Paramedicine is rapidly evolving beyond traditional clinical domains, demanding leadership that is relational, emotionally attuned, and adaptable to dynamic prehospital environments. This conceptual analysis explores emotionally intelligent, adaptive leadership as a transformative capability within paramedic practice. Drawing on interdisciplinary literature and paramedicine-specific studies, the article challenges authority-based leadership models and introduces a relational framework grounded in mentorship, self-leadership and reflective practice. Adaptive Leadership is positioned as a context-sensitive response to operational complexity, psychological stressors, and systemic ambiguity. Emotional intelligence, comprising self-awareness, empathy and relationship management is a core facilitator of cohesion, resilience and decision-making in complex, high-stakes clinical settings. The analysis integrates theoretical constructs with practical implications for paramedic education, workforce development and clinical governance. Paramedic leadership is reframed as an evolving capability: a shared journey built on trust, emotional insight, and the capacity to lead from the heart.

Predictive Modeling for Clostridioides difficile Infection: Current State of the Science, Clinical Applications, and Future Directions.

The global cancer burden continues to escalate, driven by a significant rise in new cases and cancer-related deaths. Early detection through effective screening programs is paramount for reducing mortality, and the integration of Artificial Intelligence (AI) into oncological imaging has shown transformative potential. This review comprehensively examines the evolution and clinical application of AI in oncological imaging for cancer detection across various modalities, including ultrasound, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and endoscopy, highlighting significant advancements in early cancer screening. We further address the challenges associated with AI implementation in medical imaging, including dataset bias, the need for robust regulatory frameworks, and technical integration barriers. Emphasis is placed on the necessity of standardized, diverse datasets, explainable algorithms, and equitable implementation to mitigate disparities. By aligning technological innovation with rigorous clinical validation, ethical governance, and seamless workflow integration, AI is poised to revolutionize cancer care through earlier and more accurate detection, personalized risk stratification, and ultimately, improved patient outcomes.

ABSTRACTBackgroundCritical emergency medicine (CrEM) is one of four subspecialty pillars within anesthesiology and intensive care medicine, as defined by the Scandinavian Society of Anesthesiology and Intensive Care Medicine (SSAI). Despite its recognized clinical relevance, a comprehensive definition of CrEM has until now been lacking. The aim of this study was to establish a consensus‐based definition of CrEM and delineate its core components, competencies, and operational domains.MethodsA modified Delphi study was conducted among experts from the SSAI‐CrEM education program. The process involved two iterative rounds followed by external validation with alumni from previous CrEM programs. Statements for evaluation were generated from participant essays and refined by a steering committee of experienced consultants. Consensus was defined as ≥ 90% agreement.ResultsOf 44 initial statements, 37 reached consensus and were organized into six thematic domains: (1) Core Function and Scope, (2) Competence and Training, (3) Work Environment and Challenges, (4) Interdisciplinary and Teamwork Approach, (5) Ethical and Decision‐Making Responsibilities, and (6) Need for Research and Continuous Development. CrEM was defined as a physician‐led, context‐adapted subspecialty focusing on rapid stabilization, life‐saving interventions, and high‐acuity care across diverse clinical, and prehospital environments. The results emphasize the need for structured training, ethical competence, leadership in multidisciplinary teams, and ongoing scientific development.ConclusionCrEM constitutes a distinct and essential subspecialty within anesthesiology and intensive care medicine, bridging advanced emergency care across institutional boundaries. This study provides a structured definition and framework that may support curriculum development, clinical governance, and research initiatives within the field. Future work should aim to further validate these findings and guide the evolution of CrEM in both clinical and academic contexts.Editorial CommentThis Delphi process report presents the practice and training concepts for critical emergency medicine as a subspecialty of Anesthesia and Intensive Care Medicine in the Nordic country medical context. Perhaps particular for the Nordic countries, which combine medical specialty expertise and practice areas for perioperative medicine, intensive care medicine, pain medicine, and emergency (critical) prehospital care, this document describes current goals in susbpecialty education for the Nordic practice tradition for critical emergency medicine.

