Health Care Outcomes Research Articles

Multitask multilayer-prediction model for predicting mechanical ventilation and the associated mortality rate

AbstractMechanical ventilation (MV) is a crucial intervention in the intensive care unit (ICU) for severely ill patients. However, it can potentially contribute to lung damage due to the opening and closing of small airways and alveoli. This study aims to enhance the accuracy of mechanical ventilation prediction using a comprehensive dataset from the Medical Information Mart for Intensive Care (MIMIC-III). The data were extracted with three time frames, 6, 12, and 24 h. Then, 6 h left as a time gap and the ventilation as well as the mortality during the next 48 h. The proposed model consists of two layers: Layer 1 predicts ventilation and mortality in the ICU, while Layer 2 predicts the duration of ventilation. Classification techniques are applied to identify patients in need of ventilators, employing multilayer multitask long short-term memory (LSTM) models. Regression tasks use neural networks (multilayer perception). The optimum feature subset was obtained using particle swarm optimization (PSO). Additionally, this study examines the correlation between ventilation and mortality among patients with and without acute respiratory distress syndrome (ARDS). The findings of this research can enhance health-care outcomes and inform policymakers about resource allocation in overwhelmed health services. The best results were obtained when utilizing the first 24 h for prediction. The proposed MTL model achieved promising performance of 0.944, 0.923, 0.951, and 0.921 for the first task and 0.971, 0.961, 0.963, and 0.970 for the second task for accuracy, precision, recall, score, and AUC, respectively.

Characterizing state-level structural cisheterosexism trajectories using sequence and cluster analysis, 1996-2016, 50 U.S. states and Washington, D.C., and associations with health status and healthcare outcomes.

Structural cisheterosexism is a root cause of LGBTQ health inequities. Amidst ongoing legal attacks on LGBTQ populations' rights, research is needed to examine changes in policy contexts over time and associated implications for population health and inequities. To address this gap, we constructed state-level structural cisheterosexism trajectories for each U.S. state/D.C. from 1996-2016. We used sequence analysis to quantify differences between trajectories and cluster analysis to group similar trajectories. We evaluated associations between trajectory clusters and individual-level health(care) outcomes (self-rated health, frequent mental distress, lacking insurance, lacking a doctor, avoiding care due to cost) from the 2017 Behavioral Risk Factor Surveillance System, in the overall sample and by LGBTQ status (LGBTQ vs. cisheterosexual), using multilevel logistic models. From 38 unique trajectories, we identified five trajectory clusters: "consistently-predominantly-discriminatory", "consistently-fairly-discriminatory", "moderate-with-increasing-protection", "discriminatory-change-to-fairly-protective", and "fairly-discriminatory-change-to-predominantly-protective." Overall, health(care) was worse in states characterized by consistently discriminatory laws compared to states with increasingly protective laws and disproportionately so for LGBTQ people. Findings underscore the need to abolish harmful, cisheterosexist state laws and enact protective laws to advance LGBTQ health equity. More broadly, this study demonstrates the utility of sequence and cluster analysis for assessing long-term population health impacts of structural-level determinants.

Healthcare outcomes in hospitals: Development of a conceptual framework

Healthcare outcomes in hospitals: Development of a conceptual framework

Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality

PurposeWith an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic’s effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19.Design/methodology/approachThe study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access – availability, accessibility, accommodation, cost and acceptability – were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis.FindingsAccording to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure.Practical implicationsFor Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities.Originality/valueThe study’s originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study’s practical consequences.

Clinically meaningful categorisation of ICD-10-AM (Australian modification).

