Families face long waits for their child to undergo a diagnostic assessment for possible autism. This study explored the experiences of parents and children/young people (CYP) accessing and professionals providing autism diagnostic assessments in the United Kingdom. This realist evaluation was conducted in three phases: (1) interviews and focus groups with parents, CYP and professionals from six U.K. National Health Service (NHS) childhood autism assessment and diagnosis services; (2) resulting qualitative data were analysed, and programme theories (PTs) explaining how, why and in what contexts childhood autism assessment and diagnosis pathways work well were tested and refined; and (3) recommendations for change were developed by the research team and presented to delegates at six dissemination events including 250 clinicians, managers, parents/carers, commissioners and academics involved in autism assessment and diagnosis. Delegates were invited to select and rank the most important recommendations. There were 121 participants in Phase 1 (18 CYP, 34 parents, 69 professionals). In Phase 2, both families and clinicians confirmed challenges in the assessment and diagnostic process, including increased demand for assessments and insufficient numbers of specialist multidisciplinary team (MDT) practitioners to provide adequately skilled workforces. The need to support families across the whole assessment and diagnostic process was seen as key to providing a quality service but was often not possible. Steps taken to improve the process were identified, and seven PTs covered: improving recognition of children needing referral, referral processes, service organisation, professional skill mix, assessment, feedback/report writing and training/service evaluation. In Phase 3, during consultation, 12 recommendations were selected as most important for change. Several strategies for improving services were identified that may reduce waiting times and increase acceptability and quality of childhood autism assessment and diagnosis services.Lay AbstractWaiting lists for childhood autism assessments are lengthy, meaning families wait a long time for their child to undergo a diagnostic assessment for possible autism. In this study, we explored the experiences of children, young people and parents who have gone through the assessment and diagnosis process in the United Kingdom. We also explored the views of professionals who deliver childhood autism diagnostic assessments. We conducted interviews and focus groups with children, young people, parents and professionals. We recruited participants from six U.K. National Health Service (NHS) assessment and diagnosis services. We wanted to find out how childhood autism assessment and diagnosis processes could be improved. We asked the research participants about their experiences of the autism assessment and diagnosis process to find out what worked well, who it worked well for and under what circumstances. Recommendations for change were developed by the research team and presented to delegates at six dissemination events. Delegates (including 250 clinicians, managers, parents/carers, commissioners and academics involved in autism assessment and diagnosis) were invited to select and rank the most important recommendations. In total, 121 people took part including 18 children and young people, 34 parents and 69 professionals. Participants described their experiences of the assessment and diagnosis process and challenges in the system including increased demand for assessments and there not being enough specialist skilled practitioners available to conduct assessments. Participants also described ways the childhood assessment and diagnosis process could be improved, including better information gathering during referral. The need to support families throughout the whole assessment process (and not just on receiving a diagnosis) was seen as very important. Seven key areas for improvement were identified: accurately recognising when to refer children, the referral process, service organisation, skill mix of autism assessment teams, the diagnostic assessment, feedback and report writing, and training for staff. Twelve recommendations for change were identified by delegates at the dissemination events. The findings can be used to help make recommendations for service development, reduce waiting times and improve the quality of childhood autism assessment services for children, young people and families.
Understanding health information can be difficult, which can limit people's ability to manage their health and adopt healthy practices, leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative designed to support clear conversations between health service providers and users. The initiative incorporated Teach-back, Chunk and Check, Simple Language, and Open Questions, alongside implementation support from a health literacy officer. A concurrent mixed-methods evaluation was conducted across two health programmes serving a population of approximately one million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors within a regional government authority. The evaluation comprised five components: (1) Surveys of 110 service providers' perceptions of the training; (2) Observations of 11 service providers before and after training; (3) Two focus groups with 11 service providers six months post-training; (4) Change in 73 service users' health literacy levels using two domains of the Health Literacy Questionnaire; (5) Change in service users' health and wellbeing between baseline and programme completion. Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed. Both programmes were delivered in group settings. Teach-back was reported to be challenging to apply in this context but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was helpful but difficult to deliver to busy teams. Service users' health literacy levels improved by the end of their programme, but there was no evidence that the initiative improved health and wellbeing outcomes. For example, no significant difference was observed in the primary outcome for Weight Management participants in the intervention group compared with controls (0.2 kg, - 2.3 to 1.9; p = 0.84). In this small evaluation, the initiative was well received and enhanced service providers' communication skills. Further evaluation of a strengthened initiative should focus on controlled before-and-after designs using larger samples to determine the effect on service users' health literacy and health and wellbeing outcomes.
