Effective vaccine implementation strategies are critical for successful deployment of national vaccination programmes, particularly during public health emergencies such as COVID-19. Reflecting on implementation can facilitate future pandemic preparedness and health system resilience. This study interviewed key implementation stakeholders to identify factors influencing COVID-19 vaccine implementation in Ireland. Online semi-structured interviews were conducted with sixteen stakeholders involved in policy or decision-making regarding COVID-19 vaccine implementation at national, regional, and local levels in the Republic of Ireland. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and framework analysis, to identify perceived implementation barriers and facilitators. Factors across innovation, process, individual, and organisational domains shaped implementation. Delayed or evolving evidence, alongside vaccine design and complexity, presented barriers. Process-related factors were influential, including adapting delivery approaches (e.g. scaling up to mass vaccination centres), engaging vaccine deliverers (e.g. in acute settings, pharmacy, and general practice), engaging recipients, and planning to operationalise vaccination at scale. Individual factors included opinion leaders, motivation and professional capability. Within the inner setting (Irish government and health system), resource availability, organisational infrastructure, policy frameworks, relational connections, communication, and access to information were critical for delivery. Outer setting factors, including partnerships and policy direction, were also influential. COVID-19 vaccine implementation in Ireland was shaped by various system, organisational, and individual factors, alongside rapid adaptation. These findings highlight the importance of sustained investment in staffing, organisational infrastructure, and coordinated policy frameworks to support effective vaccination programmes and strengthen preparedness for future public health emergencies.
Elective non-emergent surgical wait times have increased across countries such as Canada, straining operating room (OR) resources and affecting patient outcomes and healthcare spending. Manual scheduling systems in Ontario orthopaedic centres create wide variations in wait times, with recent declines in meeting benchmark targets despite increased procedure volumes. Challenges stem from fragmented referral processes, outdated scheduling methods and resource constraints. Artificial intelligence and machine learning (ML) offer potential solutions for optimising scheduling; however, their implementation remains inconsistent. This study aims to identify determinants affecting the rollout of a new ML-driven automated scheduling system at a high-volume elective orthopaedic surgery centre. A qualitative description approach supported by implementation science frameworks. A high-volume elective orthopaedic surgery unit at a Canadian tertiary care centre. 17 individuals from clinical, administrative and leadership roles who were directly involved in surgical scheduling. A new ML-driven automated surgical scheduling system. Perceptions of the proposed new surgical scheduling system (barriers and enablers of implementation, recommendations for improvement). Three main themes were identified, capturing challenges and enablers in the existing scheduling system: system functionality, process-related factors and resource constraints.Participants described substantial inefficiencies in the existing manual scheduling system, including outdated software, fragmented information systems, inconsistent communication and resource constraints. Across interest-holder groups, there was broad but variable perceived support for a planned ML-enabled scheduling system, particularly for improving duration prediction, access to scheduling data and reporting, alongside concerns about system complexity, workflow fit, training and resource implications. Interest-holders emphasised the importance of user-friendly design, interoperability, responsive training, phased implementation and ongoing feedback. This pre-implementation qualitative study identified significant process and resource limitations in manual orthopaedic surgical scheduling, but interest-holder support for a well-designed ML-driven system is strong. While participants anticipated potential benefits for scheduling accuracy, throughput and resource allocation, these perceived advantages will require meaningful user engagement, robust training, phased rollout and evaluation in subsequent implementation and outcome studies.
