Care Outcomes Research Articles

Psychometric Evaluation of the Medical Outcomes Study Social Support Survey in Brazilian Older People Psychometric Evaluation of MOS-SSS.

To evaluate the psychometric properties of different factorial models of the Medical Outcomes Study Social Support Survey (MOS-SSS) and screen the frequency of social support in older Brazilians. Methodological study. Five factorial models of the MOS-SSS were tested for their validity and reliability using three Brazilian samples from different locations in the country. The factorial invariance was assessed across locations using multigroup analysis. The global average score was calculated. A total of 1574 older people participated in the study. For all models, there was adequate factorial and convergent validity and good reliability; the discriminant validity was not achieved. Therefore, a second-order hierarchical model was proposed and showed validity, reliability and invariance across samples. In the three Brazilian samples, participants presented high frequency of social support. A second-order hierarchical model was fitted the Brazilian samples, allowing the calculation of the global score of social support, which was high among the participants. The MOS-SSS assesses social support levels among older individuals in community or clinical settings. Nurses can tailor interventions based on scale outcomes for personalised care for older people.

HIV Outcomes Among Women Living With HIV Who Experienced Early Sexual Violence Across Four Sub-Saharan African Countries.

Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed. We conducted a secondary analysis using nationally representative, cross-sectional Population-based HIV Impact Assessment surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017. Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and 3 HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virological suppression among WLHIV on ART. Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared with those without (adjusted odds ratio [aOR], 1.17; 95% CI: 0.95 to 1.45). Women living with HIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57 to 0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80 to 1.42) compared with WLHIV without forced first sex. While high proportions of WLHIV were on ART, report of nonconsensual first sex was associated with a lower likelihood of being on ART which may suggest that early life trauma could influence long-term health outcomes.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Home Health Care and Place of Death in Medicare Beneficiaries With and Without Dementia.

Home health care supports patient goals for aging in place. Our objective was to determine if home health care use in the last 3 years of life reduces the risk of inpatient death without hospice. We analyzed the characteristics of 2,065,300 Medicare beneficiaries who died in 2019 and conducted multinomial logistic regression analyses to evaluate the association between the use and timing of home health care, dementia diagnosis, and place of death. Receiving any home health care in the last 3 years of life was associated with a lower probability of inpatient death without hospice (Pr 23.3% vs 31.5%, p < .001), and this effect was stronger when home health care began prior to versus during the last year of life (Pr 22.5% vs 24.3%, p < .001). Among all decedents, the probability of death at home with hospice compared to inpatient death with hospice was greater when any home health care was used (Pr 46.0% vs 36.5%, p < .001), and this association was strongest among beneficiaries with dementia who started home health care at least 1 year prior to death (Pr 55.6%, p < .001). Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death without hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.

Validation of the Integrated Palliative Care Outcome Scale (IPOS) in adults with cystic fibrosis.

A primary palliative care model for cystic fibrosis (CF) recommends using the Integrated Palliative Care Outcome Scale (IPOS) for screening. Validation of the IPOS is needed. This secondary analysis utilized baseline data from a multisite trial of the palliative care model, Improving Life with CF. Adults with CF completed the IPOS, the Memorial Symptom Assessment Scale-CF (MSAS-CF), the CF Questionnaire-Revised (CFQ-R), the Patient Health Questionnaire (PHQ-8), the Generalized Anxiety Disorder (GAD-7), and the Perceived Stress Scale (PSS). IPOS structure was assessed using Cronbach α coefficients and a factor analysis. Construct validity was evaluated through bivariate relationships between IPOS scores and other questionnaire scores, and linear regressions assessing the extent to which the IPOS explains variance in quality-of-life domains. The sample comprised 256 adults with complete IPOS data. α coefficients were .86 for the IPOS total score, .81 for the Physical Symptoms subscale, .79 for the Emotional Symptoms subscale, and .63 for the Communication/Practical Issues subscale. A two-component factor structure best aligned with the current subscales. IPOS scores were significantly associated with other measures; associations with MSAS-CF and CFQ-R subscales differentiated the IPOS Physical and Emotional subscales. The IPOS total score provided unique information about the variance in the CFQ-R Physical Functioning and Respiratory Symptoms domain scores. In adults with CF, the IPOS has acceptable internal consistency and there is evidence of construct validity. These findings support adoption of the IPOS in the primary palliative care model for CF.

