Implementation Of Care Research Articles

Healthcare providers' perspectives on the Canadian Caries Risk Assessment Tool implementation in Indigenous pediatric primary care: a qualitative study

BackgroundEarly childhood caries remains a significant public health concern among Indigenous children in Canada. Integrating caries risk assessment (CRA) into primary care settings could improve early detection and intervention.ObjectivesThis qualitative study explored the barriers to implementing and integrating the Canadian CRA tool into the primary care of First Nations and Métis children in Manitoba, based on the perspectives of non-dental primary care providers (NDPCPs).MethodsFifty NDPCPs providing care to Indigenous children under six years of age were purposefully selected from ten Indigenous communities in Manitoba, including Winnipeg, Selkirk, St. Laurent, Swan River, Pine Creek, Camperville, and Pine Falls. The study employed an exploratory design, with data collected through eight focus groups and twelve in-depth key informant interviews conducted between April 2023 and September 2024. All interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis with NVivo software.ResultsParticipants included pediatricians, family physicians, public health nurses, nurse practitioners, physician assistants, dietitians, and child development workers, with an average age of 41 years (range: 24–61) and 13 years of practice experience (range: 1–40). Thematic analysis identified four major barriers to integrating the CRA tool: (1) Service provider level – time constraint, scope of practice, documentation/referral pathways, and funding; (2) Community level – oral care not priority, separation of dental and general health, lack of transportation, and healthcare distrust; (3) Caregiver and child level – lack of dental insurance, parental willingness, substituting CRA for dental visit; and (4) Provider training and skills – lack of training on fluoride varnish application and dental screening. Despite these challenges, participants expressed a positive attitude toward receiving training on early childhood caries prevention, fluoride application, and the use of the Canadian CRA tool.ConclusionThis study highlights that NDPCPs in Manitoba recognize the Canadian CRA tool as a valuable resource for improving access to early preventive dental care for First Nations and Métis children. The identified barriers provide critical insights for dental, medical, and allied healthcare providers, offering a foundation for developing strategies, guidelines, and policies to enhance preventive oral health services for Indigenous children in Manitoba.

Association between individuals with unknown health status as identified by the National Health Insurance (KDB) system and frailty: A cross-sectional study in Yamato city, Japan

Objectives Integrated implementation of health services and long-term care (LTC) prevention for older adults require programs to understand the health status of persons with unknown health status and connect them to appropriate services. Previous studies have suggested that identifying such individuals can predict those at high risk of needing LTC pertaining to care level ≥ 2 or death; however, the relationship with frailty remains unclear. This cross-sectional study aimed to examine the association between individuals with unknown health status identified using the National Health Insurance (KDB) system and corresponding frailty.Methods We used response data from the LTC Prevention Questionnaire (an all-inclusive survey conducted in 2020 targeting older adults aged ≥65 years who were not certified as requiring LTC in Yamato City, Japan). The analysis included 16,186 older adults aged ≥76 years. They were divided into two groups: "unknowns" (those who did not receive medical checkups or medical care in 2019-2020) and "knowns" (those who received medical checkups or medical care in 2019-2020). Univariate analysis and multivariate logistic regression analysis were performed for frailty (at risk for ≥8 items) in the Kihon Checklist and the applicable criteria for each field, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each.Results The OR for frailty was 1.58 (95% CI: 1.21-2.07), which was statistically significant and higher among those who had been unknown health status for two consecutive years, even after adjustment for sex, age group, and family structure. The adjusted OR for each criterion in the Kihon Checklist was 2.26 (95% CI: 1.55-3.30), which was the highest for "prevention/support for homebound" among those who were unknown for two consecutive years. Statistically significant associations were found for "20 items except five related to prevention/support for depression" and "improvement of motor functions."Conclusion Frailty was significantly associated with individuals aged ≥76 years who had not received health checkups or medical care for two consecutive years and were not certified as requiring LTC. In programs for understanding the status of persons with unknown health status and connecting them to appropriate services, it is considered necessary to actively implement measures against frailty, not just to recommend that such individuals receive health checkups and medical care.