Sudden Cardiac Death (SCD) remains a leading cause of mortality worldwide, with outcomes critically dependent on the effective implementation of the "Chain of Survival" - early recognition, early CPR, early defibrillation, and post-resuscitation care. In regional and pre-hospital settings, systemic fragmentation between emergency dispatch, ambulance services, and hospitals undermines this chain. This study presents the development, implementation, and impact evaluation of an integrated, AI-enabled multi-modal emergency care system designed to strengthen the entire Chain of Survival for SCD in a regional context.: We designed and deployed a system integrating a unified information platform, IoT-enabled devices, point-of-care testing (POCT), and AI-driven clinical decision support. The system was implemented phased across three counties in Anyang, China (population ≈ 2.1 million) from January 2022 to December 2023. We conducted a quasi-experimental before-and-after study using routinely collected emergency medical services (EMS) data. Primary outcomes were median response time (call receipt to scene arrival), pre-hospital STEMI identification rate, and return of spontaneous circulation (ROSC) for out-of-hospital cardiac arrest (OHCA) of cardiac origin. Data from 1,208 emergency cases (pre-implementation: n = 587; post-implementation: n = 621) were analyzed. Interrupted time series (ITS) analysis was performed to control for secular trends. The median emergency response time decreased from 9.8 min (IQR: 7.2-13.1) to 6.7 min (IQR: 5.1-9.0) (P < 0.001). The pre-hospital STEMI identification rate improved from 65% to 90% (p < 0.01). For OHCA of cardiac origin, the ROSC rate increased from 18% to 31% (p < 0.05), representing a 72% relative improvement. ITS analysis confirmed a significant level change for response time (β = -2.8 min, 95% CI: -3.7 to -1.9, P < 0.001) and for ROSC (β = +12% points, 95% CI: +5 to + 19, P = 0.01) immediately following implementation, with no significant pre-existing trends. The AI models demonstrated robust performance during validation (deterioration prediction AUC 0.89; STEMI detection AUC 0.92). The Anyang Model provides evidence that a systematically integrated, AI-driven platform is feasible and temporally associated with substantial improvements in regional emergency care for SCD. While causal attribution requires further validation, this systems-level approach offers a replicable framework that can be adapted to diverse resource settings.
Osteoarthritis Management Programs (OAMPs) are evidence-based, non-surgical OA service delivery models, intended for implementation in real-world settings. Identifying barriers and enablers to effective sustained implementation of OAMPs is crucial for optimising individual (micro), service (meso) and health system (macro) benefits. To synthesise evidence on barriers and enablers to implementation of primary/community care-based OAMPs. Systematic review and framework synthesis of qualitative studies published 2010-2025 (PROSPERO registration:CRD42021255698). Barriers and enablers were identified and categorised through inductive coding, mapped to the Theoretical Domains Framework (TDF), and classified at micro, meso, or macro levels. GRADE CERQual was used to judge confidence in the findings. Eighteen publications (217 OAMP providers; 111 patients) were included. Twenty barrier and 20 enabler categories were mapped against 10 TDF domains. Barriers most commonly mapped to TDF domains of environmental context and resources (limited public funding and workforce)), knowledge (healthcare professionals' (HCPs) and patient knowledge), skills (limited HCP collaboration and therapeutic alliance), beliefs about consequences (patients' OA beliefs), and memory, attention and decision processes (limited HCP autonomy, patient factors affecting OAMP participation). Enablers most commonly mapped to TDF domains of environmental context and resources (enhanced integrated care, public funding), knowledge (HCPs; patients), skills, beliefs about capabilities (HCP confidence in their skills), social/professional roles and identities (expansion of professional roles), and social influences (patient social support). Most findings were judged as high or moderate confidence. Findings highlight opportunities to facilitate OAMP implementation in primary and community care settings, and can inform targeted implementation strategies.
Human immunodeficiency virus (HIV) remains a major public health challenge, particularly in sub-Saharan Africa, where achieving sustained HIV virologic suppression continues to be difficult despite expanded access to antiretroviral therapy (ART). This challenge is further complicated among people living with HIV-HBV coinfection due to increased disease complexity, treatment burden, and adherence-related barriers. Health education plays an important role in improving adherence and virologic outcomes; however, its implementation remains inconsistent in resource-limited settings. This study explored barriers and enablers to implementing health education for HIV virologic suppression among adults living with HIV-HBV coinfection in Northwest Ethiopia. This study aimed to explore the barriers and enablers influencing the implementation of health education for HIV virological suppression among adults living with HIV-HBV co-infection in North-West Ethiopia. A facility-based interpretive qualitative study was conducted from November 13, 2025, to January 12, 2026, at the University of Gondar Comprehensive Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital in Northwest Ethiopia. A total of 28 purposively selected participants, including adult people living with HIV-HBV coinfection, healthcare providers, and HIV program managers, participated in in-depth interviews (IDIs), key informant interviews (KIIs), and focus group discussions (FGDs). Data were audio-recorded, transcribed verbatim, translated into English, and analyzed using reflexive thematic analysis with a deductive approach guided by the Consolidated Framework for Implementation Research (CFIR) using MAXQDA Analytics Pro 2024. Trustworthiness was ensured through triangulation, member checking, peer debriefing, and maintaining an audit trail. Ten barriers and eight enablers were identified across all CFIR domains. In addition to inaccurate information or graphics and transportation issues, the main reported hurdles included patient-level issues such as inadequate literacy, misconceptions about ART or viral load, anxiety about being seen attending sessions, and limited patient engagement in instructional design. Staff shortages, lack of commitment to counselling duties, a focus on ART refills rather than education, irregular or shortened sessions, lack of time, and the absence of a dedicated budget were all organizational and system-level barriers. Conversely, teamwork, clearly defined staff roles, the use of viral load monitoring tools, frequent review meetings, alignment with national HIV guidelines, patient motivation to achieve viral suppression, trust in provider advice, and improved adherence linked to education were all perceived enablers. Implementation of health education for HIV virological suppression among HIV-HBV co-infected patients is hindered by key barriers, particularly low patient literacy, misconceptions, stigma-related concerns, and systemic challenges such as staff shortages, limited time, and inadequate resources. However, strong teamwork, patient motivation, provider trust, and alignment with national guidelines serve as important enablers. Findings from this study informed the updating of the existing health education intervention to better address identified barriers and strengthen enabling factors. Testing the revised intervention for feasibility and acceptability is essential before wider implementation to improve adherence and achieve sustained HIV virological suppression in this population.