Assessment of drug therapy problems in pediatric patients using Cipolle/Morley/strand classification: A hospital based study

Drug plays an important role in treating diseases and improving health. However, inappropriate drug use can lead to the occurrence of drug-Therapy problems (DTPs). According to Cipolle/Morley/Strand classification DTPs are any undesirable event experienced by the patient that involves or is suspected to involve drug therapy and that actually or potentially interferes with a desired patient outcome. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Srinivas institute of medical science and research centre and to identify associated factors for drug therapy problems. A retrospective observational study was carried out to assess drug therapy problems (DTPs) in paediatric patients using Cipolle/Morley/Strand classification from January to June 2024. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All paediatric out patients and patients admitted to the paediatric ward during the study period were included in the study. Data were collected through medical record reviews of patients and using semi structured questionnaire. Data was analysed using Microsoft Excel. The participants mean age was 2.32 years. Among 150 patients, 116 (77.33%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. On the other hand, Adverse drug reaction was the least 4 (3.38%) drug therapy problem. Hence to ensure optimum care in paediatric patients, a targeted approach is essential. Thus, the present study concluded that pharmacists can be helpful in the identification of the drug therapy problems, their causes and the risk factors involved and thus lead to a better health care outcome.

Artificial intelligence governance framework for healthcare.

Recent advancements in the field of Artificial Intelligence (AI) provide promising applications of this technology with the aim of solving complex healthcare challenges. These include optimizing operational efficiencies, supporting clinical administrative functions, and improving care outcomes. Numerous AI models are validated in research settings but few make their way into useful applications due to challenges associated with implementation and adoption. In this article, we describe some of these challenges, along with the need for a facilitating entity to safely translate AI systems into practical use. The authors propose a new AI governance framework to enable healthcare organizations with a mechanism to implement and adopt AI systems.

Protocolizing social prescribing in mental health and addiction services: barriers and opportunities

Abstract Issue Social Prescribing (SP) is a structured approach where health professionals recommend community activities to enhance well-being. Starting in Catalonia in 2012, it expanded to the entire primary care network by 2016. By 2023, 23,338 patients received SP, showing a 2.3-fold increase from 2022. Two-thirds experienced improvement in mental well-being. Now, efforts focus on applying SP to mental health and addiction services (MHAS), where SP can be used for restoring health and well-being. Description A literature review was conducted and a working group was initiated with MHAS professionals was initiated to exchange experiences and identify needs and best practices. This was done in preparation for designing a pilot experience, which will include a qualitative study through focus groups to validate the action plan and determine barriers and facilitators in MHAS. The groups will be segmented into MHAS users and frontline professionals. Results The results of the review process and the working group sessions demonstrated that SP can be useful and beneficial for the health MHAS users. However, barriers and opportunities were identified. The main barriers detected include: the need for strong support during referrals to community activities; increased awareness of addiction among activity providers to reduce stigmatization; define inclusion and exclusion criteria; determining monitoring and evaluation tools; and mapping and updating community assets. Regarding opportunities, the following were highligthed: the interest of MHAS professionals in promoting and implementing a SP program in this area; the existence of organizations already conducting community activities focused MHAS users; and political prioritization of this issue. Lessons The implementation of a SP program protocol in MHAS is considered beneficial. It is necessary to analyse barriers to effectively address them and to identify opportunities to leverage them. Key messages • Social Prescribing has significantly enhanced mental health outcomes in Primary Care, which can imply a potential improvement in well-being of mental health and addiction services users. • Implementing Social Prescribing in mental health and addiction services offers promising integrated care opportunities, requiring barriers resolution and maximizing existing prospects.

