Health Care System Research Articles

Abstract 4123530: Disparities in Hypertension Treatment Intensification among Adults in a Large United States Healthcare System

Background: There are racial/ethnic and socioeconomic status (SES) disparities in hypertension control, even in populations with regular care. It is unclear if clinical inertia by clinicians contributes to these disparities. Objectives: To quantify racial/ethnic and SES disparities in treatment intensification (TI) among adults with hypertension. Methods: We performed a retrospective cohort study using electronic health records from Johns Hopkins primary care practices from January 2018 to December 2022. We included non-Hispanic Black (Black) and non-Hispanic White (White) adults with at least 2 elevated blood pressure readings (>=140/90 mm Hg) in the 12 months prior to the index primary care visit and a diagnosis of essential hypertension. We excluded patients with diagnoses of end-stage renal disease, liver disease, dementia, and metastatic solid tumor. Patients could contribute multiple index visits. We measured SES using the national Area Deprivation Index, which comprises 17 neighborhood-level SES indicators, and dichotomized the population into high and low median SES groups. We defined TI as a change in antihypertensive class or dose increase within 14 days of the index visit. We balanced covariates reflecting clinical need at the index visit (age, sex, blood pressure readings, cardiometabolic comorbidities, body mass index) and the index visit’s calendar time across racial/ethnic and SES groups using inverse probability weighting. We estimated annual race/ethnic and SES specific TI rates and risk difference measures of disparity with 95% confidence intervals (CI) using a clustered bootstrap. Results: The cohort included 25,287 patients (11,800 Black, 13,487 White) with 79,898 eligible visits. Black patients were more often younger, female, and residing in low SES areas compared to White patients. In 2018, TI rates for Black patients (37%, 95% CI: 36-38%) were slightly lower than rates for White patients (39%, 95% CI: 38-40%). In 2022, the disparity persisted, with the Black patients’ TI rate lower by 3% (95% CI: -5%, -1%). Similarly, low SES patients had lower TI rates than high SES patients by 2% to 3% over the study period. Conclusion: Black patients and those from low SES consistently had modestly lower rates of TI compared to White patients and those from high SES. It will be important to identify the drivers and clinical implications of these treatment disparities.

Analysis of Challenges and Opportunities for Improving the Health System in Afghanistan: Innovative Approaches and Sustainable Solutions

This research explores the challenges and opportunities for improving the health system in Afghanistan. The healthcare system is critical to any country's social and economic development. Equitable and comprehensive access to health and medical services is vital for public health and plays a critical role in improving quality of life, reducing poverty, and enhancing workforce productivity. Afghanistan, a country that has experienced decades of war, political instability, and economic crises, faces significant challenges in healthcare. The main objective is to identify the significant issues within the healthcare system and propose sustainable solutions to enhance the quality of health services. Using a mixed-method approach (qualitative and quantitative), data were collected through semi-structured interviews with experts and a review of credible scientific sources. The findings indicate that a lack of healthcare infrastructure, a shortage of specialized human resources, and management issues are among the primary challenges facing Afghanistan's healthcare system. Additionally, opportunities such as international support and utilizing modern technologies in healthcare have been identified. The study concludes that investment in infrastructure, human resource training, and strengthening international collaborations are essential to improve the healthcare situation in Afghanistan.

PROBLEMS OF THE ORGANIZATION OF THE STATE POLICY OF THE PROVISION OF MEDICAL SERVICES BY THE PRIMARY LINK OF MEDICAL AID IN UKRAINE

The article highlights key issues related to management at the level of primary health care in Ukraine. The focus is on aspects such as the growing role of primary care. Primary care is the foundation of the health care system, providing a patient's first contact with health services, prevention, diagnosis and treatment. It is especially important in the conditions of limited financial resources to continue the reforms of the medical industry in Ukraine. The article raises the issue of the availability of medical care: the relevance of management problems is due to uneven access to medical services in rural areas and remote regions. Improving the management of the medical field is necessary to overcome these difficulties. The article examines current problems in the field of primary medical care and ways to overcome them through the reform of state policy in the field of health care. The authors explore key challenges facing primary care, including insufficient funding, lack of qualified staff, uneven distribution of resources, and lack of effective governance mechanisms at various levels. Attention is paid to the issues of ensuring the availability of medical services, the quality of medical care and the implementation of new models of the organization of medical institutions. The article analyzes the reformative steps aimed at improving the functioning of the primary health care system, in particular, the introduction of family medicine and increasing the role of general practitioners. The role of state funding and the involvement of local communities in the management of medical institutions is considered separately. The conclusions emphasize the importance of improving the state's primary health care policy by strengthening financial support, infrastructure development, and improving the qualifications of medical workers to ensure a sustainable and effective health care system in Ukraine. The topic of economic challenges and management efficiency is interesting for analysis. Optimizing the use of financial resources requires their effective use, finding ways to increase the economic sustainability of healthcare institutions.

