High-quality Care Research Articles

How can effective communication help radiographers meet the expectations of patients-COMMUNICATION-a joint statement by the ESR & EFRS.

The Patient Advisory Group (PAG) of the European Society of Radiology, in collaboration with the European Federation of Radiographer Societies (EFRS), aims to highlight, in this short paper, the important role that communication plays when trying to meet patients' expectations throughout their imaging journey in a radiology department. The interactions with radiography professionals carrying out diagnostic or interventional procedures are critical in supporting high-quality patient care and patients' expectations. The key areas of consideration have been summarised in an easy-to-remember mnemonic: COMMUNICATION. There are different healthcare systems and medical imaging services across Europe, and healthcare providers should be mindful, when setting up new operational procedures, of the need for processes and systems to support the delivery of patient-centred care. At times when new or improved technology is being introduced, such as artificial intelligence applications, telemedicine, robotisation of interventional procedures, and digitised records, the impact on patient-radiographer communication and interactions should be considered. CRITICAL RELEVANCE STATEMENT: Effective communication helps radiographers meet patients' expectations by ensuring clear explanations, reducing anxiety, fostering trust, and improving cooperation during procedures. This enhances patient satisfaction, safety, and the overall quality of care, aligning with professional standards and patient-centred healthcare. KEY POINTS: Patient-centred imaging services are key to meeting patients' demands. Radiography professionals in radiology departments and medical imaging services should always communicate effectively with patients. This ESR-Patient Advisory Group publication attempts to summarise the key areas that should be embedded in patient communication. The 'COMMUNICATION' statement can be used as a reminder to all radiography professionals to work to improve patient-radiographer interactions and provide patient-focused services.

The impact of using simulation-based learning to further develop communication skills of pharmacy students and pharmacists: a systematic review

BackgroundEffective communication in healthcare, among professionals and between professionals and patients is crucial for delivering high-quality care. While simulation effectively translates technical skills to clinical practice, its impact on communication, particularly in pharmacies, is less well documented.AimThis systematic review examined the impact of simulation-based education on communication skills among pharmacy students and pharmacists. It aims to identify the types of simulations used, the outcomes obtained, and the effectiveness of these simulations in enhancing communication skills, perception and confidence.MethodWe conducted searches in MEDLINE, LISSA, EMBASE, and PsycINFO for articles on communication training through simulation for pharmacy students and pharmacists. The search covered the period from inception to August 31, 2022. To be included, studies had to meet the following criteria: (i) target pharmacy student or graduate pharmacists; (ii) use simulation in the field of clinical pharmacy; (iii) provide a complete description of the outcome measure. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. Three investigators independently evaluated each title and abstract. If each investigator considered the citation eligible, six authors progressed to full-text review. The outcomes related to communication were categorized into three groups: perception of the importance of communication in delivering high-quality patient care, confidence in communication skills, and assessed communication proficiency. The quality of studies included in this review was assessed using the Mixed Methods Appraisal Tool (MMAT).ResultsThe total number of participants was 3337. Among the 20 articles reviewed, which were primarily published in the United States over the last decade, only one focused on community pharmacists. Quasi experimental designs were predominant, and studies often relied on learners' self-assessments with non-validated questionnaires. Simulation-based learning aimed to enhance communication skills and attitudes across interprofessional contexts (involving nursing and medical students), patients, and families, frequently utilizing simulated patients. Studies evaluating outcomes have emphasized communication skills with patients and families, while those involving healthcare professionals often focused on perception of the importance of communication in delivering high-quality patient care.ConclusionDespite study heterogeneity, this systematic review concluded that simulation-based training significantly enhances perception, confidence, and communication skills. The development of clear guidelines and standardized assessment tools to evaluate communication would significantly improve the validity and reliability of future research efforts (PROSPERO registration: n°CRD42022371915).

