Evidence-based Decision-making Process Research Articles

Biofilm formation and antibiogram profile of bacteria from infected wounds in a general hospital in southern Ethiopia

Biofilm-producing bacteria associated with wound infections exhibit exceptional drug resistance, leading to an escalation in morbidity, worse clinical outcomes (including delay in the healing process), and an increase in health care cost, burdening the whole system. This study is an attempt to estimate the prevalence and the relationship between the biofilm-forming capacity and multi-drug resistance of wound bacterial isolates. The findings intended to help clinicians, healthcare providers and program planners and to formulate an evidence-based decision-making process, especially in resource-limited healthcare settings. This study was done to assess the prevalence of bacterial infections in wounds and the antibiogram and biofilm-forming capacity of those bacteria in patients with clinical signs and symptoms, attending a General Hospital in southern Ethiopia. A cross-sectional study was performed in Arba Minch General Hospital from June to November 2021. The study participants comprised 201 patients with clinically infected wounds. Demographic and clinical data were gathered via a structured questionnaire. Specimens from wounds were taken from each participant and inoculated onto a series of culture media, namely MacConkey agar, mannitol salt agar, and blood agar, and different species were identified using a number of biochemical tests. Antimicrobial susceptibility tests were performed by means of the Kirby-Bauer disc diffusion technique following the guidelines of the Clinical and Laboratory Standards Institute. A micro-titer plate method was employed to detect the extent of biofilm formation. Bivariable and multivariable logistic regression models were applied to analyse the association between dependent and independent variables, and P values ≤ 0.05 were considered as statistically significant. Data analyses were done with Statistical Package for the Social Sciences version 25. Out of the 201 clinically infected wounds, 165 were found culture-positive with an overall prevalence of 82% (95% CI: 75.9–86.9). In total, 188 bacteria were recovered; 53.1% of them were Gram-positive cocci. The often-isolated bacterial species were Staphylococcus aureus, 38.3% (n = 72), and Pseudomonas aeruginosa, 16.4% (n = 31). The Gram-positive isolates showed considerable resistance against penicillin, 70%, and somewhat strong resistance against tetracycline, 57.7%. Gram-negative isolates showed severe resistance to ampicillin, 80.68%. The overall multi-drug resistance (MDR) among isolates was 48.4%. Extended beta-lactamase (ESBL)-producing Gram-negatives and methicillin-resistant Staphylococcus aureus (MRSA) accounted for 49 and 41.67%, respectively; 62.2% of the isolates were biofilm formers and were correlated statistically with MDR, ESBL producers, and MRSA (P < 0.005). The extent of biofilm formation and the prevalence of MDR bacteria associated with infected wounds hint at a public health threat that needs immediate attention. Thus, a more balanced and comprehensive wound management approach and antimicrobial stewardship program are essential in the study setting.

Needs and opportunities for developing health and well-being profiles in Estonian local governments

Abstract The creation and implementation of health and wellbeing profile, an evidence-based framework for planning health promotion as holistic process, is the responsibility of public health practitioners, who tend work part-time and sometimes lack professional competences. The current study maps the level of awareness, attitudes, needs and possibilities of local government leaders and public health practitioners to develop and implement profiles effectively in Estonian local governments. Semi-structured interviews with leaders in local governments (10) and practitioners (9) were conducted in 2022-2023. Data was analysed using qualitative content analysis. Sample included representatives from all Estonian local governments (79 in total) and were categorized into subgroups based on local governments size, status of the profile, public health specialist employment, and educational background. Preliminary results indicate that leaders find as a supportive factors for enabling and encouraging profile compilation process for example: mandatory requirement; motivated implementors; well organized and effective workplan. Specialists find supportive factors to be cooperation on the national level, good communication practices and joint responsibility. Barriers for health promoters are the lack of time, motivation, financial resources, stakeholders understanding and meaningful action. The first qualitative study on these topics in Estonia highlight that creating a profile is supported by previous positive experience and have per contra an opposite negative effect to start the process. In general, the profile was considered necessary for helping identify problems and support decision-making processes for managing resources, however, assessment whether the profile should be obligatory is needed. In addition, there is a need for further support for the evidence-based decision-making process on the local level in health promotion by offering education and guidance from the national level. Key messages • Knowledge about the importance of public health, barriers and decision-making principles of local government leaders and specialists helps to develop interventions based on actual needs. • Continuously updated health and well-being profile ensures sustainability of health promotion action and is useful knowledge to policymakers, local government leaders and public health practitioners.

