With the accelerating global aging process, health issues among older adults have become increasingly severe. To address the challenges brought about by the aging population, a shift from a disease-centered to a function-centered healthcare model is urgently needed. The World Health Organization (WHO) introduced the concept of intrinsic capacity and published the Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care, providing an important framework for assessing and optimizing the functional status in older adults. This article systematically reviews the conceptual background and epidemiological characteristics of intrinsic capacity. It highlights that the WHO ICOPE screening tool has been adapted and validated in China, demonstrating high sensitivity in identifying declines in intrinsic capacity. Intervention studies indicate that multidomain interventions can improve intrinsic capacity, although high-quality evidence from randomized controlled trials is still lacking. Based on the WHO ICOPE guidelines, this article proposes a comprehensive management strategy covering screening, assessment, intervention and follow-up. It also recommends promoting implementation through three key aspects: establishing community-based screening systems for intrinsic capacity, improving multidisciplinary collaboration, and promoting the application of digital technologies. In the future, efforts should focus on accelerating the development of localized assessment tools, strengthening evidence-based research on integrated interventions, and promoting health data integration and intelligent early warning systems. These steps will support China in building a function-centered healthcare system for older adults and advance the achievement of healthy aging.

Background: Social accountability represents the social contract between medicine and society, encouraging healthcare professionals (HCPs) to address social and health-related issues. The importance of integrating social accountability into curricula is widely recognised, but there is a lack of comprehensive mapping of the specific elements that should be included. Objectives: To identify the key elements of social accountability that should be integrated into undergraduate health sciences curricula to develop socially accountable HCPs. Method: The scoping review was conducted following the Joanna Briggs Institute Reviewers’ Manual 2015 for scoping reviews. A comprehensive search was employed using various keyword combinations and search strings, inclusive of published and grey literature from the past 15 years. Studies were systematically charted and analysed. Results: A rigorous screening process resulted in 47 studies being included in the review. Majority of the studies were qualitative, with the highest number of studies originating from Canada, South Africa, and the United States, as well as several multi-country studies. Equity emerged as the most frequently mentioned value, while cost-effectiveness was discussed the least. Conclusion: The scoping review demonstrates that embedding equity-driven approaches, community engagement, interprofessional collaboration and transformative learning in healthcare systems and tertiary institutions is vital. Addressing these priorities through undergraduate health sciences training can foster more inclusive, responsive and effective healthcare delivery, and improve health outcomes. Clinical implications: Integrating the identified elements of social accountability into undergraduate health sciences curricula may lead to improved patient outcomes, reduced health disparities, and more effective, patient-centred care.

The wellbeing of healthcare workers is increasingly recognized as foundational to high-quality care and sustainable health systems. While various leadership frameworks promote wellbeing, there remains a gap in system-wide strategies that integrate equity, psychological safety and health promotion into leadership practice. This paper aims to address that gap by adapting the Okanagan Charter, originally developed for health-promoting universities, into a novel framework for health-promoting leadership in healthcare. This conceptual paper reinterprets the principles of the Okanagan Charter through the lens of inclusive, distributed and compassionate leadership. The authors adapt an established six-domain model to the health leadership context: embed health in all policies, adapt spaces to promote wellbeing, create thriving communities and cultures, support meaningful personal and professional development, promote engagement with health services and collaborate in continuous improvement and evaluation. For each domain, they provide theoretical rationale, leadership strategies and practice-based illustrations. This paper critically examines the applicability of the Okanagan Charter within healthcare leadership, highlights practical implementation challenges and presents a revised leadership case study grounded in real-world complexity. The findings demonstrate the utility of the six-domain model in guiding leaders to embed wellbeing into everyday practice. This paper advances existing scholarship by explicitly extending Okanagan Charter-aligned work into the domain of healthcare leadership. It offers a clear, theory-informed roadmap for leaders to integrate wellbeing, equity and health promotion into the fabric of organizational life, positioning health-promoting leadership as a strategic imperative for resilient, inclusive and high-performing health systems.