Incident heart failure: comparing management and outcome in primary care and hospital settings in Western Sweden 2008-2017

Abstract Background Heart failure (HF) is a major problem in primary care (PC) and hospital care (HC). HF patients managed in these two settings may differ in their demography, comorbidities, treatment and outcomes. Aim We aimed to compare the patient management in PC and HC in the Västra Götaland Region (VGR) in Sweden. Methods The VEGA database is an administrative database includes all patients living in VGR. Patients with a first principal or contributory diagnosis of HF (I50) ≥18 years old between 2008 and 2017 were included. One-year mortality was used as the outcome. Results In total, 62,229 new-onset HF cases were included, with 18,722 identified only in PC and 16,651 in HC. HF patients in PC were older (80.7±10.9 vs 76.1±13.6), more women (57.1% vs 44.9%), with more hypertension, musculoskeletal and mental disorders, but less myocardial infarction. Guideline directed medical therapy was more frequently used in HC despite similar medication before HF diagnosis. Patients in HC had almost 4 times higher all-cause 1-year mortality [3.92 (3.77 - 4.08), p&amp;lt;0.0001] compared with PC after adjustment for age and sex. Over 10-year period, despite decreasing mortality in both settings, hazard ratios for HC vs. PC were significantly increased for all patients (p for interaction 0.0004), which was more marked in female and for 70-80 years old patients. Conclusion Over a 10-year period, not withstanding decreasing mortality in HF patients in both PC and HC settings, differences remain between these two HF populations not only demographic profile and medications but also outcomes.

Implementation of Medical Hospitalist Care at a Korean Tertiary Hospital: A Retrospective Cross-Sectional Study

Background/Objectives: In March 2018, a tertiary teaching hospital launched a medical hospitalist team. This study presents the clinical characteristics and outcomes of medical hospitalist care and reveals the relationship between them. Methods: This study included 4003 patients first admitted to the hospitalist team via emergency room and then discharged from the hospitalist team between March 2018 and November 2022. The patients were admitted either to the teaching admitter hospitalist team or the hospitalist-led acute medical unit (AMU). Afterward, the patients were either discharged, if possible, within a few days or transferred to ward hospitalists if assigned wards for hospitalist care were available. Results: The patients’ mean Charlson Comorbidity Index score was 3.5 and the mean National Early Warning Score was 3.4. Of the admissions, 44.2% of the patients were admitted to the AMU, and 26.8% received an early consultation with a subspecialist. Each hospitalist managed 12.8 patients per month on average. The patients’ mean LOS was 14.52 days, 10.5% of patients died during hospitalization, and 13.0% of patients had unscheduled readmission within 1 month. The patients’ mean total cost per hospital stay was 572,836 won per day. Admission to the AMU was associated with a lower total cost per hospital stay, but the relationships with mortality, readmission, and LOS were not significant. Conclusions: The study reports on the outcomes of implementing a medical hospitalist care system that combines short-term admission wards with integrated care models to manage complex cases. These findings provide insights into optimizing hospitalist systems for improved patient outcomes.

Supplemental Material for Neonatal Care and Developmental Outcomes Following Preterm Birth: A Systematic Review and Meta-Analysis

Supplemental Material for Neonatal Care and Developmental Outcomes Following Preterm Birth: A Systematic Review and Meta-Analysis

Underrepresentation of Black Men in Physician Assistant and Associate Training.