Barriers to advancing the sexual and reproductive health agenda in Latin America: a qualitative study of key informants’ perspectives

BackgroundThe effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI + population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper presents the findings from the qualitative component of a broader mixed-methods scoping study aimed at establishing a priority research agenda to address healthcare gaps affecting the SRMHR of vulnerable populations. The qualitative component focused on identifying key challenges hindering progress in SRMHR and access to health services for these populations in the LAC region, drawing on the perspectives of key informants at both regional and national levels.MethodsQualitative research approach employing semi-structured interviews with key informants. A purposive sample comprised of stakeholders from relevant regional organizations and local stakeholders in selected countries (Argentina, Colombia, Peru, Mexico, Guatemala, Jamaica, and Guyana), encompassing government representatives, civil organizations, and academia. A rapid content thematic analysis was conducted to analyze the data obtained from the interviews.ResultsWe interviewed 27 key informants in SRMHR, six at a regional level and 21 at a country level. The region faces barriers around establishing and sustaining agency agendas, such as a lack of political will, political instability, and opposition from civil society groups regarding SRMHR agendas. Policy implementation presents difficulties due to insufficient and unstable funding, weaknesses in sexual and reproductive health programs, unequal policy implementation in federal countries, and the absence of evidence-based policies. The lack of high-quality data and quality indicators poses obstacles, leading to limitations in evidence generation. Access to SRMHR services faces barriers such as the low-quality provision of services, discrepancies between legislation and effective access, insufficient healthcare resources, and resistance from certain healthcare providers.ConclusionAddressing these multifaceted challenges will be crucial in advancing the agenda of sexual, reproductive, and maternal health rights and ensuring effective access to health services for the most vulnerable populations in the LAC region.

Educational needs for nursing manager competency in Korean hospitals: multi-center cross-sectional study

BackgroundNursing managers have a critical responsibility for high-quality care, nursing staff support, and business operations for hospital outcomes. As the healthcare environment has changed, the role of nursing managers and the competencies required have evolved. This study aims to assess the educational needs for nursing management competency among 155 nursing managers in one tertiary and six general hospitals in South Korea.MethodsData were collected from April 1 to May 20, 2023, using self-reported questionnaires. The Borich needs assessment and locus for focus model were used to analyze educational needs.ResultsThe results revealed that key components in the administrative manager (ensuring a safe working environment) and leader (fostering a positive workplace atmosphere) domains were most important. The lowest-scored item for performance was “Completing education to enhance competency as a manager and participating in external activities” in the educator domain. The most difficult item was “Allocation of appropriate nursing staff based on nursing requirements and adjustment of tasks” in the administrative manager domain. The top-priority items in administrative manager competencies were “Allocation of appropriate nursing staff based on nursing requirements, and adjustment of tasks” and “Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks.”ConclusionsThese findings underscore the necessity for nursing organizations to provide specialized training modules that address the identified needs, especially focusing on human resource management skills, the allocation of nursing staff, and resource acquisition and management for nursing managers. Furthermore, nursing organizations should support ongoing education and professional development activities through recognition, financial support, or career progression opportunities.

Obstacles to effective communication between physical/occupational therapists and patients in the Saudi Arabian context: a cross-sectional study

BackgroundEffective communication between healthcare providers and patients is essential for high-quality care and patient satisfaction. Barriers to communication can lead to misunderstandings and poorer health outcomes. This study aims to identify communication obstacles between physical/occupational therapists (PTs/OTs) and patients in the Saudi Arabian context.MethodsThis cross-sectional study, which was conducted from September 2022 to January 2023, involved 228 patients and 46 therapists from the rehabilitation services department. Data were collected via two self-administered questionnaires and analyzed via Pearson’s chi-square test of independence and Fisher’s exact test for categorical nominal data to assess associations between variables. A p value of less than 0.05 was considered statistically significant.ResultsMost patients (25.4%) were young adults aged 18–30 years, predominantly Saudi nationals (96.5%), with undergraduate degrees (63%). High satisfaction with therapists was reported by 69.3% of patients. The key barriers identified included limited consultation time (15.8%) and the use of medical records (4.8%). Therapists, primarily young professionals aged 25–30 years (54.3%) with 3–5 years of experience (43.5%), also reported time limitations (30.4%), physical setup issues (37.0%), and poor patient history-taking (56.5%) as significant barriers. Additional findings from our study indicated that monolingual Arabic-speaking therapists faced greater challenges in understanding language (p = 0.02), and younger therapists (aged 25–30) reported greater difficulties in managing multiple problems during sessions (p = 0.03), highlighting age and linguistic background as significant factors influencing communication efficacy.ConclusionsAddressing communication barriers through targeted interventions, such as enhanced training, improved clinical structures, and advanced electronic health records, can improve patient satisfaction and treatment outcomes. Future research should focus on longitudinal studies and specific communication training programs.

