Tackling the future in hospital pharmacy: Training as a pillar of success

The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: Artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc., as well as including training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber-resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, essential. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known "burned out worker syndrome" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.

[Translated article] Conquering the future in hospital pharmacy: Training as a pillar of success

The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc. as well as training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, inexcusable. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known "burned out worker syndrome" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.

Fostering innovation and sustainable thinking in surgery: an evaluation of a surgical hackathon

INTRODUCTION

Surgery represents a major source of carbon emissions, with numerous initiatives promoting more sustainable practices. Healthcare innovation and the development of a digitally capable workforce are fundamental in leveraging technologies to tackle challenges, including sustainability in surgery.

METHODS

A surgical hackathon was organised with three major themes: (1) how to make surgery greener, (2) the future of plastic surgery in 10 years, and (3) improving healthcare outcomes using machine learning. Lectures were given on sustainability and innovation using the problem, innovation, market size, strategy and team (PIMST) framework to support their presentations, as well as technological support to translate ideas into simulations or minimum viable products. Pre- and post-event questionnaires were circulated to participants.

RESULTS

Most attendees were medical students (65%), although doctors and engineers were also present. There was a significant increase in delegates' confidence in approaching innovation in surgery (+20%, p < 0.001). Reducing waste packaging (70%), promoting recyclable material usage (56%) and the social media dimension of public perceptions towards plastic surgery (40%) were reported as the most important issues arising from the hackathon. The top three prizes went to initiatives promoting an artificial intelligence-enhanced operative pathway, instrument sterilisation and an educational platform to teach students research and innovation skills.

CONCLUSIONS

Surgical hackathons can result in significant improvements in confidence in approaching innovation, as well as raising awareness of important healthcare challenges. Future innovation events may build on this to continue to empower the future workforce to leverage technologies to tackle healthcare challenges such as sustainability.

["Green" Hemodialysis: The Centralized Acidic Concentrate from the Dialysis Center of Policlinico of Modena]

Introduction and aim of the study. The centralized preparation and distribution system of acidic concentrate represents a true innovation in hemodialysis, when compared to acid bags, in terms of convenience and eco-sustainability. The aim of this study is to compare the use of traditional acid bags with the centralized distribution system of acidic concentrate, with particular attention to differences in terms of eco-sustainability and convenience. Methods. At the Nephrology Dialysis and Renal Transplantation Unit of the University Hospital of Modena was installed the Granumix system® (Fresenius Medical Care, Bad Homburg, Germany). Data collected before the introduction of the Granumix® system (including the used acid bags, boxes and pallets used for their packaging, liters of acid solution used and kilograms of waste generated from wood, plastic, cardboard and residual acid solution) were compared with those collected after the implementation of the Granumix® system. Factors such as material consumption, volume of waste generated, unused and wasted products, time required for dialysis session preparation and nurses' satisfaction were analyzed to document which system was more environmentally sustainable. Results. Data collected in 2019 at our Dialysis Center showed a consumption of 30,000 acid bags, which generated over 20,000 kg of waste from wood, plastic and cardboard, and approximately 12,000 liters of residual acid solution to be disposed of, with a handling weight by operators reaching nearly 160,000 kg. The use of the centralized distribution system of acidic concentrate resulted in a significant reduction in waste generated (2,642 kg vs 13,617 kg), residual acid solution to be disposed of (2,351 liters vs 12,100 liters) and weights handled by operators (71,522 kg vs 158,117 kg). Conclusions. The acidic concentrate appears to be better suited to the sustainability challenge that dialysis must faces today, particularly due to the significant increase in the number of patients, which leads to a higher number of treatments and, therefore, a growing demand for eco-sustainable products.

Strengths, challenges, and strategies for implementing pragmatic multicenter randomized controlled trials (RCTs): example of the Personalized Citizen Assistance for Social Participation (APIC) trial

BACKGROUND

Randomized controlled trials (RCTs) are rigorous scientific research designs for evaluating intervention effectiveness. However, implementing RCTs in a real-world context is challenging. To develop strategies to improve its application, it is essential to understand the strengths and challenges of this design. This study thus aimed to explore the strengths, challenges, and strategies for improving the implementation of a pragmatic multicenter, prospective, two-arm RCT evaluating the effects of the Personalized Citizen Assistance for Social Participation (Accompagnement-citoyen Personnalisé d'Intégration Communautaire: APIC; weekly 3-h personalized stimulation sessions given by a trained volunteer over a 12-month period) on older adults' health, social participation, and life satisfaction.