Abstract Introduction Children with neurodevelopmental conditions, such as autism and other neurodivergence, commonly experience sleep difficulties [1]. This can have a significant impact on the child’s cognition, behaviour and on the quality of life of other family members. Melatonin has been shown to improve sleep in autistic children and be a lifeline for parents and caregivers [2]. However, little is known about the accessibility of this treatment. Aim To understand the variation in guidance for prescribing Melatonin between Integrated Care Systems (ICS’s) in England Methodology A systematic approach was used to identify the status of melatonin prescribing in formularies across England using Google search. This included using key phrases to identify the Area Prescribing Formulary (APFs) for the 42 ICS areas across England. Searches were conducted independently by two authors. Once identified, a data extraction form was used to collect data from the formulary relating to Melatonin prescribing. Formularies listed Melatonin as a ‘Green’, ‘Amber’ or ‘Red’ drug, where Green drugs can be prescribed in primary care, Amber drugs must be initiated by specialists and then a Shared Care Agreement is used so prescribers in primary care can continue the medication; and Red drugs must only be prescribed by hospital specialists. Data was pooled, cleaned and analysed using descriptive statistics to identify patterns, similarities and differences in information included in APFs about melatonin. Ethical approval was not required for this study. Results Regional guidance was identified in 40/42 areas. Thirty-six areas listed Melatonin as an Amber drug, requiring a Shared Care Agreement (SCA) to access in primary care. Four areas listed melatonin as a ‘Red’ drug, only prescribable hospital specialist. Only one area listed melatonin as a Green drug. One area did not have a commissioned pathway for prescribing; one had no agreed prescribing guidance; and one area only allowed prescription for up to three months but did not report a status. Two areas had specially commissioned sleep services, but did not mention Melatonin prescribing. Recommended formulations varied widely across areas too. Initiation was mostly by a specialist through initiation periods varied considerably, between 2 weeks and 3 months. Clinical governance also varied, with 40 areas, 57.5% (n = 23) recommended a ‘drug holiday’ every 6–12 months with a sleep diary and 32% (n = 13) provided information about transition from paediatric to adult services at 18 years, with most suggesting a break prior to 18th birthday. Discussion The status of melatonin in formularies varies substantially across England. This is important, as patients with neurodevelopmental disability may face a postcode lottery when trying to access this critical medicine in primary care. A limitation of the study is that formulary status may not always reflect clinical prescribing behaviours (prescribing can be off-formulary or formularies can be out of date) although on the whole, formularies does restrict prescribing. More research is needed to understand Melatonin prescribing patterns to allow equality of access across the country.

Robotic surgery in Ireland: national governance framework and a guide to good practice.

Neonatal transports are essential for providing access to advanced intensive care treatment for sick and premature neonates. There is a lack of consensus of which core physiological variables, clinical parameters and quality metrics to report for clinical guidance during transport and clinical governance of transport systems. We performed a systematic literature review to identify which data variables are reported during neonatal transports and assess whether these variables are uniform and transferable across studies. In the final data extraction and quality appraisal, 108 studies were included. The studies were heterogenous, presented a large variation of registered variables and frequently lacked uniform definitions. Reaching consensus on a set of defined variables for registration and implementation internationally will enhance the opportunity to improve the safety, effectiveness and quality of care for these vulnerable neonates.

Initial Health Assessments (IHAs) are a statutory requirement for children entering care in England, mandated to be completed within 20 working days. However, widespread pressures across both community paediatrics and children’s social care are making this increasingly difficult to achieve. Compliance with statutory timescales is highly variable, with some areas reporting compliance rates lower than 50%. The growing demand for neurodevelopmental assessments, national workforce shortages and rising numbers of children in care have stretched capacity and led to delays. This article presents a centralised, general practitioner (GP)-led IHA model developed in Gloucestershire that addresses these challenges through structured training, clinical supervision, peer review and close collaboration with paediatric teams. GPs with safeguarding and child health experience deliver timely, high-quality assessments supported by dedicated administrative systems and robust clinical governance. The model not only improves statutory compliance and relieves pressure on paediatric services, but also ensures consistent, person-centred care for vulnerable children. With its strong results and adaptability, this model offers a scalable and pragmatic solution to the national IHA delivery crisis.

