Health Care Administrators Research Articles

Artificial intelligence in healthcare administration: Topic modeling with InfraNodus

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Health Care Fraud and Abuse: Lessons From One of the Largest Scandals of the 21st Century in the Field of Spine Surgery.

Up to hundreds of billions of dollars are annually lost to fraud and abuse in the US health care, making it a significant burden on the system. This study investigates a specific instance of health care fraud in spine surgery, in which a medical device company ended up paying $75 million to settle violations of the False Claims Act. We review the surgical background regarding the kyphoplasty procedure, as well as its billing and reimbursement details. We also explore the official legal complaint brought by the US Department of Justice to tell the story of how one of the most significant medical innovations in spine surgery in the 21st century turned into a widespread fraudulent marketing scheme. In the sequence, we provide a detailed root cause analysis of this scandal and propose some proactive measures that can be taken to avoid such type of unfortunate events. Ultimately, this historical health care scandal constitutes a valuable lesson to surgeons, health care administrators, medical device companies, and policymakers on how misaligned incentives and subsequent unscrupulous practices can transform a medical innovation into an unfortunate tale of fraud and deceit.

Metformin Use in the First Trimester of Pregnancy and Risk for Nonlive Birth and Congenital Malformations: Emulating a Target Trial Using Real-World Data.

Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy. To evaluate the teratogenicity of metformin use in the first trimester of pregnancy. In an observational cohort of pregnant women with pregestational type 2 diabetes receiving metformin monotherapy before the last menstrual period (LMP), a target trial with 2 treatment strategies was emulated: insulin monotherapy (discontinue metformin treatment and initiate insulin within 90 days of LMP) or insulin plus metformin (continue metformin and initiate insulin within 90 days of LMP). U.S. Medicaid health care administration database (2000 to 2018). 12 489 pregnant women who met the eligibility criteria. The risk and risk ratio of nonlive births, live births with congenital malformations, and congenital malformations among live births were estimated using standardization to adjust for covariates. A total of 850 women were in the insulin monotherapy group and 1557 in the insulin plus metformin group. The estimated risk for nonlive birth was 32.7% under insulin monotherapy (reference) and 34.3% under insulin plus metformin (risk ratio, 1.02 [95% CI, 1.01 to 1.04]). The estimated risk for live birth with congenital malformations was 8.0% (CI, 5.7% to 10.2%) under insulin monotherapy and 5.7% (CI, 4.5% to 7.3%) under insulin plus metformin (risk ratio, 0.72 [CI, 0.51 to 1.09]). Possible residual confounding by glycemic control and body mass index. Compared with switching to insulin monotherapy, continuing metformin and adding insulin in early pregnancy resulted in little to no increased risk for nonlive birth among women receiving metformin before pregnancy. Under conventional statistical criteria, anything between a 49% decrease and a 9% increase in risk for congenital malformations was highly compatible with our data. National Institutes of Health.

Influence of Job Analysis on Employee Performance in Private Hospitals of Kisii County-Kenya

Purpose: This research aims to examine the impact of job analysis on employee performance in the private hospitals of Kisii County. Even though the hiring procedures in these hospitals are strict, some of the employees working in these hospitals have been found to be performing poorly and have various challenges such as low morale, high turnover rate and poor performance. Methodology: The study adopted the use of a cross-sectional descriptive survey which was used to collect detailed information about he under-study issue, the practice of job analysis and its impact on worker productivity in Kisii County hospitals. The researcher adopted a descriptive study design, and the data for the study was collected from 108 healthcare professionals and administrators from different private hospitals in Kisii County. The collected data was then analysed using SPSS Version 24. The results were then represented tables and graphs for easy analysis. Descriptive and inferential statistics highlighted the effects of job analysis on employees’ performance. Results: The results of the study indicate that external recruitment excels with the highest mean score as can be seen by the respondents who view it as being highly effective. This is drawn from the different scores related to different study items. For instance, the mean score for job analysis was 3.78 which indicates that most respondents agreed that job analysis had a positive impact on job performance. Internal recruitment also recorded a mean score of 3.52 and a standard deviation of 1.05. On external recruitment, the scores were a 4.21 mean with a standard deviation of 0.87 which showed a very small variation in the answer spread. Lastly, employee performance scored a mean of 3.95 which indicated that employees were perceived to be running at high level based on the feedback provided. Firms that used both internal and external sources of recruitment had higher productivity than those that relied on internal sources only. However, there are some limitations such as the use of self-reported data may bring in some bias. Unique Contribution to Theory, Practice and Policy: Based on the study results, the researcher makes the following recommendations to the hospitals administration. First, there is need to undertake routine and comprehensive job analysis by companies to ensure that the company has competent employees. Secondly, the involving of employees in job analysis has numerous advantages and job satisfaction. Lastly, the researcher hypothesises that capacity building of HR employees significantly improves on the quality of job analysis. Similarly, to hospitals in Kisii County, the researcher recommends the adoption of job analysis to improve on their manpower.

