Electronic health records are crucial medical informatics elements increasingly utilized in industrialized nations to enhance health care services. Given the significance of electronic health records in improving monitoring and evaluation, along with the necessity to deliver quality, cost-effective, and patient-centered services, this study aims to examine the strengths, limitations, challenges, facilitators, and prerequisites for the implementation and utilization of electronic health records. This study was a systematic scoping review conducted in 2023. The protocol of the Joanna Briggs Institute (2015) was employed to design and execute this scoping review, while the model by Levak et al. (2010) served as a guide for its execution. Articles were searched across six major databases, including IS Web of Sciences, PubMed, Scopus, EMBASE, Cochrane, and ProQuest, using a predefined search strategy. Google Scholar was also utilized for supplementary searches. The search period spanned from 2002 to 2022. A total of 37,694 studies were identified across six primary databases. Following evaluation in three stages-title, abstract, and full-text-71 articles were deemed eligible for inclusion in this scoping review. Qualitative analysis and data classification of the selected studies identified four main themes and 31 sub-themes related to the strengths of setting up and utilizing electronic health records. Challenges associated with the launch and implementation of electronic health records were categorized into five main themes and 47 sub-themes, while facilitators and prerequisites for launching and utilizing EHRs were classified into five main themes and 30 sub-themes. It should be noted that some sub-themes were reported in only a single study; therefore, their weight should be interpreted with caution. Finally, a five-stage process was recommended to guide the successful launch and implementation of EHRs. Healthcare managers and policymakers should comprehensively consider the strengths, limitations, challenges, facilitators, and prerequisites for launching and using electronic health records. Given the relatively limited effectiveness of government incentive policies and financial support, there is a need to assess and revise these policies to enhance the implementation of EHR. Addressing user resistance requires a greater focus on organizational culture.

The American Disabilities Act of 1990 (ADA) was established to protect individuals with disabilities from discrimination against access to health care and public services and to ensure they have equitable resources. It is imperative that obstetric providers understand the applications of the ADA requirements when caring for pregnant patients with disabilities ensuring they are able to physically access outpatient care and effectively communicate with their care team.

This study aims to analyze the management of health facilities and infrastructure, identify supporting and inhibiting factors, and examine the influence of facility and infrastructure management on service quality at the Anugerah Medical Center Metro Lampung Maternity and Child Hospital (RSIA). The study uses a qualitative approach with descriptive methods. Data collection was conducted through in-depth interviews, direct observation, and documentation studies with purposively selected informants, including elements of management, health workers, administrative staff, and patients or patient families. Data validity was guaranteed through source and technical triangulation. The results of the study indicate that the management of facilities and infrastructure at the Anugerah Medical Center Metro Lampung Maternity and Child Hospital has been implemented systematically through the stages of planning, procurement, maintenance, and supervision and evaluation, although not yet fully optimal. The main supporting factors include the hospital management's commitment to improving service quality and patient safety, as well as internal policy support. Meanwhile, inhibiting factors are more technical and managerial in nature, such as the time-consuming procurement administration process, limited human resources specifically for facility maintenance, and suboptimal cross-unit coordination. The management of facilities and infrastructure has been shown to significantly impact service quality, particularly in terms of service effectiveness, patient comfort, and healthcare worker performance. The conclusion of this study indicates that the management of facilities and infrastructure is a crucial component in supporting the quality of healthcare services at the Anugerah Medical Center Metro Lampung Hospital. Therefore, it is recommended that the hospital strengthen short-term and long-term planning, optimize the integrated electronic inventory system, improve the competency of human resource facility managers, and strengthen cross-unit coordination and supervision to ensure the sustainability of the quality of maternal and child healthcare services.

Lung transplantation is conspicuously resource intensive, yet the carbon footprint of solid organ transplantation, and lung transplantation in particular, remains relatively unmapped. Moreover, there is growing evidence that climate change adversely affects lung transplant recipients, directly and indirectly. This review explores opportunities to integrate sustainable practices across the lung transplantation pathway, with the dual aims of reducing environmental impact and reducing recipient morbidity and mortality. Published literature outlines mitigation strategies to reduce the drivers of climate change, and adaptation strategies to modify the hazardous effects of the climate crisis on healthcare services. Opportunities to create "green chains" of transplant care start with appropriate recipient and donor selection, with both elements optimised to maximise operative success and avoid donor organ discard. The peri-operative phase offers scope for decarbonisation via the reduction of anaesthetic gas emissions, green procurement, and waste reduction. In the post-transplant phase, enhanced recovery after surgery (ERAS) programmes feed into longer term surveillance and care delivery, with increasing opportunities for telemedicine and noninvasive allograft monitoring, to reduce travel-related emissions. The co-ordinated adoption of low-carbon, sustainable practices within lung transplantation offers a meaningful opportunity to reduce environmental harm, enhance healthcare infrastructure and workforce resilience, and improve patient outcomes in a patient cohort vulnerable to climate change. Lessons can be drawn from the global surgery movement; however, it remains the responsibility of transplant practitioners to foster a culture of environmental advocacy and to implement systematic measurement and targets for climate change and health indicators.