Exploring Inclusion, Diversity, Equity, and Accessibility in the Built Environment: A Case Study

Continuous changes in society and the need for sustainable development demand updates in designing better built environments to respond to the variety of user needs. Notwithstanding the growing interest of research and the introduction of guidelines and standards on inclusion, diversity, equity, and accessibility, there are still several limitations in effectively and efficiently embedding such principles for the design of buildings and neighborhoods. Previous research demonstrated the critical need for innovative tools and methods to support professionals in designing responsive, inclusive spaces for an extended range of users. This article reports the results of a pilot study using the new IDEA Audit Tool for assessing how inclusion, diversity, equity, and accessibility are perceived by building occupants in a specific facility. The analysis of significant data provided by this study shows the challenges and highlights the benefits of the tool, including fostering an evidence-based decision-making process, speeding up the prioritization of critical design improvements, demonstrated through a six-month trial with a London-based inclusive design firm. The research-driven outcomes showcase the huge potential that the tool offers to improve the company strategy while evolving towards more inclusive, accessible spaces that foster diversity and equity, and has the potential to be replicated in several fields of action to raise awareness and improve the application of IDEA principles in all phases of the design process.

Influence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy

BackgroundIn the information age of health care, nurses often face information overload, leading to negative emotions, e.g., anxiety that may impede the adoption of evidence-based practice and clinical decision-making process. Nurses with higher digital health literacy can effectively process and manage information. Despite this, no research has explored the relationship between information anxiety, digital health literacy, and core competency among nurses. Therefore, this study aims to investigate the mediating effects of digital health literacy on information anxiety and core competency among nurses.MethodsFrom July to October 2023, the data for this cross-sectional study were collected. The study surveyed a total of 608 nurses from three tertiary hospitals in Fujian Province, and the survey instruments included a sociodemographic information questionnaire, Chinese revision version of the Digital Health Literacy Instrument (CR-DHLI), Information Anxiety Scale (IAS), and Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and Pearson correlation analysis were conducted using SPSS 29.0, and the mediating effect of digital health literacy was examined using Mplus.ResultsThe mean score of nurses’ information anxiety, digital health literacy, and core competency was 3.03 ± 0.91, 2.46 ± 0.56, 2.72 ± 0.88, respectively. And the mediation model of information anxiety on core competency for nurses showed a good model fit index (χ²/df = 2.207, CFI = 0.985, TLI = 0.982, RMSEA = 0.045, SRMR = 0.035). Digital health literacy was positively correlated with nurses’ core competency but negatively correlated with information anxiety. The results of path analysis revealed that information anxiety had negative and significant direct effects on NCC (β = -0.119, P = 0.004) and DHL (β = -0.297, P < 0.001). DHL had a positive effect on NCC (β = 0.306, P < 0.001). Digital health literacy played a partial mediating role, accounting for 43.54% of the relationship between information anxiety and nurses’ core competency.ConclusionsInformation anxiety among nurses was at relatively high levels, which had a negative impact on the core competency of nurses. This issue requires attention from nursing managers. The mediating role of digital health literacy in the relationship between information anxiety and core competency among nurses has been established. Nursing managers should strengthen the evaluation of nurses’ DHL and devise effective support strategies to enhance DHL, thus improving the core competence of nurses in information age.

Prioritization of Vaccines for Introduction in the National Immunization Program in the Republic of Korea.

