Health Care System Research Articles

Innovative Regional Services and Heterogeneous Communication Channels: Results from the Nationwide German egePan Project for Pandemic Management

Background: In the COVID-19 pandemic, novel regional services and communication channels emerged across all sectors of the German healthcare system. To contribute to pandemic preparedness, this study aims to describe newly established services in response to the COVID-19 pandemic from a stakeholder perspective and to examine the interprofessional communication channels, applying a nationwide cross-sectional approach. Methods: A nationwide sample of German healthcare stakeholders comprising general practitioners, associations of statutory health insurance physicians, hospital medical directors, local health departments, rescue coordination centres, medical directors of emergency services, outpatient nursing services, nursing homes, community care access centres, and hospital nursing managers was surveyed. A web-based questionnaire asked for their level of participation in newly implemented regional COVID-19 services and communication channels. Stakeholders’ level of recommendation was measured using the Net Promotor Score (NPS), a metric that assesses their satisfaction towards the services surveyed. Results: In total, 1312 healthcare stakeholders participated in the survey. Diagnostic centres (23.0–90.9%), COVID-19 wards in hospitals (40.5–92.1%), emergency medical vehicles designated solely for COVID-19 patients (16.5–68.4%), and crisis intervention teams (11.6–30.6%) exhibited the highest rates of engagement. The services receiving the highest recommendation for future use were COVID-19 focus practices (NPS: 33.4–43.7), COVID-19 wards in hospitals (NPS: 47.6–84.4), transportation of COVID-19 patients exclusively by predefined professional groups (NPS: 12.5–36.4), and newly implemented digitally supported nursing services (NPS: 58.3–100.0). Telephones emerged as the most frequently used communication channel (58.0–96.7%), while email was the primary digital channel (23.7–81.5%). Conclusions: During the COVID-19 pandemic, Germany experienced significant variation in the implementation of pandemic-related services across healthcare sectors, with stakeholders prioritising services built on existing healthcare structures. Developing a proactive digital infrastructure to connect healthcare professionals from different sectors is crucial for better future pandemic management.

Implementing Person-Centred Lean Six Sigma to Transform Dermatology Waiting Lists: A Case Study from a Major Teaching Hospital in Dublin, Ireland

The study site, a major teaching hospital in Dublin, Ireland, addressed significant challenges within its dermatology service through a comprehensive improvement initiative using a person-centred Lean Six Sigma methodology. Initially, the hospital’s dermatology department faced excessive outpatient waiting times, with 3736 patients awaiting appointments, and 1615 waiting over 12 months. The person-centred Lean Six Sigma approach, which combines Lean techniques to reduce non-value add and Six Sigma methods to eliminate variation through a person-centred lens, was applied to overhaul the referral, triage, and scheduling processes. Key interventions included standardising triage categories, centralising the triage process, and redistributing referrals equitably among consultants. A new centralised triage system was established, leading to a more efficient allocation of appointments and better management of urgent cases. Post-implementation data showed a 40% reduction in the overall waiting list and a 60% reduction in the number of patients waiting over 12 months. The initiative significantly decreased the wait times across all urgency categories, with the most notable improvements in soon and urgent referrals. These changes were also the impetus for a follow-up design-led innovation phase, where the team worked with partners across the educational and healthcare system to enable disruptive change. The success of this project provides a scalable model for improvements in similar healthcare settings.

Assessing the Fiscal Burden of Overweight and Obesity in Japan through Application of a Public Economic Framework

Introduction: Obesity continues to represent a significant public health concern, with a broad impact from both a health and economic perspective. Objective: This analysis assesses the fiscal consequences of overweight and obesity (OAO) in Japan by capturing obesity-attributable lost tax revenue and increased government transfers using a government perspective. Methods: The fiscal burden of OAO was estimated using an age-specific prevalence model, which tracked the Japanese population across different body mass index (BMI) categories. The model was populated with fiscal data for Japan, including employment activity and government spending, to calculate tax revenue and transfer costs. A targeted literature review was conducted to identify data estimating the impact of OAO on employment, income, sick leave, retirement, and mortality. These modifiers were applied to Japanese epidemiological and fiscal projections to calculate government tax revenue and spending. The incremental impact of reducing OAO in the general population was subsequently calculated. Results were estimated based on the 2023 Japanese working-age population aged 18 to 70 years. Results: The total fiscal burden of OAO in Japan, defined as BMI of at least 25, is estimated at US $13.41 billion (¥1925 billion), representing 0.4% of Japan’s gross domestic product. This consists of a loss of $6.3 billion (¥901 billion) and $1.2 billion (¥179 billion) in direct and indirect tax revenue, respectively, due to lower employment and income combined with higher sick leave. Excess OAO-attributable healthcare costs were $5.4 billion (¥769 billion), while additional pension payment spending of $0.5 billion (¥77 billion) was estimated, due to higher levels of early retirement. Conclusions: While the health implications of OAO are well documented, this fiscal analysis demonstrates the significant economic burden of OAO both to the healthcare system and broader government accounts. Policies aimed at reducing population-level obesity have the potential to benefit government accounts through increasing employment and reducing public spending, which can offset the cost of implementing these policies.

