem-solving practice underpinned by lean manufacturing principles and also adopted for health services, which have different complexity characteristics in relation to manufacturing. This study is based on the premise that Social Network Analysis (SNA) might be an effective analytical approach to account for the complexity of HCs in healthcare. Hence, two research questions are addressed: how to model and interpret HCs in health services as a social network and how SNA can either challenge or add to the lean assumptions of HC design. The use of SNA to model HCs was tested in a maternity hospital, where HCs related to five problems were analyzed, concerning the supply of instruments from the centre of sterilised materials to the surgical and obstetrics units. We analyzed the HCs of single problems and then combined the five problem-solving networks to produce a multilayered network that accounted for their interactions. The patterns of social interactions varied according to the problem and three dimensions of actors' performance (i.e. availability, reliability, and agility). SNA unveiled the complexity of HCs and provided guidance for revising the lean assumptions in their design, matching the realities of health services. [ABSTRACT FROM AUTHOR]

Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semistructured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFCs enable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community. [ABSTRACT FROM AUTHOR]

This systematic review synthesized the literature on digital health interventions for the promotion of physical activity (PA) among people with intellectual disabilities and/or autism. From an initial screening of 553 records, 10 studies underwent full-text review. Data were extracted relating to study, intervention, and sample characteristics and PA-related findings. Methodological quality was evaluated using the Crowe Critical Appraisal Tool. There were mixed findings pertaining to the effectiveness of digital health interventions for promoting PA among these populations. Positive results were reported for three of five active-video-game interventions, two of three social-media-based interventions, and one of two e-learning/multicomponent interventions. Digital health interventions can potentially be effective for promoting PA among people with intellectual disabilities and/or autism. However, the large variation in the samples and intervention types and a reliance on pre- and quasi-experimental research designs suggest that inferences should be made with caution and additional research is needed. [ABSTRACT FROM AUTHOR]

The article discusses the importance of physical activity promotion by health professionals in increasing population physical activity levels. It highlights the World Health Organization's Global Action Plan on Physical Activity and the International Society for Physical Activity and Health's Eight investments that work for physical activity as key strategies. The article emphasizes the need to strengthen the training of health professionals to increase their knowledge and skills for promoting physical activity. It also provides physical activity guidelines for different populations and discusses the effectiveness of physical activity advice in various healthcare settings. The article proposes a continuum of physical activity advice that can be tailored to different time constraints and settings. Overall, the article emphasizes the role of all health professionals in promoting physical activity and the potential impact on population health. [Extracted from the article]

The historiography of the American effort in World War I describes an American unwillingness to learn from the Allies. However true that may be for the combat arms, it was untrue for the Army Medical Department (AMEDD). The AMEDD sought a wide range of information from the beginning of the war, and through multiple channels that expand substantially and systematically once the U.S. entered the war. The information was also disseminated through multiple channels and made significant impacts on medical care in the American Expeditionary Force (AEF) during the Great War. Historians should be more cautious about assuming that all parts of the AEF were resistant to foreign information. [ABSTRACT FROM AUTHOR]

Purpose: To describe the use of work process modelling to optimise the organisation of the demand for oral health treatment in primary care units in Brazil. Materials and Methods: The oral health care routine was at first described as the “AS IS” model, which was evaluated by the oral team professionals, rearranged, and further described as the “TO BE” model described using a business process management modelling tool. The significant increase in the demand of patients due to restrictions offered by the dental service in addition to non-urgent treatments being avoided by patients during COVID-19 pandemic was also considered. Results: Structuring the work processes in a visual way using modelling tools was useful to picture the entire treatment process and adjust when needed. The use of the managerial tool was useful to understand and reorganise the workflow of organising the demand and ultimately improve the efficiency of the resources. The use of such managerial tools helped oral health professionals to efficiently rearrange their tasks and set priorities to meet their needs. Conclusions: With the use of management tools, each unit can readjust its structures and ways of working, aiming to improve the quality of public health care services provided to patients. [ABSTRACT FROM AUTHOR]

Despite considerable investment, health outcomes for First Nations people are well below those of the rest of the population in several countries, including Canada, the United States, and Australia. In this article, the authors draw on actor-network theory and the case of Birthing on Country, a successful policy initiative led by First Nations Australians, to explore the decolonization of health services. Using publicly available archival data and the theoretical guidance of actor-network theory, the analysis offers insight into how marketing techniques and technologies can be deployed to achieve improved health outcomes and implement decolonized approaches. The insights provided have theoretical implications for marketing scholarship, social implications for understanding and implementing an agenda of decolonization, and practical implications for health care marketing. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine changes in rural and urban Veterans utilization of acute inpatient care in Veterans Health Administration (VHA) and non-VHA hospitals following access expansion from the Veterans Choice Act, which expanded eligibility for VHA-paid community hospitalization. METHODS: Using repeated cross-sectional data of VHA enrollees hospitalizations in 9 states (AZ, CA, CT, FL, LA, MA, NY, PA, and SC) between 2012 and 2017, we compared rural and urban Veterans probability of admission in VHA and non-VHA hospitals by payer over time for elective and nonelective hospitalizations using multinomial logistic regression to adjust for patient-level sociodemographic features. We also used generalized linear models to compare rural and urban Veterans travel distances to hospitals. FINDINGS: Over time, the probability of VHA-paid community hospitalization increased more for rural Veterans than urban Veterans. For elective inpatient care, rural Veterans probability of VHA-paid admission increased from 2.9% (95% CI 2.6%-3.2%) in 2012 to 6.5% (95% CI 5.8%-7.1%) in 2017. These changes were associated with a temporal trend that preceded and continued after the implementation of the Veterans Choice Act. Overall travel distances to hospitalizations were similar over time; however, the mean distance traveled decreased from 39.2 miles (95% CI 35.1-43.3) in 2012 to 32.3 miles (95% CI 30.2-34.4) in 2017 for rural Veterans receiving elective inpatient care in VHA-paid hospitals. CONCLUSIONS: Despite limited access to rural hospitals, these data demonstrate an increase in rural Veterans use of non-VHA hospitals for acute inpatient care and a small reduction in distance traveled to elective inpatient services.