First experiences of patients and healthcare professionals with routine use of patient-reported outcome measures for venous thromboembolism

Background: Venous thromboembolism (VTE) can considerably limit patients’ functioning and quality of life. Using patient-reported outcome measures (PROMs), the full impact of VTE on individual patients can be captured. Methods: To evaluate experiences of patients and healthcare professionals with the routine use of PROMs for VTE patients visiting the outpatient clinic, a mixed-methods study was performed at Leiden University Medical Center, the Netherlands. VTE PROMs were incorporated in routine care since March 2023, through a digital application sending patients invitations to complete PROMs. Quantitative and qualitative data were obtained from semi-structured interviews with patients and involved healthcare professionals, and collected through the NoMAD questionnaire assessing the implementation process from the professionals’ perspective. Patients aged ≥18 years who experienced VTE and completed PROMs at two follow-up timepoints during ≥3 months follow-up, and VTE patients who did not complete PROMs at both timepoints were asked to participate. Results: Eight patients (5 completed PROMs; 3 did not) and four professionals were interviewed. Both patients and professionals experienced the use of PROMs as neutral to predominantly positive (lower-limit 3 on scale 1-5). All professionals valued the effects of PROMs on their work. Most patients felt the questionnaires contained too many questions. Suggestions to improve the completion rate, accessibility, PROMs content and the digital tool were shared. Conclusion: PROMs were believed to provide additional value during preparation for the appointment and during the consultation. The first experiences of patients and professionals, tending towards positive, can be used to improve PROMs application and support implementation in routine thrombosis care.

Nurse-Delivered Telehealth in Home-Based Palliative Care: Integrative Systematic Review.

Telehealth technologies can enhance patients' and their families' access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses' roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care. This integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice. This integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care. This integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on. This integrative systematic review synthesizes evidence on nurses' evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care. PROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038.

Falls prevention and management for older adults in home care services in Norway: a retrospective patient record review.

To evaluate Norwegian home care services' adherence to the World Falls Guidelines 2022 (WFG2022) recommendations on assessment and management of falls among older adults with a history of falling, and to evaluate the degree to which identified fall risk factors were addressed with interventions to prevent falls. We conducted a retrospective patient record review of older adults who receive home care services and have a history of falls from four municipal home care service city districts in Oslo, Norway. We collected data from electronic patient records on patient characteristics, the assessed fall risk factors, and implemented interventions to prevent falls. Adherence was analysed as the proportion of patients who received fall prevention care in line with WGF2022 recommendations. The records of 225 patients were reviewed, of which 157 (70%) patients were between the ages of 70 and 89 years, and 131 (58%) were women. A total of 54 (24%) patients had intermediate fall-risk and 171 (76%) patients had high fall-risk. Of the 54 patients with intermediate fall-risk, 50% received an assessment of balance, gait, or muscle strength, and 22% were subsequently offered exercise. Sixty-one percent of intermediate-risk patients received multifactorial fall risk assessments, and 19% received multifactorial interventions. Exercise was the most used intervention to prevent falls, but it was provided to fewer than half of the patients. Other relevant interventions, such as osteoporosis treatment and medication management, were provided to fewer than 10% of patients. The results highlight substantial gaps in the comprehensive management of fall prevention where considerably fewer patients received follow-up interventions to prevent falls compared to those who had fall risk factors identified. These results underscore the urgent need for enhanced implementation of fall prevention care within municipal home care services.

Trauma-Informed Care in Residential Care for Children At-Risk: Preliminary Evidence of Effectiveness

The RESTORE Project in Hong Kong residential childcare services aims to enhance the implementation of trauma-informed care (TIC) in residential care, to create more supportive environments for children with histories of trauma. This study presents preliminary findings on the effectiveness of the RESTORE Project. Using a mixed-method approach, the study evaluates the project’s three core programs—Boost, Care Journey, and Life Coach—evidenced by improvements in peer problems, positive youth development, and psychosocial health, alongside enhanced quality of life. A total of 34 residents were recruited (intervention group = 23, comparison group = 11), all of whom completed baseline and follow-up surveys from 2021 to 2024. A quasi-experimental design assessed the effectiveness of the TIC intervention. Qualitative data were gathered through interviews and focus group discussions with social workers and residents from the intervention group. The findings indicate that the intervention group reported fewer experiences of child abuse and family violence; more reductions in depression, anxiety, and stress; more improvements in future orientations, readiness, and perceived strength in terms of independent living; and higher levels of knowledge about childhood trauma. This study underscores the need for targeted TIC interventions involving multi-disciplinary collaboration to address the complex needs of at-risk children in residential care. Future practice should integrate group activities and physical exercises to maximize the impact of TIC interventions.

A sibling study of the prenatal and perinatal risks for cerebral palsy.