Supporting Nurses’ Commitment Towards Voluntary Error Reporting: A discursive paper of current policies and recommendations

Medical error is a serious public health concern and undermines healthcare organizations' commitment to drive safe, high-quality patient care. Voluntary error reporting (VER) is one key solution to address this concern because it is through conducting root cause analysis that constructive retrospective learning can take place to improve future practice. Nurses form the largest health workforce and are key stakeholders contributing to the institutional error management culture. While the significance of VER and nurses' role in driving this initiative cannot be further emphasized, studies revealed that nurses failed to engage in VER due to less positive experiences towards VER. Nurses' negative attitude towards VER can be attributed to unsupportive organizational responses to their act of VER, underpinned by the endorsement of blame, shame, and punitive culture consistent with the human approach to error management. This induces fear of speaking up for error among nurses, creating a culture of silence. This paper examines and discusses current policies underpinning the error management system and identifies the contemporary factors that challenge these policies, followed by proposing recommendations to support these policies to drive nurses' commitment to VER and improve the overall error management system.

The challenges and needs of international nurses who are assimilating to healthcare systems in the United Kingdom: Experience from the field.

The paper explores the barriers and enablers for international nurses who are assimilating to new healthcare systems in the United Kingdom and implications for the global healthcare context. The worldwide shortage of nurses has led to high levels of global mobility. It is therefore essential to acknowledge the international nature of healthcare and the diversity of experience within the nursing workforce. The paper reflects on the authors' experiences of designing and delivering acculturation and communication skills training for Internationally Educated Nurses (IENs) who work in the National Health Service in the United Kingdom. The paper highlights the challenges of assimilating to a new healthcare environment, the importance of support and the value of 'two-way learning'. The author discusses the hidden processes of social and personal adjustment, which are not widely reported. Successful cultural integration should be multifaceted and include opportunities for two-way learning. Nurses require ongoing and directed support to deliver high-quality care in diverse and changing health systems. As healthcare in the UK is and continues to become increasingly international, the benefits and challenges this presents need to be acknowledged by both government and healthcare management in the form of policy recommendations, guidelines and regulatory frameworks which go beyond testing clinical and linguistic skills on arrival and aims to promote well-being, retention, and reduced stress at work.

Specialized in trauma surgery-Not a simple way

The question of the need for generalists and specialists in trauma surgery is controversially discussed concerning the challenges in the healthcare system, the interdisciplinary nature of the discipline, and the consequences of increasing specialization. The hospital reform as well as the availability of personnel and financing are discussed as central points. For high-quality patient care it is essential that the balancing act between generalists and specialists is successful. Effective interdisciplinary collaboration and holistic thinking are crucial to overcome the challenges in the healthcare system and to fulfil the needs of patients.

Investigation and management of resistant hypertension: British and Irish Hypertension Society position statement.

People living with resistant hypertension (RH) are at high risk of adverse cardiovascular events. The British and Irish Hypertension Society has identified suspected RH as a condition for which specialist guidance may improve rates of blood pressure control and help clinicians identify those individuals who may benefit from specialist review. In this position statement we provide a practical approach for the investigation and management of adults with RH. We highlight gaps in the current evidence and identify important future research questions. Our aim is to support the delivery of high-quality and consistent care to people living with RH across the UK and Ireland.