Older adults with complex needs (CN), commonly defined as the coexistence of multiple chronic conditions and functional limitations, are associated with high levels of medical and long-term care (LTC) utilization. However, evidence on real-world patterns of joint medical and LTC service use among this population in China remains limited. This cross-sectional study utilized data from 177,807 individuals aged ≥ 60 years who underwent LTC insurance assessment in Shanghai between January and May 2023. CN was defined as having three or more chronic conditions with at least one limitation in activities of daily living. Within an integrated care framework, latent class analysis (LCA) was applied to identify patterns of medical and LTC service utilization based on 10 indicators informed by the Andersen Behavioral Model of Health Services Use. Multinomial logistic regression was used to examine the association between CN status and class membership, adjusting for demographic, socioeconomic, and health-related factors. Older adults with CN (n = 42,277) differed significantly from those without CN (n = 135,530) across demographic, socioeconomic, health status, and service utilization. Six latent classes of medical and LTC service utilization were identified: Low Medical & Low Care, Moderate Medical & Low Care, High Medical & All Care, High Medical & Informal Care, High Medical & Formal Care, and High Inpatient & Formal Care. Compared to non-CN individuals, CN individuals had higher probabilities of belonging to high-utilization classes, particularly High Medical & All Care, High Medical & Informal Care, and High Medical & Formal Care classes, with the Low Medical & Low Care Class as the reference. These associations remained significant after adjusting for covariates. Older adults with CN in China showed heterogeneity in patterns of medical and LTC service utilization and were more frequently represented in intensive and multi-sector service use profiles. Early identification of CN individuals and the development of risk-stratified integrated care models may help inform more coordinated and people-centered service delivery approaches.
Everyday services are increasingly being digitalised, while the proportion of older adults continues to grow. Ensuring that digital services are accessible to this population is essential to prevent digital exclusion and support autonomy. This study aimed to explore older adults' perspectives, experiences, and needs regarding digital services, identify perceived barriers to accessibility, and examine associated ethical and societal concerns. This qualitative descriptive study recruited 48 French community-dwelling older adults in France (28 women, 20 men; mean age = 76.06 years, SD = 9.21; 42 urban, 6 rural). Semi-structured interviews were conducted using an 18-item guide developed from a review of the literature on digital accessibility. The study design and reporting were informed by the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Interviews were audio-recorded, transcribed verbatim, pseudonymised, and analysed using inductive thematic analysis. Coding was performed independently by two researchers, and discrepancies were resolved through discussion. All participants reported using at least one digital technology, primarily for communication, information-seeking, administrative procedures, entertainment, and, more rarely, for professional or obligatory tasks. Participants described both advantages (e.g., convenience, ergonomic interfaces) and difficulties (e.g., lack of support, interface complexity, technical failures), leading to diverse coping strategies such as seeking help, self-learning, delegation, or avoiding digital tools when possible. Feelings toward digitalisation were ambivalent, combining perceived benefits with frustration, concerns about data security, and reflections on the impact of digitalisation on autonomy and human relationships. Participants also identified barriers to accessibility (e.g., lack of digital literacy, financial constraints, poor design, insufficient support) and proposed concrete solutions, emphasising the importance of accessible design, non-digital alternatives, adapted training, and human assistance. Digitalisation offers opportunities for older adults but also raises accessibility, ethical, and societal challenges. While many participants recognised the usefulness of digital services, they also highlighted risks related to autonomy, perceived choice, and reduced human contact. These findings underscore the need for digital services that are inclusive, intuitive, and supported by continuous human assistance to avoid reinforcing existing inequalities.