Mental health conditions in Mexico: Diagnosis trends based on hospital records.

Experience-Based Co-design (EBCD) is a participatory action research technique aimed at enhancing the experiences of both service users and service providers within healthcare services. Hence, the aim was to develop strategies to improve the engagement of youth with mental health services being delivered in Chennai, India. We adopted a modified EBCD method involving three phases (data collection, designing strategies and implementation) spread across six stages. Starting from stage-1 interviews with service users and providers to identify factors that may lead young service users to disengage from treatment, followed by group interactions undertaken separately with service providers and users to pinpoint key areas for improvement. This also included a co-design process with all stakeholders, where solutions were refined using SMART criteria and rated on a scale of 1-5, with 1 being less prioritised and 5 being highly prioritised. The final stage involved a meeting with institution management to deliberate and decide on the plan for implementation of the generated solutions. Service users, providers, and stakeholders found key areas such as outpatient department (OPD) timings, continuity in MHP-client associations, awareness about medication and treatment processes, and the facilities, including the physical environment and refreshments provided for service users, were major reasons why patients disengaged from the treatment. In this study, service users, providers, and stakeholders prioritised touch points grouped under three major themes: (1) appointments, (2) facilities and (3) awareness. Despite some challenges, EBCD was successfully implemented at the Schizophrenia Research Foundation (SCARF) in the Youth Mental Health Department, Chennai, India. EBCD was a promising methodology for service improvement and empowering service users. It identified crucial areas for enhancement and empowered the service users by involving them in the decision-making process, ultimately contributing to improved engagement and satisfaction with mental health services.

To investigate the access to specialist palliative care (SPC) and its impact on healthcare utilization at the end of life in patients with multiple myeloma (MM). This retrospective cohort study examined all Finnish patients who died of MM in 2019. Data were collected from national health databases. Patients were categorized by whether they had contact with SPC or not. We identified 278 patients (median age at death 77.5 years, 44.2% male), of whom 23.4% had SPC contact a median of 38 days before death. During the last 6 months of life, 92.4% of all patients had contact with the emergency department, 83.5% were hospitalized in secondary care, and 65.5% were hospitalized in primary care hospitals. Patients with SPC contact had fewer emergency department visits (50.8% vs. 65.3%, p = 0.041) and hospitalizations in secondary care (41.5% vs. 62.0%, p = 0.004) in the last month of life and fewer hospital deaths (69.2% vs. 84.0%, p = 0.012). Despite high healthcare service utilization at the end of life, access to SPC was often limited and late. Contact with SPC reduced acute healthcare utilization at the end of life, indicating better end-of-life care.

"They think they know me without listening": Restoring relational care and authority in Māori health encounters.

People who use drugs (PWUD) in the U.S. often face barriers to accessing harm reduction, social, and medical services, including fragmented systems and limited access to locally relevant, usable information. A digital harm reduction support tool (DHRST) that identifies clients' needs and matches them to available community resources may help address these barriers. We examined the feasibility and acceptability of a DHRST among PWUD, as well as its potential role in supporting safer practices and improving engagement with services. We recruited a convenience sample of 37 clients from a community-based harm reduction organization to participate in semi-structured interviews. Participants were ≥ 18years old, English-speaking, and able to provide informed consent. Interviews explored perceptions of the feasibility, acceptability, and potential uses of a DHRST. Data were analyzed using thematic analysis. Four primary themes emerged from our data: (1) participants viewed a DHRST as a valuable tool for navigating fragmented and locally specific information about harm reduction, social, and healthcare services; (2) participants perceived the tool as a means of enhancing safety in an increasingly unpredictable drug supply through access to real-time, peer-generated information and alerts; (3) participants expressed concerns about privacy, surveillance, and the potential unintended consequences of sharing sensitive information; and (4) participants emphasized that feasibility would depend on accessibility, including device access, digital literacy, and the availability of multiple platforms for engagement. Overall, participants expressed strong enthusiasm for the potential value of a DHRST despite concerns regarding implementation and information security. Findings suggest that a DHRST is both acceptable and potentially valuable for supporting harm reduction among PWUD, particularly as a means of improving access to locally relevant information. However, its effectiveness will depend on careful attention to structural constraints, privacy and data governance, and the broader risk environment in which information-sharing occurs. These findings support continued development of DHRSTs while emphasizing the need for user-centered and context-sensitive design.