This study presents a framework for determining the prioritization of vaccine introduction in the National Immunization Program (NIP) of the Republic of Korea, with a focus on case examples assessed in 2021 and 2023. We describe the predefined criteria for evaluating the prioritization of vaccines in the NIP and the established process in the Republic of Korea. These criteria included disease characteristics, vaccine characteristics, rationality and efficiency of resource allocation, and the acceptance of immunization. The process of prioritizing NIP introduction involved several sequential steps: a demand survey, evidence collection, preliminary evaluation, priority evaluation, and decision making. In 2021 and 2023, 14 and 25 committee members participated in evaluating the prioritization of vaccines in the NIP, respectively. Overall, 13 and 19 NIP vaccine candidates were included in the 2021 and 2023 evaluations, respectively. Through the Delphi survey and consensus processes, the priority order was determined: vaccination against Rotavirus infection was the top priority in 2021, while Influenza 4v (for chronic disease patients) took precedence in 2023. This study demonstrates an evidence-based decision-making process within the healthcare field. The outlined approach may provide valuable guidance for policymakers in other countries seeking to prioritize the inclusion of new vaccines in their NIP.

Develop an Interactive Python Dashboard for Analyzing EZproxy Logs

This paper describes the development of an interactive dashboard in Python with EZproxy log data. Hopefully, this dashboard will help improve the evidence-based decision-making process in electronic resources management and explore the impact of library use.

Relationship between nursing informatics competencies and evidence-based decision-making use among nurse managers

Background In today’s changing health systems, it is imperative that nursing managers must be proficient in nursing informatics to make evidence-based decisions, which may ultimately lead to increased organizational effectiveness. The study aims to examine the relationship between nursing informatics competencies and evidence-based decision-making (EBDM) use among nursing managers. Study design A descriptive correlational design was used in this study. Sample The sample included a total of 97 nurse managers. Setting This study was conducted at a selected private hospital. Tools Three tools were used to collect the study data as follows: (a) the nurses manager’s personal and work-related data tool, (b) the Nursing Informatics Competency Assessment Tool, and (c) Evidence-Based Decision-Making Usage Questionnaire. Results The main findings indicated that more than one-fifth (21.6%) of the study sample were proficient in total informatics competencies. In addition, EBDM attitude and beliefs had the highest mean percentage (66.13%), EBDM skills had the lowest mean percentage (52.44%), and EBDM overall had a moderate level mean percentage (60.29%). A statistically significant strong positive correlation (r=0.628, P=0.00) between the overall informatics competencies and the overall EBDM process skills was found. Conclusion Nursing informatics competencies levels influence the study participants’ attitudes and abilities regarding the use of EBDM. Recommendations Incorporate the nursing informatics qualification in the job descriptions of all nurse management levels and provide an environment that supports and allows the use of an effective EBDM process.

Revascularization Modalities in Acute Coronary Syndrome: A Review of the Current State of Evidence.

Acute coronary syndrome (ACS) stands as a leading global cause of mortality, underscoring the importance of effective prevention, early diagnosis, and timely intervention. While medications offer benefits to many patients, revascularization procedures such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and emerging hybrid approaches remain pivotal for ACS management. This review delves into the 2018 ESC/EACTS guidelines alongside an analysis of existing literature to shed light on the spectrum of revascularization methods. While both CABG and PCI demonstrate promising outcomes, the optimal choice between the two hinges on a comprehensive assessment of individual patient factors, anatomical complexity guided by advanced imaging, comorbidities, and age. The determination of whether to pursue culprit or total revascularization, as well as immediate or staged revascularization, is contingent upon various factors, including age, disease complexity, and clinical outcomes. This evidence-based decision-making process is orchestrated by a multidisciplinary heart team grounded in ongoing clinical evaluation. The primary objective of this review is to provide valuable insights into revascularization strategies and scrutinize the congruence of current guidelines with recent advancements in the field.

Teaching in the "New Normal": Using an Evidence-Based Process to Determine Should It Stay or Should It Go (SISoSIG).