Background: Current methods of categorising the International Statistical Classification of Diseases and Related Health Problems (ICD) have limitations when deciphering administrative data and monitoring healthcare outcomes. These include many-to-one relationships, non-linear sequencing, collinearity, and ambiguous miscellaneous (residual) codes. Objective: Describe novel methodology for clinically meaningful categorisation of 12th Edition of ICD Version 10 Australian modification (ICD-10-AM). Setting: State of Victoria (Australia), population of 6.6 million with over 3 million separations per annum. Method: Diagnosis codes from ICD-10-AM were aggregated into Clinical Diagnosis Group (CDG) sets according to clinical features and associated risk of in-hospital death and complications. Residual codes were excluded. Administrative data from July 2020 to June 2023 were interrogated to ascertain frequency of diagnoses captured by CDG sets. Results: 12,716 (87.9%) of 14,470 total ICD-10-AM codes were aggregated into 406 CDG sets; mean 32 (range 1-288) codes per set. One thousand seven hundred fifty-three (12.1%) were excluded (not allocated): 775 (5.4%) residual codes; 702 (4.9%) indicating reason for healthcare encounter; and 276 (1.9%) ill-defined clinical symptom codes. Over 36-months, 11.8 million separations were coded with 11,898 (82.2%) unique ICD-10-AM diagnoses, including 10,721 (90.1%) present in a CDG set. Of the 8571 (59.2%) codes associated with death or complications, 7813 (91.2%) were present in a CDG set. Conclusion: The CDG list provides a clinically meaningful method of categorisation and interrogating datasets based on ICD-10-AM and complements existing methods.

Driving Project Outcomes in Healthcare: How Servant Leadership and Team Dynamics Contribute to Success

The current research explores the project outcomes in healthcare sector of Pakistan by assessing servant leadership and team dynamics in the context of Situational Strength Theory. This research model examines the effect of servant leadership on project success via intervention of team effectiveness. Moreover, it also incorporates the moderating impacts of team level variables; team autonomy and task ambiguity in these relationships. The data is gathered from practicing health care project team members of Pakistan. Hence, for data analysis the Statistical technique Partial Least Square-Structural Equation Modelling (PLS-SEM) is employed. The findings indicate that project success is positively and significantly related with servant leadership. Servant leader increases the likelihood of project success and effectiveness directly at the team level. Mediation of team effectiveness between servant leadership and Project Success is also supported as the servant leadership practices nurtures the overall team process and foster team effectiveness. The moderation of task ambiguity is determined to be significant, while interestingly, that of team autonomy is found to be insignificant. The study also establishes the importance of servant leadership for evolving team effectiveness in project-based organizations for the achievement of project success. The results of this study are relevant for the advancement of project management practices, especially in the healthcare sector. This particular study offers practical recommendations to healthcare organizations with regard to successful implementations of effective leadership strategies that improve their team processes and enhance the attainment of desired outcomes for projects. The insights generated by this research add to the existing literature both in healthcare management and project management, fill a significant theoretical gap, and provide a basis for further studies on the role of leadership in complex settings where project organizations are involved.

Physiotherapists as first-contact practitioners for patients with low back pain in French primary care: a pragmatic cluster randomised controlled trial.

A new model of care enables French physiotherapists (PT) working in collaboration with family physicians (FP) to expand their usual scope of practice for patients with acute low back pain (LBP). The aim of our study is to evaluate the impact of this new first-contact physiotherapy (FCP) advanced practice model compared to usual FP care. A multicentre pragmatic non-inferiority cluster randomised controlled trial (RCT) has been conducted in six multidisciplinary primary healthcare centres in France. Patients from 20 to 55 years old with acute LBP consulted either the PT or the FP. PT independently assessed and managed patients including medication prescription. The primary outcome measure was disability at six weeks (Roland Morris Disability Questionnaire, range 0-24). Secondary outcomes include pain, risk disability prognosis, satisfaction with care, healthcare resources use and wait times. Data were collected at baseline, six and twelve weeks. Outcomes across arms were compared using mixed models regression analysis. Except for non-inferiority analysis of the primary outcome measure, other analyses were performed with a two-sided significance level of 0.05. Sixty patients were recruited (PT: 32, FP: 28). The adjusted mean difference between groups for disability at 6 weeks was 0.39 in favour of the FP group (95%CI: -2.03; 2.81, p = 0.753). Considering a 5 points minimal clinically important difference, the FCP-led model of care was not inferior to usual FP care for the primary outcome. There was no statistically significant difference between groups in disability at 3 months and pain at 6 weeks and 3 months. PTs prescribed significantly less medications than FPs (p < 0.001). No statistically significant difference was found for other healthcare resource use outcomes, patients' satisfaction and wait times. This is the first RCT to evaluate the impact of a FCP advanced practice model of care including medical delegated acts in a primary care setting. Our results suggest that the FCP-led model of care is not inferior to usual FP care regarding disability at 6 weeks. The FCP model could result in possible benefits in terms of healthcare resources use. Further adequate powered studies with larger sample size are needed to draw stronger conclusions. The study has been registered in ClinicalTrials.gov (NCT05200533) on the 20th of January 2022.

