Understanding how Ukrainian refugee children accessed the health care system after fleeing the war is essential to inform future preparedness and resource allocation in host countries. To use latent class analysis of registry data to identify distinct health care utilization profiles among young Ukrainian refugee children who accessed the health care system in southern Poland in 2022. This registry-based retrospective cohort study used electronic health record data from 2022 and included Ukrainian refugee children, aged 0 to 5 years, who received health care services in facilities in Małopolska Voivodeship, Poland. Participants were followed up from February 24 through December 31, 2022. The data were analyzed from April to October 2025. Healthcare utilization indicators among postwar displaced Ukrainian refugee children used as inputs to the latent profile analysis. Latent profile membership of health care utilization based on health care visit types, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded diagnoses, and intensity of health care use, with temporal patterns of system entry and service trajectories examined after profile identification. The analytic sample included 9845 Ukrainian refugee children aged 0 to 5 years (4849 [49.3%] female) who received 35 199 health care services in Małopolska Voivodeship in 2022. Age at first health care contact was evenly distributed across categories (mean [SD] of 2.7 [1.6] years), 3802 children (38.6%) had a single recorded service, 1845 (18.7%) had more than 5 services, and nearly half (4505 [45.8%]) received care in the regional capital (Krakow). Based on latent class analysis, 5 pediatric patient profiles were identified: mostly primary care (5216 [53.0%]), hospitalized with infectious diseases (1539 [15.6%]), highest health care use (1329 [13.5%]), emergency care for injuries (900 [9.1%]), and dental and preventive care (861 [8.7%]), differing in visit type, diagnostic patterns, and health care utilization intensity. Temporal patterns varied across profiles with earlier system entry among children requiring hospitalization for infectious diseases or emergency care for injuries, and later entry among those using primary care or dental and preventive care. In this cohort study of pediatric Ukrainian refugees in southern Poland, distinct health care utilization patterns were observed with early reliance on hospital and emergency care followed by greater use of primary services. These findings underscore the need for refugee-hosting countries to rapidly adapt health care resources, prioritizing inpatient and emergency care in the initial months following a crisis.
Continuity of care with a family physician (FP) is a core attribute of effective primary care and is associated with improved health outcomes, reduced service use and lower healthcare costs. In Canada, an ageing FP workforce has led to an increasing number of patients losing their FP, raising concerns about access to care and disruptions in care trajectories. While the benefits of continuity are well documented, evidence on the consequences of discontinuity in primary care, particularly from the patient perspective, remains limited. Relational discontinuity occurs when there is a disruption in the relationship between an FP and a patient, which may be related to the FP's retirement or relocation or to the closure of a clinic. This study aims to assess the effects of a disruption in the relational continuity with an FP on patient's experience and their patterns of healthcare service use. A descriptive cross-sectional survey will be administered to adults residing in Quebec, Canada's second most populous province. A total sample of 1000 respondents will be recruited, including approximately 500 individuals who have lost their FP within the past 3 years, and 500 individuals currently registered with an FP. The questionnaire covers sociodemographic characteristics, health status, access to care, use of healthcare services, out-of-pocket costs and perceived impacts of discontinuity. Descriptive and regression analyses will be used to compare experiences and perceived effects between groups and to explore equity-related differences. The study has received ethical approval from the Research Ethics Board involving human participants at Université Laval. Findings will be shared with policymakers and healthcare stakeholders to inform them on the patient-reported consequences of primary care discontinuity and support the development of strategies to mitigate its impacts.
This study explored healthcare professionals' experiences with (asynchronous) teleconsultations and (synchronous) joint consultations in primary and secondary care as well as perceived implementation barriers and facilitators to their use in clinical practice. An implementation-focused qualitative study employing semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). A systematic examination of implementation barriers and facilitators using deductive and inductive approaches, followed by thematic analysis that identified patterns, developed conceptual categories and synthesised these into overarching themes and thematic areas. Teleconsultation and joint consultation used to support collaboration and continuity of care between general practitioners and medical specialists in a Dutch urbanised area. 37 participants were interviewed between August 2021 and October 2022, including 14 general practitioners and 23 medical specialists. Four thematic areas were identified: (1) intervention, (2) interprofessional collaboration, (3) perceived patient perspective and (4) prerequisites for implementation and sustainability. Teleconsultations were highly valued by healthcare professionals, as they enhanced the quality, efficiency and flexibility of their work and improved access to care and the overall care experience for patients. Joint consultations were particularly appreciated for their interactive nature, which strengthened interprofessional relationships and supported their educational value while facilitating delivery of the right care in the right place. However, next to these facilitators several challenges were identified. Specifically, teleconsultations were hindered by variation in use, unclear expectations, a lack of dialogue and limited IT interoperability. Furthermore, scaling up joint consultations was deemed challenging due to volume requirements, time inefficiencies and organisational constraints. Teleconsultation and joint consultation were valued by healthcare professionals as tools that support continuity and quality of care. While serving distinct purposes, their combined use strengthened collaboration between general practitioners and medical specialists. However, sustainable implementation was hindered by organisational, technical, financial and governance-related barriers, as well as limited interoperability and lack of shared clinical ownership. Addressing these barriers is essential to enable scalable and routine use of digital interprofessional consultation models.
