Current Health Care System Research Articles

Ocena innowacyjności i otwartości na zmiany wśród pielęgniarek, położnych oraz ratowników medycznych

IntroductionInnovativeness, which is associated with the continuous improvement of the current healthcare system, the implementation of new ideas, the introduction of new products and equipment in the medical environment, and the change that causes the modification of existing habits and procedures, affect the development of the healthcare system and improve the quality of patient care.AimThe aim of the study was to assess the innovativeness and the openness to change of nurses, midwives and paramedics.Material and methodsThe research was conducted from November 2023 to April 2024. The total number of people participating in the survey 123 respondents. The following methods were the survey technique was used, and the method of estimation, using rating scales.Results and discussionThe study shows that nurses, midwives and paramedics have similar values of levels of innovativeness and openness to change. Openness to change is at a high level, while innovativeness, according to the adopted key, is described as above average. In the case of nurses, age, seniority, education and the position held have an impact on the level of openness to change.ConclusionsThe level of innovativeness in this group of respondents is significantly influenced by education and position. The level of openness to changes of midwives is influenced by age, education and position, while their innovativeness is influenced by the place of residence, education and position. Paramedics have a level of openness to change and innovativeness at an equal level regardless of the parameters taken into account, only the position they hold makes a difference in results.

Resilient health reforms in times of permacrisis: the Greek citizens’ perspective

This study investigates Greek citizens’ attitudes toward the current healthcare system and their perspectives on healthcare reforms. Additionally, it explores the role of both endogenous and exogenous crises in accelerating the implementation of long-overdue structural reforms that might otherwise be challenging to achieve. To this end, the research examines the level of trust in institutions and the implementation of healthcare reforms following the fiscal crisis and during the COVID-19 pandemic. The findings reveal that while most Greek citizens recognize the necessity of structural reforms within the healthcare system, approximately half of the population views these changes negatively. The primary obstacles to successful reform are identified as a lack of political will and resistance from specific interest groups. The contradiction within Greek society concerning healthcare reform is largely driven by low levels of institutional trust and social capital. Although there is a clear need for radical reforms, public perception tends to be negative when these changes are framed within political discourse. However, when reforms align with the actual needs of society, citizens’ trust in institutions increases, thereby improving the likelihood of successful policy implementation. This underscores the critical role of institutional trust in facilitating significant healthcare policy transformations.

Semantic Segmentation Based on Geometric Calibration Using AI and AR in Health Care

In the medical field, medical imaging is essential for precise diagnosis, treatment planning, and condition monitoring. The goal of this work is to improve the field of healthcare imaging by investigating the complementary applications of augmented reality (AR) and artificial intelligence (AI) in semantic segmentation. More precise identification and delineation of anatomical structures and abnormalities in medical images is made possible by AI-driven semantic segmentation, opening the door to more precise diagnosis and treatment plans. Modern AI algorithms are employed in the suggested methodology to perform semantic segmentation in a variety of medical imaging modalities, including ultrasound, CT, and MRI scans. The detection of anomalies such as tumours, irregularities in organs, and neurological disorders is made easier by these algorithms. The foundation for integrating augmented reality technologies into the healthcare ecosystem is provided by the segmented medical images. AR enhances the interaction and visualization of segmented medical data in the context of healthcare. Real-time augmented reality overlays help surgeons by improving surgical navigation and precision. Additionally, AR apps help with medical education by offering professionals and students alike an immersive learning environment. AR provides interactive visualizations to help patients understand their medical conditions when they are going for therapy and rehabilitation. The difficulties in integrating these technologies in the healthcare industry are discussed in this paper, with a focus on the significance of data privacy, regulatory compliance, and easy integration with current healthcare systems. The successful deployment of AI technologies necessitates interdisciplinary collaboration among AI developers, healthcare professionals, and AR specialists to ensure compliance with ethical, legal, and clinical standards mandated in the healthcare domain. The proposed Segmentation mask is redefined with geometric calibration and used with U-Net for image segmentation. The segmentation is experimented on Cityscapes and PASCAL VOC 2012 datasets. The experimental results show that proposed semantic segmentation based on geometric calibration yields more accuracy than its counterparts.