METHODS

A multiple case study was conducted with 14 participants, comprising one research assistant, seven coordinators, and six managers of six community organizations serving older adults, who implemented the APIC in the context of a RCT. Between 2017 and 2023, qualitative data were extracted from 24 group meetings, seven semi-directed interviews, emails exchanged with the research team, and one follow-up document.

RESULTS

Aged between 30 and 60 (median ± SIQR: 44.0 ± 6.3), most participants were women from organizations already offering social participation interventions for older adults and working with the public sector. Reported strengths of this RCT were its relevance in assessing an innovative intervention to support healthy aging, and the sharing of common goals, expertise, and strategies with community organizations. Challenges included difficulties recruiting older adults, resistance to potential control group assignments, design complexity, and efforts to mobilize and engage volunteers. The COVID-19 pandemic lockdown and health measures exacerbated challenges related to recruiting older adults and mobilizing volunteers and complicated delivery of the intervention. The strategies that mostly overcame difficulties in recruiting older adults were reducing sample size, simplifying recruitment procedures, emphasizing the health follow-up, extending partnerships, and recognizing and supporting volunteers better. Because of the lockdown and physical distancing measures, the intervention was also adapted for remote delivery, including via telephone or videoconferencing.

CONCLUSION

Knowledge of the strengths and challenges of pragmatic RCTs can contribute to the development of strategies to facilitate implementation studies and better evaluate health and social participation interventions delivered under real-life conditions.

TRIAL REGISTRATION

NCT03161860; Pre-results. Registered on May 22, 2017.

Is entrepreneurship a key factor in the development of European countries? A proposal for an innovation readiness environment (IRE) index

This study investigates the complex interplay among innovation, research and development (R&D), and entrepreneurship within the context of European nations. The focus of the study is also on the contributory role of tertiary educational institutions in nurturing entrepreneurial activities. To deepen the understanding of these multifaceted relationships and their subsequent impact on regional economies, the research introduces a novel metric termed the Innovation Readiness Environment (IRE) index. This index combines various indicators such as R&D expenditure, patenting rates, firm size, and educational levels, thereby providing a framework for evaluating firms' innovative capabilities and entrepreneurial success in a given region. Utilization of this index offers policymakers and stakeholders a nuanced understanding of the regional innovation ecosystem, facilitating the identification of strengths and deficiencies. This, in turn, enables the formulation of targeted policy interventions to enhance innovation and entrepreneurship. One relevant conclusion drawn from this study is the pivotal role of tertiary education in catalyzing entrepreneurial ventures. The findings posit that higher levels of entrepreneurial education significantly supplement an individual's likelihood of entrepreneurial success by imparting the requisite skills and knowledge indispensable in a competitive business milieu. By fostering an environment conducive to innovation, higher education institutions emerge as critical agents in cultivating entrepreneurial acumen and stimulating economic expansion. The study further incorporates a spatial analytical framework to elucidate the regional specificities of innovation at the pan-European scale.

Return on investment in science: twenty years of European Commission funded research in Alzheimer's dementia, breast cancer and prostate cancer

