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The Indiana Complex Care Coordination Collaborative (IC4) is a statewide model of care coordination design to enhance the quality of medical care for children with medical complexity (CMC) by training and embedding nurse care coordinators in primary care practices. This study examines the impact of IC4 care coordinators on caregivers' and patients' quality of medical care, access to medical and community resources, care workload, and the quality of life of caregivers and CMC. Caregivers of CMC (n = 13) completed one-hour semi-structured interviews focused on met/unmet needs, quality of medical care, co-developed shared plan of care, caregiver/patient quality of life, caregiver workload, and medical home experience. Using NVIVO, researchers used a codebook to conduct an inductive thematic analysis of the interview transcripts. The thematic analysis was revealed five overarching themes: (1) central role of the care coordinator, (2) proactive and personalized support, (3) care across the lifespan, (4) emotional support, and (5) navigating healthcare systems. Caregivers reported that they considered their care coordinator a trusted health professional who can advocate for them with other health professionals. Families appreciated that the shared plan of care created with the care coordinator can be easily disseminated to other healthcare and service professionals, as well as other family members, and helps the patients and families be seen as individuals, not just as a medical record. Care coordination can address unmet needs and greatly improve the quality of and access to care received by CMCs and their families. Unanimously, caregivers report the substantial instrumental, informational, and emotional support care coordinators (CCs) provide to access medical systems, resources, planning, and reduce patient care workload. Additionally, several caregivers reported substantial social support from the CC. However, several caregivers still reported feelings of loneliness and difficulties engaging with families without CMC.

Migrants frequently encounter significant stressors during their migration journey, which can adversely affect their mental health. The rising prevalence of mental ill-health among migrant populations is an increasing public health concern. Primary healthcare services are crucial in addressing both the physical and mental health needs of migrants with pre-existing mental ill-health diagnoses. However, it is essential to understand the factors that facilitate and hinder access to primary healthcare services for this population. This scoping review sought to identify factors that enable and hinder migrants with pre-existing mental ill-health diagnoses when accessing primary healthcare services. This scoping review followed the Joanna Briggs Institute methodology as it facilitates the inclusion of all relevant information that has not previously been combined and helps to identify gaps in existing literature as a means of informing future research. A systematic search of five electronic databases, Medline, CINAHL, PsycINFO, ASSIA, and Web of Science, was conducted between 2014-2024. Thirteen studies met the eligibility criteria and were synthesised using narrative synthesis. The findings reveal that migrants with pre-existing mental ill health diagnoses face significantly more barriers than enablers when accessing primary healthcare services. Notably, the interrelated barriers illuminate a lack of culturally appropriate alignment of primary healthcare services to address the diverse range of physical and mental healthcare needs of migrants living with pre-existing mental ill health. This scoping review offers an overview of the existing literature on the enablers and barriers faced by migrants with pre-existing mental ill-health when accessing primary healthcare services. The findings illuminate the complexities that migrants with a pre-existing mental ill-health diagnosis experience when accessing primary healthcare services. There is a need to tailor primary healthcare services to adequately meet the unique needs of migrant populations living with a pre-existing mental ill-health diagnosis.

People with intellectual disabilities often have complex healthcare needs and may therefore experience different patterns of healthcare utilization. This study examined the overlap between the use of public and private healthcare providers as an indicator of access to choice-enabled healthcare providers within a patient-choice-based health system. We assessed overlap in two complementary ways: among people with at least one private healthcare contact and among those with at least one public healthcare contact in a cohort of people with intellectual disability (ID cohort) and a referent cohort from the general population (gPop cohort). The ID cohort comprised 2 813 children and 9 079 adults, whereas the gPop cohort comprised 146 048 children and 982 186 adults. Data regarding healthcare contacts in public and privately organized healthcare were collected from the Skåne Healthcare Register. Among those with at least one contact in privately organized healthcare, both children and adults with intellectual disabilities were as likely as those in the general population to also have contacts in public primary healthcare and public somatic specialist care. However, they were more likely to have contacts in public psychiatric specialist care. Among those with at least one contact in public healthcare, children with intellectual disabilities were as likely as their age peers in the general population to also have contacts in privately organized healthcare. However, adults with intellectual disabilities were less likely than their age peers to have contacts in privately organized healthcare. These findings have important implications for patient‑choice‑based health systems. They indicate that formally available provider choice does not result in similar patterns of utilisation across populations. Also, that adults with intellectual disabilities may face challenges in navigating and using privately organised providers within such systems. The prominent role of public psychiatric specialist services further highlights the continued importance of publicly provided specialist care for this group. Together, the results underscore the need for patient‑choice‑based healthcare systems to be designed and implemented in ways that support accessibility, coordination, and navigation for people with intellectual disabilities, particularly adults with complex healthcare needs and during periods of healthcare disruption.

