Implementation Gap Research Articles

World Health Organization Guidance on Health Practitioner Regulation: An Overview

ABSTRACT: The World Health Organization has released its first comprehensive Guidance document on health practitioner regulation, addressing a critical gap in global health policy. This Commentary provides an overview of the Guidance, which aims to support countries in strengthening their regulatory systems for health practitioners. The Guidance, developed through a rigorous process involving a literature review and expert consultation, covers a broad range of health practitioners and focuses on optimizing their utilization to meet population health needs. Key highlights include the description of the global regulatory landscape, identification of regulatory challenges in all societies, and policy considerations to realize dynamic, effective, and agile regulation. The COVID-19 pandemic is cited as an important example of a catalyst for regulatory reforms that enhanced workforce availability and access. This paper, co-authored by members of the World Health Organization Technical Expert Group, emphasizes the importance of aligning regulatory systems with broader health workforce and system priorities, adopting a risk-based approach, and addressing implementation gaps. It encourages policymakers, regulators, and researchers to use the Guidance to assess and update their regulatory systems and to generate more robust evidence on the impact of health practitioner regulation on health outcomes.

Comprehensive sexuality education: indicators to evaluate interventions in Italian schools

Abstract Background Comprehensive sexuality education (CSE) is globally acknowledged as the most effective approach to promoting sexual health and preventing Sexually Transmitted Infections (STIs). However, in Italy, CSE is not consistently part of the school curriculum. The EduForIST project, funded by the Ministry of Health, introduced and tested a unique CSE model in a sample of secondary schools across six Italian regions, aiming to develop an evaluation model for potential nationwide implementation. Methods The EduForIST partnership, comprising experts from various institutions, devised a framework for monitoring and evaluating CSE interventions. Through monthly focus group discussions from April 2023 to February 2024, they established indicators for short-, medium-, and long-term evaluation of clinical and behavioral outcomes, as well as process indicators to assess intervention implementation. Results A total of 35 indicators were developed, including clinical and behavioral ones for medium and long-term outcomes, short-term behavioral outcomes, and process indicators. Data for clinical and behavioral indicators can be obtained from administrative sources like the Ministry of Health and Regional Health Authorities. The National Institute of Health provides data from relevant surveillance programs. However, many process indicators require specific data collection and calculations. Challenges such as under-reporting and underestimation persist, especially in regions with limited CSE implementation. Conclusions Creating an effective monitoring system for CSE interventions necessitates integrating diverse data sources, including health records, administrative data, and behavioral assessments. The proposed model’s effectiveness will be fully assessed by comparing pre- and post-intervention after widespread implementation in secondary schools. Meanwhile, the selected indicators serve as a foundation for evaluating baseline status of STIs and behaviors in Italy. Key messages • The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation. • By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy.

Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome

Abstract Introduction After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce the risk of recurrence. Moreover, despite 2016/2019 ESC/EAS guidance on lipid management according to risk, several studies indicate that most patients do not attain low-density lipoprotein-cholesterol (LDL-C) goals. The present study aims to describe LLT prescription patterns after a non-fatal acute coronary syndrome (ACS) and identify opportunities for improvement in secondary preventive measures, namely LDL-C control. Methods Retrospective cohort study featuring adults aged 40-80 residing in a Portuguese municipality Portugal, using Electronic Health Records between 2016 and 2022. Selected patients had ≥1 general practice appointment three years before the occurrence of an ACS, which was considered an index date. Sub-analysis was made based on patients’ age (under and high or equal to 65 years), gender, and whether their LDL-C levels were controlled according to gradual upper thresholds of 100 mg/dL in the period before the ACS event and 55 mg/dL at one-year post-ACS. Results Among the 544 selected patients, 270 were younger than 65 years. Females comprised 30% (164 patients) of the total cohort, 27% of the under-65 group, and nearly 38% of the 65 and older group. In younger patients, LDL-C levels were higher at presentation (132 mg/dL) and had a significantly greater decrease during the follow-up period compared to the older group. In the period before the ACS, 71.1% of men and 56.7% of women had no previous prescription of LLT, and younger patients had worse levels of LDL-C control (24.1%) compared to older patients (46.0%). One year post-ACS, the pattern of LLT revealed a substantial drop in patients without any LLT prescription from 66.7% to 13.6% and an increase in high-intensity LLT from 2.4% to 16.5%. Still, moderate-intensity LLT (66%) remained the most frequently used LLT. An increase in LLT potency was observed in the follow-up, although there was a decrease in patients achieving LDL-C control. Previous to the ACS event, 35.3% of men and 34.8% of women had initially controlled LDL-C levels according to defined thresholds, which significantly reduced to 11.3% and 8.5%, respectively, at one-year post-ACS. Conclusion Despite initiating or intensifying LLT after ACS, LDL-C goals were not achieved in approximately 9 out of 10 patients at 1-year follow-up, highlighting that the LLT adjustment was insufficient. Therefore, there is a need for better optimisation of LLT after ACS, unveiling an alarming gap in guideline implementation in clinical practice.