To identify and explain the health system factors influencing private general dental practitioners (GDPs) engagement in state-funded, contracted primary oral healthcare for low-income adults in Ireland, in which circumstances, for which groups, how and why. Nineteen realist interviews were conducted with frontline GDPs, health system actors and academic subject experts from Ireland and elsewhere. Collected data were then transcribed, coded, and analysed to generate context-mechanism-outcome configurations (CMOCs) and develop an overarching realist programme theory to explain causation. Thirteen individual and abstracted CMOCs were crafted and subsequently consolidated into five high level CMOCs. GDPs' engagement with state funded care is influenced by a myriad of complex health system contextual factors. These include low political and resource commitment to oral health; cost containment measures characterised by limited and outdated baskets of care and low remuneration; overtly bureaucratic oversight or contract administrative processes; adversarial communications and the absence of consultative mechanisms between the health system and GDPs. Other factors such as oral healthcare 'market' dynamics, GDPs' professional networks and community ties can also influence engagement in state care. As Ireland looks to reform its primary oral healthcare system to widen population access to care and meet national oral health policy and WHO commitments on oral health, the findings of this study provide health system leaders with evidence to leverage system change and increase or sustain GDPs' engagement in state care. Leveraging such change has the potential to improve access to care for vulnerable populations and reduce oral health inequalities.
The Internet of Things (IoT) represents a transformative paradigm in health care service delivery, offering unprecedented potential to enhance quality of care, operational efficiency, and patient outcomes through interconnected devices and real-time data analytics. Despite rapid adoption, implementation depends on patient acceptance as end users. While literature extensively documents technical and institutional perspectives, a comprehensive understanding of patient acceptance factors remains fragmented, with high technology abandonment rates. Systematic synthesis of patient perspectives is critically needed to inform user-centered design, effective implementation strategies, and supportive policy frameworks. This systematic literature review aims to identify and synthesize factors influencing patient acceptance of IoT technology in health care services, barriers hindering adoption, and effective strategies for enhancing acceptance. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we systematically searched eight electronic databases (PubMed/MEDLINE, Scopus, IEEE Xplore, Web of Science, ScienceDirect, ACM Digital Library, ProQuest, and Google Scholar) for empirical studies published between January 2016 and December 2024. Inclusion criteria encompassed peer-reviewed empirical research examining patient perspectives on IoT technology in health care services, published in English or Indonesian. From 2537 initially identified papers, 62 studies met inclusion criteria after systematic screening and full-text evaluation. Quality assessment was conducted using the Mixed Methods Appraisal Tool. The 62 included studies represented diverse geographic contexts (Asia, Europe, North America, and the Middle East) and methodological approaches. Quality assessment revealed 45 (73%) studies of good-to-excellent quality. Perceived usefulness emerged as the strongest acceptance facilitator, identified in 55 of 62 (89%) studies, followed by perceived ease of use in 47 (76%) studies, and trust and security in 42 (68%) studies. Cost-effectiveness was identified in 32 (52%) studies as an important consideration. Primary barriers included data security concerns in 26 (42%) studies, privacy issues in 24 (39%) studies, lack of digital literacy in 22 (36%) studies, and resistance to change in 20 (32%) studies. Interoperability issues and high costs were identified in 19 (31%) studies and 18 (29%) studies, respectively. User-centered design was the most frequently recommended enhancement strategy in 20 (32%) studies, followed by user-friendly interface development in 19 (31%) studies, digital literacy programs in 18 (29%) studies, and health care professional involvement in 15 (24%) studies. Digital literacy functioned as a significant moderator, and trust served as both direct predictor and mediator. Patient acceptance of IoT in health care represents a complex, multidimensional phenomenon requiring holistic approaches that integrate user-centered technology design, comprehensive digital literacy programs, trust-building mechanisms, and supportive policy frameworks. Successful implementation necessitates multilevel strategies addressing individual, organizational, and system factors simultaneously. With evidence-based, patient-centered approaches, IoT technology holds substantial potential to transform health care delivery into more proactive, personalized, and accessible services.
