Objectives: This study aims to analyze the drivers and barriers of digital transformation in radiology services within Moroccan public hospitals, identifying conditions necessary to guide these services toward a smart hospital model that enhances efficiency, quality, and governance. Prior Work: Previous research has highlighted the global importance of digitalization in healthcare, with radiology being central due to high data dependence and technological complexity. In Morocco, studies focus mostly on broad health system digitalization, with limited attention to public hospital radiology services. Approach: A narrative literature review was conducted, integrating academic publications, institutional reports (WHO, OECD, Moroccan Ministry of Health), and national strategic documents. Keywords related to digital health, hospital information systems, radiology services, and smart hospital governance were used to identify relevant sources between 2010 and 2025. The analysis built a conceptual framework linking technological infrastructure, interoperability, governance, workforce capacity, and cybersecurity with digital transformation outcomes. Results: The review identified key drivers, including robust infrastructures, interoperable PACS/RIS systems, strategic leadership, and staff training. Major barriers include heterogeneous equipment, system fragmentation, limited digital competencies, financial constraints, organizational resistance, and cybersecurity risks. Moroccan public hospitals show opportunities for modernization, particularly when digitalization is embedded within broader smart government strategies. Implications: Effective digital transformation in radiology requires integrated planning, investment in technology and workforce, phased adoption strategies, and robust governance structures. Aligning hospital digitalization with urban and national digital health initiatives can improve efficiency, quality, and patient safety.Value: This study provides a foundation for strategic planning and operational guidance to develop “intelligent radiology services” in Moroccan public hospitals, contributing to the broader modernization of healthcare delivery and digital governance.

To develop and pilot a community pharmacy pre-exposure prophylaxis (PrEP) awareness-raising and referral pathway, informed by a literature review and interviews with pharmacists and community members. Using the person-based approach and the Capability, Opportunity, Motivation-Behaviour change (COM-B) model, the pilot aimed to improve HIV/PrEP knowledge/capability and motivation through pharmacist and community awareness-raising. Opportunity was addressed by integrating PrEP consultations into pharmacy services and offering sexually transmitted infection (STI), HIV and kidney function home self-sampling kits. Financial incentives aimed at motivating pharmacists. Pharmacists initiated PrEP discussions and provided self-sampling kits. Individuals interested in starting PrEP were referred to the sexual health clinic, completed the tests and posted them to the clinic for processing. Clinic staff then confirmed PrEP eligibility and prescribed PrEP remotely. National Health Service (NHS) policy restrictions on pharmacies stocking NHS-procured PrEP informed the delivery model. The pilot evaluation focused on staff training impact, number/type of consultations and acceptability and feasibility for staff and community members. The pilot was conducted in five pharmacies across Bristol, North Somerset and South Gloucestershire from October 2024 to April 2025. A total of 55 individuals (aged 18-69 years, n=23 male, n=31 female, n=1 transgender) were made aware of PrEP and offered a referral for PrEP. Visit reasons included emergency contraception (n=14), PrEP (n=14) and opioid substitution therapy (n=11). Twenty-eight community members expressed interest in PrEP; 22 accepted a self-sampling kit, nine returned it and four were prescribed PrEP. Pharmacists and community members viewed the service positively. Barriers included pharmacists' initial lack of confidence initiating PrEP discussions and limited public awareness of PrEP availability in pharmacies. Community pharmacies represent a promising site for a PrEP awareness-raising and referral pathway. Successful scale-up requires pharmacist training, public health education and structural and policy changes to support accessible PrEP provision beyond sexual health clinics to reduce inequities.

