Community Care Research Articles

Perceptions and Experiences of Animal-Assisted Interventions for People Living With Dementia: A Qualitative Evidence Synthesis.

To synthesise stakeholders' experiences and perceptions of animal-assisted intervention (AAI) for people with dementia in community care settings. Qualitative evidence synthesis. We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic synthesis was used to analyse the data from included studies. We assessed the methodological limitations of included studies using an adaptation of the Critical Appraisal Skills Programme checklist and used Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) tool to assess confidence in review findings. This review is reported using the ENTREQ checklist. We included 14 reports from 11 studies and developed three analytical themes incorporating a gardening analogy: planting-connecting with animals, growing-engaging in AAI and nurturing-making AAI work; and six subthemes: willingness to connect, building relationships, a rich experience, the benefits of AAI, individualised and holistic approach and training and support, with 15 key findings. This review describes people's experiences and perceptions of AAI for people with dementia, and provides recommendations on the development and implementation of AAI, with moderate to high confidence. Nurses need to consider the factors that influence the implementation of AAI identified in this review, to facilitate engagement and long-term impacts while adopting AAI in community care settings. This review may enhance healthcare professionals' understanding of AAI for people with dementia in community care settings. AAI is a complex intervention that can be delivered in varied manner. A multicomponent, flexible and individualised AAI is important. Additional training and education for staff are needed. A man with dementia and his wife who share a love of dogs, advised at each step of the review, providing insights and perspectives and contributing as co-authors.

8463 Navigating Medical Decisions: A Study Of Second Opinions From Both The Physician And Patient Standpoints

Abstract Disclosure: O. Derevyanko: None. Background: In contemporary healthcare, the concept of seeking second opinions has become increasingly prevalent, shaping the dynamics of patient-physician relationships. This study aims to delve into the multifaceted landscape of second opinions, examining the perspectives of both doctors and patients. As medical decision-making becomes more collaborative, understanding the factors influencing the second opinion process is crucial for enhancing patient outcomes and fostering effective communication within the healthcare system. Objectives: • To identify patterns and discrepancies between doctors' and patients' viewpoints on the importance and impact of second opinions.• To provide insights that can contribute to the development of strategies for improving the second opinion experience for both doctors and patients.• To assess how often patients seek for second opinion MethodsA comprehensive survey conducted among 756 doctors endocrinologists in social media Instagram , aiming to explore their attitudes and concerns regarding patients seeking second opinions in medical practice and 787 patients to find out how many of them seek for a second opinion. Results: Out of the surveyed doctors, 51.3% (n=388) expressed a positive and accepting attitude toward patients seeking second opinions. This majority acknowledged the importance of patient autonomy and the right to seek additional perspectives on their medical conditions.A significant portion, 34.5% (n=261) of doctors, voiced concerns related to potential drawbacks associated with second opinions. These concerns primarily revolved around the possibility of patients receiving conflicting advice or experiencing delays in crucial treatment decisions.A noteworthy 14.2% (n=107) of doctors indicated concerns related to the potential impact of second opinions on the trust between doctors and patients. This subset of professionals expressed apprehensions about how seeking additional perspectives might influence the doctor-patient relationship. 554 out of 787 patients reported about seeking for the second opinion most of the time. Conclusion: The insights gleaned from this survey shed light on the complex landscape of doctors' perspectives on second opinions. Recognizing the nuances within these attitudes is imperative for developing strategies that support collaborative decision-making and patient-centered care in the medical community. This research contributes valuable insights to the ongoing discourse surrounding patient autonomy and doctor-patient relationships. Presentation: 6/3/2024