After pivoting to emergency remote instruction due to the COVID-19 pandemic, medical educators have added new techniques to their toolbox. As we welcome a "new normal," we may be able to teach even more effectively than we did before by adapting some of these techniques. This paper provides an evidence-based decision-making process for faculty to consider what should stay and what should go as they revise and enhance instruction from one semester to another. The SISoSIG process provides opportunities to reflect on lessons learned and discuss how to build on that learning to become even more effective practitioners.

The Global Need for Easy and Valid Assessment Tools for Orofacial Pain

The World Health Organization recently adopted a historic resolution (WHA74.5) on the urgent need for global oral health improvement. This resolution is particularly relevant in the perspective of the high prevalence of untreated oral diseases. However, one important aspect has been mentioned only in passing, namely that poor oral health often leads to orofacial pain, which is the most common reason for emergency dental visits worldwide. Therefore, an evidence-based decision-making process on oral health should include data related to orofacial pain complaints. To that end, the availability of reliable and valid assessment tools of orofacial pain and related treatment outcomes is essential. INfORM (International Network for Orofacial Pain and Related Disorders Methodology) of the International Association for Dental Research has been one of the driving forces behind the development and implementation of comprehensive sets of tools for such assessments. However, as a prerequisite for the desired global implementation, reliable and valid tools that are also brief, easy to translate, and culturally adaptable need to be further developed and tested. Some of the groundwork to facilitate this process has already been carried out. In addition, a working group within INfORM has developed a short clinical assessment tool for orofacial pain diagnostics that is near completion and will soon be ready for dissemination. Ultimately, reliable and valid orofacial pain assessment is a necessary step toward the development and implementation of appropriate “best buy” interventions that address this major driver of need for oral health care worldwide.

The Meta-Analytic Rain Cloud Plot: A New Approach to Visualizing Clearinghouse Data

As the body of scientific evidence about effective policies and practices grows, so does the need to effectively communicate that evidence to policy-makers and practitioners. Clearinghouses have emerged to facilitate the evidence-based decision-making process for education practitioners. While the results and methods for developing and analyzing the data in clearinghouses are based upon rigorous and scientific study, there has been little rigor or empirical effort to determine effective ways of presenting that evidence to practitioners. In this paper, we present a new visualization for clearinghouse data, called a Meta-Analytic Rain Cloud (MARC) Plot, designed based on evidence from the data visualization and statistical cognition literatures. We evaluate the efficacy of this visualization in a statistical cognition experiment and find that compared to three other visualizations used in practice, the MARC Plot is more effective in helping participants correctly interpret evidence (0.76, 0.43, and 0.43 standard deviation improvements respectively; each p < 0.05, corrected for multiple comparisons). To our knowledge, this is one of the first studies providing evidence regarding how to best present the type of information found in clearinghouses.

High-Cited Papers in Covid-19: A Scientometric Assessment of Global Literature Using Essential Science Indicators Database

