Care Planning Research Articles

Interventions aiming to improve advance care planning uptake in oncology: a scoping review of recent randomized controlled trials.

The evidence regarding the effectiveness of interventions aiming to improve ACP uptake appears mixed. The purpose of this scoping review is to summarize findings from recent RCTs assessing the efficacy of interventions designed to increase ACP uptake in cancer care. The PubMed database was searched for studies published between 2021 and 2023. Ten RCTs were identified that evaluated a wide range of interventions aimed at encouraging or facilitating ACP communication among patients with advanced cancer, caregivers, and HCPs. Three RCTs developed ACP facilitation tools for patients and sometimes caregivers. Six RCTs involved integrating trained ACP facilitators into patient care, and one RCT used nudges to encourage oncologists trained in ACP discussions to initiate discussions with patients at highest risk of short-term mortality. Most of the reviewed interventions were based on previously tested intervention approaches or tools. The key effects identified in this review are the facilitation of ACP discussions among patients, caregivers, and HCPs, and the documentation of patient preferences in the medical record. The direct involvement of facilitators in ACP document drafting and inclusion in patient files, as well as interventions prompting end-of-life discussions, contributed to this effect.

Using the Age-Friendly Environment Framework to Assess Advance Care Planning Factors Among Older Adults With Limited Income: A Cross-Sectional, Descriptive Survey Study.

The World Health Organization created the Age-Friendly Environment (AFE) framework to design communities that support healthy aging and equitable decision making. This framework's resource domains may account for disparately lower advance care planning (ACP) among older adults with limited incomes compared to those with high incomes. We aimed to describe and examine associations of AFE factors with ACP. We recruited and conducted cross-sectional surveys among older adults with limited incomes in 7 community-based settings in Nashville, TN. ACP and AFE item scales were dichotomized and analyzed with unadjusted phi correlation coefficients. Survey participants (N = 100) included 59 women, 70 Black/African American, and 70 ≥60 years old. Most participants agreed that their community was age friendly (≥58%) and varied in ACP participation (22%-67%). Participants who perceived easy travel and service access and sufficient social isolation outreach were more likely to have had family or doctor quality-of-life discussions (phi = 0.22-0.29, p < .05). Having a healthcare decision maker was positively associated with age-friendly travel, housing, and meet-up places (phi = 0.20-0.26, p < .05). The AFE framework is useful for exploring the environmental factors of ACP, but further research is warranted to identify specific and immediate resources to support successful ACP among populations with socioeconomic disadvantage.

Atypical lesional association (Talus Fracture + Pilon Fracture): A case report

Background: Talus fractures represent 3% to 6% of all foot and ankle fractures and are frequently associated with significant morbidity and poor outcomes. They typically result from high-energy trauma, such as motor vehicle accidents or falls from heights. The combination of talar body and tibial plafond fractures is particularly rare, with few cases reported in the literature. Case Report: We present the case of a 20-year-old female who sustained a closed injury to her right ankle after a 6-meter fall. Clinical examination revealed swelling, pain, and bruising without skin opening or neurovascular disturbances. Radiographs and a CT scan identified a non-displaced fracture of the tibial plafond, a medial malleolus fracture, and a posterior process talus fracture. The patient underwent closed reduction and internal fixation with percutaneous screws. At six months post-surgery, she exhibited a good functional outcome with minimal residual pain and slight limitations in ankle movement. Discussion: Talar body fractures commonly result from falls that exert axial compression or shearing forces. Severe cases involve comminution of the ankle and subtalar joints, often accompanied by malleoli fractures. The concomitant fracture of the tibial plafond and talus, as seen in this case, is rare. Managing such injuries is challenging due to high risks of avascular necrosis, subtalar arthritis, and restricted ankle motion. Thorough radiographic and clinical assessments are crucial for effective management, emphasizing the need for careful preoperative planning, precise anatomical reduction, and stable fixation. Conclusion: This rare case of combined talus body and tibial plafond fractures highlights the importance of comprehensive evaluation and appropriate management to minimize serious complications.