A novel light GBM framework combined with gain optimization for predicting dementia severity of Alzheimer’s disease

ABSTRACT Introduction Alzheimer’s disease (AD) is a severe brain disorder, which comprises almost 75% of all types of dementia cases. As per the latest report, the global count of Alzheimer’s disease patients is 131 million, due to which the treatment of Alzheimer’s disease is becoming a major burden to the world healthcare system. However, Alzheimer’s disease still remains incurable due to its multifactorial nature of symptoms. Therefore, early-stage diagnosis of Alzheimer’s disease is essential, which helps in the treatment and recovery of patients to a greater extent. Background In the existing literature, few research attempts are carried out for Alzheimer’s disease prediction using machine learning algorithms; yet, most of the existing techniques fail to focus on aspects such as gain-optimisation, dementia severity identification and accuracy enhancement. Methodology To solve these issues, this article presents a light gradient boosting machine-based framework, which employs a gain-optimisation algorithm using multi-category factors for the early stage prediction of Alzheimer’s disease. Further, the proposed framework introduces a detailed feature analysis for identifying the key features needed for the disease prediction and thereby classifies the Alzheimer’s disease patients into different dementia severity types. Results The extensive evaluations of the proposed framework on different dataset sizes using real-world MRI datasets of patients, clearly demonstrate the performance of the proposed work in terms of gain-optimised accuracy metrics. Further, experimental evaluations clearly prove the better performance of the proposed framework when compared to that of other ML techniques including LR, RFC, SVR, SVC and existing methods in terms of Recall, F1-score and accuracy metrics.

Neurosurgery in Pakistan: Past, Present, and Future.

Since its independence from India in 1947, Pakistan has struggled with economic crises such as global debt, corruption, constant regime change, and a decades-long war against terrorism. The resulting socioeconomic barriers have stymied efforts to develop a comprehensive and equitably accessible healthcare system, especially regarding safe, timely, and affordable surgical care. This article evaluates neurosurgery's development, current state, and prospects in Pakistan, a lower-middle-income country. We performed a literature search using PubMed and analyzed relevant articles to better understand the state and landscape of neurosurgery in Pakistan. Moreover, we conducted ecological research by querying the databases of the World Bank and the Institute of Health Metrics and Evaluation to evaluate the neurological and neurosurgical disease burden in the Pakistani population. The neurosurgical workforce in Pakistan has demonstrated rapid growth over the past two decades, with approximately 450 neurosurgeons and a neurosurgeon-per-100 000 population density of 0.114. Nonetheless, access to essential neurosurgical procedures for the treatment of diseases such as stroke has been difficult to ensure, which likely contributes to Pakistan's stroke burden, ie, stroke was still the third most common cause of death in 2019, causing 21.7% of all deaths. While Pakistan's political and economic instability has adversely affected the development of neurosurgery, the field has still made great strides and demonstrates a promising future in providing equitable neurosurgical care to all Pakistan's people.

HARNESSING PRIVACY-PRESERVING FEDERATED LEARNING WITH BLOCKCHAIN FOR SECURE IoMT APPLICATIONS IN SMART HEALTHCARE SYSTEMS

