Indigenous sovereignty in research and epistemic justice: Truth telling through research

Indigenous ways of knowing, being and doing are based on embodied sovereignty, relationality and countless generations of knowledge sharing. We call for epistemic justice in which Indigenous knowledge systems are recognised and valued in research-related contexts. We draw attention to how colonial knowledge systems silence, delegitimise and devalue specific knowers and ways of knowing, being and doing - through truth telling. This includes (1) the extent to which educational systems, research, practices, decisions, and reported outcomes are whitewashed - a process of structural and systemic discrimination, racism, and exclusion that actively alters or omits Indigenous and non-Euro-Western contributions and perspectives to fit Euro-Western norms and (2) whitewashed and racialised logic in scientific research that claims to be open, collaborative and transparent. Whitewashing not only obscures the history and contributions of Indigenous peoples and communities but also actively reinforces systemic biases and inequities. We assert the need for epistemic justice in public health research. Epistemic justice calls for Indigenous sovereignty and self-determination to be made visible. It may involve on how colonial policies, protocols, and regulations are connected to everyday lived inequities of Indigenous communities, families and individuals. Ultimately, epistemic justice is inherent to Indigenous peoples' health and wellness, self-determination and sovereignty.

Experiences and barriers in downward referral decision-making for palliative care patient caregivers under China's three-tiered linkage model: A qualitative study

Objective

This study aimed to explore hospice caregivers' downward referral decision-making experiences and barriers under the triadic linkage model in China and to analyze the deeper social dynamics of hospice referral choices.

Methods

Semi-structured interviews were conducted with caregivers handling hospice referrals from two primary hospice agencies in Nanjing, China. The themes were analyzed and summarized using the Colaizzi 7-step analysis.

Results

Four themes and nine subthemes were extracted: multidimensional caregiver psychological experience (Dilemma and Guilt, Emotional Support and Psychological Adaptation), perceived disparities between referral organizations (convenience and affordability in the home community, perceived lack of primary health care resources), limitations of caregiver decision-making (cognitive comprehension bias, difficulty in information seeking, and passive acceptance of decision making), and limitations of health care referral support (lack of health care referral guidance, inadequate referral handoffs).

Conclusions

Feedback from caregivers of hospice-referred patients reveals many barriers to hospice referral decision making and referral implementation. Overcoming these barriers entails efforts to change the cognitive misunderstandings regarding hospice referrals from patients' perspective, clarify the distribution of responsibilities among hospice agencies, and provide information support and decision-making assistance. These measures must be employed to improve the implementation of hospice referral, realize the multiple benefits of hierarchical diagnosis and treatment, boost patients' satisfaction with the referrals, and ensure the rational and efficient distribution of hospice resources.

COVID-19 vaccine acceptance and preference for future delivery among language minority, newcomer, and racialized peoples in Canada: a national cross-sectional and longitudinal study

BACKGROUND

Despite high COVID-19 vaccine coverage in Canada, vaccine acceptance and preferred delivery among newcomers, racialized persons, and those who primarily speak minority languages are not well understood. This national study explores COVID-19 vaccine acceptance, access to vaccines, and delivery preferences among ethnoculturally diverse population groups.

METHODS

We conducted two national cross-sectional surveys during the pandemic (Dec 2020 and Oct-Nov 2021). Binary logistic regression analysis investigated the association between newcomer, language, and racialized minority respondents' perceptions and acceptance of COVID-19 vaccines, experiences of discrimination when accessing health services, and sociodemographic characteristics. McNemar-Bowker tests were used to assess changes in responses collected at two time points.

RESULTS

Among 1630 respondents, 30.8% arrived in Canada within the last five years, 87.4% self-identified as a racialized minority, and 37.2% primarily spoke languages other than English or French. Although single dose COVID-19 vaccine uptake was at 92.7% among respondents, 14.8% experienced difficulty accessing vaccines, citing a need for translated resources or multi-lingual personnel. In longitudinal analysis, respondents were increasingly motivated over time to overcome barriers to accessing vaccines (61.4% to 69.6%, p = <.001). Fifty-nine percent (59.9%) of respondents would accept annual vaccination and over half would accept co-administration with routine (56.2%) or influenza (52.3%) vaccines. Experiences of racism/discrimination upon health service access were reported by 12.3% of respondents, who recommended increasing culturally safe practices and community involvement at vaccination sites.

CONCLUSIONS

Understanding how newcomers, racialized peoples, and minority language speakers perceive and access COVID-19 vaccines will support vaccination campaigns to optimize equitable access.

Artificial intelligence applications and aging (1995-2024): Trends, challenges, and future directions in frailty research

BACKGROUND

Frailty, a significant predictor of adverse health outcomes, has become a focal point of research, particularly with the advent of artificial intelligence (AI) technologies. This study aimed to provide a comprehensive bibliometric analysis of research trends in AI and frailty to map conceptual developments, collaborations, and emerging themes in the field.

METHODS

A systematic search was conducted using the Scopus database employing a comprehensive set of keywords related to AI and frailty. The search was refined to include only original articles in English, yielding 1213 documents. Data extraction was performed in October 2024 and exported in the CSV and BibTeX formats. Annual growth trends were analyzed using Microsoft Excel, while VOSviewer and R-package were used for bibliometric analyzes and visualization to identify key contributors, collaborations, and thematic clusters.

RESULTS

The analysis revealed rapid growth in research publications, with AI applications in frailty gaining prominence over the past decade. Thematic clusters highlight areas such as predictive modeling, machine learning applications, and geriatric care innovations. The United States, United Kingdom, and Italy emerged as leading contributors to publications and collaborations. The key topics included prediction models, dementia, sarcopenia, and rehabilitation. This bibliometric study underscores the increasing integration of AI into frailty research, revealing key trends, collaborative networks, and emerging areas of focus.

CONCLUSION

These findings can guide future research, foster collaborations, and enhance the application of AI technologies to improve frailty assessment and management.

Comfort in Providing Care and Associations With Attitudes Towards Substance Use: A Survey of Mental Health Clinicians at an Urban Hospital in Vancouver, Canada

INTRODUCTION

Stigma is a major driver of harms associated with substance use and can interfere with the provision of high-quality, effective healthcare for people who use drugs. Our study aimed to explore the relationship between mental health clinicians' comfort in providing substance use care and their attitudes towards substance use.

METHODS

In this cross-sectional study, the Brief Substance Abuse Attitudes Survey was administered among a convenience sample of mental health clinicians [N = 71] working in an acute care setting in Vancouver, Canada. One-way ANOVA and the Kruskal-Wallis test were used to examine the association between three levels of comfort and five predefined attitude subgroups. STROBE checklist for cross-sectional studies was used.

RESULTS

Level of comfort was significantly associated with attitudes towards substance use across three subscales: permissiveness, nonstereotyping and treatment optimism. In pairwise comparisons, the neutral group held significantly less permissive attitudes when compared to the comfortable group. However, the neutral group held more stereotypical views and less optimism about treatment outcomes, when compared to the comfortable and uncomfortable groups, respectively.

DISCUSSION AND CONCLUSIONS

Our findings highlight that mental health clinicians who are undecided or neutral about their comfort in providing substance use care are more likely to have negative views towards people with substance use disorders. Future work should explore, implement and evaluate education and training to reduce substance use disorder-related stigma among mental health clinicians and other health professionals.

What are the policy options for regulating private equity involvement in health care? A review of policies implemented or considered in seven high-income countries

Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent - and how - subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.

Teamwork between registered nurses and unlicensed assistive personnel in acute care settings: A scoping review

Background

Unlicensed assistive personnel are increasingly employed to support the nursing workforce in providing bedside care.

Aim

To scope the literature on the factors influencing teamwork between registered nurses and unlicensed assistive personnel in acute care settings.