A Review of Psychological and Moral Challenges Faced by Medical Staff in High-Stress Environments

Healthcare professionals often operate in high-stress environments that expose them to significant psychological and moral challenges. This review examines the prevalent stressors impacting medical staff, including burnout, anxiety, depression, and moral distress, as well as the coping mechanisms and institutional supports that mitigate these pressures. In exploring psychological factors, such as emotional exhaustion, and moral challenges, like ethical dilemmas and moral injury, this article highlights the compounded toll on staff well-being and patient care quality. Evidence suggests that these pressures negatively impact healthcare outcomes, leading to increased errors, higher turnover rates, and diminished staff retention. The review further discusses strategies to support healthcare workers, including peer support, institutional programs, ethics training, and resilience-building initiatives, emphasizing the need for systemic changes to foster a sustainable, compassionate healthcare environment. Addressing these challenges is essential to ensuring high-quality patient care and a resilient healthcare workforce.

Predicting Chronic Liver Disease and Jaundice Detection an Integrated Approach Using Statistical Feature Extraction and Machine Learning Algorithms

An important health concern with chronic liver disease is early identification, which is essential for management and therapy. This work suggests an integrated method to identify tattoo-induced jaundice and forecast chronic liver disease by combining statistical feature extraction with machine learning techniques. First, we use statistical techniques based on projections to extract pertinent aspects from patient data, such as test results and clinical markers. We then use Artificial Neural Networks (ANN), KNN, and Naive Bayes to categorize individuals according to the probability that they have chronic liver illness and to pinpoint jaundice episodes associated with tattooing. The KNN technique offers interpretability, managing categorical data is made simple by Naive Bayes, and complicated patterns are captured by ANN using layers of neural networks. These models' performance is assessed using the following metrics: F1 score, recall, accuracy, and precision. Our research aims to improve prediction accuracy and offer practical advice for early diagnosis and individualized treatment plans. By utilizing advanced data analysis and machine learning instruments, the integrated strategy shows promise in enhancing healthcare outcomes.

ASSESSMENT OF KNOWLEDGE ABOUT TEAMWORK AMONG NURSES

Teamwork is essential in healthcare, particularly among nurses who are crucial in patient care. Effective teamwork has been shown to improve patient safety, care quality, and healthcare outcomes. Objective: This study aimed to assess the level of teamwork knowledge among nurses at the Punjab Institute of Neurosciences (PINS) in Lahore, Pakistan, and to examine factors influencing this knowledge, including years of experience, education level, and previous teamwork training. Methods: This cross-sectional study was conducted with a sample of 100 registered nurses at PINS. Data were collected using a structured questionnaire assessing demographics and teamwork knowledge across domains such as communication, role clarity, conflict resolution, and interprofessional collaboration. Statistical analyses, including ANOVA and t-tests, were conducted to explore associations between teamwork knowledge and demographic factors. Results: The findings indicated a moderate overall teamwork knowledge score among nurses, with strengths in communication (mean score: 3.8) and interprofessional collaboration (mean score: 3.9). However, areas like conflict resolution (mean score: 3.2) and role clarity (mean score: 3.5) showed room for improvement. Higher levels of education, more years of experience, and previous teamwork training were significantly associated with greater teamwork knowledge. Nurses with advanced degrees and those who had received teamwork training scored notably higher than their peers without such training. Conclusion: The study highlights the influence of education, experience, and targeted teamwork training on nurses’ teamwork knowledge. Recommendations include implementing regular teamwork training programs, mentorship initiatives for junior nurses, and department-specific training to strengthen teamwork competencies. Future research should focus on the impact of teamwork knowledge on patient outcomes, providing insights into how enhancing teamwork skills can improve healthcare quality in Pakistan.

Medicaid Expansion and Overall Survival of Lower Gastrointestinal Cancer Patients After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy.