Behavioral decision-making tasks are widely used to study individual and social preferences, including risk-taking, temporal discounting, and cooperation-related choices such as social value orientation, trust, and reciprocity, as well as more complex social behaviors examined through social dilemma and coordination games. These tasks are often administered along with typical survey questionnaires. However, scripting complexity limits their implementation on some popular online survey platforms (e.g., Qualtrics), which are commonly used to deploy studies across large populations. Here, we share a detailed experimental protocol and the corresponding source code, which enable the modular implementation of a decision-making battery in Qualtrics, including tasks such as the social value orientation, prisoner's dilemma, trust game, and baseline nonsocial risk preference tasks. Data from 392 participants in Singapore and 94 participants in the United States (US) were collected and analyzed to validate the task battery. Their responses exhibited good quality and high convergent and divergent validity across different tasks and aligned with basic predictions of behavioral decision theory (e.g., the reflection effect and loss aversion) and social decision-making theories (e.g., inequity aversion and betrayal aversion). Responses from 314 Singapore participants and 94 US participants are shared (with their consent). The source code for the task batteries could be used to expand the database and for hypothesis testing in decision-making research. The data could facilitate comparisons with other populations and the development of simulated agents to address logistical challenges in asynchronous experiments. Overall, we go beyond mere code and data sharing to foster large-scale behavioral game theory research.
Action-oriented decisions are shaped by a sense of urgency, a state that builds as the need to commit to an action increases. When poorly regulated, this urgency may bias decisions toward impulsive choices. Because this urgency state may be influenced by different factors, we aimed to dissociate context- and reward-based sources of urgency state regulation. We determined how these regulatory modes are implemented in the motor system across healthy individuals whose impulsivity trait was assessed using the UPPS-P Impulsive Behavior Scale, with a focus on the urgency trait dimension. Participants (n=20, including 13 women) performed a left-or-right index-finger Tokens decision-making task in which contextual demands and reward prospect were orthogonally manipulated to isolate context- and reward-based urgency regulation, with single-pulse Transcranial Magnetic Stimulation (TMS) used to probe corticospinal excitability either in leg muscles, indexing broad modulation of motor activity, or in hand muscles, indexing surround inhibition, as candidate mechanisms underlying these regulatory modes. Our results indicate that context-based urgency state regulation is most evident in individuals with a lower urgency trait, whereas reward-based regulation is most prominent in those with a higher urgency trait. Both forms of regulation were associated with broad motor excitability changes, with reward-based regulation additionally associated with surround inhibition, suggesting that this signature mainly reflects reward prospect rather than urgency state. Based on our findings, urgency-related trait impulsivity may not simply reflect a persistently "higher state of urgency" but rather a different weighting of influences that shape it during decision making in the motor system.Significance statement By orthogonally manipulating contextual demands and reward prospect within a single action-oriented decision task, we show that urgency state regulation reflects multiple influences whose relative weighting varies with urgency-related impulsivity trait. Individuals with lower urgency trait primarily expressed context-based urgency regulation, whereas those with higher urgency trait showed stronger reward-based urgency regulation. TMS revealed complementary motor signatures: broad, non-selective changes in corticospinal excitability indexed global shifts in motor readiness that covaried both with context- and reward-based urgency regulation, while surround inhibition primarily tracked reward prospect as a value-related motor gain signature. Together, these results clarify how context and reward shape action commitment through shared and specific motor implementations.
