Moral distress is the psychological discomfort experienced by healthcare providers when prevented from acting on their ethical values. Although extensively studied in high-income settings, it remains relatively unexplored in Africa, where chronic resource limitations and systemic constraints shape clinical practice. This scoping review mapped African literature examining how moral distress is conceptualised and discussed, its drivers and interventions implemented to address it with a particular focus on the balance between individual and organisational perspectives. A systematic search of databases identified papers on moral distress and related concepts among healthcare providers in Africa. Data extracted included: publication year, geographical focus, study design, participants, healthcare setting, conceptual framing, definitions, factors contributing to moral distress and descriptions of interventions and their evaluations. The results were analysed thematically considering individual and organisational perspectives. 30 papers published between 1999 and 2025 across 11 African countries were included. Of these, 14 were qualitative, 10 quantitative, 2 mixed methods, 1 review, 2 commentaries and 1 book chapter. Moral distress was commonly framed as an individual psychological burden, yet its primary drivers were identified as organisational including staff shortages, excessive workloads, inadequate resources and limited institutional support. Quantitative papers explicitly referred to 'moral distress', while qualitative papers generally described ethical and moral challenges more widely. Reported interventions were mainly proposed: counselling, debriefing, ethics committees and better staffing were recommended but rarely implemented or evaluated. In practice, healthcare workers relied on informal coping strategies such as peer support, prayer and improvisation. Moral distress is increasingly explored in the literature on African health systems but remains inconsistently defined and inadequately addressed at the organisational level. Despite widespread acknowledgement of its organisational and systemic origins, responsibility for managing its effects falls largely on individuals. This review supports a systems-level understanding of moral distress and highlights the need for organisational and policy change processes. Future research should move beyond description to identifying and evaluating team-based and organisational strategies that effectively reduce or manage moral distress.
Compact, selective gas sensors are crucial for environmental and healthcare monitoring. Using density functional theory + NEGF transport simulations, we investigate the influence of the graphene nanoribbon (GNR) width on the detection of gas molecules such as CO, CO2, and NH3. We show that ultra-narrow GNRs produce molecule-specific transmission fingerprints: CO, CO2, and NH3 adsorption induce distinct shifts and broadenings of resonant channels. When the ribbon width approaches molecular scales, quantum confinement and interference effects strongly enhance the conductance modulation under finite bias. Among the three molecules, NH3 produces the highest sensitivity in the ultra-narrow device (Device 3), particularly at bias voltages above ∼2 V, due to its stronger adsorption energy and pronounced charge redistribution, leading to the largest current suppression relative to the pristine ribbon. These geometry-dependent signatures suggest a practical route to gate-tunable selectivity in GNR-based chemical sensors.
The global population is ageing at an unprecedented rate, creating substantial pressures on healthcare systems to deliver personalised, proactive, and cost-effective care for older adults. Digital twin (DT) technology, where dynamic virtual replicas of physical entities are continuously updated through real-time data, has emerged as a transformative tool in precision medicine. Despite its growing application across clinical specialties, its specific utility within geriatrics and gerontology remains underexplored in the academic literature. This narrative review aims to synthesise existing evidence on the applications of digital twin technology in geriatric and gerontological care, examine associated challenges and identify future research priorities. A narrative review methodology was employed, with a systematic search of PubMed, Scopus, Web of Science, and IEEE Xplore databases covering publications from January 2014 to December 2025. Studies were selected based on relevance to digital twins, ageing populations, or geriatric clinical domains, with data synthesised thematically. Digital twins demonstrate significant potential benefit across multiple geriatric domains, with use in cardiovascular monitoring, fall prevention, dementia management, polypharmacy optimisation, and chronic disease self-management. Key enablers include advances in Internet of Things (IoT), artificial intelligence, and electronic health records. Persistent challenges include data privacy concerns, interoperability deficits, computational costs, and ethical questions surrounding autonomy and consent in cognitively impaired populations. Digital twin technology holds considerable promise for revolutionising geriatric and gerontological care, by enabling hyper-personalised clinical decision-making, predictive risk management, and remote patient monitoring. Translating this potential into practice requires focused investment in regulatory frameworks, equitable access infrastructure, and interdisciplinary collaboration. Future research should prioritise standardisation, caregiver integration, and longitudinal validation studies within older adult populations.