Alzheimer's disease (AD), breast cancer (BC) and prostate cancer (PC) continue to be high in the research and innovation agenda of the European Commission (EC). This is due to their exceptionally large burden to the national health systems, the profound economic effects of opportunity costs attributable to decreased working ability, premature mortality and the ever-increasing demand for both hospital and home-based medical care. Over the last two decades, the EC has been steadily increasing both the number of proposals being funded and the amounts of financial resources being allocated to these fields of research. This trend has continued throughout four consecutive science funding cycles, namely framework programme (FP)5, FP6, FP7 and Horizon 2020 (H2020). We performed a retrospective assessment of the outputs and outcomes of EC funding in AD, BC and PC research over the 1999-2019 period by means of selected indicators. These indicators were assessed for their ability to screen the past, present and future for an array of causal relationships and long-term trends in clinical, epidemiological and public health sphere, while considering also the broader socioeconomic impact of funded research on the society at large. This analysis shows that public-private partnerships with large industry and university-based consortia have led to some of the most impactful proposals being funded over the analysed time period. New pharmaceuticals, small molecules and monoclonal antibodies alike, along with screening and prevention, have been the most prominent sources of innovation in BC and PC, extending patients' survival and enhancing their quality of life. Unlike oncology, dementia drug development has been way less successful, with only minor improvements related to the quality of supportive medical care for symptoms and more sensitive diagnostics, without any ground-breaking disease-modifying treatment(s). Significant progresses in imaging diagnostics and nanotechnology have been largely driven by the participation of medical device industry multinational companies. Clinical trials funded by the EC were conducted, leading to the development of brand-new drug molecules featuring novel mechanisms of action. Some prominent cases of breakthrough discoveries serve as evidence for the European capability to generate cutting-edge technological innovation in biomedicine. Less productive areas of research may be reconsidered as priorities when shaping the new agenda for forthcoming science funding programmes.

Spatial spillover effects of skilled migration on innovation in China

Despite the importance of interregional skilled migration to regional development, few studies have explored its spatial spillover effects and their changes over time. Thus, employing the Spatial Durbin Model, we investigate the presence of regional spillovers of skilled migration at both national and sub-national levels in China. Especially, we focus on the regional difference and change in the spatial spillover. Although our results confirm positive spillover effects at the national level due to the strong mobility characteristic of skilled migrants, developed regions benefit more from spillovers of skilled migration than developing regions, and such effects are divergent in different regions over time. Our findings also indicate that changes in spatial spillovers among regions are closely associated with the mobility of economic factors in geography. Theoretically, by considering the spatial effects of skilled migration on the innovation output of recipient regions, we extend the labour economics literature into geographical economic agglomeration, especially innovation economic geography. Methodologically, we examine the spatial effects at both national and sub-national levels, and capture the spatial externalities; we also apply Maximum Likelihood estimation to assess the endogeneity issues to understand the mechanisms of spillover change over time. The study can be of significance for municipalities in the policy-making of attracting talents and promoting regional innovation.

The venom and telopodal defence systems of the centipede Lithobius forficatus are functionally convergent serial homologues

BACKGROUND

Evolution of novelty is a central theme in evolutionary biology, yet studying the origins of traits with an apparently discontinuous origin remains a major challenge. Venom systems are a well-suited model for the study of this phenomenon because they capture several aspects of novelty across multiple levels of biological complexity. However, while there is some knowledge on the evolution of individual toxins, not much is known about the evolution of venom systems as a whole. One way of shedding light on the evolution of new traits is to investigate less specialised serial homologues, i.e. repeated traits in an organism that share a developmental origin. This approach can be particularly informative in animals with repetitive body segments, such as centipedes.

RESULTS

Here, we investigate morphological and biochemical aspects of the defensive telopodal glandular organs borne on the posterior legs of venomous stone centipedes (Lithobiomorpha), using a multimethod approach, including behavioural observations, comparative morphology, proteomics, comparative transcriptomics and molecular phylogenetics. We show that the anterior venom system and posterior telopodal defence system are functionally convergent serial homologues, where one (telopodal defence) represents a model for the putative early evolutionary state of the other (venom). Venom glands and telopodal glandular organs appear to have evolved from the same type of epidermal gland (four-cell recto-canal type) and while the telopodal defensive secretion shares a great degree of compositional overlap with centipede venoms in general, these similarities arose predominantly through convergent recruitment of distantly related toxin-like components. Both systems are composed of elements predisposed to functional innovation across levels of biological complexity that range from proteins to glands, demonstrating clear parallels between molecular and morphological traits in the properties that facilitate the evolution of novelty.

CONCLUSIONS

The evolution of the lithobiomorph telopodal defence system provides indirect empirical support for the plausibility of the hypothesised evolutionary origin of the centipede venom system, which occurred through functional innovation and gradual specialisation of existing epidermal glands. Our results thus exemplify how continuous transformation and functional innovation can drive the apparent discontinuous emergence of novelties on higher levels of biological complexity.