Chatbots are "computer agents that can interact with the user" in a way that feels like human-to-human conversation.1 While the use of chatbots for reference service in academic libraries is a topic of interest for both library professionals and researchers, little is known about how they are used in library reference service, especially in academic libraries in Canada. This article aims to fill this gap by conducting a web-based survey of 106 academic library websites in Canada and analyzing the prevalence and characteristics of chatbot and live chat services offered by these libraries. The authors found that only two libraries were using chatbots for reference service. For live chat services, the authors found that 78 libraries provided this service. The article discusses possible reasons for the low adoption of chatbots in academic libraries, such as accessibility, privacy, cost, and professional identity issues. The article also provides a case study of the authors' institution, the University of Calgary, which integrated a chatbot service in 2021. The article concludes with suggestions for future research on chatbot use in libraries. [ABSTRACT FROM AUTHOR]

In this study, we examine how organizational rules source knowledge. By knowledge sourcing of a rule, we mean the formation of reference ties from the rule to knowledge sources located outside of the focal rule. Rules can source knowledge from sources within the organization (e.g., other rules) and outside (e.g., research publications, policies, standards, etc.). Our theoretical model proposes that knowledge sourcing of rules is driven by inherent incompleteness of rules as a result of bounded rationality of rule makers and rule making process. Incomplete rules can lead to experiences of insufficient rule knowledge, termed "knowledge gaps," which are shaped by rule dynamics at the levels of individual rules, the rule system, and rule networks. Our theoretical model leads to several hypotheses that we test with longitudinal archival data of clinical practice guideline (CPG) changes in a Canadian healthcare organization. The findings support our theoretical model of incomplete organizational rules which encounter knowledge gaps and close them through internal and external knowledge sourcing. The theoretical and practical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

The onset of retirement and children leaving the family home may offer a "window of opportunity" for individuals to influence regular moderate- to vigorous-intensity physical activity; therefore, this study examines the feasibility of a moderate- to vigorous-intensity physical activity intervention among recently retired participants (RET) and parents (P) with children who recently left the family home. A total of 46 inactive RET and nine inactive P were randomized to a 10-week web intervention (n = RET = 25/P = 4) or waitlist control (n = RET = 21/P = 5). Intervention techniques followed the multiprocess action control framework. Enrollment (37.5% for P; 40% for RET), retention (89% for P; 83% for RET), and satisfaction were high. One hundred percent of intervention-sectioned participation increased moderate- to vigorous-intensity physical activity compared with 52% of controls; large effect size differences were observed for key multiprocess action control constructs. Participants were highly satisfied with the intervention; however, recruitment challenges of P support moving to a randomized controlled trial for only the RET group. [ABSTRACT FROM AUTHOR]

This retrospective clinical study compared two different professional maintenance therapy (MT) approaches (with and without periodic removal and decontamination of prosthetic components) on peri-implant inflammatory clinical and biochemical parameters after 5 years of implant function. A retrospective analysis based on patient records was used to assess inflammatory clinical and biochemical parameters around dental implants placed by the same clinician in a private practice. The Plaque Index (PI), peri-implant probing depth (PPD), mucosal recession (REC), bleeding on probing (BOP), and radiographic marginal bone level were determined at baseline and at each follow-up year. Moreover, at the last follow-up visit, the peri-implant intrasulcular levels of active metalloproteinasis 8 (aMMP-8) were also assessed. All participants were under MT with a 6-month recall interval. A total of 92 patients with 132 implants were selected. At the end of the study period, 12 patients with 12 implants were classified as dropouts. The remaining 80 patients and 120 implants were classified into two groups: Group 1 (42 patients, 62 implants) received MT with periodic removal and decontamination of prosthetic components; Group 2 (38 patients, 58 implants) received MT without periodic removal and decontamination of prosthetic components. No statistical differences were found between the groups regarding PI, PPD, and REC. Group 1 presented a statistically significant higher number of sites with BOP (12.4% vs 6.2%). Marginal bone loss was statistically higher in Group 2 than in Group 1 (0.23 ± 0.6 mm vs 0.78 ± 0.3 mm). Intrasulcular levels of aMMP-8 were statistically higher in Group 1 than in Group 2. The supplemental application of periodic removal and decontamination of prosthetic components during MT had a significantly positive effect on the inflammatory status of periimplant tissues. [ABSTRACT FROM AUTHOR]