A robust, expertly trained nursing workforce is needed to care for over 13 million people living with serious illness in the United States (US). However, palliative nursing workforce needs remain poorly characterized. To describe the current state and future demands for palliative nursing in the US. We conducted a narrative review of the palliative nursing workforce in the US. Literature was identified through PubMed and CINAHL (1981-2025) using terms related to palliative care, nursing, workforce, training, and certification. Articles were selected based on relevance, with additional sources identified through snowball sampling. Findings were synthesized qualitatively. We identified 39 sources, grouped into three categories: education, certification, and workforce. Palliative nursing education was not formally integrated into US nursing curricula until 2021 with the AACN publication of The Essentials, and only 12 healthcare organizations offer specialty nurse residency or fellowship programs. The National Board for Certification of Hospice Nurses was established in 1992 in the US and awarded the first certification to registered nurses in 1994; in 2025 nearly 12,000 nurses are certified. Workforce data remain limited due to the diversity of nursing roles in hospice and palliative care. No comprehensive estimate exists for the broader palliative nursing workforce; however, a 2024 national survey estimated 56,619 registered nurses working in hospice. Limited targeted measurement of the specialty palliative nursing workforce constrains the ability to quantify supply and gaps. Research linking education, training, and certification to patient outcomes could inform planning for the future US palliative nurse workforce.
Revascularization remains the cornerstone of treatment for CLTI. Conservative treatment represents an underexposed yet potentially appropriate alternative for selected elderly and frail patients. This population is characterized by high mortality rates, substantial perioperative risks, prolonged hospital stays, increased healthcare costs, and deterioration in functional status and quality of life following invasive interventions. Conservative treatment - including wound care, pain management, and when necessary, minor amputations - may offer an alternative for frail, elderly patients with CLTI. Emerging evidence suggests that, for selected patients, conservative treatment can result in acceptable wound healing rates and survival comparable to invasive strategies, without an increase in major amputation rates. Within the context of appropriate and value-based care, conservative treatment may better balance functional outcomes, healthcare utilization and patient preferences. Future research on prediction models to guide patient selection, cost-effectiveness analyses, and qualitative studies exploring patient-reported outcomes and experiences, should support evidence-based implementation of conservative treatment.
Early identification of patients at high-risk for exacerbation in mild-to-moderate chronic obstructive pulmonary disease (COPD), particularly those with chronic bronchitis (CB) phenotype exhibiting worse outcomes, is critical for slowing lung function decline and reducing the subsequent healthcare burden. While the soluble receptor for advanced glycation end products (sRAGE) correlates with emphysema severity in COPD, in mild-to-moderate COPD or patients with CB symptoms, no prospective investigation has evaluated the association between sRAGE and exacerbation risk. Sub-cohort data from the COMPASS study, a prospective study in China, were analyzed. Associations between sRAGE levels and exacerbations were assessed treating sRAGE as a continuous variable and categorized into tertile. Negative binomial regression and cox regression were used to assess exacerbation rate and onset time. Subsequent analyses of lung function, COPD Assessment Tool (CAT) score and high-resolution computed tomography (HRCT) parameters were evaluated using linear mixed-effects models based on a cutoff determined by Akaike information criteria (AIC). In the COMPASS sub-cohort, 201 patients had mild-to-moderate COPD and 230 individuals reported CB symptoms. Continuous sRAGE level was not associated with exacerbation risks, but with earlier onset time. In addition, participants in the lowest sRAGE tertile exhibited significant shorter time to first exacerbation in both populations. The lowest tertile was also associated with increased exacerbation risks in patients with CB and showed a borderline significant association in patients with mild-to-moderate COPD. No significant differences in lung function decline, HRCT changes, or CAT score progression were observed between the low- and high-sRAGE groups. Lower sRAGE level may be associated with an increased exacerbation risk in mild-to-moderate COPD and in patients with CB symptoms. Blood sRAGE is a candidate biomarker for identifying subgroups at higher exacerbation risk in populations at high risk of disease progression. Clinicaltrials.gov identifier NCT04853225; GSK study code 208630.