Access to hearing health care remains a major issue for people with hearing and balance disorders across the lifespan. University audiology clinics are in a unique position to address these disparities in access, as they serve as training programs for future clinicians and health care centers. This study examined the accessibility of university audiology clinics in various domains including financial barriers, LGBTQ+-inclusive facilities, physical access, scheduling, transportation, financial assistance, and communication. Data on accessibility domains were collected via structured phone calls with clinic reception staff at university audiology clinics and websites. Distances between the nearest bus stop or rail station and the university audiology clinic were calculated and categorized based on the frequency of service. Responses and public transportation data were analyzed using descriptive statistics. University audiology clinics had a range of accessibility features, including ways to schedule an appointment, services for patients with limited English proficiency, financial assistance, disability accommodations, availability of gender-neutral restrooms, and extended clinic hours. Most offered standard scheduling by phone, written visit summaries, and accessible physical facilities, but fewer clinics provided services for extended hours, disability accommodations, or language support. Gaps identified include gender-inclusive restrooms, bilingual staffing, and financial assistance options for patients. The mean distance from the university clinic to the nearest bus stop was 0.206 mi, and the mean distance from the university clinic to the nearest rail station was 0.488 mi. Clinics are located in slightly more socially disadvantaged areas compared to the national average. The findings provide data on the accessibility of university audiology clinics for patients from various backgrounds with differing needs (e.g., financial assistance, language support). Gaps in hearing health care access and areas for improvement of accessibility across areas such as language services, physical facilities, scheduling, and transportation for university audiology clinics are identified and discussed. Recommendations include asking about transportation options, scheduling considerations around transit schedules, installing clear signage, providing staff training, and offering tele-audiology appointments. https://doi.org/10.23641/asha.31235929.

ABSTRACT Research shows that participation in physical activity (PA) programs can benefit transgender and gender diverse (TGD) youths’ social, psychological, and physical health and development. However, previous scholars note that discriminatory environments and barriers can limit TGD youths’ organised and recreational leisure activity engagement. Despite no existing, tailored PA environments for this population, other types of programs effectively create inclusive environments for them. The purpose of this study was to gather input from adult leaders of such community programs, regarding practices and policies that could contribute to creating a safe, enjoyable PA program for TGD adolescents. Nine community leaders facilitating US-based programs with TGD and LGBTQ+ youth participants participated in individual, semi-structured interviews. They were asked about organisational policies, staff hiring, activity structure, and accessibility strategies. Template analysis revealed leaders recognise an absence of (tailored) PA programs for TGD youth. They shared concrete examples from their programs, with broad recommendations for underrepresented youth and more specific considerations for TGD youth. Leaders suggest that clear community guidelines, flexible programming, appropriate staff training, youth autonomy, and safety-promoting strategies (e.g. private meeting spaces) are necessary. Community leaders are an underutilised, invaluable resource for creating safe, enjoyable leisure contexts for TGD youth.

Background: Adults with learning disabilities and autistic adults in England face significantly higher rates of premature mortality, 22 years earlier for those with learning disabilities and over 6 years earlier for autistic adults. Barriers to healthcare access contribute to missed diagnoses and treatments. There, the aim of this review was: What are the barriers and facilitators to healthcare appointment attendance for adults with learning disabilities and autistic adults in England? Methods: A systematic search across ten databases (March 2023; updated June 2024) identified 1,727 papers. Studies were included if they reported qualitative evidence on clinical appointment accessibility for autistic adults or adults with learning disabilities in England. Fifteen studies were included and critically appraised. Findings were synthesised using Joanna Briggs Institute meta-aggregation and interpreted through a socio-ecological lens. Findings and Conclusions: Facilitators included flexible booking systems, positive healthcare professional attitudes, and the ability to develop a positive and trusting relationship between HCPs and the person they were supporting. Barriers existed at individual, relational, organisational, and policy levels, including poor communication, inadequate appointment systems, and lack of professional knowledge. Recommendations include enhanced staff training, use of liaison nurses, flexible appointment systems, and accessible communication. Policy and structural changes are needed, though further evaluation of their impact is essential.