Lumbar Chondrosarcoma in A Young Female: A Case Report and Literature Review

Introduction: Chondrosarcomas (CS) are uncommon malignant tumors that form cartilage, ranking third among primary malignant bone tumors. Although they are rare, with an incidence rate of 2%-12%, they can occur in the spine, with the lumbar region being even less common. These tumors are resistant to chemotherapy and radiotherapy, making surgical excision the treatment of choice. The extent of surgical resection is vital for the patient’s prognosis and the risk of recurrence. A unique case of lumbar CS in a young female patient is reported. Case Report: A 23-year-old female experienced progressive lower back pain and radiculopathy in both lower limbs. Laboratory tests and radiological imaging revealed an osteolytic lesion in the L5 vertebral body. Despite a biopsy that did not conclusively diagnose the lesion, a two-stage en-bloc resection was carried out. The procedure confirmed the diagnosis of grade I conventional chondrosarcoma. The patient had a successful recovery and remainedrecurrence-free after three years. Discussion: CS typically occurs in males between their 40s and 70s and can develop in various bones, with different classifications based on origin and histopathological features. Spinal CS is rare, and symptoms can be non-specific but may progress to include pain and neurological deficits. Diagnosis is primarily based on imaging, with biopsy used in some cases. Surgical resection is the mainstay of treatment due to the tumor’s resistance to other treatments. Achieving negative surgical margins is imperative but challenging, necessitating a multidisciplinary approach for optimal outcomes. Conclusion: The presented case underlines the rarity of CS in the lumbar region and the challenges in diagnosing and surgically managing such cases. Aggressive surgical resection is key to treatment, requiring careful preoperativve planning and intraoperative precision. The successful long-term disease control in our patient emphasizes the importance of complete tumor resection.

Design, implementation and usability analysis of patient empowerment in ADLIFE project via patient reported outcome measures and shared decision making

IntroductionThis paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes.BackgroundThe ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up.MethodsADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients’ clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach’ for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox.ResultsUser satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated.ConclusionsHaving finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel.

Implementation of merdeka curriculum by Islamic religious education teachers at junior high school

This research aims to see firsthand how the implementation of Merdeka Curriculum is carried out by Islamic Religious Education teachers at SMPN 7 Bandung, as one of the driving schools as well as the first school at the junior high school level to implement Merdeka Curriculum. Using a qualitative approach and a case study method at SMPN 7 Bandung, which was explored through interviews with three Islamic Religious Education teachers there, the results of this study were then analyzed through the stages of data reduction, data presentation, and conclusion drawing, so this study resulted So this study resulted in the conclusion that the implementation of the Merdeka Curriculum by Islamic Religious Education teachers at SMPN 7 Bandung is in accordance with the targets and objectives to be achieved, both by the Islamic Religious Education teachers themselves, by the school, and by the government that formulated the Merdeka Curriculum. This research has implications for the importance of planning the implementation of the Independent Curriculum by analyzing various indicators that influence it. From these implications, this research contributes significantly to finding the fact that careful planning in a curriculum implementation will help Islamic Religious Education teachers in carrying out learning better

End-of-Life and Hospice Care in Neurologic Diseases.

The care of a patient with neurologic disease at end-of-life requires expertise in addressing advance care planning, hospice, symptom management, and caregiver support. Neurologists caring for patients with advanced neurologic disease often identify changes in disease trajectory, functional status, or goals of care that prompt discussions of advance care planning and hospice. Patients nearing end-of-life may develop symptoms such as dyspnea, secretions, delirium, pain, and seizures. Neurologists may be the primary clinicians managing these symptoms, particularly in the hospitalized patient, though they may also lend their expertise to non-neurologists about expected disease trajectories and symptoms in advanced neurologic disease. This article aims to help neurologists guide patients and caregivers through the end-of-life process by focusing on general knowledge that can be applied across diseases as well as specific considerations in severe stroke and traumatic brain injury, amyotrophic lateral sclerosis, Parkinson's disease, and dementia.

Promoting clinical reasoning in undergraduate Family Medicine curricula through concept mapping: a qualitative approach.