Evaluating the readiness of healthcare administration students to utilize AI for sustainable leadership: a survey study

PurposeThis paper explores how healthcare administration students perceive the integration of Artificial Intelligence (AI) in healthcare leadership, mainly focusing on the sustainability aspects involved. It aims to identify gaps in current educational curricula and suggests enhancements to better prepare future healthcare professionals for the evolving demands of AI-driven healthcare environments.Design/methodology/approachThis study utilized a cross-sectional survey design to understand healthcare administration students' perceptions regarding integrating AI in healthcare leadership. An online questionnaire, developed from an extensive literature review covering fundamental AI knowledge and its role in sustainable leadership, was distributed to students majoring and minoring in healthcare administration. This methodological approach garnered participation from 62 students, providing insights and perspectives crucial for the study’s objectives.FindingsThe research revealed that while a significant majority of healthcare administration students (70%) recognize the potential of AI in fostering sustainable leadership in healthcare, only 30% feel adequately prepared to work in AI-integrated environments. Additionally, students were interested in learning more about AI applications in healthcare and the role of AI in sustainable leadership, underscoring the need for comprehensive AI-focused education in their curriculum.Research limitations/implicationsThe research is limited by its focus on a single academic institution, which may not fully represent the diversity of perspectives in healthcare administration.Practical implicationsThis study highlights the need for healthcare administration curricula to incorporate AI education, aligning theoretical knowledge with practical applications, to effectively prepare future professionals for the evolving demands of AI-integrated healthcare environments.Originality/valueThis research paper presents insights into healthcare administration students' readiness and perspectives toward AI integration in healthcare leadership, filling a critical gap in understanding the educational needs in the evolving landscape of AI-driven healthcare.

Impact of lung cancer screening on stage migration and mortality among the national Veterans Health Administration population with lung cancer.

Despite randomized trials demonstrating a mortality benefit to low-dose computed tomography screening to detect lung cancer, uptake of lung cancer screening (LCS) has been slow, and the benefits of screening remain unclear in clinical practice. This study aimed to assess the impact of screening among patients in the Veterans Health Administration (VA) health care system diagnosed with lung cancer between 2011 and 2018. Lung cancer stage at diagnosis, lung cancer-specific survival, and overall survival between patients with cancer who did and did not receive screening before diagnosis were evaluated. We used Cox regression modeling and inverse propensity weighting analyses with lead time bias adjustment to correlate LCS exposure with patient outcomes. Of 57,919 individuals diagnosed with lung cancer in the VA system between 2011 and 2018, 2167 (3.9%) underwent screening before diagnosis. Patients with screening had higher rates of stage I diagnoses (52% vs. 27%; p ≤ .0001) compared to those who had no screening. Screened patients had improved 5-year overall survival rates (50.2% vs. 27.9%) and 5-year lung cancer-specific survival (59.0% vs. 29.7%) compared to unscreened patients. Among screening-eligible patients who underwent National Comprehensive Cancer Network guideline-concordant treatment, screening resulted in substantial reductions in all-cause mortality (adjusted hazard ratio [aHR], 0.79; 95% confidence interval [CI], 0.67-0.92; p=.003) and lung-specific mortality (aHR, 0.61; 95% CI, 0.50-0.74; p<.001). While LCS uptake remains limited, screening was associated with earlier stage diagnoses and improved survival. This large national study corroborates the value of LCS in clinical practice; efforts to widely adopt this vital intervention are needed.

A qualitative examination of the experiences and perspectives of interprofessional primary health care teams in the distribution of the COVID-19 vaccination in Ontario, Canada.