Healthcare artificial intelligence systems often degrade in performance when deployed across institutions, with documented performance drops and perpetuation of discriminatory patterns embedded in data. This brittleness comes, in part, from learning statistical associations rather than causal mechanisms. Causal graph neural networks address this by combining graph-based representations of biomedical data with causal inference to learn invariant mechanisms instead of just spurious correlations. This Perspective reviews the methodology of structural causal models, disentangled causal representation learning, and techniques for interventional prediction and counterfactual reasoning on graphs. We discuss applications across psychiatric diagnosis and brain network analysis, cancer subtyping with multi-omics causal integration, continuous physiological monitoring and drug recommendations. These methods provide building blocks for patient-specific causal digital twins that could support in silico clinical experimentation. Remaining challenges include computational costs that preclude real-time deployment, validation challenges that go beyond standard cross-validation, and the risk of causal-washing where methods adopt causal terminology without rigorous evidentiary support. We propose a tiered framework distinguishing causally inspired architectures from causally validated discoveries and outline future directions, including scalable causal discovery, multimodal data integration and regulatory pathways for these methods. Making practical causal digital twins possible will require an honest assessment of what current methods deliver, sustained collaboration across disciplines and validation standards that match the strength of the causal claims being made.
In the 2022/2023 training cycle, the VA Prosthetic Orthotic Residency (VAPOR) Program was unable to fill all funded residency positions. Initial debriefing with residency directors revealed a likely cause to be lack of competitiveness of the VAPOR training stipend value, particularly for second-year residents. This demonstrated a need to conduct a training stipend analysis for the VAPOR program. A five-part analysis was conducted including review of the program's stipend history, review of the impact of inflation, and surveys of residency directors and current and former residents. Cumulatively, the analysis revealed that the current stipend was no longer competitive and that the profession was compensating second-year residents more than first-year residents. To effectively compete for top residency candidates, the VA must increase the current training stipend. Ultimately, 4 evidence-based recommendations were derived from the analysis as follows: (1) VAPOR Year 2 (Y2) stipends should be greater than the Year 1 (Y1) stipends; (2) VAPOR Y1 residents should receive a base stipend of $41,620 in addition to a locality adjustment based on the site location; and (3) VAPOR Y2 residents should receive a nonadjusted base stipend valued at 9.3% more than the Y1 stipend or $45,491 to be increased with a locality adjustment based on the site location. A cost-of-living adjustment should be applied to VAPOR program stipends at a minimum of every 3 to 5 years at an increase of 3-5% based on cost-of-living data from other government resources. VA bolstered resident compensation because of these findings.
People with severe mental illness (SMI) represent up to 6% of the population and experience a high burden of physical comorbidity and premature mortality. Despite longstanding international calls to develop integrated care, the optimal organisational approaches for this population remain poorly defined, and health systems lack guidance on how to redesign care pathways. This review aimed to characterise the core components, reported impacts, and implementation challenges of existing integrated care programmes for individuals with SMI and physical health conditions. This umbrella review was reported in accordance with the PRISMA 2020 and PRIOR statements. PubMed, Scopus, PsycINFO, and Cochrane were initially searched from inception to February 2025, with an updated search performed on 5 May 2026, for review studies of integrated care programmes for people with SMI and comorbid physical conditions or social vulnerabilities. Methodological quality was appraised using AMSTAR-2, and the most mature programmes were synthesised narratively using the SELFIE framework for multimorbidity-oriented integrated care. The review was registered on OSF (https://osf.io/se2u4). Seventeen review studies met the inclusion criteria, identifying 20 distinct integrated care programmes. Although heterogeneous, these programmes most commonly integrated physical healthcare within mental health services, relied on case managers, and emphasised proactive, individualised, and continuous care. Coordination with social care services and involvement of service users in programme design was limited. Governance and financing arrangements were weak, the use of digital tools was scarce, and effects on physical health and social outcomes remained modest. Evidence on effective and scalable integrated care programmes for people with SMI and physical comorbidity remains limited. These findings inform the next phase of the European Mental and Physical Health Initiative for People with Severe Mental Disorders (EU-MIND), which will use a Delphi process with key stakeholders to guide the implementation of sustainable integrated care across diverse European health systems. This study was funded as part of the EU-MIND initiative under the 2024 European Partnership on Transforming Health and Care Systems (THCS).