New colleague or gimmick hurdle? A user-centric scoping review of the barriers and facilitators of robots in hospitals.

Healthcare systems are confronted with a multitude of challenges, including the imperative to enhance accessibility, efficiency, cost-effectiveness, and the quality of healthcare delivery. These challenges are exacerbated by current healthcare personnel shortages, prospects of future shortfalls, insufficient recruitment efforts, increasing prevalence of chronic diseases, global viral concerns, and ageing populations. To address this escalating demand for healthcare services, healthcare systems are increasingly adopting robotic technology and artificial intelligence (AI), which promise to optimise costs, improve working conditions, and increase the quality of care. This article focuses on deepening our understanding of the barriers and facilitators associated with integrating robotic technologies in hospital environments. To this end, we conducted a scoping literature review to consolidate emerging themes pertaining to the experiences, viewpoints perspectives, and behaviours of hospital employees as professional users of robots in hospitals. Through screening 501 original research articles from Web-of-Science, we identified and reviewed in full-text 40 pertinent user-centric studies of the integration of robots into hospitals. Our review revealed and analysed 14 themes in-depth, of which we identified seven as barriers and seven as facilitators. Through a structuring of the barriers and facilitators, we reveal a notable misalignment between these barriers and facilitators: Finding that organisational aspects are at the core of most barriers, we suggest that future research should investigate the dynamics between hospital employees as professional users and the procedures and workflows of the hospitals as institutions, as well as the ambivalent role of anthropomorphisation of hospital robots, and emerging issues of privacy and confidentiality raised by increasingly communicative robots. Ultimately, this perspective on the integration of robots in hospitals transcends debates on the capabilities and limits of the robotic technology itself, shedding light on the complexity of integrating new technologies into hospital environments and contributing to an understanding of possible futures in healthcare innovation.

Cost minimization analysis of treatments for metastatic HER2-positive breast cancer in Peru: Fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injections.

The main objective of this study is to determine whether the employment of fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC; and Phesgo as brand name) to treat metastatic HER2-positive breast cancer patients would minimize costs compared to the traditional treatment of separate intravenous doses of pertuzumab and trastuzumab in Peru. To achieve this, we used EsSalud (the social security health insurance) data and assessed it through a mixed strategy, which consisted of a quantitative and a qualitative approach. The first one aimed to calculate the direct (non-drug consumables, drugs, and healthcare professionals) and indirect costs of both treatments to develop a comparison, whilst the second aimed to validate information and internalize the procedure in an EsSalud context. Overall, we found that the usage of PH FDC SC would be cost saving in EsSalud's context. Specifically, we found three main advantages. Firstly, PH FDC SC generates a savings of 62% in non-drug consumables, which helps alleviate the healthcare system budget constraint. Secondly, its adoption frees up 61 hours of treatment and observation time for a single patient per year, which in turn increases the attention capacity of the healthcare system in terms of nursing hours and chemotherapy couches. Thirdly, the reduction of clinic time supposes an advantage for the patient in the form of increased productivity and well-being. Hence, the adoption of this drug would improve the quality of life of patients while reducing costs and pressure on the healthcare system. This is aligned with the strategy of prioritizing the appropriate breast cancer treatment within the National Cancer Care Plan. In this regard, we also found that the savings produced from switching from the traditional intravenous treatment to the subcutaneous one would allow EsSalud to afford full annual costs of 2 additional treatments, but without increasing their budget. This would cover 7% of the gap of 29 patients who do not have access to full treatment.

Assessment of knowledge and attitude of healthcare professionals towards Mpox in a Nigerian hospital.