Primary health care (PHC) teams contributed to all phases of the COVID-19 vaccination distribution. However, there has been criticism for not fully utilizing the expertise and infrastructure of PHC teams for vaccination distribution. Our study sought to understand the role PHC teams had in the distribution of the COVID-19 vaccine in Ontario, Canada. The key objective informing this study was to explore the experiences and perspectives of interprofessional PHC teams in the distribution of COVID-19 vaccination across Ontario. A qualitative approach was used for this study, which involved 39 participants from the six health regions of the province. Eight focus groups were conducted with a range of interprofessional healthcare providers, administrators, and staff working in PHC teams across Ontario. The sample reflected a diverse range of clinical, administrative, and leadership roles in PHC. Focus groups were audio-recorded and transcribed, while transcriptions were then analyzed using thematic analysis. We identified the following four themes in the data: i) PHC teams know their patients; ii) mobilizing team capacity for vaccination, iii) intersectoral collaborations, and iv) operational challenges. PHC teams were an instrumental component in supporting COVID-19 vaccinations in Ontario. The involvement of PHC in future vaccination efforts is key but requires additional resourcing and inclusion of PHC in decision-making. This will ensure provider well-being and maintain collaborations established during COVID-19 vaccination.

Risk Factors for Pediatric Intracranial Neoplasms in the Kids’ Inpatient Database

Introduction: In children and adolescents, brain and central nervous system (CNS) tumors are the leading types of cancers. Past studies have found differing rates of intracranial cancers among races and identified additional cancer risk factors. This study aimed to see if these differences can be substantiated with further investigation of the latest version (2019) of the Kids’ Inpatient Database (KID). Methods: A total of 7,818 pediatric patients <21 years old in KID with ICD-10 codes consisting of malignant neoplasms of the brain, brainstem, and cerebral meninges (C700, C709–C719) were queried. Modifiable risk factors evaluated include: hospital region, insurance type, hospital city size, the average income of patient zip code, and location/teaching status of a hospital. Non-modifiable risk factors were race and sex at birth. Dependent variables were tested in Excel and GraphPad Prism 9 using a χ2 test with Yates’ continuity correction and Tukey’s one-way and two-way ANOVAs. Results: Mortality rates of females (2.88%) compared to males (1.99%) were significant (p < 0.05). Mortality was (4.17%) in black patients compared to (1.68%) for white (p < 0.0001), Hispanic mortality (2.95%) compared to white (p < 0.01), and mortality of Asian/Pacific Islander (3.86%) compared to white (p < 0.01). Black patients had significantly higher mortality than white, Hispanic, Asian/Pacific Islander, Native American, and other races overall (p < 0.01). There was no significant difference in the mortality rates between children’s hospitals and large hospitals for any race. After accounting for patient race, mortality was still not significantly different for patients with Medicaid insurance compared to non-Medicaid insurance types. Of the children treated at children’s hospitals, the most transferred in from outside hospitals were Native American (20.00%) followed by Asian/Pacific Islander (15.09%) then Hispanic patients (13.67%). A significant difference between races was also seen regarding length of stay (p < 0.001) and number of charges (p < 0.001). Conclusion: These findings confirm prior studies suggesting gender and race are significant factors in mortality rates for children with intracranial neoplasms. However, the findings do not identify the root causes of these discrepancies but may serve as an impetus for clinicians, healthcare administrators, and governmental leaders to improve national resource allocation to better care for pediatric patients with intracranial neoplasms.