There is a powerful global trend toward deeper integration of digital twins into modern life driven by Industry 4.0 and 5.0. Defense, agriculture, engineering, manufacturing, and urban planning sectors have thoroughly incorporated digital twins to great benefit across their respective product lifecycles. Despite clear benefits, a digital twin framework for health and medical sectors is yet to emerge. This paper proposes a digital twin framework for precision neuromusculoskeletal health care. We build upon the International Standards Organization framework for digital twins for manufacturing by presenting best available computational models within a digital twin framework for clinical application. We map a use case for modeling Achilles tendon mechanobiology, highlighting how current modeling practices align with our proposed digital twin framework. Similarly, we map a use case for advanced neurorehabilitation technology, highlighting the role of a digital twin in control of systems where human and machine are interfaced. Future work must now focus on creating an informatic representation to govern how digital data are passed to, from, and within the digital twin, as well as specific standards to declare which measurement systems and modeling methods are acceptable to move toward widespread use of the digital twin framework for precision neuromusculoskeletal health care. [ABSTRACT FROM AUTHOR]

Using detailed patient-level data, we show that patients who enjoyed relevant medical training (physicians and midwives) are 3.1 percentage points less likely to receive a C-section than semi-expert patients (nurses and physiotherapists). We examined whether this treatment gap diminishes after a Dutch law reform that aimed to (1) strengthen patients' position in health care processes and (2) increase quality of care through more openness about clinical decisions and learning from medical incidents. We hypothesize that prescriptions of the law, such as more internal debates about appropriate treatment and improved communication of clinical decisions and potential complications during consultations, are expected to make semi-expert patients more informed. Exploiting the reform in a difference-in-differences approach, in which semi-expert patients constitute the treatment group and expert patients the control group, we show that the likelihood of semi-expert patients receiving a C-section after the reform is eight percentage points lower than the changes in C-section rates among expert patients. Given that the reform especially impacted the information level of semi-experts, these findings seem to support the idea that the treatment gap is driven, at least to some extent, by agency discrimination. [ABSTRACT FROM AUTHOR]

Hearing loss affects over 1.5 billion individuals globally, with significant implications for mental health. This study investigates the association between hearing aid use and mental health outcomes, by particularly focusing on depression and unmet mental health needs (UMHN), across a diverse international sample. Utilizing data from the third wave of the European Health Interview Survey (EHIS), this study involved 17,660 participants with hearing impairment from 28 countries. The study examined the association between hearing aid use and mental health outcomes, including the likelihood of moderate and severe depression and UMHN due to lack of contact with general practitioners (GPs) and mental health specialists. Logistic regression models, adjusted for socio-demographic characteristics, health risk behaviours, and other relevant variables, were employed. Inverse probability weights were used to mitigate potential selection bias. Hearing aid usage was associated with significantly lower likelihoods of moderate depression (Odds Ratio [OR] = 0.58, 95%CI = [0.54, 0.63]) and severe depression (OR = 0.61, 95%CI = [0.55, 0.69]), compared to non-usage. Hearing aid usage was also associated with reduced UMHN due to lack of GP contact for moderate (OR = 0.82, 95%CI = [0.75, 0.89]) and severe depression (OR = 0.75, 95%CI = [0.59, 0.95]). The depression risk reductions were greater among females and higher-educated subgroups but lower in individuals aged ≥65 years. Income level and rurality also impacted UMHN due to the lack of GP contact. No associations were found between hearing aids and UMHN due to the lack of mental health specialist contact. Hearing aid adoption showed protective associations against mood disorders and lowered unmet primary mental healthcare needs. Tailoring intervention strategies to vulnerable sociodemographic profiles could optimize mental health benefits among those with hearing loss. Integrating hearing health services within mental healthcare delivery frameworks is vital amidst the rising global burden. • There is little insight into hearing aids' impact on mental health and unmet mental health needs (UMHN). • Hearing aid use was associated with lower rates of depression and UMHN, bases on 17,000 participants from 28 countries. • The findings advocate for integrating hearing health into mental health frameworks. [ABSTRACT FROM AUTHOR]

Opioids are commonly used to provide analgesia during and after congenital heart surgery. The effects of exposure to opioids on neurodevelopment in neonates and infants are not well understood. This study sought to evaluate the associations between cumulative opioid exposure (measured in morphine mg equivalent) over the first year of life and 2-year neurodevelopmental outcomes (Bayley Scales of Infant and Toddler Development-Third/Fourth Edition [Bayley-III/IV] cognitive, language, and motor scores). A single-center retrospective cohort study of infants undergoing congenital heart surgery was performed. Adjustment for measurable confounders was performed through multivariable linear regression. A total of 526 subjects were studied, of whom 32% underwent Society for Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 4 or 5 operations. In unadjusted analyses, higher total exposure to opioids was associated with worse scores across all 3 Bayley-III/IV domain scores (all P < 0.05). After adjustment for measured confounders, greater opioid exposure was associated with lower Bayley-III/IV scores (cognitive: β = −1.0 per log-transformed morphine mg equivalents, P = 0.04; language: β = −1.2, P = 0.04; and motor: β = −1.1, P = 0.02). Total hospital length of stay, prematurity, genetic syndromes, and worse neighborhood socioeconomic status (represented either by Social Vulnerability Index or Childhood Opportunity Index) were all associated with worse Bayley-III/IV scores across all domains (all P < 0.05). Greater postnatal exposure to opioids was associated with worse neurodevelopmental outcomes across cognitive, language, and motor domains, independent of other less modifiable factors. This finding should motivate research and efforts to explore reduction in opioid exposure while preserving quality cardiac intensive care. [ABSTRACT FROM AUTHOR]