The integration of artificial intelligence (AI) into Australian healthcare promises to improve diagnostic accuracy, workflow efficiency, and personalised care, yet it also introduces critical cybersecurity vulnerabilities that threaten not only data privacy but also patient safety and health system trust. This perspective argues that cybersecurity must be recognised as a core dimension of healthcare quality and formally embedded in Australia's safety governance frameworks. Drawing on recent national incidents, regulatory gaps, and international comparisons, we propose five policy actions to align AI-enabled innovation with secure, ethical, and resilient healthcare delivery. Embedding cybersecurity within clinical governance and system reform agendas is vital to ensure sustainable digital transformation.

Artificial intelligence (AI) holds huge potential in improving diagnosis and streamlining workflows in health care. However, several challenges remain, hampering the widespread adoption in clinical settings, such as for assessing data quality, bias, interoperability, and privacy, as well as for use in regulation and clinician training. Potent data channels are vital for assuring the exactness and trustworthiness of diagnostic performance. They boost the transmission of high-quality information, which is essential for expert annotations. Interoperable electronic health record integration and federated or privacy‑enhancing training approaches allow real‑time analytics while guarding patient data. Regulatory indecision and the comprehensive and continuous supervision of the process require transparent, explainable AI and shared accountability among developers, doctors, and institutions. In addition, prospective clinical validation, physician education, and governance are paramount to building trust and guaranteeing safe AI deployment in health care. This review outlines the difficulties faced when integrating these technological advancements into everyday clinical practice.

Ensuring the quality use of medicines in clinical trials: A review and perspective on optimising the role of pharmacists.

ObjectiveThe aim of this study was to explore why patients with hard-to-heal ulcers are treated without an aetiological diagnosis, using a grounded theory approach.DesignThe study employed a qualitative semistructured interview design to gain in-depth insights. Data were collected in 2024, and an explanatory model was formed in accordance with grounded theory analysis.SettingInterviews were conducted with healthcare staff across primary, community and specialist care units in Sweden, encompassing both public and private sectors and representing a wide geographical spread.ParticipantsThe study involved 23 healthcare professionals, including nurses (n=18), assistant nurses (n=2) and physicians (n=3), from 22 healthcare units that participated in a preceding national mapping study. Participants were selected purposively to represent various professional roles and healthcare levels.ResultsThe analysis resulted in a theoretical model based on two categories: Healthcare traditions and clinical practices and Clinical governance. The lack of an aetiological diagnosis can be attributed to a traditional division of tasks, where ulcer care falls within the nurses’ domain. As a result, patients often receive treatment without a physician’s involvement, especially in home healthcare. Barriers and enablers for a diagnosis are present on different levels; issues close to the patient as well as structural matters. The results illustrate how healthcare units can be positioned along a scale, from traditional work distribution to evidence-based guidelines.ConclusionsThis study can be used to get a deeper understanding of the challenges of current wound management, where clinical governance can support or undermine the movement from a traditional work distribution towards an evidence-based clinical practice. Furthermore, this study can provide a basis for discussing quality improvement, to obtain good and equal care for patients with hard-to-heal ulcers.

Abstract Background and Aims The implementation of structured clinical governance and performance management in dialysis is crucial for improving patient outcomes. Recognizing this, DaVita Brazil introduced the DaVita Quality Index (DQI) in 2023 as a benchmarking tool to standardize quality indicators and enhance clinical performance across its network of dialysis clinics. This study aims to evaluate the impact of the DQI on key dialysis-related metrics and compare the observed improvements with national and international benchmarks. Methods A longitudinal observational study was conducted across 95 DaVita Brazil dialysis clinics from July 2023 to December 2024. The DQI, with a maximum score of 100 points, was calculated monthly for each clinic based on key performance indicators (KPIs), including the percentage of patients achieving Kt/V ≥ 1.3, hemoglobin control (Hb ≥ 10 and ≥12 g/dL without erythropoietin), phosphorus ≤5.5 mg/dL, interdialytic weight gain (IDWG), and the use of central venous catheters (CVC). Data were extracted from electronic health records, and only patients undergoing hemodialysis (HD) or hemodiafiltration (HDF) for more than 90 days were included. Patients from both the public healthcare system (SUS) and private healthcare providers were analyzed together. Statistical analyses were conducted using paired t-tests and ANOVA to assess significant differences in DQI scores and individual KPIs over time. Results A total of 95 clinics participated in the program. The mean DQI score increased from 39.67 in July 2023 to 57.29 in December 2024, reflecting a 44.41% improvement (P < 0.001). Key clinical metrics demonstrated statistically significant improvements, measured as the percentage of patients achieving target values: Compared to national and international benchmarks, the DQI results demonstrated positive trends, particularly in phosphorus control and dialysis adequacy, where DaVita Brazil outperformed national averages. The implementation of structured clinical governance within DaVita Brazil clinics has facilitated alignment with global standards, including those reported in the Brazilian Society of Nephrology Dialysis Census 2023, ISN Global Kidney Health Atlas 2023, and ERA Registry 2022. Conclusion The introduction of the DaVita Quality Index in Brazil has led to significant improvements in dialysis-related clinical indicators, validating the effectiveness of a structured clinical governance model in enhancing dialysis care. These results support the expansion of DQI as a national quality improvement model for dialysis services. Future research should evaluate the program’s impact on hospitalization rates, patient survival, and long-term health outcomes.

