Healthcare Context Research Articles

Ai-driven Predictive Analytics, Healthcare Outcomes, Cost Reduction, Machine Learning, Patient Monitoring

Integrated with predictive analytics and machine learning, AI has exceeded the traditional approaches of health care contexts by focusing on patient outcomes and costs. This paper aims to discuss the adoption of integrated AI in healthcare systems, categorizing these by how AI predictive models help improve patient health by proactively estimating the course of their illness and its potential impact, prioritizing patient readmissions, and developing effective individualized treatment strategies. The research also identifies more important savings realised through avoiding redundant tests, better utilisation of resources, and shorter hospitalisations. In the current study, the authors present concrete findings for AI-driven Predictive Analytics based on realistic scenarios and quantitative data of health care systems. It also points to the fact that healthcare organisations adopting the use of AI technology have gained an objective that reduced their operations costs by 25% and improved patient outcomes whereby the readmission rates were reduced by between 15% and 20%. Furthermore, there is an evaluation of the ethical considerations of applying AI in healthcare, especially on the subject of patient’s information security. To the best of our knowledge, this study is the first to systematically review AI applications in healthcare and provide detailed suggestions for better understanding the general impact of AI in healthcare to enhance patient outcomes and manage costs. With advancement in artificial intelligence technology, there is a growing importance of how the technology can transform the health care industry.

Learning by Visualize a Nurse-Led CCOS Using the Functional Resonance Analysis Method.

Quality improvements (QIs) in dynamic and complex health care contexts require resilience and take variability into account in quality improvement. The Functional Resonance Analysis Method (FRAM) helps us understand resilience and gain insight into (un)desirable variability in the complex system of daily practice. We explored how using FRAM in the Deming cycle of a QI project can help professionals and researchers learn from, reflect upon, and improve complex processes. We used FRAM in a Dutch hospital to study a QI: Critical Care Outreach Service (CCOS). The aim was to use FRAM before and after implementation to create a FRAM model and reflect to health care professionals the mismatch between Work As Imagined (WAI) and Work As Done (WAD). The WAI FRAM model was co-created with professionals before the implementation of CCOS. We used descriptions of tasks and processes for ICU nurses and verified them in 30-minute semistructured interviews (N = 2). WAD was created by input of semistructured interviews with key professionals in CCOS (N = 21) and 3 nonparticipant observations of trained CCOS nurses. We validated WAD in 2 dialogue sessions with key professionals (N = 11). Data collection continued until saturation. Juxtaposing the WAI and WAD models showed that WAD contained additional functions and highlighted unexpectedly complex functions. Reflecting on the application of FRAM with health care professionals revealed opportunities and challenges, especially time investment. FRAM helps professionals outline processes and tasks (WAI), learn from, and reflect upon their daily practice (WAD). FRAM models help professionals identify variability proactively to improve practices that enhance resilient performance.

Geographic Socioeconomic Influences on Disease Activity in Rheumatoid Arthritis in an Academic and Safety Net Hospital System.

The objective of this study was to analyze the impact of the Area Deprivation Index (ADI) on disease activity and cardiovascular comorbidity in rheumatoid arthritis (RA). A retrospective analysis of adult patients with RA was conducted to highlight differences in academic and safety net hospital clinics. Demographics, RA medication history, patient portal engagement, primary care presence, emergency or inpatient visits, RA disease activity and functional scores, Charlson Comorbidity Index (CCI), and cardiovascular disease (CVD) presence were captured. The ADI rank was assigned using nine-digit zip codes. Patients were stratified by the upper versus lower ADI decile group and matched by age, sex, race, ethnicity, insurance, and CCI using propensity score analysis. Patients with RA from the academic practice (n = 542) and the safety net hospital (n = 496) were assessed. In the academic cohort, those with high ADI scores (>8, more deprivation) had higher RA disease activity scores (Routine Assessment of Patient Index Data 3 mean ± SD: high 13.83 ± 6.94 vs low 11.17 ± 7.37, P < 0.0001; Clinical Disease Activity Index mean ± SD: high 11.97 ± 11.74 vs low 9.40 ± 7.97, P < 0.05), more functional impairment (Multidimensional Health Assessment Questionnaire mean ± SD: high 2.99 ± 2.29 vs low 2.34 ± 2.23, P < 0.01), lower MyChart use (P < 0.001), and different smoking history (P < 0.01) compared to those with low ADI scores (<3, less deprivation). In the safety net cohort, there was a statistically significant difference only in smoking status (P < 0.05). CVD was not significantly different in either cohort. The absence of differences in RA disease activity and functional impairment in patients suggests that the ADI may not be as effective at predicting RA disease activity specifically in a safety net health care context. Identifying the discrepancies between the two systems may elucidate areas of improvement for patient care.