BackgroundAimDesignSetting/participantsResultsConclusionsTelehealth can extend the reach of specialist palliative care providers to ensure that patients can access specialist services closer to home.To examine the cost and consequences of the Specialist Palliative Rural Telehealth (SPaRTa) service compared to the traditional non-specialist general practice-based services for people requiring palliative care.The costs and outcomes for SPaRTa were compared using cost-consequence analysis principles, with a focus on net benefit and return on investment. Costs were estimated from the perspective of the health service provider for the 2020/2021 financial year, and cost-offsets associated with change in location of death and change in hospital transfers.Patients of the SPaRTa in Queensland Australia.During study period 5472 consultations were conducted from four major metropolitan hub sites to regional, rural, and remote areas at a total cost of $4 426 644. When remuneration for consultations, change to location of death and reduction in ambulance transfers were taken into account, the net-benefit to the state health system was $1 244 060, giving a return on investment of $1.28 for every dollar spent. SPaRTa complimented existing local care services, and enabled access to specialist care into the home.SPaRTa resulted in potential cost savings for the health service by enabling more convenient access to palliative care services outside of hospital settings. Decisions regarding funding for telepalliative care should consider not only the costs, but also the potential benefits to both the service providers, and the patients and families receiving this care. [ABSTRACT FROM AUTHOR]

Objective: Utilize machine learning models to identify factors associated with seeking medical care for migraine. Background: Migraine is a leading cause of disability worldwide, yet many people with migraine do not seek medical care. Methods: The web‐based survey, ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (US), annually recruited demographically representative samples of the US adult population (2018–2020). Respondents with active migraine were identified via a validated diagnostic questionnaire and/or a self‐reported medical diagnosis of migraine, and were then asked if they had consulted a healthcare professional for their headaches in the previous 12 months (i.e., "seeking care"). This included in‐person/telephone/or e‐visit at Primary Care, Specialty Care, or Emergency/Urgent Care locations. Supervised machine learning (Random Forest) and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms identified 13/54 sociodemographic and clinical factors most associated with seeking medical care for migraine. Random Forest models complex relationships (including interactions) between predictor variables and a response. LASSO is also an efficient feature selection algorithm. Linear models were used to determine the multivariable association of those factors with seeking care. Results: Among 61,826 persons with migraine, the mean age was 41.7 years (±14.8) and 31,529/61,826 (51.0%) sought medical care for migraine in the previous 12 months. Of those seeking care for migraine, 23,106/31,529 (73.3%) were female, 21,320/31,529 (67.6%) were White, and 28,030/31,529 (88.9%) had health insurance. Severe interictal burden (assessed via the Migraine Interictal Burden Scale‐4, MIBS‐4) occurred in 52.8% (16,657/31,529) of those seeking care and in 23.1% (6991/30,297) of those not seeking care; similar patterns were observed for severe migraine‐related disability (assessed via the Migraine Disability Assessment Scale, MIDAS) (36.7% [11,561/31,529] vs. 14.6% [4434/30,297]) and severe ictal cutaneous allodynia (assessed via the Allodynia Symptom Checklist, ASC‐12) (21.0% [6614/31,529] vs. 7.4% [2230/30,297]). Severe interictal burden (vs. none, OR 2.64, 95% CI [2.5, 2.8]); severe migraine‐related disability (vs. little/none, OR 2.2, 95% CI [2.0, 2.3]); and severe ictal allodynia (vs. none, OR 1.7, 95% CI [1.6, 1.8]) were strongly associated with seeking care for migraine. Conclusions: Seeking medical care for migraine is associated with higher interictal burden, disability, and allodynia. These findings could support interventions to promote care‐seeking among people with migraine, encourage assessment of these factors during consultation, and prioritize these domains in selecting treatments and measuring their benefits. Plain Language Summary: In this study, we looked at factors that related to a person's decision to seek medical care for migraine in a representative sample of over 60,000 adults with migraine in the United States. We found that only about half (51.0%) of the participants reported seeking care for migraine. We also found that people were more likely to seek medical care when migraine got in the way of their lives during and between migraine attacks, and when they had allodynia (pain from stimuli that do not normally cause pain). [ABSTRACT FROM AUTHOR]