Mental health disorders contribute significantly to the global disease burden. Integrating mental health services into primary health care (PHC) systems is a promising solution, with nurses playing a critical yet under-explored role due to their proximity to communities and holistic care approach. This study aimed to systematically review and synthesize qualitative and mixed-methods evidence. A systematic review and meta-synthesis were conducted, adhering to PRISMA 2020 and ENTREQ guidelines. Six databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, Embase) were searched from inception to June 2025, supplemented by grey literature searches. Inclusion criteria, guided by the SPIDER framework, focused on qualitative and mixed-methods studies exploring nurses' roles in PHC mental health care. Study quality was assessed using the CASP Qualitative Checklist, and data were synthesized using thematic meta-synthesis, facilitated by NVivo 14. 34 studies from 18 countries were included, revealing four overarching themes: (1) Nurses' mitigation of multilevel stigma through empathy, education, and advocacy; (2) Challenges in navigating structural barriers, including resource scarcity, training gaps, workload pressures, and access inequities; (3) Adaptive psychosocial intervention practices using holistic assessments, empowerment strategies, technology, and cultural adaptations; and (4) Leadership in interprofessional patient-centered care through collaboration, trust-building, recovery-oriented frameworks, and systemic advocacy. Nurses are instrumental in advancing mental health equity in PHC systems by addressing stigma, overcoming barriers, delivering tailored interventions, and leading collaborative care. Enhancing their impact requires mandatory mental health training, resource allocation, interprofessional frameworks, and further research in diverse global contexts.

BACKGROUND Fatigue is debilitating and costly for patients with Crohn’s disease (CD) and the healthcare system. Thus, as there are no well-established therapies for fatigue in patients with CD, it is essential to investigate its risk factors and collaborate to prevent or reduce its burden. AIM To evaluate the variables associated with fatigue in outpatients with CD receiving pharmacological treatment. METHODS It is an observational study. Data, including sociodemographic information, inflammatory bowel disease fatigue scores, visual analog scale scores, Depression Anxiety Stress Scale-21 scores, insomnia assessment results, and laboratory test results, were collected. Statistical analyses included Student’s t tests, logistic and linear regressions, and receiver operating characteristic curve analysis, with a P value of < 0.05 indicating statistical significance. RESULTS One hundred patients were included (77% presented with fatigue). In the linear regression analysis, symptoms of depression, anxiety, stress, and insomnia were simultaneously included as predictors of fatigue. Although the model was statistically significant (adjusted R 2 = 0.128; P = 0.002), no single symptom was significantly associated. A composite score (0-4) was developed by summing the scores of the 4 symptoms, which were coded dichotomously (odds ratio = 2.60; 95% confidence interval: 1.61-4.83; P < 0.001). The composite score showed good discriminative capacity (area under the curve = 0.775). Patients with fatigue had higher total leukocyte (P = 0.034) and segmented neutrophil (P = 0.017) counts and lower lymphocyte (P = 0.019) and eosinophil (P = 0.036) counts. Effect sizes ranged from moderate to high (Cohen’s d 0.39-0.61), indicating that fatigue may be associated with a leukocyte pattern consistent with relative neutrophilia and lymphopenia. CONCLUSION Fatigue is associated with psychological symptoms, a sedentary lifestyle, and alterations in leukocyte subpopulations. Assessments incorporating composite symptom scales and hematological parameters may be practical and cost-effective for patients with fatigue.

Patients with diabetic retinopathy (DR) are at risk of visual deterioration owing to systemic and financial barriers in accessing appropriate care. DR screening tools that implement artificial intelligence (AI) algorithms are gaining recognition due to their accuracy and high-throughput potential. This systematic literature review aimed to understand the economic, humanistic, and clinical burden associated with delayed DR management and the impact of AI-based screening tools for diagnosis and treatment. MEDLINE, Embase, and Cochrane Library databases were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1 January 2014 to 28 October 2024). Screening, extraction, and quality assessment were performed by two independent reviewers. Supplementary searching was conducted to evaluate visual outcomes. In total, 33 records were included. Economic evidence demonstrated that infrequent screening was initially cost-saving but decreased patient quality-adjusted life years, delayed sight-threatening DR diagnosis, and resulted in high treatment-related costs in the long term. Several studies found delayed DR treatment to adversely impact visual acuity, central subfield thickness, and time spent with vision loss. The majority of economic studies evaluating AI-based screening found its use to result in lower overall costs than conventional screening, while two noted higher costs attributable to greater screening uptake and increased specialist referrals. Most studies that modeled clinical impact found AI-based screening to reduce blindness or vision loss versus conventional screening. This research underscored the considerable harms associated with delayed DR diagnosis and treatment. AI-based screening tools have the potential to become powerful instruments in supporting improved clinical outcomes for patients and economic benefits for healthcare systems.