This study examined the experiences of perinatal patients whose providers consulted a perinatal psychiatry access program to address patient mental health. In this cross-sectional study, perinatal patients whose providers contacted the psychiatry access program within the previous 6 months completed a survey to assess their experiences with receiving mental health care and mental health service recommendations from their provider. Among 73 participants, 68 (93%) received at least one provider resource or referral recommendation, of whom 68% (N=46) followed through with at least one recommendation. Barriers included scheduling conflicts, lack of child care, and discomfort with therapy or group-based services. Most participants expressed satisfaction with their provider's role in addressing mental health concerns. Although patient satisfaction was high, engagement with some recommended services was low. Future research should investigate patient-centered approaches and how to better connect patients to recommended services.

Human papillomavirus (HPV) related cancer incidence is higher among American Indian/Alaska Native (AI/AN) women than among White women. Limited access to health care or preventive services in rural communities might increase cancer risk among AI/AN people. To understand disparities in Alaska, this study compares rural/urban HPV vaccination rates of AI/AN with non-AI/AN people. Immunization rate data were extracted for each year during 2018-2023. Immunization rates from the Alaska Immunization Information System (VacTrAK) were compared between AI/AN and non-AI/AN people. From 2018 to 2023, HPV vaccine series completion among Alaska adolescents aged 13-15 years ranged from 32% to 39%, with 32% up to date in 2023; 48% had initiated vaccination. AI/AN adolescents had significantly higher completion than non-AI/AN peers (48% vs. 29%, p < 0.01), with consistently higher coverage across years and in both rural and urban settings after stratification; rural coverage was higher overall. Regional disparities were substantial, with series completion ranging from 15% to 58%. HPV vaccination coverage among Alaska adolescents remained low from 2018 to 2023, with substantial decline between initiation and series completion. AI/AN adolescents had significantly higher coverage than non-AI/AN peers, challenging assumptions about access and highlighting the effectiveness of community-centered, Tribal-led vaccination efforts. Persistent regional and urban-rural disparities, along with recent declines in AI/AN coverage, underscore the need to strengthen equitable strategies and improve series completion.

Domestic violence (DV) is a major public health concern that negatively affects women's reproductive health. The COVID-19 pandemic and related lockdowns may have exacerbated DV and its consequences. This study aimed to assess reproductive health outcomes associated with DV among married women in Iran during the COVID-19 lockdown. A cross-sectional study was conducted between November 2020 and September 2021, including 5317 married women attending healthcare centers across Iran. Data were collected on socio-demographic characteristics, fertility-related factors, and experiences of DV using the revised Conflict Tactics Scales (CTS2). Multivariate logistic regression models were applied to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between DV and reproductive health outcomes, adjusting for potential confounders. Women who experienced DV were significantly more likely not to use contraceptives (AOR = 2.08; 95% CI, 1.61-2.70). DV was also associated with reduced likelihood of exclusive breastfeeding (AOR = 1.59; 95% CI, 1.21-2.10), lower participation in Pap smear screening (AOR = 1.43; 95% CI, 1.09-1.87), and higher risk of sexually transmitted infections (STIs) (AOR = 2.41; 95% CI, 1.33-4.38). These associations remained significant after adjusting for age, education, employment, and parity. DV during the COVID-19 pandemic is strongly associated with adverse reproductive health outcomes among Iranian women, including unsafe contraceptive practices, inadequate breastfeeding, missed cervical cancer screening, and increased STI risk. These findings underscore the urgent need for public health interventions, including enhanced social and healthcare support, safety measures, and accessible reproductive health services for women experiencing DV, particularly during pandemics or periods of social restriction.