Technology-forcing to reduce environmental noise pollution: a prospectus

BACKGROUND

Environmental movements of the late 20th century resulted in sweeping legislation and regulatory actions to reduce the prevalence of diverse pollutants. Although the consequences of noise pollution to public health, environment, and the economy have been recognized over the same time period, noise has received far less policy attention. Correspondingly, even while evidence of the diverse and detrimental effects of noise pollution on human health has grown, solutions and actual reductions in environmental noise remain seemingly out of reach.

OBJECTIVE

To address this shortcoming, we developed a prospectus for environmental noise reduction through technology-forcing policies. Technology-forcing describes intent to encourage technological solutions for pollution control through policy and regulations, and has been a critical component of national and global progress in reducing environmental pollutants.

METHODS

We take advantage of the unique policy history for noise in the United States - which initially enacted, but then abandoned federal noise regulation. We compare this history against outcomes from contemporaneous environmental legislation for air, water, and occupational pollution control, to demonstrate the potential for technology-forcing to reduce noise pollution. Our review then identifies promising solutions, in the form of existing technologies suitable for innovation and diffusion through technology-forcing regulations and incentives.

RESULTS

Based on this review, we outline a program for noise policy development to support efforts to reduce environmental noise pollution worldwide. The proposed program consists of three steps, which are to (i) identify dominant sources of noise pollution, (ii) combine legislative or regulatory provisions with suitable systems of enforcement and incentives, and (iii) anticipate and prepare for stages of technological change.

IMPACT STATEMENT

Analysis of noise policy often focuses on justifying the need to reduce noise pollution. In this article, we demonstrate how technology-forcing regulations could also promote much-needed innovation and diffusion of technologies to reduce environmental noise pollution. We first establish the potential for technology-forcing by comparing technology outcomes from environmental legislation passed contemporaneously to the inactive US Noise Control Act. We next review promising innovations available for diffusion in multiple sectors to reduce environmental noise. Lastly, we recommend a program to support development of technology-forcing noise policies, to help ensure that the benefits of reduced noise pollution are distributed equitably.

"The genie is out of the bottle": a qualitative study on the impact of COVID-19 on continuing professional development

BACKGROUND

The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social distancing regulations. The purpose of this study was to obtain the perspectives of CPD leaders on the impact of the pandemic to elucidate trends, innovations, and potential future directions in the field.

METHODS

Semi-structured interviews were conducted between April-September 2022 with 23 CPD leaders from Canada and the USA. Interviews were audio-recorded, transcribed, and de-identified. A thematic analysis approach was used to analyse the data and generate themes.

RESULTS

Participants characterised COVID-19 as compelling widespread change in the field of CPD. From the interviews, researchers generated six themes pertaining to the impact of the pandemic on CPD: (1) necessity is the mother of innovation, (2) the paradox of flexibility and accessibility, (3) we're not going to unring the bell, (4) reimagining design and delivery, (5) creating an evaluative culture, and (6) a lifeline in times of turmoil.

CONCLUSION

This qualitative study discusses the impact of the pandemic on the field of CPD and leaders' vision for the future. Despite innumerable challenges, the pandemic created opportunities to reform design and delivery. Our findings indicate a necessity to maintain an innovative culture to best support learners, to improve the healthcare system, and to prepare for future emergencies.

Virtual reality as an engaging and enjoyable method for delivering emergency clinical simulation training: a prospective, interventional study of medical undergraduates

BACKGROUND

It is a requirement that medical students are educated in emergencies and feel well prepared for practice as a doctor, yet national surveys show that many students feel underprepared. Virtual reality (VR), combined with 360-degree filming, provides an immersive, realistic, and interactive simulation experience. Unlike conventional in-person simulation, it is scalable with reduced workforce demands. We sought to compare students' engagement and enjoyment of VR simulation to desktop computer-based simulation.