Bevacizumab, originally developed by Genentech under the brand name Avastin® as an anti-cancer drug, has gained widespread off-label use in ophthalmology due to its similar mechanism of action to other anti-VEGF treatments and its significantly lower cost compared to available on label alternatives for ophthalmological indications. While off-label bevacizumab has been standard in clinical practice for over a decade, recently, a repurposed formulation (brand name: Lytenava®, Outlook Therapeutics Ltd), developed specifically for vascular retinal conditions, received marketing approval from the European Medicines Agency. This raises questions about what the price for a repurposed formulation should reasonably be, reflecting the efforts to obtain regulatory approval. This paper examines potential cost-based-plus pricing for such a repurposed formulation of bevacizumab using a novel pricing framework across four scenarios. By evaluating the pricing structure through an analysis of critical cost components, including, among others, research and development expenditures, manufacturing costs, and cost-of-capital, the study proposes a price range of €73 to €177 per injection. The explicit breakdown of these cost components provides valuable insights into the economic structure of repurposed biosimilars like bevacizumab, emphasizing how a cost-based-plus pricing model can support more transparent and informed negotiations between pharmaceutical companies and healthcare payers. Ultimately, this approach contributes to the development of pricing strategies that balance affordability for healthcare systems with sustainable returns for manufacturers while fostering the broader development of repurposed treatments. The findings of this paper aim to advance the dialogue on equitable pricing for repurposed therapies.

Nearly two thirds of Australian adults are estimated to use complementary therapies, including 36% who consult with such providers. Despite this relatively high use, traditional and complementary medicine (T&CM) providers and mainstream practitioners rarely collaborate. The World Health Organization (WHO) advocates for the integration of T&CM, as appropriate, towards strengthening universal health coverage and people-centred health care. This study explored the perspectives of primary care providers on greater integration of T&CM with Australia's healthcare system. Guided by a health policy and systems research approach, this qualitative study used purposive and convenience sampling to recruit general practitioners, registrars, and practice nurses. Semi-structured, in-depth interviews were thematically analysed using a hybrid inductive/deductive approach. The four main themes arising from the 13 interviewees were: (i) exposure to T&CM; (ii) perception of safety; (iii) priorities of the healthcare system; and (iv) acceptability. Participants had varying levels of knowledge about T&CM, which influenced attitudes towards T&CM integration. Participants were generally supportive of greater integration of T&CM providers with the health system, but patient safety, practitioner regulation, a robust evidence-base, and adequacy of T&CM provider training were factors shaping their views. Further research with a larger sample and a broader mix of stakeholders is needed to better understand Australians' appetite for, and the appropriateness of, more formal utilisation and/or integration of T&CM. Making robust evidence for specific T&CM therapies and providers more accessible to established or in-training healthcare professionals may be a pathway for greater understanding of the scope of T&CM practice in Australia.