Pneumococcal conjugate vaccines (PCVs) have transformed the epidemiology of pneumococcal disease while providing a real-world model for understanding how vaccination reshapes antimicrobial resistance (AMR) in Streptococcus pneumoniae. In this Mini Review, we examine PCV-associated AMR dynamics through linked epidemiological, ecological, and genomic processes. We first distinguish two complementary AMR-reducing pathways: direct suppression of vaccine-type serotypes that historically carried antibiotic-nonsusceptible lineages, and indirect reduction of antibiotic exposure by preventing pneumococcal and respiratory disease syndromes that commonly trigger empirical treatment. We then explain why these effects are incomplete. The capsular biosynthesis operon, antimicrobial resistance determinants, and virulence protein genes occupy distinct genomic layers; therefore, post-PCV AMR outcomes depend not only on serotype removal, but also on capsular switching, recombination, mobile resistance elements, lineage fitness, carriage reservoirs, and antibiotic selection. Recent whole-genome sequencing and Global Pneumococcal Sequence Cluster studies show that serotype replacement is best interpreted as lineage-level ecological restructuring, with region-specific consequences for resistant disease. We further discuss how global and regional epidemiology, including serotype-specific invasiveness and uneven vaccine uptake, modifies PCV-associated AMR impact. Finally, we consider higher-valency PCVs, protein-based vaccines, and trained-immunity-based host-directed strategies as complementary future directions. We argue that next-generation pneumococcal vaccines should be evaluated not only by immunogenicity and serotype coverage, but also by their effects on antibiotic use, carriage dynamics, resistant lineage expansion, capsular switching, and long-term population-genomic outcomes.
Dengue is an arboviral disease of major public health relevance in Colombia, where recurrent endemic-epidemic transmission intersects with climatic variability, urbanization, population mobility, co-circulation of viral serotypes and lineages, seasonal healthcare pressure, and substantial direct and indirect costs. Although dengue prevention and response in Colombia include epidemiological surveillance, clinical diagnosis, management of warning signs, vector-control activities, outbreak response, and assessment of preventive interventions, these components may be implemented unevenly across territories and may remain insufficiently integrated with health system planning, operational readiness, and economic risk assessment. This technical report proposes an evidence-informed conceptual preparedness framework for dengue in Colombia. The framework was developed through a structured narrative synthesis of peer-reviewed evidence, preparedness-oriented guidance, and Colombia-specific epidemiological, clinical, operational, and health system considerations. It is intended to complement, rather than replace, existing dengue surveillance, prevention, and response strategies by organizing decision points across five interrelated domains: surveillance-to-action, risk-stratified clinical triage, adaptive vector control, contextual vaccination assessment, and healthcare response capacity. A cross-cutting economic risk-mapping component is included to identify relevant cost domains and potential pathways of preventable burden related to outpatient care, hospitalization, productivity loss, outbreak response, severe disease, and healthcare service saturation, without constituting a formal economic evaluation. The framework emphasizes territorial prioritization, timely translation of risk signals into action, early recognition of patients at risk of progression, alignment between community-based interventions and healthcare capacity, and contextual assessment of emerging tools such as tetravalent dengue vaccines and Wolbachia-based vector strategies. It also recognizes implementation constraints, including data interoperability, laboratory and genomic capacity, workforce availability, territorial inequities, financing, pharmacovigilance, governance, and feasibility of local adoption. Future evaluation should assess operational indicators such as signal-to-alert time, triage performance, severe dengue incidence, hospitalization, healthcare resource utilization, stock availability, equity, and cost-effectiveness. In heterogeneous endemic settings, this conceptual framework may support more coordinated dengue preparedness; however, its operational usefulness, economic value, scalability, and policy relevance require stakeholder validation, territorial adaptation, pilot implementation, and prospective evaluation.