Mental healthcare in South Tyrol

Mental healthcare in South Tyrol, as everywhere in Italy, is still characterized by Law 180, which came into force in 1978 under the leadership of Franco Basaglia and Bruno Orsini. The Ministry of Health subsequently set atarget number of beds of 10/100,000 inhabitants. Unlike in other parts of Italy, private clinics play aminimal role in South Tyrol. The "Psychiatric Services" are part of the state healthcare system responsible for all citizens and are also responsible for compulsory outpatient care. According to the concept of community care, also due to the small number of inpatient beds, agreat deal of care is provided on an outpatient basis. Coercive measures can only be used in the case of an illness requiring urgent treatment that the patient refuses, without recourse to endangering circumstances (self-endangerment or danger to a third party). Inpatient hospitalization is only possible if treatment also takes place and the principle of "outpatient before inpatient" also applies in this context, i.e., coercive treatment can only take place as an inpatient if it cannot be carried out as an outpatient. Forensic psychiatry has very few places and mentally ill offenders are often in prison or occupy beds in general psychiatric wards. Compared to Germany there are fewer beds available but staffing levels are better, particularly for nursing. In relation to the number of inhabitants, compulsory treatment is more frequent than in Germany, whereas involuntary hospitalization and physical restraint are much rarer (only possible in Italy by court order).

Maternal experiences and preference of maternity services in Singapore: A descriptive qualitative study

ProblemLittle is known about mothers’ experiences and preferences for maternity services in Singapore. A more nuanced understanding would identify areas for improvement in perinatal care, reducing the burden on healthcare providers in supporting maternity services. BackgroundExpecting mothers are typically referred to hospital-based antenatal and postnatal services in Singapore. In recent years, Singapore has made maternity services available in primary care community settings called polyclinics, to improve accessibility of such services. AimTo explore the experiences and preferences of Singaporean mothers in receiving maternity services in acute hospitals and polyclinics. MethodsA descriptive qualitative study design was adopted, and data were collected from September to October 2023. In total, 13 mothers were recruited from a maternity care hospital in Singapore. Individual semi-structured audio-recorded interviews were conducted, and data were analysed using thematic analysis. FindingsThree themes were identified: (1) Considerations when seeking maternity care, (2) Differing preferences and satisfaction levels, (3) Hopes for better perinatal care for mothers and babies. DiscussionMost mothers preferred seeking hospital-based antenatal care and were more inclined to do postnatal follow-ups in polyclinics. Factors like accessibility, cost and perceived expertise of healthcare providers influenced the decision-making. Maternal satisfaction with care services also fluctuated based on interpersonal factors and whether their informational needs were met. ConclusionOverall, mothers’ perceptions of maternity services were positive. Findings suggest the possibility of further expanding maternity services in community settings to increase professional support for mothers. Future research is needed to ascertain these findings in non-English speaking and non-subsidized settings.

Autistic and schizotypal traits exhibit similarities in their impact on mentalization and adult attachment impairments: a cross-sectional study

BackgroundDeficits in mentalizing and attachment occur in the autism and schizophrenia spectrum, and their extended traits in the general population. Parental attachment and the broader social environment highly influence the development of mentalizing. Given the similarities in the symptomatology and neurodevelopmental correlates of autism spectrum disorder (ASD) and schizophrenia (SCH), it is crucial to identify their overlaps and differences to support screening, differential diagnosis, and intervention.MethodsThis cross-sectional study utilized questionnaire data from 2203 adults (65.1% female, mean age[SD] = 37.98[9.66]), including participants diagnosed with ASD, SCH, and those exhibiting subclinical traits to investigate the associations between mentalizing, attachment, and perceived social support during adolescence across the autistic and schizotypy spectrum.ResultsIt was revealed that both autistic and schizotypal traits have comparable effects on insecure adult attachment, primarily through challenges in mentalizing. The impact of mentalizing deficits on adult attachment slightly varies between autistic and schizotypal traits. Conversely, perceived social support during adolescence relates to improved mentalizing and secure adult attachment as a protective factor during development.ConclusionsThese outcomes highlight the significance of supportive therapeutic relationships and community care while suggesting directions for further research and collaborative treatments addressing ASD and SCH, considering the differential impact of mentalizing on adult attachment.

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis: One Decade Later.

In 2012, the National Academies of Sciences, Engineering, and Medicine convened a committee charged with addressing the quality of cancer care in the United States and providing recommendations to policymakers and the cancer care community on strategies to improve cancer care delivery from the time of diagnosis through end-of-life. The resulting committee report, titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis (2013), presented a conceptual framework that included six interconnected components of care with corresponding recommendations. Over the past decade, the delivery of high-quality of cancer care has become more challenging and increasingly demanding on the workforce. In this manuscript, we review the goals and recommendations made in 2013, describe progress to date, and offer insights into future dedicated efforts and/or new strategies needed to achieve high-quality cancer care.

