Expression of Concern Notice: Analysis of the implementation of teletraining and teleIEC in healthcare services: Case study

Due to the economic and social priorities afforded health services in the United States, research on new delivery modalities such as the Internet is gaining in popularity. Claims of the Internet's potential range from a promise to revolutionize the fundamental way health care is delivered to a tool for empowering patients through enhanced interaction with providers (Rice, 2001). Even though a great amount of attention has been given to e-health activity, the preponderance of publications to date has focused on the Internet as a source of health information. However important this form of e-health is, this type of service simply does not face the same constraints that must be addressed by those actually delivering health care services or tightly regulated pharmaceutical products. In this paper, we examine e-health by focusing explicitly on the delivery of health care products and services. Our examination of e-health activity is guided by two broad research questions. First, we ask what the potential is for the development of online health care services by examining its potential in major health care service and product sectors. Second, based upon case studies of two online health service firms, we seek to understand the emerging strategies of firms that are attempting to enter the health care market with an entirely online approach. Our examination of current e-health trends, as well as our two case studies, demonstrates the tremendous potential for health-related commercial activity on the Internet. However, our examination of the barriers facing ehealth from the US health system also pointed out the almost insurmountable challenges. We therefore conclude that a “click and mortar” model may perhaps be the optimal strategy for e-health.

Mandate for Accreditation in Plastic Surgery Ambulatory/Outpatient Clinics

Review question/objective The objective of this review is to analyse and synthesise the best available evidence on the experiences of Indigenous people who engage in health care encounters in Western settings and contexts. The review question is: What are the experiences of Indigenous people engaged in health care encounters in Western settings and contexts? Inclusion Criteria Types of Participants Studies including two groups of participants, regardless of age or gender, will be considered for this systematic review. The first group is persons of Indigenous descent from the following countries and continents appearing most frequently in the literature: North America, South America, New Zealand, Australia, and Scandinavian countries. These countries include peoples such as First Nations, Native Americans, Metis, Inuit, North American Indians, South American Indians, Inca, Maori, Aboriginal and Torres Strait Islander peoples of Australia, and Sapmi. This list is not exhaustive, and any Indigenous population identified in a study will be included. Indigenous populations who immigrate to new countries will be excluded, given that immigrant status can confound Indigenous status. The second group of participants to be considered for inclusion is health care providers who work in Western settings and context, including, but not limited to, nurses, physicians, nutritionists, midwives, social workers, physiotherapists, occupational therapists, speech and language therapists, and respirologists. Phenomena of Interest The phenomenon of interest is the experience of Indigenous people in health care encounters in Western health care settings and context. Health care encounters refer to any interactions between an Indigenous person and a health care provider within the scope of Western health care services. All reasons for health encounters will be considered. Context The context will be Indigenous persons seeking health care services in Western settings and context. These services may be located within urban, rural, or remote health care settings where Western health care services are delivered.