The Internet of Medical Things (IoMT) refers to interconnected medical systems and devices that gather and transfer healthcare information for several medical applications. Smart healthcare leverages IoMT technology to improve patient diagnosis, monitoring, and treatment, providing efficient and personalized healthcare services. Privacy-preserving Federated Learning (PPFL) is a privacy-enhancing method that allows collaborative method training through distributed data sources while ensuring privacy protection and keeping the data decentralized. In the field of smart healthcare, PPFL enables healthcare professionals to train machine learning algorithms jointly on their corresponding datasets without sharing sensitive data, thereby maintaining confidentiality. Within this framework, anomaly detection includes detecting unusual events or patterns in healthcare data like unexpected changes or irregular vital signs in patient behaviors that can represent security breaches or potential health issues in the IoMT system. Smart healthcare systems could enhance patient care while protecting data confidentiality and individual privacy by incorporating PPFL with anomaly detection techniques. Therefore, this study develops a Privacy-preserving Federated Learning with Blockchain-based Smart Healthcare System (PPFL-BCSHS) technique in the IoMT environment. The purpose of the PPFL-BCSHS technique is to secure the IoMT devices via the detection of abnormal activities and FL concepts. Besides, BC technology can be applied for the secure transmission of medical data among the IoMT devices. The PPFL-BCSHS technique employs the FL for training the model for the identification of abnormal patterns. For anomaly detection, the PPFL-BCSHS technique follows three major processes, namely Mountain Gazelle Optimization (MGO)-based feature selection, Bidirectional Gated Recurrent Unit (BiGRU), and Sandcat Swarm Optimization (SCSO)-based hyperparameter tuning. A series of simulations were implemented to examine the performance of the PPFL-BCSHS method. The empirical analysis highlighted that the PPFL-BCSHS method obtains improved security over other approaches under various measures.

Patient involvement in interdisciplinary bedside rounds from nursing and medical students' perceptions. A Swedish qualitative interview study.

Patient involvement in the interdisciplinary bedside round (IBR) increases care quality and safety but is influenced and perceived differently by different round participants. Nursing and medical students are still not structurally embedded in the healthcare system, and they participate in interdisciplinary bedside rounds for educational purposes. Thus, the students may give a valuable perspective on patient involvement from the 'outside view'. This study aimed to describe nursing and medical students' perceptions of patient involvement in IBRs. This study has a qualitative design with individual interviews. Eighteen informants were recruited with the help of gatekeepers from two sites in Sweden: a university training health clinic and a county hospital. They participated in one-to-one semi-structured interviews, which were analysed with an inductive qualitative content analysis approach. The study has been approved by the Swedish Ethical Review Authority. Informed consent was received from all participants. The results yielded five categories. Two sub-themes and one theme of meaning emerged as a 'red thread' across the categories. The theme of meaning was: 'In hospital rounds, the patient is a respected guest, but with a disadvantaged "alien status" due to the hosts' difficult medical language and unclear routines'. Students perceive patients are not fully involved in IBRs, and the healthcare team controls this involvement due to patients' lack of knowledge and vulnerability, the hectic hospital environment, and complicated medical language. Doctors lead IBRs and encourage or discourage patient involvement and nurses act as patient advocates, supporting their involvement. According to nursing and medical students, patients are seldom involved in IBRs due to multiple interaction barriers and despite communicational facilitators. Their involvement depends on healthcare professionals. Further research should investigate other IBRs stakeholders' perspectives on patient involvement in IBRs to facilitate it.

Healthcare Value Assessment: A Critical Review of Economic Outcome Metrics and Future Directions

This paper provides a critical review of economic outcome metrics used in healthcare value assessment, emphasizing the evolving landscape of resource allocation, patient-centered approaches, and standardization efforts. With healthcare costs rising globally, the efficient allocation of limited resources is essential. Metrics like Quality-Adjusted Life Years (QALYs), Disability-Adjusted Life Years (DALYs), Incremental Cost-Effectiveness Ratios (ICERs), and Cost-Benefit Analysis (CBA) are central to guiding funding decisions, influencing insurance coverage, and shaping treatment prioritization. Emerging trends, such as the integration of artificial intelligence (AI) and big data, are enhancing the precision of these assessments, while patient-centered metrics underscore the importance of patient satisfaction and quality of life. Additionally, there is a growing push for the standardization of these metrics to create consistent frameworks across diverse health systems. This paper explores case studies, practical applications, and future directions to provide insights into how healthcare systems can adopt more effective, globally aligned economic assessments.