Evaluation of Community Pharmacist’s Knowledge, Attitudes, and Practices Regarding the Pharmacotherapy Management of Gouty Arthritis in Lahore, Pakistan

Background: Gouty arthritis is a prevalent but frequently misdiagnosed condition particularly in developing countries. As a medical expert pharmacists are essential to patient medication management, patient education, and treatment protocol adherence but insufficient information is present on related to gouty arthritis in Pakistan. Objective: The purpose of the study is to evaluate retail pharmacists (KAP) knowledge, attitude, practices regarding gouty arthritis in Lahore community pharmacies. It also examines the relationship between KAP scores and demographic characteristics finding gaps in pharmacist knowledge and treatment of arthritis. Methods: A study with a cross-sectional design was carried out on retail pharmacists working in community pharmacies throughout Lahore. Data on their knowledge attitude and practice regarding gouty arthritis were gathered using a structured questionnaire. The data were summarized using descriptive statistics. The Kolmogorov-Smirnov test evaluated normality, in addition to measures of skewness and kurtosis. Statistical analysis involved Fishers exact test and the Chi-square test to ascertain relationships between KAP scores and demographic factors. Effect size was measured using Cramer's V and Phi-square. Results: There is no significant association between demographics of pharmacists and knowledge. There is no association between our study variables and attitude. The post-hoc comparison of p values of different demographics shows no association with the practice regarding gouty arthritis. Conclusion: Despite their generally positive attitudes toward patient care community pharmacists have a notable knowledge gap regarding gouty arthritis. Enhanced training and education are required to improve community pharmacies handling of gout. Limitation such as sample size and response bias should be addressed in future research.

Getting mammograms shouldn’t be so bumpy: Improving mammogram workflow in VA community care.

345 Background: The interplay between VA-based care and Community Care (CC) has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to Community Care; while this process should be smooth and seamless, it is instead challenging to navigate, with inconsistent rates of completion and results often not relayed to patients leading to delayed/missed diagnoses. We applied extensive QI methodology towards overhauling the VASD Community Care Mammogram workflow to improve rates of CC mammogram completion and results released to patients in a timely manner. Methods: We evaluated the CC mammogram workflow and implemented interventions at VASD from 01/2022-04/2023. An A3 was used for tracking process improvement. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings/interviews were set up to identify pain points with the primary users to allow for continuous process evaluation and improvement. Primary outcome was the frequency with which a CC mammogram order had mammogram completed and result released to patient within the expected timeframe by VISN 22 metrics (BIRADS 0,3,4,5,6 <7 days and BIRADS 1,2 <14 days to notification). Results: Process mapping of the VASD CC mammogram process revealed significant waste and failure modes. Notably among these was the splintered tracking systems used across multiple users and lack of automated follow-up reminders. Multiple PDSAs involved standardizing workflow by developing an SOP that focused on standardization of tracking orders/results, creating automated task reminders, while also adding backup systems and double-checks. To centralize and standardize the patient tracking process, we repurposed the Coordinated Care Tracking System (CCTS), a VA-based tool that is used for tracking patients in other departments and creating reminders for follow up, while storing patient data in a centralized location. We also redesigned and streamlined the mammogram ordering menu within CPRS. Implementation of the above interventions increased monthly rates of mammograms completed and reported to patients in a timely manner from a median of 67.5% to 100% in all BIRADS groups by 10/2022, and sustained at 100% through 04/2023. Conclusions: Standardization of workflow and incorporation of CCTS software into the CC Mammogram process led to an appreciable improvement in rates of CC mammogram scheduling and timely result notifications. Improved tracking of CC mammogram patients has the potential to prevent unnecessary patient harm. It is worth considering whether CCTS and a similar standardized process should be incorporated into other CC programs, as these issues are not unique to VASD mammograms.

