Health Care Entities Research Articles

The Evolution of Health Information Technology for Enhanced Patient-Centric Care in the United States: Data-Driven Descriptive Study.

Health information technology (health IT) has revolutionized health care in the United States through interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electronic patient access to health information. This study aims to examine progress in health IT adoption and its alignment with the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP's) mission to enhance health care through data access and exchange. This study leverages data on end users of health IT to capture trends in engagement in interoperable clinical care data exchange (ability to find, send, receive, and integrate information from outside organizations), e-prescribing, electronic public health reporting, and capabilities to enable patient access to electronic health information. Data were primarily sourced from the American Hospital Association Annual Survey IT Supplement (2008 to 2023), Surescripts e-prescribing use data (2008 to 2023), the National Cancer Institute's Health Information National Trends Survey (2014 to 2022), and the National Center for Health Statistics' National Electronic Health Records Survey (2009 to 2023). Since 2009, there has been a 10-fold increase in electronic health record (EHR) use among hospitals and a 5-fold increase among physicians. This enabled the interoperable exchange of electronic health information, e- prescribing, electronic public health data exchange, and the means for patients and their caregivers to access crucial personal health information digitally. As of 2023, 70% of hospitals are interoperable, with many providers integrated within EHR systems. Nearly all pharmacies and 92% of prescribers possess e-prescribing capabilities, an 85%-point increase since 2008. In 2013, 40% of hospitals and one-third of physicians allowed patients to view their online medical records. Patient access has improved, with 97% of hospitals and 65% of physicians possessing EHRs that enable patients to access their online medical records. As of 2022, three-fourths of individuals report being offered access to patient portals, and over half (57%) report engaging with their health information through their patient portal. Electronic public health reporting has also seen an increase, with most hospitals and physicians actively engaged in key reporting types. Federal incentives have contributed to the widespread adoption of EHRs and broad digitization in health care, while efforts to promote interoperability have encouraged collaboration across health care entities. As a result, interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and patient access to health information have grown substantially over the past quarter century and have been shown to improve health care outcomes. However, interoperability hurdles, usability issues, data security concerns, and inequitable patient access persist. Addressing these issues will require collaborative efforts among stakeholders to promote data standardization, implement governance structures, and establish robust health information exchange networks.

Real-world insights into the management of hemophilia A in Italy: treatment patterns and healthcare resource utilization

PurposeThis real-world analysis described the Hemophilia A (HA) population in Italy, evaluating drug utilization and consumption of factor VIII (FVIII) products of patients under prophylaxis and on-demand therapy.MethodsFrom Jan-2017 to Jun-2022, male patients with HA were identified through prescriptions of FVIII products [extended half-life FVIII, standard half-life recombinant FVIII, and plasma-derived FVIII (EHL FVIII, SHL rFVIII, and pdFVIII, respectively)], or emicizumab or FVIII plus von Willebrand factor or HA-related hospitalization using administrative flows of Italian healthcare entities. Patients on treatment with FVIII products during 2021–2022 were stratified by treatment regimen (prophylaxis/on-demand). The mean annual consumption expressed in International Units (IU) of EHL FVIII and SHL FVIII in patients treated during 2021–2022 having at least 12-month follow-up were assessed.ResultsAmong included HA patients, 145 (39.5%) received EHL FVIII and 222 (60.5%) SHL FVIII. Of 165 patients on prophylaxis, 105 (64%) received an EHL FVIII and 60 (36%) an SHL FVIII. The mean annual consumption of FVIII was 336,700 IU (median 319,000 IU) for EHL FVIII and 440,267 IU (median 360,500 IU) for SHL FVIII. Specifically, for patients on EHL FVIII, the most common drugs were efmoroctocog alfa (N = 51) and damoctocog alfa pegol (N = 50), followed by turoctocog alfa pegol (N = 25) and rurioctocog alfa pegol (N = 19). Of 702 HA patients initially treated with FVIII products, 74 (10.5%) switched to emicizumab during follow-up.ConclusionThese findings revealed an extensive use of EHL FVIII products, suggesting growing efforts from clinicians to optimize prophylactic strategies and achieve better bleeding protection.