Healing through tradition: the role of Indigenous Elder support in child and youth mental health in Canada

The current mental health care system in Canada, with its focus on western biomedical and individualistic approaches, does not support Indigenous holistic views of wellness and silences Indigenous knowledges through colonial ideologies. This research identifies the vital support that mental health services must include to create culturally relevant and safe services: Elders. Elders provide holistic approaches to mental wellness that consider cultural, individual, family, and community needs to promote healing. To explore the roles of Elders in mental health services, a comprehensive narrative review was conducted. All 22 included studies were conducted by Indigenous scholars or with Indigenous communities. Findings were organized into three themes: (a) Elders are knowledge keepers: sharing wisdom; (b) need for cultural-based teachings, ceremonies, and land-based healing led by Elders; and (c) Importance of relationships for increasing youth’s mental wellness. Barriers were identified that prevent Elder involvement, and recommendations for mental health programmes are provided.

Node Localization Based on Unsupervised Approach and Secure Routing for Healthcare Management in Delay‐Tolerant Network

ABSTRACTThe ability of the current global healthcare system to continue providing high‐quality medical care has been questioned. By using delay‐tolerant networks (DTNs) in healthcare management, people that spend a lot of time treating illnesses are exposed to more people while also putting their lives in danger. Unsupervised approach‐based node localization and secure routing in DTNs are developed in the proposed method. The proposed adaptive density‐based localization algorithm is constructed in two modules. The entire network is clustered depending on density utilizing density‐based spatial clustering of applications with noise (DBSCAN). An RSA‐based location estimation algorithm is employed to identify the unlocalized node within each cluster. After finding the location of each node, routing mechanism is carried out. An adaptive spray and wait routing strategy is utilized in the proposed method. When a node only has one copy of a message, the spray and wait, routing mechanism moves the relay node while it waits for the destination to be countered. Then modified DNA encryption algorithm is applied for secure data transmission. It is used for encrypting the information before storing it in the network. The trusted center will generate the private key needed for encrypting the data based on the sensitivity level of the information. This proposed algorithm is tested with several metrics which attain better performance, like 94% localization accuracy, 6% localization error, average residual energy of 93%, 5.7 Mbps throughput, 18% encryption time, and 14% decryption time. Thus, the techniques used in the proposed approach are the best choice for node localization, energy efficiency, and secure data transmission in DTN.

Metal-Responsive Fluorophore and Amikacin-Conjugated Heparin for Bacterial Cell Imaging and Antibacterial Applications.

The escalating prevalence of bacterial infections presents a formidable challenge to current global healthcare systems. Rapid identification and quantification of bacterial pathogens with anticipated sensitivity and selectivity are crucial for targeted therapeutic interventions to mitigate disease burden, drug resistance, and further transmission. Concurrently, there is a pressing need to innovate novel approaches to combat infections and counter antibiotic resistance. Herein, we demonstrated the development of heparin (HP) conjugates modified with a Zn2+-induced "turn-on" fluorophore, 2-(pyridin-2-yl)-1H-benzo[d]imidazole (PBI), that interacts with bacterial cells via specific binding with the surface-exposed heparin-binding proteins (HPBs), thereby inducing fluorescence signals for rapid and selective sensing of whole bacterial cells. Additionally, amikacin (Amk) antibiotic was integrated into the modified heparin polymer (HP-PBI-Amk) to augment its antibacterial efficacy via reactive oxygen species generation. Despite the nephrotoxicity of only amikacin, its inclusion in the biopolymer retains its antibacterial properties while providing biocompatibility. The outcome of this study demonstrates the development of HP-PBI and HP-PBI-Amk as promising strategies for bacterial detection and eradication, respectively, offering potential avenues for future research and clinical applications.

Biochemistry and Future Perspectives of Antibiotic Resistance: An Eye on Active Natural Products.

Antibiotic resistance poses a serious threat to the current healthcare system, negatively impacting the effectiveness of many antimicrobial treatments. The situation is exacerbated by the widespread overuse and abuse of available antibiotics, accelerating the evolution of resistance. Thus, there is an urgent need for novel approaches to therapy to overcome established resistance mechanisms. Plants produce molecules capable of inhibiting bacterial growth in various ways, offering promising paths for the development of alternative antibiotic medicine. This review emphasizes the necessity of research efforts on plant-derived chemicals in the hopes of finding and creating novel drugs that can successfully target resistant bacterial populations. Investigating these natural chemicals allows us to improve our knowledge of novel antimicrobial pathways and also expands our antibacterial repertoire with novel molecules. Simultaneously, it is still necessary to utilize present antibiotics sparingly; prudent prescribing practices must be encouraged to extend the effectiveness of current medications. The combination of innovative drug research and responsible drug usage offers an integrated strategy for managing the antibiotic resistance challenge.