Education through poetry has long attracted the attention of scientists. As one of the oldest and most complex human arts, poetry can facilitate the learning of educational materials for the audience. Medical poetry conveys important points to medical students and makes difficult medical vocabulary easy for them. Including humanities in medical education is a measure to increase medical art awareness, compassion, and empathy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Misuse of prescription opioids is a well-established contributor to the US opioid epidemic. The primary objective of this study was to identify which level of care delivery (ie patient, prescriber, or hospital) produced the most unwarranted variation in opioid prescribing after common surgical procedures. STUDY DESIGN: Electronic health record data from a large multihospital healthcare system were used in conjunction with random-effect models to examine variation in opioid prescribing practices after similar inpatient and outpatient surgical procedures between October 2019 and September 2021. Unwarranted variation was conceptualized as variation resulting from prescriber behavior unsupported by evidence. Covariates identified as drivers of warranted variation included characteristics known to influence pain levels or patient safety. All other model variables, including prescriber specialty and patient race, ethnicity, and insurance status were characterized as potential drivers of unwarranted variation. RESULTS: Among 25,188 procedures with an opioid prescription at hospital discharge, 53.5% exceeded guideline recommendations, corresponding to 13,228 patients receiving the equivalent of >140,000 excess 5 mg oxycodone tablets after surgical procedures. Prescribing variation was primarily driven by prescriber-level factors, with approximately half of the total variation in morphine milligram equivalents prescribed observed at the prescriber level and not explained by any measured variables. Unwarranted covariates associated with higher prescribed opioid quantity included non-Hispanic Black race, Medicare insurance, smoking history, later hospital discharge times, and prescription by a surgeon rather than a hospitalist or primary care provider. CONCLUSIONS: Given the large proportion of unexplained variation observed at the provider level, targeting prescribers through education and training may be an effective strategy for reducing postoperative opioid prescribing. [ABSTRACT FROM AUTHOR]

In this case study, we describe a client, pseudonymously named Kai, who suffered multiple firearm injuries and was enrolled in a hospital-based violence intervention program (HVIP). Kai required multi-disciplinary care in pediatric and adult Level I Trauma Centers. His care was complicated by behavioral health issues, poverty, and a lack of adequate access to community-based healthcare and social support, leading to deteriorating health, frequent hospitalizations, and high health care utilization. Providers from the HVIP repeatedly worked with Kai, advocated for enhanced care, and provided him with the support necessary to heal and recover. This case report details the exceptional work HVIPs can do to support at-risk individuals, disrupt the cycle of violence, and promote healing and safety. [ABSTRACT FROM AUTHOR]

Purpose: To summarize and critique research on the experiences and outcomes of sexual minority women (SMW) treated with surgery for breast cancer through systematic literature review. Methods: A comprehensive literature search identified studies from the last 20 years addressing surgical experiences and outcomes of SMW breast cancer survivors. Authors performed a quality assessment and thematic content analysis to identify emergent themes. Results: The search yielded 121 records; eight qualitative studies were included in the final critical appraisal. Quality scores for included studies ranged 6-8 out of 10. Experiences and outcomes of SMW breast cancer survivors were organized by major themes: 1) Individual, 2) Interpersonal, 3) Healthcare System, and 4) Sociocultural and Discursive. Conclusions: SMW breast cancer survivors have unique experiences of treatment access, decision-making, and quality of life in survivorship. SMW breast cancer survivors' personal values, preferences, and support network are critical considerations for researchers and clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Since the COVID-19 pandemic, psycho-oncological care has increasingly been provided virtually and/or telephonically. We examined whether patients' therapeutic alliance (TA) – an essential processual outcome – differs due to altered modes of care delivery (MOCD) and assessed, if MOCD impacts patients' care satisfaction and patient reported outcomes. Methods: Survey and documentation data from newly diagnosed cancer patients that were cared for in the new form of care 'isPO' in Germany, were analyzed. Patients were surveyed after completing the one-year psycho-oncological care program. MOCD was operationalized by the ratio of patients' face-to-face, telephonic or video-based consultations to all their consultations. Regression analyzes were conducted to determine a possible relationship between MOCD and TA, between MOCD and patients' care satisfaction ('subjective effectiveness' and 'satisfaction and needs-orientation') and patient reported outcomes (anxiety and depression, sense of coherence, global health status). Findings: MOCD does not significantly influence TA. Regression models on the possible effect on subjective effectiveness and satisfaction and needs-orientation do not show statistical significance with only MOCD as the predictor. MOCD does not predict any of the patient reported outcomes. Conclusions: During the pandemic, neither TA, care satisfaction nor patient reported outcomes were affected by the MOCD in the new form of care 'isPO'. Therefore, the MOCD didn't negatively affect quality of care, which indicates that telephone or video consultations seem to be useful alternatives for psycho-oncological care in Germany. [ABSTRACT FROM AUTHOR]

Talking about sexuality in a health care total institution is not an easy task insofar as it contributes to the disclosing of the subjective and cultural postures of professionals, in contexts still marked by the absence or lack of professional training on this subject. Talking about sexuality can also endanger or challenge the institution. This paper presents a secondary analysis of what is presented as a form of "clinical ethnography". The materials used in this study were collected in 1996–1997, in the context of a crisis situation caused by the revelation of illicit sexual relations between a head special educator and a young woman labelled as mentally handicapped, in a care institution. In the course of a psychosociological intervention carried out in response to a request from the management of the institution, professionals from different categories were able to express themselves on these "events" and to address, more generally, issues related to sexuality in the institution. The sessions, moderated by the author of the study and a psychoanalytic research assistant, were recorded and transcribed for subsequent feedback to participants. The thematic content analysis of the transcripts of the sessions allowed for a better understanding of the psychosocial obstacles to communication about sexuality, the subjective difficulties related to speaking out, the phenomena of denial of sexuality, as well as the representations of sexuality in institutional situations. The documents discussed here invite reflection on the complexity of collecting information and stories about sexuality in institutional settings. They explore communication processes and, in particular, the difficulties of communicating about sexuality and sexual abuse in institutions in the health and social sector. This study suggests ways in which clinical support can be provided to teams affected by and confronted with traumatic events and the personal and professional difficulties that may arise from such situations. [ABSTRACT FROM AUTHOR]