Compassionate Healthcare In Action (CHIA) is a new questionnaire to measure patient experiences of compassionate care, with a particular focus on observable behaviours. It has been designed to address gaps in currently available metrics. It is generalisable across healthcare contexts and has been developed with patient and public involvement throughout. The present study sought to build on earlier development to evaluate the CHIA's face validity, perform item reduction, establish dimensionality, validity and reliability. Face validity was assessed via cognitive interviews with UK healthcare service users. Interviews used a Three-Step Test Method to understand how CHIA items were used, and which items were considered most/least important in measuring patient experiences of compassionate care (Study 1). Cross-sectional survey data were analysed using inter-item correlations, item discrimination indexes, item and local dependency analyses and exploratory factor analysis. Statistical analyses were combined with cognitive interview data and panel reviewed to inform item reduction (Study 2). A final cross-sectional survey corroborated single-factor dimensionality through confirmatory factor analysis alongside establishing reliability and validity (Study 3). 21 cognitive interviews established face validity and identified items with stronger face validity (Study 1). These results were combined with survey analyses (n = 311). Seven items were removed resulting in a 14-item CHIA demonstrating a single factor structure (Study 2). In Study 3, further survey analysis (n = 301) reinforced results showing a strong unidimensional structure, internal consistency, test-retest reliability and validity: content, face, convergent and discriminant. The CHIA is a brief and generalisable metric that evaluates patient perceptions of compassionate care they receive. It has been robustly developed and has strong psychometric properties. The CHIA shows promise for supporting healthcare services to evaluate and improve their care. Further research could examine the CHIA in different contexts and populations. Lived experience consultants supported prior CHIA development papers. In this paper a lived experience consultant (experience of physical and mental healthcare services) was involved in reviewing methodology and materials, advising on and helping with recruitment, contributing to review panel discussions, reviewing and authoring this manuscript. Additionally, methods throughout sought to amplify the voices of diverse populations who could complete the CHIA.
Transgender and gender diverse (TGD) individuals undergoing gender-affirming mastectomy (GAM) face unique challenges related to breast cancer risk assessment and screening. This study aimed to identify factors that influence healthcare professionals' (HCPs) integration of cancer risk evaluation, including genetic assessment, within the context of GAM and pre-surgical planning. We conducted semi-structured qualitative interviews with 20 healthcare professionals - including six primary care providers, five cancer genetic counselors, six oncologists, and three plastic surgeons - experienced in caring for TGD patients considering or undergoing GAM. Using a social constructivist framework, we applied reflexive thematic analysis to explore HCP perspectives and generate key themes. We conceptualized five key themes: (1) HCPs perceive no clear ownership for care integration of breast cancer risk assessment; (2) conflicting guidelines force HCPs to rely on their own judgment, resulting in inconsistent practice; (3) care pathways are driven by individual HCP champions rather than standardized protocols; (4) GAM frequently occurs at young ages prior to age of population cancer risk screening initiation, complicating risk discussions; and (5) structural failures in care delivery compromise patient safety. Improving cancer risk assessment for TGD patients undergoing GAM demands clear institutional accountability, harmonized evidence-based guidelines, standardized care pathways, and genetic counseling embedded into multidisciplinary gender-affirming care teams. These coordinated structural efforts are critical to integrate equitable, personalized, and patient-centered cancer prevention with gender-affirming surgical care.
Patient navigation programs (PNPs) have been increasingly applied in breast cancer (BC) care of underserved clients, as they can significantly assist them with coordinating services across the care continuum. However, existing evidence has produced inconclusive findings regarding the empirical adequacy of BC-related caring interventions developed from PNPs. Hence, the aim of the present systematic review and meta-analysis was to clarify the benefits of PNPs across all phases of the BC care continuum. Primary outcomes comprised care-continuum indicators extracted predominantly from medical records, while secondary outcomes included client-reported healthcare measures. Five electronic data sources were searched for randomized controlled trials (RCTs) that investigated the effectiveness of PNPs across the BC care continuum from 1995 to January 10, 2025, with no restrictions on clients' sociodemographic characteristics. A random-effects model, using both the DerSimonian-Laird (DL) method and the Hartung-Knapp (HK) adjustment, was applied to estimate standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, with 95% confidence intervals (CIs). Thirty-seven RCTs met the inclusion criteria, including four cluster RCTs and 33 individual RCTs. Quantitative synthesis was not feasible for time-to-resolution, adherence to adjuvant or post-treatment follow-up care, timely treatment initiation, treatment completion, satisfaction with care, or psychological distress; therefore, the effectiveness of PNPs for these outcomes remains uncertain. Meta-analyses of individual RCTs, all conducted using a DL random-effects model, indicated that PNPs significantly improved diagnostic follow-up compliance (OR, 2.42; 95% CI, 1.64, 3.59; P < 0.001); screening mammogram adherence (OR, 2.18; 95% CI, 1.71, 2.77; P < 0.001); and timely diagnostic resolution (OR, 2.51; 95% CI, 1.21, 5.24; P = 0.014). Using the same DL model, PNPs also improved quality of life (SMD, 0.44; 95% CI, 0.09, 0.79; P = 0.014) and reduced anxiety (SMD, -0.94; 95% CI, -1.66, -0.22; P = 0.010). However, no statistically significant effects were observed under the DL model for depression (SMD, -0.34; 95% CI, -0.71, 0.04; P = 0.076) or BC knowledge (SMD, 0.27; 95% CI, -0.19, 0.73; P = 0.247). Substantial heterogeneity was observed across most pooled outcomes (I2 = 63.9%-93.0%), accompanied by wide prediction intervals that included the null value. After applying the HK adjustment, the previously observed beneficial effects of PNPs on timely diagnostic resolution, quality of life, and anxiety were no longer statistically significant. Although initial analyses suggested that PNPs may improve several BC-related outcomes, these observed benefits were reduced in magnitude and, in some cases, no longer statistically significant after applying more conservative adjustment methods. Moreover, substantial heterogeneity across studies and the overall low methodological quality limit the certainty of the evidence. Therefore, the current findings should be interpreted cautiously, and further high-quality RCTs are needed to draw more definitive conclusions about the effectiveness of PNPs across the BC care continuum. CRD42023487495.