Mpox is a zoonotic viral disease that presents significant public health challenges. Despite the pivotal role of healthcare workers, research on their knowledge and attitudes towards mpox is limited. This study aimed to assess healthcare workers' knowledge, awareness and attitude regarding mpox as well as associated factors at Rivers State University Teaching Hospital in Nigeria. A descriptive cross-sectional study design was employed, utilizing a 34-item semi-structured questionnaire. Knowledge levels were categorized as good (> 70% score), fair (50-69%), or poor (< 50%), while attitudes were classified as positive (> 70% score), moderate (50-69%), or negative (< 50%). Statistical analyses included independent sample T-test, One-way Analysis of Variance, and Chi-square tests. Among a total of 227 healthcare professionals, majority were females (59%) and singles (54.2%). Over 79% correctly identified mpox as a viral infection, while 59.9% recognized its potential transmission through a monkey bite. Overall, 22.5% demonstrated good knowledge. Majority (61.7%) acknowledged the potential of mpox as a worldwide pandemic, with 89% agreeing it could strain affected countries' healthcare systems. Healthcare workers exhibited moderate to positive attitudes towards mpox. Gender (Males, (p = 0.003), age (> 40 years (p = 0.008), years of experience (6-10 years; (p < 0.001), professional qualification (physicians, (p = 0.002), and previous mpox training (p < 0.001) significantly influenced knowledge levels, but no significant associations were found between demographic variables and attitudes. The study revealed a high level of awareness but low to fair knowledge among most participants. Healthcare professionals also demonstrated moderate to positive attitudes towards mpox. Factors such as gender, age, years of experience, professional qualification, and previous training on mpox influenced knowledge levels, but did not influence attitude in the study participants highlighting the importance of targeted educational interventions.

Multilevel Facilitators and Barriers to Healthcare Organization and Delivery among Childhood Cancer Survivors.

Childhood cancer survivors (CCS) are at risk for medical and psychosocial late effects of their disease and its treatment and are recommended to receive annual follow-ups. Yet, rates of follow-up adherence are suboptimal and may be influenced by the organization and delivery of their healthcare. This research aimed to examine experts' perceptions of facilitators and barriers to healthcare organization and delivery to CCS. Thirty-one clinicians and administrators in a comprehensive cancer center's research consortium were interviewed about system-level factors that may promote or deter annual follow-ups among CCS. Interview transcripts were coded and inductively analyzed using a study-specific scheme. Three main themes were identified: (1) healthcare system influences (59%); (2) social determinants of health (25%); and (3) intra/interpersonal factors (16%). Prominent subthemes included age-related changes in the transition of healthcare responsibility that disrupt ongoing CCS care (28.1%), the breadth and quality of psychosocial support available to navigate CCS to follow-up (13.5%), and transportation challenges (24.6%; especially in low-resource areas). In contrast, community trust facilitated follow-up (17.3%). The system of healthcare was prominent in receipt of follow-up by CCS, and further influenced by social determinants of health and intra/interpersonal factors. Easing transitions of responsibility (from parents to CCS, and acute care to survivorship teams) may be beneficial, especially when social determinants of health obstacles are present. Psychosocial wrap-around care is essential, along with promoting staff awareness of obstacles that CCS encounter in low-resource communities.

PUBLIC ANTI-CRISIS MANAGEMENT AND COMMUNICATIONS WHEN PROVIDING EMERGENCY MEDICAL AID IN THE MEDICAL INDUSTRY OF UKRAINE

In this article, the authors focus on several key problems that arise in the process of management and communication in crisis situations related to the provision of emergency medical care. The article examines approaches to managing crisis situations in the sphere of health care of Ukraine in conditions of increased uncertainty and instability. The authors emphasize the importance of effective communication between medical institutions, government structures and the public to ensure prompt response to emergency situations. The article examines various aspects of public crisis management, including planning, organization of resources, and coordination of actions during the provision of emergency medical care. The article analyzes the tools of public management, which allow to minimize various consequences of incoherence of actions between state institutions and medical institutions. Special attention is paid to the importance of prompt decision-making and establishment of communication links between state bodies, medical workers and the population. The possibilities of applying international experience in the field of anti-crisis management and its adaptation to Ukrainian realities are also discussed. The conclusions of the article emphasize the need to reform the health care system in the direction of strengthening its resilience to crises, improving communication mechanisms, and implementing innovative management solutions to increase the effectiveness of providing emergency medical care in emergency situations. The article emphasizes the need for quick decision-making, building effective communication chains between medical staff, patients and other stakeholders. Special attention is paid to the challenges associated with the lack of resources, the limited capabilities of the health care system in the context of crises and the role of leadership in implementing changes. The article also offers recommendations for improving communication processes and management approaches that will contribute to increasing the effectiveness of medical care during emergency situations, particularly in wartime.