Beyond Design: Examining the Implementation of Gender-Responsive Social Protection in Ethiopia

Recent years have witnessed increased global attention and investment in inclusive and gender-responsive social protection programming in low- and middle-income countries. While high-level design commitments are important and welcome, in practice, they may not guarantee protection from vulnerabilities and a reduction in gender inequality. Programme implementation presents a critical, yet often underestimated, challenge. This article offers insights into the reality of implementing the gender provisions of Ethiopia’s Productive Safety Net Programme. Drawing on qualitative data from rural Ethiopia, it shows that the implementation of the gender provisions has generated implementation gaps and inconsistencies. The findings highlight the need to move beyond commitments on paper and allocate greater resources and attention to the implementation of gender-responsive social protection.

Deliberation on continuous spread of corruption in South Africa

Corruption is widely spread in South Africa and is against the norms of honestly, morals, values, ethics, and good governance. The reasons of corruption may be individual (personal greed for luxury, power, authority), organisational (inadequate monitoring and evaluation, reporting processes), legislative (no compliance), strategic (lack of ethical culture), to state a few. The study is aimed to find answers to the following guiding research question, such as: what is the extent of corruption in South Africa? The qualitative study utilised secondary sources through the literature review of articles and document review of annual/official reports to gather relevant information. The information was further assessed using document analysis. The findings show that corruption is spreading at every level of government, and even public and private sectors are getting exposed to cases of misconduct. The country has established various legislative frameworks to combat corruption. The objectives of anti-corruption frameworks are operationalised through the establishment of anti-corruption organistaions. Some of them are Corruption Watch; National Anti-Corruption Advisory Council; Financial Intelligence Centre; Organisation Undoing Tax Abuse; and National Anti-Corruption Hotline. The findings show that although there are anti-corruption measures in place, the inadequate compliance may create implementation gaps, hence corruption keeps on spreading at political level, bureaucratic offices, and even in municipalities. The study suggests policy measures to minimise the scope and spread of corruption.

School as a Safe Space through Gender-Responsive Basic Education Policy

Quality education promotes gender-responsive policies. Yet, this is not always the case in developing countries like the Philippines. There are gaps in policy implementation, and safety issues faced by LGBTQIA+ learners persist. Purpose. This study focuses on teachers’ and learners’ perception of Gender-Responsive Basic Education Policy (GRBEP) implementation and the safety of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and expanding identities (LGBTQIA+) learners in public and private schools. Hence, it determined the GRBEP implementation level and LGBTQIA+ learners' safety level. No significant correlation between policy implementation and learners’ safety, and no significant difference between public and private schools’ policy implementation and learners’ safety were assumed. The minimal studies and the urgent need to ensure a gender-responsive and safe learning environment underscore the significance of this research. Methodology. Validated questionnaires were distributed to 744 learners and teachers: 401 from private schools and 343 from public schools. The data collected were analyzed using mode, percentage, Pearson’s product-moment correlation, and independent samples test. Results. Learners and teachers perceived a “high level of implementation” of GRBEP in schools. LGBTQIA+ learners were generally “safe” in schools. The implementation level of Gender-Responsive Basic Education Policy correlates with the safety level of LGBTQIA+ learners in school, as it was statistically significant (p=.026 < α=0.05). There is no substantial evidence of a difference between public and private schools’ implementation level of GRBEP (p = 0.544 > α=0.05). There is not enough evidence of a significant difference between public and private schools’ safety levels of LGBTQIA+ learners (p = 0.188 > α=0.05). Conclusion. An efficient GRBEP implementation by schools ensures a working educational policy. LGBTQIA+ learners are safe in the learning environment. Public and private schools must strengthen awareness campaigns, address misconceptions and overlooked realities, conduct real-time monitoring, evaluation, and feedback mechanisms, as well as foster partnerships and linkages to uphold a safe space for every learner. With these actions, policymakers and school administrators can work towards creating a true quality and inclusive education that supports the well-being and success of all learners, regardless of their sexual orientation, gender identity, or gender expression.