Access to healthcare may be driving unplanned and potentially avoidable hospital admissions for people diagnosed with inflammatory bowel disease (IBD). Interventions to reduce unplanned and potentially avoidable admissions need to be developed based on a clear conceptual framework that identifies the system-level access barriers contributing to these admissions. This scoping review aimed to synthesize the health system components for reducing unplanned IBD admissions to develop a conceptual framework to guide future interventions for reducing unplanned admissions. A scoping review was conducted to identify literature exploring factors associated with unplanned IBD admissions and interventions to reduce IBD admissions. Literature published between January 2000 and October 2024 was identified from 4 electronic databases (Medline, Embase, CINAHL, and PubMed). A narrative synthesis presented the findings, guided by Candidacy Framework, to understand issues in healthcare access. Of 1980 records identified, 17 were included. Avoidable IBD admissions result from inequity across the patient journey through healthcare, specifically in access to: (1) earlier intervention during a flare, (2) specialist clinical advice about symptoms and psychosocial issues, (3) rapid access to outpatient care, (4) patient education, (5) systems that support self-management, (6) proactive care strategies, and (7) collaborative health professional working and referrals. Addressing service permeability (ease of using services) and local production of candidacy (patient-provider relationships and macro-structural conditions) are understood as most important for addressing avoidable unplanned IBD admissions. The Health System Access Framework is useful for understanding how services need to address patient care.
There is limited knowledge about how patients experience artificial intelligence (AI) in healthcare. Concerns regarding safety and quality could be a barrier between patients and the healthcare system when implementing AI. It is crucial to understand patients' attitudes, and how they may react to AI being implemented when aiming to preserve their trust. We investigated patients' attitudes toward AI-assisted colonoscopy to gain insights that can be used when introducing this new technology to future patients. This is a qualitative study based on semi-structured focus group interviews. Habile, Danish-speaking adults who had received an AI-assisted colonoscopy were invited. We conducted six focus group interviews, with 20 participants in total. All interviews were recorded and transcribed. Data were analysed using thematic analysis. Patients described a sense of vulnerability in relation to undergoing a colonoscopy. Three main themes were identified. The first theme is 'Empathy and professionalism-trust in AI-assistance in colonoscopy depends on human factors'. The second and the third themes are 'Information about AI should be proportional to the consequences', and 'Trying to make sense of AI during colonoscopy-balancing curiosity, irrelevance, and vulnerability'. Trust in AI-assistance is dependent on trust in the clinicians. While AI has many strengths, it cannot provide empathy, which is essential for patients in distressing moments, such as during a colonoscopy. AI should be considered a supportive tool, while the endoscopist remains responsible for clinical decisions and patient outcomes. If written information about AI is provided, it should be informative but concise, avoiding details that generate more confusion than clarity.