This study is motivated by the fluctuating number of participants at LPK Takemura Indonesia, Bandung Regency, and the urgent need to improve its quality management system in order to compete in the digital era and meet industry requirements. The purpose of this research is to examine how the implementation of Total Quality Management (TQM) can enhance the performance of LPK Takemura, particularly in terms of sales (training participant enrollment), customer satisfaction, and internal institutional management. This study employs a qualitative descriptive approach, with data collected through observation, in-depth interviews, and documentation. Informants were selected using purposive sampling, involving the founder, director, administrative staff, and active training participants. The findings indicate that most TQM principles have been implemented at LPK Takemura, including customer focus, employee involvement, and continuous improvement. This implementation has positively impacted institutional performance, especially in increasing the number of participants (sales), improving customer satisfaction, and strengthening internal management. Moreover, the integration of a gender perspective in training contributes to women’s empowerment, promotes inclusive entrepreneurship, and fosters a more equitable and participatory work environment. The implementation of TQM is proven not only to improve the institution’s sales performance but also to generate broader social and economic implications.

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

Purpose This study aims to examine how hotels adopt technology, focusing on differences between urban hotels and thermal resorts in Denizli, Türkiye, through the lens of the technology–organization–environment (TOE) framework. Design/methodology/approach This study uses a qualitative exploratory approach. Semistructured questions and scenario technique were used. Data were collected through face-to-face interviews with managers and department heads of four- and five-star hotels in the region. Findings Technology adoption remains limited in this smaller, locally focused destination, with managers primarily leveraging technology for operational convenience and digital marketing. Notable disparities emerged between hotel types: urban hotels adopt more innovations, while thermal resorts predominantly adhere to a conventional service approach. Research limitations/implications This study is limited to managerial perspectives from one region and excludes direct input from guests and employees, which may affect generalizability. Future research should integrate diverse stakeholder views and measure the financial outcomes of technology adoption. Practical implications The TOE framework reveals that adoption hinges on internal readiness, leadership and external market forces. Staff training and infrastructure support are essential for successful implementation. Strategic use of tools such as smart TVs and QR menus enhances service quality, while staff adaptation – especially among older employees – requires targeted support and training. Social implications This study highlights that technology adoption in hotels is not purely technical but is closely linked to social dynamics, including guest expectations, cultural preferences and interpersonal interaction. In thermal resorts, the preference for human contact among elderly or tech-averse guests underscores the need for socially inclusive service models. Originality/value This study offers insights from an underresearched region, emphasizing how the TOE framework shapes technology adoption in small-scale hotel contexts.

Abstract Introduction Effective communication about medication changes during hospitalisation is critical for patient understanding, satisfaction, and adherence. This service evaluation examined how older patients and their carers perceive healthcare professionals’ communication around medication changes during inpatient care. Methods A qualitative study was conducted using semi-structured interviews with 10 participants (6 older inpatients, 4 carers) across four geriatric wards. Thematic analysis was applied. Sampling was guided by information power, with data saturation achieved after 10 interviews. Participants had a mean age of 77.5 years, eight patients were British, one Pakistani, and one Black African. Results Patients and carers described communication about medication changes as limited and inadequate, often leaving them feeling confused, anxious, and uncertain about decisions being made. There was a clear expectation for timely explanations delivered in straightforward language, with a strong emphasis on understanding the reasons behind each change. When communication was effective, it helped build trust, fostered a better medication understanding, and encouraged adherence. In contrast, poor communication undermined confidence and led to disengagement. Patients also expressed a strong wish to be involved in decisions, yet many felt marginalised or left out of important conversations. They placed high value on transparency and being offered treatment options. Carers emerged as key contributors to the process, often taking the initiative to seek clarification and advocate for the patient’s needs. Their involvement was viewed as crucial to delivering safe, informed, and person-centred care. Conclusion Prioritising clear, timely communication, including explicit rationale for medication changes, along with shared decision-making and active carer involvement, can strengthen trust, support adherence, and improve continuity of care. These findings highlight the need to embed patient-centred communication into staff training and routine clinical practice. Ethics approval was not necessary for this study as it is a service evaluation. Local approval has been secured from the hospital Trust.