To introduce a new service delivery intervention to improve equity of access to home dialysis therapy and describe the process of intervention development. Despite strong evidence in favour of home dialysis, its uptake remains stubbornly low in England and elsewhere. Furthermore, uptake levels vary between kidney services and between population groups. The Inter-CEPt study identified several enablers of access to home dialysis, including: receptive organisational cultures; adoption of reflective practice; engagement in quality improvement, and shared belief in the benefit of home dialysis. Drawing on the Inter-CEPt study, and using established intervention development frameworks, we developed 'Location of Dialysis Care in Kidney Life' as a targeted intervention for improving the uptake of home dialysis. In this paper, the intervention and the processes involved in its design are described. This involved co-design workshops with professional stakeholders and people with lived experience. The Location of Dialysis Care in Kidney Life intervention consists of two principal components: (1) quality improvement activities focussed on supporting dialysis care in the home, and (2) dedicated home therapies leadership roles and activities in kidney services. The rationale of the intervention is to develop and sustain a culture that improves equitable access to home dialysis. We report a staged process of intervention development that combines the principles of evidence-based intervention development and user co-design. The resulting intervention proposal can be adapted by kidney services to meet their specific needs and challenges. The study identifies organisational culture as one of the biggest determinants of uptake in home dialysis. No other study to our knowledge has fully investigated this as a barrier to home dialysis, nor indeed how to begin to change it. The Location of Dialysis Care in Kidney Life intervention requires future piloting and evaluation.
In March 2025, the expiration of federal pilot funding for Safer Supply Programs (SSPs), combined with restrictive provincial legislative changes to harm reduction service provision in Ontario, disrupted care for thousands of clients at risk of toxic drug poisoning. This study examines the impacts of these changes on client health, social stability, and overdose risk across a continuum of access. We conducted 30 semi-structured virtual interviews between September and November 2025 with clients who were enrolled in an SSP prior to March 31, 2025. Participants were recruited via purposive and snowball sampling. Data were analyzed using Braun and Clarke's reflexive thematic analysis to explore experiences across three distinct groups: those who maintained continuity with their prescriber or SSP, those who transitioned to a new prescriber or SSP, and those who lost access entirely. Experiences of harm were directly proportional to the degree of service disconnection. Participants who maintained access (n = 10) retained clinical stability, but reported chronic anxiety and "survivor's guilt" regarding peers who lost care. Participants who transitioned to an alternative prescriber (n = 13) experienced a "medicalization of harm reduction" characterized by increased surveillance (e.g., urine screens, monitored dosing), revoked take-home doses, and the loss of trusted relationships, which undermined their autonomy and stability. Those who lost access entirely (n = 7) experienced significant harms, such as the loss of an entire ecosystem of care (i.e., medication, primary care, and community), an immediate return to the unregulated fentanyl market, and engagement in survival strategies that can lead to criminalization. Notably, 100% (n = 5) of participants who reported an overdose following the policy changes belonged to this group. The loss of federal funding for SSPs in Ontario did not solely reduce medication availability; it severed the structural and relational network that supported participants' reintegration into health care services that they previously felt uncomfortable accessing due to stigma, surveillance and mistreatment. Findings reveal a "continuum of disconnection" where the removal of wraparound supports and the reintroduction of punitive clinical practices function as forms of structural violence. Sustainable, low-barrier models are urgently needed to prevent further morbidity and mortality.
