Entire Journey Research Articles

Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT.

Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.

Design overview and usability of the codesigned My Surgical Pathway E-health tool for supporting patient self-managed surgical preparation and recovery

IntroductionSurgery plays a critical role in global health, often facing significant quality challenges such as high rates of postoperative complications, variability in patient outcomes, and inconsistencies in care pathways, due to the complex nature of the perioperative journey. The My Surgical Pathway (MSP) app is an e-health intervention designed to address these challenges by supporting self-management and integrated care throughout the entire perioperative journey. This study aims to describe the features and functions of MSP and report on the results of usability testing from both patients and healthcare workers. MethodsThis mixed-methods study evaluated the usability of the My Surgical Pathway (MSP) app using quantitative surveys, qualitative feedback, and observation data from patients and healthcare workers. Structured 2-hour user testing sessions included interaction with the MSP app, completion of the User Version of the Mobile Application Rating Scale (uMARS), and think-aloud activities. Data analysis combined quantitative and qualitative insights to identify usability issues and inform potential improvements. ResultsThe mixed-method user-testing evaluation of the co-designed e-health intervention revealed high overall app quality scores, with an average of 4.50 out of 5. All user-type interfaces received mean scores above the minimum acceptability threshold of 3.0, demonstrating the intervention's efficacy in supporting patient surgery journeys, enhancing healthcare worker coordination, and meeting diverse user needs. Notably, the highest individual item scores were for credibility of source (4.92) and interactivity (4.85), highlighting the application's reliability and engaging nature. ConclusionsThe study evaluated the 'My Surgical Pathway' (MSP) e-health intervention, co-designed with consumers and healthcare workers to support self-management of surgical care. Results indicate high user satisfaction, with an overall app quality score of 4.50 out of 5 on the uMARS tool. Users praised MSP's engagement, education, and responsiveness, highlighting its potential to improve patient experiences and clinician workflows. Recommendations for future research include expanding participant diversity and hospital settings, and employing longitudinal designs for a comprehensive evaluation.

Prospective assessment of AI-enabled cost savings, continuous support, and psychosocial enhancement (AI New Era Study).

e13615 Background: Cancer patients (pts) need extensive primary care across their treatment journey, yet the world's primary health systems struggle with patient volume and resource scarcity. This study aims to assess the effectiveness of Artificial Intelligence (AI) medical service model in primary care and clinical service pre-screening, as well as their potential impact on improving the quality of medical services and reducing medical costs. Methods: A total of 17,856 medical consultation inquiries from 7,522 pts with various types of cancer have been collected and categorized. The study employed a novel AI-driven medical service model (based on large language model), amalgamating clinical guidelines with a local oncology database, to prospectively field questions from 454 cancer-afflicted pts. Clinicians evaluated the accuracy and comprehensiveness of the responses to basic medical issues, while pts assessed the intelligibility and satisfaction. Results: Treatment-related inquiries constituted 34.44% (n = 6,149) of the total, with 81.53% of pts asking such questions. Basic medical issues were addressed in 65.56% (n = 11,707) of inquiries, raised by 59.78% of pts. Specific concerns within basic medical issues included test report explanations (20.45%), adverse reaction consultations (19.82%), and medication information requests (17.66%). In light of the prevalence of basic medical issues, the study prospectively explores the potential of AI technology to revolutionize medical models, driving the advent of a new era in healthcare research. As result, the AI model exhibited high performance across several metrics: accuracy (96.87 ± 10.29), comprehensiveness (97.40 ± 9.91), intelligibility (95.72 ± 12.62), and satisfaction (96.34 ± 11.03). Notably, the model demonstrated a proficiency in identifying queries necessitating physician expertise, with a 95.60% accuracy rate upon review. A survey of 50 outpatients indicated an enhancement in service speed (7.78%) and patient satisfaction (14.29%). This increase in satisfaction was primarily ascribed to pts' heightened sense of control and safety. When benchmarked against GPT-4, the AI model's overall performance was significantly superior (95.08 ± 10.05 vs 89.70 ± 12.85, p<0.01), particularly in domestic drug knowledge and gene report analysis. Conclusions: Largely fueled by the advanced capabilities of large language model, AI has the potential to profoundly reshape the entire patient care journey. Our AI medical service model efficiently meets key healthcare needs, addressing over half of clinical issues and cutting costs. It also guides pts to the right specialists for timely care. Early surveys indicate better primary care and improved doctor-patient relations. Further research is needed to understand AI's effects on fairness, access, and outcomes across varied demographic and socioeconomic strata.