Integrating Multi-Cancer Early Detection (MCED) Tests with Standard Cancer Screening: System Dynamics Model Development and Feasibility Testing.

Cancer screening plays a critical role in early disease detection and improving outcomes. In Australia, established screening protocols for colorectal, breast and cervical cancer have significantly contributed to timely cancer detection. However, the recent introduction of multi-cancer early detection (MCED) tests arguably can disrupt current screening, yet the extent to which these tests provide additional benefits remains uncertain. We present the development and initial validation of a system dynamics (SD) model that estimates the additional cancer detections and costs associated with MCED tests. This article describes the development of a simulation model built to evaluate the additional patient diagnoses and the economic impact of incorporating MCED testing alongside Australia's well-established standard of care (SOC) screening programs for colorectal, breast, cervical and lung cancers. The model was designed to estimate the additional number of patients diagnosed at each cancer stage (stage I, II, III, IV, or unknown) and the associated costs. This simulation model allows for the analysis of multiple scenarios under a plausible set of assumptions regarding population-level participation rates. An SD model was developed to represent the existing SOC national cancer screening pathways and to integrate potential clinical pathways that could be introduced by MCED tests. The SD model was built to investigate three scenarios for the use of MCED testing: firstly, to explore the viability of MCED testing as a substitute among individuals who are not opting for SOC screening for any reason; secondly, to implement MCED testing exclusively for individuals ineligible for SOC screening, yet have high-risk characteristics; and thirdly, to employ MCED testing after SOC screening to serve as a triaging/confirmatory tool for individuals receiving inconclusive test results. The three primary scenarios were constructed by varying diagnostic accuracy and uptake rates of MCED tests. The clinical utility and outcomes of MCED testing for screening and early detection still lack comprehensive evidence. Nonetheless, this simulation model facilitates a thorough analysis of MCED tests within the Australian healthcare context, providing insights into potential additional detections and costs to the healthcare system, which may help prioritise future evidence development. The adaptable yet novel SD model presented herein is anticipated to be of considerable interest to industry, policymakers, consumers and clinicians involved in informing clinical and economic decisions regarding integrating MCED tests as cancer screening and early detection tools. The expected results of applying this SD model will determine whether using MCED testing in conjunction with SOC screening offers any potential benefits, possibly guiding policy decisions and clinical practices towards the adoption of MCED tests.

Constructing a measure for self-perceived open organizational culture in a university hospital pharmacy.