Building paper bridges: adapting citizenship and immigration regimes to international displacement

Implementation gaps in the areas of naturalization and immigrant regularization emerge through a mismatch between the documents a residence country requires, and the documents that refugees and migrants can realistically provide. Those caught in this gap may live undocumented or risk statelessness. Residence countries can close such paperwork gaps by adapting legal interpretations and easing administrative requirements. When Colombia faced large-scale international displacement from Venezuela, state actors identified documentation-based implementation gaps in its nationality law and regularization procedures; they then took an innovative – yet not faultless – approach by adapting its citizenship and immigration regimes to accommodate displaced Venezuelans. These changes strengthened access to essential rights and increased the well-being of many. In this article, we develop the concepts of paperwork gaps and paper bridges and discuss the actors, impact, and limitations of Colombia’s policy innovations in the areas of nationality by birth, naturalization, and regularization based on research conducted from 2020 to 2023. The study advances the literature on government learning regarding policies within citizenship and immigration regimes that target internationally displaced populations.

Evidence gaps in conservative non-pharmacological interventions and guideline implementation for high-burden non-communicable diseases: protocol for an overview of reviews

Non-communicable diseases (NCDs) represent a high burden for the society and affected individuals. Conservative non-pharmacological interventions play a first-line role in the treatment and management of most NCDs. Systematic reviews...

Sustainable Mobility as a Service: A Scientometric Review in the Context of Agenda 2030

City planners are facing an emergency to develop, promote, and implement actions that allow the mobility needs of people and businesses in cities (and their surroundings) to be satisfied to assure a better quality of life. Among the different actions to promote, there is public transport, which should be the cornerstone of sustainable urban mobility. The only way to achieve the transition from private to public is by integrating services into a multimodal network and then encouraging interchange between different modes of transportation. In this context, the development of mobility as a service (MaaS) solutions is significant, and different studies have been developed in recent years. The paper thus introduces a scientometric review of such a topic in relation to the Sustainable Development Goals of Agenda 2030. The study focuses on the current state of MaaS implementation, trends, and research gaps, with an in-depth analysis of emerging themes, based on 819 documents selected from the WoS and Scopus databases. Introducing the database, and research methodology, an accurate interpretation of the data generated by the bibliometric analysis, and the primary evaluation parameters are outlined. The identified studies have been then categorized into three thematic groups with the intention of offering a comprehensive study that identifies the shortcomings and difficulties in the research carried out in these areas up to today. Particular attention is paid to how this research relates to the Sustainable Development Goals.