Clinical reasoning is a crucial skill for physicians, enabling them to bridge theoretical knowledge with practical application. The gap between basic sciences and clinical practice persists as a challenge, with traditional teaching methods yet to effectively bridge it. Concept maps (CMs), visual tools for organizing and connecting knowledge, hold promise for enhancing clinical reasoning in the undergraduate medical curriculum. However, further research is required to ascertain if CMs facilitate clinical reasoning development in medical students transitioning from basic sciences to clinical practice. This study aims to delineate how CMs can facilitate clinical reasoning in patients with multimorbidity within undergraduate Family Medicine curricula, as perceived by students and tutors, and to understand the implementation process and resources required. This exploratory qualitative study formed a part of an action research project. While introducing an educational intervention to 5th-year medical students, we conducted a qualitative evaluation. Subsequently, semi-structured group interviews were conducted with students, and a focus group was conducted with tutors. Three main educational impacts were identified: integration of clinical information, support for patient management and care plan, and collaborative learning. Key aspects for successful CM implementation included clear instructions for map construction, using user-friendly software, allocating sufficient time for the task, encouraging group discussion of CMs, and incorporating tutor feedback. CMs are pedagogical tools that facilitate clinical information integration and support management and treatment plans, helping students better understand multimorbidity patients and promoting some components of clinical reasoning in undergraduate medical education.

Predicting Outcome in Clear Aligner Treatment: A Machine Learning Analysis

Background/Objectives: Machine learning (ML) models predicting the risk of refinement (i.e., a subsequent course of treatment being necessary) in clear aligner therapy (CAT) were developed and evaluated. Methods: An anonymized sample of 9942 CAT patients (70.6% females, 29.4% males, age range 18–64 years, median 30.5 years), as provided by DrSmile, a large European CAT provider based in Berlin, Germany, was used. Three different ML methods were employed: (1) logistic regression with L1 regularization, (2) extreme gradient boosting (XGBoost), and (3) support vector classification with a radial basis function kernel. In total, 74 factors were selected as predictors for these methods and are consistent with clinical reasoning. Results: On a held-out test set with a true-positive rate of 0.58, the logistic regression model has an area under the ROC curve (AUC) of 0.67, an average precision (AP) of 0.73, and Brier loss of 0.22; the XGBoost model has an AUC of 0.67, an AP of 0.74, and Brier loss of 0.22; and the support vector model has a recall of 0.61 and a precision of 0.64. The logistic regression and XGBoost models identify predictors influencing refinement risk, including patient compliance, interproximal enamel reduction (IPR) and certain planned tooth movements, for example, lingual translation of maxillary incisors being associated with the lowest risk of refinement and rotation of mandibular incisors with the highest risk. Conclusions: These findings suggest moderate, well-calibrated predictive accuracy with both regularized logistic regression and XGBoost and underscore the influence the identified factors have on the risk of refinement in CAT, emphasizing their importance in the careful planning of orthodontic treatment and the potential for shorter treatment times, less patient discomfort, and fewer clinic visits. Identification of at-risk individuals could support tailored clinical decision-making and enable targeted interventions

Barriers to initiating and implementing palliative and end-of-life care for children with life-limiting conditions: a mixed-methods study in a UK children’s hospital

BackgroundTo ensure that children with life-limiting conditions (LLC) and their families have access to a palliative care pathway from diagnosis to death and bereavement, a better understanding of the challenges...

Meaningful Healthcare and Social Service Access for Homeless Populations: Generating Alliances Through Theories of Therapeutic Landscape

ABSTRACT Poor health can both facilitate and be facilitated by homelessness. The desire for serious illness care to occur at home and increased attention to home-and-community-based health services prompts consideration of how the therapeutic nature of place can shape patient-centered care for those who live outside of traditional housing. Three key concepts from therapeutic landscape are illustrated by findings from an empirical, grounded theory study (RASCAL-UP) of a mobile palliative care provider for the homeless: (1) healing pilgrimages and migrations; (2) place-based therapeutic networks; (3) spaces of care and control. Through application of therapeutic landscape theory, health workers can better comprehend the healthcare decisions and goals of people experiencing homelessness. Applications of therapeutic landscape theory can guide healthcare professionals toward equitable care planning and support programming and policy to enhance care options for homeless populations.