To inform the adaptation of an existing tobacco use treatment (TUT) programme into a contextually appropriate service for Lebanon's safety-net primary care system. In-person focus group discussions with an in-depth thematic analysis. Two primary healthcare centres in Beirut, Lebanon PARTICIPANTS: 61 individuals who smoked cigarettes (n=36) and waterpipe (n=25). The analysis revealed four primary themes: 1) smoking as a coping mechanism for national crisis, 2) lack of perceived fit of the programme with the Lebanese context, 3) differing perceptions of harm and addiction by tobacco product, 4) perceived effectiveness of programme components. Participants reported that smoking helped them cope with stress resulting from the national crisis and felt that patient education material did not reflect local norms around tobacco use. Participants' views on the relative harm and addictiveness of cigarettes and waterpipe were often discussed in the context of differing use patterns. Addressing mental health, using competent and non-judgmental counsellors, and sharing real-life success stories were recommended to improve engagement in TUT. Tobacco is embedded within the Lebanese social and cultural life. Our findings inform implementation efforts by identifying contextual needs specific to the Lebanese population that smokes. Tailoring TUTs can increase acceptability, effectiveness and sustainability of smoking cessation efforts in Lebanon and similar low-resource contexts.
Social prescribing and supported self-management are two components of the National Health Service (NHS) personalised care model and have proven effectiveness in primary care settings. Social prescribing is a range of non-clinical services that address the psychological, psychosocial, and environmental issues affecting a person's well-being. Patients undertake supported self-management tasks to increase their knowledge, skills, and confidence in managing their health and medical care. However, these practices are not yet routinely integrated into radiation therapy. With 53.5 million people alive with cancer within 5 years of diagnosis worldwide, potentially living with the long-term effects of cancer and its treatments, there is significant potential for the application of social prescribing and supported self-management within radiation therapy, specifically, with application globally. A scoping review was conducted utilising PubMed, ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate online electronic databases. The Joanna Briggs Institute critical appraisal checklists were employed as appraisal tools, and the review adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. From five different countries, twelve studies met the inclusion criteria. The Joanna Briggs Institute critical appraisal grid identified three predominant themes: the needs and current clinical practices of healthcare professionals; the unmet needs experienced by patients; and existing strategies in practice and future directions. Breast cancer was the largest cancer diagnosis represented across the included studies, while this provides insight into patients' experiences, the unmet needs of other cancer diagnoses may differ and are not fully explored in this review. Various non-surgical oncology-based (encompassing all oncology treatments, excluding surgery), social prescribing and supported self-management strategies were identified, providing continuous support to patients from diagnosis to 'living with and beyond cancer'. Non-surgical oncology health care professionals (particularly radiation therapists) are well placed to recommend social prescribing and supported self-management. However, additional training is required to improve knowledge and confidence in doing so. A hybrid approach offering both online and in-person support was deemed effective, enhancing the accessibility of course content and enabling patient participation at their convenience. While these programs are well-established in the community, hospitals must strengthen their connections with primary care networks to bridge the gap between treatment completion and the support needed during 'living with and beyond cancer'. This review identifies the need to prioritise further support for the individual needs of non-surgical oncology patients throughout their care pathway. The benefits of early implementation of social prescribing and supported self-management strategies are evident, suggesting that these interventions should not be delayed until treatment is complete. People living with cancer often need support beyond medical treatment to manage their health and wellbeing. This study reviewed research on social prescribing, which links people to non-medical support and self-management in cancer care, focusing on their use in radiation therapy. This study found that these approaches can help meet patient needs across the care journey, but they are not widely used in radiotherapy and staff may need more training to deliver them. This matters because offering this support earlier and more consistently could improve quality of life for people living with and beyond cancer.