An open organizational culture in the workplace represents an environment where information, ideas, and feedback are freely exchanged among all members, regardless of position or rank. Currently, there are no valid survey instruments to measure this culture within a healthcare context. To address this gap, we developed a survey instrument to measure self-perceived open organizational culture at a university pharmacy using a test re-test study design. Data were collected during classroom training on basic mediation skills study. Participants completed the same questionnaire before (test phase) and after the training (validation phase). The questionnaire included statements assessing open organizational culture. The data were analyzed using standardized psychometric methods, including correlations, Exploratory Factor Analysis (structural validity), and construct validity by correlating the open organizational culture scores with the Interpersonal Communication Inventory. In the test phase, 191 participants (161 females, 84%; response rate = 39.7%) contributed to the initial construction of the self-perceived open organizational culture survey instrument. In the validation phase, 81 of the original respondents completed the questionnaire again. Three latent factors were identified, retaining 22 of the 37 items: "enabling systems" (7 items), "open behavior" (8 items), and "trusting and supporting coworkers" (7 items). High correlations were found among the three factors (r > 0.6), and between these factors and the Interpersonal Communication Inventory (r > 0.35). Cronbach's alphas were all above 0.85, indicating good internal consistency. During the validation phase, the factors demonstrated high internal consistency, test/re-test correlations, and agreement. This study presents a 22-item survey instrument for measuring individual differences in self-perceived open organizational culture within a university hospital pharmacy. The instrument demonstrates internal consistency and construct validity. Further validation of its psychometric properties and testing in other healthcare departments are recommended.

Competencies and learning outcomes for healthcare professionals in climate change and sustainability: A protocol for a scoping review

Rationale The planetary crisis is a serious threat to human health. Healthcare professionals need to be trained to adapt to and mitigate against this crisis. Competencies, curricular frameworks and learning outcomes relating to climate change and sustainability (CC&amp;S) have been proposed for healthcare professionals. A synthesis of these competencies, learning outcomes and frameworks is necessary to identify commonalities and differences, understand the process of their development and highlight areas for future development. Objective The objective of this scoping review is to identify and synthesise the evidence on competencies, curricular frameworks and learning outcomes for healthcare professionals in climate change and sustainability. Inclusion criteria Sources relating to healthcare professionals and healthcare students, describing competencies, curricular frameworks and learning outcomes in CC&amp;S, will be included. Sources in all healthcare contexts will be included. Sources in the English language, published from 2014 to June 2024 will be considered for inclusion. Methods The review will be conducted in line with the Joanna Briggs Institute guidance for scoping reviews. The following electronic databases will be searched: PubMed, Embase, CINAHL, PsycINFO, SocINDEX, Academic Search Complete, Business Source Complete, British Education Index, Australian Education Index, Scopus and ERIC. A search of the grey literature will also be conducted. Two reviewers will independently screen the titles and abstracts and full texts for eligibility. Data extraction will be conducted independently by two reviewers. A narrative summary and tables will be presented. Key stakeholders will be consulted throughout the review. Discussion This review will summarise the range of competencies, curricular frameworks and learning outcomes proposed internationally for various healthcare professionals. The findings will be used to inform core competencies for all healthcare professions in CC&amp;S, in addition to highlighting gaps in the literature and areas for future development. The findings will be disseminated at conferences and in a peer-reviewed publication. Registration This protocol was registered on 31st July 2024 on the Open Science Framework (https://osf.io/vnx2g).

Stress in social and health care professionals working with people with intellectual disabilities: risk and protective factors

Objectives Those working in the field of intellectual disabilities are confronted with a multitude of stressors, which can give rise to considerable psychological difficulties. The objective of this study was to identify the key predictors of perceived and relational stress among professionals working in intellectual disability centers. Methods A cross-sectional design was employed, with 726 professionals participating (mean age = 43.35 years, SD = 11.19), predominantly women (78.6%). The variables assessed included perceived stress, relational stress, emotional balance, life satisfaction, social support, empathy, and counseling training. The analysis was conducted using structural equation modeling and qualitative-comparative analysis of fuzzy data (QCA). Results The study revealed that the stress levels of the study participants were moderate to low. The relationship between emotional balance and stress was mediated by life satisfaction. In both structural equation models, negative affect and life satisfaction were identified as primary predictors, significantly influencing perceived and relational stress. Additionally, QCA highlighted that empathy and social support, along with these factors, contribute to explaining stress levels. Conclusions Our findings highlight the necessity of implementing preventive strategies and support systems to mitigate stress among healthcare professionals who work with individuals with intellectual disabilities. These findings contribute to the existing body of knowledge regarding stress management in this specialized healthcare context.