To evaluate the associations between prenatal and perinatal factors and CP risk using a statewide sibling-comparison design. We established a cohort of over 4 million singleton births in California during 2007-2015, and we identified families with outcome-discordant siblings of 1213 CP and 1544 non-CP. We estimated odds ratio (OR) and 95% confidence interval (CI) for CP according to perinatal factors including preterm birth (PTB), small for gestational age, low Apgar score, and prenatal factors including maternal pregnancy complications (perinatal infection, gestational diabetes, preeclampsia) and lifestyle-related factors (cigarette smoking, pre-pregnancy overweight). The perinatal factors remained strongly associated with CP using sibling design, although the point estimates were smaller for PTB (cohort OR = 4.72, 95%CI 4.42-5.04, sibling OR = 3.49, 95%CI 2.74-4.46) and low Apgar score (cohort OR = 19.62, 95%CI 17.99-21.41, sibling OR = 8.79, 95%CI 5.49-14.08). In sibling design, the associations between maternal pregnancy complications or pre-pregnancy overweight and CP risk were attenuated to null. We observed stronger effects between maternal cigarette smoking and CP in the sibling design, however sensitivity tests indicated possible bias from carryover effects. Adverse perinatal factors remained strongly associated with childhood CP, while uncontrolled confounding bias required considerations for pregnancy complications and CP development. We conducted a population-based sibling comparison study to evaluate the associations between several prenatal and perinatal factors and cerebral palsy (CP). Preterm birth, small for gestational age, and low Apgar score at birth remained strongly associated with CP using the sibling comparison design. The associations between several maternal pregnancy complications and CP were close to null in the sibling comparison design, raising the possibility of uncontrolled confounding bias in the cohort analyses. We demonstrated that a sibling comparison design can provide valuable information to triangulate research evidence for CP etiology, but a careful implementation and interpretation of findings is warranted.

Implementation of Goal-Oriented Care in Belgium: Experiences From 25 Primary Care Organisations.

Goal oriented care (GOC) and its readiness for implementation has been described in scientific literature, but research on GOC implementation in primary care organisations is limited. This study aims to capture the experiences of primary care organisations in implementing GOC in their context. A qualitative study, with data triangulation, was conducted. Primary care organisations that experimented with the implementation of GOC in their context were followed. Data were analysed using inductive thematic analysis. Seven themes supporting GOC implementation were identified. Project leaders from the primary care organisations experienced that related concepts can serve as a foundation for initiating the implementation of GOC. The implementation process is an iterative and reflective process, with resistance viewed as an integral part of the process, offering opportunities for reflection. Collaborating with partners, especially the active participation of patients, was seen as a facilitator. Furthermore, having a clear vision for GOC is necessary. Projects invested in adapting tools and processes to align with GOC and provided relevant training. The findings led to recommendations that can guide the implementation of future GOC projects. Effective implementation extends beyond the development and adaptation of tools; it requires translating theoretical concepts into practical application and creating a shared vision on GOC.

Strengthening Web-Based Login Security Using Vigenère Cipher and AES ENCRYPT() Method in MySQL

As technology advances further, more crimes are being committed on social media. These days, people can connect to the internet using technological devices like PCs (Personal Computers) or portable electronic devices like smartphones or tablets. This study presents a dual-layer encryption system combining the Vigenère Cipher and MySQL’s AES_ENCRYPT() to enhance the security of web-based login systems. The system encrypts user credentials on the client side using the Vigenère Cipher and applies additional encryption on the server side with AES_ENCRYPT(). This approach ensures secure data transmission and storage, reducing risks of plaintext exposure and unauthorized access. Comparative testing demonstrated that the dual-layer encryption method significantly improves resistance to brute-force attacks and database breaches compared to conventional techniques like SHA-256. Encrypted credentials remain secure even in the event of a database compromise, as decryption requires the correct secret keys. The system’s design also highlights the importance of robust key management to maintain data confidentiality and integrity. While this method introduces minor performance overhead and requires careful implementation, its advantages in safeguarding sensitive user information outweigh these limitations. This dual-layer approach is particularly suited for applications demanding high-security standards, making it a viable solution for mitigating contemporary cyber threats effectively.

How patient-centered is the gynecological care provided for patients with genitourinary syndrome of menopause in Switzerland? A survey on the implementation of patient-centered care.

How patient-centered is the gynecological care provided for patients with genitourinary syndrome of menopause in Switzerland? A survey on the implementation of patient-centered care.

Retrieval-Augmented Generation: Advancing personalized care and research in oncology.

Retrieval-Augmented Generation: Advancing personalized care and research in oncology.