Safeguarding is a critical component of healthcare services, particularly as it relates to protecting vulnerable populations. It aims to shield individuals from violence, exploitation, sexual abuse, and neglect. The concept of safeguarding goes beyond physical protection, encompassing psychological, social, and legal dimensions that uphold individual rights—especially for vulnerable groups such as children, women, persons with disabilities, and those with limited access to safe healthcare services. This community engagement initiative aimed to raise awareness and understanding of safeguarding and risk mitigation in healthcare services. The safeguarding workshop involved participants from Muhammadiyah organizations and utilized group discussions, case studies, role-plays, and scenario-based simulations. Pre- and post-training evaluations were conducted to assess the increase in participant understanding. The results indicated an improvement in safeguarding knowledge and led to the drafting of the initial Safeguarding Guidelines for Health Council of Muhammadiyah Central Board. These guidelines encompass safeguarding definitions, core principles, preventive strategies, case-handling procedures for violence, exploitation, and sexual abuse (VESA), and reporting mechanisms tailored to Muhammadiyah’s context. iven the novelty of safeguarding as a concept, some participants found it challenging to identify forms of VESA or understand preventive measures. Thus, continued efforts through advanced training and broader policy dissemination are necessary to deepen understanding and enhance implementation. Safeguarding is a critical component of healthcare services, particularly as it relates to protecting vulnerable populations. It aims to shield individuals from violence, exploitation, sexual abuse, and neglect. The concept of safeguarding goes beyond physical protection, encompassing psychological, social, and legal dimensions that uphold individual rights—especially for vulnerable groups such as children, women, persons with disabilities, and those with limited access to safe healthcare services. This community engagement initiative aimed to raise awareness and understanding of safeguarding and risk mitigation in healthcare services. The safeguarding workshop involved participants from Muhammadiyah organizations and utilized group discussions, case studies, role-plays, and scenario-based simulations. Pre- and post-training evaluations were conducted to assess the increase in participant understanding. The results indicated an improvement in safeguarding knowledge and led to the drafting of the initial Safeguarding Guidelines for Health Council of Muhammadiyah Central Board. These guidelines encompass safeguarding definitions, core principles, preventive strategies, case-handling procedures for violence, exploitation, and sexual abuse (VESA), and reporting mechanisms tailored to Muhammadiyah’s context. iven the novelty of safeguarding as a concept, some participants found it challenging to identify forms of VESA or understand preventive measures. Thus, continued efforts through advanced training and broader policy dissemination are necessary to deepen understanding and enhance implementation.

This timely and comprehensive volume explores the evolving concept of Society 5.0 - a forward-looking, human-centered society where cutting-edge technologies such as the Internet of Things (IoT), Artificial Intelligence (AI), robotics, and augmented reality seamlessly integrate into daily life, healthcare, industry, and public services to enhance quality of life and social well-being. Industry 5.0, as a vital enabler of this vision, emphasizes collaborative interactions between humans and smart systems, driving innovations in personalized healthcare, sustainable industries, and connected communities. This first part of a multi-volume set provides readers with foundational insights into the principles, enabling technologies, and strategic opportunities shaping Industry 5.0 and Society 5.0. Edited contributions from subject matter experts offer a roadmap for harnessing Medical IoT (Internet of Medical Things) applications within this new societal framework. The book covers essential topics such as high-performance computing in healthcare decision support, AI-driven diagnostic solutions, cybersecurity in digital health systems, and ethical data practices in patient care. It also highlights emerging use cases, including IoT-enabled wearable devices for women's security and smart diagnostic tools for early disease detection. Key features: Presents a detailed overview of Industry 5.0 and Society 5.0, their fundamentals, enabling technologies, and future prospects. Examines the role of Industry 5.0 in transforming medical and healthcare services through the integration of IoT and AI-driven solutions. Explores innovative applications such as AI-based diabetic retinopathy detection, IoT applications in digital healthcare, and patient-centric data ethics frameworks. Discusses advances in smart farming and sustainable industrial practices within the Industry 5.0 paradigm. Highlights opportunities for bridging research gaps in high-performance computing for holistic healthcare decision support. Provides use case studies on IoT-enabled healthcare security solutions and digital health systems.

Background: The national statistics encompassed 16,708 teenage pregnancies in 2019 in Sri Lanka. Adolescent pregnancy due to child sexual abuse is a global phenomenon with clearly known causes and serious health, social, and economic consequences. Police data reported 1,254 cases of sexual abuse, with 214 pregnancies in 2024 in Sri Lanka. Case study: Case 1: A 16-year-old child who was sexually abused by a relative of hers presented at 18 weeks of gestation; Case 2: 15-year-old child who was living together with her boyfriend presented at 10 weeks gestation following unanimous information to police for statutory rape; Case 3: A 15-year-old child who was sexually abused by her brother-in-law presented at the gestation of 23 weeks and Case 4: A 12-year-old mentally retarded child who was sexually abused by an unknown person presented at 19 weeks of gestation. These cass studies highlights instances of teenage pregnancies resulting from rape and incest in Matale, Sri Lanka. They were from the low socio-economic class. All of the adolescents faced significant social consequences, including financial hardship, disrupted educational opportunities, and intense social stigma. Teenage pregnancies can significantly limit adolescents' future opportunities and overall well-being, affecting their prospects for education, employment, and stable family life. These young mothers are also at increased risk of domestic violence, abuse, and exploitation. Moreover, teenage pregnancies are associated with adverse health outcomes for both the mother and the child, underscoring the importance of timely referral to appropriate healthcare services. In Sri Lanka, where abortion in cases of rape is illegal, adolescent pregnancies resulting from sexual violence may lead to unsafe abortion practices. According to the Ministry of Health, unsafe abortions account for approximately 25% of maternal deaths, highlighting a serious public health concern. Conclusions: This situation highlights several deficiencies in Sri Lanka's healthcare and legal services. Considering provisions for legal abortion in cases of rape and incest, improving sexual health knowledge among adolescents including family planning methods and emergency contraception, will improve the situation.