While home-based self-sampling for cervical cancer screening is an evidence-based strategy proven to increase screening access and uptake, it is not currently recommended in the US despite recent Food and Drug Administration approval of the first at-home self-sampling device. Little nationally representative research has examined preference for and drivers of home-based self-sampling over clinic-based testing (the standard of care). To assess women's perspectives about, reasons for considering, and factors associated with preferring at-home self-sampling for cervical cancer screening. This population-based cross-sectional study used data from the 2024 Health Interview National Trends Survey (HINTS 7), a nationally representative survey of the civilian, noninstitutionalized US adult population offered between March and September 2024. Respondents included in this study were individuals aged between 21 and 65 years who were eligible for cervical cancer screening per the US Preventive Services Task Force guidelines and who self-reported their gender identity. Respondents who indicated not needing cervical cancer screening or who did not report their preference for any screening modality (home-based self-sampling or clinician-collected sampling) were excluded. Data were analyzed from May 12 to 25, 2025. Age, race and ethnicity, income, educational level, sexual orientation, marital status, health insurance, urbanicity of residence, trust in the health care system, past-year number of visits to a health care practitioner, and prior experience of discrimination or prejudice when getting medical care. The main outcome was preference for at-home vaginal self-sampling over clinic-based testing, measured using the HINTS 7 question, "If you had choice, how would you prefer to do the cervical cancer screening test?" Responses were: preference to have a health care practitioner do the test in his or her office, preference to self-collect specimen for the test at home, not knowing which option to choose, and not applicable. Weights were assigned to improve representativeness of the general US adult population. The proportion of individuals who reported preferring either screening modality was estimated using weighted percentages. Survey-weighted odds ratios (ORs), adjusted for covariates, were calculated to identify factors associated with preference for at-home self-sampling. Among the 2300 women included (mean [SD] age, 45.5 [29.2] years), most were married or living as married (weighted percentage, 58.2% [95% CI, 56.5%-60.0%]), health insured (91.9%; 95% CI, 90.7%-93.1%), and educated up to some college (61.6%; 95% CI, 60.1%-63.0%). Overall, 462 (20.4%; 95% CI, 17.4%-23.4%) preferred at-home self-sampling, 1402 (60.8%; 95% CI, 57.2%-64.4%) preferred clinic-based testing, and 436 (18.8%; 95% CI, 15.5%-22.1%) were uncertain about their choice. Non-Hispanic Black respondents (adjusted OR [AOR], 0.45; 95% CI, 0.21-0.96) had lower odds of preferring at-home self-sampling compared with non-Hispanic White individuals. Women who had experienced prejudice or discrimination when getting medical care had higher odds (AOR, 1.94; 95% CI, 1.16-3.22) of preferring at-home self-sampling. The most commonly self-reported reasons for preferring at-home self-sampling were privacy (54.9%; 95% CI, 49.8%-60.0%), time constraints (35.1%; 95% CI, 29.0%-41.2%), and fear of embarrassment (33.4%; 95% CI, 28.0%-38.8%). In this cross-sectional study, marginalized populations, individuals with low income, and individuals who do not trust the health care system were more likely to prefer at-home self-sampling for cervical cancer screening or not know which option to choose. To address cervical cancer inequities and increase screening uptake, the findings suggest US guidelines should incorporate home-based self-sampling as an alternative to clinic-based testing, women's education and empowerment should be enhanced, and tailored interventions focusing on high-risk groups are needed to increase awareness and self-confidence in performing home-based self-sampling.

There are limited data available to understand the value of bioactive glass for spinal fusion procedures. Bone morphogenic protein-2 (BMP-2) is an established graft that has been on the market for roughly 24 years, while bioactive glass represents a newer class of graft technology. The objective of this study is to compare economic, health care utilization, and postoperative outcomes associated with the use of a bioactive glass vs BMP-2. A retrospective, comparative study was conducted to compare a bioactive glass, FIBERGRAFT (DePuy Synthes, Raynham, MA), to BMP-2. The Premier hospital billing database was used. Patients who underwent lumbar fusion from 2016 to 2024 with bioactive glass or BMP-2 were included. The primary study outcome was index hospital cost. The exploratory outcomes were length of stay, operation room time, and 1-year pseudarthrosis, spinal infection overall (defined as the presence of spinal infection or surgical site infection), and surgical site infection only. Patients in each graft group were balanced using propensity score matching. Analyses were conducted for the overall cohort (primary) and, as a sensitivity analysis, for a subset of patients based on primary procedure and diagnosis. The group sizes for each cohort before balancing were 1,013 and 59,394 patients for bioactive glass and BMP-2, respectively. After matching, the group sizes for both grafts were 1013 patients for a total of 2026 patients in the matched cohort. In the matched cohort, 65 to 74 years was the most frequent age group (34% in each cohort), and more than half were women (57% bioactive glass, 56% BMP-2). The mean (95% CI) index hospital costs were $40,187 ($39,132, $41,241) for bioactive glass and $45,010 ($43,809, $46,211) for BMP-2, representing a mean difference (95% CI) of -$4823 ($-6382, $-3265), P < 0.001. The exploratory endpoints were similar for both grafts. Both the primary and sensitivity analyses demonstrated consistent results. This study suggests that patients who undergo lumbar fusion with bioactive glass have lower index costs and similar health care resource utilization and postoperative outcomes compared with those who receive BMP-2. Results from this study may help payers, health care systems, and providers make value-based decisions regarding product utilization. This research provides an understanding of hospital costs, health care resource utilization, and 1-year outcomes of bioactive glass used in lumbar fusion surgery using a comparative study design.