Pre-post-evaluation of a dementia-specific advance care planning toolkit for Japanese primary care clinicians.

The population of people living with dementia (PLwD) continues to grow in Japan where advance care planning (ACP) for PLwD is relatively new. Our aim was to evaluate the feasibility and cultural acceptability of a dementia-specific ACP communication skills toolkit for Japanese primary care clinicians. We delivered 13 training sessions in primary care clinics across central Japan and conducted a post-training survey to assess whether the toolkit increased confidence in dementia-specific ACP communication skills and the acceptability of the toolkit with the following four statements: (1) The language in the sessions was clear, (2) The sessions took an appropriate amount of time to complete, (3) The design of the sessions was an effective educational method, and (4) The sessions were culturally appropriate for communication with Japanese patients with dementia and their family members. We asked participants to respond using a 5-point Likert scale from strongly agree to strongly disagree. All participants were Japanese and included 80 physicians (mean age 39.8 years), 33 nurses (mean age 45.7 years), and 58 other participants (mean age 42.9 years), who were 30.0%, 87.9%, and 55.2% female, respectively. Most participants practiced in rural settings. In pre- post-comparisons, participant confidence increased in determining capacity, understanding dementia prognosis, goals of care, eliciting surrogates, recommending self-care practices to families, and leading family meetings (all p < 0.001). Most participants strongly agreed or agreed that the toolkit was an effective method (96.9%), took an appropriate amount of time (94.5%), contained clear language (89.8%), and was culturally appropriate (73.6%). Dementia-specific ACP communication skills toolkit can be delivered in Japan. Japanese primary care clinicians generally felt the dementia-specific ACP toolkit increased their confidence in ACP communication skills and was acceptable. The language, time, and design were well received, though further work is needed to improve the cultural appropriateness of the toolkit.

NURS-02. THE DEVELOPMENT AND IMPLEMENTATION OF SKINCARE TREATMENT PLANS AND PRODUCT KITS FOR PEDIATRIC PATIENTS RECEIVING TARGETED THERAPIES THAT CAUSE SKIN TOXICITY

Abstract BACKGROUND Mitogen-activated protein kinase (MAPK) pathway inhibitors are incorporated into the treatment regimens for several pediatric cancers. However, they commonly trigger dermatologic side effects, which can be challenging to manage and may have a significant impact on the quality of life. METHODS We previously performed a prospective study looking at the satisfaction and utilization of skincare kits and patient education regarding basic skincare practices. Based on these data, we developed revised skincare product kits and treatment plans that can be individualized for patients who are at risk of developing dermatologic side effects from targeted therapies. RESULTS Based on our prior study, 77% of patients thought the skincare kits and instructions were helpful. Seventy-seven percent of patients also recommended that they be distributed at the initiation of therapy. Through this study, we discovered that the patient reported medical history questions were inconsistent when compared with medical chart reviews. The most common discrepancies included information regarding patient’s diagnosis, prescribed medications, skin-related problems, and past medical history. From this data, we have developed a new skincare product kit and patient skincare plans which we distribute to every patient prior to starting their targeted therapy. The skincare kits consist of a cleanser, emollient, oral care products, sunscreen, pyrithione zinc containing shampoo, and facial moisturizers for adolescent patients. Our patient skincare plans consist of patient-specific information including diagnosis, medications, and their targeted agent. The plan provides details on how and when to use each product, application time, and order in which to apply products and topical medications. CONCLUSION Our project has highlighted the importance of patient education regarding dermatologic side effects in those starting targeted therapies. We have successfully implemented this by providing our patients with both skincare products and patient-specific care plans.

Health Care Navigators for Perioperative Advance Care Planning

This cohort study evaluates the addition of a patient-centered intervention to an advance care planning process for older surgical patients.