Medicaid Managed Care and Pediatric Dental Emergency Department Visits

Millions of economically disadvantaged children depend on Medicaid for dental care, with states differing in whether they deliver these benefits using fee-for-service or capitated managed care payment models. However, there is limited research examining the association between managed care and the accessibility of dental services. To estimate the association between the adoption of managed care for dental services in Florida's Medicaid program and nontraumatic dental emergency department visits and associated charges. This cohort study used an event-study difference-in-differences design, leveraging Florida Medicaid's staggered adoption of managed care to examine its association with pediatric nontraumatic dental emergency department visits and associated charges. This study included all Florida emergency department visits from 2010 to 2014 in which the patient was 17 years or younger, the patient was a Florida resident, Medicaid paid for the visit, and a primary or secondary International Classification of Diseases, Ninth Revision, code was used to classify a nontraumatic dental condition. Analyses were conducted between May 2023 and April 2024. The county of residence transitioning Medicaid dental services from fee-for-service to a fully capitated managed care program managed by a dental plan. The rate of nontraumatic dental emergency department visits per 100 000 pediatric Medicaid enrollees and the associated mean charges per visit. Nontraumatic dental emergency department visits are a well-documented proxy for access to dental care. Data on emergency department visit counts came from the Florida Agency for Health Care Administration. Medicaid population denominators were derived from the American Community Survey's 5-year estimates. Among the 34 414 pediatric nontraumatic dental emergency department visits that met inclusion criteria across Florida's 67 counties, the mean (SD) age of patients was 8.11 (5.28) years, and 50.8% of patients were male. Of these, 10 087 visits occurred in control counties and 24 327 in treatment counties. Control counties generally had lower rates of NTDC ED visits per 100 000 enrollees compared with treatment counties (123.5 vs 132.7). Over the first 2.5 years of implementation, the adoption of managed care was associated with an 11.3% (95% CI, 4.0%-18.4%; P = .002) increase in nontraumatic dental emergency department visits compared with pre-implementation levels. There was no evidence that the average charge per visit changed. In this cohort study, Florida Medicaid's adoption of managed care for pediatric dental services was associated with increased emergency department visits for children, which could be associated with decreased access to dental care.

Analyzing the Effectiveness of Non-remote Monitoring Telemedicine Within the United States After 2019, Including Future Implications as a Healthcare Medium, Regarding Its Statistical and Analytical Disciplines: A Systematic Review

Telemedicine is the utilization of healthcare services remotely via numerous applications that connect the patient with a qualified physician. Telemedicine plays a vital role in providing accessible healthcare to individuals who are unable to do an in-person visit, and its involvement in healthcare is analyzed through the analytical/statistical lens, financial lens, and ethical lens. Telemedicine systems have demonstrated their potential to serve as a functional healthcare medium, but many barriers to an increase in its implementation and efficacy still exist after the COVID-19 pandemic. Despite the importance of telemedicine, knowledge of its implied efficacy and efficiency in providing healthcare is poor, and already existing research doesn’t address solutions to the barriers of telemedicine. The research aims to address this gap by doing a comprehensive, systematic literature review on the efficacy, barriers to implementation, practicality, and future implications of telemedicine’s utilization in the healthcare sphere. Furthermore, by adding a unique perspective on this topic and consolidating research data for the general healthcare field to utilize, this further addresses missing medical knowledge regarding telemedicine consultations. This research screened 737 different articles and papers to gather information regarding telemedicine and its efficacy. Results were filtered and screened using the PRISMA method to maintain a standard of high-quality, impartial, and accurate data throughout the research paper. Only the sources which pertained to the research question were chosen to be included in the paper. Trends were identified in the chosen articles, which were viewed by the contributors and referenced in the paper. Telemedicine has demonstrated profound evidence of benefits for both patients and healthcare administrations. However, concerns regarding its accessibility and efficacy remain. Suggestions are made for medical administrations and for public knowledge to provide solutions for these concerns.

The Influence of Continuance Commitment on Job Satisfaction of Barangay Health Workers in Malaybalay City, Bukidnon

This study examined the influence of organizational commitment on the job satisfaction among Barangay Health Workers (BHWs) in Malaybalay City, Bukidnon, calendar year 2022-2023. A total of 140 BHWs were selected through a simple random sampling. A survey questionnaire from Allen and Meyer (1990), and Taylor and Bowers (1972) were adapted and pilot-tested obtaining a Cronbach’s alpha of 0.838. Descriptive and inferential statistics such as frequency, percentage, mean, standard deviation, Pearson product-moment correlation, and simple linear regression were used to treat the data. Based from the data gathered, the demographic profile of the respondents revealed that majority of BHWs are aged between 31 to 35 years, females, high school graduates, and with a length of service between 11 to 15 years. The findings further showed that BHWs exhibit a remarkably very high level of attachment and commitment to their roles and responsibilities, attributed to their strong motivation, dedication, and passion to serve the community's health needs and very high job satisfaction. In addition, the test of correlation revealed that organizational commitment of BHWs had significant positive relationship with job satisfaction, thus the first null hypothesis was rejected. Meanwhile, the study’s regression analysis exhibited that continuance had a significant impact toward job satisfaction. This implied that they are committed that is why they are satisfied, apart from the norm that employees are satisfied that is why they are committed. This fact highlighted that BHWs feel that they will lose more when they leave their job than they will gain despite their meager honorarium. Hence, this research underscores the importance of fostering and sustaining organizational commitment among BHWs, as it directly influenced their job satisfaction and, ultimately, the quality of healthcare services provided to the community. It is worthy to note that policymakers and healthcare administrators may recognize the significance of these factors in supporting and retaining a dedicated and effective healthcare workforce at the grassroots level.