Making school home: A therapeutic design for students with intellectual disabilities

Abstract Inclusive school design is urgent not only to provide students with disabilities with environment that allows equal access to education but also to facilitate them with a supportive environment to help their healing process and to avoid psychological trauma. This article discusses the application of therapeutic design in a school for students with intellectual disabilities. The design follows therapeutic criteria consisting of: care in community, design for domesticity, social valorization, and integration with nature. Schools are designed as cluster systems using centralized circulation to improve spatial connectivity and to allow more social interaction. Additionally, the integration with nature is implemented through the use of more openings and inner courtyard. This article is in response to Sustainable Development Goals number 4: Quality Education.

Three Philosophies of Person‐Centred Care, From the Perspectives of Care Workers and Managers Supporting Older People

ABSTRACTThe prominence of person‐centred care has been widely recognised in recent decades. In England, care governance frameworks prioritise the views and wishes of individual people receiving support. Despite workforce development initiatives linked to this agenda, there remains no consensus on the meaning of person‐centred care in the English care sector. An actor‐centred study explored understandings of person‐centred care from the perspective of care workers and managers working with older people in residential and community care. Analysis of interviews with 20 participants led to development of a typology based on the beliefs, values and practices of the interviewees. The three typological groups interpreted person‐centred care within their own distinctive philosophies: Nurturing Mental Health, Nurturing Agency and Nurturing Intimacy. The findings offer fresh insight into the ways an abstract concept is understood within the context of day‐to‐day practice with older people. Existing workforce development guidance encourages professionals to understand person‐centred care by enacting a series of wide‐ranging, desirable outcomes, which is potentially confusing for those working on the front line. This study shows, instead of trying to be all things to all people, staff emphasise a few specific outcomes and values in enacting person‐centred care, reflecting nuances in their overall understanding of older people's well‐being.

Service Access and Supportive Care Experiences among Urban and Rural Cancer Survivors: Informing Social Work Practice.

Access to medical and supportive care services is important for the health and quality of life of cancer survivors; however, services are not always available or accessible to all survivors equally. This study aims to explore the experiences of cancer services among cancer survivors in urban and rural settings to inform social work practice. Authors conducted interviews with 25 cancer survivors (colorectal, n = 13; hematological, n = 12) in the West of Ireland, using a narrative inquiry approach. Thematic analysis was used to analyze the data. Authors found variations in the availability of supportive care services for urban and rural cancer survivors. Often, services designed to maximize survivors' individualized choices and needs in community care were limited in rural communities, preventing some survivors from having their physical and psychological needs met. Additionally, access to services proved to be a barrier for rural cancer survivors. Rural survivors stated that traveling to appointments required time and planning, and the implications of travel costs were an increased burden. When rural survivors had good social support, access to services became less of an issue. The study confirms geographical disparities and recommends a review of supports that better meet survivors' needs and informs social work practice.

Application of Community Detection Methods to Identify Emergency General Surgery–Specific Regional Networks

There is growing interest in developing coordinated regional systems for nontraumatic surgical emergencies; however, our understanding of existing emergency general surgery (EGS) care communities is limited. To apply network analysis methods to delineate EGS care regions and compare the performance of this method with the Dartmouth Health Referral Regions (HRRs). This cross-sectional study was conducted using the 2019 California and New York state emergency department and inpatient databases. Eligible participants included all adult patients with a nonelective admission for common EGS conditions. Interhospital transfers (IHTs) were identified by transfer indicators or temporally adjacent hospitalizations at 2 different facilities. Data analysis was conducted from January to May 2024. Admission for primary EGS diagnosis. Regional EGS networks (RENs) were delineated by modularity optimization (MO), a community detection method, and compared with the plurality-based Dartmouth HRRs. Geographic boundaries were compared through visualization of patient flows and associated health care regions. Spatial accuracy of the 2 methods was compared using 6 common network analysis measures: localization index (LI), market share index (MSI), net patient flow, connectivity, compactness, and modularity. A total of 1 244 868 participants (median [IQR] age, 55 [37-70 years]; 776 725 male [62.40%]) were admitted with a primary EGS diagnosis. In New York, there were 405 493 EGS encounters with 3212 IHTs (0.79%), and 9 RENs were detected using MO compared with 10 Dartmouth HRRs. In California, there were 839 375 encounters with 10 037 IHTs (1.20%), and 14 RENs were detected compared with 24 HRRs. The greatest discrepancy between REN and HRR boundaries was in rural regions where one REN often encompassed multiple HRRs. The MO method was significantly better than HRRs in identifying care networks that accurately captured patients living within the geographic region as indicated by the LI and MSI for New York (mean [SD] LI, 0.86 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.16 [0.13] for REN vs 0.32 [0.21] for HRR) and California (mean [SD] LI, 0.83 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.19 [0.14] for REN vs 0.39 [0.43] for HRR). Nearly 27% of New York hospitals (37 of 139 hospitals [26.62%]) and 15% of California hospitals (48 of 336 hospitals [14.29%]) were reclassified into a different community with the MO method. Development of optimal health delivery systems for EGS patients will require knowledge of care patterns specific to this population. The findings of this cross-sectional study suggest that network science methods, such as MO, offer opportunities to identify empirical EGS care regions that outperform HRRs and can be applied in the development of coordinated regional systems of care.