In low-risk populations, the faecal immunochemical FIT test is excellent at excluding colonic malignancy, with a negative predictive value (NPV) of 99.8%. However, effectiveness in a high-risk iron deficiency anaemia (IDA) population is unclear. This has significant resource implications for health care services worldwide. This study aims to establish the NPV of FIT for colorectal cancer in patients with IDA. Single-centre retrospective study. Over 12 months, paired cases of FIT <10µg Hb/g faeces and IDA were identified. Those not completing colonoscopy or CT pneumocolon were excluded. The prevalence of cancer, low-risk and high-risk polyps, defined by British Society of Gastroenterology (BSG) guidelines, was established, and the NPV was calculated. One thousand twenty-three cases were identified, of which 451 had undergone complete colonic investigation. Mean age was 68 (SD: 11.8). 286/451 (63%) were female. 381/451 had undergone colonoscopy, 78/451 CT pneumocolon with 404/451 also having gastroscopy (OGD). 8/451 (1.8%) had a colonic malignancy. 11/404 (2.7%) had an upper GI malignancy and 14/451 (3.1%) a cancer outside the GI tract. The NPV for colorectal cancer was 98.2% (95% CI: 96.9-99.5). In 24/451 (5.3%) advanced polyps were found, NPV 94.7% (95% CI: 92.6%-96.8%). In 118/451 (26%) low-risk polyps were found, NPV 73.8% (95% CI: 69.8%-77.9%). The NPV of FIT in IDA appears lower than reported in low-risk symptomatic populations, and it is unclear if this is adequate to negate the need for colonoscopy. Prospective multicentre studies are needed to evaluate this fully.

The Supplemental Security Income (SSI) program remains an important source of financial support for low-income families of children, adolescents, and young adults with disabilities. In most states, SSI eligibility also qualifies children for the state Medicaid program, providing access to health care services. The Social Security Administration (SSA), which administers the SSI program, considers a child disabled under SSI if there is a medically determinable physical or mental impairment or combination of impairments that results in marked and severe functional limitations. The impairment(s) must be expected to result in death or have lasted, or be expected to last, for a continuous period of at least 12months. The income and assets of families of children with disabilities are also considered when determining financial eligibility. When an individual with a disability becomes an adult at age 18, the SSA considers only the individual's income and assets. The SSA considers an adult disabled if there is a medically determinable impairment (or combination of impairments) that prevents substantial gainful activity for at least 12 continuous months. SSI benefits are important for youth with disabilities who are transitioning to adulthood. The purpose of this statement is to provide updated information about SSI medical and financial eligibility criteria and the disability determination process. Although pediatricians do not make the determination for SSI eligibility, this statement discusses the pediatrician's role in alerting families to the possibility of SSI support, connecting families to resources to assist in the application process, and providing timely documentation required for the application.

Despite many hospitalized children missing recommended vaccines, vaccines are rarely administered during hospitalization. Our objective was to explore the key determinants for inpatient vaccine delivery in a sample of 11 US children's hospitals. We used the Pediatric Health Information System database to identify children's hospitals in the Pediatric Research in Inpatient Setting network who were in the top tertile (n = 6) and the bottom tertile of inpatient vaccine administration (n = 5). We recruited pediatric nurses, pharmacists, and hospitalists to participate in semistructured interviews. Interview questions were based on the Consolidated Framework for Implementation Research and focused on current practices and barriers to inpatient vaccine delivery. Interviews were conducted via telephone or teleconferencing and were recorded and transcribed. Two reviewers independently coded transcripts using thematic analysis; a third reviewer resolved discrepancies, as needed. We conducted 36 interviews: 10 hospitalists, 14 nurses, and 12 pharmacists. Several themes emerged as key determinants for inpatient vaccine delivery, including the following: 1) timing: vaccine administration happened predominately at discharge, which at times jeopardized vaccine delivery; 2) access: vaccinating during hospitalization was particularly important when children had difficulty accessing primary care or when traditional health care services were disrupted, eg,during the COVID-19 pandemic; and 3) workflow: vaccine-related workflow is often not standardized and lacks ownership. Despite variability in vaccine administration across children's hospitals, there are many common barriers and determinants. Solutions that address these barriers and meet the needs of multidisciplinary clinicians are essential to improve inpatient vaccine delivery.