Methods

A scoping review was conducted using the Arksey and O'Malley (2005) framework. Eight electronic databases were searched from inception of each database to August 2024 to locate studies that reported issues relating to teamwork between registered nurses and unlicensed assistive personnel on patient care in general wards of acute care settings. Two reviewers independently screened titles, abstracts, and full text for eligibility. The data were extracted, analysed, and synthesised using the data-based convergent qualitative synthesis.

Results

Thirty-eight studies were included. Five themes were generated: (1) role clarity, (2) delegation, (3) communication, (4) ward culture and practice, and (5) interpersonal relationships. Challenges in registered nurses-unlicensed assistive teamwork include unclear roles and responsibilities, ineffective delegation, and communication barriers. Work culture that excludes unlicensed assistive personnel from shift handovers were found to hinder shared goals for patient care. The importance of interpersonal relationships between registered nurses and unlicensed assistive personnel was highlighted to aid in the power disparity between them.

Conclusions

This review found suboptimal teamwork between registered nurses and unlicensed assistive personnel. Teamwork between registered nurses and unlicensed assistive personnel can be improved through clearly defined roles and responsibilities, better delegation practices, effective communication, and improved interpersonal relationships. Future research should focus on optimising communication processes and enhancing registered nurses' delegation skills through education.

Impact of patients' personality traits on digital health Adoption Strategies for family practices

BACKGROUND

Various governments highlight the relevance of digitalization in family practices; however, still some adoption barriers persist due to an inadequate understanding of why patients engage in digital use cases. Different studies show that personality traits influence how individuals assess digital use cases. Nevertheless, the effect of personality has not yet been tested in a family practice setting, even though family doctors are in an optimal position to use these personality insights via an empathetic communication approach in their direct patient interaction.

OBJECTIVE

This paper aims to assess the impact of different personality traits on patients' technology acceptance and derive implications for Digital Health Adoption Strategies of family practices - hence, what family doctors need to consider when influencing a patient's decision to adopt a particular digital use case.

METHODS

After reviewing the literature regarding the impact of personality on technology acceptance, we combined two established UTAUT and Big-Five questionnaires in a web-based survey. Recruiting a large cross-sectional sample of adults living in Germany, we conducted regression analyses to determine the effect of personality and sociodemographics on technology acceptance of four digital use cases in family practices.

RESULTS

Our sample of 1,880 participants indicated that sociodemographics explained technology acceptance better than personality traits. Specifically, digital literacy, age and frequency of doctor visits affected people's perception of different digital use cases while extraversion appeared as key personality trait in technology acceptance.

CONCLUSION

Family practices only need to consider personality traits selectively in developing Digital Health Adoption Strategies. Nevertheless, we argue that different patient personality profiles can guide family doctors in tailoring their communication while implementing digital use cases.

Understanding Complexities in Collaborative Management of Knowledge on Advance Care Planning for Multi-morbid Patients Within Personalized Integrated Care

Healthcare has shifted from paternalistic model of care to patient-centered care where shared decision making is key. The need to share and manage contributions and expertise of different healthcare professionals underlines the relevance of collaborative knowledge management (CKM). However, CKM in healthcare requires one to understand the complexities in integrating multiple aspects of care and the challenges associated with interdisciplinary collaboration and knowledge sharing among healthcare providers. In this study, we use a system modeling approach to understand the complexities in collaborative management of knowledge on advance care planning for multi-morbid patients, within personalized integrated care. To achieve this, focus group discussions (FGD) with 11 participants from Basque Public Health System (Osakidetza) in Spain were involved in identifying the key challenges and developing a systemic thinking model. As a result, three key challenges were identified, i.e., (1) culture, where citizens are not willing to talk about death; (2) healthcare professionals, whose attitude and perspectives need to change; and (3) the current system, that has to change its care model towards a holistic and a shared care model. From the developed causal loop diagrams (CLDs), it is noted that perpetuation of fragmented and paternalistic care is likely to get worse without recognition of the advance care plan (ACP) as a social need and as a crucial part of the clinical practice change.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41666-025-00185-w.

Exploring the pharmacist's role in regional, rural, and remote kidney transplant care: Perspectives of health professionals and transplant recipients

Background

Role clarification amongst health professionals is necessary for successful interprofessional collaboration. Despite a demonstrated need for pharmacists in the provision of care to regional, rural, and remote kidney transplant recipients, this role is not well defined.

Objectives

This study explored health professionals' and kidney transplant recipients' perceptions around the role of the pharmacist in the provision of care to kidney transplant recipients from regional, rural, and remote areas of Australia.

Methods

Semi-structured interviews and focus group discussions were conducted with Australian kidney transplant health professionals and kidney transplant recipients respectively. Transcripts were analysed thematically and deductively coded using a simplified framework of role theory constructs.

Results

Participants consisted of a multidisciplinary cross section of transplant health professionals (n = 26) and both deceased and living donor kidney transplant recipients (n = 30). Six role theory constructs were identified from the data with regards to the pharmacist's role: role identity, role ambiguity, role overload, role overqualification, role underqualification, and role insufficiency. Core role expectations centred around provision of ongoing education and support with medication management and supply (role identity), however pharmacists remain underutilised for delivery of medication education (role overqualification). A transdisciplinary model of care was suggested to overcome current shortfalls (role overload, role insufficiency). There was hesitancy around pharmacist-led immunosuppressant monitoring and titration (role ambiguity, role underqualification).

Conclusions

Kidney transplant recipients in regional, rural, and remote areas experience unique barriers and challenges associated with medication management, necessitating an increased level of involvement and support from the pharmacist.

The impact of AI-based decision support systems on nursing workflows in critical care units

AIM

This research examines the effects of artificial intelligence (AI)-based decision support systems (DSS) on the operational processes of nurses in critical care units (CCU) located in Amman, Jordan.

BACKGROUND

The deployment of AI technology within the healthcare sector presents substantial opportunities for transforming patient care, with a particular emphasis on the field of nursing.

METHOD

This paper examines how AI-based DSS affect CCU nursing workflows in Amman, Jordan, using a cross-sectional analysis. A study group of 112 registered nurses was enlisted throughout a research period spanning one month. Data were gathered using surveys that specifically examined several facets of nursing workflows, the employment of AI, encountered problems, and the sufficiency of training.

RESULT

The findings indicate a varied demographic composition among the participants, with notable instances of AI technology adoption being reported. Nurses have the perception that there are favorable effects on time management, patient monitoring, and clinical decision-making. However, they continue to face persistent hurdles, including insufficient training, concerns regarding data privacy, and technical difficulties.

DISCUSSION

The study highlights the significance of thorough training programs and supportive mechanisms to improve nurses' involvement with AI technologies and maximize their use in critical care environments. Although there are differing degrees of contentment with existing AI systems, there is a general agreement on the necessity of ongoing enhancement and fine-tuning to optimize their efficacy in enhancing patient care results.

CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

This research provides essential knowledge about the intricacies of incorporating AI into nursing practice, highlighting the significance of tackling obstacles to guarantee the ethical and efficient use of AI technology in healthcare.

Awareness of the Role of Artificial Intelligence in Health Care among Undergraduate Nursing Students: A Descriptive Cross-Ssectional Study

BACKGROUND

Artificial intelligence (AI) has the potential to revolutionize healthcare by improving efficiency and reducing errors; however, challenges such as inadequate funding and lack of awareness among healthcare professionals hinder its integration into healthcare service delivery.

AIM

To assess the awareness of undergraduate student nurses regarding the role of AI in healthcare.

DESIGN

A descriptive cross-sectional design was used.

SETTINGS

The study was conducted at two nursing colleges in Pakistan: The Foundation University College of Nursing and the Institute of Nursing Wah Medical College.

PARTICIPANTS

A sample of 162 student nurses was selected, consisting of BSc Nursing students from the two nursing institutions.