Progressive Supranuclear palsy (PSP) disease progression, management, and healthcare resource utilization: a retrospective observational study in the US and Canada

BackgroundProgressive supranuclear palsy (PSP) is a rare neurodegenerative brain disease with rapid progression and currently limited treatment options. A comprehensive understanding of disease progression, management, and healthcare resource utilization is limited, and further research is challenging due to the small population of patients. To address these challenges in conducting PSP research, individuals with PSP were recruited using a multichannel approach tailored specifically to the PSP community. We performed a retrospective observational study using data abstracted from participant medical records collected from multiple patient care centers.ResultsSeventy-two individuals with PSP were eligible for inclusion. On average, 144 medical documents per participant were collected from an average of 2.9 healthcare centers per participant, with a mean study period of 7.9 years. Among participants with a date of symptom onset documented in the medical records, the median time for the onset of the first fall was 2.0 years (IQR 3.2) before diagnosis, the median onset of unsteady gait or gait impairment was 1.2 years (IQR 1.8) before diagnosis, and the median onset of mobility problems was 0.8 years (IQR 1.8) before diagnosis. The most widely utilized healthcare resources, with at least 85% of participants using each of these resources at some point during the disease course, were medications (100%), imaging (99%), assistive devices (90%), supportive care (86%), and surgeries and procedures (85%).ConclusionsThis retrospective study adds to the current understanding of PSP symptoms, comorbidities, and healthcare resource utilization (HRU) across the disease journey. By involving individuals with PSP and their caregivers or legally authorized representatives in the research process, this study was unique in its approach to participant recruitment and enabled individuals to participate in research without the need for travel. We collected medical documents from multiple healthcare centers, allowing for broad data collection covering the entire disease journey. This approach to the collection of real-world data may be used to generate valuable insights into many aspects of disease progression and management in PSP and many other rare diseases.

Evolution of Pathological Techniques for the Screening of Cervical Cancer: A Comprehensive Review.

The evolutionary journey of cervical cancer screening has been a major medical success story, considering the substantial role it has played in dwindling the disease burden. Through sustained collaborative efforts within the medical community, significant advances have been made from the humble yet path-breaking conventional Pap smear to the current automated screening systems and human papillomavirus(HPV) molecular testing. With the integration of artificial intelligence into screening techniques, we are currently at the precipice of circumventing the pitfalls of manual cytology readings and improving the efficiency of the screening systems by a significant margin. Despite the technological milestones traversed, the high logistics and operational cost, besides the technical know-how of operating the automated systems, can pose a major practical challenge in the widespread adoption of these advanced techniques in cervical cancer screening programs. This would suggest the need to adopt strategies that are tailored to the demands and needs of the different settings keeping their limitations in mind. This review aims to take the reader through the entire evolutionary journey of cervical cancer screening programs, highlight the individual merits and demerits of each technique, and discuss the recommendations from the major global guidelines.

The relationship between employee experience and employee engagement with the moderating role of positive affect in finance sector

Employee experience refers to the entire journey of an employee within an organization, encompassing interactions from pre-employment to post-employment. In order to gain and maintain a sustainable competitive edge, organizations should incorporate human-centered design and prioritize employee experience in their organizational reforms, taking into account employees' emotions, ambitions, and expectations. This study aims to provide a clearer and operationalized understanding of the employee experience concept and empirically examines its relationship with employee engagement, considering the moderating role of positive affect - a state of pleasant feelings and moods that people often experience in business life-. Data was collected from 1347 employees in the finance sector of Türkiye, revealing that employee experience consists of dimensions such as manager support and collaboration, organizational identification and development, and career-focused human resource (HR) practices. These dimensions are positively associated with employee engagement. The study also examines the moderating role of the employees'positive affect on the relationship between these constructs. Policy implications of the findings are discussed.