Primary care patients can benefit from counseling to address unhealthy lifestyle habits. Despite this, evaluations most often note that primary care facilities are not using the full potential of healthy lifestyle counseling methods. Studies comparing prevention efforts in different countries generally find substantial differences between countries. Quantitative studies carried out in a project targeting health professionals and patients in the U.S. and Sweden have demonstrated considerable differences between the two countries. In particular, U.S. health care professionals were found to be more engaged in lifestyle counseling than their Swedish counterparts. The aim of this qualitative study was to more fully explore and compare U.S. and Swedish primary care physician's views on and involvement in promoting healthy lifestyles. In total, 28 tape-recorded, semi-structured interviews were carried out with Swedish and U.S. primary care physicians. Data were analyzed using a combination of inductive and deductive qualitative content analysis approaches. Primary care physicians in both countries viewed addressing lifestyle habits like smoking, lack of physical activity and poor diet as important, but their level of commitment ranged "from dedicated to merely doing one's duty". This overarching theme was reflected across categories concerning role responsibility, client receptiveness and perceived impact, self-efficacy, supporting mechanisms, and working conditions. U.S. physicians were generally more engaged in promoting healthy lifestyles and described more structured routines and greater personal responsibility, whereas Swedish physicians more often relied on referral options and shared responsibility across professional groups. In both countries, lifestyle change was seen as difficult, and physicians' involvement was shaped by confidence, skills, time, and available support. Limited resources and constrained working conditions, particularly lack of time, were barriers contributing to doubts about the effectiveness of counseling efforts. There was consensus in both countries about addressing lifestyle habits as an integrated part of their role as primary care physicians. The study suggests that physicians were uncertain about the effectiveness of their interventions concerning unhealthy lifestyles, implying a need for further dissemination of the latest evidence for such interventions. Physicians requested a team approach for promoting healthy lifestyles with a clearly defined role for physicians in these efforts.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by impairments in social communication and restricted or repetitive behaviors. In Malaysia, timely identification within routine primary care services remains challenging, particularly outside major urban centres. This study examined factors associated with ASD diagnosis among children attending government primary care clinics in Kelantan to inform strategies for strengthening primary care developmental surveillance. A clinic-based cross-sectional study was conducted from March to September 2025 in five districts. Using purposive sampling, 207 children aged 18 months to 12 years were recruited during routine clinic visits, developmental presentations and primary care visits. Sociodemographic and clinical data were captured via a structured proforma. All enrolled children underwent Sensory-Behavior Profile screening followed by clinical assessment utilizing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria regardless of screening result. Simple and multiple logistic regression were applied to examine associations between child and parental characteristics and ASD diagnosis. Of the 207 children analysed, 29 were newly diagnosed with ASD during the study assessment and 178 were classified as non-ASD. In the multivariable analysis, two factors remained independently associated with ASD diagnosis. Older age at assessment was associated with higher odds of ASD diagnosis (aOR 1.30, 95% CI 1.10,1.55; p = 0.003), a finding that likely reflects later recognition, presentation, referral, or diagnostic confirmation within primary care pathways rather than an etiologic risk factor. First-born children were more likely to have an ASD diagnosis than second- or later-born children (aOR 2.48, 95% CI 1.08,5.71; p = 0.033). These findings support the strengthening of primary care developmental surveillance through consistent routine screening, improved clinician competency in developmental surveillance, increased parent awareness, and clear, time-bound referral pathways linked to timely assessment capacity within routine child health services.