Abstract Background and Aims The implementation of structured clinical governance is critical in improving patient outcomes in dialysis care. In 2023, DaVita Kidney Care Brazil (DKC Brazil) introduced the DaVita Quality Index (DQI) as a national benchmarking tool, aiming to enhance clinical performance and standardize care across its network of dialysis clinics. The DQI incorporates multiple quality indicators, including dialysis adequacy, anemia control, vascular access, and metabolic parameters, to provide a comprehensive performance score. This study evaluates the impact of DQI implementation on mortality and hospitalization rates over an 18-month period and compares these findings to national and international benchmarks. Methods A retrospective observational study was conducted across 95 DaVita Kidney Care Brazil dialysis clinics, covering patients undergoing hemodialysis (HD) and hemodiafiltration (HDF) for more than 90 days. Patients from both public healthcare (SUS) and private healthcare providers were analyzed jointly. The study period was from July 2023 to December 2024. Were analyzed Mortality rate (%) (measured monthly), Hospitalization rate (%) (percentage of patients admitted per month) and DaVita Quality Index (DQI) score (scale 0–100). Data Sources were the Electronic Health Records (EHR) and BI dashboards from DaVita Kidney Care Brazil. Statistical Analysis used Pearson correlation coefficient to assess the association between DQI scores and hospitalization/mortality trends, and paired t-tests were conducted to evaluate significant differences over time. Benchmarking Comparison was data compared with: Brazilian Society of Nephrology (SBN) Dialysis Census 2023, ERA Registry 2022 (European benchmarks) and ISN Global Kidney Health Atlas 2023 (International data). Results A total of 20 147 patients were analyzed across 95 clinics. The mean DQI score increased from 30 in July 2023 to 59 in December 2024, reflecting a 96.7% improvement over the study period. The improvement in DQI was associated with significant reductions in mortality and hospitalization rates: A strong negative correlation was observed between DQI scores and mortality rates (r = −0.82, p<0.001), indicating that clinics with higher DQI scores exhibited lower mortality over time. A similar trend was observed for hospitalization rates (r = −0.76, p=0.004). Conclusion The implementation of the DaVita Quality Index (DQI) in DKC Brazil has been positively associated with lower mortality and hospitalization rates, supporting its role as a structured clinical governance tool. Compared to Brazilian national data (SBN 2023) and international benchmarks (ERA Registry 2022, ISN Atlas 2023), DaVita Brazil demonstrated improvements in patient outcomes, particularly in regions with historically lower-quality indicators. The expansion of the DQI program and further refinement of quality improvement initiatives could serve as a model for broader national implementation in dialysis programs, reinforcing the importance of structured governance in renal care.

Background: The quality of hospital service and clinical governance depends heavily on patient satisfaction as an essential indicator. The identification of satisfaction determinants helps healthcare providers enhance their delivery methods, particularly in public hospitals with limited resources.Objective: The research investigated patient satisfaction while applying Six Sigma principles to determine its essential determinants in a tertiary care government hospital.Methods: A facility-based cross-sectional study took place from November 2023 to December 2024 by selecting 400 patients through random methods. The 19-item structured questionnaire assessed patient satisfaction in three domains that included service utilization, patient-provider interaction, and facility-related factors. A five-point Likert scale evaluated the general satisfaction of patients. The researchers used SPSS to analyze the data through factor analysis and bivariate regression to identify the predictors.Results: The patient satisfaction level reached 80.4% in the study. The clinical care delivered by doctors and nursing staff proved to be the primary factor that satisfied patients. Facility-related amenities showed substantial gaps because patients expressed dissatisfaction with toilet cleanliness, waiting space availability, dietary services, and pharmacy queue lengths. The unclean state of toilets proved to be the primary cause of patient dissatisfaction because 40% of participants expressed their discontent. The study revealed that elderly patients together with those who reported poor health status demonstrated lower satisfaction levels. The analysis showed that service quality improvements directly resulted in increased patient satisfaction.Conclusion: The overall satisfaction scores were positive, but nonclinical service domains require substantial improvement. The satisfaction levels could increase substantially through hospital hygiene improvements, outpatient procedure optimization, patient-provider communication enhancement, and technology-based queue management systems. The implementation of the Six Sigma methodology for regular monitoring enabled healthcare providers to develop evidence-based strategies that enhance clinical governance in government hospitals.