Investigation of geographic disparities of diabetes-related hospitalizations in Florida using flexible spatial scan statistics: An ecological study.

Hospitalizations due to diabetes complications are potentially preventable with effective management of the condition in the outpatient setting. Diabetes-related hospitalization (DRH) rates can provide valuable information about access, utilization, and efficacy of healthcare services. However, little is known about the local geographic distribution of DRH rates in Florida. Therefore, the objectives of this study were to investigate the geographic distribution of DRH rates at the ZIP code tabulation area (ZCTA) level in Florida, identify significant local clusters of high hospitalization rates, and describe characteristics of ZCTAs within the observed spatial clusters. Hospital discharge data from 2016 to 2019 were obtained from the Florida Agency for Health Care Administration through a Data Use Agreement with the Florida Department of Health. Raw and spatial empirical Bayes smoothed DRH rates were computed at the ZCTA level. High-rate DRH clusters were identified using Tango's flexible spatial scan statistic. Choropleth maps were used to display smoothed DRH rates and significant high-rate spatial clusters. Demographic, socioeconomic, and healthcare-related characteristics of cluster and non-cluster ZCTAs were compared using the Wilcoxon rank sum test for continuous variables and Chi-square test for categorical variables. There was a total of 554,133 diabetes-related hospitalizations during the study period. The statewide DRH rate was 8.5 per 1,000 person-years, but smoothed rates at the ZCTA level ranged from 0 to 101.9. A total of 24 significant high-rate spatial clusters were identified. High-rate clusters had a higher percentage of rural ZCTAs (60.9%) than non-cluster ZCTAs (41.8%). The median percent of non-Hispanic Black residents was significantly (p < 0.0001) higher in cluster ZCTAs than in non-cluster ZCTAs. Populations of cluster ZCTAs also had significantly (p < 0.0001) lower median income and educational attainment, and higher levels of unemployment and poverty compared to the rest of the state. In addition, median percent of the population with health insurance coverage and number of primary care physicians per capita were significantly (p < 0.0001) lower in cluster ZCTAs than in non-cluster ZCTAs. This study identified geographic disparities of DRH rates at the ZCTA level in Florida. The identification of high-rate DRH clusters provides useful information to guide resource allocation such that communities with the highest burdens are prioritized to reduce the observed disparities. Future research will investigate determinants of hospitalization rates to inform public health planning, resource allocation and interventions.

APPOINTMENT MAKER USING COMPUTERIZED VOICE

The Appointment Maker Using Computerized Voice is a novel system designed to streamline the process of scheduling appointments in healthcare settings through the integration of voice recognition and natural language processing technologies. By leveraging speech-to-text and text-to-speech capabilities, the system enables users to interact with the appointment booking interface using spoken commands, eliminating the need for manual input and enhancing accessibility for individuals with diverse technological proficiencies. This intuitive interface simplifies the appointment scheduling process, allowing users to book, reschedule, or cancel appointments with ease. Furthermore, the Appointment Maker employs machine learning models to understand and interpret user queries, providing accurate responses and assistance in real-time. By leveraging pre-trained language models and fine-tuning them on domain-specific data, the system demonstrates robust performance in understanding diverse user inputs and generating contextually relevant responses. This capability enhances user experience by providing personalized and timely assistance, akin to interacting with a human receptionist.The Appointment Maker features a backend database for storing and managing appointment and user information, ensuring data integrity, security, and efficient resource utilization. The relational database schema facilitates seamless coordination between users, healthcare providers, and administrative staff, enabling efficient scheduling and management of appointments. Overall, the Appointment Maker Using Computerized Voice represents a significant advancement in healthcare administration, offering a user-friendly and efficient solution for appointment scheduling while improving accessibility and patient experience. Key Words: Computerized Voice ,Natural Language Understanding (NLU), Speech to Text, Text to Speech.