The Use of Telehealth for People With Disabilities: A Systematic Literature Review and Narrative Synthesis.

To identify the use of telehealth for people with disabilities in community or primary care settings and to explore effective telehealth interventions for this group. Systematic literature review and narrative synthesis. The literature search was conducted in January 2024 using five electronic databases including PubMed, EMBASE, CINAHL, Cochrane library and PsycINFO. The review followed the Tawfik's guideline and adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for reporting. Out of 7363 retrieved articles, 1871 duplicates were removed, 5389 were excluded after title and abstract review, and 4 were excluded due to unavailable full text. One additional article was obtained through citation and hand searching. Thirteen studies were quality assessed using the Mixed Methods Appraisal Tool. Quantitative data were narratively synthesised. Thirteen quantitative studies were selected including three quasi-experimental studies and ten randomised controlled trials. The types of telehealth included telemonitoring, computerised intervention, virtual reality, telephone care, mHealth tools, decision support tools, digital storytelling and technology-assisted language interventions. The most common type of disability was intellectual disability, and the most common telehealth provider was the digital device itself. Most studies used surveys as the data collection method and the interventions were mostly conducted individually. Computer-based telehealth interventions demonstrated significant improvement in attention, health knowledge and psychological well-being. Telephone, virtual reality and tablet interventions also had positive impacts on body weight, motor coordination and pragmatic language skills. Telemonitoring was also beneficial. This systematic review examined the current state and effectiveness of telehealth interventions for people with disabilities. However, few intervention studies were found, and some studies were of poor quality. Continued interest and efforts from the government and researchers are needed targeting people with disabilities. Results provide valuable insights for healthcare providers, policymakers and researchers. They raise awareness about the potential of telehealth to address healthcare disparities and improve access to care for people with disabilities. No patient or public contribution: Systematic review.

MHealth Apps in the Digital Marketplace for Pediatric Patients With Cancer: Systematic Search and Analysis.

The substantial increase in smartphone ownership has led to a rise in mobile health (mHealth) app use. Developing tailored features through mHealth apps creates a pathway to address the health care needs of pediatric patients with cancer and their families who have complex care needs. However, few apps are designed specifically to integrate with pediatric cancer care. This study reports a systematic search and analysis of mHealth apps available on the Apple App (iOS) and Google Play (Android) stores designed for pediatric cancer through a list of features that serve (1) patients, (2) caregivers, or (3) both audiences. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed apps for pediatric patients with cancer and caregivers available as of January 30, 2024. We searched the Apple App and Google Play stores with a list of keyword combinations focusing on pediatric cancer care. The inclusion criteria were (1) specifically apps targeted toward pediatric patients with cancer, their families, or both; (2) available in either app store; and (3) available in English. Apps were assessed using the Mobile Application Rating Scale (MARS). The MARS is a quality assessment for mHealth apps, including components of engagement, functionality, aesthetics, and informational quality (5-point Likert scale items-1: low and 5: high quality). In total, 22 apps were identified and 17 of those apps were available on both platforms. The most popular features (n=12) were resource sharing, symptom tracking, reminders, care team connections, journaling, community support, medication tracking, data visualizations, and appointment tracking. Features and interfaces were designed for caregivers (n=9) more frequently than the patients (n=7) while a subset of apps created options for both users (n=6). A total of 16 apps received positive reviews (mean 4.4, SD 0.59; Min=3.1, Max=5.0). A small subset (n=3) achieved over 5000 downloads; however, the majority (n=15) had fewer than 500. More than half (n=12) of the apps were not available in English. Apps requested access to a range of device functionalities to operate (mean 2.72, SD 3.13; Min=0, Max=10). Out of 22, a total of 17 apps were publicly accessible. The mean MARS scores for the apps ranged from 1.71 (SD 0.75) to 4.33 (SD 0.82). Overall, apps scored high on functionality (mean 3.72, SD 0.54) but low on engagement (mean 3.02, SD 0.93). Our review highlights the promising yet underdeveloped potential of mHealth apps in pediatric oncology care, underscoring the need for more inclusive, comprehensive, and integrative digital health solutions. Future developments should actively involve key stakeholders from the pediatric oncology community, including patients, families, and health care professionals, to ensure the apps meet specific needs while addressing linguistic and cultural barriers.