Heart Disease Diagnosis and Diet Recommendation System Using Ayurvedic Dosha Analysis

The current healthcare system often fails to account for individual health needs, leading to ineffective preventive measures and dietary guidance. Ayurvedic principles, which focus on the Dosha, offer a profound understanding of an individual's constitution, influencing their health, vulnerability to specific diseases, and ideal dietary choices. This paper explores the evolving intersection of ancient Ayurvedic wisdom and modern technology in the realm of disease diagnosis. Ayurveda, with its emphasis on personalized well-being, has long been a source of holistic health practices. In this context, the study delves into the intricate system of Ayurvedic Dosha analysis and its potential applications in contemporary healthcare. The research introduces an innovative way that seamlessly integrates traditional Ayurvedic pulse examination with state-of-the-art technology. By employing pulse sensors and advanced algorithms, the system not only identifies specific ailments but also classifies patients into Ayurvedic Prakriti types. Going beyond conventional diagnosis, this holistic approach extends to personalized recommendations, encompassing diet, lifestyle, Ayurvedic treatments, exercise, and daily routines. While addressing the challenges of harmonizing ancient principles with modern technology, the paper also presents the performance metrics of the model. The accuracy rates are as follows: Logistic Regression (LR) - 85.94%, Random Forest - 89.21%, Decision Tree - 99.70%, and k-Nearest Neighbors (KNN) - 86.43%. These metrics underscore the robustness of the system. In addition to outlining core concepts, methodologies, and model accuracies, the study explores current trends and recent developments in the field, offering readers a comprehensive understanding of Ayurvedic Dosha-based disease diagnosis. The research contributes to the broader discourse on healthcare by paving the way for early detection and individualized, holistic well-being for patients.

Factors Influencing Telehealth Adoption in Managing Healthcare in Saudi Arabia: A Systematic Review.

The utilization of telehealth as an effective means to provide quality services is steadily rising across different tiers of the health system. However, advancing telehealth utilization relies on the current healthcare systems' infrastructure, policies, cultural factors, and utilization requirements can influence the utilization of telehealth within Saudi Arabia's healthcare system. This study seeks to systematically review the literature related to examining the factors influencing telehealth adoption and identifying the barriers and determinants of the use of telehealth in Saudi's healthcare system. A systematic review methodology was utilized in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodology included an exploratory and narrative design, a dual-phase search strategy, eligibility criteria, and analysis. The Joanna Briggs Institute (JBI) tool was employed to assess the quality of the chosen papers. The search yielded 3197 articles to which eligibility criteria were applied. Thirteen articles were deemed eligible, screened, and utilized for comprehensive analysis in the present study. Numerous articles indicated that the utilization of telehealth has risen in Saudi Arabia, particularly during the COVID-19 pandemic. The investment strategies have aligned with the demand for telehealth systems. The primary challenges were resource limitations and the absence of cultural frameworks conducive to the utilization of telehealth in the country. Telehealth represents a major technological breakthrough in the healthcare industry. However, there are some drawbacks to its adoption. The limited availability of Telehealth technologies poses a significant challenge. Secondly, relying solely on privatization might not adequately address the issue at hand. Third, there is a lack of knowledge and awareness regarding its associated benefits among healthcare staff. The establishment of telemedicine and telehealth infrastructure necessitates significant financial investment, which serves as a major factor and obstacle to the widespread adoption of telehealth.

Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference.

The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.

Leveraging Flask API and Machine Learning to Forecast Multiple Diseases

The study described in this abstract used machine learning to predict several diseases, and it integrated the model into a Flask API. A user-friendly platform for disease prediction based on patient symptoms and medical history was the goal of the paper. A number of strategies were used to optimize the predictive performance once the machine learning model had been trained on a sizable dataset of patient records. The model was made accessible as a web service through the usage of the Flask API, enabling simple deployment and integration into current healthcare systems. The study's findings demonstrated that the model could accurately forecast diseases with a high degree of precision, and the Flask API gave healthcare professionals an easy way to use the model in real-world settings. The study underscores the significance of developing open and user-friendly platforms for healthcare applications and shows the potential of machine learning and online APIs in improving disease detection. Additionally, the study discovered that the model could correctly identify disorders even in the absence of conclusive diagnostic tests.