In the United States, often only tertiary centers offer cytoreductive surgery and heated intraperitoneal chemotherapy (CRS+HIPEC) for peritoneal metastases in advanced lower gastrointestinal malignancies. Growing evidence shows that Medicaid expansion under the Affordable Care Act (ACA) of 2010 enhanced healthcare access and outcomes. We sought to determine whether Medicaid expansion was associated with decreased all-cause mortality of lower gastrointestinal cancer patients following CRS+HIPEC. We analyzed data from the National Cancer Database (2010-2019) on lower gastrointestinal cancer patients who underwent CRS+HIPEC. Medicaid expansion, introduced under the ACA in 2010, extends health insurance to low-income adults. We categorized states by expansion timing: early (2010-2013), immediate (January 2014), late (after January 2014), or no expansion to assess the impact of Medicaid expansion on mortality using a multivariable Cox regression model. Of the 1001 study patients, 671 (67%) were diagnosed in Medicaid expansion states. Grade and Medicaid expansion status were the only factors independently associated with overall survival on multivariable analysis. On average, patients in Medicaid expansion states experienced a 4% increase in annual survival compared with those in non-expansion states who had a 1% decrease in annual survival over the study period. Patients from states that had an early expansion of Medicaid and patients with lower-grade tumors had significantly better overall survival. Our study findings suggest that improved access to healthcare through Medicaid expansion was associated with increased survival rates of lower gastrointestinal cancer patients who undergo CRS+HIPEC for the treatment of peritoneal metastases.

Survival rate of diabetic-related lower extremity amputees in hospitals in the Eastern Cape.

Diabetes mellitus (DM) is a global health concern that has greatly affected South Africa. The gap in the current management of DM has resulted in complications such as lower extremity amputations (LEAs) and death. Eastern Cape province reflects this struggle, with disparities in access to healthcare and poor health outcomes. Understanding survival rates and associated factors between the urban Livingstone Hospital and the rural Nelson Mandela Academic Hospital can improve health interventions and outcomes. This study compared the survival rate of patients in urban areas and those in rural areas. This retrospective cohort study was conducted in an urban and a rural hospital by reviewing existing medical records of diabetic patients who underwent an LEA between 2016 and 2019. The retrospective cohort study examined 439 diabetic-related LEA cases. This study found that residing in rural areas significantly decreased the risk of mortality by 62% compared with living in the urban areas. Factors such as haemoglobin A1c (HbA1c) levels, nephropathy, cardiovascular disease, human immunodeficiency virus (HIV), other comorbidities and level of amputation significantly influenced survival probabilities. Survival analysis indicated a significant difference in the 3-year survival probabilities of the two groups, favouring rural residency (p = 0.001). The biggest cause for concern between the two regions was uncontrolled blood glucose levels as this resulted in high mortality rates. Insights from this study have shown that introducing podiatry and orthotics at primary healthcare (PHC) could improve foot care and reduce diabetic-related LEAs and mortality.

Breaking barriers: improving mammography screening accessibility and quality of care for breast cancer women with disabilities in Saudi Arabia

IntroductionBreast cancer screening remains pivotal in early detection and intervention. However, disparities persist, particularly among women with disabilities, necessitating a comprehensive understanding of their screening practices. This study aims to investigate breast cancer screening behaviours in Saudi women with disabilities.MethodsA cross-sectional study conducted in Saudi Arabia surveyed 307 women with disabilities, evaluating their screening frequency, knowledge of mammography, disability types, and duration. The Statistical Package for the Social Sciences (SPSS) was employed for data analysis.ResultsThe study found that 70.4% of participants had irregular breast cancer screenings, and 92.5% lacked tailored information on breast cancer screening. The primary sources of information were support groups (59.3%) and healthcare professionals (25.4%). Significant associations were observed between education levels and awareness of the importance of mammography and the increased risk of breast cancer in individuals with disabilities. Notably, participants with higher education levels demonstrated greater awareness.ConclusionThe findings highlight substantial gaps in breast cancer screening practices and knowledge among Saudi women with disabilities. There is a critical need for tailored educational programs, accessible information, and targeted awareness campaigns to address these disparities. Enhancing the accessibility of screening services and information for this demographic is essential for improving healthcare equity and outcomes.