Transforming Rectal Cancer Detection: The Role of Emerging Technologies

Rectal cancer is a common and serious disease. Early diagnosis of rectal cancer can improve the effectiveness of treatment and the prognosis of the disease. Modern medical technology not only provides doctors with a series of methods to diagnose rectal cancer, but also brings more and more new means. This is a very exciting area of research, and many scientists and doctors are pushing the boundaries of knowledge and working to develop real, tangible inventions and techniques that can improve clinical outcomes for patients. We hope that by providing an indepth analysis of the current and potential future impact of these emerging technologies on rectal cancer detection, the article will serve to inform both the scientific community and the public about the revolutionary leaps forward that are being made in this area. These technologies, as well as the new diagnostic and therapeutic approaches that they facilitate, have the potential not only to greatly improve the management and outcome of rectal cancer, but also to substantially enhance the patient experience and indeed reshape the entire patient journey. The future directions and implications of these new technologies will also be explored, including their potential of changing the outcomes of rectal cancer, the ethical consideration in their implementation, as well as the challenges and barriers to their wide adoption.

"I'm not getting paid to give you a TED talk on how my trans body works". Experiences of hysterectomy gender affirming surgery: A qualitative study.

To explore the experiences of care surrounding hysterectomy as part of gender affirming surgery. An in-depth reflexive thematic analysis from accounts by 10 out of 12 people was undertaken. Experiences were then mapped to the surgery journey as a template for developing system responsiveness. No one person's experience of the procedure was affirmed across the entire surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. The physical care environment influenced the experience, for example, the waiting room was marginalizing (intimidating), with a gendered clinic name and toilets. Some participants took a female support person/partner so that "people looking would assume that I was there supporting her, not the other way around." Communication misalignments were evident around information provided/understood about fertility and ovarian preservation. Participants were also placed in the position of both receiving care and providing education: "I also shouldn't have to be going in there for treatment, and then being expected to educate the medical professional that's meant to be helping me… I'm not getting paid to give you a TED talk on how my trans body works." The experiences mapped across the surgery journey highlighted multiple levels of service provision development needed to foster inclusive practice, for example, from workforce education to healthcare policy. Healthcare for transgender people can be unsafe and inequitable. Increasing transgender health responsiveness across the surgery journey will facilitate better alignments in communication and uphold bodily autonomy, leading to safer and inclusive practice.

First mile and last mile analysis using users’ perceived quality of Jakarta Mass Rapid Transit (MRT Jakarta) North-South Corridor Phase 1

To address urban problems caused by high usage of private vehicles, it is important to understand how MRT Jakarta as a new public transportation mode in Jakarta, could support the mobility needs of its users not only within MRT stations but also throughout the entire journey from origin to destination. This study aims to analyze the socio-demographic characteristics of MRT Jakarta users, the first mile and last mile spatial mobility pattern, and the perceived quality of overall journey using MRT Jakarta. An online questionnaire was employed to collect data directly from MRT Jakarta users, encompassing socio-demographic information, spatial mobility patterns, and users’ evaluations on several influencing factors. The study concludes that improving the quality of the first mile segments can significantly improve the overall journey quality using MRT Jakarta.

PROPOSED METHOD FOR IMPLEMENTATION OF RAILROADS FOR FREIGHT TRANSPORTATION

Honduras is a country that lacks the development of rail transport for the mobilization of cargo within the territory, generating congestion on the roads and problems of merchandise since practically only road transport is available within the country. The country has a privileged geographic location due to its location in the heart of America, making it attractive for several entities to be part of a project to implement a 730 km freight train from the customs office in Puerto Cortes, making the entire journey in the Honduran territory and returning to its starting point. The objective of this work is to propose a graphical method to determine the route of a freight train in Honduras. This method is based on identifying on a map protected zones, import/export zones, cargo ports and customs, determined by the number of containerized cargo passing through the country. As a result, a route for the freight train is obtained that prioritizes the areas with the highest container movement, avoiding the passage through the highways of some of the country's major cities. The main contribution is the proposal of a graphic and systematic methodology to evaluate the possible logistic transport routes that give continuity to this initiative.