METHODS

Data were collected using a pre-validated questionnaire adapted from Ahmad et al. (2023), comprising multiple-choice and Likert scale questions. The questionnaire assessed demographic information and awareness of AI, including barriers and advantages of AI in healthcare. Descriptive statistics were used for data analysis. Frequencies and percentages were calculated for demographic variables and responses from participants.

RESULTS

Of the total sample, 59.9 % of students had heard of AI in healthcare, while only 43.8 % had the requisite technical skills to understand AI literature. Additionally, 38.3 % had never encountered AI applications in their profession. The primary barriers to AI education were the lack of specialized courses (35.8 %) and mentorship (41.4 %), while key benefits included faster healthcare procedures (51.2 %) and a reduction in medical errors (32.7 %).

CONCLUSIONS

Although many student nurses are aware of AI, there is a substantial gap in technical knowledge and practical application. To address this, nursing curricula should include dedicated AI courses and practical training modules. Enhanced educational resources and support networks are crucial for overcoming existing barriers and leveraging AI's potential to transform healthcare practices.

Personal and work-related factors associated with nurse resilience: An updated systematic review using meta-analysis and narrative synthesis

BACKGROUND

Nursing shortages and increased workforce turnover have significantly increased nurses' workloads, thus increasing the risk of burnout and stress, particularly during the COVID-19 pandemic. A systematic review published in 2019 suggested that resilience could act as a buffer to adversity; however, the factors associated with resilience during and after this global pandemic have not been identified.

OBJECTIVES

To identify personal and work-related factors associated with nurse resilience, including the period during and after the COVID-19 pandemic.

DESIGN

Systematic review.

DATA SOURCES

The search was conducted between January and February 2024 in the following databases: CINAHL Plus, MEDLINE (Ovid), PsycINFO, EMBASE, and Scopus, using the key terms 'resilience', 'hardiness', 'work', 'employ', 'occupation', 'job', and 'nursing'.

REVIEW METHODS

Quantitative studies with English full text, published between 2018 and 2024, were selected if they assessed resilience and its associated factors among nurses providing direct patient care. Two authors independently completed the data selection process. Studies with quality assessment grades of 3 or above were included for final analysis. A meta-analysis was utilised for the mean resilience levels from studies using the same measures of resilience, and a narrative synthesis was performed for the demographic and work-related factors.

RESULTS

Fifty-nine cross-sectional studies with a quality assessment score of 3 or above were included. Forty-seven studies were included in a meta-analysis, which reported an estimated mean resilience level of 20.69 using a random-effects model (95 % CI [18.53, 22.85], z = 18.79, p < 0.0001, I2 = 95.1 %). Twenty studies with the Connor Davidson Resilience Scale (CD-RISC)-25 and five with the CD-RISC-10 were meta-analysed for the mean resilience levels of 62.85 (95 % CI: [55.60, 70.10], z = 16.97, p < 0.0001, I2 = 31.70 %) and 26.34 (95 % CI: [20.85, 31.83], p < 0.0001, I2 = 0 %), respectively. A low mean resilience level was identified. Sixteen demographic factors were identified as associated with resilience. Twenty job demand factors negatively associated with resilience were determined and categorised into exhaustion, psychological factors, and work challenges. Thirty-two job resource factors positively related to resilience were identified and classified into the following categories: psychological factors, leadership, work performance, well-being and quality of life, and social and organisational support.

CONCLUSIONS

Understanding the job demand and resource factors can help organisations minimise the risks and develop institutional strategies to protect nurses from the negative impact of COVID-19 or future pandemics on nurses' well-being.

A critical Response to "How firearm legislation impacts firearm mortality", A focused look at Canadian and Australian evidence

A recent review article in Health Policy Open, entitled "How firearm legislation impacts firearm mortality internationally: A scoping review" claims that Australian and Canadian firearms legislation is associated with reductions in homicide and suicide by firearms. Unfortunately, the review overexaggerates the effectiveness of firearms legislation in Australia and Canada, leaves out some important studies, and does not rigorously examine these articles. Eight Australian studies are referenced that examine the association between gun control legislation, primarily the National Firearms Act (NFA), and firearm homicide. Seven studies find no association between gun control legislation and firearm homicide. Only one study finds a reduction in female homicide but this is contradicted by a study using methods controlling for confounding factors. Four studies examining suicide rates and the association with the NFA find no associated benefit, including the single study that controls for confounders. Two studies find an associated decline in firearm suicide rates with the NFA but there is a decline in non firearms homicide rates at the same time that makes it impossible to know if the decline is associated with the NFA or another variable. The results of the Canadian studies on legislation and the association with firearms homicide points to no beneficial association when more methodologically sound methods and studies are reviewed. Canadian studies on the association with legislation and suicide by firearm demonstrate a reduction in suicide rates with a substitution for other methods and no overall reduction in suicide rates. Overall, Australian and Canadian studies to not appear to demonstrate beneficial associations with gun control legislation.

Measurement invariance and differential item functioning of a care staff proxy measure of nursing home resident dementia-specific quality of life (DEMQOL-CH): do care aides' first language, and care aides' and residents' ethno-cultural background matter?

Quality of life (QoL) is a priority goal of dementia care, but measuring QoL becomes increasingly difficult as a person's ability to self-report declines. QoL measurement is particularly challenging among Nursing home (NH) residents, due to their often advanced cognitive impairment. The DEMQOL-CH is a validated tool to assess NH residents' QoL, using care staff proxy reports. Care staff and residents often have diverse ethno-cultural backgrounds, which may affect the measurement of QoL. Our objective was to assess measurement invariance and differential item functioning (DIF) of the DEMQOL-CH based on care staff ethno-cultural background, language, and resident ethno-cultural background. In a convenience sample of 9 NHs in the Canadian province of Alberta, research assistants conducted structured interviews with 119 care staff between July and September 2021 to complete DEMQOL-CH assessments of 612 residents. We performed confirmatory factor analyses, multiple group item response theory analyses, and DIF analyses. Measurement of the overall DEMQOL-CH score was affected by care staff ethno-cultural background and language (lack of scalar measurement invariance), but not by resident ethno-cultural background. Six of the 31 DEMQOL-CH items had DIF based on both, care staff ethno-cultural background and language, 2 items had DIF based on care staff ethno-cultural background, 4 items had DIF based on care staff language. Resident ethno-cultural background did not lead to DIF. The lack of measurement invariance and the presence of DIF affects the comparability of DEMQOL-CH assessments collected from care staff with diverse ethno-cultural and/or language backgrounds. However, the extent of the issues identified is small and the tool's other psychometric properties are robust. Therefore, we suggest that it is reasonable to continue to use the DEMQOL-CH in its current form, with careful consideration of methods to deal with and adjust for measurement invariance.

Social isolation and loneliness in non-communicable chronic diseases: Impact of COVID-19 pandemic, population aging and technological progress

AIMS

Social isolation and loneliness have increasingly emerged as closely linked to onset and progression of non-communicable chronic diseases (NCDs). The aim of this review is to highlight the importance of addressing social isolation in the prevention and management of NCDs such as obesity, type 2 diabetes, and cardiovascular diseases in order to hinder their development and improve their outcomes.

DATA SYNTHESIS

Social isolation and loneliness affect a significant portion of the older adult population, due to decrease in social interactions, chronic illnesses and sensory impairments. However, many other vulnerable populations may experience social isolation because of psychiatric or disabling health conditions, substances abuse, low socioeconomic status, unemployment and belonging to ethnic or marginalized minorities. The unprecedented COVID-19-related social distancing can be taken as a proof-of-concept of the detrimental role of poor interactions in NCDs prevention and management not only at individual level but also in a public health perspective. Indeed, social isolation has been linked to unhealthy lifestyle choices, disrupted sleep quality, low utilization of healthcare, preventive services and adherence to treatments. Underlying mechanisms like inflammation and stress responses may also play a role in the association between social isolation and worse NCDs outcomes.