The underrepresentation of Black men in the health care workforce, particularly among physician assistants and associates (PAs), represents a missed opportunity to alleviate shortages of health care professionals and enhance workforce diversity. Increasing the number of Black men in the training pipeline could significantly benefit education, patient care, and overall health outcomes. To analyze patterns from 2013 to 2021 among Black men applying to and matriculating into PA programs and compare these figures with the age-specific US population of Black men. This cohort study assessed deidentified application and matriculation data from the Central Application Service for Physician Assistants (CASPA) for PA training programs in the US, alongside US Census data. CASPA applicants reporting race and gender identities as Black male were included. Data were obtained March 10, 2023, from the 2012-2013 to the 2020-2021 application cycles; data were analyzed from June 2023 to May 2024. Black male applicants and matriculation. Patterns and proportion of Black male applicants and matriculants to PA programs relative to total rates and expected numbers. From 2013 to 2021, PA programs grew 64.3%, with an increase in applicants from 19 761 to 30 196 and matriculants from 6192 to 11 115. Despite this growth, the representation of Black men among applicants (from 435 to 732) and matriculants (from 73 to 156) remained stagnant, averaging 2.2% and 1.2%, respectively, significantly lower than their 8.7% (3 920 231 individuals aged 20-29 years) representation in the US Census. In 2021, the matriculation rate for Black men (156 of 732 [21.3%]) was notably lower than the matriculation rate for all applicants (11 115 of 30 196 [36.8%]). Based on the expected proportion of Black men in the PA applicant age range, there should have been 2641 applicants (actual: 732) and 972 matriculants (actual: 156) across 308 PA programs in 2021; these numbers indicate that, per program, approximately 9 applicants would have to have been evaluated and 3 matriculated to achieve parity, in contrast to the mean of 2 applicants and 1 matriculant per 2 programs. In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate 9 Black male applicants and matriculate 3 Black men annually.

KardioNet Digital - a structured care model involving digital tools for intersectoral communication and a patient-focused strategy for treatment of heart failure

Abstract Introduction Inefficiencies and discontinuities in care at the interfaces within Germany's healthcare system, especially between acute and outpatient care, present significant challenges in managing patients with heart failure (HF). The management complexity of HF has increased with the advent of new digital tools, though patient acceptance of these tools remains contentious. The prevention of loss of diagnostic and therapeutic information for this complex disease is crucial for cross-sectoral communication (hospital - office-based cardiologist - general practitioner) and quality of care. Purpose Our goal was to examine the impact of digital app-supported coordination of HF management across different healthcare providers from hospital discharge to the ambulatory sector and to assess patients' acceptance of a structured care program. A patient-focused digital strategy, supported by a Heart Failure Nurse (HFN), aimed to facilitate structured follow-up and patient empowerment, focusing on patient-reported outcomes and experiences (refer to Table 1). Results Out of 401 patients screened during their hospital stay for HF, only 57 (14.9% male, 12.6% female) participated in the KardioNet Digital (KND) program. NYHA classifications were I (3.5%), II (49.1%), III (40.4%), and IV (7.1%); Diagnoses included CMP (26, 45.6%), CAD (19, 33.3%), valvular HF (8, 14.0%), and others (4, 7.0%). The mean age was 55.03 years, with a notable difference in participation based on age (≥70 years: 9.5% male, 33.3% female; &amp;lt;70 years: 90.5% male, 66.7% female). Age was a significant determinant of program participation. Patients who regularly used the app benefited from several features: A total of 35 alerts (17 patients) were triggered for reasons such as bodyweight increase (2kg or more) and device-induced alerts (i.e. false shock delivery, 3x slow-VT, Syncope), leading the HFN to contact the patients. This early intervention prevented rehospitalization due to decompensation of heart failure in 11 patients (64.7%) and addressed device-related alarms for organizing an emergency hospital visit by HFN. Despite substantial incentives, such as support from an HFN and expedited appointments with specialists for follow-up therapy, refusal rates were high (refer to Table 2). Conclusion A structured, digitally supported cross-sectoral care model for heart failure patients can potentially improve care coordination and outcomes. However, the success of such programs critically depends on patient willingness and the seamless integration into existing healthcare structures. Despite valuable incentives, we observed low acceptance of the program. Even among motivated participants (14.1%), there is a significant need for substantial support and education on digital literacy for the widespread implementation of digital tools in real-world settings for the treatment of heart failure.Workflow of structured digital supportReasons for Declining Participation

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and outcomes in patients with chronic kidney disease: A report from the APHRS-AF registry