• Inappropriate in-hospital settings increase clinical risk for acute medical patients. • A Medical Admission Unit run by Internists redesigned the acute patient flow. • MAU ensured a high turn-over downsizing the outlying phenomenon. • MAU centralised unstable medical patients reducing in-hospital mortality. • A patient-centred and problem-oriented approach lowers clinical risk. the burden of acute complex patients, increasingly older and poli-pathological, accessing to Emergency Departments (ED) leads up hospital overcrowding and the outlying phenomenon. These issues highlight the need for new adequate patients' management strategies. The aim of this study is to analyse the effects on in-hospital patient flow and clinical outcomes of a high-technology and time-limited Medical Admission Unit (MAU) run by internists. all consecutive patients admitted to MAU from Dec-2017 to Nov-2019 were included in the study. The admissions number from ED and hospitalization rate, the overall in-hospital mortality rate in medical department, the total days of hospitalization and the overall outliers bed days were compared to those from the previous two years. 2162 patients were admitted in MAU, 2085(95.6%) from ED, 476(22.0%) were directly discharged, 88(4.1%) died and 1598(73.9%) were transferred to other wards, with a median in-MAU time of stay of 64.5 [0.2–344.2] hours. Comparing the 24 months before, despite the increase in admissions/year from ED in medical department (3842 ± 106 in Dec2015–Nov2017 vs 4062 ± 100 in Dec2017-Nov2019, p <0.001), the number of the outlier bed days has been reduced, especially in surgical department (11.46 ± 6.25% in Dec2015–Nov2017 vs 6.39 ± 3.08% in Dec2017-Nov2019, p =0.001), and mortality in medical area has dropped from 8.74 ± 0.37% to 7.29 ± 0.57%, p <0.001. over two years, a patient-centred and problem-oriented approach in a medical admission buffer unit run by internists has ensured a constant flow of acute patients with positive effects on clinical risk and quality of care reducing medical outliers and in-hospital mortality. [ABSTRACT FROM AUTHOR]

The multiple benefits of family-based treatment (FBT) used in substance use disorder (SUD) treatment include increased treatment engagement, better treatment outcomes, and cost-effectiveness compared to other behavioral health treatment modalities. However, the prevalence and types of FBTs offered among SUD treatment facilities are largely unknown. The present study used data collected during 2009–2010 from 325 treatment centers in the United States to (1) explore the prevalence in the utilization of FBT in SUD treatment, and (2) identify differences between treatment facilities that do and do not offer FBT. Results indicated that the adoption of FBT was negatively associated with the percentage of clients who were unemployed or involved in the criminal justice system at time of intake, and positively related to the number of hours of individual therapy and treatment center emphasis on utilizing the 12 Steps. Additionally, the majority of treatment centers that followed the American Society of Addiction Medicine (ASAM) clinical guidelines offered FBT. Lastly, the percentage of families involvement was negatively associated with centers' proportion of revenues from Medicaid (i.e., health insurance for those with limited income) and positively associated with treatment center revenues from private insurance. The impact of having FBT in SUD treatment centers is discussed. [ABSTRACT FROM AUTHOR]

Information and communication technology (ICT) and digital media are less accessible for persons with intellectual disability (ID) but are important for citizenship. The aim was to conceptualize officials understanding of ICT usage among people with ID, and to analyze the possible influence of this understanding on the provision of services for people with ID. A qualitative study was conducted, using semi-structured interviews with municipal officials and politicians in the disability service area. Thematic analyses were conducted. ICT use is understood as an arena for democratization. Findings also illustrate the tension between integrity and protection as well as between legal and moral aspects of digital transformation in service provision. This understanding of digitalization is permeated by an individualized approach but conditioned by organizational issues. Disability services can be understood as undergoing digital transformation where regulative and normative elements in this area need to be harmonized to facilitate digitalization successfully. Points of interest: This study examines politicians' and officials' perceptions of the digitalization of intellectual disability services. This is important as it influences the possibility for persons with ID to be online. Digitalization is understood to enable democratization in terms of participation in decision-making, and social activities, and to 'be a part of society' but the support and structure to be online are under construction. The article suggests that the process of digitalization is also about the responsibility of its provision and use, laws, and of morals, and integrity. [ABSTRACT FROM AUTHOR]