Factors associated with time to relapse in pulmonary tuberculosis patients using penalized Cox models.

Pulmonary tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs. Despite advances in treatment, TB remains a major public health challenge, particularly in developing countries. This retrospective cohort study aimed to identify factors that influence the time to relapse in patients with pulmonary tuberculosis. All smear-positive pulmonary tuberculosis patients (1548 patients) whose data were recorded in the tuberculosis registration system of Golestan University of Medical Sciences and Health Services from March 2014 to March 2019, and followed up until February 2021. To analyze the data, we applied LASSO, MCP, and SCAD penalized Cox models. Based on the AIC and BIC criteria, the MCP penalized model was better than the LASSO and SCAD penalized models. The variables of age at diagnosis (> 35 vs. 35, HR = 2.77), marital status (married vs. single, HR = 8.49), chronic renal failure (Yes vs. No, HR = 5.36), and pre-treatment smear test results (+ 1 vs. 1-9Basil, HR = 0.65 and + 2 vs. 1-9Basil, HR = 0.96) influenced time to relapse according to the MCP penalized Cox regression model. Health care systems should focus on identification of factors that influence time to relapse and developing interventions to reduce relapse rates.

Assessing the Quality of an Online Democratic Deliberation on COVID-19 Pandemic Triage Protocols for Access to Critical Care in an Extreme Pandemic Context: Mixed Methods Study.

Online democratic deliberation (ODD) may foster public engagement in new health strategies by providing opportunities for knowledge exchange between experts, policy makers, and the public. It can favor decision-making by generating new points of view and solutions to existing problems. Deliberation experts recommend gathering feedback from participants to optimize future implementation. However, this online modality has not been frequently evaluated. This study aims to (1) assess the quality of an ODD held in Quebec and Ontario, Canada, on the topic of COVID-19 triage protocols for access to critical care in an extreme pandemic context and (2) determine its transformative aspect according to the perceptions of participants. We conducted a simultaneous ODD in Quebec and Ontario on May 28 and June 4, 2022, with a diversified target audience not working in the health care system. We used a thematic analysis for the transcripts of the deliberation and the written comments of the participants related to the quality of the process. Participants responded to a postdeliberation questionnaire to assess the quality of the ODD and identify changes in their perspectives on COVID-19 pandemic triage protocols after the deliberation exercise. Descriptive statistics were used. An index was calculated to determine equality of participation. The ODD involved 47 diverse participants from the public (n=20, 43% from Quebec and n=27, 57% from Ontario). Five themes emerged: (1) process appreciation, (2) learning experience, (3) reflecting on the common good, (4) technological aspects, and (5) transformative aspects. A total of 46 participants responded to the questionnaire. Participants considered the quality of the ODD satisfactory in terms of process, information shared, reasoning, and videoconferencing. A total of 4 (80%) of 5 participants reported at least 1 change of perspective on some of the criteria and values discussed. Most participants reported that the online modality was accessible and user-friendly. We found low polarization when calculating equal participation. Improvements identified were measures to replace participants when unable to connect and optimization of time during discussions. Overall, the participants perceived the quality of ODD as satisfactory. Some participants self-reported a change of opinion after deliberation. The online modality may be an acceptable alternative for democratic deliberation but with some organizational adaptations.