Governance of healthcare quality: exploring the relationships between hospital board performance and healthcare quality outcomes

PurposeThis paper aims to contribute to the existing literature in the field of hospital governance by exploring the relationship between the attributes and performance of hospital boards and hospital performance in terms of quality of healthcare.Design/methodology/approachA survey of board performance in public hospitals in Morocco was carried out, in which we surveyed all board members of the 13 hospitals in the Casablanca-Settat region. A total of 82 members responded (82% response rate) to the previously adapted and validated self-evaluation questionnaire on board self-assessment questionnaire (BSAQ) board member performance.FindingsOn average, the hospital boards studied had eight members. In terms of clinical expertise, half the members were physicians and 17% were nurses. In addition, positive correlations were found between certain board characteristics, notably age, seniority, members' perceptions of their impact on the quality of healthcare and several dimensions of board performance. In parallel, the results showed strong and significant associations between turnover rate and BSAQ score. Negative correlations were also found between average length of stay and BSAQ score. With regard to mortality parameters, it should be noted that we were unable to establish a strong empirical correlation between hospital boards' self-assessed performance and other hospital mortality indicators.Research limitations/implicationsThe present study offers a rigorous rationale for the use of the French-translated BSAQ in the hospital context, and we hope that others will use this tool in future work within the framework of evidence-based research. In addition, the BSAQ tool’s focus on board competencies (and not just structure, composition or processes) provides valuable insights into what boards need to learn in order to function effectively. However, despite the insistence of the authors of this study on the need for a comprehensive census of public hospital board members in the region, several obstacles were encountered. Firstly, there were difficulties related to vacancies within the hospitals, which had the effect of restricting the representativeness of the sample. Secondly, access to hospital board members proved complex due to their busy schedules and the confidential nature of their meetings. Finally, it is important to note that national performance indicators in Morocco may not be as reliable as in other countries, which could complicate the identification of high-performing hospital systems and, consequently, make inference difficult.Originality/valueThis study provides large-scale empirical evidence of processes related to the governance of quality of healthcare and elucidates the existence of an association between hospital board performance and clinical performance. The use of validated tools such as the BSAQ should therefore help improve the performance of boards and governance in public hospitals.

Economics and Equity of Large Language Models: Health Care Perspective.

Large language models (LLMs) continue to exhibit noteworthy capabilities across a spectrum of areas, including emerging proficiencies across the health care continuum. Successful LLM implementation and adoption depend on digital readiness, modern infrastructure, a trained workforce, privacy, and an ethical regulatory landscape. These factors can vary significantly across health care ecosystems, dictating the choice of a particular LLM implementation pathway. This perspective discusses 3 LLM implementation pathways-training from scratch pathway (TSP), fine-tuned pathway (FTP), and out-of-the-box pathway (OBP)-as potential onboarding points for health systems while facilitating equitable adoption. The choice of a particular pathway is governed by needs as well as affordability. Therefore, the risks, benefits, and economics of these pathways across 4 major cloud service providers (Amazon, Microsoft, Google, and Oracle) are presented. While cost comparisons, such as on-demand and spot pricing across the cloud service providers for the 3 pathways, are presented for completeness, the usefulness of managed services and cloud enterprise tools is elucidated. Managed services can complement the traditional workforce and expertise, while enterprise tools, such as federated learning, can overcome sample size challenges when implementing LLMs using health care data. Of the 3 pathways, TSP is expected to be the most resource-intensive regarding infrastructure and workforce while providing maximum customization, enhanced transparency, and performance. Because TSP trains the LLM using enterprise health care data, it is expected to harness the digital signatures of the population served by the health care system with the potential to impact outcomes. The use of pretrained models in FTP is a limitation. It may impact its performance because the training data used in the pretrained model may have hidden bias and may not necessarily be health care-related. However, FTP provides a balance between customization, cost, and performance. While OBP can be rapidly deployed, it provides minimal customization and transparency without guaranteeing long-term availability. OBP may also present challenges in interfacing seamlessly with downstream applications in health care settings with variations in pricing and use over time. Lack of customization in OBP can significantly limit its ability to impact outcomes. Finally, potential applications of LLMs in health care, including conversational artificial intelligence, chatbots, summarization, and machine translation, are highlighted. While the 3 implementation pathways discussed in this perspective have the potential to facilitate equitable adoption and democratization of LLMs, transitions between them may be necessary as the needs of health systems evolve. Understanding the economics and trade-offs of these onboarding pathways can guide their strategic adoption and demonstrate value while impacting health care outcomes favorably.