Examining Barriers to the Utilization of Malaria Control and Prevention Services in the South West Region, Cameroon

Purpose: The purpose of this study is to examine the barriers to the utilisation of malaria control and prevention services in the southwest region of Cameroon precisely in the Fako division. Cultural beliefs and practices significantly influence health-seeking behaviours in communities, even when faced with life-threatening diseases like malaria. Methodology: Qualitative data were collected through structured interviews to understand the preferred treatment methods for malaria, the rationale behind the disease's continuous prevalence within the community, and the low usage of prevention methods prescribed in the hospitals. The data were analysed using a thematic technique, and presented following the themes that were elicited during the in-depth interviews and focus group discussions. Findings: This study found that herbal medical practices are deeply rooted in the community's culture and need to be more quickly supplanted by modern medical practices. The study found that the resistance to malaria prevention methods was fueled by a lack of awareness about the importance of malaria prevention and control, contributing to the high malaria prevalence rate in the community. Also, the study found that the current healthcare system needs to be culturally sensitive, potentially leading to a lack of trust and confidence among community members. Additionally, financial constraints significantly impact the utilisation of preventive and treatment measures like mosquito nets, health centres, and community health workers. Unique Contribution to Theory, Practice and Policy: These findings aligned with the Health Belief Theory (HBT), which explains that individuals' beliefs and attitudes towards malaria prevention in these communities constitute a significant barrier to malaria eradication. Community members perceive malaria as a severe disease and believe they are at risk of contracting it, leading to action due to susceptibility. However, traditional remedies are preferred due to perceived barriers to mosquito nets, such as cost, lack of access, and perceived ineffectiveness of the mosquitoes’ nets. The study concluded that a culturally sensitive approach to malaria treatment and prevention, built on the community's beliefs and practices, can improve health outcomes. Therefore, organisations in charge of malaria prevention must adapt their approach to align better with the community's cultural values. The study further recommended that education and awareness campaigns about malaria prevention and control should be tailored to the community's cultural realities.

Enhancing Medical Information Security Through Blockchain Technology

Healthcare data management systems today face pressing challenges in maintaining data transparency, traceability, immutability, and security. Additionally, the centralized framework of many current healthcare systems raises concerns over potential catastrophic failures at single points. Blockchain technology stands out as a transformative solution, offering a decentralized and innovative approach with the potential to redefine healthcare data management. This paper investigates the transformative impact of blockchain in the realm of healthcare data management. It underscores how blockchain can drive revolutionary progress and substantial improvements in the sector. The paper examines the key features and benefits of blockchain, shedding light on the vast opportunities it opens up for healthcare. We provide an in-depth look at current projects and case studies, illustrating the practical application of blockchain in various healthcare contexts. Moreover, we address the significant research challenges hindering the full integration of blockchain into healthcare systems. The paper concludes by outlining future research directions that could further the advancement of blockchain in healthcare, paving the way for a new standard of excellence in data management.

Exploring the lack of continuity of care in older cancer patients under China's 'integrated health system' reform.

Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused. To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China. A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically. Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system. The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.

Toward a New Era of Smart and Secure Healthcare Information Exchange Systems: Combining Blockchain and Artificial Intelligence

Healthcare Information Exchange (HIE) is becoming a fundamental operation in current healthcare systems. In such systems, electronic health records (EHRs) are digitally stored inside each medical centers and, sometimes, are required to be shared between various healthcare facilities (HCFs). Indeed, sharing patient information is crucial and might be vulnerable to power outages, data misuse, privacy or security violations, and an audit trail. Hence, researchers have focused recently on cutting-edge technologies to develop secure HIE systems and ensure data privacy during transactions. Among such technologies, blockchain and artificial intelligence (AI) occupy a vital role in researchers’ focuses and efforts to detect risky transactions in HIE systems, thus enhancing their security and privacy. While the blockchain allows HCFs to link to each other without requiring a central authority, AI models offer an additional security layer when sharing patient data between HCFs. This paper presents a survey about HIE systems, and the aim is two-fold: we first present the architecture of HIE systems along with their challenges; then, we categorize and classify the current state-the-art-techniques that show the potential of using blockchain and AI technologies in such systems.

Managing End of Life Needs of Frail, Older Adults in the Community: The Role of a Hospital-Based Community Outreach Team

Abstract Background Our current healthcare systems are designed around periods of acute illness and are ill equipped to meet the needs of multimorbid and frail adults with worsening mobility, cognition and function. According to The Irish Longitudinal Study on Aging (TILDA), Ireland has a high proportion of hospital deaths, indicating inadequate community and home care supports. Recognizing patients who are likely to benefit from supportive and palliative approaches with a goal to die at home can be done using a combination of tools and based on advanced care planning discussions. Methods In 2021, our Department for Older Persons Services allocated a team consisting of a Registrar and Advanced Nurse Practitioner in Frailty to form an outreach service. Inpatients who appear nearing end of life who have expressed wishes to avoid further hospitalization and to die at home are identified during their admission. Home visits allow for a holistic assessment and family members are given the opportunity to ask questions. We provide education on end of life, trying to anticipate needs and often see patients and families through periods of deterioration until they stabilize again in a ‘new normal’ or begin the process of active dying. We communicate with Public Health Nurses, General Practitioners and the Community Palliative Care Team. Results Families and carers supporting loved ones who wish to avoid further hospitalization and die at home benefit from combined medical and nursing support & specialist expertise the team brings. Conclusion Addressing end of life for multimorbid patients living with severe frailty is a global challenge. Hospital admission is an ideal time to begin conversations regarding goals of care and initiate advanced care planning. The outreach team work together with hospital and community colleagues to the common goal of following patients’ wishes at end of life.