As direct and continuous providers of patient care, nurses are more susceptible to various forms of psychological stress within the healthcare environment compared to other healthcare professionals. Nurses in paediatric wards, who maintain constant contact with children and their families, are particularly vulnerable to moral distress. This study aimed to explore the perceptions and experiences of Iranian nurses regarding moral distress in paediatric settings. This qualitative study employed inductive content analysis, conducted between 2023 and 2024. Data were collected through semi-structured individual interviews and analysed following Graneheim and Lundman's approach. Twelve participants experiencing moral distress were selected via purposive sampling from the Babol and Tehran Universities of Medical Sciences. The findings identified four primary categories and eight subcategories: moral distress related to colleagues (doctors and nursing colleagues); moral distress related to parents (conflict with children's rights and distrust of nurses); moral distress related to organizational factors (understaffing and workload undermining holistic care and professional ethics; and inadequate equipment and resources compromising care and fostering dishonesty); and psychological tensions following moral distress (mental conflict involving the cognitive and emotional burden of moral compromise; and helplessness and despair in the face of systemic failure). Rather than representing isolated individual experiences, these findings illustrate that moral distress in paediatric nursing is deeply rooted in the structural and relational conditions of healthcare settings. The results highlight that repeated exposure to ethical conflicts can erode professional values, impede the delivery of holistic care, and intensify emotional suffering. Consequently, this study contributes to a deeper understanding of moral distress as a systemic phenomenon requiring organizational intervention rather than merely an individual coping response. The findings underscore the necessity for healthcare managers and policymakers to implement systemic mechanisms, such as specialized educational programmes and workshops, to mitigate moral distress among nurses. Furthermore, identifying the inherent stressors in paediatric nursing and reducing nurses' exposure to moral dilemmas are essential steps toward safeguarding ethical practice and enhancing care quality. This study contributes by shifting the focus from merely describing moral distress as a set of themes toward understanding it as a critical indicator of organizational strain and ethical vulnerability in paediatric nursing.
Accurate identification of rheumatoid arthritis (RA) within routinely collected health data is essential for disease surveillance, service planning and research. This study aims to determine the proportion of recorded RA diagnoses in primary care records that met predefined validation criteria for RA ascertainment. We conducted a retrospective diagnostic validation study of subjects with a SNOMED-coded RA diagnosis recorded in the Pinnacle Midlands Health Network primary care database in 2018-2025. RA status was assessed using a structured, hierarchical validation pathway incorporating rheumatology specialist involvement, disease-modifying antirheumatic drug (DMARD) exposure and RA-specific serology (rheumatoid factor [RF] and anti-cyclic citrullinated peptide [aCCP] antibodies), with independent review of equivocal cases by two senior rheumatologists. Positive predictive value (PPV) was calculated against this composite reference standard. Additional internal validation was performed in random samples of DMARD-exposed subjects with and without specialist involvement. Among 3,831 subjects with a SNOMED-coded RA diagnosis, 3,306 were confirmed to have RA, corresponding to a PPV of 86.3% (95% confidence interval 85.2-87.4%). PPV was highest among subjects with documented rheumatology specialist involvement (94.4%). Misclassification was concentrated among subjects without specialist involvement, DMARD exposure or serological data, accounting for most false-positive diagnoses. Internal validation demonstrated modest residual misclassification when DMARD exposure alone was used, particularly in subjects without specialist involvement. SNOMED-coded RA diagnoses in primary care demonstrate high PPV, but reliance on coding alone may lead to misclassification. Adoption of validated case definitions, alongside refinement of diagnostic coding practices, is essential to support accurate epidemiology research and health service planning.