METHODS

We conducted a prospective, interventional, evaluation study. The study was carried out on final year medical students undertaking their Pre-Foundation Assistantship (n = 116) at Imperial College School of Medicine (ICSM) in London. We compared objective engagement, subjective engagement, and subjective enjoyment of VR simulation to desktop computer-based simulation using cardiac arrest and life-threatening asthma scenarios. Engagement was measured objectively using students' physiological parameters, including heart rate and eye tracking, and facilitator observations using the validated 'Behavioural Engagement Related to Instruction' (BERI) protocol. Students' subjective engagement and enjoyment levels were measured using a post-session survey.

RESULTS

Students' maximum heart rates were significantly higher during VR simulation with a mean difference of 4.2 beats per minute (3.2 to 5.2, p < 0.001), and eye tracking showed they spent a significantly greater mean percentage of time of 6.4% (5.1 to 7.7, p < 0.001) focusing on the scenarios in VR compared to standard desktop. Qualitative data showed students enjoyed and felt engaged with the sessions, which provided a safe space for learning.

CONCLUSIONS

Our study shows that students found VR simulations enjoyable and were more engaged compared to standard desktop simulation. This suggests that 360-degree VR simulation experiences provide students with immersive, realistic training, which is scalable, giving them the unique opportunity to manage emergencies and work within emergency teams, which would not typically occur during traditional training.

Sources of financing: Which ones are more effective in innovation-growth linkage?

The study assesses the impact of eight sources of financing (internal funds, bank loans, credit lines, trade credit, equity, grants, leasing and factoring) on innovation and firm growth. It provides evidence that not all external financing sources have the same impact on innovation and growth. Output additionality on turnover growth seems higher for equity financing. In contrast, employment growth appears to be more associated with financing sources linked to increased fixed assets or the solving of liquidity problems. The number of financing instruments used together also seems to matter, revealing the existence of complementarities.

The potential of artificial intelligence to revolutionize health care delivery, research, and education in cardiac electrophysiology

The field of electrophysiology (EP) has benefited from numerous seminal innovations and discoveries that have enabled clinicians to deliver therapies and interventions that save lives and promote quality of life. The rapid pace of innovation in EP may be hindered by several challenges including the aging population with increasing morbidity, the availability of multiple costly therapies that, in many instances, confer minor incremental benefit, the limitations of healthcare reimbursement, the lack of response to therapies by some patients, and the complications of the invasive procedures performed. To overcome these challenges and continue on a steadfast path of transformative innovation, the EP community must comprehensively explore how artificial intelligence (AI) can be applied to healthcare delivery, research, and education and consider all opportunities in which AI can catalyze innovation; create workflow, research, and education efficiencies; and improve patient outcomes at a lower cost. In this white paper, we define AI and discuss the potential of AI to revolutionize the EP field. We also address the requirements for implementing, maintaining, and enhancing quality when using AI and consider ethical, operational, and regulatory aspects of AI implementation. This manuscript will be followed by several perspective papers that will expand on some of these topics.

Industry star or production elite: evidence from total factor productivity of Chinese electricity sector's green transformation

China is constantly seeking rapid, high-quality growth in order to meet its carbon peaking and neutrality goals. Approximately 40% of China's carbon emissions come from the electric power industry, which is beset by issues of poor efficiency and excessive emissions. Thus, it is essential to determine if environmental restrictions increase economic benefits total factor productivity while still preserving the environment. We use the Quasi-DID method to examine the impact of carbon emissions trading scheme on firm-level total factor productivity of electric power companies. The findings demonstrate the following: (1) carbon emissions trading scheme considerably impedes total factor productivity development; (2) the primary cause of this detrimental impact is the need for additional improvements in marketization since green innovation is still in its infancy; (3) additional study indicates that law enforcement's heterogeneity is what affects this restriction. Our research may both enhance the Chinese carbon emissions trading scheme's effectiveness assessment framework and point out several potential avenues for high-quality growth.

Empowering early career pharmacists: Unleashing non-clinical competencies through pharmacy residency

INTRODUCTION

Pharmacy residency programs traditionally prioritize clinical skills development. However, non-clinical competencies, such as leadership, conducting education, and innovation, are now emerging as pivotal factors in propelling pharmacists toward excellence in practice. The extent to which these non-clinical skills are effectively fostered by residency programs remains unclear. This study aims to explore how residency programs propel the development of crucial non-clinical competencies such as leadership, conducting education, and innovation.