Abstract Introduction Apomorphine is an adjunct therapy used in Parkinson’s disease, requiring careful coordination at discharge. A local review identified inconsistency in discharge documentation, supply of equipment, and communication with the movement disorder team. This quality improvement project aimed to improve discharge safety and communication through implementation of a structured checklist. Method Cycle 1 involved the introduction of an apomorphine discharge checklist on Ward L5, with compliance monitored and feedback provided. In Cycle 2, further improvements included medical staff education and ensuring full stock of apomorphine equipment on the ward. In Cycle 3, the Parkinson’s Disease Nurse Specialist (PDNS) led monitoring of discharges and delivered ongoing staff training. Data were collected retrospectively across three cycles: Cycle 1: March to December 2020. Cycle 2: May–July 2021. Cycle 3: November 2022–May 2024. Results Following Cycle 1, compliance improved across all three measures (0% to 100%). In Cycle 2, a single identified case showed full compliance. In Cycle 3, of six patients: 100% of patients were discharged either with an appropriate supply of apomorphine and equipment, or the pharmacist documented that the family already had a sufficient supply of all necessary medications and equipment. 33% had movement disorder team contact details documented. 83% had an identified and satisfied receiving team. Performance dipped in Cycle 3, attributed to weekend/on-call discharges, staff turnover, and one discharge from surgical ward. Conclusion This quality improvement project showed that initial implementation of the checklist led to significant improvements in discharge safety for patients on apomorphine. However, sustainability proved challenging due to staffing changes and variability in ward practices. This work highlights the need for ongoing education ensure safety in complex medication discharges.

PROspectiVe imaging research DEsign and coNducT (PROVIDENT): Considerations for clinical trials and studies using imaging (Part I).

The Integrated Financial Management System (IFMS) was created by the International Monetary Fund (IMF) and was designed for use by ‎government entities; however, over time, a lack of information for its effective management in local governments has been observed. The ‎objective of this study is to identify the challenges in implementing the IFMS, considering a governance and institutional capacity approach ‎in local governments. A systematic review of the scientific literature was conducted, following the PRISMA guidelines. The search process ‎identified 671 documents from Scopus, 229 from Refseek, and 294 from Google Scholar. Twenty-five articles were then selected for the ‎final analysis. The results show that the processes and practices carried out by local public institutions to make and regulate decisions, ‎automation, digitization, internal control, and staff training are seen as challenges for the implementation of an IFMIS. Likewise, the lack of ‎strategies, the use of analytical tools, regulations for financial management and collaborative work, corruption, territorial and psychosocial ‎factors also limit the implementation of the IFMS. Consequently, improvised staff training, poor internal control, a lack of effective ‎knowledge in the use of ICTs and electronic systems, and a lack of investment in digitalization become the main challenges for local ‎governments in implementing this system‎.

A significant challenge to achieving global 2030 elimination goals for blood-borne viruses (BBVs) is identifying undiagnosed individuals and relinking those who are no longer in care. To address this, the UK government has implemented opt-out BBV testing in emergency departments (EDs) to increase access to BBV testing in high prevalence areas. All adult ED patients having a routine blood test are automatically tested for HIV, hepatitis B and C, unless they opt out. This study aimed to identify barriers and facilitators to the implementation of ED opt-out BBV testing and provide recommendations for future rollouts. Semi-structured interviews with 23 staff members across five ED sites in very high HIV prevalence areas were analysed thematically, informed by Normalisation Process Theory. While there was some variation in staff knowledge and understanding of the programme, overall acceptance of the opt-out testing approach was found to be high. Training had a positive impact on staff understanding of the purpose of the intervention and the correct process, including the opt-out model. High workloads and competing priorities in EDs were significant barriers to testing. However, some specific systems and processes that facilitated the uptake of testing included automation and BBV champions. Giving the programme time to embed into practice and ensuring feedback loops and flexibility to 'tweak' the process was also essential to sustaining the programme. To embed opt-out testing into emergency care, sites should implement automated test ordering, staff training, clear communication and dedicated champions, which can help to support earlier diagnosis, reduce inequalities and improve patient outcomes.