In the transition from compensated to decompensated cirrhosis, median survival decreases from 12 to two years, and patients face some of the highest rates of unplanned hospital admissions. Despite existing recommendations, palliative care is not routinely offered to this population. The aim of this study is to evaluate the effectiveness and implementation of an interdisciplinary palliative care intervention for patients with cirrhosis and their informal caregivers. The LiverCare study is a multi-center, mixed-method, pragmatic, non-randomised clinical study with a hybrid type 1 effectiveness-implementation design. The study is conducted in hepatology departments across four hospitals in three of Denmark's five regions. It is guided by the British Medical Research Council and Reach, Effectiveness, Adaption, Implementation, Monitor frameworks and includes both a feasibility study and a mixed-method process evaluation. The LiverCare intervention is grounded in a palliative approach, emphasising open, exploratory palliative care conversations. The intervention is integrated into routine outpatient care and the palliative care conversations are delivered by hepatologists and liver nurses who attended a specially designed course within palliative care. Eligible participants are adults with decompensated liver cirrhosis of any etiology who meet at least one general and one disease-specific palliative care indicator, assessed using the Supportive and Palliative Care Indicators Tool. Informal caregivers are invited to participate in the intervention. Palliative care conversations are initiated following a formal invitation and continue after four to ten weeks and then every six months up to 36 months or until study withdrawal or death. The primary outcome is healthcare utilization, defined as the number and length of hospital admissions, compared to a historic cohort. Secondary outcomes include outpatient contacts, symptom burden, quality of life, and caregiver burden. The study also includes cost-effectiveness and cost-utility analysis. Insights gained from the study will inform future implementation strategies and contribute to the advancement of palliative care practices in hepatology. The results will further support education, training, and competence development for healthcare professionals caring for patients with advanced liver disease. The study is registered on clinicaltrials.gov (NCT05431946), approved by The Danish Data Protection Agency and reported to the Committee on Health Research Ethics (20222000-31).

Diabetic foot is one of the most severe complications of diabetes mellitus, with physical, psychological, social, and economic consequences. Evidence suggests that up to 75-80% of diabetic foot complications are preventable through appropriate preventive care. Although structured preventive protocols, such as the Diabetic Foot Program, have been adapted for the primary care in Spain, their integration into routine clinical practice remains suboptimal. This paper describes the protocol for the iMplanta study, which aims to evaluate the effectiveness of an implementation strategy for the Diabetic Foot Program in primary care. The iMplanta study is a two-arm cluster randomized controlled trial to be conducted in 20 primary care centres (PCCs) in Mallorca (Balearic Islands, Spain). PCCs will be randomly allocated (1:1) to either an intervention group or a control group. The intervention group will receive a structured implementation strategy for the Diabetic Foot Program developed using the Implementation Mapping framework, while the control group will continue with usual care, applying the Diabetic Foot Program without additional implementation support. Data will be collected at three time points: baseline (covering the 12 months prior to study initiation) and 6 and 12 months post-implementation. Implementation outcomes will be evaluated using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), complemented by Proctor et al. implementation outcomes (acceptability, feasibility, and appropriateness). This study will generate evidence on how to effectively implement a preventive Diabetic Foot Program in real-world primary care. By applying implementation science principles, iMplanta aims to inform sustainable and transferable implementation strategies to increase uptake of evidence-based diabetic foot prevention and improve care delivery for people living with diabetes. Prospectively registered on ClinicalTrials.gov, no. NCT07004179. Date of registration February 20, 2025.