Community health nurses play a vital role in delivering preventive, promotive, curative, and rehabilitative healthcare services through home visits and outreach programs. The community nursing bag has long served as an essential tool for carrying supplies, equipment, medications, and records required for field-based nursing care. However, conventional community bags face several limitations, including infection-control concerns, excessive weight, poor ergonomic design, environmental impact, and limited integration with digital technologies. These challenges necessitate the modernization of traditional community nursing bags to meet the evolving demands of contemporary healthcare practice. This review explores the concept of eco-smart and technology-integrated community nursing bags as innovative solutions for enhancing field-based nursing care. This review discusses the traditional community bag technique, existing practices, and major challenges associated with conventional bags. It further examines eco-smart innovations such as sustainable fabrics, reusable sterilizable kits, biodegradable packaging, solar-powered charging systems, and water-resistant eco-friendly materials that promote environmental sustainability and improve usability. Technological advancements, including portable diagnostic devices, digital documentation systems, telehealth connectivity, Global Positioning System (GPS) technology, artificial intelligence (AI), and Internet of Things (IoT)-enabled applications, are highlighted for their potential to improve assessment, communication, continuity of care, and patient monitoring. This review also addresses infection-prevention enhancements such as antimicrobial surfaces, UV sterilization units, contamination-control compartments, and integrated hand hygiene systems. The relevance of these innovations to rural healthcare, disaster response, maternal and child health services, and geriatric home care is discussed. Additionally, challenges related to cost, training, digital literacy, and infrastructure limitations are examined. Future directions emphasize policy support, curriculum reform, research, and prototype development. Reimagining the community nursing bag as an eco-smart and technology-enabled system has the potential to improve healthcare accessibility, patient safety, sustainability, and quality of care, thereby strengthening community and public health nursing practice in the digital era.
This study investigates family physicians' attitudes toward lifestyle medicine, focusing on how these attitudes manifest in their health-promoting lifestyles and the moderating role of their healthcare sector attainment. Employing a quantitative, cross-sectional design, multicentric data were collected from 215 family physicians via an online survey accessed through professional networks. Data were collected using a study-specific demographic and healthcare sector information form, a custom questionnaire designed for attitudes toward lifestyle medicine, and The Health-Promoting Lifestyle Profile II. Findings revealed a positive association between health-promoting lifestyles and attitudes toward lifestyle medicine. The healthcare sector attainment significantly moderated this relationship, with private practice physicians showing a significant link between their health-promoting lifestyles (specifically, personal stress management, health responsibility, physical activity, and nutrition behaviours) and their attitudes toward lifestyle medicine. Conversely, this connection was not statistically significant in the public sector. The findings were discussed within the framework of social and organizational psychology theories and relevant literature. These results suggest that while physicians generally acknowledge lifestyle medicine, its embodiment through personal health behaviours is more pronounced in specific professional contexts. Our study underscores the need for sector-specific strategies to integrate lifestyle medicine more effectively into clinical practice. Policy initiatives should address structural barriers in the public sector that might hinder physicians' personal engagement with health-promoting behaviours, thereby impacting their professional advocacy for lifestyle medicine. Future research should explore the underlying mechanisms within different healthcare sectors and employ longitudinal designs to establish causality, ultimately aiming to enhance physician well-being and advance preventive care across all settings.
Oral and periodontal diseases are among the most prevalent chronic disorders worldwide and arise from complex interactions between microbial biofilms and dysregulated host immune responses. Despite significant advances in conventional therapies, clinical management remains challenging because of limited drug penetration, rapid clearance within the oral cavity, and poor patient compliance. In this context, microneedle (MN)-based drug delivery systems have emerged as promising minimally invasive platforms for localized and controlled therapeutic delivery. However, the adaptation of MN technologies from transdermal to oral applications requires application-specific redesign owing to the unique anatomical, physiological, and mechanical characteristics of oral tissues. Current literature also remains fragmented, particularly regarding the integration of oral tissue biology, advanced manufacturing strategies, and multifunctional MN design. This review provides a comprehensive and critical analysis of MN systems for oral and periodontal applications, with particular focus on the enabling role of additive manufacturing (AM). First, the biological characteristics of oral tissues and their implications for drug delivery are discussed, followed by an overview of MN technologies, biomaterials, and fabrication approaches. Particular emphasis is placed on oral application-specific design considerations, including mechanical constraints, penetration depth, bioadhesion, retention, and controlled drug release. Emerging therapeutic applications, ranging from antibacterial and anti-inflammatory therapies to immunomodulatory and regenerative strategies, are also critically evaluated. Recent advances in 3D-printed MNs are highlighted, emphasizing their potential for customizable architectures, integrated drug delivery systems, and patient-specific therapeutic platforms. In parallel, major translational challenges, including mechanical reliability, retention under salivary conditions, regulatory complexity, and manufacturing scalability, are critically discussed. Future perspectives involving the integration of artificial intelligence (AI), smart biomaterials, biosensor technologies, and precision medicine approaches are also explored. Beyond summarizing recent advances, this review identifies the key scientific challenges, current knowledge gaps, and emerging engineering strategies required for the successful clinical translation of 3D-printed oral and periodontal MN systems. Overall, it provides a critical roadmap for the rational design and development of next-generation personalized MN platforms, highlighting the convergence of advanced biomaterials, biofabrication technologies, and precision medicine as a foundation for future oral healthcare.