NU Care Lazisnu Ngronggot is one of the Zakat Management Organizations (LAZ) owned by Nahdlatul Ulama, located in Ngronggot, Nganjuk Regency. NU Care Lazisnu Ngronggot, in carrying out its activities, conducts programs aimed at improving community welfare through the management of zakat, infak, and sedekah funds, implemented through special programs. These include the collection, distribution, and utilization of zakat, infak, and sedekah (ZIS) funds. In the management of infak and sedekah funds, there is a special program from NU Care Lazisnu Ngronggot called the NU Coin Program. The NU Coin Program is expected to provide specific benefits in improving the welfare of the Ngronggot community through the management of infak and sedekah funds. Welfare distribution should be achieved for all layers of society. This includes adequate educational welfare, healthcare services, and decent income for all community members, especially in the Ngronggot District. It is hoped that the NU Coin Program will provide greater benefits in the equitable distribution of community welfare in various aspects. This study uses qualitative research methods. The results show that the management of funds through the NU Coin Program has successfully improved community welfare through innovative distribution programs in various aspects. Firstly, the program has succeeded in increasing community access to healthcare and education services through financial and facility assistance. Secondly, the program has also contributed to increasing community income through economic empowerment and skills training. Additionally, transparency and accountability in fund management are important factors that encourage active community participation.

BackgroundDespite policy prominence and frameworks focusing on health inequalities, healthcare leaders do not feel they have the skills and knowledge to reduce health inequalities. This comparative case study explored four areas in England to understand the challenges, opportunities, and drivers of local health systems addressing health inequalities and what ‘good’ practice might look like.MethodsInterviews were held with 46 people working in health care services across the NHS, local authority or voluntary, community, social enterprise sectors. Key documents (n = ~ 10) in each of the four areas relating to reducing health inequalities were analysed using documentary analysis methods. Interviews and documents were coded and analysed independently before being integrated to synthesise findings. Analysis was conducted using a two-stage approach - firstly, an inductive analysis of emergent themes; secondly, to build knowledge on each case studys’ system approach of reduction of health inequalities, principles of the Action Scales Model were used.ResultsNineteen themes were identified across the four case studies; some themes were not apparent in all the case studies, nor in either the documentary analysis or interviews. These themes allowed us to compare between cases to explore what might be contributing to good practice. Themes identified included: understanding the local context; facilitators of how to tackle health inequalities and improve health and wellbeing; and future concerns. The secondary analysis highlighted potential levers for action from each case study; these included optimising retention and recruitment of workforce and allowing time and resources for longer-term planning. Two case study areas which appeared to have system resilience, demonstrated having a shared vision, strong partnerships, understanding of the system, and putting people and communities at the heart of decision making.ConclusionThis comparative case study makes a crucial contribution in the understanding of health systems addressing health inequalities in their local areas. The combined interview and documentary analysis findings provide rich insights of local systems’ documented strategies, plans and what is happening ‘on the ground’.