CONCLUSIONS

Social isolation negatively impacts on the development, progression and management of NCDs. Effective interventions for social isolation should address both societal factors and healthcare-related needs. To counteract the detrimental effects of social distancing during COVID-19 pandemic, the use of telemedicine was implemented. However, telemedicine is not always available, and legislative and age-related barriers persist.

The role of nanomedicine and artificial intelligence in cancer health care: individual applications and emerging integrations-a narrative review

Cancer remains one of the deadliest diseases globally, significantly impacting patients' quality of life. Addressing the rising incidence of cancer deaths necessitates innovative approaches such as nanomedicine and artificial intelligence (AI). The convergence of nanomedicine and AI represents a transformative frontier in cancer healthcare, promising unprecedented advancements in diagnosis, treatment, and patient management. This narrative review explores the distinct applications of nanomedicine and AI in oncology, alongside their synergistic potential. Nanomedicine leverages nanoparticles for targeted drug delivery, enhancing therapeutic efficacy while minimizing adverse effects. Concurrently, AI algorithms facilitate early cancer detection, personalized treatment planning, and predictive analytics, thereby optimizing clinical outcomes. Emerging integrations of these technologies could transform cancer care by facilitating precise, personalized, and adaptive treatment strategies. This review synthesizes current research, highlights innovative individual applications, and discusses the emerging integrations of nanomedicine and AI in oncology. The goal is to provide a comprehensive understanding of how these cutting-edge technologies can collaboratively improve cancer diagnosis, treatment, and patient prognosis.

Evaluation of a care pathway for older adults presenting with nonspecific complaints at the emergency department: a before-and-after study

PURPOSE

Managing older patients presenting at the Emergency Department (ED) poses challenges due to their predisposition to present with nonspecific complaints (NSC). With an ageing population and ED overcrowding, significance of NSC is expected to grow. Therefore, we implemented a structured care pathway to address the complexity of NSC presentations. The aim of this study is to evaluate the effectivity of this care pathway.

METHODS

We conducted a before-and-after study to evaluate the NSC care pathway, which included risk stratification, standardized assessment and diagnostic measurements. A control group receiving standard care was established in two hospitals (hospital 1 and 2) before implementation. Patient enrollment occurred from April 2021 to November 2024. Outcomes included length of stay in the ED (LOS-ED) and in hospital (LOS-H), revisits, diagnostic completeness (i.e. 100% agreement between all ED and hospital discharge diagnoses) and perceived quality of care.

RESULTS

In total, 164 control and 235 intervention patients were included in this study. Median LOS-ED and LOS-H did not show significant differences between the control and intervention patients. Implementation of the care pathway showed non-significant trends towards improved diagnostic completeness (47.1% vs 37.2%, p = 0.096). This might be associated with the non-significant observed decrease in 30-day readmissions (7.5% vs. 12.7%, p = 0.256). Patient-reported outcomes indicated a positive experience with the quality of care.

CONCLUSION

The care pathway did not improve LOS-ED and LOS-H as hypothesized, possibly due to logistical barriers and patient variability. However, trends suggested improved diagnostic completeness and fewer 30-day readmission rates. Further research initiatives are needed to enhance patient outcomes and care for NSC patients.

TRIAL REGISTRY NUMBER

NL8960, date 9-10-2020.

Palliative Care for People With Very Severe to Extreme Behavioural and Psychological Symptoms of Dementia (BPSD): A Scoping Review

AIM

To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting.

DESIGN

Scoping review.

REPORTING METHOD

The PRISMA-ScR reporting guideline.

METHODS

The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis.

DATA SOURCES

Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO.

RESULTS

This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers.

CONCLUSIONS

This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care.

IMPACT

Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Health leaders' perspectives and attitudes on medical assistance in dying and its legalization: a qualitative study

BACKGROUND

Medical Assistance in Dying (MAiD) has transformed health policy and practice on death and dying. However, there has been limited research on what shaped its emergence in Canada and the beliefs and views of health leaders who hold positions of influence in the healthcare system and can guide policy and practice. The objective of this study was to examine health leaders' perspectives on the factors that led to the emergence of MAiD and explore their attitudes about the legalization of MAiD.

METHODS

In this qualitative study, we conducted online semi-structured interviews with health leaders from April 2021 to January 2022. Purposive and snowball sampling techniques were used to recruit health leaders who have expertise and engagement with the delivery of MAiD or palliative and end-of-life care, and who hold positions of leadership relevant to MAiD in their respective organisations. Inductive thematic analysis was used to analyze the transcribed interviews.

RESULTS

Thirty-six health leaders were interviewed. Participants identified six factors that they believed to have led to the introduction of MAiD in Canada: public advocacy and influence; judicial system and notable MAiD legal cases; political ideology and landscape; policy diffusion; healthcare system emphasis on a patient-centred care approach; and changes in societal and cultural values. Participants expressed wide-ranging attitudes on the legalization of MAiD. Some described overall agreement with the introduction of MAiD, while still raising concerns regarding vulnerability. Others held neutral attitudes and indicated that their attitudes changed on a case-by-case basis. Participants described four factors that they considered to have had influence on their attitudes: personal illness experiences; professional experiences and identity; moral and religious beliefs; and, the valence of patient autonomy and quality of life.

CONCLUSIONS

This study highlights the wide-ranging and complex attitudes health leaders may hold towards MAiD and identifies the convergence of multiple factors that may have contributed to the legalization of MAiD in Canada. Understanding health leaders' attitudes and perspectives on the legalization of MAiD may inform stakeholders in other countries who are considering the legalization of assisted dying.

Healthcare professionals' perspectives on barriers and facilitators to implementing a warning signs intervention for older rural-dwelling medical patients at risk for hospital readmission

INTRODUCTION

Prior research has identified that older rural patients and their families view preparation for detecting and responding to worsening health after a hospital stay as their most pressing unmet need, and perceive an evidence-based warning signs intervention that prepares them to do so as highly likely to meet this need. Yet, little is known about healthcare professionals' perspectives about potential barriers and facilitators to implementing warning signs interventions, especially in rural communities.

AIM

This study aimed to identify potential barriers and facilitators to healthcare professionals' provision of a warning signs intervention in rural communities.

MATERIALS AND METHODS

In this qualitative descriptive study, we examined healthcare professionals' perspectives on potential barriers and facilitators to providing a warning signs intervention. A purposive, criterion-based sample of healthcare professionals, stratified by professional designation (three strata - nurses, physicians, and allied healthcare professionals) who provide health care to rural dwellers in Ontario, Canada participated in semi-structured telephone focus-group discussions or 1:1 interviews on barriers and facilitators to delivering the intervention. Data were analyzed using conventional qualitative content analysis.

RESULTS

Twenty-seven healthcare professionals participated in focus groups and 15 in 1:1 interviews for a total of 42 healthcare professionals. Analysis by healthcare professional stratum revealed nine categories of barriers and facilitators: material resources; human resources; healthcare professional communication; healthcare professional knowledge and skill; healthcare professional buy-in; context of rural practice; patient- and family-specific characteristics; risks and liabilities; and timing of intervention delivery. Seven of these categories converged across healthcare professional strata. However, the reasons why different healthcare professional strata perceived the categories as important, and the ways in which they saw them functioning as barriers and facilitators, varied. Our findings shed light on barriers and facilitators that should be considered to ensure successful implementation of the intervention in rural communities.

DISCUSSION

This study adds to the limited research on rural healthcare professionals' perspectives on barriers and facilitators to delivering a warning signs intervention.

A balancing act: exploring ethical and legal concerns associated with release of personal information in alert systems for missing persons with dementia

BACKGROUND

Technology, such as alert systems, can foster community engagement in locating missing persons with dementia and minimize potential harm. However, concerns arise about implications of public disclosure of missing individual's personal information (such as age, photographs, physical descriptions, and medical conditions) within alert systems. Until now, there has been no review of these concerns, particularly in the Canadian context. Our study aimed to explore community members' perspectives on the ethical and legal concerns associated with the release of personal information in alert systems for missing persons with dementia.