To address the issues of insufficient utilization of multimodal data and limited model robustness in the prediction methods for tourism brand influence, firstly, this study adopts a Transformer-based pre-trained model as the feature extractor to generate embedded representations of multimodal data, including text, images, and audience feedback. Secondly, an attention mechanism is introduced through a multimodal attention-aware module to achieve in-depth fusion of cross-modal features, thereby enhancing the model's understanding of the correlation between film and television communication and tourism brands. Thirdly, the Adaboost ensemble learning algorithm and the Catch Fish Optimization Algorithm (CFOA) are combined to improve the stability and accuracy of prediction results. Finally, based on the effect of film and television communication, the influence of tourism brands is predicted. The research results show that the prediction accuracy of the proposed model reaches 94.1%, 91.3%, and 93.7% on text data, audience feedback data, and image data respectively, and 92.5% on multimodal fusion data, all of which are superior to other models. The results of ablation experiments indicate that the attention mechanism, Adaboost, and CFOA all make significant contributions to the model performance, among which the attention mechanism is the most critical for cross-modal information fusion. In addition, in the context of film and television communication, the proposed model achieves the highest prediction accuracy for each indicator of Anhui Province's tourism brand, which is an improvement compared with the context without film and television communication. This fully verifies the role of film and television communication in enhancing the predictability of brand influence. This study aims to improve the prediction performance of tourism brand influence and also provides intelligent decision support for the construction of Anhui's tourism brand. Furthermore, it promotes the continuous improvement of brand value of the regional tourism industry in the environment of digital communication.
Training in quality improvement (QI) and patient safety remains highly variable despite regulatory mandates. We describe a novel, intensive 5-day experiential QI education programme for postgraduate trainees that integrates real-world observation, brief didactic sessions and workshop-based improvement work, supplemented by creative storytelling and team-based development of campaign media products. First-year anaesthesia residents conducted over 100 structured operating room observations and interviews, collected quantitative and qualitative data on distractions and presented improvement proposals that they developed to institutional stakeholders along with narrative campaign videos. Postcourse evaluations demonstrated a significant increase in trainee confidence in QI methodology and presentation, with participants valuing the experiential and creative elements over traditional didactic instruction. This model demonstrates the feasibility, reproducibility and educational value of immersive, short-duration QI training in authentic clinical settings and suggests a promising alternative to longer, resource-intensive curricula.
Preparedness for emerging pathogens can be strengthened by leveraging lessons from COVID-19 therapeutic trials. The COVERAGE Africa trial (NCT04920838, ANRS033, 2021-22), one of the few COVID-19 therapeutics trials conducted in resource-limited settings, sought to identify early treatment strategies for ambulatory patients at-risk for severe disease in Guinea and Burkina Faso. This implementation research, based on secondary data from the Burkina Faso sites, aimed to document the trial's implementation and to identify the factors that influence it. The PEARLES framework was applied to identify and classify indicators related to political, economic, administrative, regulatory, logistical, ethical and societal factors influencing trial's implementation. Data drawn from regulatory documents, weekly internal reports, financial documents, programmatic data, equipment receipt slips, contracts and logistical documents, as well as the dynamic of recruitment in the trial were analysed to describe these indicators as either facilitators-supporting the trial's execution as planned-or barriers-causing delays, hindering progress or leading to deviations. Barriers to trial implementation included: (1) the trial's adaptive design, needing iterative protocol amendments leading to regulatory delays that were aggravated by the misalignment between national and international care guidelines, (2) funding disbursement lags, (3) challenges in participants' enrolment due to inadequate screening sites organisation that compromised patient confidentiality and (4) significant increase in the refusal rate during the trial, rising from 3% in 2021 to 38% in 2022. Despite these constraints, mitigation strategies such as prefinancing, mobile team deployment and site renovations enabled effective trial delivery. Strong governmental support, rapid mobilisation of funders and flexibility in staff deployment facilitated trial's implementation. To enhance trial readiness in emergency situations, countries need political commitment, preapproved protocols, dedicated research infrastructure and rapid funding mechanisms. Stakeholder engagement and preparedness exercises are essential to strengthen clinical trial capacity in low-resource settings particularly across sub-Saharan Africa.