The understanding of spatial inequality in health care services is critical for reasonable policy‐making and management. In this study, we present a novel approach to analyze the demand–supply of health care services using taxi data. Taxi data provide observations of individual travel activities, and hence can be used to characterize the actual demand–supply of health care services. We apply the proposed approach in Guangzhou, China to carry out a case study. The results show the spatial disparities in health care service access. About 21.05% of the total population has high hospital accessibility, while the remaining 78.95% has relatively low hospital accessibility (i.e., roughly an “80/20” distribution). It is found that 6.29% of the population lives in high‐density suburban communities but has relatively low hospital accessibility. Most of the hospitals serve a population that is compatible with their capacity. One hospital is found to have a small capacity but to serve a large population, while two hospitals have relatively high capacities but serve small populations. These findings can help improve our understanding of spatial inequalities in public service provision, and may also provide useful information to address the health care problems of an aging population in contemporary, rapidly urbanizing China.

This research explores how registered nurses constructed their leadership role during the provision of health care services in acute care, adult hospitals in Brisbane, Queensland, Australia. As health care organizations change to meet the demands of the twenty first century, nurses in Australia are coming to realize there is a dissonance between what they perceive to be the relevance of their work and the perception of the relevance of nurses' work by others in the health care system. Consequently, nurses' contributions to health care services are not recognized. The literature highlights that one way to address this problem is to articulate the various leadership roles contemporary nurses are asked to undertake. This is the aim of this thesis. This research seeks to illuminate the role of the nurse within changing health care systems by making clear the nature of their work through the perspectives of leadership. Consequently, the purpose of this study is to explore how nurses have undertaken leadership initiatives in their role as health care providers within contemporary health care organisations. The literature review generated following research questions: 1. How do nurses describe leadership within their health care organisations? 2. How do nurses experience leadership within their health care team? 3. How do nurses construct their leadership role whilst providing health care services? In order to legitimate its findings this study aimed to provide a clear theoretical framework. In order to gain a clear understanding of the personal experiences and meanings of the participants, the theoretical framework for this study was underpinned by the interpretive philosophies the epistemological framework of constructionism and the theoretical perspective of symbolic interactionism. The methodology of case study enabled an empirical investigation of a contemporary nursing phenomenon, leadership wherein the researcher was able to pose questions to those nurses from whom most could be learned. Data were collected through two stages. In stage one, the exploratory stage data was collected through three focus group interviews. Stage two aided deeper exploration of the nurses' leadership constructs with data obtained through one-to-one interviews. Analysis of the data enabled the development of a model of nurse leadership. Participants identified that their leadership was constructed through three perspectives of Self as Leader, Self and Others and Self in Action. The findings contrast the nurses' unique leadership constructs to those of health care organisations, highlight the lack of acknowledgment for nurse leadership within health care teams, and demonstrate how the nurses' leadership constructs influence their decision to act in the provision of patient care. This study concludes that as the nurses come to realise traditional leadership models are incompatible with their goal of achieving patient centred care, they have developed a different style of leadership to achieve their vision of patient centred care. Finally this study offers recommendations in the areas of nursing practice, nursing education and research.

Review Question: This review aims to answer the following specific question: What are nurses’ experiences of preparing for and managing the ethical challenges posed by catastrophic public health emergencies and health care disasters? Review Purpose/Objectives: The purpose of this systematic review is to systematically review and synthesise research literature reporting nurses’ experiences of ethical preparedness for dealing with catastrophic public health emergencies and health care disasters and the ethical quandaries that may arise during such events. INCLUSION CRITERIA: Types of Participants: The review will consider publications that include nurses registered or authorised under a given country’s state of emergency provisions to practice in jurisdictions in which a public health emergency (e.g. pandemic influenza) or sudden‐onset mass casualty health care disaster (e.g. flood, hurricane, earthquake, tsunami, volcanic eruption, terrorist attack) have occurred, or may occur. Phenomena of interest: This review will examine the phenomenon of nurses’ experiences of preparing for and/or managing ethical issues arising during a public health emergency or health care disaster. Consideration will be given to, but not be limited to nurse preparation for and management of ethical issues associated with: development of local public health emergency (including pandemic influenza) and sudden‐onset health care disaster plans provision of first health care contact for the general public personal protection and correct use of safety equipment providing front line clinical care providing community and primary health care assistance with containment measures triaging in a range of settings, including general practices, community health centres, and local hospitals maintaining infection control vaccinations informing the public work attendance.