Macronutrient and Micronutrient Intake Among US Women Aged 20 to 44 Years

Nutritional status before and during pregnancy is important for maternal health and fetal growth and development. To describe secular trends in nutrient intake from foods, beverages, and supplements among pregnant and nonpregnant women of reproductive age in the US. This was a secondary series of cross-sectional analyses of the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Pregnant (n = 1392) and nonpregnant (n = 9737) women aged 20 to 44 years who provided at least 1 reliable dietary recall were included for analysis. These analyses were performed between February 2022 and July 2024. The primary outcomes included the mean usual intake of macronutrients and micronutrients, as well as the prevalence of inadequate intake of micronutrients. This representative sample included 1392 pregnant women (mean [SE] age, 28.5 [0.3] years) and 9737 nonpregnant women (mean [SE] age, 32.2 [0.1] years). Among pregnant women, a weighted mean (SE) of 27.0% (1.8%) of women were in their first trimester, and 33.8% (2.2%) were in their second trimester. Mean (SE) carbohydrate intake decreased between 1999-2000 and 2013-2018 among pregnant women (306.9 [7.6] to 274.9 [5.7] g/d; β = -2.1 [0.4]; P < .001) and between 1999-2000 and 2017-2018 among nonpregnant women (251.9 [4.9] to 216.9 [3.3] g/d; β = -1.9 [0.4]; P = .002). Between 1999-2000 and 2013-2018, the proportion of pregnant women who consumed below the Estimated Average Requirement of vitamin A increased by 10.9 percentage points (pp) (95% CI, 5.2-16.7 pp), and the proportion of pregnant women who consumed below the Estimated Average Requirement of vitamin C increased by 8.9 pp (95% CI, 3.9-14.0 pp). Similarly, the proportion of nonpregnant women with inadequate intake of vitamin A, vitamin C, and iron increased by 19.9 pp (95% CI, 12.3-27.5 pp), 11.1 pp (95% CI, 4.5-17.7 pp), and 4.9 pp (95% CI, 1.7-8.2 pp), respectively, between 1999-2000 and 2017-2018. The mean (SE) calcium intake increased from 1120.6 (41.4) to 1308.7 (49.0) mg/d for pregnant women (β = 11.7 [4.3]; P = .03) and from 849.5 (19.8) to 981.2 (27.9) mg/d for nonpregnant women (β = 6.7 [2.6]; P = .03; β2 = -1.3 [0.2]; P < .001). Among pregnant women, the prevalence of inadequate intake decreased by 16.1 pp (95% CI, 8.3-23.9 pp) for magnesium (P < .001) and 33.2 pp (95% CI, 24.0-42.4 pp) for vitamin K (P < .001); among nonpregnant women, the proportion with inadequate intake decreased by 16.1 pp (95% CI, 10.4-21.7 pp) for calcium (P < .001), 15.5 pp (95% CI, 7.3-23.6 pp) for magnesium (P < .001), and 33.3 pp (23.5-43.0 pp) for vitamin K (P < .001). This cross-sectional study of pregnant and nonpregnant women of reproductive age found that vitamin A, vitamin C, and iron intake decreased over the past 2 decades, which may have substantial maternal and fetal health implications. By identifying these nutrient gaps and trends in inadequate intake in this at-risk population, scientific, health care, and regulatory communities may be better poised to adopt recommendations to improve nutrient intake.