Diagnostic Accuracy of IDX-DR for Detecting Diabetic Retinopathy: A Systematic Review and Meta-Analysis.

Diagnostic Accuracy of IDX-DR for Detecting Diabetic Retinopathy: A Systematic Review and Meta-Analysis.

It takes a lot: Exploring implementation of therapeutic foster care as an alternative to residential care

It takes a lot: Exploring implementation of therapeutic foster care as an alternative to residential care

Systemic barriers and stigma: Healthcare provider perspectives on perinatal and neonatal care in the fentanyl crisis.

Systemic barriers and stigma: Healthcare provider perspectives on perinatal and neonatal care in the fentanyl crisis.

Advance care planning and goals of care discussions in perioperative care: a scoping review.

Advance care planning and goals of care discussions in perioperative care: a scoping review.

Unlocking new frontiers in epilepsy through AI: From seizure prediction to personalized medicine.

Artificial intelligence (AI) is revolutionizing epilepsy care by advancing seizure detection, enhancing diagnostic precision, and enabling personalized treatment. Machine learning and deep learning technologies improve seizure monitoring, automate EEG analysis, and facilitate tailored therapeutic strategies, addressing the complexities of epilepsy management. However, challenges remain, including issues of model accuracy, interpretability, and applicability across diverse patient populations. Ethical considerations, such as safeguarding patient privacy, ensuring data security, and mitigating algorithmic bias, underscore the importance of responsible AI integration. Collaborative efforts among neurologists, data scientists, and regulatory authorities are critical to refining models, establishing ethical guidelines, and ensuring safe clinical adoption. This review examines AI's transformative potential, its current limitations, and the multidisciplinary initiatives driving its effective implementation in epilepsy care.

Qualitative analysis of patient and key informant interviews to inform integration of HIV pre-exposure prophylaxis services into gynecology care in Alabama.

HIV pre-exposure prophylaxis (PrEP) use is low among Southern, Black cis-gender women (CGW). Gynecology clinics are well-positioned to integrate PrEP services as a component of sexual and reproductive healthcare for CGW. Identify key determinants to PrEP implementation into routine gynecologic care. Qualitative, in-depth interviews (IDIs). We conducted IDIs with key informants (i.e., physicians, nurses, medical assistants) and focus group discussions (FGDs) with patients accessing care in a gynecology clinic serving under- and uninsured women in Alabama. IDIs explored individual-, setting-, and process-level factors that may impact PrEP care implementation in a clinic serving approximately 3000 women yearly, 64% of whom are Black women. Ten key informants participated in individual IDIs (median age 33.5, range 24-58 years, 80% female); 20 women participated in either 1 of 4 FGDs (n = 8) or an individual IDI (n = 12); median age 32, range 19-44. The following themes emerged: (1) patient- and provider-level stigmas related to sexuality, sexually transmitted infections (STIs), and HIV limit discussions about sexual health and HIV prevention. (2) Providers report limited knowledge about prescribing and monitoring PrEP, which is reflected in patient's observations that providers do not routinely initiate discussions about HIV prevention or PrEP. (3) Providers utilize a more risk-based approach to PrEP counseling; patients expect non-targeted, comprehensive sexual health information. (4) Structural and social barriers will be challenges to implementing PrEP in routine gynecological care. (5) Patients and providers support a clinic-wide approach to integration of PrEP into gynecology clinics. Discussions around sexual health and STIs are limited in routine gynecologic care, but patients expect comprehensive counseling from knowledgeable providers. Additional provider training may increase comfort discussing and providing PrEP. These findings will inform development of implementation strategies to integrate PrEP care into gynecologic services.

Generative AI-driven personalization of the Community of Inquiry model: enhancing individualized learning experiences in digital classrooms