Care workers, collectivisation and protest: a case for feminist and anti-capitalist resistance against the state

Nation-wide organised protests by Accredited Social Health Activists (ASHAs), arguably the backbone of India's fragmented healthcare system, form a watershed moment in feminist protest in India by centring demands for the regularisation of their ‘voluntary’ and undercompensated work. This distinct subaltern group (the ASHAs) engages with the state through dynamic political protest. This article critically explores the protest strategies adopted by ASHAs to better understand feminist protest on the Indian political landscape. It adopts a reflexive method of inquiry by unpacking how ASHA policy perpetuates institutional patterns of gender-based occupational segregation and how ASHAs, in turn, navigate and respond to these challenges. Somewhere between victimhood and agency, ASHA workers have reclaimed a site of struggle and resistance. Indeed, in the face of gender-based discrimination, ASHA workers are agitating on their own terms. A postcolonial feminist lens allows us to explore the axes of resistance adopted by ASHAs, including their medium of protest, which offers a space for different performative strategies: the self-sustained and self-contained leadership and mobilisation in which ASHAs reject gender-based stereotypes, exclusion, disadvantage and discrimination; and the use of protest to build sites of resistance, solidarity and negotiation. This theoretical framework offers valuable insight by shifting focus away from judicial strategies and towards ASHA workers as ‘protesters’ and as authors of their own narrative.

Community Nursing Practice in Hypertension Management in China: Qualitative Analysis Using a Bourdieusian Framework.

This study explores the practices of Chinese community nurses in hypertension management, using Pierre Bourdieu's theory of practice to understand how their routines are shaped by sociocultural and institutional forces, along with their professional dispositions. A qualitative descriptive study was conducted in Shenzhen, China, between March and June 2024, and is reported following the COREQ guidelines. Eighteen nurses, each with at least 1 year of full-time experience in hypertension care within the local community healthcare system, were recruited from a participant pool established through prior research. Face-to-face individual semistructured interviews were conducted using a structured interview protocol, and data were analyzed through thematic analysis. Community nurses face tensions between traditional health beliefs and modern hypertension care, as well as institutional pressures that prioritize efficiency over personalized care. Power imbalances, particularly the authority of doctors, complicate their role. However, nurses adapt their care strategies through embodied practices, balancing clinical standards with patient needs. Community nurses are not mere enforcers of guidelines but adaptive professionals who navigate complex sociocultural norms, institutional demands, and power dynamics in hypertension care. This study underscores the necessity for flexible, culturally sensitive practices to improve public health outcomes.

Cutting-Edge Machine Learning in Biomedical Image Analysis: Editorial for Bioengineering Special Issue: “Recent Advance of Machine Learning in Biomedical Image Analysis”

Biomedical image analysis plays a critical role in the healthcare system [...]

Scoping the barriers to influenza and pneumococcal vaccinations from the perspectives of patients with cancer: is there a role for the pharmacist?

AbstractBackgroundRoutine immunisation for influenza and pneumococcal disease has the potential to reduce morbidity and mortality in patients with cancer.AimThis scoping review aims to determine barriers to influenza and pneumococcal vaccinations from the perspective of patients with cancer and to discuss the potential role of the pharmacist in impacting these barriers.DesignA systematic search of seven databases, including MEDLINE (Ovid), Cochrane Library, Informit (health), PubMed, and CINAHL (complete), from database inception to 6 June 2023 was conducted. Search terms included: 'cancer', 'vaccination', 'influenza', 'pneumococcal', and 'barrier'. Articles published in English that describe barriers to receiving vaccinations from the perspectives of patients with cancers were included. Barriers were thematically analysed.ResultsTwenty‐five articles met the inclusion criteria. Barriers identified in the literature were analysed into three key themes: healthcare professionals, patients, and healthcare system barriers. A key healthcare professional barrier was lack of recommendations from the treating oncologist or haematologist. Patient barriers included lack of information about the indication for vaccination as part of patients' cancer treatment and fear of side effects. Access to vaccination services was reported as a healthcare system barrier.ConclusionThis scoping review highlights the significant barriers to influenza and pneumococcal vaccination according to patients with cancer. Healthcare professionals, patients, and health systems were identified as key barriers. Enablers to improve vaccination rates include patient education, increased healthcare professional vaccine recommendations, and improved access. Although pharmacists have a potential role to play in addressing these barriers, the feasibility and impact of their involvement requires further research.

Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post Quasi-Experimental Quality Improvement Project.

The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework. This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre-post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites. There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2-Risk Identification and Just Culture-and Dimension 4-Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2. The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.