Sarcopenia in general practice: Towards improving muscle health screening, assessment and management in Australia.

An estimated one in five Australians aged 60 years and older have sarcopenia, marked by progressive and accelerated loss in muscle mass, strength and function. Sarcopenia is associated with considerable healthcare costs and a myriad of adverse health outcomes, including increased risk of death. Despite its clinical importance, muscle health is often overlooked in routine clinical practice, hindering diagnosis and treatment. In July 2023, eight representatives from Australia's primary care and research communities convened to discuss barriers to sarcopenia screening, assessment and management within routine clinical practice. Solutions were proposed to improve the implementation of muscle health assessment and management in general practice. This article summarises the key discussions and outcomes from this meeting. Strategies to improve the implementation of muscle health assessment and management in general practice include (1) improving public awareness; (2) professional education; (3) provision of tools and resources; (4) advocacy and policy; and (5) increasing collaborative efforts between healthcare professionals, professional societies, universities, electronic medical record software vendors and the government.

Service delivery in postpandemic period for routine childhood immunization in Assam following capacity building with BRIDGE IPC Skill tool

ABSTRACT Background: For COVID-19 pandemic and associated factors, around 25 million children missed routine immunization in 2021. NFHS-5 for Assam reported 67% coverage with routine immunization in 2019–21 which is below national average (77%) and lowest among Indian States/UTs. Lack of knowledge and skill among provider can reduce coverage. To address vaccine hesitancy and demand generation for routine immunization, BRIDGE IPC Skills (Boosting Routine Immunization Demand Generation) training in routine immunization for frontline workers considered an effective tool. Objectives: To estimate the service delivery in postpandemic period for routine childhood immunization in Assam following capacity building with a BRIDGE IPC Skill tool. Materials and Methods: This cross-sectional comparative study was conducted among immunization service providers from April 2022 to March 2023, where training coverage of service providers on BRIDGE IPC Skill was assessed. Comparison was made between functionalities of trained services by service providers with untrained ones. Results: A total of 2312 session sites were visited, of which 67.7% of frontline workers were trained, while 32.3% were not trained. Alternate vaccine delivery was present in 58.5%. Updated due list was present in 64.1% vs 29.8% in trained and untrained sites. Significant association was found between delivery of key message and status of frontline worker on BRIDGE IPC Skill training. Conclusion: Capacity building of frontline workers on BRIDGE IPC Skill can boost efficiency of frontline workers and may facilitate in addressing gaps that EXIST between health care system and community.

Assessing variations in care delivered to rural out of hospital cardiac arrest patients in the interfacility transfer setting.

There is significant variation in out-of-hospital cardiac arrest (OHCA) outcomes between different regions. We sought to evaluate outcomes of OHCA patients in the interfacility transfer (IFT) setting, between critical care transport (LifeFlight) and community Emergency Medical Services (EMS), in the state of Maine. This was a retrospective analysis of our institution's electronic medical record and the Maine EMS database. Data were collected from January 1, 2019, to December 31, 2021. Only adult OHCA encounters requiring an IFT for definitive post-cardiac-arrest care were included. Demographics, EMS agency, IFT vital signs, targeted temperature management (TTM) medications, cerebral performance category (CPC) scores, survival to discharge, and other descriptive variables were collected. Ninety-three patients met inclusion criteria, with LifeFlight transferring 30 of them (32.3%). LifeFlight was more likely to initiate TTM compared to other EMS agencies (p=0.012), have run-sheets reported (p=0.001), and serve rural areas (p=0.036). LifeFlight was associated with more epinephrine (0.034) and norepinephrine (<0.001) use. Only 37% of IFTs had physician orders, with none (0.0%) of them defining vital sign targets. No difference in survival to discharge or CPC scores was observed between LifeFlight and other EMS agencies. No significant variation in comorbidities or vital signs was observed. There was no difference in survival to discharge or CPC scores between LifeFlight and ad hoc EMS agency. LifeFlight was associated with more TTM and vasopressor utilization during IFT. Most IFT encounters did not have dedicated physician orders, and none of the orders included vital sign targets.