Abstract Background The Atrial Fibrillation Better Care (ABC) pathway is based on three pillars: "A" avoid stroke with oral anticoagulation, "B" better symptoms control, and "C" optimization of cardiovascular risk factors and lifestyles. This integrated approach has been associated with improved outcomes in atrial fibrillation (AF) patients, but few data are available in patients with chronic kidney disease (CKD). Purpose To investigate the correlation between chronic kidney disease, adherence to the ABC pathway, and the occurrence of adverse events in patients with AF enrolled in the Asian-Pacific Heart Rhythm Society-AF Registry. Methods Logistic regression was used to investigate factors associated with CKD, warfarin use and rhythm control strategies. Cox regression analysis adjusted for age≥75 years, paroxysmal AF, CHA2DS2VASc≥2, chronic obstructive pulmonary disease, cancer, and ABC adherence was used to calculate Hazard Ratios (HRs) and 95% Confidence Interval (CI) for the risk of primary outcomes in patients with CKD (eGFR &amp;lt;60 ml/min/1.73m2). Sensitivity analyses were performed in moderate (eGFR 59-30) and severe CKD (eGFR&amp;lt;30). Interaction analysis investigated the effect of ABC pathway based on presence or absence of CKD. Primary outcomes were the risks of all-cause death, major cardiovascular events (MACE: Cardiovascular death, acute coronary syndromes, thromboembolic events, and acute heart failure) and major bleeding. Results We included 2 578 AF patients without CKD (age 66.5±11.3 years, 32.5% females) and 1 047 AF patients with CKD (75.3±10.3 years, 40.8% females). Lower ABC pathway full adherence was observed in CKD patients (42.1% vs 29.5%, p&amp;lt;0.001), primarily due to low adherence to "A" and "C" criteria. Logistic regressions confirmed the lower likelihood of anticoagulation (Odds Ratio (OR) 0.61, 95%CI 0.44-0.83), a higher use of warfarin (OR 1.50, 95%CI 1.23-1.83) and lower use of rhythm control strategies (OR 0.79, 95%CI 0.66-0.94) in CKD patients. After one-year follow up, patients with CKD had a higher incidence of all-cause death (1.6% vs 7.2%, p&amp;lt;0.001) and MACE (3.4% vs 8.1%, p,0.001) compared to those without CKD. On Cox multivariable analysis (Figure 1, Panel A-D), CKD and ABC adherence were independently associated with the risk of all-cause death (HR 2.54, 95%CI 1.69-3.80 and HR 0.57, 95%CI 0.35-0.93, respectively) and MACE (HR 1.58, 95%CI 1.14-2.20 and HR 0.66, 95%CI 0.46-0.95, respectively). The risk of primary outcomes was the highest in those with severe CKD. No association was found with the risk of major bleeding. The interaction analysis confirmed that the beneficial effect of ABC pathway adherence on death (p int= 658) and MACE (p int= 0.568) was irrespective of CKD. Conclusion AF patients with CKD have low ABC pathway adherence and high risk of all-cause death and MACE. Efforts to improve the ABC pathway adherence in AF patients with CKD are needed to improve their long-term clinical outcomes.Figure 1.Cox regression analyses

Critical care admissions and outcomes in pregnant and postpartum women: a systematic review

Critical care admissions and outcomes in pregnant and postpartum women: a systematic review

Assesing health needs of women with breast cancer in a Regula Hospital Dispensary in Crete, Greece

Abstract Background Understanding the health needs of women with breast cancer is essential for tailor-made care. Socio-economic factors impact care access and outcomes. Previous research has indicated variations in healthcare experiences based on factors such as education level, employment status, and income. However, specific insights into the health needs of women with breast cancer in Crete, Greece, remain limited. Purpose The current study aimed at assessing the health needs of women with breast cancer. Methods A total of 161 women were surveyed between June 2023 and December 2023 in a regular Hospital Dispensary at a General Hospital in Heraklion, Greece. Results The majority were married (46%) and had an average of 2 children. 16% were graduates of secondary education and 42 % graduates of higher education, 33% retired and 19% full-time employees. Most participants (45%) reported a family income between 10,001 to 20,000 €, 29% under 10000 € and 26 % between 20001 to 30000 €. The majority had received additional medical treatment (75%), with surgery being the most common (30.6%). Other treatment included radiation therapy (28%), chemotherapy (23%), and hormone therapy (18%). Prevalence of comorbidities was high, with hypertension (97%), coronary heart disease (92%), cholesterol issues (43.5%), arrhythmias (82%), thyroid disease (81%), diabetes mellitus (79.5%), and bleeding disorders (43.5%) being reported. Smoking was also prevalent among participants (79.5%). Conclusions This study highlights the complex health needs of women with breast cancer in Crete region, Greece and emphasizes the prevalence of comorbidities and the importance of tailored support services and comprehensive care approaches for this population. Key messages • Considering socio-economic factors is critical in healthcare planning and intervention strategies. • Emphasizing the importance of tailored support services and comprehensive care approaches for this population.