Chronic limb threatening ischemia (CLTI) in older adults is associated with severe morbidity and high mortality. The rising prevalence is largely driven by the aging population and confronts healthcare systems with challenges like increasing demand for chronic care, staff shortage and rising healthcare costs. To improve post-operative outcomes and reduce the burden on healthcare systems, multimodal prehabilitation has gained interest and has the potential to improve post operative outcomes. However, evidence of the effect in older adults with CLTI remains scarce. The aim of this study is to determine whether a multimodal multicomponent prehabilitation program (MMPP) reduces length of stay and improves clinical, patient-reported and economic outcomes of older adults with CLTI. We developed a multicenter randomized controlled trial, with embedded cost-effectiveness analyses.. CLTI-patients aged 65 years or older, planned for revascularization, and their primary informal caregiver (IC) will be eligible. A total of 300 patients will be randomized to receive either standard preoperative care or a 2-week MMPP. All patients receive a general health screening. The MMPP includes physiotherapy and, if indicated, referral to a geriatrician, dietician or smoking-cessation coach, ferric carboxymaltose infusion or pre-arranged homecare. The primary outcome is length of stay. Exploratory secondary outcomes include minor complications, quality of life of patient and IC and health related quality of life. Descriptive secondary outcomes include 30-day and 6-month mortality, major complications, readmissions, burden on the IC, cost-effectiveness; and experiences and preferences regarding shared decision making. To the best of our knowledge, this is the first randomized controlled trial to evaluate the effect of an MMPP within older CLTI-patients. Findings will inform healthcare professionals whether an MMPP should be implemented in routine vascular surgical practice to reduce length of stay and improve clinical and patient-centered outcomes. The study is registered at the International Clinical Trials Registry Platform (NL-OMON58069).
Diabetes is a major health concern in Malaysia, yet no comprehensive review has assessed the quality of care for these patients. This study aims to systematically review published evidence on type 2 diabetes mellitus (T2DM) management in Malaysian primary health care (PHC), focusing on the achievement of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL-C) targets (ABC control). A scoping review was conducted, involving a comprehensive search of four databases (PubMed, Embase, Scopus, and MyMedR) and grey literature for publications up to December 2024. Studies were included if they reported on at least one ABC indicator among the general adult T2DM population in Malaysian PHC settings. The scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. EndNote was used for deduplication, and Rayyan was utilised for the screening process. Data were extracted and synthesised narratively. A total of 109 publications were included. Publications increased post-2010 but remained geographically concentrated in urban states. Large-scale studies heavily relied on the National Diabetes Registry. HbA1c was the most reported indicator. Findings revealed no evidence of improvement in HbA1c and BP control over two decades; achievement rates were 30-45% for HbA1c (<7.0%) and 20-50% for combined BP target (<130/80 mmHg). Conversely, LDL-C control (≤2.6 mmol/L) showed a modest improvement, with achievement rates rising from approximately 30% to 50% over a decade. Despite a substantial increase in research, the HbA1c and BP control for T2DM in Malaysian PHC has remained static and suboptimal, highlighting a persistent gap between clinical guidelines and real-world outcomes. The modest improvement in LDL-C suggests that progress is achievable. These findings underscore the need for a balanced policy focus on all three ABC indicators, strategies to overcome systemic barriers, and continued investment in the national registry to guide evidence-based improvements in diabetes care.
Pacific peoples experience significant health inequities. National health data often aggregate diverse Pacific communities into a single category, potentially masking important differences in social-context health needs between subgroups. This study aimed to describe the epidemiology and health indicators of Pacific Peoples enrolled at Pegasus Health Primary Health Organisation (PHO), Waitaha Canterbury, Aotearoa New Zealand (NZ), from the five largest ethnic subgroups: Samoan, Tongan, Cook Islands Māori, Niuean, and Fijian peoples. This cross-sectional study used anonymised administrative data from Pegasus Health PHO, NZ. All enrolled patients with Pacific ethnicity recorded at any level were identified (n = 14,209). Demographic characteristics, socioeconomic deprivation, smoking status, and diabetes diagnoses were analysed by ethnicity using descriptive statistics. Samoan patients comprised 52.8% of Pacific peoples enrolled (n = 7,498), followed by Fijian (18.4%), Tongan (14.3%), Cook Islands Māori (11.2%), and Niuean (3.4%). The population was predominantly young (mean age ranged from 27 to 32 years). Socioeconomic deprivation varied substantially: 33% of Samoan and 25% of Tongan patients lived in the most deprived areas (quintile 5), compared to 17% of Fijians who lived in quintile 5. Smoking prevalence ranged from 7.2% (Fijian) to 13.1% (Cook Islands Māori). Diabetes ranged from 5.5% (Cook Islands Māori) to 9.3% (Samoans). Substantial heterogeneity exists across Pacific subgroups in Canterbury regarding demographics, socioeconomic circumstances, and key health indicators. Disaggregated ethnicity data reveal distinct patterns that are obscured when Pacific peoples are treated as a single homogeneous group. This has important implications for targeting health services and designing interventions to achieve health equity.