METHODS

Using a qualitative descriptive approach, we conducted semi-structured interviews with 18 participants: people living with dementia, care partners, service providers, first responders, and experts in ethics, policy, and the law from Canada and the United Kingdom. We conducted a thematic analysis of the interview data to inductively explore ethical and legal concerns.

RESULTS

Our findings identified the following concerns: Balancing safety and privacy, stigmatization, risk of victimization and abuse, and informed consent. There is a challenge of balancing safety with privacy due to the urgency of locating missing persons when sharing personal information publicly. Disclosure of personal information, such as cognitive impairment, can increase the risk of stigmatization, victimization, and abuse for both the missing individuals and their care partners. Unfortunately, conversations about alert systems and consent do not typically occur before someone goes missing, even though people living with dementia have the right to participate in these conversations.

CONCLUSIONS

Alert systems can promote community involvement in locating missing persons with dementia but must balance safety and privacy concerns. Implementation of education and policies would mitigate stigmatization, victimization, and abuse. Early conversations with people living with dementia and their care partners to understand their preferences, along with an advance consent process, can help address consent concerns. Our framework, which emphasizes ethical and legal considerations, can guide policy, practice, and decision-making to support the autonomy of people living with dementia.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of the COVID-19 pandemic on mortality and treatment costs of patients with colorectal cancer

BACKGROUND

The COVID-19 pandemic negatively impacted lung cancer patient's mortality and health services utilization (HSU) costs; however, it is unclear if these impacts are true for other cancers, such as colorectal cancer (CRC).

METHODS

A population-based retrospective cohort design was used to compare 1-year mortality, survival, HSU and associated costs of patients who were diagnosed with CRC in Alberta, Canada during pre-pandemic (March 17th, 2018 to March 16th, 2019), intra-pandemic (March 17th, 2020 to March 16th, 2021), and post-pandemic (March 17th, 2021 to March 16th, 2022) periods. Kaplan-Meier and Cox regressions were used to estimate survival and hazard ratios. General linear regression models with gamma family and log link were used to estimate differences in HSU costs.

RESULTS

There were 2297, 2003 and 2393 patients diagnosed with CRC (incidence of 53, 45, and 54 per 100,000 population) in the pre-, intra-, and post-pandemic periods, respectively. Across the three periods, the proportion of stage III & IV CRC at diagnosis was 39.4 %, 42.4 % and 40.1 %; and survival at 365 days was 81.3 %, 79.2 %, and 81.0 %, respectively. Although the highest 1-year mortality was found intra-pandemic, differences were not statistically significant. The highest HSU costs were found among patients diagnosed with CRC during the intra-pandemic period ($61,800 per patient per year), followed by pre- ($57,140) and post-pandemic ($50,680).

CONCLUSION

For patients diagnosed with CRC, there are associations between the COVID-19 pandemic, delay in cancer diagnosis (as shown by the decreased incidence and the increased proportion of later stage cancer at diagnosis), and increased mortality and treatment costs. As these findings are similar to what has been found for lung cancer patients, generalizability to other cancers becomes more likely.

Policy options for a pan-Canadian mental health and substance use health workforce strategy

Canada needs a systematically developed, fit-for-purpose Mental Health and Substance Use Health (MHSUH) workforce strategy to improve and coordinate planning across jurisdictions, provider types, and the public and private sectors. Guided by a pan-Canadian advisory committee, our project synthesized evidence and refined key priorities through a virtual policy dialogue. This article describes the insights generated at this dialogue and highlights the coordinated priority actions for a MHSUH workforce strategy for Canada. Specific actions are recommended under the following five priorities: (1) collect data for planning; (2) support the workforce; (3) target recruitment; (4) optimize and diversify roles; and (5) close policy gaps. This proposed strategy can inform effective workforce planning, foster the well-being of the MHSUH workforce, and facilitate retention and recruitment. Engagement from MHSUH system partners, including leaders from government, provider, and lived experience organizations, is essential to advancing this workforce strategy.

Stigma experiences and adaptations in accessing healthcare services among hill tribes in Thailand: A qualitative study

BACKGROUND

One of the significant barriers to accessing healthcare services is the stigma experienced from healthcare workers. Individuals can be significantly impacted by stigma owing to being classed according to particular characteristics, such as being tribal members. This study aimed to understand the experiences and adaptations of hill tribe people in Thailand, who face stigma when accessing healthcare services.

METHODS

A qualitative phenomenological method was used to elicit information from hill tribe members with prior experience accessing healthcare. A question guide was used to interview the participants. The interviews were conducted in private and confidential rooms in hill tribe villages in August 2021. Each interview lasted for 45 minutes.

RESULTS

A total of 85 people participated in the study: 25 men and 60 women. The Akha and Lahu people constituted the majority of the participants. Many had no education, and the average monthly income was 2,500 baht per family. Three forms of stigma were detected among hill tribe people accessing healthcare services in different hospitals: verbal stigma, physical stigma, and contempt. Three levels of impact were found: completely not understood with no effect, little understanding with little pain, and fully understood with full impact. Two reactions to stigma were identified: nonresponse and response (proper, nonproper immediate response and assertive response). Three factors were protective against stigma: speaking fluent Thai, wearing modern clothing, and the ability to pay medical fees.

CONCLUSIONS

Hill tribe people face several forms of stigma related to various levels of impact and different reaction approaches. Some factors can protect against encountering stigma while accessing healthcare services in hospitals. The implementation of programs to reduce stigma should focus on improving the understanding of people's different cultures and languages and effective communication skills for hill tribe people. The central government of Thailand should develop a national strategic plan to improve these socioeconomic statuses.

Supporting Social Work Leaders: Supervision, Intersectionality, and Nonprofit Leadership

This study explores the lived experiences of 15 women of color who hold leadership positions within nonprofit organizations (NPOs). Underpinning this inquiry is a critical feminist framework. The findings underscore significant gaps in social work supervision, particularly as they pertain to women of color in leadership positions. These gaps highlight systemic issues and point to the broader challenges these women face in receiving the guidance and support necessary for effective leadership. The study also reveals the organizational challenges that arise from the persistence of racialized and gendered power differentials within the nonprofit sector. These dynamics, often a reflection of wider societal inequalities, manifest within organizations through the perpetuation of traditional power structures, making it even more difficult for women of color to thrive and succeed. The study calls attention to how these challenges are embedded in the nonprofit landscape, leading to a continual recreation of inequitable power relations. Ultimately, this research emphasizes the need for more inclusive and equitable supervision practices and organizational structures to better support women of color in leadership roles within NPOs.

ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions

Attention deficit hyperactivity disorder (ADHD) is notably overrepresented in substance use treatment centers, with an estimated prevalence of 21-23% when screening practices are implemented. Many adults in these settings receive an ADHD diagnosis for the first time, highlighting the frequent underdiagnosis of ADHD among individuals seeking treatment for alcohol and substance use issues. Additionally, those entering treatment programs represent only a small fraction of the broader population with problematic alcohol use. This review explores the research on the prevalence and treatment of co-occurring ADHD and substance use disorders (SUD), with a particular emphasis on alcohol use disorders (AUD) as the most common SUD. It also provides clinical guidelines for the screening and diagnosis of ADHD in patients with active alcohol and substance use and offers recommendations to enhance screening practices and improve access to treatment for individuals with co-occurring ADHD and AUD.