Integrating patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) is essential for advancing towards patient-centred care. Implementation of these measures faces challenges, including the selection of appropriate instruments and the lack of digital tools that meet clinical and operational requirements. The objectives of this study were to identify and describe the essential functionalities that digital tools should provide to facilitate the implementation of PROMs and PREMs from hospital pharmacy services and to assess their level of implementation in clinical practice. An expert working group conducted a multiphase methodological and descriptive study between March and October 2024. Through literature review and structured expert panel consensus, a checklist of 15 essential functionalities was defined. This checklist was applied to nine digital tools used or in development in Spanish hospitals. Additionally, a national descriptive cross-sectional web-based survey, distributed via Google Forms, was conducted among 75 hospital pharmacy services to assess the current status of implementation of PROMs/PREMs. The checklist includes functionalities grouped into three domains: data and information management, system function and interaction and clinical use of reports. The evaluation revealed high variability in compliance: while features such as graphical display, remote access and questionnaire validation were commonly present, key aspects such as clinical calendar integration and dynamic questionnaire personalisation were less developed. The findings of the survey highlight a low level of adoption, with only 8% of centres collecting PROMs/PREMs digitally and 7% using them for real-time patient monitoring. Despite this, 91% of respondents agreed that these tools should be structurally integrated into hospital pharmacy services. This study proposes a set of essential functionalities for evaluating digital tools aimed at collecting PROMs/PREMs in hospital pharmacies. The findings highlight substantial variability in functionality and limited implementation in routine practice, supporting the need for tools that are better aligned with clinical and operational requirements.
The National Volume-Based Procurement (NVBP) policy was implemented in China in 2018 to address escalating pharmaceutical expenditures. This study aimed to describe long-term price trends, regional variations in bid-winning drug prices, and supply stability during the 2018-2024 implementation period. Data were obtained from the Shanghai Sunshine Pharmaceutical Procurement Platform and the Comprehensive Service Platform for NVBP. Price trends of bid-winning and alternative drugs were analyzed using monthly procurement data for Batches 1-7, excluding the insulin-specific sixth batch.Laspeyres, Paasche, and Fisher price indices were calculated using January 2018 as a common index anchor to standardize long-term price comparisons, rather than as a batch-specific pre-policy baseline. Regional disparities in bid-winning drug prices were examined using official bid-winning results for Batches 1-5 and Batches 7-10, with purchasing power parity indices estimated by the national product dummy method. Supply shortages were measured as monthly regional order-delivery gaps during the first post-implementation year of each included batch and classified into five severity levels. Bid-winning drugs showed substantial price declines after implementation, with Laspeyres, Paasche, and Fisher indices decreasing by approximately 55%-85%, 60%-85%, and 50%-80%, respectively. Prices remained stable at low levels without obvious rebound. Alternative drugs showed smaller and more fluctuating declines of approximately 5%-40%, 5%-40%, and 10%-40%, respectively. Supplementary interrupted time-series analysis of the Fisher index showed significant negative immediate level changes for bid-winning drugs across all included batches, whereas alternative drugs showed smaller and less consistent immediate changes. Regional PPP point estimates were generally lower in economically developed regions than in the western region, although many individual batch-region comparisons were not statistically significant. First-year supply shortages ranged from approximately 17% to 33% across batches. Lower-priced drugs were more frequently observed in higher shortage-severity categories, with drugs priced below 0.5 CNY accounting for 77.6% of severe shortages. This nationwide descriptive study documented sharp and sustained price declines for bid-winning drugs, smaller and heterogeneous declines for alternative drugs, persistent regional price disparities, and supply shortages under China's NVBP. These findings suggest a policy tension between price reduction, regional equity, and supply security.If these descriptive associations reflect underlying procurement mechanisms, future policy refinements may consider regional price-differential monitoring, dynamic price-adjustment mechanisms for extremely low-priced drugs, supply guarantee requirements, and reward-penalty mechanisms for procurement participants.