The primary purpose of developmental care, the core requirement of premature infant care, is to provide a demand-central care model that reduces pressure in the environment to assist preterm infants in neonatal intensive care units (NICUs). While developmental care is the care aim of NICUs, no validated measures are currently available in Taiwan to evaluate the developmental care ability of nurses. To improve the quality of care provided to preterm infants and strengthen the on-the-job education received by nurses, the current status of relevant competencies in NICU nurses must be elucidated. In this study, the original English version of the Developmental Support Competency Scale for Nurses (DSCS-N) developed by the Korean scholars Kim and Shin was translated into a Traditional Chinese version (DSCSN-TC) and evaluated for reliability and validity. The DSCS-N was translated using the Brislin translation model and cross-cultural equivalence was reviewed using the Jones process. Content validity (including content relevance and item clarity) was subsequently verified. Reliability and validity were assessed using descriptive statistics, confirmatory factor analysis, item analysis, and internal consistency reliability. Convenience sampling was used to enroll 153 nurses (N = 153) as participants, all of whom had worked for more than one year in a NICU at one of three medical centers. The 19-item DSCSN-TC has a total possible score range of 19 to 76. Content Validity Index, evaluated by eight experts, was .92. The mean total score was 64.91 (SD = 7.61). CFA confirmed a good fit for the six-factor structure: CFI = .935, TLI = .919, RMSEA = .063, and SRMR = .05. The Cronbach's alpha values for the six factors were: interaction (.717), critical thinking (.833), parental support (.676), professional development (.762), partnership (.784), and environmental support (.688). The overall Cronbach's alpha for the scale was .935. The findings show the DSCSN-TC to be a reliable and valid measure when applied in either research or clinical settings to evaluate developmental care competency in nurses. Based on the preliminary testing results, the original instrument was further refined and evolved into a DSCSN-TC 2.0 version with the aim of providing an even more precise assessment of the developmental supportive care competence of nursing staff. 中文版護理師發展性照護能力量表之信效度檢驗. 發展性照護旨在提供以早產兒需求為中心的照護模式，藉由降低環境的壓力以協助早產兒在新生兒加護病房中穩定成長，此為早產兒照護的核心理念。然而國內甚少使用測量工具評估護理師的發展性照護能力。為了增進早產兒照護品質及加強護理師在職教育，確認護理師發展性照護能力之現況實乃必要，經系統性文獻搜尋，發現源自韓國Kim及Shin發展之護理師發展性照護能力量表（Developmental Support Competency Scale for Nurses, DSCS-N）符合臨床需求。. 本研究旨在將DSCS-N量表中文化，並進行其信效度檢驗。. 採用Brislin翻譯模式將量表翻譯成中文，並以Jones流程進行文化對等性檢視，隨後進行內容效度檢驗（內容適用性及文字清晰度），驗證性因素分析、項目分析及內在一致性等方式進行信效度驗證。. 經8位專家評估內容效度指標為.92，本研究採方便取樣納入3家醫學中心之新生兒加護病房年資滿一年以上之護理師共153位。此量表共19題，總分為19–76分，平均總分數為64.91分（SD = 7.61）；以驗證性因素分析證實六因素架構有良好適配：比較性配適指標值為.935、非規範配適指標值為.919、近似均方根誤差值為.063、標準化均方根殘差值為.05；6個因素分別命名為互動、批判性思考、父母支持、專業發展、夥伴關係及環境支持，整體量表之Cronbach's alpha為.935，其次量表則是介於.676– .833。. 顯示中文版護理師發展性照護能力量表（Development Support Competency Scale for Nurses- Traditional Chinese Version, DSCSN-TC）具良好之信效度，可於臨床或研究中測量護理師之發展性照護能力；本研究根據初步測試結果，已針對原工具進行修訂，演進為DSCSN-TC 2.0版本，期能更精確地評估護理人員之發展性支持照護能力。.
This study aims to investigate the factors influencing the impact of healthcare team collaboration on vaccination status among patients with Chronic Obstructive Pulmonary Disease (COPD) in primary care settings in Beijing, China. A multicenter cross-sectional survey was conducted among members of family doctor teams in Beijing from October to December 2025. A structured questionnaire assessed team collaboration behaviors, influencing factors, guideline awareness, and vaccination practices. Descriptive statistics and chi-square tests were performed. A total of 209 valid responses were included (response rate: 92.07%). Although 57.9% of participants supported shared responsibility for vaccination, only 24.9% reported frequent team discussions, and 9.1% reported none in the past three months. Unstable vaccine supply (M=2.83) and limited performance incentives (M=3.76) were key barriers. While 66.5% of respondents were familiar with relevant guidelines, only 44.5% consistently provided strong vaccination recommendations in clinical scenarios. Patient hesitancy was primarily attributed to concerns about side effects (69.4%). Most respondents (67.0%) estimated vaccination coverage among COPD patients to be below 30%. A substantial gap exists between guideline awareness and implementation of vaccination in primary care COPD management. Limited team communication, inadequate system support, and patient hesitancy jointly constrain vaccination uptake. Strengthening structured team collaboration, improving incentive mechanisms, and enhancing scenario-based guideline training may help improve vaccination coverage in this population.