The role of standardized quality systems in the management of a healthcare provider

Review Article, Pol J Public Health, Vol. 134 (2024): 69-72 Daria Żuraw, Paulina Oleksa, Mateusz Sobczyk, Kacper Jasiński, Mikołaj Porzak, Alicja Sodolska, Monika Żybowska, Anna Rzewuska-Fijałkowska Student Scientific Association at the Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland DOI_disc_logo 10.12923/2083-4829/2024-0015 © 2024 Author(s). This is an open access article distributed under the Creative Commons Attribution-NonComercial-No Derivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) Abstract Since the 1940s, the healthcare sector in Poland has been in constant evolution and requires constant improvement in the quality of services provided and customer-patient satisfaction. To facilitate quality management, systems dedicated to healthcare entities have been developed over the years, and others have been adapted to medical facilities. These methods are based on efficient, planned, repeatable, documented procedures based on current medical knowledge. The key is to choose the right system, tailored to the way the entity operates. A quality management system defines: organizational structure, available resources, procedures and processes to be implemented, the way information and documents communicate and flow, and the responsibility for quality assurance care and compliance. Creating awareness and a pro-quality attitude in the field of medical services makes it possible to learn about instruments and solutions aimed directly at healthcare provider, as well as those that can be adapted and subsequently implemented. Keywords: ISO standards, accreditation standards, total quality management, adverse events, medical mistake, management.

Impact of an Education Module on the Knowledge and Attitudes of EM Physicians Towards Prescribing Buprenorphine/Naloxone for Opioid Use Disorder.

Opioid overdose continues to be a major cause of morbidity and mortality. Buprenorphine is an important treatment for patients with opioid-use disorder (OUD) and initiation in the emergency department (ED) has been shown to improve outcomes for these patients. Our objective was to assess the impact of a three-pronged education package on the knowledge and attitudes of emergency physicians towards using buprenorphine for treatment of OUD. Procedures/data/observations: We developed a three-pronged educational package including back- ground rationale for OUD treatment with buprenorphine, an evidence-based ED buprenorphine induction pathway and electronic medical record tools. This package was deployed to providers in an urban academic ED. A voluntary confidential pre-post survey was administered. Using a 6-point Likert Scale, participants were asked about their understanding, experience, and confidence with prescribing. A one-hour, three-pronged educational package changed the attitudes of emergency physicians towards buprenorphine treatment and demonstrated an increase in willingness and confidence to prescribe it for patients with OUD. Our findings suggest that healthcare entities that wish to boost buprenorphine prescribing can impact willingness and confidence to prescribe with a short education package.

Evaluation of Medical Waste Generated from Government Hospitals and Healthcare Centers in the City of Hodeidah, Yemen

In the present study, the current status of medical waste management in the city of Hodeidah was presented in terms of its definition, components, sources, and threats that may result from improper handling. This investi-gation aims to study the potential environmental and health impacts of existing medical waste produced by the government hospitals and healthcare entities in Hodeidah City, in addition to comparing the applied methods and procedures with the methods and procedures that are applied in developed countries. The research study was carried out from January 2022 until January 2023, and targeted ten government hospitals and healthcare institutions in Hodeidah City. It relied on descriptive and analytical scientific methods, which aim to describe and analyze medical solid waste generated from the selected institutions. The result of the study showed that the total quantities of waste produced in all studied government health facilities amounted to approximately 599,038 kg/year. The percentage of non-hazardous waste was about 67% against hazardous waste which was 33%. Hospitals that receive more patients and have more beds as well as a multiplicity of their specialties generate larger medical wastes. The present research investigation revealed that government hospitals and healthcare centers in the city of Al-Hodeidah have low levels of health and safety conditions. They do not meet the local and international standards and requirements in the Medical Waste Management Guides and Recommendations. The poor management situation of medical waste could expose Yemeni citizens to danger. The healthcare insti-tutions should be supervised and controlled and ensure management of medical waste following environmental regulations and laws.