An evaluation of a mentoring program in Emergency Medicine: A qualitative assessment using semi-structured interviews

Background Mentorship plays a crucial role in professional development, particularly in fields like emergency medicine. However, the dynamics of mentor-mentee relationships in this context remain underexplored. Understanding these dynamics is essential for optimizing mentorship programs and enhancing healthcare outcomes. This research investigates the factors influencing mentorship relationships in emergency medicine within the United Arab Emirates (UAE) context. It seeks to uncover the characteristics and dynamics of these relationships through qualitative analysis, providing insights into facilitators and barriers to success. Methods The study adopts a qualitative approach, conducting interviews with both mentors and mentees. Thematic analysis is employed to identify recurring themes in mentor-mentee interactions. The analysis delves into the supportive, communicative, approachable, knowledgeable, and empathetic traits of effective mentors. It also explores hindrances such as time constraints, resource limitations, random mentor allocation, and gender and cultural differences. Results The research findings underscore the pivotal role of mentors in fostering successful mentorship relationships. Effective mentors exhibit traits such as supportiveness, communication skills, approachability, knowledge, and empathy. Conversely, barriers to these relationships include mentees' behavior, time and resource constraints, random mentor allocation, and gender and cultural disparities. Conclusions While highlighting the importance of mentorship in emergency medicine, the study identifies the need for tailored mentorship approaches. It emphasizes the significance of selecting, training, and supporting mentors and optimizing mentorship programs. The research also suggests developing guidelines, aligning mentorship goals with healthcare priorities, fostering diversity, and integrating mentorship into professional development and quality assurance mechanisms. Ultimately, this study sheds light on the complexities of mentor-mentee relationships in emergency medicine, offering valuable insights for academic research, practice, and policy development in the UAE healthcare context.

A systematic literature review on how consumer and community involvement have shaped and influenced pre-pregnancy care interventions for women with diabetes

BackgroundDiabetes and pregnancy studies have found better outcomes when interventions were developed with consumer (individuals with lived experience of diabetes) and community involvement. When consumers are central to development and delivery of interventions, study participants have better engagement and outcomes, particularly for individuals from culturally and linguistically diverse (CALD) and/or lower socio-economic backgrounds. Our study aims to examine the scope of consumer and community involvement (CCI) in the construction and implementation of pre-pregnancy care (PPC) interventions and discuss a framework for consumer-lead intervention development.MethodsA systematic literature review was conducted, examining 3 electronic databases. A meta synthesis analysis of tabulated data summarized in a literature matrix was undertaken with a phenomenological approach to develop a Pre-Pregnancy Care CCI-Driven Intervention Framework.ResultsOverall, 4642 papers were identified, with 29 meeting inclusion criteria. The meta-synthesis and literature matrix identified several common themes across previous studies. These were: barriers to accessing (PPC) such as negativity and stigma in care from behaviours, attitudes and perceptions of HCPs; limited appointment availability not aligning with work and family commitments; fear of losing a “normal” pregnancy journey; awareness of risk but unwillingness to discuss if consumers have not established trust with HCPs; inaccessibility to CALD appropriate PPC and contraception; and digitisation of PPC information resources including peer support and social media. From these results, a PPC Consumer-Driven Intervention Framework for Women with Pregestational Diabetes was developed with recommendations.ConclusionConsumers have been under-involved in the majority of previous developments and implementation of interventions for women with diabetes and pregnancy, and their representation as stakeholders in interventions is paramount to the longevity of intervention outcomes. To assist community involvement in diabetes pregnancy intervention design and delivery we created a new framework, for improving clinical and social outcomes in healthcare, empowering relationships between HCPs and consumers, and highlighting the value of lived experience and women-centred care for increased community engagement.

The Promise of Remote Patient Monitoring.