Health services increasingly face decisions about how to integrate immersive technologies into routine practice. International guidance highlights the need for structured governance in digital health, yet extended reality (XR) initiatives are often launched through isolated pilots without a clear assessment of organizational readiness or implementation risk. Although factors influencing XR adoption are well documented, health care organizations and system-level decision-makers still lack practical, governance-oriented tools to translate these determinants into structured strategic decisions made before implementation. This study aims to develop multicriteria decision analysis for extended reality (MCDA-XR), a strategic governance framework that translates behavioral, organizational, and technical implementation determinants into a structured decision-support process for health care organizations. The study followed a sequential mixed methods design covering the first 2 phases of a 3-stage framework development and validation project. Phase 1 (identification) defined strategic criteria by integrating theoretical perspectives on organizational complexity, behavior change, technology acceptance, and immersive safety, together with a targeted review of XR implementation evidence. Phase 2 (construction) refined the framework through participatory sessions. A multidisciplinary group of 33 stakeholders, including professionals and managers from hospital and primary care settings, and postgraduate students, evaluated the proposed criteria for strategic relevance and operational clarity. This process resulted in a refined 10-criterion structure and the establishment of a dual-score assessment logic. Phase 3 (validation), planned as a subsequent step, will examine how the framework performs when applied prospectively in clinical settings. The development process yielded a framework comprising 10 operational criteria grouped into 3 conceptual domains (human, organizational, and technical). Stakeholder ratings indicated high strategic relevance across all criteria, with mean scores ranging from 4.03 (SD 0.95) for workflow integration to 4.61 (SD 0.56) for safety and comfort. The final instrument applies a dual-assessment approach in which each criterion is rated separately for strategic importance and organizational readiness. Mapping these dimensions enables organizations to identify priority gaps, particularly areas of high importance and low readiness, and to distinguish between manageable constraints and critical barriers requiring targeted preparatory action prior to implementation. MCDA-XR addresses a key governance gap in XR implementation by providing a structured way to align adoption decisions with institutional priorities and operational constraints. Rather than relying on descriptive feasibility assessments, the framework is intended to support explicit prioritization and action-oriented decision-making at the organizational level. MCDA-XR is positioned for Phase 3 evaluation, which will examine the practical utility, interpretability, and implementation relevance of the framework when applied prospectively in real-world clinical deployments.
This article reviews the historical development and current challenges of pharmacy education in Japan, focusing on structural reform and the shift toward competency-based education. The 1992 revision of the Medical Care Act and the 1993 sorivudine incident heightened awareness of medication safety and accelerated expansion of pharmacists' clinical responsibilities, prompting educational reform. In 2006, a six-year pharmacy education program (6-YP) was introduced as the primary pathway to pharmacist licensure, while a four-year program (4-YP) was retained for research-oriented training. The Model Core Curriculum (MCC) standardized pharmacy education nationwide. The 2013 revision defined ten graduation-level competencies, reflecting an outcome-based framework. The 2022 MCC further reconceptualized competencies as capabilities that develop longitudinally across the professional lifespan and strengthened alignment with medical and dental education, public health perspectives, research literacy, and digital competencies. Pharmacist licensure in Japan is granted for life, and continuing education is not legally mandated. Although multiple voluntary certification systems promote advanced practice, variability among programs has raised concerns regarding transparency and standardization. Establishing a nationally coordinated continuing professional development framework and promoting lifelong competency development remain key priorities in response to technological innovation and evolving healthcare needs.
Critical care nurses work in demanding clinical environments where professional values, staffing conditions, ethical climate, workload and burnout may influence job satisfaction. Understanding these relationships is important for supporting nurse retention and stable, safe intensive care practice. To assess professional nursing values, perceived work environment, and job satisfaction among critical care nurses in Palestine. This descriptive cross-sectional study included 263 nurses working in critical care units across 15 hospitals in the West Bank, using a convenience sampling approach, with a response rate of 87.7%. Job satisfaction was treated as the primary dependent variable. Descriptive statistics, multiple linear regression, and mediation analyses were performed using SPSS 26.0. Nurses reported strong professional values (116.25 ± 9.55), moderate perceptions of the work environment (2.42 ± 0.30) and moderate job satisfaction (89.17 ± 10.57). Work environment was the strongest predictor of job satisfaction (β = 0.576, p < 0.001), while workload (β = -0.166, p = 0.021) and intention to leave (β = -0.163, p < 0.001) were negative predictors; the model explained 47.4% of variance. Mediation analyses indicated significant indirect association between professional values and job satisfaction through work environment (B = 0.152), between the work environment and intention to leave through job satisfaction (B = -0.533), and between workload and intention to leave through job satisfaction (B = 0.082; All p < 0.001). Professional values were indirectly associated with job satisfaction through the perceived work environment. However, workload and intention to leave were associated with lower satisfaction. These findings highlight the need for adequately staffed, collaborative, well-resourced critical care environments, including workload monitoring, shared decision-making, supportive leadership and nurse recognition systems. Nurse Managers should monitor workload, ensure adequate nurse-patient ratios, involve nurses in unit-level decisions, provide recognition and strengthen interprofessional collaboration in critical care units. No Patient or Public Contribution.