Capabilities of generative AI (GenAI) tools continue to advance, positioning them as promising resources for supporting healthcare education. However, their implementation also presents challenges and unknown implications related to Diversity, Equity and Inclusion (DEI). Despite the growing body of literature on GenAI, there remains a significant gap in research examining how DEI considerations are addressed in GenAI applications in healthcare education. This review synthesizes existing literature on the integration of DEI in GenAI applications for healthcare education. Specifically, it examines how DEI is recognized, the strategies used for its integration, and the reported outcomes of these efforts. It also identifies limitations and offers recommendations for integrating DEI in GenAI within healthcare education. JBI scoping review methodology was used, and three databases (PubMed, Embase, and CINAHL) were searched. The reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the scoping review (PRISMA-ScR). Descriptive statistics and content analysis were conducted, with findings reported using tables and narrative summaries. This review included 16 studies. Content generation for educational materials was the dominant use case (n = 12), while fewer studies explored more complex applications such as interactive virtual patient simulations (n = 3) and simulation-based, scenario-driven training (n = 2), which may reflect the early stage of the field. Notable gaps identified across the 16 studies included a lack of consistent conceptual clarity regarding how to operationalize and integrate DEI, limited engagement with diverse partners in the development of GenAI, and a lack of evaluations examining how DEI is incorporated or addressed. Most studies instead evaluated aspects of GenAI performance or user perspectives. By identifying these gaps, this review offers a foundation for developing frameworks that support systematic DEI integration across the GenAI lifecycle, from innovation development and implementation through to evaluation, and informs future research directions by calling for multi-perspective collaboration and institutional accountability in how GenAI is monitored and evaluated. This scoping review represents an important first step upon which future efforts can build to advance the integration and evaluation of DEI in GenAI applications for healthcare education.
Acutely ill children are at risk of receiving unnecessary antibiotic prescriptions, yet within this context, clinical decision support systems (CDSS) have the potential to improve clinicians' prescribing behaviour. Since the uptake of CDSS is limited, research into the facilitators and barriers to its use and the preferred content and functions is needed to promote its use. Four focus groups were conducted among Belgian general practitioners, paediatricians, and ear/nose/throat physicians. The groups took place in a university building, a regional hospital, and online, and were semi-structured according to the interview guide. We transcribed recordings and performed reflexive thematic analysis. All participants were asked to provide feedback on the final themes. Twenty-five physicians participated in the study. The analysis produced four themes: (i) Physicians prefer a pragmatic approach completing the CDSS, with as little additional work as possible; (ii) The comprehensive advice given by the CDSS should be concise, unambiguous, and presented clearly; (iii) The CDSS can reduce diagnostic uncertainty, especially by making physicians aware of alarm symptoms of serious illness; (iv) The scope should be determined beforehand, and implementation should consider reliability and technical barriers. Participants proposed several possibilities for the content and functions of the CDSS, which are informed by their workload, clinical uncertainty, and their emphasis on professional autonomy. The results of this study contribute to the development of a user-friendly CDSS for the assessment of acutely ill children in ambulatory care. Physicians prefer a CDSS that is pragmatic to apply and shows clear guidance on diagnostics and disease management, including support to reduce uncertainty regarding illness severity. The implementation of a CDSS plays a pivotal role in enhancing antimicrobial stewardship.
High-throughput sequencing has transformed clinical diagnostics of rare diseases (RD), cancer and infectious diseases by enabling the identification of disease-causing genetic alterations and facilitating individualised treatment and care. In response to these advances, Genomic Medicine Sweden (GMS) was established in 2017 as a national collaborative effort to accelerate implementation of genomics-based precision medicine within Sweden's regionally organized, publicly funded healthcare system. GMS brings together the seven university healthcare regions and their associated medical faculties, in collaboration with healthcare regions across Sweden, Science for Life Laboratory, patient organizations, industry and governmental agencies. Activities are coordinated through national disease-specific expert groups, supported by cross-cutting functions in bioinformatics, health economics, ethics, education and patient engagement. At the operational level, seven Genomic Medicine Centres, embedded at university hospitals, develop and deliver harmonised genomic diagnostics nationwide. The National Genomics Platform provides secure infrastructure for large-scale data storage, analysis, and national and international data sharing. Following initial project-based funding, GMS now receives long-term governmental support. This review describes the national implementation of genomic-based precision diagnostics, discusses challenges and lessons learnt, and highlights key milestones across disease areas, including whole-genome sequencing in RD and paediatric cancer, comprehensive genomic profiling of haematological malignancies and solid tumours, pathogen genomics in microbiology, pharmacogenomic testing and emerging applications of polygenic risk scores in complex diseases. Collectively, these efforts have contributed to more than 500,000 genomic tests being performed within Swedish healthcare between 2017 and 2025. Finally, we outline future diagnostic needs and priority areas to ensure sustainable, scalable and equitable access to precision medicine.