Choline Supplementation for Infants, Children, and Pregnant People

What Is the Issue? Choline is an essential nutrient produced by humans and animals and is important during pregnancy, fetal growth, and the development of the brain and nervous system. Most people do not get enough choline from their diet. Fetal alcohol spectrum disorders (FASD) are a set of conditions where fetuses have been exposed to alcohol and this affects memory, learning, and development from early childhood to later life. Choline supplements are products used to complement choline-deficient diets. Given the role of choline in fetal development, choline supplements are a potential intervention to support pregnancy or to mitigate the developmental harms in children from prenatal exposure to alcohol if supported by evidence of their effectiveness for these purposes. What Did We Do? To inform decisions about the use and timing of choline supplementation to support health outcomes in infants and children, CADTH sought to identify and summarize the literature about the effectiveness and safety of choline supplementation given to any pregnant people or given to children with either prenatal alcohol exposure or FASD. We also attempted to identify evidence-based recommendations for using choline supplementation in these populations. We searched key resources and conducted a focused internet search for relevant evidence published since 2014. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We found few publications investigating this topic, and several studies had low statistical power and imprecise results. The clinical evidence was mixed depending on whether choline was given to the pregnant person or child, which interventional groups were compared, what the clinical exposures or diagnoses were in the study population, the time point and duration of choline supplementation, which outcomes were measured, and how old children were during follow-up. For choline supplementation in healthy pregnant people, evidence was mixed for infant and child neurocognitive and neurodevelopmental outcomes or behavioural symptoms; there were little-to-no differences in safety outcomes. For choline supplementation in pregnant people exposed to alcohol, evidence was mixed for infant and child neurocognitive and neurodevelopmental outcomes, body size, and brain region sizes; some minor side effects were reported overall. For choline supplementation in children with FASD, most evidence showed little-to-no benefits for neurocognitive and neurodevelopmental outcomes, and brain structure; limited evidence showed higher fishy body odour and some other unspecified adverse symptoms for children given choline. Guidelines based mostly on low-quality evidence or expert opinion recommend that all pregnant people, including those with gestational diabetes mellitus or on vegan or vegetarian diets, increase their choline intake through diet or supplements. We did not find clinical effectiveness evidence for choline supplementation in infants with FASD, or guidelines regarding choline supplementation in either infants or children with FASD, that met inclusion criteria for our report. What Does it Mean? Health care professionals and decision-makers can use this evidence to inform decisions around applicability of choline supplementation for pregnant people, or for infants and children with FASD, in their practice. There may be a need to balance the knowledge that choline intake is low at the population level and important for fetal development with the identified clinical effectiveness evidence for choline supplementation, which was limited and mixed for all evaluated patient populations. Careful consideration of the following may also be important to inform decisions about the appropriateness of choline supplementation: the care plan and other intensive and concurrent interventions for children with FASD; stigma and challenges faced by pregnant people and children in the context of prenatal alcohol exposure; cultural dietary practices; and accessibility, cost, and availability of supplements.

Oxygen generation and delivery: Start to end

Oxygen is vital for our life. In hospitals, the medical team should also have knowledge of its generation and how it ends till it is ready for consumption at the patient end. Various oxygen generation plants like pressure swing adsorption (PSA) plants, Liquid medical oxygen plant are available at every medical institute but basic technical knowledge holds importance. Medical gas pipeline system is a well designed network spread through out the hospitals which boost life in the patients but utmost handling and care of these necessitates regular check and audits to that every point of the system provides maximum usage with minimum leakage. (Provide appropriate messages of about 35-50 words to be printed in centre box): Oxygen is the very basis for survival of the patients. Careful planning and knowledge is the essential requirement. Why is it important is well known, but how and whats of the oxygen generation plants is the need of the hour.

Stated patient preferences for overnight at-home diagnostic assessment of sleep disorders.