An ecological approach to humanizing healthcare organizations for patients, providers, and communities

Healthcare delivery exposes care providers and leaders to suffering, loss, moral dilemmas, conflicts, and overwhelm. The cumulative effects of workplace stress and trauma have organizational impacts (turnover, cynicism, and conflict), personal impacts (burnout, mental illness, and traumatic stress), and patient care impacts (reduced empathy, poor communication, and errors). Organizations have attempted to address these issues largely through individual wellness offerings. A systematic approach is needed to create environmental conditions that support people to remain resilient, engaged, and compassionately connected in the face of constant trauma exposure. This article describes an ecological model for developing and sustaining resilience based in neuro and social science. It includes practical strategies to reshape leaders' understanding, perspectives, and competencies to enhance systemic well-being.

Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks

Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.

The Primary Care Medical Record Industry in Canada and Its Data Collection and Commercialization Practices

Importance

Massive volumes of health data flow to commercial data brokers worldwide, yet little empirical research has examined how this industry functions and the implications for patients.

Objective

To describe and analyze the primary care medical record industry in Canada and its data collection and commercialization practices.

Design, Setting, and Participants

This qualitative study of the Canadian primary care health data industry used situational analysis, a grounded theory methodology. Data sources included semistructured interviews of individuals affiliated with the commercial health data industry from May 2022 to May 2023 and publicly available documents. Data were analyzed from May 2022 to May 2024.

Main Outcomes and Measures

Individual semistructured interviews and relevant publicly available documents were analyzed to gain an understanding of data collection and commercialization practices in the primary care record industry. The analysis involved a continuous and iterative process of data collection and analysis, theoretical sampling, data-driven coding, and creation of theoretical concepts.

Results

A total of 19 interviews were conducted and 22 documents were sampled. Study participants described the primary care medical record industry in Canada as consisting of complex reciprocal relationships between commercial health data brokers, physicians, for-profit chains of primary care clinics, and pharmaceutical companies. In an emerging vertically integrated business model, the data broker brought the primary care clinics and physicians in house as a clinical subsidiary, thus obtaining more control over clinical practices. Participants understood the primary care medical record industry as having potential to transform patient care, but-because of financial considerations-also tied to pharmaceutical industry interests. According to participants, patients were not involved in decisions related to how their records were collected and used.

Conclusions and Relevance

This qualitative study found that each entity within the Canadian primary care medical record industry contributes to, and benefits from, the conversion of patient medical records into commercial assets. The industry's activities reflect the pharmaceutical companies' interests. Patients are notably absent from decision-making; thus, the industry's activities may not reflect their values or interests.

Emergency Department Navigator Interventions and Outcome Measures: A Scoping Review

INTRODUCTION

Emergency department (ED) patient navigators are increasingly used, but a lack of understanding of how ED navigator interventions are designed, described, and evaluated creates gaps in our ability to understand, monitor and improve care. The purpose of this scoping review is to identify how the literature describes and evaluates ED patient navigator interventions for older people transitioning to a primary care setting.

METHODS

A scoping review was conducted following the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews. We searched three databases: MEDLINE, EMBASE and CINAHL. We included English language articles without any restrictions on study designs that two reviewers screened. All articles focused on distinct ED navigator roles to facilitate transitions for older people from the ED to primary care were included. Data extraction was completed by the primary reviewer and validated by two secondary reviewers. We report study characteristics in a table. Descriptive content analysis was used to analyse the main findings.

RESULTS

A total of 10 studies were included out of 2102 articles identified. All studies used quantitative designs except one, which used a qualitative research design. Four studies were conducted in the United States, two in Australia and the UK and one in Canada and Belgium. Twenty unique outcome measures were identified, with hospital admission rate, frequency of ED presentations and ED/hospital length of stay being the most common. We identified six intervention components: assessment, consultation, liaison, development of care plan, referral and follow-up. Interventions using 4 or more components more commonly reported positive outcomes. Outcome measures used to evaluate interventions were often not tracked across care settings, potentially obscuring the impact of ED navigator interventions across the care continuum.

CONCLUSION

Future research should examine which patients benefit from ED navigation and which outcome measures might help contextualise intervention effectiveness across care settings.

Exploring the Relationship Needs of Service Users During Crisis Interventions: A Qualitative Study

People in crisis sometimes seek professional support, and the relationship between service users and professionals is crucial in overcoming the crisis. To understand the relationship needs of people in crisis, 29 semi-structured interviews with service users were conducted and analyzed using a grounded-theory approach. The findings reveal that people in crisis seek a professional who is there for them, recognizes the crisis as an emergency and a solvable situation, treats them with respect, and offers individual support. Furthermore, there needs to be a general fit between professionals, the support services, and service users for a supportive relationship to be established. However, two main aspects were discovered where service users differ depending on the resources they can access during the crisis: While people with access to many resources seek a rather distant and egalitarian relationship, those with access to fewer resources prefer more intimate and hierarchical relationships with professionals.

COVID-19 and Recurrent Pregnancy Loss Management: Trends in Clinical Care From a Tertiary Centre

OBJECTIVES

To investigate the impact of the COVID-19 pandemic on the care received by patients with recurrent pregnancy loss (RPL) in British Columbia, Canada. To explore the differential impact of socioeconomic status on health care utilization outcomes during the COVID-19 pandemic for patients with RPL.

METHODS

This is a retrospective cohort study of patients from an RPL clinic located within a tertiary referral centre. Patients were divided into 2 groups based on the date of their initial visit to the clinic: (1) pre-pandemic group (March 1, 2018-February 28, 2020) and (2) pandemic group (March 1, 2020-February 28, 2022). Data were sourced from the RPL Clinic Database and Population Data BC. Outcomes assessed included visit trends, immediate pandemic impact, and socioeconomic effects.

RESULTS

Demographic and clinical characteristics were not significantly different between study groups, except for increased referral rates to fertility clinics by the RPL clinic during the COVID-19 pandemic (4.90% vs. 9.50%). The mean number of visits per patient was comparable between pre-pandemic (3.50 ± 2.00) and during the pandemic (3.40 ± 3.40). However, monthly initial visits were lower during the pandemic (12.50 ± 3.10) compared with pre-pandemic (14.40 ± 4.83). Telehealth was rare in the pre-pandemic period and increased dramatically during the pandemic, with virtual visits reaching up to 64% of total and 94% of initial visits. The pandemic's onset caused immediate drops in total (38.80%) and initial visits (51.70%). Health care utilization was higher among those with less material deprivation, whereas contrasting effects were observed in those with less social deprivation.

CONCLUSIONS

The COVID-19 pandemic impacted the care received by patients with RPL within a tertiary care centre. There was a shift in how services were provided to patients, uniquely impacting specific populations within the community.

Racial and Ethnic Disparities in Predictive Accuracy of Machine Learning Algorithms Developed Using a National Database for 30-Day Complications Following Total Joint Arthroplasty

BACKGROUND

While predictive capabilities of machine learning (ML) algorithms for hip and knee total joint arthroplasty (TJA) have been demonstrated in previous studies, their performance in racial and ethnic minority patients has not been investigated. This study aimed to assess the performance of ML algorithms in predicting 30-days complications following TJA in racial and ethnic minority patients.

METHODS

A total of 267,194 patients undergoing primary TJA between 2013 and 2020 were identified from a national outcomes database. The patient cohort was stratified according to race, with further substratification into Hispanic or non-Hispanic ethnicity. There were two ML algorithms, histogram-based gradient boosting (HGB), and random forest (RF), that were modeled to predict 30-days complications following primary TJA in the overall population. They were subsequently assessed in each racial and ethnic subcohort using discrimination, calibration, accuracy, and potential clinical usefulness.

RESULTS

Both models achieved excellent (Area under the curve (AUC) > 0.8) discrimination (AUCHGB = AUCRF = 0.86), calibration, and accuracy (HGB: slope = 1.00, intercept = -0.03, Brier score = 0.12; RF: slope = 0.97, intercept = 0.02, Brier score = 0.12) in the non-Hispanic White population (N = 224,073). Discrimination decreased in the White Hispanic (N = 10,429; AUC = 0.75 to 0.76), Black (N = 25,116; AUC = 0.77), Black Hispanic (N = 240; AUC = 0.78), Asian non-Hispanic (N = 4,809; AUC = 0.78 to 0.79), and overall (N = 267,194; AUC = 0.75 to 0.76) cohorts, but remained well-calibrated. We noted the poorest model discrimination (N = 1,870; AUC = 0.67 to 0.68) and calibration in the American-Indian cohort.