Analyzing Patient Satisfaction Relationship with Hospital Management

The relationship between patient pleasure and medical institution management is a crucial element of healthcare shipping structures worldwide. This research targets to research the complicated dynamics that influence affected person delight inside the context of medical institution control practices. By analyzing various factors consisting of best of care, conversation, responsiveness, and overall health center surroundings, this takes a look at seeks to discover the underlying mechanisms thru which powerful hospital control contributes to enhanced affected person satisfaction. The findings of this analysis will offer treasured insights for healthcare administrators, coverage makers, and researchers, highlighting the significance of green health center management techniques in improving affected person studies and consequences. Through a comprehensive evaluate of literature, statistical evaluation of affected person comments, and case studies from leading hospitals, this research endeavors to shed mild on how medical institution control practices may be optimized to foster better stages of affected person delight, ultimately contributing to higher health outcomes and patient properly-being. KEYWORDS: Research Paper, Staff behavior, Statistical Analysis, Visualize Findings,

A study on awareness and perception about perinatal death auditing among health care workers in two districts of Karnataka State, India

ABSTRACT Background: To start perinatal death auditing, doctors should have good knowledge about it. Objectives: To know the awareness and perceptions of doctors about different aspects of perinatal death auditing like 1) different types of contributors; 2) high-risk approach; 3) consequences; 4) documentary requirements; and 5) existing system of mortality meeting/child death reviews. Methodology: The perinatal death auditing project was implemented in two districts of Karnataka state. As a part of the pre-intervention survey, awareness and perceptions of doctors and a few health care administrators were explored. They were requested to participate in the study. Those who consented were approached in their hospitals and interviewed. Trained medical social workers conducted the interviews. Awareness was scored from 0 to 3 with 0 being no knowledge and 3 being good knowledge. Perceptions were scored from 0 to 3 with 0 being no negative perceptions and 3 being fear of legal consequences. The responses were documented, scored, and described. Results: Though 22 doctors were eligible, only 16 consented to participate in the study. Knowledge of doctors about different contributors was inadequate. They were apprehensive about legal consequences. They knew that documentation could protect them and be useful in a court of law. They were not clear about the conduct of mortality meeting/existing system of child death reviews. Conclusion: Knowledge was inadequate. They were apprehensive about legal consequences. Training of doctors and allaying apprehensions are required for starting perinatal death auditing.

Defying the odds: Facilitating integration of abortion care into clinical practice in the United States

ObjectivesWe sought to describe the experiences of physicians who successfully incorporated abortion care into their practices in the United States. We explored facilitators of and barriers to abortion provision. Study designIn this qualitative study, we conducted semistructured interviews with a national sample of obstetrician–gynecologists and family medicine physicians providing abortion care. Interviews addressed facilitators of and barriers to abortion provision, lessons learned and recommendations for future providers. We analyzed data using a content analysis approach. ResultsWe interviewed 14 obstetrician–gynecologists and 11 family medicine physicians providing abortion care as part of their practices. We identified four categories of facilitators and barriers: personal, community, training, and workplace factors. Major facilitators included supportive leadership and professional mentorship. Major barriers included antagonistic colleagues and leadership. Lessons learned included proactively assessing leadership support, identifying institutional allies, actively minimizing workplace conflict and being perceived as a team player. Recommended resources to increase abortion provision included clinical support, mentorship, funding, negotiation coaching, and access to clinical policies. ConclusionsInstitutional leadership support emerged as a critical facilitator for initiating and continuing to offer abortion care. Efforts to expand abortion access should include investments in supportive leadership, both in academic and community practices. ImplicationsMaximizing abortion access is essential to counteract the legislative and political restrictions imposed on abortion care. Institutional support is a critical facilitator of abortion provision, and efforts to expand abortion access should include investments in supportive leadership and health care administration.

Barriers and enablers to the implementation and sustainability of short-stay arthroplasty programs for elective primary total hip and knee replacement: A systematic review with qualitative evidence synthesis.