Multimorbidity, the coexistence of multiple chronic conditions, poses significant challenges to patients, particularly in low- and middle-income countries (LMICs) like India. Limited research has been done to understand the patient treatment burden and capacity from India, which is essential to design and implement effective interventions for managing multimorbidity. We explored the barriers and facilitators to patient capacity for managing multimorbidity in primary care settings in Kerala, India. We conducted a qualitative study using semi-structured interviews with patients diagnosed with two or more chronic conditions (n = 42) seeking care in primary care settings in Kerala. Data were analysed thematically using two conceptual frameworks of treatment burden and patient capacity: Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) as theoretical lenses. Our findings show that the complexity of conditions, financial constraints, and cultural practices were barriers to patient capacity. Facilitators that contributed to patient capacity were social support, accessible healthcare, and a positive attitude towards health. Primary care services provide selective care for patients with multimorbidity, leading to treatment burdens outweighing patient capacity. Financial constraints further impacted participants' ability to access out-of-pocket medications. This study highlights how the complexity of multimorbidity and financial constraints in primary care settings in Kerala influences patient capacity. Understanding how treatment burden and patient capacity influence patients in India and similar LMIC settings will enable the design of interventions that enhance patient capacity and reduce treatment burden within the cultural and health system context.

Globally, chronic wounds resulting from diverse etiologies impose a significant physical, psychosocial, and economic burden and have remained a highly neglected public health challenge. Yet, people in rural Ethiopia have limited access to quality and comprehensive wound care. There is a marked paucity for an integrated, holistic care model in the primary healthcare settings. Hence, this study aimed to develop a context-tailored, integrated, holistic, chronic wound care package in Ethiopia. A multi-method approach was applied, including a scoping review, formative assessments, Theory of Change workshops and a qualitative validation study. Purposive sampling was employed to recruit participants. Collected data were transcribed, coded, and thematically analysed to generate insights for refining the intervention package. A total of 49 stakeholders participated in the Theory of Change (ToC) workshops, while 36 participants were included in the qualitative study. The intervention package is structured around six core thematic components: awareness-raising and stigma reduction, capacity-building, active case detection and follow-up, program and supply chain management, Institutional and community-based rehabilitation, monitoring, and evaluation. Implementation and scale-up of these components are designed to cascade across three levels of the existing primary healthcare system, specifically the health organization, the health facility level, and the community level. This study introduced a context-driven, integrated, and holistic wound care package aimed at managing chronic wounds alongside their associated mental health and psychosocial challenges. The package encompasses interventions that address the physical, psychological, and social impacts of chronic wounds in individuals affected by neglected tropical diseases of the skin and related conditions. It employs multilevel implementation strategies targeting individuals, communities, and the health system to reduce morbidity, disability, and the economic and psychosocial burdens linked to chronic wounds. This standardized, scalable, and sustainable care model provides a promising approach for Ethiopia and other low- and middle-income countries.

Students can practice learning in an interprofessional environment during their education in order to enable a well-functioning cooperation between healthcare professions. The aim of interprofessional learning (IPL) is for all students to contribute with their expertise and work in teams under supervision, which has been shown to improve their understanding of their own and each other's roles. However, previous research in interprofessional learning in primary healthcare is limited. The aim of the study was to describe and explore interprofessional learning in primary healthcare from the perspectives of patients, students, and supervisors. A mixed method approach was used with 35 participants (14 students, 16 patients and 5 supervisors) in a convergent design. Data collection and the analysis of questionnaires and interviews were conducted simultaneously. The responses to the questionnaires were analysed descriptively, and the interviews were analysed thematically. The results, based on the perspectives of the patients, students, and supervisors, showed that IPL supported the students in focusing on the patient and contributed to a patient-centred approach. The interprofessional learning of the students evolved gradually through an increased responsibility in the cooperation. In order to balance individual and collective learning, the supervisors could take a step back to support the students' pursuit of independence. These findings suggest that IPL could improve and develop quality in primary healthcare. The results of the present study emphasize that the patient perspective plays an important role in students' interprofessional learning as it contributes to a holistic approach and perspective in healthcare. The supervisors play an important role in structuring the IPL, acting as role models, nurturing cooperation between the students and being responsible for patients' safety.