CONCLUSIONS

The ML algorithms demonstrate an inferior predictive ability for 30-days complications following primary TJA in racial and ethnic minorities when trained on existing healthcare big data. This may be attributed to the disproportionate underrepresentation of minority groups within these databases, as demonstrated by the smaller sample sizes available to train the ML models. The ML models developed using smaller datasets (e.g., in racial and ethnic minorities) may not be as accurate as larger datasets, highlighting the need for equity-conscious model development.

LEVEL OF EVIDENCE

III; retrospective cohort study.

The Integrated Care Team: A primary care based-approach to support older adults with complex health needs

Many older adults have complex needs and experience high rates of acute care use and institutionalization. Comprehensive Geriatric Assessment (CGA) is a specialized multidimensional interprofessional intervention to prevent such outcomes, but access to CGA in the community is limited. The Integrated Care Team (ICT) is a proactive case-finding intervention to support older adults with complex needs in primary care. The ICT provides nurse practitioner-led shared-care supported by a pharmacist, family physician, and geriatrician. Patients undergo a CGA, and a person-centred plan of care is implemented. We conducted a mixed-methods evaluation of the ICT. Patients were 81 ± 9.2 years old, 71% were women. Patients had a high burden of dementia and multimorbidity and received 12.8 ± 5.8 prescriptions daily. The ICT improved prescribing and reduced emergency department visits by 49.5% (P = 0.0001). Patients, care partners, and referring physicians reported high satisfaction with care. The ICT is currently being expanded to support additional primary care providers.

What is the State of Organisational Compassion-Based Interventions Targeting to Improve Health Professionals' Well-Being? Results of a Systematic Review

AIM

To identify and assess the state of knowledge regarding compassion-based interventions and outcomes, targeted to the organisational level, that aim to improve health professionals' well-being.

DESIGN

Systematic review.

DATA SOURCES

Using the PICO model, the clinical question and search strategy were structured. The searches were performed on 20 September 2022 and 26 December 2023 in the Scopus, CINAHL, EMBASE, PsycINFO and ProQuest Dissertations & Theses Global databases. Content analysis was applied to analyse data, and the PRISMA and SWiM guidelines were followed for reporting.

RESULTS

Thirty-eight studies, mostly from the United Kingdom and the United States, met the inclusion criteria and were quality assessed and analysed. Compassion-based interventions that target the organisational level are quite new, thus representing a burgeoning initiative. In this review, many included quantitative studies revealed significant methodological challenges in effectively measuring organisational compassion (interpersonal relationships, organisational culture and retention/turnover). However, the review findings overall indicate that interpersonal connections between colleagues that foster a sense of community, through shared experiences, mindfulness and (self-)compassion practices and social activities, may be a protective factor for well-being. Further, the review emphasises the crucial role of management support in catalysing organisational changes to improve health professionals' well-being.

CONCLUSION

Evidence strongly suggests that fostering human interconnectedness among health professionals is associated with enhanced well-being. Further rigorous studies are needed to validate these findings, clarify the organisational cultural aspects of compassion and develop an effective outcome measurement tool for organisational compassion.

PRACTICE IMPLICATIONS

Organisational compassion-based interventions may help foster a culture of compassion within organisations, enhance health professionals' capacity for compassion and benefit both their well-being and the quality of care provided to patients and relatives.

PATIENT CONTRIBUTIONS

This review is part of a larger project about compassion and includes two patient representatives (mothers of children with cancer) in the research team.

Preventing healthcare worker burnout in primary care settings through the trauma-informed CARES Leadership Competency Model

Staff burnout, a pervasive and persistent issue in the Canadian primary care environment, demands urgent and immediate attention. The managerial response to this problem has been largely reactive, especially in the post-COVID era. The need for proactive approaches to equip health leaders to detect early signs of burnout in healthcare workers and intervene effectively is more pressing than ever. Health leaders are beginning to acknowledge the significant role that trauma plays in impacting workers' propensity to experience burnout, leading to the growing recognition of trauma-informed best practices in healthcare management. This article will introduce the CARES Model, a leadership competency framework that underscores the connections between leadership competencies and employee-leader engagement to detect early signs of burnout in primary care workers. The model, along with the proposed CARES toolkit, strongly emphasizes trauma-informed best practices and will enable health leaders to better proactively prevent burnout through appropriate, empathetic, and efficient interventions.

Public safety personnel's perceptions of mental health training: an assessment of the Emotional Resilience Skills Training

Public safety personnel (PSP) work experiences necessitate diverse and frequent exposures to potentially psychologically traumatic events (PPTEs) and other occupational stressors, which may explain the higher prevalence of mental health disorders and suicidal ideation among PSP relative to the general population. Consequently, PSP require emotional coping skills and evidence-informed mental health training to navigate arduous situations. The Emotional Resilience Skills Training (ERST) is a pilot 13-week mental health training program led by a peer and based on the robustly evidenced Unified Protocol for the Transdiagnostic Treatment of Mental Disorders. The study assessed whether PSP: perceived the ERST as improving their mental health or their management of stressors; applied the associated knowledge and skills; and would recommend ESRT to other PSP. Data were collected using a self-report survey and focus groups. A total of 197 PSP (58% male) completed a self-report survey and 72 PSP (33% female) participated in a sector-specific focus group to assess the ERST. The results indicate that PSP perceived ERST as helpful when applied. Almost all participants would recommend the training to other PSP. PSP expressed the ongoing need for mental health skills and knowledge, but also identified mental health training gaps during early-career training and stages.

Disordered eating behaviours, self-compassion, and psychological distress in Canadian general surgery residents

BACKGROUND

Surgical residents experience higher levels of negative stress and helplessness compared to the general population. Studies have linked stress to negative eating habits. Despite the high stress and burnout among surgical residents, studies on their disordered eating behaviors remain limited. Understanding the factors contributing to these findings will help optimize mental health during residency training.

METHODS

This study is a mixed-methods cross-sectional survey of all general surgery residents in Canada. The survey assessed disordered eating, quality of life, and self-compassion using the Eating Attitudes Test (EAT-26), Kessler Psychological Distress Scale (KPDS), and Self-Compassion short-form scale (SCSF). A qualitative component examined factors influencing eating habits in residency. Logistic regression was performed to identify factors associated with at-risk disordered eating behaviors.

RESULTS

Out of 450 surgical residents, 128 residents completed the survey (28 ​%). Respondents were 23 ​% male and split evenly across all postgraduate levels. There were 68 ​% of respondents who identified as having psychological distress and 34 ​% exhibited high risk behaviors for disordered eating. High levels of psychological distress (OR 3.29; 95 ​% CI [1.39-7.76]) and elevated BMI (OR 3.99; 95 ​% CI [1.63-9.77]) were significantly associated with exhibiting at-risk disordered eating behaviors Positive factors influencing eating were having a partner at home and having non-residency related extracurriculars. Negative factors were overnight call shift frequency, call shift length, and volume of pages.

CONCLUSION

This is the first nationwide survey examining eating behaviors among general surgery residents. This population was found to have elevated rates of high-risk behavior for disordered eating.