Fever is one of the most common symptoms in children and a leading cause of their hospitalisation. Nurses, as primary caregivers in paediatric wards, play a pivotal role in the assessment and management of children with fever. However, nurses' perceptions and experiences of fever management are influenced by cultural contexts, psychological and social factors, as well as prevailing health system policies. The aim of the study was to explore nurses' perceptions influencing their management of childhood fever, including barriers and facilitators to evidence-based practice. A qualitative descriptive design using a conventional content analysis approach. Nineteen nurses working in paediatric wards participated in individual semi-structured interviews conducted between March 20, 2024 and May 20, 2025. Purposive sampling was used to recruit participants with direct experience in managing fever in children. Data were audio-recorded, transcribed verbatim and analysed inductively using qualitative content analysis as described by Graneheim and Lundman. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Data analysis resulted in the extraction of one main theme titled 'Navigating Uncertainty and Psychological Strain in Pediatric Fever Management' and five main categories. Nurses described challenges related to the absence of locally adapted clinical guidelines, lack of continuous education, hierarchical dependence on physicians, fever phobia and misconceptions, which led to non-evidence-based decision-making and unnecessary interventions. The findings underscore the need for developing culturally appropriate local clinical guidelines, implementing evidence-based continuous educational programmes, enhancing nurses' professional autonomy and providing effective family education. These interventions can improve care quality, reduce nurses' occupational anxiety and ultimately enhance child health outcomes. Understanding nurses' experiences and challenges may inform the development of educational interventions, localised clinical guidelines and organisational strategies to improve the quality and consistency of fever management in children. What problem did the study address? ◦The study addressed the gap between evidence-based fever management guidelines and actual nursing practice in paediatric settings. What were the main findings? ◦Nurses' clinical decision-making was influenced by fear of complications, parental expectations, organisational factors and contextual factors. Where and on whom will the research have an impact on? ◦The findings may impact paediatric nurses, healthcare administrators and policymakers by informing strategies to support evidence-based fever management in hospital settings. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. No patient or public contribution: Patients or members of the public were not involved in the design, conduct, reporting or dissemination plans of this research, as the study focused on nurses' professional experiences.
To investigate whether eligibility for Veterans Health Administration (VA)-purchased community care, which expanded Veterans' access to care outside VA, was associated with increased polypharmacy or potentially inappropriate medication use among older adult Veterans. Regression discontinuity design, leveraging the distance threshold for community care eligibility (residing > 40 miles from the nearest VA facility with ≥ 1 or more full-time primary care physician), to examine the effects of community care eligibility on polypharmacy and potentially inappropriate medication use among Veterans aged ≥ 65 years. VA pharmacy data for all prescriptions filled at VA facilities, VA Program Integrity Tool files for prescriptions paid by VA and filled in community pharmacies, and Medicare Part D data. Analyses included annual cross-sectional samples of Veterans 36-39 miles or 41-44 miles from their nearest VA facility during FY 2016-2019. The sample included 399,250 Veteran-year observations, of which 226,157 (56.6%) were 36-39 miles and 173,093 (43.4%) were 41-44 miles from the nearest eligible VA facility. Overall, we observed no discontinuities across the 40-mile threshold in the number of unique medications filled annually (-0.06 medications; 95% confidence interval [CI], -0.15 to 0.03). There were no discontinuities in proportions of Veterans filling ≥ 5 unique medications (-0.25 percentage points [pp]; 95% CI, -0.84 to 0.34), ≥ 10 medications (-0.55 pp.; 95% CI, -1.24 to 0.14), ≥ 1 medication on the Beers list (-0.02 pp.; 95% CI, -0.63 to 0.59), or ≥ 1 high-risk drug-drug interaction (-0.05 pp.; 95% CI, -0.17 to 0.07). Among Veterans with mental health conditions, exceeding the 40-mile threshold was associated with a higher likelihood of filling ≥ 10 unique medications annually (2.06 pp.; 95% CI, 0.42 to 3.70). We did not observe clinically or statistically significant discontinuities in other subgroups. Overall, eligibility for VA-purchased community care was not associated with increased polypharmacy or potentially inappropriate medication use among older adult Veterans.