ORGANIZATION OF METHODOLOGICAL PRINCIPLES OF THE STATE INNOVATION POLICY IN THE SPHERE OF INFORMATIZATION OF THE HEALTH PROTECTION SYSTEM OF UKRAINE

The article highlights the key issues related to the need to modernize the health care system, globalization and integration into international structures, health care reform. In Ukraine, the process of health care reform is underway, which involves increasing the efficiency of the medical services system, their availability and quality. Innovations can accelerate these processes, in particular through the introduction of digital technologies (e-health, telemedicine), automation of management of medical facilities, development of remote diagnosis and treatment. The state innovation policy will allow to more effectively prepare for similar challenges in the future through the development of new vaccines, diagnostic methods, monitoring systems and management of medical resources. Support from the state (for example, through preferential taxation) to the development of the private medical services sector will reduce the burden on the state budget. In addition, it contributes to the attraction of investments in this area. Therefore, the state innovation policy in the field of health care is a relevant tool for ensuring the sustainable development of the health care system of Ukraine, increasing its efficiency and competitiveness, which meets the modern challenges and needs of society. The authors analyze the key aspects of the state policy aimed at the informatization of medical institutions, in particular, the digitalization of medical services, the introduction of electronic medicine, the creation of unified information platforms and patient databases. The article examines the importance of developing a clear methodology for the implementation of innovative solutions, as well as the role of the state in creating favorable conditions for the informatization of the health care system. The authors also analyze the international experience and the possibilities of its adaptation for Ukrainian realities, emphasizing the need to establish effective cooperation between state bodies, medical institutions and technological companies. The article concludes about the importance of an integrated approach to the informatization of the health care sector in order to improve the quality of medical services and increase the efficiency of medical resource management.

"It is not the fault of the health care team - it is the way the system works": a mixed-methods quality improvement study of patients with advanced cancer and family members reveals challenges navigating a fragmented healthcare system and the administrative and financial burdens of care.

Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study's goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients' mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient's death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, "It is not the fault of the health care team - it is the way the system works." Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, "It seems like everything is like an isolated incident… there's no overall, big picture viewpoint." (2) Administrative burdens, "In the end I gave up [scheduling care] because I was tired of calling." (3) Financial burdens, "This oncologist wanted to put him on a drug…but it was $4000 a month." Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

Transforming Healthcare Through Effective Health Administration Practices: A Systematic Review

The role of effective health administration practices is crucial in transforming healthcare organizations by enhancing efficiency, improving patient outcomes, and promoting operational sustainability. This systematic review synthesizes the current body of knowledge on health administration practices that have demonstrated transformative impacts within healthcare settings. A comprehensive literature search across major databases, including PubMed, Scopus, and Google Scholar, was conducted, focusing on studies published in recent years. Key themes emerging from the review include workforce management, patient-centered care, digital health solutions, quality improvement methods, and financial management strategies. Findings suggest that effective health administration practices contribute significantly to optimizing healthcare delivery, reducing costs, and increasing patient satisfaction. However, challenges such as staff resistance and high implementation costs remain barriers to adopting these practices widely. This review highlights the need for continued research into long-term impacts, cost-effectiveness, and adaptability of these practices in diverse healthcare environments. The findings provide valuable insights for healthcare administrators and policymakers aiming to implement evidence-based strategies to foster continuous improvement and adaptability within healthcare systems.

INNV-17. SAME-DAY DISCHARGE AFTER LASER INTERSTITIAL THERMAL THERAPY: A PROSPECTIVE COHORT PILOT STUDY WITH A MATCHED CONTROL GROUP

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for intracranial pathologies, offering precision and control over tissue damage. With implementation of enhanced recovery after surgery (ERAS) protocols within neurosurgery, identifying patients amenable for same-day discharge (SDD) is an important step towards streamlining perioperative care following LITT, and correspondingly, we aim to summarize our initial experience. METHODS We conducted a prospective study at the University of Miami Hospital of 7 patients who underwent LITT for intracranial pathologies and were discharged on the same day of ablation (post-ablation day 0, PAD0). We then performed a retrospective case-control study against a historic matched PAD1 cohort comparing categorical and continuous variables for statistical significance. RESULTS The mean age of the PAD0 cohort was 55 years with 71% males. Preoperative neurological status and comorbidities did not differ significantly between the PAD0 and PAD1 cohorts for KPS (median [IQR]: 80 [80-90] vs. 90 [80-90], p=0.40), mFI-5 (median [IQR]: 1 [1.5] vs. 0 [1], p=0.54), and mFI-11 (median [IQR]: 1 [1.5] vs. 1 [1], p=0.52). PAD0 outcomes demonstrated no immediate complications, neurosurgical readmissions, or significant neurological deficits within 6 months post-procedure and were non-significantly different than PAD1 patients. No PAD0 patient experienced intracranial hemorrhage or vasogenic edema following LITT that necessitated further intervention. CONCLUSIONS Our study demonstrates the safety and feasibility of same-day discharge following LITT for intracranial pathologies in the appropriately selected patient. Through meticulous patient selection and optimized perioperative protocols, expedited recovery without compromising patient outcomes was achieved. This approach holds potential for substantial cost savings and resource optimization within healthcare systems. Further research and quality improvement initiatives are warranted to refine patient selection criteria and maximize the benefits of same-day discharge in LITT practice.