Cancer Nursing Frameworks to Guide Clinical Capability, Education and Careers: A Scoping Review of the International Literature.

This review aimed to provide a current global profile of all existing cancer nursing competency, capability, education and career frameworks and map capabilities and competencies to the clinical, facilitation of education, management and research pillars of practice. Scoping review. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Epistemonikos, Google Scholar, Medline, and PubMed. Gray literature searches and reference list searches were also performed. This review was guided by Arksey and O'Malley's method and followed PRISMA guidelines for reporting. Screening and data extraction was conducted independently by two or more authors. The quality of frameworks were assessed using The Joanna Briggs Institute (JBI) critical appraisal checklist for textual evidence: policy/consensus guidelines. Data were analyzed and narratively synthesized by experienced cancer nurse researchers. Thirty-four articles were included, comprising of 29 cancer nursing frameworks. Frameworks were categorized as competency frameworks, career and education frameworks, education/learning pathways, and career/professional development frameworks. Competencies and capabilities described in the frameworks were mapped to the four pillars of practice including clinical (n = 27), facilitation of learning (n = 20), leadership and management (n = 23), and research and scholarship (n = 24). Comprehensive cancer nursing frameworks are pivotal in enabling nurse leaders to grow and develop the cancer nursing workforce globally. They are also integral to support cancer nurses in providing high-quality, effective, and safe care for patients and their families across the cancer continuum. This is the first review to comprehensively capture and synthesize the capabilities, educational components, and career pathways outlined in existing cancer nursing frameworks worldwide and highlights where areas of improvement are needed to support professional growth, job satisfaction and retention of cancer nurses. This article is a review of frameworks and does not include patient or public contribution.

Evaluating the effect of a virtual reality digital therapeutic on maternal stress among expectant and postpartum Black and Latina mothers: a protocol paper

BackgroundMaternal mental health is vital to overall well-being, particularly among expectant and postpartum Black and Latina women who experience higher stress levels and mental health challenges. Traditional healthcare systems often fail to meet these needs, underscoring the need for innovative and accessible interventions. NurtureVR, a digital maternal mental health and educational program, leverages virtual reality to offer mindfulness, relaxation, and guided imagery to support these women.ObjectivesThis protocol aims to evaluate whether NurtureVR, a digital therapeutic, can reduce stress levels and mental health symptoms in pregnant and postpartum Black and Latina women, improve sleep, enhance pregnancy and childbirth experiences, and increase pregnancy and postpartum health literacy.MethodsThe Nurturing Moms study uses a pre- and post-intervention design with a 5-week NurtureVR program. Fifty participants, 25 expectant and 25 postpartum Black and Latina women, will be recruited through clinics, community organizations, and online platforms. The study involves three phases: baseline assessments of stress, mood, self-efficacy, demographics, and health history; daily use of NurtureVR for 15 minutes during the third trimester and six weeks postpartum; and follow-up assessments at six weeks postpartum. The program includes 49 modules on labor and delivery, stress during pregnancy, nutrition, breastfeeding, hormonal changes, 3D VR representations of fetal development, pain management simulations, and mindfulness exercises for labor. Participants will report stress, anxiety, mood, and pain levels following each VR session. Additional qualitative insights will be gathered through focus groups, and an optional survey will be administered one-year post-intervention to evaluate long-term effects.ConclusionsThe Nurturing Moms study seeks to create a more inclusive and equitable healthcare landscape, demonstrating that digital interventions like NurtureVR are essential for providing high-quality maternal care. By democratizing access to clinical research and healthcare, this decentralized trial promotes equity, improves the generalizability of findings, and accelerates the development of new treatments. The study’s innovative approach has the potential to improve maternal experiences of stress, sleep, and overall health outcomes for Black and Latina mothers and children, despite limitations such as sample size, language barriers, and the preliminary nature of a pilot and feasibility study.