Time taken for cardiology care and one-year results for primary care physicians' referrals for cardiology consultation in heart failure patients: clinical implications for heart failure management

Abstract Background and Purpose The clinical trajectory of patients with heart failure (HF) is characterised by frequent episodes of decompensation requiring urgent medical assistance, hospitalisations, and an increased risk of mortality. HF clinical guidelines recommend early visits by health professionals after hospital discharge, yet little evidence exists regarding the associations between delayed medical attention and outcomes in HF patients. To assess the clinical impact of the time taken to receive cardiology care for referrals from primary care physicians (PCPs) to a cardiology department in HF patients, we selected 6,859 HF patients who visited the cardiology service at least once between 2010 and 2021. Methods Using an interrupted time series regression model, we analysed the impact of integrating e-consultations into the healthcare model (implemented in 2013) and evaluated the time taken to receive cardiology care, as well as all-cause, cardiovascular (CV), and HF-related hospital admissions and mortality. The primary objective of this analysis was to examine the associations between delays in cardiology care following a PCP referral and 1-year outcomes (HF-related, cardiovascular, and total hospitalisations; and HF-related, cardiovascular, and total mortality). Results Almost 50% were women, and the mean age was 77.8 years. Arterial hypertension (79.6%), diabetes (34%), atrial fibrillation (51.4%), ischemic heart disease (20.4%), and cerebrovascular disease were the most prevalent comorbidities. The mean time from PCP referral to cardiology consultation in the overall population was 22.3 days: &amp;lt;8 days in 53.9%, 8-14 days in 17.1%, 15-30 days in 15.9%, and &amp;gt;30 days in 13.0% of patients, respectively. One year after cardiology consultation, 68.6% of patients required assistance in an Emergency Department; 22.5% were hospitalised for any cause, 14.9% for cardiovascular reasons, and 9.2% for HF-related issues. Moreover, total mortality at 1-year was 8.6%, comprising 4.3% cardiovascular mortality and 1.3% HF-related deaths. Multivariate analysis of the relationship between the time taken to receive cardiology care and 1-year outcomes revealed a significant increased risk associated with a longer delay in cardiology assistance, particularly evident in the subgroup of patients with previous hospital admissions due to worsening HF (see Table). Conclusions Throughout the follow-up period, a reduced time taken to receive care was independently associated with better 1-year outcomes. We believe that our experience can contribute to the development of a more efficient ambulatory care pathway for HF patients, especially those at high risk, such as those with a history of hospitalisation due to worsening events. Our findings further support the clinical guideline recommendation for early contact by health professionals following hospital discharge, extending it to include PCP referrals for cardiology consultations.

Mapping patient pathways for NCDs from a policy perspective: a novel multinational initiative