Primary Health Care (PHC) is vital to supporting emergency preparedness and health care resilience. There is limited evidence of the impact of crises on PHC services and financing. We aimed to explore the impact of the full-scale invasion of Ukraine in February 2022 on PHC services in the country. We used a mixed-methods approach. Survey data were collected using an online questionnaire sent to a sample (n = 86) of PHC providers in Ukraine in January-February 2023. Fifteen providers were then randomly selected for semi-structured interviews from among those that reported an impact of war and from those areas most affected by conflict. Interviews took place in March 2023. 37% of PHC providers reported being affected by the full-scale invasion. Qualitative data revealed greater impacts at the beginning of the invasion, to which facilities adapted by the time of the survey. The most reported disruptions were electricity cuts (76%) and currency depreciation/price increases (72%). The most reported increased medical need was cardiovascular disease (CVD; 58%) (with qualitative data suggesting an increase in CVD among younger patients) followed by mental illnesses and disorders (55%). 59% of PHC providers reported an increase in remote consultations. Among those facilities that reported a change in revenues, the nature of the change depended on the type of ownership. For example, only 9% of private providers reported increased revenues from humanitarian aid, while 79% (n = 58) of public providers indicated an increase in these sources. To continue strengthening Ukraine's PHC system, the benefit package must be aligned with clinical guidelines, particularly for CVD and mental health; increases in remote consultations should be closely monitored for quality; and payment systems must be adjusted to ensure equity of financing regardless of provider ownership. These findings offer insights for strengthening PHC and emergency-preparedness in other contexts.
Medical ethics is an applied branch of ethics that addresses the moral issues and challenges encountered in clinical practice. Medical ethics should be adhered to during clinical practice. Non-adherence to medical ethics may cause unnecessary burdens and consequences on patients, deterioration of health status, exposure to other health problems or diseases, unnecessary surgery, additional medical expenditure, psychological distress, bodily injury and death. Globally, adherence to medical ethics is not uniform, while in Ethiopia, there is limited information on adherence to medical ethics and its determinants. Therefore, this study aimed to assess the level of adherence to medical ethics and its determinants among medical doctors in Ethiopia. An institution-based cross-sectional study was conducted among 1,012 medical doctors from 01 August 2024 to 31 October 2024 in Ethiopia. A multistage sampling technique was applied to select the respondents. A structured self-administered questionnaire was used for data collection. Relevant descriptive statistics was done for all variables. Multivariable binary logistic regression analysis was used to identify factors significantly associated with adherence to medical ethics. The study revealed that only 588 (58.1%) medical doctors had good adherence to medical ethics. Year of medical ethics course (AOR: 1.77; 95% CI: 1.27, 2.46), integration of medical ethics course with clinical practice (AOR: 1.34; 95% CI: 1.08, 1.72), pre-service orientation on medical ethics (AOR: 1.60; 95% CI: 1.15, 2.23), in-service training on medical ethics (AOR: 1.44; 95% CI: 1.11, 1.89), institutional ethics committee (AOR: 1.54; 95% CI: 1.11, 2.13), clinical communication skills (AOR: 1.68; 95% CI: 1.08, 2.61), clinical leadership skills (AOR: 1.74; 95% CI: 1.07, 2.86), knowledge of medical ethics (AOR: 2.56; 95% CI: 1.72, 3.83), and attitude towards medical ethics (AOR: 10.38; 95% CI: 7.02, 15.33) were significantly associated with adherence to medical ethics. Adherence to medical ethics among medical doctors was low. Year of medical ethics course, integration of medical ethics course with clinical practice, pre-service orientation on medical ethics, in-service training on medical ethics, institutional ethics committee, clinical communication skills, clinical leadership skills, knowledge of medical ethics, and attitude towards medical ethics were significantly associated with adherence to medical ethics. Therefore, the implementation of various strategies and interventions is very important to improve adherence to medical ethics among medical doctors in Ethiopia.