Comparative analysis of international and Malaysia approaches to the treatment of patients with chronic gastritis from the point of view of evidence-based medicine

Background: Chronic gastritis, often resulting from *Helicobacter pylori* infection, is a widespread gastrointestinal disorder. The condition requires evidence-based treatment approaches to ensure effective management and improved patient outcomes. This study conducts a comparative analysis of the treatment approaches for chronic gastritis in Malaysia and internationally, focusing on adherence to evidence-based medicine (EBM) practices. Understanding the similarities and differences in these approaches is critical for enhancing Malaysia's healthcare strategies. Methods and Materials: The study employed a systematic review of relevant literature sourced from global medical databases, including PubMed, Embase, and Cochrane Library. The review focused on therapeutic options, diagnostic standards, and evidence-based protocols for managing chronic gastritis, with emphasis on both international and Malaysian healthcare systems. Studies included in the review primarily focused on adult patients diagnosed with chronic gastritis and treated using evidence-based methodologies. Results: The analysis revealed significant parallels in the treatment protocols between Malaysia and international guidelines, particularly in the use of proton pump inhibitors (PPIs) and antibiotic regimens for *H. pylori* eradication. However, differences emerged in the implementation of advanced diagnostic tools, accessibility of healthcare services, and the influence of local antibiotic resistance patterns. While Malaysia follows global best practices, rural-urban healthcare disparities impact the consistency of treatment delivery and patient outcomes. Conclusion: Both international and Malaysian approaches to chronic gastritis prioritize evidence-based medicine. The findings suggest that Malaysia effectively adapts international guidelines to its local healthcare context, though improvements are needed in addressing healthcare accessibility and antibiotic resistance. Enhanced implementation of EBM practices, particularly in rural areas, and personalization of treatment based on resistance patterns, could further optimize patient outcomes in Malaysia.

Ethnic disparities in perceived racism, patient-provider communication and healthcare utilization: Asian Americans

ABSTRACT Background Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities by influencing patient-provider communication and utilization of healthcare services. Objective This study aimed to investigate how Asian American subgroups differ in their perception of everyday racism, internalized racism, and perceived racism in healthcare settings and whether these perceptions predict their interactions with their health care providers and their utilization of healthcare services. Methods An online survey study was conducted. ANOVA tests were employed to compare the differences in perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system among Filipino (N = 310), Japanese (N = 242), Chinese (N = 287), Asian Indian (N = 304), Korean (N = 199) and Vietnamese (N = 151) participants. Multiple regression analyses assessed whether perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system predicted healthcare service utilization and patient-provider communication among the Asian subgroups sampled. Results There were significant group differences in perceived everyday racism (F = 8.56, p < .001), internalized racism (F = 3.46, p < .01), perceived racism in healthcare (F = 4.57, p < .001). Perceptions of racism and socioeconomic variables were found to predict patient-provider communication and utilization of healthcare services disparately across various Asian subgroups. For instance, the perception of everyday racism was a significant predictor of patient-provider communication for each of the subgroups, excluding the Vietnamese participants. Internalized racism was a significant predictor only for Filipino and Chinese participants. Surprisingly, perceived racism in healthcare was not a predictor for any of the subgroups. Conclusion Findings highlight the complex interplay of sociodemographic factors and perceived racism in shaping patient-provider communication and healthcare service utilization within the Asian American community. Implications are suggested for addressing the unique challenges faced by different Asian American subgroups and for promoting equitable healthcare access and fostering positive patient-provider relationships among the Asian American subgroups.