METHODS

Pharmacists who completed a pharmacy residency program and their preceptors from a tertiary teaching hospital took part in semi-structured interviews. Thematic analysis, employing an inductive approach and aided by NVivo software, was used to identify recurrent themes in the interview responses.

RESULTS

Competency development was shaped by four key themes: system-dependent facilitators, system-dependent barriers, individual resident attitudes, and pharmacy department influences. The structure of the residency program was perceived to strongly support competency development in conducting education. The impact on the leadership and innovation competencies development was comparatively lesser.

CONCLUSION

Pharmacy residency is perceived as effective in supporting non-clinical competency development when there is a clear structured framework with objectives and guidance for pre-defined activities and tasks known to support competency development. Ambiguity and a lack of standardized guidance in developing specific competencies were identified as factors that diminish their relevance for both residents and preceptors. To enhance residency programs, it is essential to establish clear frameworks, with pre-defined objectives and activities known to support competency development and supplement them with the necessary skills-building courses where appropriate.

Custom-Made Implant Fabrication for Chin Augmentation Using Piled-Up Expanded Polytetrafluoroethylene Sheets: An Innovative Surgical Technique and Literature Review

BACKGROUND

Alloplastic chin augmentation is the most common esthetic surgical treatment to reshape the chin. However, factory-made chin implants are typically standardized rather than custom-made and have potential to cause complications. Although the fabrication of custom-made implants by using computer-assisted planning and 3D-printing technology has become widespread, the process has several disadvantages, including long preoperative prosthesis preparation times, high costs, and unsuitability for patients with asymmetric chins or those who undergo combined mandibuloplasty before implant placement. The present study developed an innovative chin augmentation technique involving stacked expanded polytetrafluoroethylene (e-PTFE) sheets that is suitable for most patients and has minimal side effects.

MATERIALS AND METHODS

A retrospective review of a single surgeon's experience was performed over a 2 year period for patients who underwent a procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. This study analyzed the outcomes, complications (temporary nerve numbness, wound infection, hematoma formation, and implant displacement), and patient satisfaction during follow-up.

RESULTS

Between January 2018 and December 2020, 38 patients underwent the procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. Six patients (15.8%) experienced nerve-related temporary numbness, and one (2.6%) experienced wound infection. None had developed major complications such as implant displacement or wound infection at follow-up. Moreover, the patients demonstrated a high level of satisfaction with the surgical results.

CONCLUSION

Piled-up e-PTFE sheets can be used to produce custom-fit porous polyethylene chin implants that result in minimal complications and a very high satisfaction rate.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Drivers of business model innovation in family firms: A dataset analysis

In recent years, both in the world of research and consulting, the concept of innovation in the business model has been gaining a lot of interest. As a result, an incipient number of scientific and popular publications are being generated, which try to delimit and explain this term, as well as work methodologies for its application in the business world. The family business field can benefit from the application of this approach. But, at the same time, it can also serve as an object of study since its special idiosyncrasy will allow to deepen the analysis of successful business models. To illustrate innovation in business models, data from 112 family firms representative of the regional economy are presented. The companies are also associated with the Murcian Association of Family Businesses (Amefmur). The collaboration with this organization has made it possible to obtain very valuable and representative information thanks to the support provided. The collection of information was carried out through an electronic survey. These data could be especially useful for establishing business recommendations for this type of companies and for analyzing other possible interrelationships of the variables available in the database.

Old problems, new solutions: harnessing technology and innovation in Parkinson's disease-evidence and experiences from Thailand

The prevalence of Parkinson's disease (PD) is increasing rapidly worldwide, but there are notable inequalities in its distribution and in the availability of healthcare resources across different world regions. Low- and middle-income countries (LMICs), including Thailand, bear the highest burden of PD so there is an urgent need to develop effective solutions that can overcome the many regional challenges associated with delivering high-quality, and equitable care to a diverse population with limited resources. This article describes the evolution of healthcare delivery for PD in Thailand, as a case example of a LMIC. The discussions reflect the author's presentation at the Yoshikuni Mizuno Lectureship Award given during the 8th Asian and Oceanian Parkinson's Disease and Movement Disorders Congress in March 2023 for which he was the 2023 recipient. The specific challenges faced in Thailand are reviewed along with new solutions that have been implemented to improve the knowledge and skills of healthcare professionals nationally, the delivery of care, and the outcomes for PD patients. Technology and innovation have played an important role in this process with many new tools and devices being implemented in clinical practice. Without any realistic prospect of a curative therapy in the near future that could halt the current PD pandemic, it will be necessary to focus on preventative lifestyle strategies that can help reduce the risk of developing PD such as good nutrition (EAT), exercise (MOVE), good sleep hygiene (SLEEP), and minimizing environmental risks (PROTECT), which should be initiated and continued (REPEAT) as early as possible.

Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation

BACKGROUND

Despite the known benefits of exclusive breastfeeding, global rates remain below recommended targets, with Ireland having one of the lowest rates in the world. This study explores the efficacy of Participatory Action Research (PAR) and Work-Based Learning Groups (WBLGs) to enhance breastfeeding practices within Irish healthcare settings from the perspective of WBLG participants and facilitators.

METHODS

Employing a PAR approach, interdisciplinary healthcare professionals across maternity, primary, and community care settings (n = 94) participated in monthly WBLGs facilitated by three research and practice experts. These sessions, conducted over nine months (November 2021 - July 2022), focused on critical reflective and experiential learning to identify and understand existing breastfeeding culture and practices. Data were collected through participant feedback, facilitator notes, and reflective exercises, with analysis centered on participant engagement and the effectiveness of WBLGs. This approach facilitated a comprehensive understanding of breastfeeding support challenges and opportunities, leading to the development of actionable themes and strategies for practice improvement.

RESULTS

Data analysis from WBLG participants led to the identification of five key themes: Empowerment, Ethos, Journey, Vision, and Personal Experience. These themes shaped the participants' meta-narrative, emphasising a journey of knowledge-building and empowerment for breastfeeding women and supporting staff, underlining the importance of teamwork and multidisciplinary approaches. The project team's evaluation highlighted four additional themes: Building Momentum, Balancing, Space Matters, and Being Present. These themes reflect the dynamics of the PAR process, highlighting the significance of creating a conducive environment for discussion, ensuring diverse engagement, and maintaining energy and focus to foster meaningful practice changes in breastfeeding support.

CONCLUSION

This study highlights the potential of WBLGs and PAR to enhance the understanding and approach of healthcare professionals towards breastfeeding support. By fostering reflective and collaborative learning environments, the study has contributed to a deeper understanding of the challenges in breastfeeding support and identified key areas for improvement. The methodologies and themes identified hold promise to inform future practice and policy development in maternal and child health.

"A Most Equitable Drug": How the Clinical Studies of Convalescent Plasma as a Treatment for SARS-CoV-2 Might Usefully Inform Post-Pandemic Public Sector Approaches to Drug Development

Interventional clinical studies of convalescent plasma to treat COVID-19 were predominantly funded and led by public sector actors, including blood services operators. We aimed to analyze the processes of clinical studies of convalescent plasma to understand alternatives to pharmaceutical industry biopharmaceutical research and development, particularly where public sector actors play a dominant role. We conducted a qualitative, critical case study of purposively sampled prominent and impactful clinical studies of convalescent plasma during 2020-2021.

A Comprehensive Framework for Hospital@Home Care Models

Hospital@home is a healthcare approach, where patients receive active treatment from health professionals in their own home for conditions that would normally necessitate a hospital stay.

OBJECTIVE

To develop a framework of relevant features for describing hospital@home care models.

METHODS

The framework was developed based on a literature review and thematic analysis. We considered 42 papers describing hospital@home care approaches. Extracted features were grouped and aggregated in a framework.

RESULTS

The framework consists of nine dimensions: Persons involved, target patient population, service delivery, intended outcome, first point of contact, technology involved, quality, and data collection. The framework provides a comprehensive list of required roles, technologies and service types.

CONCLUSION

The framework can act as a guide for researchers to develop new technologies or interventions to improve hospital@home, particularly in areas such as tele-health, wearable technology, and patient self-management tools. Healthcare providers can use the framework as a guide or blueprint for building or expanding upon their hospital@home services.