Acetabular dysplasia (AD) is a prominent cause of hip pain and dysfunction among adolescents and young adults (AYAs). The gold standard treatment is periacetabular osteotomy (PAO), but there is limited research regarding the perspectives of those considering this procedure. We explored the decision-making and needs of people with AD related to PAO to inform future decision aid development. We conducted semi-structured interviews with people with AD age ≥13 years who underwent PAO >6 months ago. Questions explored experiences with AD diagnosis, PAO decision-making, and thoughts and preferences regarding a PAO decision aid. We inductively and deductively coded interviews to identify key themes. 17 participants (12 female, 5 male) completed the interview (age at first PAO = 19.6 ± 5.0 years, range 13-29 years; time from surgery to interview = 934.5 ± 405.7 days; range 312-1510 days). Key themes included: 1) Participants experienced two distinct pathways for AD diagnosis with the majority seeing multiple providers from symptom onset to AD diagnosis while others were diagnosed after imaging due to an acute musculoskeletal injury; 2) Participants overwhelmingly felt relief upon being diagnosed with AD; 3) Female and male participants disclosed PAO concerns that differed by sex; 4) Participants appreciated engaging in shared decision-making around PAO with their surgeon and healthcare team and valued open, transparent conversations about the surgery and recovery; 5) Participants desired tailored peer connections; 6) Participants would value a PAO decision aid that was online, interactive, and comprehensive. AYAs with AD experience different pathways to diagnosis and the decision to undergo a PAO. They value open, honest communication with their surgical team and peer connections, and favor the development of a comprehensive interactive online decision aid. This work can serve as a model for similar formative research for AYAs considering a variety of elective orthopaedic procedures. (1)Most people with acetabular dysplasia (AD) see multiple providers from symptom onset to diagnosis, and experience relief upon being diagnosed.(2)Females and males with AD considering periacetabular osteotomy (PAO) hold concerns that differ by sex.(3)People with AD considering PAO appreciate transparent and open communication with their surgeon and also desire tailored peer connections.(4)People with AD considering PAO would value a comprehensive decision aid that is online and interactive to facilitate the decision-making process. Level V.
This study aims to examine how self-leadership and caring can be conceptually integrated to strengthen the legitimacy of nursing clinical judgement in complex healthcare environments. This study adopts a conceptual analysis design. A conceptual analysis approach was used to synthesise theoretical perspectives from self-leadership scholarship and caring theory to clarify the internal conditions that support accountable clinical decision-making. Self-leadership was selected because it offers a framework for understanding the self-regulatory processes underlying intentional professional action, whereas caring theory conceptualises nursing as a moral-relational practice grounded in human dignity and ethical responsibility. Integrating these theories enabled examination of how regulatory capacity and moral orientation converge to strengthen relational accountability in nursing clinical judgement. This conceptual analysis proposes a relational accountability framework comprising three interrelated components: regulatory reflexivity, moral-relational orientation and accountable enactment. Regulatory reflexivity supports intentional reasoning and behavioural alignment, moral-relational orientation directs decision-making towards relational responsibility and patient dignity and accountable enactment reflects the transparent communication and justification of clinical decisions within relational care contexts. Relational accountability offers a theoretical basis for strengthening the legitimacy of nursing clinical judgement by integrating internal regulatory capacity with caring-based ethical orientation. The framework provides directions for future empirical inquiry into accountable decision-making in nursing practice. No patient or public contribution.