A real-world analysis of adherence, biochemical outcomes, and healthcare costs in patients treated with rosuvastatin/ezetimibe as single-pill combination vs. free combination in Italy.

To compare medication adherence, lipid goal attainment, and healthcare costs between patients receiving a single-pill combination (SPC) vs. a free combination treatment (FCT) of rosuvastatin/ezetimibe (ROS/EZE) in Italy. Administrative databases of healthcare entities covering ∼7 million individuals were used to identify adults prescribed with ROS/EZE as SPC or FCT between January 2018 and June 2020. Adherence was calculated as the proportion of days covered (PDC) after cohort balancing by propensity score matching. Patients with available LDL cholesterol testing were assessed for the proportion of those who at baseline were above lipid targets recommended by ESC/EAS Guidelines for their cardiovascular risk category and reached the target during follow-up. Among 25 886 patients on SPC and 7309 on FCT, adherent patients were more represented in SPC than FCT cohort (56.8 vs. 44.5%, P < 0.001), and this difference remained significant (P < 0.001) after stratification by cardiovascular risk (very high, high, and other). The proportion of patients reaching LDL cholesterol target at 1 year follow-up was significantly (P < 0.001) higher in SPC vs. FCT cohort: 35.4 vs. 23.8% for very high cardiovascular risk, 46.9 vs. 23.1% for high risk and 71.6 vs. 49.5% for other risk. Total healthcare costs per patient at 1 year follow-up were lower in SPC vs. FCT users (2337€ vs. 1890€, P < 0.001). In both cohorts, costs were mainly driven by drug expenses and hospitalizations. This real-world analysis in dyslipidaemic patients found that treatment with ROS/EZE as SPC resulted in better adherence, higher chances of reaching lipid goals, and cost savings over FCT, in all cardiovascular risk categories.

The Effect of Antidepressants on Withdrawal in Patients with Alcohol Dependence: A Retrospective Study.

The use of electronic health records has expanded in the past decades, with healthcare entities storing terabytes of patient health data. In this study, we investigated how these databases can be utilized to generate clinically relevant information. We used the Office of Addiction Services and Supports Client Data Systems data merged with the NYS Medicaid Data Warehouse to study the relationship of certain antidepressants on alcohol withdrawal (AW) rates in patients with alcohol dependence (AD). We found that in patients with AD, bupropion was associated with a significantly reduced rate of AW compared to selective serotonin reuptake inhibitors (SSRIs). This may be due to the ability of bupropion to inhibit dopaminergic reuptake. This retrospective study provides the advantage of being faster and less expensive than randomized controlled trials (RCTs).

Follow-up in a point-of-care diabetic retinopathy program in Pittsburgh: a non-concurrent retrospective cohort study

BackgroundThe Point-of-Care Diabetic Retinopathy Examination Program (POCDREP) was initiated in 2015 at the University of Pittsburgh/UPMC in response to low diabetic retinopathy (DR) examination rates, a condition affecting a quarter of people with diabetes mellitus (PwDM) and leading to blindness. Early detection and treatment are critical with DR prevalence projected to triple by 2050. Approximately, half of PwDM in the U.S. undergo yearly examinations, and there are reported varying follow-up rates with eye care professionals, with limited data on the factors influencing these trends. POCDREP aimed to address screening and follow-up gap, partnering with diverse healthcare entities, including primary care sites, free clinics, and federally qualified health centers.MethodsA non-concurrent retrospective cohort study spanning 2015–2018 examined data using electronic health records of patients who underwent retinal imaging. Imaging was performed using 31 cameras across various settings, with results interpreted by ophthalmologists. Follow-up recommendations were made for cases with vision-threatening DR (VTDR), incidental findings, or indeterminate results. Factors influencing follow-up were analyzed, including demographic, clinical, and imaging-related variables. We assessed the findings at follow-up of patients with indeterminate results.ResultsOut of 7,733 examinations (6,242 patients), 32.25% were recommended for follow-up. Among these, 5.57% were classified as having VTDR, 14.34% had other ocular findings such as suspected glaucoma and age-related macular degeneration (AMD), and 12.13% were indeterminate. Of those recommended for follow-up, only 30.87% were assessed by eye care within six months. Older age, marriage, and severe DR were associated with higher odds of following up. Almost two thirds (64.35%) of the patients with indeterminate exams were found with a vision-threatening disease at follow-up.ConclusionThe six-month follow-up rate was found to be suboptimal. Influential factors for follow-up included age, marital status, and the severity of diabetic retinopathy (DR). While the program successfully identified a range of ocular conditions, screening initiatives must extend beyond mere disease detection. Ensuring patient follow-up is crucial to DR preventing programs mission. Recommended strategies to improve follow-up adherence include education, incentives, and personalized interventions. Additional research is necessary to pinpoint modifiable factors that impact adherence and to develop targeted interventions.