The promise of remote patient monitoring (RPM) lies in its ability to revolutionize health care delivery by enabling continuous, real-time tracking of patient health outside traditional clinical settings. The COVID-19 pandemic accelerated the adoption of RPM, particularly in underserved and rural populations, highlighting both its potential and the persistent barriers that limit its widespread use. This paper explores the critical role of technological advancements-such as wearables, artificial intelligence (AI), and broadband expansion-in sustaining and optimizing RPM in the postpandemic era. We examine Michigan as a microcosm of national health care challenges, focusing on its diverse population and geographic barriers, and propose condition-specific RPM protocols to address these inequities. Key facilitators and barriers to RPM implementation are discussed, with a focus on AI integration, community engagement, and digital infrastructure. We also explore the role of policy reform and public-private partnerships in supporting RPM's scalability and long-term sustainability. Our findings suggest that while RPM offers a powerful tool for improving health care access and outcomes, especially for chronic conditions and rural maternal health, sustained investment in technology and infrastructure is critical. By addressing these challenges, RPM can become a cornerstone of modern health care, reducing disparities and improving care delivery for underserved populations.

A Retrospective Observational Study Evaluating COVID-19 Mortality and Morbidity in a Rural ICU Among People Over and Under 65.

Background The literature surrounding COVID-19 mortality in the elderly compellingly leans towards the elderly faring worse. The populations of such literature often combined the rural and urban populations or simply discounted the rural population altogether. Anecdotal evidence suggests that this stigma is misplaced and that the elderly are not always at risk of the worst health outcomes. Method SARS-CoV-2-positive patients who were admitted to the ICU of Hatta Hospital were included in the study. They were split into two groups, those under and those over the age of 65.Percentage mortality, morbidity using Acute Physiology and Chronic Health Evaluation II (APACHE II), and duration of hospital admission were assessed in the two groups, and statistical analysis was performed. Results Seventy-twopatients were deemed eligible for inclusion. Percentage mortality of the total population was 16.67% (N=12). In the under 65's arm the mortality percentage was 12.5% and the percentage mortality of the over 65's was 21.9% (N=7); chi-squared=1.13 (p=0.29).There was no statistical significance between mortality in the two arms. The global average time to discharge was 20.64 ± 1.98 days. The average time to discharge in the under-65's was 19.83± 2.64 days; the average time to discharge in the over-65 group was 21.66 ± 3.04 days; p= 0.65. The global average APACHE II score was 10.52 ± 0.77. The mean APACHE II score for the under 65's arm was 8.24 ± 0.95 while the mean APACHE II score for the over 65's was calculated at 13.2 ± 1.04: p=0.0008. Conclusion Overall, mortality was not significantly different, nor was their duration of stay. There was a significant difference in their morbidity; however, both groups had similar healthcare outcomes. The elderly did not face worse health outcomes than their younger counterparts. There is a gap in the literature discussing rural healthcare.

Integrating Modern Design and Sustainability in Healthcare Architecture: A Comparative Case Study of Sri Lanka's National Nephrology Hospital and the UK's NHS New Hospital Programme

Hospital architecture has evolved significantly, influenced by advancements in medical science, technology, and societal needs. This paper examines the historical progression of hospital architecture, highlighting modern trends such as patient-centred design, modular construction, sustainability, and digital integration. It emphasizes the relevance of these trends to Low and Middle-Income Countries (LMICs), focusing on the China-Sri Lanka Friendship National Nephrology Hospital (NNSH) in Polonnaruwa. The study employs a qualitative approach, utilizing historical data, literature reviews, and case studies from developed and developing countries, primarily focusing on the NNSH and the UK's NHS New Hospital Programme (NHP).The NNSH exemplifies innovative hospital design, incorporating energy-saving technologies, climate-responsive features, and disaster resilience. It functions as a community hub, promoting health education and outreach. Insights from the NHP emphasize the integration of digital solutions, standardized designs, and sustainable practices, which are pivotal for enhancing healthcare infrastructure in LMICs.Strategic recommendations address challenges such as cost constraints, infrastructure gaps, and technical expertise in LMICs, including digital transformation, net-zero carbon strategies, green practices, and adherence to standardized guidelines. This comparative study underscores the importance of adaptable and sustainable hospital architecture in improving healthcare delivery and outcomes in Sri Lanka and other LMICs.