Exploring Reading Motivation of Undergraduate Level Students: A Narrative Inquiry

Exploring Reading Motivation of Undergraduate Level Students: A Narrative Inquiry

Pelatihan Pengajaran Bahasa Inggris Dasar Menggunakan Metode TPR (Total Physical Response) sebagai Solusi Pembelajaran bagi Guru TK di KB/TK Nasrullah

Choosing the right English learning method for early childhood is very important. At an early age, children's development is in a concrete phase. Therefore, the learning process applied to early childhood education must be based on something real or tangible in accordance with the learning objectives, which is to convey basic concepts that have meaning through real experiences, in order to enhance the creativity, memory, and curiosity of the child. The Community Service Program (PKM) involves a series of structured stages. First, observation and survey of the location where the PKM activities will be carried out to ensure all necessary preparations. As a plan to fully implement this activity, it will be divided into two parts. First, a final evaluation will be conducted on the training that has taken place. The final step is to prepare a final report summarizing the entire program journey, including objectives, methods, findings, and recommendations for the future.

WeStore or AppStore: How Customers Shop Differently in Mobile Apps vs. Social Commerce

In the dynamic e-commerce environment, social commerce has emerged as a revolutionary force, transforming how consumers interact and transact online. This paper investigates the differences in customers’ search and purchase patterns between a prominent online retailer’s burgeoning social commerce channel, the WeChat mini-program, and its native mobile app. We analyze the customers’ entire journey through a sequential search model that encapsulates decisions from channel selection to product search, search termination, and the final purchase. This study contributes to the search model literature by being the first to estimate both fixed and marginal search costs in a sequential search model in an omnichannel retail environment. We calculate fixed search costs, marginal search costs, and preferences for each channel, revealing differences in customers’ behaviors across channels. Our analysis shows that customers’ fixed search costs are higher, but marginal costs are lower on WeChat channel compared to the App channel. Also, customer characteristics like historical spending levels and search timing influence their search costs. From these insights, we suggest strategies tailored to each channel capitalizing on the differences in customers’ search costs. The first strategy encourages search initiation by lowering fixed search costs through peer-to-peer link sharing in the WeChat channel. The second strategy aims to minimize marginal search costs using search-triggering coupons in the App channel. Implementing these strategies significantly boosts conversion rates and profits for the online retailer. This research is one of the first to explore the differences between traditional retail channels and emerging social commerce channels.

SignalP: The Evolution of a Web Server.

SignalP ( https://services.healthtech.dtu.dk/services/SignalP-6.0/ ) is a very popular prediction method for signal peptides, the intrinsic signals that make proteins secretory. The SignalP web server has existed since 1995 and is now in its sixth major version. In this historical account, we (three authors who have taken part in the entire journey plus the first author of the latest version) describe the differences between the versions and discuss the various decisions taken along the way.

Co-design of a digital solution for total hip and knee arthroplasty journey: A case study

End-users’ involvement is crucial to develop human-centered solutions; patient acceptance and endorsement by clinicians will be achieved when the features of digital solutions align with their needs and expectations. The aim of the study was to develop the overall concept of digital solution to increase transparency, foster patient adherence, and improve patient-provider communication across the entire total hip and knee arthroplasty journey from admission to discharge, and beyond. Two-stage iterative co-design process was used. Systematic literature reviews and qualitative interviews were conducted to understand the problem. In addition, co-creation sessions were used develop the solution for a reference implementation. As a result, a total of 19 technical and functional requirements were identified. In addition, ten additional functional requirements were identified for future design. The results demonstrate the overall concept of a digital solution for the reference implementation. The uniqueness of the solution lies in the vision of wider integrated systems, which could offer a clinical platform for clinicians to provide patient-focused care remotely, while monitoring patients’ progress closely.

Block Chain Technology: Emerging Trend in Manufacturing Industry

Block chain technology has emerged as a transformative force, disrupting traditional systems across industries. Block chain has interdisciplinary applications, making it relevant across fields such as finance, law, healthcare and logistics. Applying block chain to supply chain management not only enhances the efficiency of the process but also builds a foundation of trust among participants and consumers by providing a transparent and secure record of the product's entire journey

Mapping Food Losses in International Supply Chains: A Case Study of India’s Marine and Meat Exports

Food losses in international supply chains (ISCs) have garnered attention in global policy discussions due to their profound implications for global food security, livelihoods, and sustainable development. This study utilizes insights from knowledge informant interviews related to India’s two most exported food products to China and Vietnam. It comprehensively overviews the entire journey of these exportable and imported food products, from the export packing stage to final tradable point(s) of delivery while examining the nature, causes, and stages of food losses in ISCs. The study findings highlight that reducing food losses in marine and meat products requires various strategies, such as incentivizing reefer container manufacturing, facilitating capacity building and targeted training programs, and fostering public–private partnerships for trade infrastructure development, establishment of cold supply chains, and harmonization of rules, regulations, and standards through mutual recognition arrangements. Additionally, greater collaboration and synergy among stakeholders in ISCs are deemed crucial.