Older adults living in long-term care homes often experience impairment in mobility and function requiring physical therapy rehabilitation. Maintaining residents' physical function can promote quality of life, reduce pain and skin breakdown, and support the provision of personal care. Family/care partners notably contribute to resident well-being. Understanding engagement between physical therapists and family/care partners is essential to advancing resident rehabilitation and health outcomes, particularly as staffing capacity, time, and access to rehabilitation services become increasingly constrained. This review aimed to synthesise and assess the quality of the literature describing engagement between physical therapists and family/care partners of older adults in long-term care. A scoping review was conducted following Arksey and O'Malley's framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Six databases and grey literature were searched without date restrictions. Papers were eligible for inclusion if they: (1) described engagement between physical therapists and family/care partners as reported by any participant group; (2) were conducted in a long-term care home or equivalent setting; (3) focused on physical rehabilitation for older adults; and (4) were available in English. Any study design was eligible. Data were analysed thematically and methodological quality was assessed. Of 3443 papers and records screened, nine studies were included. Most (n=8) were qualitative and conducted in high-income countries and all were rated as "good" quality. Four themes surfaced describing engagement between physical therapists and family/care partners in long-term care: (1) physical therapists support greater family/care partner involvement in rehabilitation; (2) opportunities to enhance structured communication between physical therapists and family/care partners; (3) misalignment of family/care partner expectations with physical therapy service capacity; and (4) enhancing role clarity and value of family/care partners in rehabilitation. Engagement between physical therapists and family/care partners in long-term care homes is underdeveloped despite recognition of its potential benefits. Clearer role definitions, structured communication, and supportive organisational policies are needed to enhance collaboration, reduce caregiver burden, and support manageable physical therapist workloads. Strengthening these partnerships could improve rehabilitation processes, resident health outcomes, and sustainability of long-term care services.
As the shift to electric mobility intensifies, unpredictable EV charging challenges grid stability. This study proposes a multi-layered machine learning framework balancing grid optimization and user service. First, session-level prediction models estimated energy and cost; XGBoost achieved the highest energy accuracy ([Formula: see text]), while Random Forest best predicted cost ([Formula: see text]). Second, a station-level forecasting model using XGBoost demonstrated exceptional precision for daily demand ([Formula: see text], MAE=0.90 kWh). Finally, K-Means clustering segmented drivers, revealing a user base dominated by Heavy Energy Users (43.5%) and Occasional Visitors (38.8%). This segmentation enables Charge Point Operators to design personalized services and demand response strategies. Overall, the framework integrates prediction, forecasting, and behavioral segmentation to support scalable, data-driven decisions. Ultimately, these insights equip utility providers and operators with the necessary tools to proactively manage load congestion and optimize capital expenditure planning.
Clinical pathways are increasingly adopted to control costs and enhance quality management, becoming a standardized approach in treatment. This study aims to develop a hospital-specific clinical pathway for non-small cell lung cancer (NSCLC) surgery based on national standards and actual treatment practices, and evaluate its service efficiency through simulation. We analyzed 94 electronic medical records of NSCLC surgeries performed between May 2020 and November 2022, evaluating the need for localization by statistically examining treatment process delays. A Time Petri Net model was established for this pathway, with simulations conducted to measure post-implementation changes in hospital length of stay (LOS). The hospital's existing processes were generally consistent with national standards. Validation of the Time Petri Net model confirmed its effectiveness. Simulation results showed that the average LOS was reduced from a baseline of 8.20 days to 7.76 days, saving a total of ~ 10.28 h (individual diagnostic/treatment processes were shortened by 0.15-5.04 h). Implementing this tailored clinical pathway significantly improved service efficiency by aligning it with national guidelines, enabling better integration and optimization of medical resources while improving overall clinical pathway management quality.
The COVID-19 pandemic accelerated telehealth service adoption in physiotherapy, including telerehabilitation (TR). However, the extent of TR use and factors influencing its implementation in Germany remain unclear. This study aimed to evaluate TR use in physiotherapy (during COVID-19 lockdowns, current use, future intentions, conditions treated, content, setting, and session type) and identify barriers and facilitators from physiotherapists' (PTs) perspectives. A mixed-methods sequential explanatory design was employed, combining a cross-sectional online survey (n = 152) with two focus group interviews (n = 9). The survey collected data on demographics, TR use, barriers, and facilitators. Focus groups explored themes emerging from the survey in greater depth. Data were analyzed using descriptive statistics and content analysis, integrating quantitative and qualitative findings. Quantitative and qualitative findings were integrated through explanatory linking and joint display in a comparative analysis table. TR use peaked during COVID-19 lockdown (32.26%) but decreased to 18.06% by October 2022, with 26.45% intending future use and 43.87% considering it. Among TR users, musculoskeletal conditions were most commonly treated (75%), followed by sports (38%), pulmonology (33%), and neurology (27%). The primary barrier was lack of physical examination (74% agreement). While technical challenges were not reported as a major barrier in the survey, interviews revealed significant concerns about insufficient internet bandwidth and technical infrastructure. Common reasons for using TR included promoting patient self-management (78% agreement) and broadening therapy options (69% agreement). Qualitative data identified additional implementation facilitators, including structured implementation processes, appropriate technical infrastructure, and patient involvement in decision-making. While TR implementation in German physiotherapy shows growth potential, several barriers currently limit its adoption. Successful implementation requires addressing PTs capabilities, knowledge gaps, professional identity concerns, and environmental factors. Addressing these issues could enhance patient care quality, increase service accessibility, and advance healthcare delivery models.