As the global elderly population grows, there is an increasing need for reliable and easy to use health monitoring tools that support independent living and reduce strain on healthcare system. This study presents the development of a wearable, Internet of Things (IoT) enabled device designed to monitor vital signs and environmental conditions in real time. The system integrated two low-cost sensors: the MAX30100 for tracking blood oxygen saturation (SpO₂) and heart rate, and the BME680 for measuring temperature, humidity, gas resistance (for VOCs), and air pressure. These sensors were connected to ESP8266 microcontroller that transmitted data through Wi-Fi to a mobile dashboard using the Blynk platform. To improve accuracy, especially during motion, signal processing techniques such as a moving average filter were implemented. The device was tested against commercial health monitoring tools and demonstrated strong performance, with an average error of ±2% for SpO₂ and ±5 BPM for heart rate. It also included threshold-based alerts to notify users or caregivers when readings exceed safe limits. This study contributes to the advancement of affordable, remote health monitoring systems by offering a practical solution that combines physiological and environmental sensing in a compact, user-friendly design. Its potential applications include elderly home care, telehealth services, and mobile health clinics.

Prostate cancer (PC) is the second most common cancer in men. Although many studies have assessed its economic burden, no recent reviews have focused on studies conducted under current clinical guidelines. This study systematically reviews recent cost-of-illness studies evaluating direct and indirect costs associated with PC. A systematic search was conducted using the PICOS framework and a combination of free-text and MeSH terms in PubMed and the Cochrane Library, and only free-text terms in EconLit. The search included articles published between January 2015 and October 2025. Data on total, direct, and indirect costs were extracted and synthesized. All costs were converted to 2025 USD, and quality of studies was assessed with a simplified version of the CHEERS checklist. Ninety-five studies met the inclusion criteria. Direct medical costs for non-metastatic prostate cancer (nmPC) varied widely by disease stage, treatment, and country, ranging from approximately US$1200 to US$280,000 per patient-year, with higher costs observed in advanced stages and in patients experiencing treatment-related adverse events (AEs). Progression to metastatic disease was associated with a marked cost escalation, with annual costs largely driven by systemic therapies and skeletal-related events. Indirect costs ranged from US$666 to US$12,900 per patient-year and accounted for up to 30% of total PC-related costs, primarily due to productivity losses from premature mortality. PC imposes a substantial economic burden on healthcare systems and society, particularly in advanced stages. Policy promoting early detection, risk-adapted treatment, and equitable therapy access may help contain costs. Further research should address the economic impact of emerging diagnostics and minimally invasive interventions.

Transportation noise is increasingly recognized as a cardiometabolic stressor, but its relationship with type 2 diabetes mellitus (T2DM) remains poorly defined. We examined whether transportation noise exposure was associated with incident T2DM in a large, diverse U.S. healthcare system cohort. We identified adults without baseline T2DM from the Houston Methodist Learning Health System Registry (2016-2023). Transportation noise exposure was assigned at the census block group level using the 2020 U.S. Department of Transportation National Transportation Noise Map. Five noise categories were examined: Road, Rail, Aviation, Road plus Aviation and Total. Cox proportional hazards models estimated associations across predefined categories, Quiet (≤45 dB), Moderate (45-54 dB) and Loud (≥55 dB), and per 10 dB increase, adjusting for demographics, cardiometabolic risk factors, socioeconomic vulnerability and PM₂.₅. Among 984 658 adults (2.1 million person-years), 39 587 developed T2DM (1.88 per 100 person-years). Loud rail noise (HR 1.14; 95% CI: 1.01-1.29) and loud total noise (HR 1.17; 95% CI: 1.03-1.33) were associated with higher T2DM risk. Continuous models showed similar patterns, with each 10 dB increase in rail noise (HR 1.09; 95% CI: 1.05-1.13) and road noise (HR 1.04; 95% CI: 1.01-1.08) associated with a higher hazard of incident T2DM. Effect sizes were modest but internally consistent and aligned with prior environmental noise studies. Transportation noise, particularly rail noise, was associated with higher T2DM risk. Given plausible mechanisms involving sleep disruption and stress-related neuroendocrine activation, these findings add to evidence linking environmental noise to metabolic health and motivate further studies to evaluate causality and potential benefits of noise mitigation.