Abstract Background Chronic diseases like CVD and DM pose global health challenges. Understanding patient pathways is vital for effective disease management and reducing morbidity and mortality. However, until now, comprehensive multinational mapping of patient pathways from a policy or regulatory perspective in the context of chronic disease has not been undertaken. Previous investigations into patient pathways mainly focused on the perspective of individual patients, assembling trajectories of those patients, but did not delve into how these pathways were designed. Methods Patient pathways for CVD and DM will be mapped across 11 countries: Belgium, Finland, France, Hungary, Iceland, Italy, Latvia, Poland, Romania, Slovenia, and Spain. Using a survey tool, detailed descriptions and diagrams of healthcare pathways will be collected, stratified by Kaiser Permanente health pyramid strata. Stakeholder interviews on policy and practice level will refine mappings and identify gaps in the policies. Results Preliminary findings reveal diverse healthcare trajectories and identified multiple gaps in disease management across countries. For many countries, a complete well-developed patient pathway was not found; instead, the pathways were rather fragmented and lacking for some strata of the health pyramid. These insights underscore the need for tailored interventions and enhanced care coordination to optimize continuity of care and patient outcomes. Conclusions Comprehensive patient pathway mapping offers a strategic framework to address gaps in chronic disease management. Our study emphasizes the importance of collaborative efforts in developing context-specific interventions and strengthening healthcare systems to improve public health outcomes. Key messages • Comprehensive patient pathway mapping reveals numerous gaps in global chronic disease management, prompting the need for enhanced strategies. • Collaborative efforts are key to addressing gaps in chronic disease care.

Impact of Carbon Source on Bacterial Cellulose Network Architecture and Prolonged Lidocaine Release

The biosynthesis of bacterial cellulose (BC) is significantly influenced by the type of carbon source available in the growth medium, which in turn dictates the material’s final properties. This study systematically investigates the effects of five carbon sources—raffinose (C18H32O16), sucrose (C12H22O11), glucose (C6H12O6), arabinose (C5H10O5), and glycerol (C3H8O3)—on BC production by Komagataeibacter hansenii. The varying molecular weights and structural characteristics of these carbon sources provide a framework for examining their influence on BC yield, fiber morphology, and network properties. BC production was monitored through daily measurements of optical density and pH levels in the fermentation media from day 1 to day 14, providing valuable insights into bacterial growth kinetics and cellulose synthesis rates. Scanning electron microscopy (SEM) was used to elucidate fibril diameter and pore size distribution. Wide-angle X-ray scattering (WAXS) provided a detailed assessment of crystallinity. Selected BC pellicles were further processed via freeze-drying to produce a foam-like material that maximally preserves the natural three-dimensional structure of BC, facilitating the incorporation and release of lidocaine hydrochloride (5%), a widely used local anesthetic. The lidocaine-loaded BC foams exhibited a sustained and controlled release profile over 14 days in simulated body fluid, highlighting the importance of the role of carbon source selection in shaping the BC network architecture and its impact on drug release profile. These results highlight the versatility and sustainability of BC as a platform for wound healing and drug delivery applications. The tunable properties of BC networks provide opportunities for optimizing therapeutic delivery and improving wound care outcomes, positioning BC as an effective material for enhanced wound management strategies.

Acquaintance, attitude, and perceived barriers regarding scientific research publications among clinical nurses: a cross-sectional study at tertiary care hospitals in western Rajasthan

IntroductionIn today's era, conducting nursing research is crucial for the advancement of the nursing profession. Scientific publications in clinical research aim to improve patient care outcomes and foster a sense of importance for nurses within the healthcare team. However, clinical nurses often fall behind due to factors such as limited familiarity, attitudes toward research, and encountered barriers.ObjectivesThis study was conducted to assess the knowledge, attitude, and perceived barriers regarding scientific research publications among clinical nurses at tertiary care hospitals in western Rajasthan.MethodologyA cross-sectional descriptive study was conducted among the clinical nurses. The participants were assessed for their knowledge, attitude, and perceived barriers regarding scientific research publications through a self-administered questionnaire.ResultsThe study revealed that 92% of the participants lacked sufficient knowledge about scientific research publications and 78.3% experienced moderate perceived barriers. Pearson's correlation coefficient indicated a weak positive correlation (r = 0.143, p = 0.007) between knowledge and attitude and a significant negative correlation (r = −0.143, p = 0.012) between knowledge and perceived barriers. However, multiple linear regression analysis showed no significant relationship among the clinical nurses in terms of knowledge, attitude, and perceived barriers toward scientific research publications.ConclusionThis study on clinical nurses revealed that the majority had insufficient knowledge about scientific research, while over half had neutral attitudes toward research publications. In addition, a significant portion of the clinical nurses reported experiencing moderate perceived barriers.