The triad of excellence in oncology nursing: The synergy of clinical governance climate, digital health competence, and patient-centered care.

Autism diagnosis in Wales: The case of governance-driven medicalisation in care pathways.

Contributing factors to missed nursing care: A systematic review with clinical implications for practice and patient safety.

The practice of medicine has always rested on service, patient care, education, and research. Corporatization, however, threatens this foundation. It redefines patients as consumers, physicians as providers, and care as a commodity, with decisions increasingly driven by revenue cycles. ¹ For Pakistan, the dangers are profound. Corporatization diverts resources toward lucrative services while neglecting primary care, trauma, and emergency medicine. ² It also accelerates the migration of skilled clinicians into private hospitals, draining the public sector. ³ Families already bearing over 60% of health costs out-of-pocket⁴ face further impoverishment through unnecessary investigations and procedures. ⁵ The ethical contradiction is stark. In Islam, healthcare is an amanah (trust), not a commodity. ⁶ International evidence is sobering as in United States alone, corporatization has produced the world’s highest health spending without better outcomes, ⁷ while in India it has fostered overuse of costly interventions. ⁸ But a LMIC like Pakistan cannot afford such distortions. A rejection of corporatization is unrealistic. Instead, Pakistan needs a hybrid model that combines efficiency with compassion. Hospitals must institutionalize clinical governance, ⁹ transparent procurement, and standardized service packages. Senior clinicians in administrative roles require managerial and leadership training to ensure fiscal responsibility without abandoning ethics. ¹⁰ However, there are good examples in Pakistan. The Indus Hospital Network offers free, high-quality care funded through philanthropy and efficiency, ¹¹ while Liaquat National Hospital demonstrates cross-subsidization where private revenue sustains charitable care. ¹² These models show that sustainability is possible without commodifying medicine. we must choose whether hospitals will be judged by profits or by lives healed. As Berwick notes, the true test of a health system is not whether it enriches shareholders but whether it relieves suffering. ¹³

Background: Medical emergencies, although rare in dental settings, can pose serious risks to patient safety. Prompt recognition and response are vital, especially in high-stress clinical environments. Visual aids like medical emergency charts (MECs) play a key role in enhancing preparedness and ensuring standardized responses. Objective: To assess the knowledge, preparedness, and awareness of dental practitioners in Nineveh Province regarding medical emergencies and the availability and understanding of medical emergency charts in their clinical settings. Methods: A cross-sectional study was conducted from January to March 2025 among 700 dentists working in Nineveh Health Directorate facilities. A structured online questionnaire, based on previously validated tools, collected data on demographics, emergency knowledge, and awareness of MECs. Statistical analysis was performed using SPSS version 26, with chi-square tests to determine significance. Results: While participants showed moderate theoretical knowledge—100% correctly identified the syncope position and 70.4% correctly selected adrenaline for anaphylaxis—only 43.4% knew the correct CPR compression ratio (30:2). A concerning 76% were unfamiliar with MECs, and 93% reported the absence of such charts in their clinics. Additionally, only 51% of dentists felt prepared to handle medical emergencies. Professional role showed significant correlation with knowledge, whereas years of experience did not. Conclusion: There is a critical gap between dentists’ theoretical knowledge and practical preparedness in managing medical emergencies. The lack of MEC awareness and availability highlights the need for mandatory chart implementation, regular emergency training, and inclusion of visual protocols in clinical environments. Addressing these gaps is essential to uphold patient safety and meet international clinical governance standards.