Women's Health Care Delivery and Coordination After Transitioning From One Electronic Health Record to Another: Perspectives From Staff in the Veterans Health Administration

ObjectivesThe Veterans Health Administration (VA) is transitioning its 1,300 health care facilities from one electronic health record (EHR) to another. The transition aims to improve care delivery and interoperability; however, specific effects on women veterans, who comprise only 7.5% of the patient population, may be obscured without focused evaluation. We aimed to characterize the perspectives of VA staff regarding the impact of transitioning EHRs on women's health care delivery. MethodsWe conducted semistructured interviews with VA staff members involved in delivering or coordinating care for women at three sites that had transitioned EHRs within the past year. Interviews were audio-recorded and transcribed. We used a rapid, templated qualitative analytic approach to identify salient themes in the data. ResultsWe interviewed 16 staff members across VA departments and roles. Although some participants felt the new EHR held promise, most identified challenges with the EHR rollout and implementation (e.g., insufficient training) and the EHR product (e.g., system inefficiencies and latency). Participants highlighted several ways the EHR transition disproportionately affected care delivery for women veterans, including via backlogs of community care referrals, insufficient opportunities for providers to gain proficiency with sex-specific workflows in the new EHR, and outdated listings for veterans who have changed their names. Participants reported that these issues affected their morale and contributed to decreases in productivity and delayed care. ConclusionsMany of our findings reflect challenges that affect VA staff broadly, whereas others may be compounded among women veterans and the VA staff who serve them. To achieve the goal of delivering timely, equitable, high-quality, comprehensive health care services to women veterans, continued efforts to monitor and address the impacts of the EHR transition on this population are needed.

Inter-reader reliability and diagnostic accuracy of PI-RADS scoring between academic and community care networks: How wide is the gap?

ImportanceThe Prostate Imaging Reporting & Data System (PI-RADS) scoring guidelines were developed to address the substantial variation in interpretation and reporting of prostate cancer (PCa) multiparametric MRI (mpMRI) results, and subsequent updates have sought to further improve inter-reader reliability. Nonetheless, the variability of PI-RADS scoring in real-world settings may represent a continuing challenge to the widespread standardization of prostate mpMRI and limit its overall clinical benefit. ObjectiveTo assess variability in mpMRI interpretation and reporting of PCa, we evaluated the discrepancies in PI-RADS scoring between community practices and a tertiary academic care center. Design, setting, and participantsWe identified 262 mpMRI studies from nonacademic facilities, reinterpreted by radiologists at our institution between January 2016 and July 2022. Results of targeted MRI fusion biopsy were identified for 193 of these patients, totaling 302 lesions. PI-RADS scoring from both community and academic interpreters were recorded in addition to presence of clinically significant PCa (csPCa) on pathological analysis of targeted cores. Main Outcome and measuresThe primary outcome was inter-reader reliability via intraclass correlation (ICC) and the kappa statistic. We also assessed the diagnostic accuracy of PI-RADS scoring for detecting csPCa for both cohorts via receiver operator characteristics (ROC) analysis and compared these findings using paired-sample area difference under curve analysis. ResultsInter-reader agreement and reliability of PI-RADS scoring per lesion was generally poor (absolute agreement ICC = 0.393, 95% CI: 0.288–0.488; consistency ICC = 0.407, 95% CI: 0.308–0.497; kappa = 0.336, 95% CI: 0.267–0.406). Reliability results from studies obtained after the publication of PI-RADSv2.1 were similar to those of the overall analysis. No agreement was observed in the subgroup of lesions scored as PIRADS 3 by community interpreters. No statistically significant difference in diagnostic accuracy was observed between cohorts (ROC area under curve [AUC]: 0.759 vs. 0.785, respectively; P = 0.337). PI-RADS 3 was determined to be the optimal cutoff for detecting clinically significant disease in both cohorts. Conclusions and relevanceOur results suggest that mpMRI diagnostic accuracy for detecting csPCa is not significantly different between academic and community practices. However, significantly poor reliability of mpMRI was observed between cohorts, suggesting the risk of introducing practice variation for community prostate cancer management. Variability, particularly for PI-RADS 3 lesions, can lead to inconsistent biopsy recommendations, which may result in missed csPCa or unnecessary biopsies.