Patient-Centered Care Models in Primary Healthcare: A Systematic Review of Implementation and Outcomes

This systematic review evaluates the implementation and outcomes of patient-centered care (PCC) models in primary healthcare settings. Patient-centered care is a foundational approach in primary healthcare, emphasizing patient preferences, needs, and values to improve the quality of care and health outcomes. A comprehensive literature search was conducted across PubMed, Cochrane, and MEDLINE databases, focusing on studies that assessed the impact of PCC models such as the Patient-Centered Medical Home (PCMH) and shared decision-making. Forty studies met the inclusion criteria, covering a range of patient populations and healthcare settings. Findings indicate that PCC models enhance patient satisfaction, improve health outcomes, and increase patient engagement in care. Additionally, these models positively impact provider satisfaction and may reduce healthcare costs by lowering emergency visits and hospitalizations. However, challenges in implementation, including provider workload and resource needs, were commonly reported. This review underscores the effectiveness of PCC models in primary care and highlights the need for structured, resource-supported implementation strategies. Further research is recommended to optimize PCC approaches across diverse populations and healthcare systems.

INNV-23. UNDERSTANDING THE BURDEN OF MIDH1/2 DIFFUSE GLIOMA AND THE COMPLEXITY OF NAVIGATING THE PATIENT PATHWAY: INSIGHTS FROM PATIENTS AND CAREGIVERS

Abstract Diffuse gliomas with mutations in isocitrate dehydrogenase 1 or 2 (mIDH1/2) are characterized by a slow-progressing yet life-limiting disease predominantly in young people. We report interim findings from a qualitative study to describe the mIDH1/2 diffuse glioma patient pathway, experience of the disease, and treatment approaches. Patients, caregivers, and patient-association group (PAG) representatives undertook individual interviews, with patients also completing standardized exercises as pre-work. Materials were developed in collaboration with the International Brain Tumour Alliance. Patients were aged ≥12 years with mIDH1/2 glioma and last resection ≥6 months before enrollment, either undergoing active observation or receiving chemotherapy/radiotherapy. Caregivers were living with the patient. PAG representatives were active members of a brain tumor PAG. From November 2023 to March 2024, 30 patients (Australia: n=10; China: n=6; France, UK: n=5 each; Canada, Japan: n=2 each), two caregivers (China, Australia: n=1 each) and one PAG (UK) participated. Median age of patients was 41.5 years, with 17 astrocytoma and 13 oligodendroglioma diagnoses. Presentation symptoms, circumstances of diagnosis and treatment, access to care, and navigation in the healthcare system differed per patient and within countries. Surgical resection was perceived as a crucial stage, both feared and desired. A second opinion was more often sought for surgery than for subsequent treatment approaches. Patients undergoing chemotherapy/radiotherapy (n=17) or active observation (n=13) expressed substantial physical, socioeconomic, financial, and psychological burden. Patients receiving active observation experienced strong and ongoing anxiety, as the uncertainty of tumor recurrence took a toll on their emotional wellbeing in the long term. The experience of people living with mIDH1/2 diffuse glioma is heterogeneous regarding their pathway and complexity navigating the healthcare system, with a substantial psychological and socioeconomic impact. Improved education, as well as facilitating early navigation and prioritizing shared decision-making along the disease pathway, will better support people living with mIDH1/2 diffuse glioma.