Maintaining health service during COVID-19: A study on regional health services

The pandemic has inevitably led to disruptions in the provision of health services for all those patients not affected by COVID-19. At the same time, we have observed differences among health services in their ability to maintain their activities in the face of shocks: while some health services were largely able to ensure core functions, other suffered delays in prevention, acute care, and rehabilitation. In this paper, we explore the effect of regional health policies in terms of governance, workforce, and health service delivery on the ability to maintain oncological services during the COVID-19 pandemic to assess the resilience of the system. The study is based on secondary data collected on the 21 Italian regional health services during the first wave of the pandemic. We discuss the theoretical and practical implications of providing health services with specific characteristics pertaining to governance, workforce, and health service delivery to support the resilience of regional health policies during a crisis or shock.

Determinants associated with receiving a medical appointment through the primary care access points for unattached adults in Quebec: A cross-sectional study

Canada is experiencing an unprecedented primary care crisis, with 6.5 million Canadians reporting lacking a family physician, including 31% of the Quebec population. To address this problem, the province of Quebec implemented primary care access points (in French, they are Guichets d'accès à la première ligne, or GAPs) to help unattached patients navigate and access primary care services while awaiting attachment. We aimed to examine the determinants associated with unattached patients receiving a medical appointment compared to another service through the GAP. Cross-sectional data (n = 13,291) from two GAPs were collected (June 2022 to March 2023). Multivariable logistic regression was carried out. Being younger, calling for an acute health problem, medication renewal or to have administrative documentation filled, having a physical or mental health problem, and using GAP A (compared to GAP B) were associated with an increased likelihood of receiving a medical appointment. This study is the first to document the characteristics of patients using the GAP and their needs.

From perpetual pilots to sustainable transformation: Scaling up geriatric care

With an ageing population, there is an increasing need to focus on the care of older adults, particularly those who are more medically complex. Frail older adults are more likely to require care from multiple providers across multiple settings. It is well recognized that the current Canadian healthcare system is not well-designed for this complex population. To address the health system challenges, health leaders are rapidly developing and implementing programs to better support the ageing population. Unfortunately, this often means that organizations are implementing and scaling health and social care programs with limited evidence or understanding of the specific context in which it was implemented. Drawing on regional experiences, this article will explore challenges and offer solutions related to the implementation, spread, and scale of healthcare programs for older adults.

Resilience among family physicians during the COVID-19 pandemic in Canada

The purpose of this study was to investigate how the COVID-19 pandemic's inaugural wave impacted the professional autonomy of family physicians in Canada. This study highlights how family physicians' resilience enabled them to overcome the many challenges they faced to provide health services to patients and has enabled them to rebuild their sense of purpose and duty of care. Four themes were found to summarize physician experiences: (1) loss of clinical autonomy and control; (2) abandonment and neglect by the health system; (3) a fear of patients "falling through the cracks" and moral injury; and (4) building resilience to support duty of care in family practice. These results highlight the emergence of resilience among family physicians to restore professional autonomy in family practice, overcoming moral injury in order to fulfil their "duty of care" to their patients. Physicians believe the health system's crisis preparedness efforts need to be dedicated to protecting the autonomy of practicing physicians to maintain the continuity of quality patient care in future health crises.

Dynamic QR Codes and Data Analytics: Novel Methods for Evaluating Just-in-Time Nursing Education

BACKGROUND

The introduction of low-frequency-use clinical devices presents challenges to nursing education, particularly regarding knowledge retention and increased risk of skill decay.

METHOD

This quality improvement project aimed to evaluate access and use of just-in-time (JIT) multimodal educational resources retrievable via dynamic quick response (QR) codes following the introduction of a new but infrequently managed hemostatic compression device for inpatient nurses within an academic health system.

RESULTS

Data analytics from a 12-month period demonstrated engagement with the JIT resources, yielding a total of 122 written procedure views, 56 video views, and 66 QR code scans. Notably, 64.3% of video views coincided with QR code scans, indicating that QR codes effectively facilitated resource retrieval.

CONCLUSION

Easily accessible JIT multimodal educational resources support competent patient care in infrequent clinical scenarios. Data analytics provide a novel method for evaluating and enhancing nursing education practices through data-driven approaches. [J Contin Educ Nurs. 2025;56(5):183-189.].

Hurricane Helene: Lessons Learned

This article examines the response of a community hospital in southern Appalachia during and after Hurricane Helene, a severe natural disaster that highlighted both the strengths and challenges of rural health care delivery. This experience reveals critical lessons for emergency nursing, including the need for flexibility, community collaboration, and comprehensive preparedness plans addressing both patient care and staff needs. By integrating these insights, health care systems can strengthen their capacity to respond to future disasters while supporting their workforce and communities effectively.

Development of a culturally competent training curriculum for healthcare professionals to promote vaccination and tackle vaccine hesitancy: A Delphi study

BACKGROUND

Addressing vaccine hesitancy is crucial, especially when considering cultural factors. This article outlines the creation of a training curriculum model designed to equip healthcare professionals with the essential knowledge, expertise, and cultural competency required to effectively promote vaccination and tackle vaccine hesitancy.

METHODS

A two-round Delphi Study with 23 experts from four European countries-Spain, Greece, Romania, and Cyprus - and diverse backgrounds, based on predetermined criteria, was undertaken. The aim was to identify key topics, through purposive sampling, ensuring diversity and representativeness within the participant group. The process generated valuable insights and highlighted the significance of all statements in culturally sensitive vaccination practices. Five statements from each module were chosen as the fundamental content of the curriculum. These selections were based on mean scores, range, and median values.

RESULTS

The curriculum model reflects the collective insights of experts, paving the way for improved vaccination advocacy and community engagement. It encompasses four modules based on the Papadopoulos Tilki and Taylor (PPT) model for cultural competence, each targeting specific learning objectives to enhance healthcare professionals' abilities in advocating for vaccination and providing culturally appropriate care for population groups in diverse cultural contexts.

CONCLUSION

The training curriculum model emphasizes intercultural communication, empowerment, and advocacy, offering a holistic strategy for promoting vaccination acceptance. It is crucial for healthcare professionals to possess the necessary knowledge, skills, and resources to effectively protect the health and welfare of communities. This, in turn, contributes to the development of enduring, fair, and robust healthcare systems.

Predictor importance of organizational factors of burnout in child welfare workers

BACKGROUND

The prevalence and predictors of work-related burnout have been extensively investigated within the child welfare workforce. However, the understanding of significant predictors has largely relied on traditional regression analyses, which often fail to capture the unique contributions of each predictor. Dominance analysis (DA) is an advanced quantitative method that determines the relative importance of predictive variables in multiple regression models.

OBJECTIVE

This study aimed to determine which empirically-based predictor had the most impact on work-related burnout in child welfare workers.

PARTICIPANTS AND SETTING

This study used a sample of newly hired frontline child welfare workers (n = 597) who had been on the job for 18 months.

METHODS

A DA was used to analyze a regression model of eight empirically based predictors of work-related burnout in child welfare workers.

RESULTS

Findings among frontline child welfare workers (n = 597) indicate that time pressure contributed the most unique variance (17 %) when predicting work-related burnout and dominated all other organizational factors predicting work-related burnout.

CONCLUSIONS

Findings have implications for child welfare organizations and child welfare workforce policy development.

Implementing the pillars of value-based care: Leadership lessons from the CIUSSS Centre Ouest de l'Ile de Montreal

The Canadian healthcare landscape is characterized by its ambitious pursuit of innovation in response to challenges such as resource limitations and system restructuring. However, meaningful innovations cannot be sustained without leadership that empowers a patient-first integrated model of care. This article will explore the transformative changes of CIUSSS Centre Ouest de l'Île de Montréal directed to implanting the pillars of a value-based health system. We showcase our "Hospital-at-Home" program as an example to highlight the critical role of leadership in setting our vision of "Care Everywhere," empowering our healthcare workforce, and in ensuring successful implementation and sustainment. Our manuscript aims to provide insights into the leadership strategies that have underpinned these achievements, focusing on how these innovations have anticipated emerging healthcare demands, and highlighting a sustainable model for health leaders and policy-makers who are addressing similar challenges.