Purpose This paper examines how artificial intelligence (AI), understood as a form of cognitive automation, may reshape the labour structures and social functions of contemporary libraries. It seeks to explain how AI can complement, rather than displace, the library's communal role by supporting its capacity to act as a Third Place. Design/methodology/approach The paper adopts a sociotechnical, conceptual approach, synthesizing research from library automation, social infrastructure and science and technology studies. It develops a theoretical model – the bifunctional institution – to analyse the interaction between algorithmic systems and the social–material dimensions of library work. Findings The study finds that AI may reduce routine interpretive labour and create organisational capacity for librarians to engage in relational, pedagogical and community-oriented activities. However, these benefits are contingent on robust governance, institutional autonomy and professional agency. AI can strengthen the library's social mission when integrated responsibly but may exacerbate inequalities or undermine transparency if adopted uncritically. Research limitations/implications As a conceptual paper, the work does not include empirical data. It highlights the need for future qualitative and organisational studies examining how AI tools are adopted in practice, how labour is redistributed within specific institutions and how governance structures mediate the relationship between automation and community-oriented work. Practical implications The model highlights conditions necessary for responsible AI adoption, including ethical governance, staff training and alignment of AI systems with public values and professional norms. Social implications By enabling a renewed focus on community engagement and shared learning, AI may reinforce libraries as crucial forms of social infrastructure in increasingly digitised and fragmented societies. Originality/value The paper offers one of the first theoretical integrations of automation studies and Third Place scholarship. It advances the concept of functional complementarity and provides a new framework for understanding libraries as bifunctional institutions composed of interdependent algorithmic and social layers.

Purpose This study analyzes how small and medium companies (SMEs) operating in China's cross-border e-commerce (CBEC) sector might employ digital transformation techniques to boost operational resilience and sustainability. Design/methodology/approach Using a mixed-methods approach, this study includes a quantitative survey of 250 CBEC companies and qualitative interviews with 15 SME representatives. This architecture allows us to investigate the connections among digital transformation programs, resilience plans, and sustainability results. Findings The results show that SMEs enhance operational efficiency and support sustainable practices using digital tools, including e-commerce platforms, data analytics, and Customer Relationship Management systems. Furthermore, operational resilience is a crucial mediator in the link between digital transformation and sustainability, so a high degree of integration of these projects improves general performance and competitiveness. Research limitations/implications Although the study offers insightful analysis, its limited sample of Chinese SMEs could limit the generalizability of the results. Future studies should consider longitudinal study methods to evaluate long-term effects and widening industry and geographic contexts. Practical implications While spending on digital technologies and staff training, managers are urged to include resilience solutions in their operational systems. This strategic approach improves flexibility and helps SMEs flourish in fast-changing worldwide environments. Originality/value This paper presents novel contributions by linking resilience capabilities with digital transformation projects inside SMEs, using a creative approach that emphasizes their significant influence on negotiating uncertain business environments.

Background: Vascular access-site complications after catheterization remain a significant cause of morbidity and mortality. While patient- and procedure-related risk factors are well described, the impact of structured, interdisciplinary training programs is less well established. We evaluated the effect of a structured training program for cardiologists and interventional staff on access-site-related complications after transfemoral coronary interventions. Patients and methods: Over 36 months, we tracked all elective transfemoral coronary interventions at our institution. After an initial 6-month observational phase, we implemented a structured training program for cardiologists and catheter lab staff, using initial complication rates as the baseline. The training included quarterly sessions, pre-interventional angiological assessment for high-risk patients, pre-interventional assessment for all patients, and sheath removal by assistants. We prospectively assessed all access-site related complications using a standardized protocol and analysed incidence changes with a regression model, adjusting for patient-specific risk factors over time. Results: Quarterly training and pre-interventional angiological assessment for high-risk patients did not significantly impact complication rates. However, pre-interventional angiographical assessment for all patients and sheath removal training for assistants significantly reduced complication rates. The results remained consistent after adjusting for patient-specific risk factors. Conclusions: Structured angiological training for interventional staff significantly reduces access-site related complications. Interdisciplinary collaboration enhances patient safety and minimizes adverse events.