Background: Breast-conserving surgery (BCS) followed by adjuvant radiotherapy (RT) remains the standard of care for early-stage breast cancer (ESBC), supported by decades of randomized trials demonstrating reduced local recurrence and improved survival. Recent advances in radiobiology, molecular profiling, and treatment delivery have expanded the range of RT options, allowing for more personalized, risk-adapted approaches. Objective: This review aims to summarize and critically evaluate current radiotherapy strategies for ESBC, with a focus on hypofractionated regimens, radiotherapy omission, and the influence of patient age on treatment selection and outcomes. Content: We discuss the clinical evidence supporting moderate and ultra-hypofractionated RT schedules, including long-term results from the START and FAST-Forward trials, and highlight the gradual adoption of these regimens into practice. We examine barriers to widespread implementation, such as concerns about long-term toxicity in younger patients and financial disincentives in certain healthcare systems. The review also explores RT omission in low-risk elderly patients, emphasizing ongoing debates surrounding adherence to endocrine therapy, patient quality of life, and evolving trial data. Age-specific considerations, including differences in tumor biology, life expectancy, and treatment tolerance, are integrated throughout the discussion to underscore the need for individualized treatment planning. In this context, it is important to consider the side effects of hormonal therapy, as younger women may experience greater impacts on fertility, sexual health, and daily functioning, while older women are more prone to bone loss, joint pain, and metabolic effects, all of which influence quality of life and adherence to treatment. Conclusions: As evidence continues to support shorter and more targeted RT regimens, clinical practice must adapt to balance efficacy, safety, and patient-centered outcomes. Treatment decisions should increasingly reflect patient-specific factors rather than age alone. Ongoing trials and extended follow-up will further refine these approaches, advancing the paradigm of personalized radiotherapy in early breast cancer.

Despite the relatively high turnover rates and increasing demand for homecare, little is known about the costs of turnover for homecare employers. To create effective policies to reduce turnover and associated costs, employers require an understanding of what factors contribute to the costs of turnover. Building upon existing models from labour economic and human resources theories, we worked with subject matter experts from a large homecare employer organization to co-design the first known homecare cost of turnover model. The resulting model accounts for sector-specific cost differences and can be used to estimate the costs of homecare worker turnover. As homecare continues to face high workforce instability, clear estimates of the cost of turnover can guide organizations and decision-makers in the evidence-based design of retention policies and programs to the benefit of homecare workers, funders, those seeking homecare, and the broader health and social care system.

ABSTRACT Safety is a major concern in healthcare. Human reliability analysis (HRA) is a systematic risk assessment technique that has been applied in healthcare systems to make a positive contribution to patient safety. Much research has been conducted on this topic. However, there is currently no systematic literature review and no detailed summary or categorical study has been formally conducted. The aim of this review is to analyze the status of HRA in healthcare between Jan. 2000 and Aug. 2025. Specifically, publications from the Web of Science (WOS) were analyzed for publication trends, collaborative networks, and keyword co‐occurrence networks. The literature was also categorized according to the different research methodologies of HRA in various adverse events, with a focus on different performance influencing factors (PIFs) in HRA. Based on these findings, we identified and discussed several promising research directions that can help the community better understand how HRA is applied in healthcare.

Digital communication technologies are transforming healthcare delivery in low-resource settings. In Kenya, tools such as Short Message Service (SMS) and mobile health (mHealth) platforms are being increasingly utilised to enhance communication, patient engagement, and service delivery in public hospitals. This study examined the types of digital communication tools used in Kenya’s public health system, their impact on patient satisfaction, and service outcomes. A systematic literature review that included ten studies conducted between 2017 and 2024 was undertaken. Data were analysed thematically to identify patterns in technology use, challenges, and patient-centred outcomes. SMS-based and interactive two-way messaging systems were the most common tools. They enhanced appointment adherence, treatment follow-up, and patient engagement while improving communication efficiency and satisfaction. Two-way interactions strengthened provider–patient relationships by enabling timely responses to patients’ concerns. However, challenges such as poor network coverage, limited access to mobile devices, and inadequate staff training hindered full implementation. Digital communication tools, particularly SMS and mHealth platforms, have significantly improved patient satisfaction and healthcare delivery in Kenya. Addressing infrastructural and literacy barriers will be essential for sustaining equitable, efficient, and patient-centred digital healthcare systems.