The Ministry of Health (MOH) has introduced the Virtual Consultation Service (VCS) in government health clinics in Malaysia since 2019, to connect patients and healthcare providers virtually using video conferencing platforms such as Google Meet, MySejahtera and Health Information Exchange. Despite being the largest rollout of telemedicine in the country and MOH's planning to scale up the service in public primary care, little is known about patient satisfaction and its contributing factors towards the VCS. Therefore this study aimed to determine patient satisfaction with VCS in public primary care and its associated factors. A cross sectional study was conducted among patients who attended outpatient service at selected government health clinics in West and East Malaysia using online data collection. A total of 411 patients were recruited through stratified and systematic random sampling by using a Malay-validated Telehealth Usability, Acceptability, and Satisfaction Questionnaire (TUASQ). Data were analysed using simple and multiple linear regression. Patients reported a relatively high mean satisfaction score for VCS (20.87 out of 25; SD&#x2009;=&#x2009;3.61), indicating generally positive perceptions of the service. Adjusted model revealed that acceptability has emerged as the strongest predictor of satisfaction (&#x3b2;&#x2009;=&#x2009;0.410, p&#x2009;<&#x2009;0.001), followed by usability (&#x3b2;&#x2009;=&#x2009;0.382, p&#x2009;<&#x2009;0.001), explaining 89.4% of the variance in satisfaction scores. Patients were highly satisfied with VCS in Malaysian public primary care using multiple virtual platforms. Acceptability and usability of VCS were determinants of satisfaction, indicating that patients value ease of use, convenience, privacy and quality interaction beyond their demographic characteristics. Policymakers should leverage these study findings to guide the scale-up and optimisation of this health service in the future.

Community-based hepatitis B virus (HBV) screening programs are widely used to identify chronic infection in high-risk immigrant populations in the United States. However, screening alone does not ensure engagement in care, and the processes that determine progression from diagnosis to sustained clinical management remain poorly characterized. In particular, there is limited longitudinal evidence evaluating real-world implementation across the full HBV care continuum. We conducted a RE-AIM-based implementation evaluation of a longstanding community-based HBV screening and education program among Korean American immigrant communities in the northeastern United States from 2009 to 2016. Through 152 outreach events, we delivered culturally and linguistically tailored education, venipuncture-based serologic testing, direct disclosure of results, and referral to care. Using prospectively collected programmatic data, we assessed reach, operational yield, and attrition across the care continuum among individuals testing positive for hepatitis B surface antigen (HBsAg), with longitudinal follow-up of up to eight years. Among 8,453 individuals screened, 204 (2.4%) were HBsAg positive. Of these, 121 (59.3%) had longitudinal follow-up data available, and 71 (58.7%) accessed clinical care, corresponding to 34.8% of all HBsAg-positive individuals. Most participants who accessed care received follow-up through private community-based outpatient practices (64/71; 90.1%) rather than centralized systems. Approximately 42 individuals required screening to identify one case, and 104 to achieve one confirmed linkage to care. Substantial attrition occurred between diagnosis and initial clinical engagement, representing the primary loss point in the care continuum. Lack of health insurance was the most frequently reported structural barrier. Community-based HBV screening effectively identifies individuals with chronic infection but does not ensure completion of the prevention pathway. This study provides longitudinal, real-world evidence quantifying attrition across the HBV care continuum and demonstrates that prevention is an implementation-dependent process requiring sustained engagement beyond initial screening. Strategies that integrate screening with patient navigation, longitudinal follow-up, and improved access to care are needed to enhance linkage to care and clinical outcomes in high-risk populations.