The COVID-19 pandemic disrupted maternal healthcare globally, yet localized experiences within structurally constrained settings remain underexplored. In Saskatchewan, Canada, pre-existing inequities relating to geography and health care access shaped how women experienced pregnancy and early motherhood during the pandemic. This study explored the lived experiences of women who were pregnant and gave birth during the COVID-19 pandemic, with particular attention to how healthcare disruptions, social restrictions, and structural conditions shaped care experiences, distress, and resilience. This qualitative interpretive phenomenology study drew on 35 individual interviews and three focus group discussions with a total of 51 women who were pregnant or gave birth between March 2020 and December 2022. Participants were purposively sampled across urban, rural, and northern Saskatchewan. Data were analyzed using reflexive thematic analysis. Four themes were identified: living with pandemic risk and uncertainty; fragmentation of maternal care; emotional toll of isolation; and coping and resilience. Women described heightened fear and moral responsibility, disrupted access to prenatal and postpartum services, depersonalized communication, and limited mental health and lactation support, particularly in rural and northern regions. While virtual care improved accessibility for some women, it often lacked relational and embodied dimensions of care. Family support, trusted healthcare providers, and digital resources facilitated coping and resilience. The pandemic intensified existing inequities in maternal healthcare, revealing vulnerabilities in communication, continuity, and culturally responsive care. Findings underscore the need for equity-oriented emergency preparedness, hybrid models of care, strengthened maternal mental health services, and meaningful involvement of people with lived experience in planning future responses.
Drowning-associated cardiac arrest is associated with high mortality and poor neurological outcomes. The appropriate prognosis prediction and determination of a treatment plan are crucial. A 19-year-old Japanese male was playing in a river. His friend found him drowning and immediately pulled him out. He experienced cardiac arrest. His friend called for emergency services and performed bystander cardiopulmonary resuscitation. When the emergency service later arrived at the scene, the patient was in a state of return of spontaneous circulation. The patient was transported to our hospital by air ambulance. He was subsequently admitted to the intensive care unit and later discharged without residual higher brain dysfunction as a result of multidisciplinary treatment, including venovenous extracorporeal membrane oxygenation (V-V ECMO). In drowning-associated cardiac arrest with rapidly progressive hypoxemia, early initiation of V-V ECMO as part of comprehensive post-cardiac arrest management may contribute to favorable neurological outcomes.
Provision of equipment for the purpose of stimulant inhalation is prohibited under UK law. Crack cocaine use is prevalent and rising in England, where the SIPP (safer inhalation pipe provision) study piloted and evaluated a crack equipment and workforce training intervention. We report mixed method findings from the baseline component of the study, prior to intervention implementation. The aim of this paper is to situate quantitative findings regarding respiratory risk through qualitative exploration of crack inhalation practice in a context of stimulant equipment prohibition. In this paper we report descriptive findings from baseline survey data (n = 727) with a focus on thematic analysis of interview data (n = 33). Participants were recruited through drug treatment services and peer networks in six geographical locations in England, with survey eligibility criteria including crack use (injecting or smoking) in the past 28 days. Of the 733 participants who completed the baseline questionnaire, 727 (99%) smoked crack in the past month and were included for further analysis. A minority reported crack injection (28%). Over half (55%) used crack daily in the past month. Many (60%) reported respiratory symptoms, with one third experiencing a respiratory-related hospitalisation. Qualitative data illustrate ingenuity of crack equipment practice, with participants fashioning pipes out of materials ranging from umbrella handles, through to tin cans and plastic inhaler cases. Ash and stainless-steel scourer were primarily used as suspension materials. Accounts of practice illustrate connections between materials used and respiratory harms, the latter exacerbated by poor living conditions and limited availability of supports. We evidence a high burden of respiratory harm among people who smoke crack in England. Stimulant inhalation equipment prohibition contributes to a constellation of respiratory risk, with use of unsafe materials and impoverished living environments exacerbating health harms among a highly marginalised population. There is a need to reorientate drug services to support safer crack inhalation practice and reduce respiratory risk. Legislative change can facilitate this process. ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454.