The diagnostic workup for assessment of sleep disorders commonly involves overnight testing to assess sleep patterns and pathological events. So far, little is known about preferences for provision of home sleep tests to patients with sleep disorders. This study aims to close this gap by eliciting preferences for home sleep testing using a discrete choice experiment (DCE). A DCE with seven attributes of at-home sleep testing and three levels per attribute was developed using a fractional factorial design. Patients with and without previous sleep testing experience were recruited from two large sleep centers in Germany. Coefficients for attribute levels were calculated using a conditional logit model to estimate their influence on choice decisions and calculate the relative importance of each attribute. 305 patients (54.5 ± 13,1 years, 65.3% male) were enrolled, and 288 surveys with complete data included for analysis. Attributes with greatest relevance were Waiting time to discuss sleep study results; Waiting time to conduct sleep study, and Sleep quality during measurement. Of lowest importance was Diagnostic accuracy of sleep study, followed by Effort to apply sleep study device. Significant heterogeneity in choice behavior was found, including differences by gender, willingness-to-pay for sleep studies, and previous experience with sleep studies. Preferred location for conducting sleep testing was at-home in 50.7% and in-lab in 46.9%. Preferences and relative importance of home sleep test attributes vary among different subgroups. Considering those preferences can be important for clinicians and policymakers when designing care pathways and planning of testing policies for sleep disorders.

Safely gaining experience in death and dying: Simulation in palliative care and end-of-life education

BackgroundTraining in palliative and end-of-life (EOL) care provision represents a critical topic in health professional curricula for ensuring a workforce prepared to provide safe and person-center care at the end of one's life. This manuscript describes the incorporation of a simulation-based learning experience (SBLE) and the evolution of a professional elective course for student pharmacists related to palliative and EOL care. Educational activityA SBLE was incorporated into a long-standing professional pharmacy elective course in palliative and EOL care. The decision to incorporate and utilize SBLE to introduce topics of deprescribing, communication, prioritization of quality of life, and establishing goals of care was utilized in recognition of a need to establish a psychologically safer environment to allow students to explore these topics prior to the advanced pharmacy practice experiences. DiscussionIncorporation of SBLE in this professional elective course resulted in a favorable effect on course enrollment. Observations from structured debriefing and anecdotal student feedback suggest that students had trouble tailoring care plans to the circumstances, particularly in focusing on de-escalating medication treatments, emphasizing the need for training in the care for this patient population which incorporate considerations for goals of care. Lessons related to the influence of environmental distractions, expressions of discomfort conveyed by body language, and challenges in prioritizing and focusing on tailoring care plans given evolving information at hand were identified. ImplicationsWe describe the effective implementation and utilization of SBLE in a professional elective focused on palliative and EOL care for student pharmacists. Future directions include research initiatives designed to evaluate the impact of simulation on key competencies and areas developed through participation in such exercises. Systematic evaluation of outcomes and competencies related to team dynamics, sympathetic communication, professional identity formation and resiliency and preparation for dealing with death and dying in experiential learning are planned.

Modernizing Procurement in Supply Chain with AI and Machine Learning Techniques

Public procurement in Europe represents, on average, 16.9% of the GDP and is the cornerstone of the European Single Market. Simplifying public procurement and reducing procurement administrative costs for the public and private sectors can deliver substantial benefits at the national and European levels. However, the complexity and diversity of public procurement processes, as well as the huge expenditure at hand, implement automatic systems tailored to specific procurement needs necessary. This paper shows how artificial intelligence, and in particular machine learning techniques, can be used to modernize public procurement. It presents implemented systems and showcases pilot projects. The results of an extensive evaluation are also reported. The paper also argues that public procurement should be used more strategically by public administrations. This means aligning procurement actions with overall business objectives and using procurement to leverage supplier innovation and create a competitive advantage. Such advanced objectives are seldom achieved through the lowest price model. The paper also contains several recommendations for both the supply and demand sides to help realize the full potential of public procurement. On the supply side, recommendations relate to a better understanding of how artificial intelligence can be used in procurement activities, working with AI systems, and creating AI systems. On the demand side, recommendations involve the careful planning of how and when to use AI in procurement activities.

Rationale and Design of a Multicenter Trial on Exploratory Analysis of the Effects of Advance Care Planning Guided by the Prediction Program of Heart Failure Prognosis on Quality of Life in Patients With Heart Failure ― ACQUAINT-Trial ―

Rationale and Design of a Multicenter Trial on Exploratory Analysis of the Effects of Advance Care Planning Guided by the Prediction Program of Heart Failure Prognosis on Quality of Life in Patients With Heart Failure ― ACQUAINT-Trial ―