The European Society of Cardiology (ESC) develops and updates clinical practice guidelines (CPGs) based on the latest evidence. However, their implementation remains suboptimal, leading to missed opportunities to improve cardiovascular (CV) outcomes. The success of CPG implementation is influenced by four key factors: (1) patient-related barriers, (2) health care professionals' engagement, (3) the clarity and usability of CPGs, and (4) the health care system and economic context in which care is delivered. To address these challenges, innovative strategies are needed to bridge the gap between CPG recommendations and clinical practice. The ESC has developed several initiatives to improve implementation, including (1) educational programmes, (2) examinations for cardiologists, (3) accreditation policies, and (4) registries. However, persistent gaps indicate that knowledge dissemination alone is insufficient. A more integrated, structured, and equitable approach to quality-of-care improvement is required. Despite the need for evidence-based implementation strategies, only a limited number of high-quality randomised controlled trials (RCTs) have evaluated individual approaches for CV conditions. Strategies such as text messaging, educational interventions, the involvement of non-physician health workers, structured order sheets, and financial incentives have been tested, but their feasibility and effectiveness can vary across health care systems. Future research should explore the potential of artificial intelligence (AI)-enhanced technologies to support and scale implementation efforts. This manuscript reviews current evidence on CPG implementation and proposes strategies to enhance the adoption of best practices in CV care.

ABSTRACT Integrating healthcare systems with intelligent transportation networks represents a critical frontier in modern urban infrastructure, where efficient resource allocation and timely service delivery can significantly impact patient outcomes. However, current approaches often fail to capture the complex interplay between healthcare facility accessibility and transportation dynamics, particularly during emergencies. Additionally, the temporal dependencies in healthcare service delivery follow strict sequential patterns that significantly influence both routine operations and emergency response effectiveness. To address these challenges, we propose a multi‐scale spatio‐temporal transformer network for healthcare and transportation (MST‐HT) that leverages generative AI capabilities. Our model employs multiple specialised transformer networks to model different spatial scales, capturing hidden dependencies while using graph convolutional networks to learn static infrastructure features. The architecture incorporates healthcare district patterns, emergency response corridors and facility distributions through a novel gating mechanism that adaptively combines features based on their predictive importance. The model maintains awareness of critical service delivery patterns by embedding healthcare‐specific temporal position information while optimising resource allocation. Experiments on real‐world datasets demonstrate MST‐HT's superior performance, achieving a 15.7% reduction in emergency response times and a 23.4% improvement in resource allocation efficiency compared to state‐of‐the‐art baselines.

ABSTRACT Background The impact of health technology systems (HTS), including telehealth and patient portals, on patient-provider communication, especially among women with a high-risk pregnancy who need more in-depth medical assessments, is not fully understood. Hence, this study explored the experiences of women experiencing high-risk pregnancies and perinatal healthcare providers with telehealth and patient portals using the patient-provider communication framework. Methods This qualitative study used a phenomenological approach. Purposeful sampling was used to recruit fifteen women experiencing high-risk pregnancies and eight providers from two obstetric practices, predominantly serving women on Medicaid. Semi-structured interviews were conducted, transcribed, and then analyzed using inductive thematic analysis. Results The themes and subthemes were developed iteratively. The main themes were consistent across both groups while the subthemes varied. The main themes included benefits of and barriers to HTS, patient-provider interaction, system-level actions, and future recommendations. The analysis revealed that while HTS improved access to care and empowered patients, both groups faced significant challenges. Providers noted that HTS do not address the complex needs of high-risk pregnancies and the issue of workflow disruption. Patients appreciated the convenience of HTS, but reported delays in communication and limited interaction with healthcare teams. Conclusions HTS are emerging safety net tools that can improve access to prenatal care and increase shared-decision making and patient empowerment. High-risk pregnancy needs require multifactorial solutions to ensure comprehensive care leveraging HTS, with patient-provider communication at the core of managing these challenges. Healthcare systems need to invest in improving HTS to meet the needs of vulnerable populations. Plain Language This study explored the experiences of women experiencing high-risk pregnancies and perinatal healthcare providers with health technology systems (HTS), specifically telehealth and patient portals. Interviews were conducted with fifteen women with high-risk pregnancies and eight healthcare providers from two obstetric practices, predominantly serving women on Medicaid. The analysis revealed that while HTS improved access to care and empowered patients, both groups faced significant challenges. Providers noted that HTS do not address the complex needs of high-risk pregnancies and the issue of workflow disruption. Patients appreciated the convenience of HTS, but reported delays in communication and limited interaction with healthcare teams.