Intensive care and emergency medicine overuse and sustainability

This review examines the issue of overtreatment and overdiagnosis in the context of intensive care and emergency medicine and its relationship to sustainability. It shows that the intensive use of resources, both human and technology, is often associated with risks of overuse, especially in critical medical situations. More diagnostic and therapeutic measures are often taken than necessary, leading to both stress for the patient and ahigh consumption of resources. One of the main problems is the often difficult distinction between necessary and excessive treatment. Uncertainty in acute care, coupled with legal concerns, often leads to defensive medicine. This means that, for safety reasons, physicians initiate more diagnostic tests and treatments than are clinically necessary. There are also economic disincentives in the healthcare system that encourage overtreatment. The paper also discusses the role of guidelines, particularly with respect to patient preferences. These can help to avoid unnecessary admissions to the intensive care unit and thus contribute to sustainability. The discussion shows that sustainability should not be at odds with high-quality patient care. Rather, treatment options should also be considered in terms of their contribution to sustainability, without neglecting the individual needs of patients.

Ten Reflections to Consider Before Your First Research Project.

Pediatrics is an ever-evolving field, and clinicians focused on clinical care, including pediatric hospital medicine providers, are in an ideal position to develop research projects that advance evidence-based practice. However, clinical providers get pulled away from their research to deliver high-quality education and care at the bedside to children and families. The challenges of balancing these important goals are ones most faculty will face their entire career. This is most difficult for faculty taking on their first project, as they have yet to refine their research skills, learn their various institutional resources, and build a research team. The purpose of our manuscript is to offer 10 reflections to consider when developing your first research project. We intentionally focused on concepts we felt were highly relevant to first research project experiences. Our goal is to motivate talented clinicians and encourage the development of a solid project foundation to avoid the various pitfalls we have experienced.

Values of welfare technologies: a qualitative study of how employees in Swedish care for older adults understand and justify the use of new technology

BackgroundIn Swedish care for older adults, the use of welfare technology − for example, medicine-dispensing robots and GPS alarms − stimulates ongoing evaluations and negotiations. National policy documents, as well as previous research, indicate that these technologies are expected to improve the quality and efficiency of care but also involve potential or experienced challenges in providing high-quality care and the conditions for care workers − often portrayed as a conflict between political and caring organizational values. More research is thus needed on how the use of welfare technology is justified at central and municipal government levels as well as within care-providing organizations. This article aims to identify how the introduction and use of welfare technology is justified by employees and in policy documents pertaining to welfare technology in Swedish care for older people.MethodsQualitative interview data involving 37 individuals were collected in municipalities in southern Sweden. The interviewees were managers, administrative staff, and licensed practical nurses working in home care services or special housing for older adults, offering care 24/7. Policy documents and agreements of significance for Swedish welfare technology policy were analysed. The analysis focused on values promoted as significant for the provision of care and related to the use of welfare technology. Justifications and values were analysed as belonging to different ‘worlds of worth’, as either shared or conflicting, and contextually situated.ResultsThe documents reflect values regarding, for instance, efficiency, independence, good working conditions, optimised use of human resources, and time to tend to relationships. The employees justified the use of welfare technologies with reference to optimisation and efficiency, activation and participation, dignity and freedom, social relationships, and good working conditions. These values represent three different worlds of worth − the industrial world, the civic world, and the domestic world − and are situated in employees’ everyday work practices.ConclusionsValues presented by employees and in policy documents are shared rather than conflicting. However, employees emphasise values associated with the domestic world, downplaying industrial values. We argue that politicians and civil servants should consider the situated judgements made by employees and develop more bottom-up strategies. This requires an acknowledgement of the existing values hierarchy, where values of optimisation and efficiency are held in high esteem but to accommodate higher values rather than as end goals.