We Hope You're Listening: Qualitative Study of Advice Given by Individuals with Parkinson's Disease.

Patient-centered care for persons with Parkinson's disease (PwPD) is associated with positive outcomes, but is lacking in current healthcare systems. In this qualitative study, we solicited advice from PwPD to medical professionals, family members/friends, and newly-diagnosed PwPD. Through an online survey, 275 PwPD answered open-ended questions asking for their advice. Responses were analyzed using content analysis. Interrater reliability was 94.5%. Three qualitative themes were identified. First, participants advised enhancing care and communication, with healthcare professionals balancing clinical constraints with compassion, and family/friends balancing support with appreciating autonomy of PwPD. The second theme was empowering PwPD through increasing their knowledge of the disease and care options. The third reflected the importance of focusing on well-being and connection. The results highlight several gaps in meeting the needs of PwPD in healthcare settings and personal relationships, underscoring the importance of integrating their perspectives in shaping approaches to care.

Out-of-pocket fertility preservation expenses: data from a Japanese nationwide multicenter survey

BackgroundThe expenses related to fertility preservation or subsequent assisted reproductive treatments are significant for adolescents and young adult patients in Japan’s current healthcare system. With fertility preservation becoming more widespread in developed countries, it is expected that these costs will be covered by insurance or subsidies. It is critical for patients, healthcare providers, and the government to know the costs that patients will be responsible for. In Japan, the costs of fertility preservation and subsequent assisted reproductive technology are not covered by insurance, but patients can apply for subsidies from the local and central governments if certain conditions are met. Presently, the above-mentioned costs, as well as the amount paid by the patient, vary by facility. Therefore, it is essential to ensure patients’ continued access to necessary medical care despite the associated costs.MethodsIn this study, questionnaires were mailed to 186 certified fertility preservation facilities in Japan to assess patients who had undergone fertility preservation or assisted reproduction. The questionnaires were sent between October 27, 2023 and March 31, 2024, with 140 of the 186 facilities responding (response rate: 75.3%).ResultsOur findings show that approximately one-third of the costs was borne by the patients.ConclusionGiven these circumstances, sustainable pricing and insurance coverage are necessary for both patients and facilities.

Role of Wearable Health Devices in Public Health: Developing Flexible Electronics for Seamless and Continuous Health Monitoring

The strategy for personalized medicine is the incorporation of regular health check-ups and wearable health devices into public health campaigns. These innovations have the potential to reduce the burden on healthcare systems by enabling early detection, improved management of chronic conditions, and provision of real-time personal health data to individuals. To achieve this, problems related to the accuracy of devices used, security of data stored in these devices, compliance with usage requirements by consumers, and relations with the current healthcare system must be addressed. A solution to these barriers has been proposed as a Non-Invasive Flexible Sensors for Health Monitoring (N-IFS-HM) approach which involves making sensors that are lightweight, attractive looking, and provide accurate continuous health information without disturbing the users during their daily activities. Through detailed simulation studies conducted in different healthcare settings, this paper examine the dependability and effectiveness of N-IFS-HM implementation. Consequently, based on simulation results done on delicate sensors such as these, vital signs, activities and minimal discomforting healthcare products can be traced accurately. According to this finding, wearable digital technology with sophisticated flexible electronics can revolutionize how public health is assessed.

"What got you here, won't get you there": Students as leaders of the change we need.

Lack of access, system inequities, and inefficiencies plague our current healthcare system. With a challenge this complex, no one intervention is sufficient; all will be necessary. The primary care system needs a strong health workforce prepared in bold new ways. Students represent an important voice, given their role as future leaders of health education and healthcare. For students to lead, educators must leverage education paradigms that position current students as leaders of transformation. Yet, in current health education systems, students are often seen as passive recipients of knowledge and skill. Transformative education seeks to foster critical reflection (an ongoing process of questioning unhelpful assumptions and power relations) and informed action in students to enable them to challenge and change norms and change practices, structures, and society. This article highlights the value of transformative education in cultivating thoughtful change agents and provides one tangible example of a new education/practice model that puts this paradigm into action.