Midwives' perspectives on personalised maternity care in the UK

Background/Aims Personalised care is associated with high-quality, safe maternity care. Limited evidence exists on midwives' perception of personalised care and potential barriers and facilitators associated with implementing it in practice. The aim of this study was to explore midwives' perspectives of personalised care. Methods An online mixed-methods survey was conducted exploring the perspectives of 46 NHS midwives. Data were analysed using descriptive statistics and thematic analysis. Results Assessing individual needs was perceived as a key facilitator and time restrictions were considered a significant barrier to providing personalised care in practice. Conclusions Providing personalised care is associated with increased job satisfaction for midwives, and key barriers include inflexible healthcare systems and limited resources. Implications for practice The findings contribute to an understanding of the factors that influence the provision of personalised care and have the potential to inform improvements in maternity services.

The Role of Traditional Medicinal Plants in Managing Malaria and HIV Co-Infection

Malaria and HIV co-infection presents a significant public health challenge, particularly in Sub-Saharan Africa, where co-morbidity rates are highest. Conventional therapies, including antiretrovirals and antimalarial drugs, are expensive and often associated with side effects that lead to noncompliance. Traditional medicinal plants offer an affordable and culturally accepted alternative. This review explores various plants used historically in the treatment of both malaria and HIV, focusing on their phytochemical constituents, mechanisms of action, and clinical efficacy. Plants such as Catharanthus roseus, Adenia venenata, and Morinda lucida have demonstrated antimalarial and antiviral properties, often through bioactive compounds like alkaloids and flavonoids. Additionally, integrating these traditional medicines with modern healthcare systems faces regulatory challenges, but there is promising potential for synergies in treatment efficacy. Further research, clinical trials, and interdisciplinary collaboration are necessary to validate these medicinal plants and improve the management of malaria and HIV co-infection. Keywords: Traditional medicinal plants, Malaria, HIV co-infection, Phytochemicals, Antimalarial properties.

Enhancing Patient Procedures through Process Improvement: A Systematic Review of Patient-Centered Care Approaches

Patient-centered care is increasingly recognized as a fundamental component of high-quality healthcare, emphasizing the need for healthcare systems to optimize patient procedures. This systematic review explores the role of process improvement methodologies in enhancing patient procedures while aligning with patient-centered care approaches. A comprehensive search of studies published between 2016 and 2023 was conducted across multiple databases, focusing on healthcare interventions using Lean, Six Sigma, and Total Quality Management methodologies. The findings demonstrate that process improvement techniques significantly reduce waiting times, procedural errors, and inefficiencies, ultimately improving patient satisfaction and safety. Moreover, integrating patient-centered care approaches ensures that patients’ needs, preferences, and values are central to healthcare decision-making, further enhancing procedural effectiveness. However, challenges such as resistance to change and resource limitations were noted. This review underscores the importance of combining process optimization with patient-centered care to achieve sustainable improvements in patient outcomes and procedural efficiency. Future research should focus on the long-term impact of these methodologies and the role of technology in further advancing patient-centered approaches.

Analysis of rational prescription of medicines by village clinics: a repeated cross-sectional study of a province in eastern China.

To analyse the rational prescription of medicines by village clinics following China's implementation of the New Healthcare System Reform (NHCSR). Retrospective study. Village clinics in a province in eastern China. Our evaluation was based on the core drug use indicators reported in the study 'How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators'. The level of rational use of medicines (RUMs) in village clinics improved in 2018 compared with 2009; the average number of drugs per prescription decreased from 3.66 to 2.77, the percentage of prescriptions including antibiotics decreased from 65.40% to 46.00%, and the percentage of prescriptions including injections decreased from 55.75% to 37.48% (all p<0.01), whereas the percentage of drugs prescribed from the list of essential medicines increased from 66.50% to 80.34%, and the percentage of drugs prescribed by generic names increased from 61.29% to 70.65% (all p<0.01). The level of RUMs improved after the implementation of the NHCSR, however, it was found that there was still a gap between the level of RUMs in 2018 and the international reference value. Financial investments, electronic prescription systems, improved supervision and regular training are essential actions that must be implemented.