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately impacted by HIV and other sexually transmitted infections (STIs). Recent biomedical innovations such as HIV pre-exposure prophylaxis, STI vaccines and testing offer new prevention tools. However, realising these benefits hinges on GBM disclosing their sexuality and receiving appropriate support from healthcare providers (HCPs). We aimed to understand GBM's experiences of sexual healthcare in Aotearoa New Zealand. We conducted an inductive thematic analysis of free-text responses to the Sex and Prevention of Transmission Study, a large and diverse national cross-sectional behavioural surveillance survey of GBM in 2022. Data from 422 participants reporting negative experiences when discussing their sexuality and sexual health with HCPs were examined. Overall, 19.1% reported a negative experience discussing their sexuality with an HCP. Six themes were derived from participants' experiences. Negative reactions to GBM's sexuality and sexual health needs centred around four themes: (1) judgement and prejudice, (2) disrespect, (3) discrimination, and (4) inexperience and skill deficits. Additionally, two themes related to: (5) participants' views about how their HCP's demographic characteristics (e.g. age, gender, religion, sexual orientation) might underpin their behaviour, and (6) consequences of GBM's negative experiences (changing HCPs, forgoing sexual health services, suffering poor mental and physical health). In the era of biomedical HIV/STI prevention, GBM's ability to communicate about their sexuality and sexual health will be a key antecedent to eliminating HIV and STI transmission. Strategies spanning health workforce training and targeted service expansion are needed to improve experiences of sexual healthcare services for GBM. Heterosexist environments that underpin judgement and prejudice, disrespect, discrimination and lack of skill must be addressed; cultural competence and safety must support diverse HCPs to improve delivery; and the consequences for those whose care is compromised by negative healthcare experiences must be mitigated.

There is limited literature on educational interventions for primary care clinicians (PCC) addressing the unique considerations in opioid prescribing for older adult patients. We aimed to evaluate self-reported knowledge, confidence, and behavior change by PCC and the degree to which respondents followed through with their intentions to implement specific clinical strategies after receiving a brief educational intervention about opioid prescribing in older adults. Analysis of pre-, post-, and one-month follow-up surveys of PCC. PCC working within our institution's 13 primary care clinics. The brief educational training was conducted over 20 months and focused on limited benefits and unique harms of chronic opioid use in older adults, opioid use disorder screening, and harm reduction strategies. The surveys assessed perceived knowledge and confidence in non-opioid medication options and opioid safety strategies before and after the intervention and potential use of strategies to address opioid use in their clinical practice. The one-month follow-up survey asked if participants had started implementing opioid safety strategies with patients. We also collected information on age, gender, race, ethnicity, and health professions discipline. Sixty-five PCC received the intervention and completed the immediate post-training survey. Of these, 24 also completed the one-month follow-up survey. We found increased perceived knowledge of the effectiveness of long-term opioids for chronic pain and increased confidence in suggesting non-opioid treatment options among all participants after the training. Post-training, all but one clinician planned to implement at least one of the taught opioid safety strategies. At one-month follow-up, depending on the strategy, between 10%-78% of participants had implemented their planned strategy. Our findings show that a brief opioid-focused educational intervention for practicing PCC is associated with increased perceived knowledge and confidence immediately after the intervention and a high likelihood of implementing some of the taught strategies one month later. These findings suggest that brief trainings may be impactful educational interventions for practicing PCC.

Deep demographic ageing is triggering a twin crisis in healthcare: a rising prevalence of multimorbidity among older adults and a severe global shortage of healthcare professionals, particularly nursing staff, which together create life-threatening gaps in long-term care. Although artificial intelligence shows significant potential to alleviate these pressures by improving the efficiency and accessibility of geriatric healthcare, its integration faces critical challenges spanning systemic, user-level, and societal dimensions. This review aims to systematically analyze the current applications of artificial intelligence in geriatric healthcare, identify key barriers hindering its effective integration, and propose stakeholder-specific roadmaps. This scoping review follows the PRISMA-ScR guidelines. This review was conducted using a two-step search strategy from five databases: PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science. First, a comprehensive search was performed across five electronic databases for literature published between January 1, 2015, and September 30, 2025. Second, the reference lists of identified studies and relevant reviews were manually screened. The study selection followed the PCC framework, focusing on evidence of artificial intelligence applications, implementation challenges, and proposed solutions in geriatric healthcare. Artificial intelligence is extensively applied across five key domains in geriatrics: health monitoring and disease management, safety supervision and risk prevention, cognitive and mental health support, social interaction and emotional companionship, and daily living assistance. Despite this potential, three major barrier categories were identified: (1) Systemic fractures; (2) User-level resistance, and (3) A widening social divide. In response, the study proposes concrete roadmaps, such as mandating Fast Healthcare Interoperability Resources standards for data interoperability, establishing ethical artificial intelligence certification, deploying culturally adaptive designs, and initiating workforce upskilling programs. Artificial intelligence holds significant promise for mitigating the global geriatric healthcare crisis exacerbated by demographic aging and nursing shortages. However, realizing its full potential requires a coordinated, multi-stakeholder approach to overcome the entrenched systemic, human, and social obstacles. The proposed roadmaps provide an actionable framework that may facilitate the development of artificial intelligence systems that are more efficient, equitable, and human-centered, pending empirical validation in real-world settings. The protocol has been registered on OSF.