<p style="text-align: justify;"><strong>Introduction:</strong> The rapid production of a large volume of literature during the last 2-3 phases of the Covid-19 disease outbreak created a substantial burden for clinicians and scientists. Therefore, this paper provides a bibliometric overview on the high-cited papers indexed in the ESI database in the field of Covid-19, during 2020-21, focusing on the research domain and keywords, main actors (countries, organizations and authors) and main sources of publications. <strong>Methods:</strong> The Essential Science Indicators (ESI) database is widely used to assess scientific outputs. ESI include highcited papers that have received enough citations to place them in the top 1% when compared to all other papers published in the same year in the same field. High-cited papers are defined as papers receiving 100 or more citations since their publication. Therefore, high-cited papers included in ESI database are of high-quality in each field and therefore used in this study. A bibliometric analysis based on 848 high-cited papers extracted from the Essential Science Indicators database was carried out to provide insights into performances and research characteristics of Covid-19 literature. Indicators were applied to evaluate the influence of the most productive journals, countries/territories, organizations and authors. Social network analysis was performed to evaluate and visualize the interaction among productive countries/territories, organizations, authors and keywords using VOSviewer software.<strong> Results:</strong> The results showed that the 848 high-cited papers received 244699 citations were from 9734 authors employed at 2607 organizations based in 101 countries/territories. The papers were published in 369 journals in the field. The top 5 core journals ranked based on: (i) total papers were New England Journal of Medicine (37), Science of the Total Environment (35), Science (28), The Lancet (21) and Nature (18) and (ii) total citations were New England Journal of Medicine (28173), Lancet (17128), JAMA-Journal of the American Medical Association (9603), International Journal of Antimicrobial Agents (5865) and Nature Medicine (5659). The top 5 organizations ranked on (i) total papers were Huazhong University of Science &amp; Technology (42), Harvard Medical School, USA (41), University of Oxford, U.K. (31), University of Cambridge, U.K. (25) and London Global University (UCL)(25) and (ii) total citations were Huazhong University of Science &amp; Technology, China (32563), University of Hong Kong (17868), Tsinghua University, China (15827), University of Oxford (13802) and Guanzhou Medical University, China (13155). The top 5 authors ranked on: (i) total papers were Y. Zhang (15), Y. Hu (14), L. Liu (14), J,. Wang (14) and Y. Liu (13) and (ii) total citations were Y. Liu (23285), J. Xiang (.20391), Y. Hu (18804) and Y. Zhang (16495). The top five countries ranked on : (I) total papers were USA (336), China (222), U.K. (153), Italy (90) and Germany (74) and (ii) total citations were China (114620), USA (88474), U.K. (46535), Italy (24546) and Germany (24028).Based on network map using VOSviewer, there were micro, meso and macro level collaborations based on common interests in a specific topic. Analysis of all keywords showed that the research was distributed into 6 clusters. <strong>Conclusion:</strong> Results obtained from this study can provide valuable information for researchers to better identify present and future hotspots in Covid-19-related fields. The most relevant literature on the Covid-19 pandemic will also provide information relevant to the evidence-based decision-making process and future studies are essential to gain precise knowledge on Covid-19 infection across various human organs and various sub-fields and sectors. <p style="text-align: justify;"><strong>Key words:</strong> Covid-19, High-Cited Papers, ESI, Global Papers, Bibliometrics, Scientometrics.

Using geographically weighted regression analysis to cluster under-nutrition and its predictors among under-five children in Ethiopia: Evidence from demographic and health survey.

Malnutrition among under-five children is a common public health problem and it is one of the main cause for the mortality of under-five children in developing countries, including Ethiopia. Therefore, lack of evidence about geographic heterogeneity and predictors of under-nutrition hinders for evidence-based decision-making process for the prevention and control programs of under-nutrition in Ethiopia. Thus, this study aimed to address this gap. The data were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2016. A total of 9,384 under-five children nested in 645 clusters were included with a stratified two-stage cluster sampling. ArcGIS version 10.5 software was used for global, local and ordinary least square analysis and mapping. The spatial autocorrelation (Global Moran's I) statistic was held in order to assess the pattern of wasting, stunting, and underweight whether it was dispersed, clustered, or randomly distributed. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of under-nutrition indicators through SaTScan version 9.6 software. Geographically weighted regression (GWR) version 4.0 software was used to model spatial relationships in the GWR analysis. Finally, a statistical decision was made at p-value<0.05 with 95%CI for ordinary least square analysis and geographically weighted regression. Childhood under-nutrition showed geographical variations at zonal levels in Ethiopia. Accordingly, Somali region (Afder, Gode, Korahe, Warder Zones), Afar region (Zone 2), Tigray region (Southern Zone), and Amhara region (Waghmira Zones) for wasting, Amhara region (West Gojam, Awi, South Gondar, and Waghmira Zones) for stunting and Amhara region (South Wollo, North Wollo, Awi, South Gondar, and Waghmira zones), Afar region (Zone 2), Tigray region (Eastern Zone, North Western Zone, Central Zone, Southern Zone, and Mekele Special Zones), and Benshangul region (Metekel and Assosa Zones) for underweight were detected as hot spot (high risk) regions. In GWR analysis, had unimproved toilet facility for stunting, wasting and underweight, father had primary education for stunting and wasting, father had secondary education for stunting and underweight, mothers age 35-49 years for wasting and underweight, having female children for stunting, having children eight and above for wasting, and mother had primary education for underweight were significant predictors at (p<0.001). Our study showed that the spatial distribution of under-nutrition was clustered and high-risk areas were identified in all forms of under-nutrition indicators. Predictors of under-nutrition were identified in all forms of under-nutrition indicators. Thus, geographic-based nutritional interventions mainly mobilizing additional resources could be held to reduce the burden of childhood under-nutrition in hot spot areas. In addition, improving sanitation and hygiene practice, improving the life style of the community, and promotion of parent education in the identified hot spot zones for under-nutrition should be more emphasized.