Integrating hypertension detection and management in HIV care in South Africa: protocol for a stepped-wedged cluster randomized effectiveness-implementation hybrid trial

BackgroundHIV clinical guidelines recommend hypertension detection and management to lower cardiovascular disease risk, but these have not been effectively implemented for people living with HIV (PWH). Addressing this implementation gap requires community-engaged implementation studies focused on addressing implementation barriers specific to the HIV care context.MethodsThis protocol describes a type 2 effectiveness-implementation hybrid study conducted in nine primary care clinics in Johannesburg. The study will evaluate the effect of implementation strategies on guideline-recommended blood pressure assessment and management in HIV clinics and the effects of assessment/management on patient blood pressure. A stepped-wedge, cluster randomized study design was used to randomize clinics to the time at which they receive the implementation strategies and patient intervention. The implementation strategies tested include identifying and preparing care champions, changing record systems, conducting ongoing training, providing audit and feedback, and changing the physical structure/equipment. The patient intervention tested includes detection of elevated blood pressure, educational materials, lifestyle modification advice, and medication where needed. Implementation outcomes include adoption, fidelity (co-primary outcome), cost, and maintenance of the blood pressure assessment protocol in participating clinics, while patient outcomes include reach, effectiveness (co-primary outcome), and long-term effects of the intervention on patient blood pressure. These will be assessed via direct observation, study records, staff logs, medical chart reviews, and patient and healthcare worker surveys. To examine effects on the implementation (intervention fidelity) and effectiveness (patient blood pressure changes) co-primary outcomes, we will use the standard Hussey and Hughes model for analysis of stepped-wedge designs which includes fixed effects for both interventions and time periods, and a random effect for sites. Finally, we will examine the costs for the implementation strategies, healthcare worker time, and patient-facing intervention materials, as well as the cost-effectiveness and cost-utility of the intervention using study records, patient surveys, and a time and motion assessment.DiscussionThis study will address knowledge gaps around implementation of cardiovascular disease preventive practices in HIV care in South Africa. In doing so, it will provide a dual opportunity to promote evidence-based care in the South African HIV care context and help refine implementation research methods to better serve HIV populations globally.Trial registrationClinicalTrials.gov: NCT05846503. Registered on May 6, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT05846503.

The development of an intradisciplinary staff training intervention on the optimal management of behavioural and psychological symptoms of dementia: A qualitative study

Introduction: Behavioural and psychological symptoms of dementia (BPSDs) are a group of highly prevalent symptoms in residents with a neurocognitive disorder (NCD), including agitation and depressive symptoms. Caregiving staff often mention knowledge and skills deficits regarding optimal BPSD management. While several staff trainings on BPSDs management exist internationally, their transferability to other clinical contexts is limited, owing to methodological challenges. Therefore, to address this implementation gap, there is a strong need for trainings based on high-quality research to strengthen existing evidence, ensure feasibility and reproducibility. Methods: This qualitative study, part of a larger research project, occurred in 2022 on a long-term care (LTC) center unit and an alternate level of care (ALT) hospital unit located in the Province of Quebec, Canada. This study aimed to: 1) evaluate the needs and perceptions of staff caregivers regarding BPSD management, 2) identify the training content and modalities to prioritize according to experts, 3) develop an intradisciplinary training on BPSD management, and 4) pretest the preliminarily version of the training. Objectives one and two were evaluated using focus groups and objective four using individual cognitive interviews. Qualitative interview data was audio-recorded with participants’ consent, transcribed verbatim, and thematically content analyzed using an established method. Results: Overall, thirteen caregivers participated in objective one (8 from the LTC unit, and 6 from the ALT unit). The main staff training need identified on each site was the management of resident’s aggressive behaviours. Staff verbalized a preference for a virtual training. Objective 2 involved a panel of eight experts. Experts recommended the use of an online training platform, and certain training models and indicators. Based on caregivers and experts’ input, five interactive online staff training capsules lasting from 20-25 minutes each and an algorithm guiding the evaluation and management of BPSDs were created. The training capsules and the algorithm were iteratively improved following cognitive interviews with 4 caregivers from the participating sites. Conclusion: An interactive virtual staff training on BPSD management was created based on staff and expert consultation. The next step in investigation will be to evaluate the feasibility and acceptability of the training.