A review of the literature reveals that there is no descriptive epidemiological study based on the source of candidaemia in intensive care units(ICUs). In addition to that the number and scope of studies evaluating breakthrough candidaemia in ICUs are limited. The primary objective of this study was to analyse the epidemiology of candidaemia in our ICUs based on the source of each case, and the secondary aim was to evaluate breakthrough candidaemia. 141 adult patients(&#x2265;&#x2009;18 years) who had Candida spp. growth in their blood cultures 48&#xa0;h after admission to an ICU were included in the study. Statistical comparisons were made between groups for abdominal, central venous catheter and primary candidaemia. The level of significance was set at &#x3b1;&#x2009;=&#x2009;0.05. In the classification based on the sources of candidaemia, 52 (37%) were abdominal, 32 (23%) were central venous catheter-related, 55 (39%) were primary candidaemia and 2 (1%) were urinary tract-related. Total parenteral nutrition use rates were significantly lower in primary candidaemia than in abdominal candidaemia (p&#x2009;<&#x2009;0.001). Steroid use rates were significantly higher in primary candidaemia than in abdominal candidaemia (p&#x2009;=&#x2009;0.021). Mortality rates on days 14 and 28 did not differ significantly according to the source of infection. Beakthrough candidaemia rates were significantly higher in abdominal candidaemia. The acute physiology and chronic health evaluation II (APACHE-II) score at ICU admission was significantly higher in the breakthrough candidaemia(p&#x2009;=&#x2009;0.037). A significant proportion of candidemia cases in our intensive care units were non-catheter-related candidemia. Breakthrough candidaemia was found to be more common in patients with high APACHE-II scores at ICU admission and in candidaemia originating from the abdomen.

To evaluate whether intraosseous (IO) autologous bone marrow concentrate (BMC), containing mesenchymal stem cells (MSCs) enumerated in vitro as colony forming unit-fibroblasts (CFU&#x2011;F), reduces or delays conversion to total hip arthroplasty (THA) compared with matched conservative care, and to assess the influence of disease progression and CFU&#x2011;F dose on outcomes. A monocentric matched cohort (n&#x2009;=&#x2009;434 hips; 217 BMC, 217 control) was followed for up to 15 years. Bone marrow was aspirated from the iliac crest, processed into BMC to concentrate nucleated cells, and injected intraosseously into the femoral head under fluoroscopy. Demographics, BMI, osteoarthritis grade, and CFU&#x2011;F were recorded. The primary outcome was THA&#x2011;free survival by Kaplan-Meier with log&#x2011;rank testing. Cox proportional-hazard models provided adjusted effects and predictions. Progression to THA after 15 years occurred in 16.1% (35 of 217) of patients receiving IO BMC versus 40.1% (87 of 217) of control patients receiving conservative care. Kaplan-Meier curves demonstrate superior THA&#x2011;free survival with BMC overall, mild osteoarthritis, and with increased CFU&#x2011;F dose. No adverse events were observed. Revision surgeries were not performed in those receiving BMC (0 of 35), compared to an 8.0% revision rate among control patients (7 of 87). IO BMC was associated with substantially delayed progression to THA with a CFU&#x2011;F dose-response and favourable safety profile. These findings suggest that IO BMC may represent a clinically meaningful joint-preserving option for selected patients with hip osteoarthritis, particularly when performed before advanced disease progression and with higher CFU-F doses.