Transition of care: toward tailored transition of adolescents with osteoporosis and metabolic bone diseases to adult care through an integrated, people-centered, disease-specific health services framework

BackgroundThe Egyptian Academy of Bone and Muscle Health in collaboration with the Egyptian College of Pediatric Rheumatology have identified two indicators to ensure optimum health outcomes among children: one is developmentally and nutritionally appropriate healthcare, and the second is the availability of an effective transition of care model from pediatric care to adult health services. Currently, there is no national guidelines on transition of care for children and adolescents with osteoporosis and metabolic bone disease. To close this gap, this work was carried out to develop the Egyptian guidelines for transition model of care.ResultsThe final recommendation included 12 specific domains. These included the following: targeted population, transition age, transition readiness, patient-targeted care, and disease-specific knowledge, patient education, and optimum model for the transition of care, transition referral, management approach, high quality of care, documentation, and recent service approaches as well as standards and quality indicators. All the overarching principles and most voters agreed with the 12 amended recommendations.ConclusionTransitional care is the term used to describe services that seek to bridge this care gap. Based on the best available data and professional judgment, these consensus-based recommendations guide ways to achieve optimal outcomes in transitional care for adolescents with osteoporosis and metabolic bone disorders. Though focussed on transition of care of bone and muscle health, this article can be the bases for transition services for children with other chronic conditions. This could be used as a blueprint for additional national or internationally healthcare transition policies.

Telehealth vs face-to-face consultations in a urological oncology clinic: a randomised controlled trial.

To determine the effectiveness of telehealth, among patients reviewed for urological oncological diseases, compared with standard face-to-face (F2F) consultations with regard to patient-reported satisfaction through use of a validated questionnaire. We conducted a single-centre randomised controlled trial in 126 patients recruited from the Crown Princess Mary Cancer Centres urological oncology clinics. Patients were randomised to either a telehealth audio-only (telephone) consultation group or a standard F2F consultation group for their next routine appointment. Validated questionnaires, using a 4-point Likert index scale, were completed at the end of the appointments. Questionnaire scores were analysed using the Mann-Whitney U-test. The primary outcome measured was patients' preference for type of consultation on subsequent follow-up. Secondary outcomes involved evaluation of efficiency, quality of care, ease of understanding, overall satisfaction, professionalism, limitations, and convenience. A total of 63 patients in the F2F group and 53 patients in the telephone group completed and returned the validated questionnaires. Patients' preference for next follow-up was statistically significant, favouring the telephone group (P = 0.012). For the secondary outcomes, patients in the telephone group also reported greater satisfaction with regard to the efficiency and timing of the consultation (P = 0.005). Conversely, patients in the F2F group reported higher rates of satisfaction with regard to 'tests and follow-up' and the clinician's ability to deal with their issues, as compared to the telephone group (P = 0.002). Also, patients in the F2F group reported higher rates of perceived quality of consultation (P = 0.027). Our study demonstrates that patients with urological oncological diseases attending routine follow-up generally prefer telehealth over F2F appointments. However, patients in the F2F group perceived that there was a higher quality of care in their consultation, and that the services provided were superior, in comparison to patients in the telehealth group. These are barriers to the widespread adoption of telehealth in urological oncology follow-up care and are rarely reported in the current literature.

Establishing trust in emergency telehealth consultations.

Over recent years, emergency telehealth has developed rapidly in Australasia. From the patient's perspective, establishing trust with a healthcare provider is uniquely challenging when using the audio and video modalities commonly used in telehealth. It is crucial to consider how we may improve the delivery of care through this emerging pathway if high-quality care is to be delivered. Several simple techniques have been identified in the literature and can be employed to create trust and improve the patient-provider relationship. These include ensuring privacy and an appropriate setting for the consultation; considering how eye contact and expressions are best used; providing alternative options to telehealth; and clearly identifying names, roles and qualifications. We describe how these methods can best be employed in the virtual emergency care setting.

Основные направления совершенствования диабетологической помощи в условиях поликлиники (по результатам социологического исследования).