Progress and challenges in implementing the Sendai Framework for Disaster Risk Reduction at sub-national levels: insights from Aceh, Indonesia

ABSTRACT Common gaps in the current reporting system regarding the progress of meeting the targets Sendai Framework for Disaster Risk Reduction (SFDRR) implementation in low- and middle-income countries include (1) systematic bias towards central governments’ interests and narratives; (2) reports suffer from lack of independent process committed to evidence-based reporting; (3) progress reports do not reflect adequate aggregation of progress from sub-national levels. This research focuses on assessing the progress of SFDRR implementation at sub-national levels in Aceh province, Indonesia – the place where Indian Ocean Tsunamis killed around 170,000 people on Boxing Day 2004. The authors combined key informant interviews and content analysis of policy documents to collect evidence of the progress in the four SFDRR priorities for action. Two case villages in Aceh demonstrated challenges and opportunities at local levels. Findings suggest gaps in SFDRR implementation include a lack of deliberation of risk assessment and knowledge dissemination, discontinuity of regional DRR forums, lack of incentives for mitigation and shared commitments, and responsibility. Progress at village levels is equally challenging due to the lack of funding allocation, discontinuity of village-level preparedness, and lack of adoption of sustainable recovery and community participation. In summary, since the progress of implementing DRR across four priority areas of the SFDRR in Aceh is not optimal, Aceh authorities (e.g. provincial and district secretariats), provincial and district Disaster Management (DM) Agencies, and other relevant DM actors need to comprehensively improve DRR across all four Priorities for Action of the framework in the province.

Temporary Labor Migration from Sri Lanka to Gulf Cooperation Countries: Analyzing Labor Trafficking Amidst the Financial Crisis

Background and Aims: The financial crisis in Sri Lanka (SL) has marked a significant growth in temporary labor migration to Gulf Cooperation Countries (GCC). Temporary labor migration refers to migration from one state to another in pursuit of employment opportunities for a temporary period. The National Policy on Migration for Employment (NPME) and the National Action Plan of SL asserted the importance of developing labor migration policies in response to the country’s severe need for remittances during the financial crisis. A financial crisis occurs when a country's expenditure exceeds its national income, resulting in a shortage of goods and services for its citizens. Along with this understanding, this paper examines how the temporary labor migration from SL to GCC has developed in response to the financial crisis in the country. It argues that reforming labor migration policies solely based on remittance does not appear to be adequate to protect migrants from trafficking. In this setting, the key research question is how labor trafficking has risen amidst the financial crisis in SL. Methodology: In this study, Delphi indicators have been utilized to identify the demarcations of labor trafficking. The data was collected from thirty interviews conducted with family members of labor migrants who migrated to GCC in 2022. Results: The results indicate that shortcomings in the governance of labor migration during the financial crisis in SL have led to an increase in labor trafficking. Conclusion: The paper concludes with the discursive, implementation, and efficacy gaps in the governance of labor migration and suggests a right-based framework to guarantee equitable recruitment procedures.

Do companies walk the talk? Commitments and actions in global supply chain labor standards

This article examines the efforts towards implementing minimum labor standards in global supply chains through the lens of corporate social responsibility. The adoption of supplier codes of conduct has driven efforts to monitor and enforce standards within these chains. Nonetheless, challenges persist in translating commitment into action, giving rise to gaps in implementation. We address two critical phenomena: corporations' varying internalization of responsibility to implement labor standards, and the translation of these written commitments into actions. Through two distinct studies, we explore how companies ‘walk the talk’, and navigate the gaps between corporate recognition of responsibility and the establishment of management systems to implement labor standards. The first study demonstrates that a minority of companies are diligent in committing to implement their codes. Only 17% accept a shared responsibility to implement the code, and most companies only refer to audit visits or the termination of supplier contract as mechanisms put in place. The second study does not find conclusive evidence of a correlation between corporate commitments and the evaluation of their corporate sustainability practices in supply chains as evaluated by KnowtheChain. However, results suggest that companies do better when they promote the collaborative approach with suppliers in their implementation efforts.