Role of Non-Residential Larval Habitats in Aedes Spatiotemporal Egg Production.

Aedes mosquitoes play a pivotal role as vectors of several arboviral diseases, presenting significant public health challenges worldwide. Their invasive success in tropical regions has raised substantial medical concerns. In Guatemala, Aedes mosquitoes are widely distributed and are the primary vectors of the dengue virus. Efforts to control and monitor Aedes populations have evolved over time, incorporating strategies such as spatial repellents, larvicides, genetic modifications, and targeted interventions. Previous research has shown the heterogeneous spatial-temporal distribution of these mosquitoes within each season, influenced by temperature variations and favorable environmental conditions for breeding. This study analyzed hot-spot patterns of spatiotemporal egg density in Santa Elena de la Cruz, Petén, Guatemala, from March to September 2022. The aim was to determine whether these patterns were influenced by non-residential larval habitats with plant cover that are not treated by healthcare entities, as well as the proximity between such habitats. Our findings include the collection and registration of over 16,000 Aedes eggs during the study period. Local analyses revealed hot-spot patterns in egg densities associated with non-residential larval habitats and their proximity. These insights highlight critical focal points where targeted interventions could be implemented more effectively, resulting in cost-efficient mosquito vector control.

Unpacking the dynamics of workplace innovation among nurses: The synergistic relationship between psychological ownership and high-performance work systems

ABSTRACT The study investigated the influence of high-performance work systems on the relationship between psychological ownership and workplace innovation among nurses in the health sector of Ghana. A sample of 327 nurses was selected using convenience sampling technique. The data obtained from self-reported questionnaires were evaluated using partial least squares structural equation modelling. The results indicate that psychological ownership and high-performance work systems positively influence workplace innovation, and high-performance work systems enhance the nexus between psychological ownership and workplace innovation. The findings suggest that the management of health care entities should focus on creating a workplace culture that cultivates psychological ownership among employees and implements high-performance work systems to foster workplace innovation.

Road to a National Health Information Network: US Trusted Exchange Framework and Common Agreement (TEFCA).

The Trusted Exchange Framework and Common Agreement (TEFCA) is a U.S. government initiative aimed at promoting the secure and interoperable exchange of electronic health information (EHI) across the healthcare ecosystem. In the U.S., TEFCA was established as part of the 21st Century Cures Act, signed into law in December 2016. Methods: A literature search using the PRISMA guidelines will be conducted through PubMed, CINAHL, Google Scholar, and Web of Science, for dates 2013-2024 will be conducted. Results will be demonstrated with a timeline, graphics, and written text on the key points of technical and operational standards for HIE, rules and expectations for data sharing under the Common Agreement, governance framework for implementation and enforcement principles, stakeholders and collaborators, and interoperability challenges. TEFCA seeks to improve patient care, reduce healthcare costs, and enhance overall healthcare quality by facilitating the seamless exchange of data between different healthcare entities. Sharing this information can contribute to nursing informatics practice and knowledge as the U.S. and other countries strive towards better interoperability in the race to improve patient care and outcomes using health information technology.