Weaving narrative threads with social psychological processes: Narrative modulations in online consumer reviews of a medical memoir

With the growing prevalence of health and illness narratives on digital platforms, research examining the social psychological processes involved in these storytelling environments remains scarce. This paper addresses this research gap by conducting a mixed-methods study of digital storytelling within the UK’s healthcare context, focusing on online consumer reviews of the medical memoir, Do no harm: stories of life, death and brain surgery (Marsh, 2014). Utilising computer-assisted text analysis methods of LIWC-22 and the Sketch Engine, linguistic cues for cognitive, affective, social and perceptual processes are identified in a corpus of online consumer reviews. A subsequent qualitative analysis, based on ‘narrative modulation’ (Huang, 2024, 2020), investigates the role of these processes in constructing and developing storylines across the user reviews. Finally, the study explores how consumer reviews in the form of ‘small stories’ challenge canonical narratives in the UK’s healthcare services. This research advances the field of narrative studies by emphasising the role of social psychological processes (Chung and Pennebaker, 2019) in modulating emerging, evolving and counter narratives in digital storytelling. The findings reveal an instrumental role of social psychological processes, as signalled by linguistic cues, in shaping narrative threads in online user reviews. This study not only develops narrative modulation as a valuable concept for narrative analysis, but also underscores its effectiveness when combined with computer-assisted text analysis tools for in-depth examinations of narrative data. Furthermore, it provides critical insights into digital storytelling in healthcare contexts, promoting knowledge transfer across narrative studies, stylistics, social psychology and medical humanities.

CRISPR/Cas12a dual-mode biosensor for Staphylococcus aureus detection via enzyme-free isothermal amplification

Accurate and reliable detection of Staphylococcus aureus (S. aureus) is essential for preventing infections, particularly in healthcare and food safety contexts. This work presents a novel dual-mode biosensor that integrates the CRISPR/Cas12a system with an enzyme-free isothermal amplification method for detecting S. aureus. Hybridization chain reaction (HCR) and catalytic hairpin assembly (CHA) amplify the aptamer-triggered response, significantly enhancing sensitivity. CRISPR/Cas12a′s nuclease activity is utilized in two modes: cis cleavage generates a fluorescence signal, while trans cleavage produces an electrochemical signal, enabling dual-mode detection. The biosensor demonstrates outstanding performance, with a limit of detection (LOD) as low as 5.7 CFU mL−1 in electrochemical mode and 133.7 CFU mL−1 in fluorescence mode, showcasing excellent accuracy, stability, and sensitivity. It has been successfully applied to detecting actual samples, confirming its practical applicability. This innovative approach offers a powerful tool for the swift and precise identification of S. aureus and paves the way for developing next-generation dual-mode biosensors for various analytes. Future research will aim to simplify the detection process further, making it more accessible for use in resource-limited settings.

Chronic Pain in Spanish Physiotherapy Practice: Treatment Challenges and Opportunities in Diverse Healthcare Settings-A Qualitative Study.

Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context.

Pediatric Dental Care and Antibiotics: A Comprehensive Update

Abstract Antimicrobial agents, a foundational component of contemporary medical practice, have significantly transformed the management of microbial infections, effectively protecting human well-being and prolonging life expectancy. Nevertheless, this extraordinary advancement faces a mounting challenge in the form of antimicrobial resistance (AMR). The ongoing evolution of microorganisms to withstand the impact of these substances has led to a decline in the efficacy of formerly dependable treatments, thereby presenting a critical menace to medical progress and prompting an exigent need for action. This paper undertakes a comprehensive exploration of the utilisation and correct application of antimicrobials within the context of paediatric dental healthcare. By meticulously examining the intricate interplay between therapeutic efficacy and the emergence of AMR, the overview delves into the pivotal function these agents fulfil in both preventing and treating dental infections in young patients. In addition, this update sheds light on the potential repercussions stemming from improper prescription practices, unwarranted overutilisation and insufficient adherence to established guidelines.

Moving Towards Ethical-Practical Recommendations for Alzheimer's Disease Prediction: Addressing Interindividual, Interprofessional, and Societal Aspects.