Tahmima’s Utopia in The Startup Wife: The Existential Feminism in a Male Tech World

Tahmima Anam's newest novel, The Startup Wife (2021), represents a debacle of a female utopia. Since the modern world humans live in nowadays is science-oriented and focused on technology, the novel deals with the significance of courtship and female entrepreneurship. Tahmima uses Asha Ray as the main female character in the novel. By analyzing certain instances from the novel that depict the entire journey of Asha Ray as a female scientist, the paper primarily focuses on the role of women in science. This young woman, with her natural programming abilities and self-assurance, comes up with an algorithm for a brand-new social media company that has the potential to transform an entire society for the better. It is critical to realize that before determining one's essence by existentialism, one must acknowledge his existence. The paper concludes that with her feminist fervor, Asha Ray is forced to recognize the importance of upholding what she views as hers. Having Asha Ray as a female in a male-dominated industry turns her into a subsided woman. The suffering of women in the startup world to be heard is at the heart of Asha's work. Women in a technologically male-dominated world can use Tahmima Anam's The Startup Wife as an example to examine existential feminism, which this paper aims to demonstrate and deliver to readers.

AHP P01 A Survey To Explore The Use Of Nutritional Outcome Measures In Clinical Practice By Dietitians In Oesophago-Gastric Cancer Care In The British Isles

Abstract Background Dietitians in clinical practice face the challenge of providing high quality care whilst demonstrating clinical effectiveness and continuous improvement. Assessing the effectiveness of dietetic intervention is vital in ensuring the provision of clinically effective dietetic services. Nutritional outcome measures are key in identifying the impact of dietetic interventions; enabling dietitians to objectively measure the effectiveness of their care as well as providing patients, other health care professionals and commissioners with data around the value of care provision. Currently there are no specific nutritional outcomes associated with oesophago-gastric cancer care in the UK. Methods A survey was disseminated through direct personal emails to 93 Dietitians known to be working in UGI, a list derived from NOGCA audit sites of 2021, with the aim of assessing the current use of nutritional outcome measures by Dietitians working in oesophago-gastric cancer acute care in the British Isles. Further promotion was directed through a UGI Dietitians Forum and through social media posts. A YouTube video was produced and distributed alongside the survey, with the aim of providing education around identifying nutritional outcomes. The video also aimed to connect personally with people, with a visual presentation from the researcher. Results 54 responses represented the entire patient journey. Whilst 72% of respondents reported identifying and documenting dietetic outcomes, the quality of these assessments was low, mainly focusing on weight, weight changes and hand grip strength. Other common themes related to nutritional intake, quality of life and symptom impact. Less common outcomes measured included standardised nutritional assessment (PG-SGA), gastro-intestinal symptom evaluation, optimised prehabilitation, biochemical parameters and patient experience. There was little standardisation in how outcomes are used and when they were taken. There is no national database available to collate OG nutritional outcome data, representing a missed opportunity to support national benchmarking. Conclusions This study has presented not only the inconsistencies in nutritional outcome data collection (definition, timing and tools) and the need for standardisation of outcomes use in this speciality, it has also demonstrated the challenges around the promotion of outcomes measures and application/roll out into clinical practice. Novel ways of obtaining and evaluating nutritional outcomes will need to be considered. This will form the basis of a further research study, exploring barriers to completion of nutritional outcomes.

Using Discrete-Event Simulation to Balance Staff Allocation and Patient Flow between Clinic and Surgery

We consider the problem of system-level balanced scheduling in a pediatric hospital setting. A hospital clinic has a queue for patients needing care. After being seen in clinic, many require follow-up surgery, for which they also wait in a queue. The rate-limiting factor is physician availability for both clinic visits and surgical cases. Although much existing work has been done to optimize clinic appointments, as well as to optimize surgical appointments, this novel approach models the entire patient journey at the system level, through both clinic and surgery, to optimize the total patient experience. A discrete-event simulation model of the system was built based on historic patient encounter data and validated. The system model was then optimized to determine the best allocation of physician resources across the system to minimize total patient wait time using machine learning. The results were then compared to baseline.