Rehabilitation is very crucial for the treatment of chronic illnesses; it is still not widely used in primary healthcare in low-resource countries like Pakistan. Although there is ample evidence of gaps in the health system, behavioural factors that influence provider engagement with rehabilitation services remain poorly understood, especially regarding attitudes, social influences, and a sense of control over service provision. This study investigated how providers' attitudes, societal expectations, and perceived control affected their engagement in a rehabilitative health system-strengthening initiative in Pakistan using the Theory of Planned Behavior (TPB). This qualitative exploratory study was a sub study of ReLAB-HS initiative, which sought to incorporate assistive technology and rehabilitation services into primary care. Data was collected between July and August 2024 from two Networks of Care (Thatta and Swat) from the two provinces Sindh and Khyber Pakhtunkhwa. Participants (n&#x2009;=&#x2009;61) were among the five cadres and purposefully chosen, including Lady Health Workers, Lady Health Supervisors, Primary Healthcare Providers, Rehabilitation Professionals, and members of Technical Working Group Data were analyzed using a combined inductive-deductive approach guided by the Theory of Planned Behavior (TPB), with coding and theme development conducted in Atlas.ti.24. Interviews revealed that providers' attitudes shifted from initial skepticism to recognizing rehabilitation as a crucial part of primary care, particularly after observing improvements in patient functioning. Subjective norms, reinforced through peer support and digital platforms such as WhatsApp, played a key role in sustaining engagement, although broader uptake was constrained by cultural norms and gender-related stigma. Perceived behavioral control improved with training and job aids, increasing providers' confidence to integrate rehabilitation into practice. However, persistent structural and environmental barriers including time constraints, heavy workloads, and limited access to assistive technology reduced providers perceived behavioral control and restricted sustained implementation. Despite these challenges, many providers adopted adaptive strategies to continue delivering rehabilitation services. Our findings demonstrate that attitudes, subjective norms, and perceived behavioral control collectively shaped provider engagement with rehabilitation services. Peer networks, supportive supervision, and capacity-building initiatives facilitated positive behavioral change; however, these alone were insufficient for long-term integration at the primary care level. Addressing structural barriers including weak referral systems, limited assistive technology, workforce shortages, and sociocultural stigma is essential for sustainable rehabilitation integration.

Digital health interventions are emerging as an approach to support obesity management through self-management and remote care. However, utilization, impact, and practicality remain unclear. This study aims to map research on digital health interventions for obesity management among adults, describing their characteristics, uses, and outcomes, and identifying gaps. A comprehensive scoping review following Arksey and O'Malley's methodological framework, in accordance with the Joanna Briggs Institute's guidelines and reported in line with the PRISMA-ScR guidelines, examined studies published between 2015 and 2025 across four databases: PubMed, Google Scholar, Scopus, and APA PsycNet. A total of 43 studies met the eligibility criteria. Digital health interventions for obesity encompassed consultations and education on healthy lifestyle, behavioral change strategies, physical activity, dietary management, weight goal setting, intermittent fasting, gamification, and psychological support. Digital health interventions were delivered through telehealth, mobile apps, web-based programs, multicomponent digital approaches integrating several digital tools, and hybrid models combining digital delivery with face-to-face communication. These interventions often supported by devices such as digital scales, wearable trackers, and telemonitoring units to enhance self-monitoring, adherence, and engagement. The interventions were implemented across clinical, workplace, and community settings, including adaptations developed during the COVID-19 pandemic. The included studies showed varying and inconsistently reported outcomes, with some showing significant weight loss, improvements in metabolic markers and behavioral outcomes, including dietary adherence, physical activity, and self-monitoring, as well as favorable feasibility outcomes and the potential to maintain continuity of service delivery during the COVID-19 outbreak. Digital health interventions used telehealth, mobile applications, web-based, multicomponent, and hybrid models across different settings, including healthcare settings (e.g., clinical and primary care) and community settings. Digital devices, such as scales, wearables, and activity trackers, were often incorporated to support self-tracking, adherence, and engagement. Reported outcomes included weight loss, improved self-monitoring, and behavioral changes such as enhanced dietary adherence and increased physical activity, and a favorable feasibility outcome; however, these outcomes were not consistently reported across all studies. Key gaps included short follow-up periods and limited evidence from LMICs. Future research should prioritize sustainable, equitable, scalable, culturally adapted, and cost-effective digital interventions.