Biomarkers for predicting Alzheimer's disease (AD) are advancing and their implementation in various healthcare systems is imminent. There is a need for ethical standards addressing information needs, socio-ethical concerns, and expectations of healthy and at-risk persons. We present an ethical approach that integrates different existing ethical frameworks and discussion of our empirical, cross-cultural findings in a multi-layered perspective by addressing three levels. The micro-level focuses on the communication between counseling professionals, persons at risk or in an early stage of dementia, and family members. The meso-level addresses interprofessional cooperation and exchange as a key element for best person-centered care. The macro-level considers public health promotion, the media, and public-funded research. This approach allows to address key ethical concepts including beneficence, non-maleficence, autonomy, informational self-determination, empowerment, and justice. Our contribution specifically examines the ethical challenges associated with AD prediction by means of biomarkers, based on insights from a German-Israeli comparison, and promotes a transdisciplinary discussion across different healthcare contexts. We propose a reflection on three levels to go beyond the clinical counseling context and to consider the rapidly evolving field of biomarkers in the coming years. Our ethical-practical recommendations should not be considered final, but rather procedural and will require continuous adaptation regarding culturally varying practices, new algorithms, meta-analyses, and re-evaluation of established recommendations.

Modeling disagreement in automatic data labeling for semi-supervised learning in Clinical Natural Language Processing.

Computational models providing accurate estimates of their uncertainty are crucial for risk management associated with decision-making in healthcare contexts. This is especially true since many state-of-the-art systems are trained using the data which have been labeled automatically (self-supervised mode) and tend to overfit. In this study, we investigate the quality of uncertainty estimates from a range of current state-of-the-art predictive models applied to the problem of observation detection in radiology reports. This problem remains understudied for Natural Language Processing in the healthcare domain. We demonstrate that Gaussian Processes (GPs) provide superior performance in quantifying the risks of three uncertainty labels based on the negative log predictive probability (NLPP) evaluation metric and mean maximum predicted confidence levels (MMPCL), whilst retaining strong predictive performance. Our conclusions highlight the utility of probabilistic models applied to "noisy" labels and that similar methods could provide utility for Natural Language Processing (NLP) based automated labeling tasks.

Development of a CVD mortality risk score using nutritional predictors: A risk prediction model in the Golestan Cohort Study

Background and AimWe aimed to develop a dietary score using prediction model method for evaluating the risk of cardiovascular disease (CVD) mortality and suggesting a simple and practical scoring system within the healthcare context. Method and ResultsA total of 43878 adult participants (aged 37-80 years) from the Golestan Cohort Study (GCS) were included in analysis. A random split of the subjects into the derivation (n=28930) and the validation sets (n=14948) was done. The Cox proportional hazard model was used to develop prediction model for the 8-year risk of CVD mortality. The model’s discrimination and calibration were assessed by C-statistic and calibration plot, respectively. To enhance clinical utility, we devised a point-based scoring system derived from our model. This prediction model was developed by nine predictors including age, physical activity level (MET minutes/week), waist-to-hip ratio, tea intake (cup/day), vegetable intake (gr/1000 kcal/day), white meat intake (gr/1000 kcal/day), salt intake (gr/1000 kcal/day), dairy intake (Cup/1000 kcal/day), and percentage of protein intake. The model had an acceptable discrimination in both derivation (C-statistic: 0.76, p<0.001) and validation (C- statistic: 0.77, p<0.001) samples. Also, the calibration of model in both derivation and validation datasets was 0.81. ConclusionThis is the first attempt to develop a risk prediction model of CVD mortality and the risk scoring system by the majority of nutritional predictors in a large cohort study. This nutritional risk assessment tool is suitable for motivating at-risk individuals to make lifestyle and dietary pattern changes to reduce future risk to prevent health problems.

Disrupted Candidacy: A Longitudinal Examination of the Constrained Healthcare-Access Journeys of National Health Service Workers in Scotland Seeking Supports for Long COVID Illness.