A bibliometric analysis of the dental scientific literature on COVID-19.

ObjectivesThe rapid production of a large volume of literature during the early phase of the COVID-19 outbreak created a substantial burden for clinicians and scientists. Therefore, this manuscript aims to identify and describe the scientific literature addressing COVID-19 from a dental research perspective, in terms of the manuscript origin, research domain, study type, and level of evidence (LoE).Materials and methodsData were retrieved from Web of Science, Scopus, and PubMed. A descriptive analysis of bibliographic data, collaboration network, and keyword co-occurrence analysis were performed. Articles were further classified according to the field of interest, main research question, type of study, and LoE.ResultsThe present study identified 296 dental scientific COVID-19 original papers, published in 89 journals, and co-authored by 1331 individuals affiliated with 429 institutions from 53 countries. Although 81.4% were single-country papers, extensive collaboration among the institutions of single countries (Italian, British, and Brazilian institutions) was observed. The main research areas were as follows: the potential use of saliva and other oral fluids as promising samples for COVID-19 testing, dental education, and guidelines for the prevention of COVID-19 transmission in dental practice. The majority of articles were narrative reviews, cross-sectional studies, and short communications. The overall LoE in the analyzed dental literature was low, with only two systematic reviews with the highest LoE I.ConclusionThe dental literature on the COVID-19 pandemic does not provide data relevant to the evidence-based decision-making process. Future studies with a high LoE are essential to gain precise knowledge on COVID-19 infection within the various fields of Dentistry.Clinical relevanceThe published dental literature on COVID-19 consists principally of articles with a low level of scientific evidence which do not provide sufficient reliable high-quality evidence that is essential for decision making in clinical dental practice.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00784-021-03916-6.

THE ROLE OF UNITARY COST DATA RECORDS FOR DECISION MAKING IN THE ROMANIAN HEALTH SYSTEM

At present, in Romania there is no unitary system for collecting cost data at the hospital level, so the policies in the field are not based entirely on valid and solid evidence. One of the current trends in health management is the use effectiveness and efficiency indicators in the evidence-based decision-making process. The variability of medical practice is one of the elements that lead to difficulties in the analysis of cost and outcome data. In order to stay at the basis for decisions, cost data must be uniformly collected and must use a unitary methodology and tools, so that their processing and aggregation and analysis can be done without compromise and avoiding the induction of systematic errors and thus invalidity of data and results obtained from these data. A detailed knowledge of resources consumption patterns in hospitals is needed and this should be complemented with an in-depth cost analysis in order to be able to calculate standard costs and relative values ​​that allow a real and informed assessment of the level of consumption in hospitals. Keywords: cost data, hospital, health policy Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-ansi-language:EN-US; mso-fareast-language:EN-US;}

Focusing urban policies on health equity: the role of evidence in stakeholder engagement in an Italian urban setting