Heart failure (HF) remains a global cause of morbidity and mortality and is increasingly complex to manage due to high prevalence of multimorbidity and coexisting cardiorenal and metabolic (CaReMe) syndrome. Individualised care through integrated service models can improve quality and maximise patient outcomes. This scoping review identifies and synthesises models of integrated care for multimorbid HF and CaReMe syndrome, analysing organisation, implementation, and reported outcome measures. A systematic search was conducted in MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), COCHRANE library, and grey literature. Eligible studies included primary research published between 2014 and 2025 describing integrated, multispecialty, or multidisciplinary team (MDT) models of care for adults with multimorbid HF and CaReMe disease. The search followed PRISMA-ScR reporting standards and studies reviewed using standardised tools informed by Joanna Briggs Institute (JBI) and Cochrane Collaborations Tool methodologies. Five studies were identified from upper-middle and high-income countries that incorporated MDT integrated care models. Models were mapped to the Effective Practice and Organisation of Care (EPOC) framework explaining key components of integrated care. Positive outcomes included reduced hospitalisations, improved treatment adherence, enhanced collaborative processes, and patient engagement. Limited governance structures, variable outcome measures, gaps in financial and technological evaluations were also identified. Integrated care models for multimorbid HF and CaReMe syndrome demonstrate potential to enhance care coordination and quality of life. Evidence gaps persist regarding practical implementation, economic viability, and flexibility across healthcare settings. Future research should prioritise patient co-design, standardised outcomes, and shared decision-making frameworks.
Allied health clinicians need strong death literacy to navigate loss, grief, dying, and death. Their roles include system navigation, advocacy, and psychosocial support, often bridging healthcare, community, and social services. Adequate death literacy is essential for holistic, compassionate care. This study assessed death literacy among allied health clinicians in the Central Coast region of New South Wales, Australia. An anonymous, cross-sectional online survey conducted between February and March 2025 collected demographic, professional, and 29-item Death Literacy Index-Revised (DLI-R) data. Subsequent analyses compared overall and subscale death literacy scores across Central Coast allied health disciplines and against published Australian norms for the (a) general population, (b) health professionals, and (c) end-of-life and bereavement care volunteers. A total of 144 allied health clinicians completed the survey, including nutrition and dietetics, physiotherapy, podiatry, psychology, occupational therapy, speech pathology, social work, oral health, counselling, allied health assistants, and other disciplines. There were significant differences in the overall death literacy scores across allied health disciplines, with differences in mean scores ranging from 0.280 to 1.238 (p < 0.01). These differences extended to most subscales; however, after adjusting for potentially confounding characteristics, only social work remained significantly different from the "other" group in overall scores. Subscale differences persisted, including higher hands-on care scores in physiotherapy and occupational therapy, and higher factual and community knowledge scores in social work, compared with the "other" group. Overall, allied health clinicians' death literacy (mean = 5.671) was significantly higher than Australian Online Research Panel norms for the general population (mean = 4.830; p < .001); and lower than health professionals (mean = 6.510; p < .001); end of life care volunteers (mean = 6.640; p < .001); and grief and bereavement care volunteers (mean = 6.590; p < .001). Allied health clinicians appear to hold some discipline-specific strengths in death literacy subscales. Although overall death literacy was higher than that of the general population, it remained lower than that of health professionals, end-of-life care volunteers, and volunteers in grief and bereavement. These findings highlight gaps in allied health workers' ability to understand, access, and act on end-of-life care options. This study focuses on allied health clinicians, a group that plays an important role in everyday health and palliative care but has rarely been included in research on death literacy. It offers new information about who makes up this workforce and the roles they perform. By providing what is believed to be the first benchmarked death literacy profile for this group, the study shows where allied health workers feel confident and where they need more support and training. It also highlights gaps in clinical practice, tertiary allied health education programs, and ongoing professional development, while providing a clear starting point for future research and workforce planning to improve death literacy, end-of-life, and bereavement care.