Pharmacists, as one of the most accessible health care professionals, are often cited as a solution for filling gaps in health care services due to growing shortages of primary care physicians and nurses in the United States. However, future demand forecasts for pharmacists may be low owing to systematic undercounting of pharmacists in nontraditional Managed Care, Pharmaceutical Industry, and Academia roles by the Bureau of Labor Statistics. Accurate and inclusive demand estimates are needed to best inform workforce planning for pharmacists in traditional and nontraditional roles across all industries. The urgency to have accurate demand forecasts including all types of pharmacists is difficult to overstate because PharmD program enrollment has dramatically declined to a level that challenges maintaining pharmacists in traditional community and health system roles-before the need for Managed Care, Pharmaceutical Industry, and Academia pharmacists is even considered. This viewpoint aims to consider this aspect of the demand question of "will there be enough pharmacists?" to help mitigate future pharmacist supply risk to all industries for current and yet unknown functions that will arise, regardless of pharmacist supply, for medication experts to shape the future standards of patient care.

Paediatric patient experience during hospitalisation stays: Developing paediatric PREMS questionnaires through a collaborative Delphi study.

The utilisation of transoral robotic surgery (TORS) has grown in popularity over recent years with wide applications for both benign and malignant disease. It is important to recognise that the introduction of robotic surgery inserts a new variable into an already error-prone healthcare service that has a high preventable adverse event rate. Surgical safety checklists (SSC) have been well established in recent years and demonstrated to improve outcomes and reduce complications. This study aims to introduce a novel SSC designed for use specifically in operating theatres for cases using TORS. A modified Delphi process was utilised to define consensus for a proposed TORS specific SSC. An initial iteration was devised using a literature search. Experts with significant TORS experience rated each proposed item for potential inclusion using a Likert scale. The process was repeated until consensus was reached for all items. Two rounds were completed with seven experts agreeing on various items to be included in the TORS specific SSC. This novel surgical safety checklist is the first developed specifically for use with TORS. It has been designed using robust Delphi methodology with several TORS experts from high-volume centres across the UK. The aim of the TORS SSC is to be used alongside the WHO SSC and requires ideally long-term and multi-centre adoption in order to validate its implementation.

Since the introduction of the Convention on the Rights of Persons with Disabilities (CRPD), there have been calls to develop standards for evaluating compliance and implementation. Human rights 'indicators' are a recognized, if somewhat contested, way to measure states' compliance with human rights treaties. The additional CRPD requirement for active involvement of people with disabilities in monitoring and implementation has sparked efforts towards participatory design of such tools. We present a rationale for the development of a CRPD indicator in the mental health context. We adopted a combined doctrinal analysis and scoping review approach to examining literature on human rights indicators. Unsurprisingly, a much wider literature exists on indicators concerning the rights of people with disabilities generally. For mental health-focused efforts, compliance tools have focused on either (1) the implementation of specific CRPD provisions, (2) mental health-related legislation, or (3) consisted of audit and service quality assessment tools that consider human rights at the service level. We observe that no tools or indicators have been developed in the mental health context that include a full, integrated assessment of the CRPD across society (both including and extending beyond healthcare services to include areas like housing, employment, and anti-discrimination law). To address this gap, we conclude by proposing the development of a co-designed indicator that is inclusive of the full spectrum of rights contained within the CRPD.

The global aging population is rapidly increasing, prompting the United Nations to declare the "Decade of Healthy Aging" (2021-2030) to improve the quality of life for older adults. Health-related quality of life (HRQoL) is crucial in this context, and the International Classification of Functioning, Disability and Health (ICF) provides a standardized framework for its evaluation. This study aimed to apply a previously proposed method for converting SF-36 domain scores into ICF qualifiers in community-dwelling older adults attending primary care services in a middle-income country, describing the resulting classification of functioning domains using standardized ICF qualifiers. A cross-sectional study was conducted with older adults aged 60 and above who accessed primary healthcare services and had no cognitive impairment. Participants underwent HRQoL assessment using the SF-36, and ICF codes previously linked to SF-36 domains were classified using ICF qualifiers. A simple calculation method was developed to convert SF-36 scores into ICF qualifiers. The study included 52 participants, with a mean age of 71.6±7.0years, 92.3% of whom were women. The ICF framework qualified 27 codes from SF-36 domains. Moderate impairments were observed in "Bodily Pain," "General Health," and "Vitality" domains, while "Physical Functioning," "Social Functioning," and "Mental Health" domains showed mild impairments. No impairments were noted in the "Role Physical" and "Role Emotional" domains. The application of ICF qualifiers to SF-36 domain scores yielded standardized classifications of HRQoL domains across the ICF framework, allowing HRQoL outcomes to be described according to the severity levels defined by the ICF qualifier scale.