A robust multi-key authority system for privacy-preserving distribution and access control of healthcare data

Innovation in medical technology and communication has rapidly empowered the development of smart healthcare devices. This has led to privacy breaches, threats and vulnerabilities to sensitive patient data that result in unwanted or targeted advertising. Previous research has focused on protecting access to sensitive patient data from unauthorized entities, especially by defining roles of healthcare entities in the overall system with their access privileges. However, such efforts need to be further robust due to the involvement of a single key authority that may lead to a critical point of failure. In this paper, this vulnerability has been addressed by developing a novel approach to crucially increase the number of key authorities using homomorphic encryption. The proposed approach ensures genuine access to the verified entity by forming a subsystem of t key authorities from a total of n authorities (t<n). This creates rigorous challenge to a malicious attacker, obfuscating the selection and functioning of key access packets in a multi-key authority setup. The results of the proposed approach achieve medical data confidentiality, entity authentication, and strategic data sharing. The security of the proposed approach is assessed for different vulnerabilities of the overall system using a challenge–response game model. Moreover, the proposed approach is found to be better and secure as compared to existing schemes.

Job Satisfaction and Associated Factors Among Primary Healthcare Workers: A Cross-Sectional Study From Qassim Region, Saudi Arabia.

Background The healthcare sector is one of the most important sectors in any country. Any disruption in the productivity of the workforce majorly affects healthcare entities. Job satisfaction directly interferes with the individual's productivity. Hence, the job satisfaction of healthcare workers (HCWs) is a fundamental issue to discuss, investigate, and study to improve the outputs to their maximal levels, especiallyif limited studies are done in this regard. Methodology A descriptive, cross-sectional, facility-based study was conducted among 302 HCWs in 30 primary healthcare centers (PHCCs) in the Qassim region, Saudi Arabia, using a pretested, validated, electronically self-administered "Satisfaction of Employees in Health Care" (SEHC) questionnaire. Our sample included physicians, nurses, pharmacists, dental workers, and lab and radiology technicians. Data were analyzed using SPSS version 29 (IBM Corp., Armonk, NY). Results The mean score of the overall perception of job satisfaction in primary healthcare staff was 3.9 (±1.01) out of one to five scale questions. This implies a high satisfaction in 71.2% (n = 215) of the sample. Nurses expressed the highest satisfaction with their roles, comprising 26.5% (n = 80)who reported high satisfaction. Second in line were physicians, demonstrating high satisfaction levels with 14.2% (n = 43). The third place was for lab technicians, 4.6% (n = 14) of whom expressed high satisfaction. Many factors were found to be significantly statistically associated with job satisfaction, including gender (p = 0.015), age (p = 0.001), job rank (p = 0.027), number of patients seen per day (p = 0.002), type of primary healthcare duty (p = 0.042), and health workers' years of experience (p = 0.000). Conclusion The study revealed that HCWsat primary healthcare facilities in the Qassim region, Saudi Arabia, were highly satisfied with their jobs. Significant statistical relationships were found between job satisfaction and factors such as years of experience, type of duty in PHCCs, and number of attendees per day. To improve HCWs' job satisfaction, we recommend that they receive additional organizational support and response to feedback, a reduced workload achieved through increased staffing, and flexible work shifts. We also recommend investigating satisfaction in the private healthcare sector.

Building a research-focused academic practice partnership: A stepwise approach

The 20th century began a period of reform in nursing education and practice, with more nurses receiving advanced degrees and serving in key leadership roles throughout healthcare organizations. During this period, the transformation of the healthcare delivery system encouraged innovation and collaboration between academic nursing programs and other healthcare entities to develop partnerships based on a shared vision and goals. As a result, nurses are negotiating academic-practice partnership agreements and leading interprofessional teams to meet the needs of collaborating organizations. This article describes a stepwise approach to building a research-focused academic practice partnership, from a needs assessment to an evaluation of the partnership.