Widespread adoption of single-use intermittent catheters for bladder drainage has led to increased costs and environmental waste. Reusable catheters could reduce both. The MultICath study showed that combined reusable and single-use catheters (Mixed-use) was non-inferior to single-use catheters for urinary tract infection and quality of life, but the economic impact is unknown. We aim to determine whether Mixed-use is cost-effective compared to Single-use only. Cost-utility and cost-consequence analyses were conducted alongside MultICath. The analysis took the United Kingdom payer perspective, using individual patient-level data of the 578 randomised (1:1) trial participants over 12 months. Costs included catheter and cleaning costs, antibiotic costs, and health-related visit costs. Outcomes were measured in quality adjusted life years (QALYs), estimated from EQ-5D-5L data. Incremental, sensitivity, and scenario analyses were conducted. Mixed-use participants used on average 902 (95% CI 755.13; 1049.31) fewer single-use catheters per annum than Single-use participants. Mixed-use was cost-effective in all analyses. Base-case annual incremental cost savings were -£1348.82 (95% CI -1939.98; -757.65) whilst incremental QALYs were negligible (-0.001; [-0.026; 0.024]). These estimates produced a positive net monetary benefit of £1328.82 at a willingness-to-pay threshold of £20,000. The probability of Mixed-use being cost-effective was never below 96.6%. The primary limitation was differential withdrawal rates between groups, accounted for in sensitivity analyses. Mixed-use is cost-effective for the UK National Health Service, and provision of reusable catheters should be considered. These findings are also relevant for other health services worldwide with high single-use catheter costs.
This paper proposes a novel dispatch formulation for micro-mobility vehicles using a quantum annealing (QA). In recent years, QA has gained increasing attention as a high-performance solver for combinatorial optimization problems. Meanwhile, micro-mobility services have been rapidly developed as a promising means of realizing efficient and sustainable urban transportation. In this study, the dispatch problem for such micro-mobility services is formulated as a quadratic unconstrained binary optimization (QUBO) problem, enabling efficient solving through QA. Furthermore, the proposed formulation incorporates historical usage data to enhance operational efficiency. Specifically, customer arrival frequencies and destination distributions are modeled into the QUBO formulation through a Bayesian approach, which guides the allocation of vacant vehicles to designated stations for waiting and charging. Simulation experiments are conducted to evaluate the effectiveness of the proposed method, with comparisons to conventional formulations such as the vehicle routing problem. Additionally, the performance of QA is compared with that of classical solvers to reveal its potential advantages for the proposed dispatch formulation. The effect of reverse annealing on improving solution quality is also investigated.