In the complex landscape of health care, the relationship between medical practice and health insurance is increasingly crucial for effective care delivery. This paper emphasises the importance of integrating health insurance education into medical training, focusing on its impact on patient outcomes, health care accessibility, and system sustainability. It posits that health care providers with a comprehensive understanding of health insurance can offer more informed, efficient care by adeptly navigating coverage complexities. The study utilised a pretest‐post‐test design with a yearlong health insurance education curriculum at Wake Forest University School of Medicine. Student participants from various medical programmes self‐assessed their knowledge and comfort across 13 health insurance topics before and after the intervention. The curriculum included workshops and a capstone project, emphasising real‐life patient insurance challenges. Results show statistically significant improvements in 13 participants' understanding of health insurance concepts, highlighting the curriculum's effectiveness. The findings advocate for the inclusion of health insurance education in medical curricula. Such knowledge is vital in systems with diverse insurance models, like the United States, where understanding insurance intricacies is key to patient care. The study's limitations, such as a small sample size and reliance on self‐reported data, suggest the need for further research with more participants and objective measures. In conclusion, incorporating health insurance education into medical training is essential for preparing health care professionals to navigate insurance complexities, make informed treatment decisions, and guide patients effectively. This approach fosters well‐rounded professionals capable of managing both medical and financial aspects of patient care, leading to more equitable and efficient health care delivery. Future research should explore the long‐term effects of this education on clinical practice and patient outcomes, particularly its impact on health care costs and patient satisfaction. [ABSTRACT FROM AUTHOR]

Rationale: Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation. Aims and Objectives: This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD. Methods: A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa‐wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate. Results: Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization. Conclusion: Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD. Plain Language Summary: This review explored the reasons for the use and non‐use of rehabilitation services among persons with Parkinson's disease (PwPD) by searching existing literature. It aimed to describe the reasons for referral, types and rates of rehabilitation services utilize and factors that affect rehabilitation service use. A comprehensive literature search was conducted across selected databases, unpublished data sources and reference lists. Studies published in English from January 2002 until December 2022 were selected. Two reviewers selected, screened and extracted the data. A descriptive analysis was performed. Twelve studies were included in the review and found that impairments and activity limitations were the key reasons for referrals to rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for rehabilitation. Also, physiotherapy, occupational therapy and speech and language therapy/pathology were the most utilized rehabilitation services. The rate of rehabilitation service utilization among the PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization. In conclusion, PwPD present with numerous functioning problems which require rehabilitation. Adequate measures are needed to improve access to rehabilitation for all PwPD. [ABSTRACT FROM AUTHOR]

The meningococcal group B vaccine, 4CMenB, is a broad-spectrum, recombinant protein vaccine that is licensed for protection against meningococcal group B disease in children and adults. Over the past decade, several observational studies supported by laboratory studies have reported protection by 4CMenB against gonorrhoea, a sexually transmitted infection caused by Neisseria gonorrhoeae. Gonorrhoea is a major global public health problem, with rising numbers of diagnoses and increasing resistance to multiple antibiotics. In England, more than 82 000 cases of gonorrhoea were diagnosed in 2022, with nearly half of the cases diagnosed among gay, bisexual, and other men who have sex with men. There are currently no licensed vaccines against gonorrhoea but 4CMenB is estimated to provide 33–47% protection against gonorrhoea. On Nov 10, 2023, the UK Joint Scientific Committee on Vaccination and Immunisation agreed that a targeted programme should be initiated using 4CMenB to prevent gonorrhoea among individuals at higher risk of infection attending sexual health services in the UK. This decision was made after reviewing evidence from retrospective and prospective observational studies, laboratory and clinical data, national surveillance reports, and health economic analyses. In this Review, we summarise the epidemiology of invasive meningococcal disease and gonorrhoea in England, the evidence supporting the use of 4CMenB for protection against gonorrhoea, and the data needed to inform long-term programme planning and extension to the wider population. [ABSTRACT FROM AUTHOR]

The traditional qualifications and work of a health librarian may not, at first glance, seem like they readily lend themselves to the wider work of an organisation. Too often librarians are seen as experts in a small specialist field. However, as librarians, we know that at our core is extensive digital experience and knowledge as well as a core set of transferrable skills that can be adapted to meet the ever‐changing needs of the organisation. This article describes how the library evidence team became part of a wider board project to develop a governance system for Apps. It also describes how the skills of librarians can be developed to work in this area and raise the profile of the team within the board. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively assess the prevalence of secondary overtriage (SO) within a rural regional Appalachian health care system. Methods: Trauma registry data was extracted for all trauma activation transfer patients from 2017 to 2022. Transferred patients were then stratified into two groups, non-secondary overtriage (non-SO) or SO. Patients were considered SO if they met three criteria following transfer: an Injury Severity Score (ISS) of less than 15, no required operative intervention, and discharge within 48 hours of arrival. Descriptive statistics were compared for age, length of stay (LOS), ICU LOS, and ISS. Surgical subspecialty consultations were compared between the two groups. Patients in the SO group were further assessed by body region of injury and Abbreviated Injury Score (AIS). Results: Among 3,291 trauma activation transfer patients, 43% (1,407) were considered SO transfers. Patients in the SO group were significantly younger, had shorter average hospital and ICU LOS, and lower ISS compared to the non-SO group. Additionally, 25.7% of patients in the SO group had injuries to the head or neck of which 8.96% have an AIS ≥3. 21% of patients had injuries to the face, with 0.14% having an AIS ≥3. Conclusions: 43% of transfer patients in this study met our definition of SO. Although no optimal rate of SO has been universally established, limiting SO stands to benefit both patients and trauma systems. This study highlights how institutional analysis of transfer patients may help inform transfer protocols to reduce secondary overtriage and overutilization of scarce resources. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To develop and determine the acceptability of a group-based digital health psychoeducational intervention aimed at reducing cancer worry based on acceptance and commitment therapy for individuals at high risk for pancreatic cancer. SAMPLE & SETTING: 13 individuals at high risk for pancreatic cancer with a genetic variant or family history. METHODS & VARIABLES: Three groups met virtually for one hour each week for four weeks. These sessions provided psychoeducational materials. Digital resources provided mindfulness and educational content. Reported measurements included qualitative responses and participant-reported acceptability. RESULTS: All participants found the sessions to be useful and would recommend them to others. Recommendations from the first two groups included requests to access the content provided during the remote sessions, contributing to the creation of digital content for the third group. IMPLICATIONS FOR NURSING: Individuals at high risk for pancreatic cancer can benefit from psychoeducation to reduce cancer worry, which can be accomplished through digital psychoeducational interventions. [ABSTRACT FROM AUTHOR]