#1961 Cardiovascular-kidney-metabolic syndrome components and cardio-vascular disease mortality based on half-a-million Asian adults

Abstract Background and Aims The American Heart Association (AHA) has recently issued guidelines addressing the “Cardiovascular-Kidney-Metabolic (CKM) Syndrome” to mitigate cardiovascular diseases. In parallel, European healthcare entities have established the CaReMe (CArdioRenal and MEtabolic) Partnership, emphasizing interdisciplinary health concepts. This study aims to evaluate CKM prevalence and its associated components in a substantial Asian cohort, along with the risk of cardiovascular mortality. Method The investigation focused on a cohort of 565 940 participants aged 20 years and above enrolled in a health screening program in Taiwan spanning from 1994 to 2017. The study assessed cardiovascular disease (CVD) and cause-specific mortality related to CKM stages and its components—hypertension, diabetes, chronic kidney disease, metabolic syndrome, and hyperlipidemia. Multivariable Cox proportional hazards models were employed to calculate hazard ratios (HRs). Results In this cohort with more than half-a-million Asian adults, approximately 74.3% exhibit CKM syndrome, distributed as 28.1% in Stage 1, 38.9% in Stage 2, 4.9% in Stage 3, and 2.4% in Stage 4. Among individuals aged 50 and above, almost 90% had CKM. The CKM components—hypertension (20.5%), chronic kidney disease (CKD) (11.1%), hyperlipidemia (28.4%), metabolic syndrome (13.1%), and diabetes (5.5%)—display diverse prevalence rates. We identified 13,449 participants who had CVD mortality, and the median follow-up was 15 years. CKM predicts CVD mortality with a dose-response relationship: Hazard Ratios (HRs) for Stage 2 is 2.34 (95% confidence interval (CI): 2.06, 2.65); HR for Stage 3 is 2.69 (95% CI: 2.36, 3.07), and HR for Stage 4 is 4.70 (95% CI: 4.11, 5.39). Within CKM, 43.3% have two or more components, 20.4% have three or more, and 7.3% have four or more. In those aged 65 and above, 66.6% have two or more components, 37.9% have three or more, and 17.8% have four or more. Participants with two or more components exhibit a higher CVD mortality risk than those with a single CKM component. Conclusion The prevalence rates of CKM and its components vary, contributing to distinct risks of cardiovascular disease mortality. A clustering phenomenon exists among different components, where an increased number of clustered factors corresponds to a higher risk of cardiovascular disease mortality.

Aguhyper: a hyperledger-based electronic health record management framework

The increasing importance of healthcare records, particularly given the emergence of new diseases, emphasizes the need for secure electronic storage and dissemination. With these records dispersed across diverse healthcare entities, their physical maintenance proves to be excessively time-consuming. The prevalent management of electronic healthcare records (EHRs) presents inherent security vulnerabilities, including susceptibility to attacks and potential breaches orchestrated by malicious actors. To tackle these challenges, this article introduces AguHyper, a secure storage and sharing solution for EHRs built on a permissioned blockchain framework. AguHyper utilizes Hyperledger Fabric and the InterPlanetary Distributed File System (IPFS). Hyperledger Fabric establishes the blockchain network, while IPFS manages the off-chain storage of encrypted data, with hash values securely stored within the blockchain. Focusing on security, privacy, scalability, and data integrity, AguHyper’s decentralized architecture eliminates single points of failure and ensures transparency for all network participants. The study develops a prototype to address gaps identified in prior research, providing insights into blockchain technology applications in healthcare. Detailed analyses of system architecture, AguHyper’s implementation configurations, and performance assessments with diverse datasets are provided. The experimental setup incorporates CouchDB and the Raft consensus mechanism, enabling a thorough comparison of system performance against existing studies in terms of throughput and latency. This contributes significantly to a comprehensive evaluation of the proposed solution and offers a unique perspective on existing literature in the field.

Ambulatory Quality Improvement Despite COVID-19: Blueprint for a Successful System for Continuous Improvement.