End-of-life care for forensic psychiatric patients: Ethical, legal, and systemic challenges in integrating palliative approaches.

Dementia is one of the leading causes of dependency among older people and poses a critical challenge for long-term care systems. Despite the importance of the issue, national data on the prevalence of dementia in residential care homes remain limited. A cross-sectional, observational, and institution-based study was conducted within the framework of the SINDIA project. The study was based on an online survey addressed to the technical directors of residential care homes for older people in Portugal, carried out between January and July 2024. The questionnaire collected information on institutional characteristics (sector, territorial location, base monthly fee, dementia specialization, and total number of residents) and on the prevalence of formally diagnosed dementia cases and of cognitive decline without a recorded diagnosis. Data were analyzed using the R software (version 4.1.2). Mean percentages and 95% confidence intervals (Student's t-method), weighted by NUTS-2 region, were calculated. A hierarchical cluster analysis (Ward's method) was also performed to identify distinct institutional profiles. On average, 31.7% of residents had a formal dementia diagnosis and 22.3% showed signs of undiagnosed cognitive decline, resulting in 50.2% of the resident population presenting some degree of cognitive impairment, after data cleaning. The proportion varied across territories, institutional sectors, monthly fees and self-reported specialization. A cluster analysis identified three distinct institutional profiles, with a majority group of facilities characterized by lower diagnostic formalization, especially in the non-profit sector and among lower-cost institutions. The findings are suggestive of a very high prevalence of cognitive impairment in Portuguese residential care homes. These results highlight the need for public policies aimed at improving early diagnosis, enhancing staff training, and reducing territorial and institutional inequalities in the response to dementia.

Provider buy-in to leadership priorities, patient experience measurement, and quality improvement (QI) is necessary for sustained improvements in care. However, little is documented about provider perceptions of patient experience measurement and QI in primary care. We examined provider perceptions of the work environment, patient care issues, measurement of and improvement in care quality, as well as their knowledge and perceived usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group (CG-CAHPS) Survey measures for QI. We surveyed and interviewed providers about their use of CG-CAHPS for QI. Of the 143 providers at a large urban Federally Qualified Health Center (FQHC), 74 (52% response) completed a web-based survey; 19 were also interviewed. We asked questions about the clinic environment, use of the CG-CAHPS survey, patient interactions, burnout, job satisfaction, and compensation. We replicated measures from six relevant surveys. Providers reported working in supportive environments that encouraged QI efforts, having leadership and colleagues who facilitated improvements that enabled them to do their job better (M = 3.8 on a 5-point scale), and serious efforts to solve problems (M = 3.7). Providers also reported significant barriers to patient care (e.g., time pressure and patient complexity). Interviews highlighted providers' difficulty in managing visit duration and ensuring effective patient-provider communication. Participants expressed mixed views on the usefulness of CG-CAHPS scores for QI (M = 2.5), suggesting a need for leadership to discuss and engage with CG-CAHPS performance more regularly. QI in primary care is often guided by patient experience outcomes. The time pressures faced by FQHC providers to care for patients with complex needs heighten the need for targeted interventions that enhance provider support. Providers also identified several areas that needed improvement, some of which are measured by CAHPS items: tools to communicate laboratory or other test results to patients, tools to elicit information on patient concerns, improved access to interpreter services, training for other care team staff, and more discussion of best practices. To improve the patient experience, primary care organizations should foster environments that support QI and invest more in QI that better incorporates patient feedback and experience measures in ways that are relevant to providers and actionable by organizations to improve care experiences. Addressing these issues has the potential to improve both patient care outcomes and provider satisfaction. This is both practical and important given that CAHPS measures or other standardized patient experience measures, although not mandated, are increasingly in use.

Impact of acoustic environment in intensive care unit on nurses' well-being during COVID-19: A qualitative interview study.