“I Don’t Know Whether It’s Priority, or Capacity, or Both”: Implementation Gaps in Employment Policies Targeting People with Disabilities in Kenya and Bangladesh

Disabled people are often excluded from employment, particularly in accessing waged employment. This exclusion persists despite enabling policies and legislature, indicating a need to address gaps in implementation. To improve policy implementation, it is crucial to better understand the gap between policy intention (what was planned) and effect (what happens), including reasons that widen this gap (what explains what happened). This study explores this in the context of Kenya and Bangladesh, drawing on key informant interviews and analysis of policies and programmes related to employment, social protection, and disability. Using the policy triangle framework, we analysed the policy context, process, actors, and content of relevant policies and programmes. The study identified key policy provisions on employment quota, social assistance, job placement services, tax incentives, and training opportunities, all of which were designed to promote employment for disabled people. However, implementation is limited in both countries, for reasons including ambiguity in policies, unavailability of data for monitoring, and lack of transparency among implementers. The data suggest that addressing these aspects would promote accountability among duty-bearers, advocacy power among rights-holders, and ultimately improve implementation and inclusion of disabled people in employment.

Cardiovascular Disease Training Programmes: Three Schemes to Train Leaders for Future Challenges.

Cardiovascular disease (CVD) represents the largest burden of disease globally and despite the availability of strong evidence supporting cost-effective treatments for people with CVD, the implementation of these treatments remains low, especially in low-income settings. Shortages in workforce have led to focus on how to increase clinical capacity. However, a simplistic focus on training clinicians will not fill the gaps in research, policy and implementation, which also need to be addressed at the same time. There are multiple efforts to develop early career capacity across diverse areas at national and international level to address these gaps. To-date, there have been limited efforts to compare or evaluate such programmes, and there are no efforts to harmonise such programmes to take advantage of synergies. We now compare three international programmes on global cardiovascular research to train individuals in their early- and mid-career by aims, experience and outputs.

The Amphibian Genomics Consortium: advancing genomic and genetic resources for amphibian research and conservation.

Amphibians represent a diverse group of tetrapods, marked by deep divergence times between their three systematic orders and families. Studying amphibian biology through the genomics lens increases our understanding of the features of this animal class and that of other terrestrial vertebrates. The need for amphibian genomic resources is more urgent than ever due to the increasing threats to this group. Amphibians are one of the most imperiled taxonomic groups, with approximately 41% of species threatened with extinction due to habitat loss, changes in land use patterns, disease, climate change, and their synergistic effects. Amphibian genomic resources have provided a better understanding of ontogenetic diversity, tissue regeneration, diverse life history and reproductive modes, antipredator strategies, and resilience and adaptive responses. They also serve as essential models for studying broad genomic traits, such as evolutionary genome expansions and contractions, as they exhibit the widest range of genome sizes among all animal taxa and possess multiple mechanisms of genetic sex determination. Despite these features, genome sequencing of amphibians has significantly lagged behind that of other vertebrates, primarily due to the challenges of assembling their large, repeat-rich genomes and the relative lack of societal support. The emergence of long-read sequencing technologies, combined with advanced molecular and computational techniques that improve scaffolding and reduce computational workloads, is now making it possible to address some of these challenges. To promote and accelerate the production and use of amphibian genomics research through international coordination and collaboration, we launched the Amphibian Genomics Consortium (AGC, https://mvs.unimelb.edu.au/amphibian-genomics-consortium) in early 2023. This burgeoning community already has more than 282 members from 41 countries. The AGC aims to leverage the diverse capabilities of its members to advance genomic resources for amphibians and bridge the implementation gap between biologists, bioinformaticians, and conservation practitioners. Here we evaluate the state of the field of amphibian genomics, highlight previous studies, present challenges to overcome, and call on the research and conservation communities to unite as part of the AGC to enable amphibian genomics research to "leap" to the next level.