We aimed to systematically review contemporary evidence on the barriers and enablers to implementing and sustaining short-stay arthroplasty programs for elective primary total hip and knee replacement from the perspectives of patients, health professionals, carers, healthcare administrators, funders and policymakers and to map the findings to the Theoretical Domains Framework (TDF). Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (up to 19 August 2023). Primary qualitative or mixed-methods studies reporting on perspectives relating to the review aims that utilised a short-stay programme were eligible for inclusion. Study quality was assessed using the qualitative critical appraisal tool from the Joanna Briggs Institute. Data were analysed inductively. The final themes were mapped to the TDF. The confidence in the findings was assessed using GRADE CERQual. Fifteen studies were included. Twelve barrier themes and twelve enabler themes were identified. Three themes were graded with high confidence, 10 were graded with moderate confidence, three were graded with low confidence, and eight were graded with very low confidence. The most pertinent domains that the themes were mapped to for patients were beliefs about capabilities, reinforcement, and the environmental context and resources. Health professionals identified knowledge, environmental context and resources as important domains. Two domains were identified for carers: (1) social/professional role and identity and (2) memory, attention, and decision processes. We identified key barrier and enabler themes linked to the TDF that can be used to guide implementation initiatives and promote the sustainability of short-stay arthroplasty programs.

Resilience and related factors in caregivers of adult cancer patients: a systematic review

Background: This systematic review aimed to investigate resilience and its related factors in caregivers of adult patients with cancer. Materials and methods: A systematic search of online electronic databases including Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) was performed using keywords extracted from Medical Subject Headings such as “Psychological Resilience”, “Caregiver”, and “Cancer” from the earliest to 6 June 2023. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Results: A total of 2735 caregivers of cancer patients participated in 15 studies. The majority of the studies found that caregivers of cancer patients had high levels of resilience. Factors related to the resilience of cancer patients’ caregivers included caregivers’ social support, caregivers’ quality of life, patients’ resilience, caregivers’ family function, patients’ performance, caregivers’ age, caregivers’ health status, caregivers’ self-esteem, caregivers post-traumatic growth, caregivers religious, caregivers hope, caregivers positive affect, patients age, patients social support, patients resilience support, patients quality of life, caregivers’ anxiety, caregivers’ depression, caregivers’ burden, caregivers level of education, caregivers financial problem, caregivers memory, caregivers negative affect, caregivers post-traumatic stress disorder, maternal distress, and patients post-traumatic stress disorder. Conclusion: Therefore, healthcare administrators and policymakers can enhance the resilience of caregivers and the quality of care they provide by instituting ongoing training initiatives focused on evaluating mental well-being and implementing coping strategies for managing stress and depression.

Examining the creation of synergy in community coalitions for smoke-free environments in Armenia and Georgia.

Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n = 83) and semi-structured interviews with leaders and members (n = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy.

Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study

Delirium is an acute brain dysfunction associated with an increased risk of mortality and future dementia. To describe the prevalence of clinically documented delirium in the United States on World Delirium Awareness Day2023. This is a sub-analysis of a prospective, cross-sectional, online, international survey. All health care settings were eligible, with the exception of operating rooms and outpatient clinics. Health care clinicians, administrators, and researchers completed the survey. The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. and 8:00 p.m. on March 15, 2023. Secondary outcomes were related to health care delivery. Descriptive statistics are reported. Differences between unit types (non-intensive care unit vs intensive care unit) were examined for all outcomes. Ninety-one hospital units reported on 1318/1213 patients. The prevalence of clinically documented delirium was 16.4% (n= 216/1318) at 8:00 a.m. and 17.9% (n= 217/1213) at 8:00 p.m. (P=0.316) and significantly differed between age groups, reported discipline, unit, and hospital types. Significant differences were identified between non-intensive care unit and intensive care unit settings in the use of delirium-related protocols, nonpharmacologic and pharmacologic management, educational processes, and barriers to evidence-based delirium care. To our knowledge, this is the first epidemiologic survey of clinically documented delirium across two time points in the United States. Delirium remains a significant burden and challenge for health care systems. The high percentage of units using delirium management protocols suggests administrator and clinician awareness of evidence-based strategies for its detection and mitigation. We provide recommendations for future studies and quality improvement projects to improve clinical recognition and management of delirium.