The postpartum period is a critical time when women need information and support for both their own health and newborn care. Mobile health applications can significantly improve access to information during the postpartum period. However, the effectiveness of such applications depends on understanding postpartum women's usage preferences and expectations. Existing evidence on postpartum mobile health applications is largely derived from studies conducted in South Asian and East African contexts, highlighting the need for context-specific data from Türkiye. This study aimed to determine the usage preferences and expectations of postpartum women regarding mobile applications developed for the postpartum period. This descriptive study was conducted with 385 postpartum women in Istanbul, Türkiye. Data were collected between October 2024 and February 2025 using a structured Descriptive Information Form prepared by the researchers. The form included items related to sociodemographic characteristics, obstetric characteristics, and opinions regarding the use of mobile applications during the postpartum period. Data were analyzed using descriptive statistics, chi-square and multivariate logistic regression analysis. Willingness to use mobile applications was significantly associated with age, educational level, income status, parity, and mode of birth. The most frequently requested application content included newborn care (45.5%), common newborn problems and their management (42.9%), and emergency situations related to maternal and newborn health (40.5%). Participants also emphasized the importance of applications providing reliable, clear, and up-to-date information. Postpartum women have specific preferences and expectations regarding mobile health applications designed for the postpartum period. Developing user-centered mobile applications that prioritize newborn care and emergency-related content may support postpartum health services and enhance maternal and newborn health outcomes.
People with experiences of homelessness are at higher risk for suicide-related thoughts, behaviors, and deaths by suicide compared to those without homeless experience. This complex risk can be tied in part to extreme social need and multimorbidity. To meet these needs and reduce this risk, people with experiences of homelessness frequently require care from multiple providers. Continuity of care is protective against suicide risk, with care coordination playing a central role. Despite the importance of continuity of care in suicide prevention and the potential for mental health nurses to provide care coordination, few studies have explored this potential in relation to people with experiences of homelessness. Provide a potential practice application to illustrate the possible value of using the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) to measure and improve continuity of care as an important element of suicide prevention for people with experiences of homelessness. Using the U.S. Department of Veteran Affairs (VA) Homeless Patient-Aligned Care Team (HPACT) model and universal VA suicide risk screening protocol as a practice exemplar, we discuss the ACSS-MH subscales to illustrate a potential care delivery evaluation and way the psychiatric nursing community can optimize continuity of care, suicide risk detection and suicide prevention in this population. Innovative screening and practice models are needed to effectively prevent suicide in high-risk populations, like people with experiences of homelessness. This case study provides insight into the ACSS-MH measure and VA-based homeless-specific primary care as an example of how psychiatric nurses could similarly use this measure to impact the safety of patients with experiences of homelessness by intentionally fostering continuity related to suicide prevention. This discussion of a practice application shows how the use of a validated measurement tool could drive quality improvement and research that begins with the measurement of continuity related to suicide prevention for high-risk populations.
Household livelihood vulnerability (HLV) remains a critical yet underexplored determinant of child health in climate-sensitive coastal regions of Bangladesh, where recurrent climate hazards disrupt livelihoods, reduce income stability, intensify food insecurity, and limit access to essential health services. Therefore, this study examines the extent and determinants of HLV and its implications for child health in southwestern coastal Bangladesh. Following the survey method, this community-based cross-sectional study was carried out in six villages of Dacope upazila in Khulna district of Bangladesh. Data were collected from 348 randomly selected caregivers of under-five children at the household level from July to October 2024. The findings demonstrated that the prevalence of HLV was 58.6% in the study area. HLV showed significant spatial and occupational variation, with the highest prevalence observed in Sutarkhali village and among households primarily dependent on Sundarbans-based natural resource extraction. Multivariate logistic regression analysis revealed that higher odds of livelihood vulnerability were examined among Muslim households, households with multiple dependents, food insecure households, those that had recently borrowed money from friends or relatives, and those relying on local government assistance. Conversely, household heads with primary, secondary, or higher education, monthly savings of BDT ≤ 1,000, and households with multiple income earners had lower odds of livelihood vulnerability. Furthermore, child health analysis revealed a significant relationship between household vulnerability and child undernutrition, indicating that children from vulnerable households were more likely to be severely underweight than peers from non-vulnerable households. This study highlights the need for integrated policy responses that simultaneously address livelihood insecurity and child health particularly, strengthening climate-resilient and diversified livelihoods, expanding education, vocational training, and financial inclusion programs (e.g., savings schemes and microcredit), and the integration of vulnerability assessments into child-nutrition programs through targeted cash transfers, supplementary feeding, growth monitoring, and nutrition counseling in coastal Bangladesh.