Cord Blood Platelet Lysate-Loaded Thermo-Sensitive Hydrogels for Potential Treatment of Chronic Skin Wounds

Background/Objectives: Chronic skin wounds (CSWs) are a worldwide healthcare problem with relevant impacts on both patients and healthcare systems. In this context, innovative treatments are needed to improve tissue repair and patient recovery and quality of life. Cord blood platelet lysate (CB-PL) holds great promise in CSW treatment thanks to its high growth factors and signal molecule content. In this work, thermo-sensitive hydrogels based on an amphiphilic poly(ether urethane) (PEU) were developed as CB-PL carriers for CSW treatment. Methods: A Poloxamer 407®-based PEU was solubilized in aqueous medium (10 and 15% w/v) and added with CB-PL at a final concentration of 20% v/v. Hydrogels were characterized for their gelation potential, rheological properties, and swelling/dissolution behavior in a watery environment. CB-PL release was also tested, and the bioactivity of released CB-PL was evaluated through cell viability, proliferation, and migration assays. Results: PEU aqueous solutions with concentrations in the range 10–15% w/v exhibited quick (within a few minutes) sol-to-gel transition at around 30–37 °C and rheological properties modulated by the PEU concentration. Moreover, CB-PL loading within the gels did not affect the overall gel properties. Stability in aqueous media was dependent on the PEU concentration, and payload release was completed between 7 and 14 days depending on the polymer content. The CB-PL-loaded hydrogels also showed biocompatibility and released CB-PL induced keratinocyte migration and proliferation, with scratch wound recovery similar to the positive control (i.e., CB-PL alone). Conclusions: The developed hydrogels represent promising tools for CSW treatment, with tunable gelation properties and residence time and the ability to encapsulate and deliver active biomolecules with sustained and controlled kinetics.

The Role of Healthcare Workers in Modern Medicine: A Comprehensive Review of Challenges, Contributions, and Future Directions

Healthcare workers are essential to the functioning and sustainability of modern healthcare systems. This review explores the diverse roles, contributions, and challenges faced by healthcare professionals, including physicians, nurses, pharmacists, allied health professionals, and support staff. Each role contributes uniquely to patient care quality, system efficiency, and overall health outcomes. However, healthcare workers encounter numerous obstacles, including high workloads, resource shortages, mental health strain, and interdisciplinary coordination challenges. This review also highlights significant contributions that healthcare workers make toward enhancing patient safety, operational efficiency, and public trust. Through case studies and analysis, we examine strategies for supporting healthcare workers, including training, mental health resources, and improved resource allocation. Finally, we provide recommendations for future directions to bolster healthcare worker resilience and efficiency, ensuring that healthcare systems remain adaptable and capable of delivering quality care. This article emphasizes the need for holistic support systems to sustain a resilient and effective healthcare workforce.

Enhanced Recovery After Surgery (ERAS) Protocols: Advancements and Implementation Challenges

Enhanced Recovery After Surgery (ERAS) protocols are a set of evidence-based guidelines designed to improve surgical outcomes by optimizing perioperative care. This approach integrates multidisciplinary strategies to reduce postoperative complications, shorten hospital stays, and enhance overall patient recovery. This article provides a comprehensive review of the advancements in ERAS protocols, including multimodal analgesia, optimized fluid management, early mobilization, and postoperative care. It also addresses the implementation challenges faced by healthcare systems, such as variability in adherence, resource constraints, and the need for interdisciplinary collaboration. By examining current evidence and real-world applications, this article highlights the potential benefits and obstacles of ERAS protocols, offering insights for future improvements and wider adoption.

Status of the implementation of pharmacogenetics in clinical practice in Spain: from regional to national initiatives.

Pharmacogenetics (PGx) has the potential to improve patient care, allowing to transform medical interventions by providing personalized therapeutic strategies. Scientific evidence supports the use of PGx in clinical practice and international organizations are developing clinical guidelines to facilitate the utilization of PGx testing. However, clinical implementation of PGx is limited and unequal worldwide. This review summarizes regional and national Spanish initiatives to implement PGx in the clinical practice. Diverse strategies to implement PGx in healthcare are applied across countries or even in the different regions of a specific country. Such was the case of Spain, a European country with 17 Autonomous Regions and two Autonomous Cities, each one with capacity to manage their own healthcare systems. Nevertheless, during the past years, many initiatives and strategies have been launched in Spain to develop different aspects of PGx. Importantly, the National Healthcare System has approved a PGx testing catalogue. This review highlights the crucial work and efforts of scientific societies (like the Spanish Society of Pharmacogenetics and Pharmacogenomics), of experts in PGx, of healthcare providers and of governmental parties in the implementation of PGx to personalize patient therapy, focused in Spain.