ABSTRACT Health equity in All Policies requires decision makers to face the health impact of their decisions and its distribution among different population groups. Since the evidence policy gap often prevents them from using the evidence provided by experts, appropriate mechanisms of governance are needed to overcome this barrier. In Turin (Italy, pop. 900,000) a community of experts, policymakers and stakeholders was engaged in a participatory evidence-based decision-making process to raise awareness and foster intersectoral actions to tackle social health inequalities. This health equity assessment of urban policymaking was based on the action-research model and moved through three steps: i) co-investigation into the mechanisms responsible for generating health inequalities, ii) co-decision of priorities, iii) co-creation and implementation of actions. The two-years process was continuously fed with new evidence from the Turin Longitudinal Study, linking health, resident and socioeconomic stories of individuals and families. Overall, the equity lens is an effective criterion to identify potential health gains as achievable targets for policymaking, a useful metric for comparative analysis of the impact of different policies and a mean to foster stakeholder’ to cooperate. The case-study shows that a systematic cooperative effort with stakeholders is needed to ensure effectiveness and participation in change and innovation.

Towards evidence-based integration of services for HIV, non-communicable diseases and substance use: insights from modelling.

Towards evidence-based integration of services for HIV, non-communicable diseases and substance use: insights from modelling.

Assessing Water Security in Water-Scarce Cities: Applying the Integrated Urban Water Security Index (IUWSI) in Madaba, Jordan

Water security is a major concern for water-scarce cities that face dynamic water challenges due to limited water supply, climate change and increasing water demand. Framing urban water security is challenging due to the complexity and uncertainties of the definitions and assessment frameworks concerning urban water security. Several studies have assessed water security by granting priority indicators equal weight without considering or adapting to the local conditions. This study develops a new urban water security assessment framework with application to the water-scarce city of Madaba, Jordan. The study applies the new assessment framework on the study area and measures urban water security using the integrated urban water security index (IUWSI) and the analytic hierarchy process (AHP) as a decision management tool to prioritise and distinguish indicators that affect the four dimensions of urban water security: drinking water, ecosystems, climate change and water-related hazards, and socioeconomic aspects (DECS). The integrated urban water security index (IUWSI) highlights the state of water security and intervention strategies in Madaba. The study reveals that urban water security in Madaba is satisfactory to meet basic needs, with shortcomings in some aspects of the DECS. However, Madaba faces poor security in terms of managing climate- and water-related risks. The IUWSI framework assists with a rational and evidence-based decision-making process, which is important for enhancing water resources management in water-scarce cities.

Histologic margins and the residual tumour classification scheme: Is it time to use a validated scheme in human oncology to standardise margin assessment in veterinary oncology?

There is no consensus on the definition of a complete histologic excision in veterinary oncology; many definitions have been used in various studies, but these have been arbitrarily selected with no apparent justification. The residual tumour classification scheme, where a complete histologic excision is defined as a histologic tumour-free margin >0 mm, has been used for >40 years in human oncology by all of the major clinical staging organizations and is considered highly prognostic for the vast majority of malignant tumours in people. Because of the widespread use of the residual tumour classification scheme both clinically and in research studies, this standardized approach permits better communication between clinicians, an evidence-based decision-making process for adjuvant treatment options following surgical resection, minimizes exposing patients to unnecessary adjuvant treatments and a better ability to compare local tumour control for specific tumours between different studies. The adoption of the residual tumour classification scheme in veterinary oncology would likely achieve similar outcomes and minimize the prevalent confusion within the veterinary community, amongst both general practitioners and specialists, regarding the definition of what constitutes a complete histologic excision.

Project profile: Study on global AGEing and adult health in China

With accelerating and rapid ageing in China, there is an urgent need to collect reliable, valid and cross-nationally comparable data on health in the elderly to provide basis for richer and empirical analysis on the changing health over one's life course and compression of morbidity. To meet the demands of this growing special population, planning and preparing on related social protection mechanisms (health and pension systems) should also based on evidence-based decision-making process. Based on long-term follow-up, large scale cohort study is indispensible for the etiology of common chronic diseases and disabling conditions. This study aims to introduce the background, project objectives, contents, baseline characteristics, strength and weakness as well as prospect, related to the Study on global AGEing and adult health in China.