Enhanced Recovery After Surgery (ERAS) programmes improve perioperative outcomes, but real-world adherence varies widely across institutions, limiting their effectiveness. Disease-Specific Care Certification (DSCC) provides governance and standardisation but lacks operational mechanisms for frontline implementation. This study evaluates an integrated Quality Control Circle (QCC) model aligned with DSCC and ERAS protocols to improve perioperative reliability and patient-centred outcomes in joint replacement. A pre-post quasi-experimental study was conducted involving 515 patients undergoing elective total joint replacement. A multidisciplinary QCC team employed root-cause analysis, Pareto prioritisation and iterative Plan-Do-Study-Act cycles to refine processes. DSCC governance principles were used to structure standardised pathways, unify documentation and reinforce interdisciplinary communication. Outcomes included ERAS compliance, length of stay (LOS), preoperative discomfort (thirst, dry mouth), unnecessary blood preparation, complications and staff competency. ERAS compliance increased from 80.9% to 100% after implementation. Preoperative thirst (p=0.0156) and dry mouth scores (p=0.0073) improved significantly. LOS decreased from 6.63 to 5.98 days. Unnecessary blood preparation was reduced from 237 units to zero. Staff competency improved across all domains. No increase in postoperative complications or readmissions was observed. Integration of QCC operational tools, DSCC governance and ERAS clinical elements yielded substantial improvements in perioperative reliability, efficiency and patient comfort. The QCC-DSCC-ERAS hybrid model is feasible, scalable and potentially generalisable to other institutions seeking high-reliability perioperative care.
Cancer is a major and growing challenge in developing countries, where limited resources contribute to poor outcomes to patients and families. Family-centered care, which considers both cancer patients and their families as the central focus of care, has been shown to improve the health of cancer patients and their family caregivers. However, the existing evidence is primarily concentrated in high-income settings, and comprehensive data about family-centered cancer care in developing countries is lacking. Therefore, this review was conducted to synthesize the existing evidence on family-centered cancer care in low- and middle-income countries. A comprehensive review was conducted using an integrative design. Relevant articles were searched in PubMed, ScienceDirect, Epistemonikos, the Cochrane Library, African Journals Online, and CINAHL. Data were extracted into a standardized data extraction form, and a narrative synthesis was employed to integrate and present the findings. Protocol registration number: CRD42025639842. Out of 336 identified records, 18 articles involving 2,373 participants were included in this review. Despite its limited implementation in low- and middle-income countries, family-centered care was associated with improvements in quality of life, psychosocial health, emotional wellbeing, lifestyle, social interaction, and functional status, and with a reduction in symptom burden among cancer patients. It also enhances quality of life and mental wellbeing, while reducing the caregiving burden among family caregivers. Findings of this review underscore the beneficial effects of family-centered care in enhancing health outcomes for cancer patients and their family caregivers. However, its application remains significantly low in developing countries. Moreover, there is also a lack of a uniform definition and implementation strategy for family-centered care approach. Therefore, future research should focus on developing context-specific and culturally appropriate family-centered care models that can be effectively integrated into existing healthcare systems in developing countries. Not applicable.
Lenacapavir is a first-in-class HIV capsid inhibitor with a long-acting formulation that enables twice-yearly dosing for both treatment and prevention. Its novel mechanism and extended dosing interval represent a paradigm shift in HIV care. Sub-Saharan Africa bears the highest global HIV burden but has historically experienced delayed access to biomedical innovations, raising concerns about equity and persistent global health disparities. This article presents a narrative review and policy analysis examining lenacapavir's scientific potential, its role in HIV treatment and prevention, and the structural, economic, and policy challenges affecting equitable access in African settings. Emerging evidence indicates that lenacapavir is highly effective in heavily treatment-experienced individuals, including those with multidrug-resistant HIV, and its long-acting pharmacokinetic profile supports sustained viral suppression. As a prevention strategy, twice-yearly administration offers a practical alternative to daily oral pre-exposure prophylaxis (PrEP), with the potential to improve adherence and overcome barriers related to stigma and pill burden. Despite its promise, equitable access across Africa may be limited by high costs, patent protections, restricted licensing agreements, health-system weaknesses, and evolving global HIV financing. These challenges could hinder timely introduction and widespread uptake, particularly in resource-constrained settings. Ensuring equitable access will require coordinated action among governments, international agencies, pharmaceutical manufacturers, donors, and civil society to strengthen affordability, availability, and implementation within existing HIV prevention and treatment programs. Lenacapavir represents a transformative advance in HIV therapy and prevention. Its impact in Africa will depend not only on scientific innovation but also on equity-focused policies, sustainable financing, and coordinated implementation strategies.