Temporal and regional trends in Canada for the epidemiology and management of diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are a common downstream consequence of diabetes and pose significant concern to the health of affected individuals. There are currently limited data available that detail the epidemiology and inpatient burden of DFUs in Canada. This study aims to provide updated data on the epidemiological and economic burden of DFUs in Canada between 2015 and 2019. Using the Canadian Institute for Health Information Patient Cost Estimator the authors estimated, as the primary outcome, the number of DFU inpatient cases in Canada, the associated financial burden of these admissions on the Canadian healthcare system, physician compensation, and average patient length of hospitalisation. This analysis covered 12 Canadian jurisdictions and was stratified by age, sex, province and geographical region. The secondary outcome was to highlight temporal trends in the public health burden of DFUs by computing the average annual percentage change (AAPC; the weighted average of several annual percentage changes over multiple years) using Joinpoint (Surveillance Research Program National Cancer Institute, US) regression analysis. The total number of cases, average length of hospitalisation and physician costs across Canada were highest for patients over ≥60 years of age. By region, the total number of cases and standardised physician costs were highest in Central Canada, followed by Western Canada, and subsequently Eastern and Northern Canada. In 2019, there were >1800 patients with DFUs admitted to Canadian acute care hospitals. Despite having the lowest number of inpatient admissions, Northern Canada had the highest associated inpatient costs, followed by Central, then Western and, lastly, Eastern Canada. Overall, mean inpatient costs remained stable over time across all age groups (AAPC 0.61; 95% confidence interval: -1.87-3.15), with an average cost of >$10,000 CAD per case. Average physician cost across all jurisdictions was approximately $1000 CAD per case, with the mean hospitalisation time being nine days. The findings of this study emphasise the dynamic nature of the economic and epidemiological DFU burden in Canada, underscoring the need for targeted interventions, multidisciplinary care and evidence-based resource allocation for the optimal management of diabetes and DFUs.

Equity and Outcome Events in Hidradenitis Suppurativa: Exploring Effect Modifiers Associated with Diagnostic Delay in the Real World.

Patients with hidradenitis suppurativa (HS) experience significantly delayed diagnoses of 7-10years from symptom onset on average, but the reasons for this remain largely unknown. This study investigated drivers of diagnostic delay from the perspective of healthcare system equity. A literature review was performed to identify published factors associated with delayed HS diagnosis to inform data analysis. Clinical and demographic data from the Adelphi HS Disease Specific Programme (DSP)™, a real-world cross-sectional survey of dermatologists and their consulting patients in France, Germany, Italy, Spain, the UK and the USA in 2020/2021, were used to model factors influencing delay to diagnosis from onset of symptoms and first consultation. Factors influencing delay to HS diagnosis in the literature with the most available evidence were misdiagnosis, delay in specialist referral and patient embarrassment. Data analysis revealed that increasing age was associated with reduced diagnostic delay after symptom onset. Patients with HS who were White or in Germany were also more likely to receive a faster diagnosis. Smokers, patients with concomitant conditions, or a family history of HS were slower to be diagnosed. When time to diagnosis following first consultation was assessed, increasing age was associated with quicker diagnosis. Moreover, patients with a family history of HS were diagnosed quicker, whereas those with high body mass index, more concomitant conditions, in employment, managed by multiple physicians or European were more delayed. On the basis of a thorough analysis of real-world data, multiple factors that potentially influenced the timely diagnosis of HS have been identified. For the first time, this study quantifies the relative impact of these modifiers, providing valuable insights into areas that require attention for faster diagnoses and improved disease outcomes.

PhD-DNP Collaboration: An Integrative Review of Scholarly Partnerships in Nursing.

Nurses holding terminal degrees, Doctor of Philosophy (PhD), Doctor of Nursing Science (DNS), and Doctor of Nursing Practice (DNP), fulfill different roles in nursing. The continued growth of nursing science and practice is dependent on alliances between these nurses that produce state-of-the-art knowledge and support the translation of evidence to practice. This integrative review described characteristics of scholarly collaborations between nurses holding a research-focused degree, the PhD, and those holding a practice-focused degree, the DNP. Five major nursing, medicine, and education databases were searched for peer-reviewed, original articles addressing or describing the characteristics of PhD-DNP scholarly collaborations, published through March 2023. In total, 15 articles met the inclusion criteria, and an integrative synthesis was conducted using constant comparison and thematic analysis. Findings included one overarching theme, Role Clarification, as well as four subthemes that emerged across the sample, describing key characteristics of collaborative PhD-DNP scholarship: (1) Mutual understanding and appreciation of strengths; (2) Strategic project planning and team building; (3) Clear organizational/administrative directives and guidance; and (4) Shared goals for the nursing profession. Articles describing the collaboration between nurses holding doctoral degrees are limited and provide primarily lower-level research evidence and evidence-based practice outcomes. Despite efforts to foster scholarly collaborations among nurses holding terminal degrees, more research is needed to clarify individual roles, offer tangible strategies for collaboration, and measure outcomes of collaboration benefitting healthcare systems, patient outcomes, and the nursing profession. This integrative review involved only the review of the extant literature.