A sociological assessment of satisfaction with outpatient care for patients with diabetes mellitus in the Republic of North Ossetia-Alania was carried out. The results of the study make it possible to identify the main problems faced by patients at the primary health care level and identify possible ways to level them. The purpose of the study: to assess the satisfaction of patients with diabetes mellitus with the quality of medical care provided in outpatient settings. Materials and methods. The questionnaires of 450 patients with diabetes mellitus, urban (66%) and rural (34%) residents were analyzed. Of these, 45% are men and 55% are women aged 39–59 years (39.0%), 60–79 years (36.0%), over 80 years (6.0%). The questionnaire included 12 questions on various aspects of the clinic’s activities. Data processing and analysis were performed using the IBM SPSS Statistics 27.0.1 software and analytical complex. Results. A study of the satisfaction of patients with diabetes mellitus with outpatient medical care has revealed a number of organizational and medical problems. The regularity of visits to the endocrinologist by patients is one of their main conditions for the effectiveness of therapeutic and preventive measures and dispensary supervision. A fairly high percentage (72%) visit the clinic from 2 to 5 times a year. It is alarming that 28% of patients visit an endocrinologist only once a year, which is a sign of low adherence to treatment on the part of patients. Rural residents visit an endocrinologist less often than urban residents. Young people are more often dissatisfied with the time that the doctor spends at the reception and more often face rude treatment from the medical staff. The comorbidity of diabetes mellitus requires the provision of high-quality medical care in accordance with the expectations of patients, which is provided with logistical equipment and staffing Conclusion. The results obtained are an indicator of the quality of medical care and indicate the presence of problem areas in the activities of medical organizations providing outpatient care to patients with diabetes mellitus. Special attention should be paid to the organization of dispensary follow-up in order to reduce the risks of developing complications of the disease. It is necessary to increase the availability of primary health care by making appropriate management decisions at the level of regional health authorities.

Perceived clinical competence and its related factors among registered nurses employed at selected outpatient clinics in Egypt.

Nurses' clinical competence is a significant concern in all healthcare settings due to the necessity of delivering high-quality patient care. Understanding and addressing the factors related to competence are crucial for promoting nurses' clinical competence and ultimately improving patient outcomes. Producing and maintaining a skilled nursing workforce is essential to protect communities. This study aimed to assess the level of self-evaluated clinical competence and its correlation with demographic and occupational variables among registered nurses employed at selected outpatient clinics in Egypt. The study utilized a descriptive cross-sectional design with a self-administered, two-part questionnaire that assessed participants' demographic and occupational variables as well as perceived clinical competence in various healthcare settings. It took place at outpatient clinics of two governmental hospitals and five primary healthcare centers in Mansoura City, Egypt between January, and June 2023. A purposive sample of 450 nurses took part in this study. The average score of nurses' clinical competence was 155.3±7.2 out of 230, indicating a "moderate level". In terms of professional behaviors and general performance, the average score for clinical competence was 48.4±3.6 and 40.7±4.1 respectively. Additionally, the average score for clinical competence regarding core and advanced nursing skills were 43.4±3.0 and 22.8±1.5 respectively. Among the domains of clinical competence, the highest average score was associated with "professional behaviors" as it forms the backbone of nursing practice. There was a highly significant relationship between the average score of clinical competence and the participant's age, sex, level of education, and years of clinical work experience (P<0.001). Nurses perceived their level of clinical competence as moderate. To enhance nurses' clinical competence, future studies and interventions should focus on promoting supportive work environments, providing ongoing education and training in advanced nursing skills, and the fostering development of critical thinking skills in nurses. Healthcare organizations should implement educational interventions to enhance nurses' clinical competence. These interventions should include continuous professional development opportunities, mentorship programs, inclusive training initiatives, and structured feedback mechanisms. These measures will help nurses stay up-to-date with the latest practices and technologies, create a supportive learning atmosphere, and address the unique needs and challenges faced by nurses of different genders and specialties.

Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study.

Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care. This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care.