The impact of traffic on equality of urban healthcare service accessibility: A case study in Wuhan, China

In the present study, the amounts of medical waste materials, sharps, liquid waste, hazardous waste, household waste and recyclables generated from 375 healthcare services including private hospitals, state hospitals, university hospitals, private medical centres, dialysis centres, cottage hospitals and private dentist surgeries were determined, and the relation between the amount of the waste and the bed capacities, inpatient and outpatient numbers were evaluated. The amount of regulated medical waste corresponded to 28.8% of the total waste streams collected from the healthcare services, and the major producers were private hospitals. The major producers of hazardous waste were state hospitals with a generation rate of 57.9%. The main results of the study indicate that the quantities of the waste streams generated from healthcare services in accordance with the outpatient number gave more appropriate results than the other evaluation methods. Furthermore, evaluation based on the bed capacities gave reasonable results except for recyclables and hazardous waste. As a result of the evaluation of the medical waste generation rate with bed capacities, the generation rate was determined as 2.11 ± 3.83 kg bed(-1) day(-1) and this rate was 1.45 ± 9.84 kg outpatient(-1) day(-1) for the evaluation by outpatient numbers. The observed significant P values (P > 0.05) indicate that the evaluation of the waste streams in healthcare services based upon outpatient numbers did not show any reasonable change according to service category.

Purpose– The purpose of this paper is to explore, through a case study, and using Pawson and Tilley's notion of context-mechanism-outcome configurations, how a sectoral innovation system (SIS) for health technologies has developed.Design/methodology/approach– The case study data were collected as part of a large study that looked at technology innovation and adoption in the UK's National Health Service and were collected using an interpretive case study methodology. Primary data came from interviews and secondary data from published sources, including articles authored by members of the innovation team.Findings– The paper identifies three specific configurations of context, mechanism and outcome that were important in the case and discusses how these contribute to a broader understanding of a healthcare services SIS.Research limitations/implications– Research conducted through a single case study is open to the criticism that its findings are not generalisable but it has offered an economical way of gaining a deep description of a situation and an understanding of the contextual factors affecting a phenomenon. The paper presents a refined model for understanding SISs that though primarily rooted within the healthcare care sector has potential for application in other sectors, especially those that encompass a significant public-sector component.Practical implications– The paper's findings and conclusions have relevance to healthcare service innovation policy development. The findings will also be useful to professionals responsible for innovation projects and their support within the sector.Originality/value– The paper makes an important contribution to the understanding of a SIS for healthcare services as well as refining a general model of SISs.

ABSTRACTThe aim of this study is to investigate the factors related to post‐traumatic stress disorder (PTSD), depression and anxiety mental disorders, as well as the quality of life of Syrian refugees and to examine the relationships between mental health disorders and the quality of life of Syrian refugees. Data were collected via face‐to‐face surveys with 613 adult Syrian refugees in an urban setting. Brislin's methodology was used for translating scale items, involving initial translation, back‐translation and review by another professional translator. The study utilised the PTSD Scale, Beck Anxiety Scale, Depression Scale and Quality of Life Scale (QOLS). Descriptive, correlational and multivariate regression analysis were applied. Findings of correlational analysis indicate that PTSD levels among Syrian refugees are significantly related to gender, income level and employment. Depression levels are significantly associated with trauma history, healthcare service use, marital status and employment. Anxiety levels are significantly related to gender, trauma history, healthcare service use, employment and income. According to the findings of the regression analyses, the relationships between depression, quality of life and PTSD are complex. Meanwhile, anxiety decreases quality of life and increases PTSD. Quality of life moderates the relationship between depression and PTSD, as well as between anxiety and PTSD. The study concludes that the mental disorder levels of Syrian refugees, in terms of PTSD, depression and anxiety, are linked to their socio‐demographic characteristics. These results highlight the importance of social, economic and cultural factors, healthcare and social services and the socio‐demographic characteristics of the region where refugees have settled after displacement.