Improving TRansitions ANd outcomeS for heart FailurE patients in home health CaRe (I-TRANSFER-HF): a type 1 hybrid effectiveness-implementation trial: study protocol

BackgroundSome of the most promising strategies to reduce hospital readmissions in heart failure (HF) is through the timely receipt of home health care (HHC), delivered by Medicare-certified home health agencies (HHAs), and outpatient medical follow-up after hospital discharge. Yet national data show that only 12% of Medicare beneficiaries receive these evidence-based practices, representing an implementation gap. To advance the science and improve outcomes in HF, we will test the effectiveness and implementation of an intervention called Improving TRansitions ANd OutcomeS for Heart FailurE Patients in Home Health CaRe (I-TRANSFER-HF), comprised of early and intensive HHC nurse visits combined with an early outpatient medical visit post-discharge, among HF patients receiving HHC.MethodsThis study will use a Hybrid Type 1, stepped wedge randomized trial design, to test the effectiveness and implementation of I-TRANSFER-HF in partnership with four geographically diverse dyads of hospitals and HHAs (“hospital-HHA” dyads) across the US. Aim 1 will test the effectiveness of I-TRANSFER-HF to reduce 30-day readmissions (primary outcome) and ED visits (secondary outcome), and increase days at home (secondary outcome) among HF patients who receive timely follow-up compared to usual care. Hospital-HHA dyads will be randomized to cross over from a baseline period of no intervention to the intervention in a randomized sequential order. Medicare claims data from each dyad and from comparison dyads selected within the national dataset will be used to ascertain outcomes. Hypotheses will be tested with generalized mixed models. Aim 2 will assess the determinants of I-TRANSFER-HF’s implementation using a mixed-methods approach and is guided by the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0). Qualitative interviews will be conducted with key stakeholders across the hospital-HHA dyads to assess acceptability, barriers, and facilitators of implementation; feasibility and process measures will be assessed with Medicare claims data.DiscussionAs the first pragmatic trial of promoting timely HHC and outpatient follow-up in HF, this study has the potential to dramatically improve care and outcomes for HF patients and produce novel insights for the implementation of HHC nationally.Trial registrationThis trial has been registered on ClinicalTrials.Gov (#NCT06118983). Registered on 10/31/2023, https://clinicaltrials.gov/study/NCT06118983?id=NCT06118983&rank=1.

CDSS Adoption and the Role of Artificial Intelligence in Saudi Arabian Primary Healthcare

The integration of advanced Clinical Decision Support Systems (CDSS) is crucial in healthcare, especially in developing countries. However, the challenges to CDSS implementation in these settings are often overlooked, leading to implementation gaps. This study investigates the adoption of CDSS in primary healthcare facilities in Saudi Arabia through in-depth interviews with general practitioners. The advancement of primary healthcare systems in developing nations necessitates appropriate technological solutions to address issues such as equitable access, service quality, and patient satisfaction. The adoption of CDSS can potentially improve patient satisfaction and enhance medical consultations. Artificial intelligence -driven technologies like the Velys robot are transforming the medical field by assisting doctors in surgical procedures. In healthcare, Artificial intelligence (AI) can address issues related to complex diseases, aging populations, and workforce shortages. AI solutions can streamline patient flow, improve care coordination, and support personalized healthcare management. By assessing the impact of AI on patient care, healthcare efficiency, and effectiveness can be enhanced. This research highlights the challenges and opportunities in CDSS adoption in developing countries, with implications for healthcare improvement in Saudi Arabia.

Analysis of school rules and regulation implementation: Basis for policy enhancement program

This study analyzes the existing school rules and regulations at Manocmanoc Elementary School to develop a policy enhancement program. It examines the level of knowledge, attitudes, and implementation of school rules among intermediate pupils. Using a quantitative-correlational approach, including surveys and document analysis, the research explores relationships and gaps in rule implementation, highlighting strengths and weaknesses. It considers the alignment of rules with educational goals, the promotion of a positive and inclusive school culture, and the balance between discipline and flexibility. Key findings reveal significant relationships between knowledge, attitudes, and implementation, identifying areas for improvement. The study recommends refining rule enforcement consistency, ensuring continuous oversight and training, and promoting deeper rule understanding. Additionally, it suggests establishing transparent disciplinary measures and linking fair implementation to a positive learning environment. The outcomes serve as a foundation for a proposed policy enhancement program, offering evidence-based recommendations to foster a conducive learning environment, enhance student engagement, and address contemporary educational challenges. The study's focus on a single school may limit generalizability. Future research could expand to multiple schools to validate and extend these insights. Implementing these recommendations is expected to create a better learning atmosphere for all students.