In this article, we describe our experience developing and implementing a multipronged approach to improve performance across a strategic subset of quality measures within primary care. Detailed techniques include data visualization and analytics, process reengineering, team engagement, visual project management, continuous improvement methods and training, and incentives and recognition. We achieved positive change across 12 high priority measures which we deemed the "High Value Framework (HVF)" by fostering a collaborative, nonpunitive, problem-solving culture. We focused on measures that had the greatest potential for impact from a clinical, reimbursement, and reputational perspective. More importantly, we sustained gains despite the challenges posed by the COVID-19 pandemic, thereby demonstrating programmatic resilience and high process reliability. This systematic approach serves as a practical blueprint for other healthcare entities seeking to navigate the complexities of quality improvement in a dynamic environment. The model provides a strategic framework for prioritizing and standardizing quality measures, effectively engaging stakeholders, and managing organizational change. Our model emerged from a need to address real-world operational challenges, rather than as an academic or theoretical exercise, and was developed independently of existing literature on measure prioritization and standardization at the time of its inception.

Functioning of healthcare entities as learning organisations in Poland on the example of Podlaskie voivodeship

&#x0D; &#x0D; &#x0D; The article aims to present issues regarding learning organisations in the context of the functioning of healthcare entities as examples of such organisations in Poland. A literature review was conducted, and the research problem and two research questions were formulated for verification. The subject of the study is public healthcare entities functioning as learning organisations in Poland, using the example of the Podlaskie voivodeship. In order to gather literature for the article, the desk research method was used, using scientific databases: Google Scholar and ScienceDirect. The literature on the subject covers the years 2015–2023. Firstly, the literature was reviewed, defining a learning organisation. Next, methods and tools used in organisational learning were listed. Lastly, the validity of medical entities as learning organisations was discussed. The next part of the article presented therapeutic entities from Podlaskie voivodeship as learning organisations in 2016–2022. The general criteria of the “Learning Organization” Competition were presented, followed by a discussion on the awarded therapeutic entities. In the end, the limitations of the article were discussed, and conclusions and practical implications were formulated. It was emphasised that changing and responding to market trends is essential for modern health organisations to sustain themselves in a turbulent market. The ability to constantly improve knowledge and search for it is crucial here. Therefore, in healthcare entities such as learning organisations, constant access to knowledge, not strictly medical, is crucial for medical and administrative staff. Helpful in the pursuit of this knowledge accumulation are various methods and tools that support the organisational learning and experience process.&#x0D; &#x0D; &#x0D;

Bridging the gap: How investing in advanced practice nurses could transform emergency care in Africa.

This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa. APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce. Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN-specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost-effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce. Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce. The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes. APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care. The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long-term impact and establish best practices for its implementation in emergency care across Africa.

Implementation of the 2015 American Thyroid Association guideline changes across a health system: A quality improvement opportunity

BackgroundWith the release of the 2015 management guidelines, the American Thyroid Association narrowed the indications for postoperative radioactive iodine (RAI) in well-differentiated thyroid cancer. However, the adoption of new guidelines varies between healthcare entities. The goal of this study was to characterize the appropriateness of RAI use within our health system, before and after the 2015 guideline changes. MethodsIn this retrospective cohort study, we identified patients who were treated for well-differentiated thyroid cancer between 2011–2020. Patients were characterized as “undertreated,” “appropriately treated,” or “overtreated” with RAI. Variation in RAI use was assessed using interrupted time series and multivariable logistic regression analyses. ResultsAmong 6310 patients, the mean age was 50 ± 15 years, and 74% were female. There was an immediate drop in the likelihood of receiving RAI after the release of the 2015 guidelines (p = 0.016), and the likelihood of receiving RAI therapy continued to significantly decline over time (OR 0.83, p < 0.001). Despite this trend in the absolute rate of RAI use, there was a significant increase in overtreatment with RAI after the release of the 2015 guidelines (p < 0.001), indicating imperfect uptake of the new criteria. Two hospitals within the health system were identified as disproportionate contributors to overtreatment (Hospital 4: OR 6.50, p < 0.001; Hospital 6: OR 8.63, p < 0.001). ConclusionsWhile the use of postoperative RAI was largely appropriate across our health system, rates of guideline adherence differed between hospitals. Efforts to standardize treatment protocols systemwide may enable more rapid and consistent uptake of new management guidelines.