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Hereditary transthyretin-related amyloidosis is an autosomal dominant disorder. Recently, disease-modifying therapies (DMTs) have been developed. For at-risk individuals, genetic analysis aids in the early administration of medical care; however, few studies have evaluated the current status of genetic counselling and management of presymptomatic carriers of amyloidogenic variants. Methods: We retrospectively evaluated the medical records of 202 consecutive participants. Results: A total of 103 clients who received genetic counselling for predictive testing were at-risk, and 83 underwent predictive testing. Genetic testing results were positive in 33 patients, 11 of whom had confirmed amyloid deposition and were administered DMTs. For presymptomatic V30M (p.V50M) carriers, 32.0 ± 2.4 years (median ± standard error) was the age when amyloid deposition was first identified (95% confidence interval 27.4–36.6). Serum transthyretin (TTR) levels decreased serially with an estimated slope of −1.2 mg/dL/year. Conclusions: Our study suggests the clinical utility of management using a combination of predictive testing and monitoring methods. Psychosocial support should be considered with collaboration between geneticists/genetic counsellors and psychologists. For a more optimised protocol for monitoring and designing future interventional trials in presymptomatic carriers, prospective cohort studies are necessary to clarify the natural history, particularly in the early stages of the disease. [ABSTRACT FROM AUTHOR]

Objectives: Research indicates psychologists typically lack subjective understanding of voice hearing. Voice hearing simulation training has potential to improve understanding, empathy and confidence among clinicians, but psychologists have had limited input into its development. This study investigated psychologists' and a psychotherapist's clinical experience of working with people who hear voices and their views and recommendations for voice hearing simulation training. Design: This was a qualitative study. Methods: Clinical psychologists and one psychotherapist (N = 17) participated in semi‐structured interviews. Thematic analysis was used to analyse transcribed data. Results: The Clinical Experience theme comprised of subthemes Barriers to engagement, Diversity of voice hearing experiences, Lack of subjective understanding, Curiosity about voice hearing, Empathy for voice hearers, Using personal experiences to relate to voices, Clinical experience increases knowledge, Importance of supervision and colleague's support, Benefits of experiential training, Limited training in non‐psychosis settings and Clinical experience increases confidence. The Views on Voice Hearing Simulation Training theme comprised of subthemes Improves subjective understanding, Concern about distress, Discomfort as a strength of voice hearing simulations, Artificiality of simulation, Increases empathy and Over‐estimation of understanding. The Recommendations theme comprised of subthemes Discuss artificiality, Co‐production, Promote voice diversity, Support staff and Maximise inclusivity. Conclusions: Findings indicate that clinical experience improves psychologists' confidence and knowledge, yet participants reported a lack of subjective understanding of voice hearing. Co‐produced simulation training between individuals who hear voices and clinicians was anticipated to improve subjective understanding, empathy and therapeutic relationships, which could support a range of staff and improve quality of care delivered. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the experiences of women with moderate‐to‐severe mental health difficulties during pregnancy, with a focus on establishing their psychological needs. Psychological distress caused by mental health difficulties during pregnancy is common and can significantly impact women and their babies. However, women's subjective experiences of difficulties with their mental health throughout pregnancy, alongside their experiences of staff, services and treatments are less well understood. Design: In this qualitative study, an Interpretive Phenomenological Analysis (IPA) approach was used. Methods: Semi‐structured interviews were conducted with participants recruited via a regional Perinatal Mental Health Service. Interviews were transcribed and analysed following the IPA methodology. Results: Five superordinate themes were identified which represented the lived experiences of the 11 participants on their journey through pregnancy whilst living with mental health difficulties and subsequent psychological distress: (i) Feeling the 'wrong' feelings, (ii) Societal pressures and a desire for greater acceptance, (iii) Searching for answers despite a lack of resources, (iv) What made a difference and (v) Experiences and expectations of service provision. Within these themes, 13 subordinate themes were also identified. Conclusions: These themes highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy as well as postnatally. While perinatal mental health services are evolving, there is still an urgent requirement for services to continue to develop to meet women's needs, as well as to develop the role of clinicians as facilitators of engagement with needs‐matched care. [ABSTRACT FROM AUTHOR]