PurposeThis paper explores the integration of generative artificial intelligence (GenAI) into the Community of Inquiry (CoI) framework, focusing on how GenAI can dynamically personalize online learning environments. The study aims to examine how GenAI can enhance social, cognitive and teaching presence, thus meeting the diverse needs of individual learners and improving engagement in digital classrooms.Design/methodology/approachThe paper employs a conceptual approach, building on existing literature about the CoI framework and GenAI. It proposes a theoretical model that illustrates how GenAI can personalize social, cognitive and teaching presence in real-time, using engagement patterns, performance data and feedback mechanisms to adapt learning pathways for individual students.FindingsThe study finds that GenAI can significantly enhance personalized learning by dynamically adjusting the CoI framework’s elements. GenAI-driven interactions improve student engagement through personalized prompts and adaptive content delivery, while AI-generated feedback provides timely and individualized support, fostering a more responsive and student-centered learning experience.Practical implicationsFor educators, the integration of GenAI into the CoI framework offers scalable solutions for personalized instruction and feedback. Institutions can leverage AI-driven insights to create more adaptive, learner-centered environments that improve learning outcomes, satisfaction and engagement, especially in large-scale online courses.Social implicationsThe paper highlights the potential for AI-driven education to bridge gaps in personalized learning, promoting equity and inclusivity. However, it also addresses ethical concerns such as data privacy, algorithmic bias and the digital divide, urging careful implementation to ensure that AI enhances rather than undermines educational fairness.Originality/valueThis paper provides a novel perspective on the intersection of GenAI and the CoI framework, proposing a unique conceptual model for AI-enhanced online education. It offers valuable insights for educators, researchers and institutions aiming to create more personalized, effective and inclusive digital learning environments.

Perspectives and Experiences With Large Language Models in Health Care: Survey Study.

Large language models (LLMs) are transforming how data is used, including within the health care sector. However, frameworks including the Unified Theory of Acceptance and Use of Technology highlight the importance of understanding the factors that influence technology use for successful implementation. This study aimed to (1) investigate users' uptake, perceptions, and experiences regarding LLMs in health care and (2) contextualize survey responses by demographics and professional profiles. An electronic survey was administered to elicit stakeholder perspectives of LLMs (health care providers and support functions), their experiences with LLMs, and their potential impact on functional roles. Survey domains included: demographics (6 questions), user experiences of LLMs (8 questions), motivations for using LLMs (6 questions), and perceived impact on functional roles (4 questions). The survey was launched electronically, targeting health care providers or support staff, health care students, and academics in health-related fields. Respondents were adults (>18 years) aware of LLMs. Responses were received from 1083 individuals, of which 845 were analyzable. Of the 845 respondents, 221 had yet to use an LLM. Nonusers were more likely to be health care workers (P<.001), older (P<.001), and female (P<.01). Users primarily adopted LLMs for speed, convenience, and productivity. While 75% (470/624) agreed that the user experience was positive, 46% (294/624) found the generated content unhelpful. Regression analysis showed that the experience with LLMs is more likely to be positive if the user is male (odds ratio [OR] 1.62, CI 1.06-2.48), and increasing age was associated with a reduced likelihood of reporting LLM output as useful (OR 0.98, CI 0.96-0.99). Nonusers compared to LLM users were less likely to report LLMs meeting unmet needs (45%, 99/221 vs 65%, 407/624; OR 0.48, CI 0.35-0.65), and males were more likely to report that LLMs do address unmet needs (OR 1.64, CI 1.18-2.28). Furthermore, nonusers compared to LLM users were less likely to agree that LLMs will improve functional roles (63%, 140/221 vs 75%, 469/624; OR 0.60, CI 0.43-0.85). Free-text opinions highlighted concerns regarding autonomy, outperformance, and reduced demand for care. Respondents also predicted changes to human interactions, including fewer but higher quality interactions and a change in consumer needs as LLMs become more common, which would require provider adaptation. Despite the reported benefits of LLMs, nonusers-primarily health care workers, older individuals, and females-appeared more hesitant to adopt these tools. These findings underscore the need for targeted education and support to address adoption barriers and ensure the successful integration of LLMs in health care. Anticipated role changes, evolving human interactions, and the risk of the digital divide further emphasize the need for careful implementation and ongoing evaluation of LLMs in health care to ensure equity and sustainability.

GPU Optimization for Causal AI: Accelerating the PC Algorithm

GPU acceleration is revolutionizing causal inference through the PC algorithm, transforming a previously computationally prohibitive task into a practical analytical approach for complex, high-dimensional datasets. The architecture of modern GPUs, with their massively parallel processing capabilities, aligns perfectly with the inherent parallelism of conditional independence tests central to causal discovery. From algorithm redesign to memory optimization and precision considerations, careful implementation strategies can yield performance improvements of several orders of magnitude compared to traditional CPU implementations. The evolution from NVIDIA A10 to A100 and H100 GPUs has progressively reduced computation times and expanded practical dataset sizes, enabling real-time causal inference applications in fields ranging from finance and healthcare to industrial control systems. This technological advancement bridges the gap between theoretical causal modeling and practical deployment, moving AI systems beyond correlation to understand true causal relationships.