Evidence examines how persons experiencing Long COVID (LC) struggle to secure healthcare for symptoms. However, few studies examine healthcare workers experiencing LC, nor the complex and multiple difficulties faced when seeking and receiving healthcare. This study is based on two phases of longitudinally conducted qualitative interviews, 6 months apart, with National Health Service (NHS) workers experiencing LC, from different occupational roles at NHS locales in Scotland (first interviews, n = 50; second interviews, n = 44). Multiple factors restricted healthcare access, including worries about pressuring the NHS and concerns over LC being legitimised. When healthcare was sought, workers struggled to secure support, referrals and treatment. The following reasons were included: (1) context: the restrictive pandemic healthcare context; (2) illness climate: low GP knowledge surrounding LC and how this could be treated, trends for ascribing symptoms to other causes and reluctance to diagnose LC; (3) sense-making of LC: healthcare availability linked to occupational role identity. To visualise and examine healthcare barriers, candidacy theory is applied, drawing inferences between healthcare context, illness climate, sense-making and identities. NHS workers' complex journeys represent Disrupted Candidacy, intersecting challenges across candidacy domains, restricting the seeking and receiving of LC healthcare. Findings provide insights into why NHS workers resisted and withdrew from healthcare-seeking, and the barriers they faced when attempting to secure LC support. This study presents a pathway for future LC illness research to use a modified candidacy theory framework. This research focuses on amplifying and learning from lived experiences, and the voices of NHS workers in Scotland experiencing LC. Interviews represent primary data for this study; thus, participants and their healthcare journeys are centred in this research and all aspects of production, reporting and output. Explicit discussions of stakeholder group involvement are highlighted in the methods section.

Walking the Talk: "Reflexivity" to Advance Integration of Patient Reported Outcomes for Cancer Care Screening.

In this commentary, we propose the use of video-reflexive ethnography (VRE) as a means to support integration of patient-reported outcomes (PROs) in cancer care screening. As for any policy or intervention, the optimization of PROs depends on moving beyond their mere formal introduction, and depends on the integration of PROs in the everyday practice contexts of health care professionals (HPEs). The use of VRE allows for video-playback sessions among oncology professionals to support team-based learning and practice-change grounded in "reflexivity." Through a review of previous methods used to support organizational change in healthcare settings (e.g., policies, quality improvement initiatives, simulation sessions), we present some unsung advantages of VRE that can be applied to a complex integrated setting, such as cancer care. As opposed to other methods to create change, VRE does not dictate new measures, but rather supports "bottom-up" provider-initiated changes to health care practices and contexts, grounded in collaborative day-to-day practice. We argue that VRE optimizes PROs in cancer care by facilitating their effective and sustainable integration, to promote improved patient care.

Building Trust and Loyalty in the Workplace

This article explores practical strategies for managers and executives to increase trust and loyalty in employee relationships. The article outlines how trust is built over time through consistency, integrity, and care. Specific guidance is provided around communicating expectations, pay transparency, work-life balance, career development, culture, and recognition. Fulfilling implicit and explicit psychological contracts through these approaches deepens employee loyalty and commitment. Case studies then demonstrate how appreciation, recognition, and social/fun activities further strengthen bonds. Real-world industry examples show the concepts applied successfully in technology, healthcare, and retail contexts. The article argues that prioritizing relationships through integrity and compassion lays the groundwork for resilient, high-performing organizational cultures where leaders leave a lasting positive legacy.

Evaluating progress and accountability for achieving COP26 Health Programme international ambitions for sustainable, low-carbon, resilient health-care systems.

A global initiative to develop low-carbon, resilient health systems-the COP26 Health Programme-launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop robust ones that are adaptable to different health-care system contexts. These indicators should be designed to capture tangible outcomes, support policy making, and prevent greenwashing. Integration of more robust indicators into independent scientific monitoring can support systematic inclusion of health care in global climate strategies, thereby enhancing the overall effectiveness of the COP26 Health Programme.