My research journey began while caring for critically ill patients and questioning what happens after they leave the intensive care unit (ICU). This curiosity evolved into a systematic program of research on post-intensive care syndrome and evidence-based recovery interventions that has influenced how nurses approach the transition from critical illness survival to meaningful recovery. The goal of my research has been to eliminate delirium, oversedation, and immobilization in intensive care and to maximize the quality of survivorship for patients and family members after critical illness. I have led investigations into implementation of the ABCDEF bundle (assess, prevent, and manage pain; both spontaneous awakening and spontaneous breathing trials; choice of analgesia and sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment), demonstrating how organizational factors like workload burden, unit leadership, and interprofessional coordination influence implementation adherence and patient outcomes. My work in telemedicine-enhanced follow-up care of patients with post-intensive care syndrome addresses the cognitive, physical, and psychological impairments that affect more than half of ICU survivors. Work implementing ICU diary and peer support programs has shown how evidence-based interventions can support patients and family members when barriers to implementation are systematically addressed. My efforts embody interdisciplinary collaboration, integrating nursing science with implementation science, health services research, and clinical psychology. My journey illustrates how bedside observations, when coupled with rigorous inquiry, collaborative partnerships, and intentionality to let patient and family voices reshape thinking, can drive meaningful contributions that improve outcomes for patients and families beyond survival.

Proximal humeral fractures (PHFs) are a significant healthcare burden, representing the third most common osteoporotic fracture in older adults. Although open reduction and internal fixation (ORIF) with the Proximal Humeral Internal Locking System (PHILOS) provides a reliable rate of osseous union, postoperative complications such as shoulder stiffness and residual pain remain prevalent. Current rehabilitation protocols are predominantly glenohumeral-centric and often overlook fracture-associated scapular dyskinesis. This randomized controlled trial (RCT) aims to evaluate whether incorporating a systematic scapular control and stabilization program into standard postoperative rehabilitation yields superior outcomes after PHILOS fixation. A single-centre, prospective RCT was conducted from June 1, 2023, to December 31, 2024. Sixty eligible patients (aged 18 to 80years) with severely displaced two- or three-part PHFs were randomized (1:1) to a scapular-focused rehabilitation (SFR) group (n = 30) or a standard rehabilitation (SR) group (n = 30). Both groups attended supervised physiotherapy twice weekly for 12weeks, with the SFR group receiving additional systematic scapular stabilization exercises. The primary outcome was the Constant-Murley score (CMS) at 12months. Secondary outcomes included the Disabilities of the Shoulder, Arm, and Hand (DASH) score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Pain and Disability Index (SPADI), and visual analog scale (VAS) pain scores assessed at one, three, six and 12months, along with EuroQol (EQ) scores, patient-reported satisfaction and radiographic evaluations (neck-shaft angle [NSA] and humeral head height [HHH]). Baseline characteristics were well balanced between the two cohorts. The SFR group had significantly higher adjusted mean CMS at 1month (46.1 ± 7.5 vs. 41.5 ± 8.4; P = 0.039) and threemonths (63.4 ± 9.6 vs. 57.2 ± 9.1; P = 0.018) postoperatively than the SR group. Similarly, the SFR cohort had significantly superior DASH, ASES, SPADI pain, and VAS pain scores at one and threemonths (all P < 0.05). Furthermore, health-related quality of life, comprehensively evaluated via EQ-5D and EQ-VAS indices (P < 0.05), as well as patient-reported satisfaction metrics (P < 0.001), were markedly higher in the experimental cohort during the initial threemonths of intensive rehabilitation. However, these functional differences attenuated over time, with no statistically significant differences in CMS (P = 0.325) or secondary clinical outcomes at the 12-month final follow-up. Radiographic analysis revealed no significant intergroup differences in NSA or HHH at any time point (P = 0.600 and P = 0.462 at 3months, respectively), indicating that the targeted intervention did not compromise construct stability. Incorporating systematic scapular-focused exercises into standard postoperative rehabilitation after PHILOS fixation for PHFs serves as a beneficial adjunct that significantly accelerates early functional recovery, reduces early postoperative pain, and improves patients' overall health utility and satisfaction in the early stages. These early gains are achieved without compromising fracture reduction or implant stability. Although long-term functional outcomes converge by 12months, this accelerated recovery trajectory provides substantial clinical value by effectively reducing the burden of early postoperative disability in a vulnerable demographic.

College students represent a population that is considered clinically at low risk; yet, early adulthood constitutes a crucial time point when nutritional and metabolic risks manifest themselves. This retrospective observational study evaluated anemia, blood pressure, and body mass index (BMI) characteristics of college students undergoing a health screening examination organized by their university in India. Anonymized electronic health records were analyzed for 13,628 college students between the ages of 18 and 30 years old attending annual health screening from 1 June 2023 to 31 May 2024. The sample consisted of 77.2% of the eligible students. BMI, blood pressure, and hemoglobin levels were classified according to international standards. Gender-based differences were explored through chi-square tests and Cramer's V measures. Association between anemia and screening-confirmed hypertension was assessed using Pearson correlations and multiple logistic regression. In addition, model discrimination, calibration, classification parameters, and internal validation were evaluated. There were 7,012 (51.5%) female students and 6,616 (48.5%) male students in the sample population. In total, 47.3% of the students were either overweight or obese, 8,081 (59.3%) fulfilled the criteria for high blood pressure according to the ACC/AHA guidelines, while 7,227 (53.0%) fulfilled WHO guidelines for anemia based on gender. Hypertension screening was also more common among men (66.6%) compared to women (52.4%; p < 0.001). In the adjusted models, being male was significantly linked with anemia and hypertension screening, while being overweight was significantly linked with hypertension screening. This study showed the high prevalence of undiagnosed anemia and cardiometabolic risks among university students, suggesting the importance of health promoting universities in systematic screening programs and follow-ups.

Effective transition from pediatric to adult care is essential in Duchenne muscular dystrophy (DMD), but evidence on how transition is delivered in everyday practice remains limited. In Turkey, no clinical framework specifies how transition should occur, although national regulation requires completion of transfer by age 23. This study aimed to describe current practice, identify barriers and facilitators from physician and patient perspectives, and compare findings with international frameworks to inform a national guideline. As part of the AIM-DMD (National plan of action to raise Awareness and Improve Medical care of Duchenne Muscular Dystrophy) initiative, we conducted a national cross-sectional survey between June and December 2025, comprising parallel sub-studies of physicians and patients with DMD and their caregivers. Two structured online questionnaires were developed, guided by the Got Transition Six Core Elements framework and international Delphi consensus statements. The physician survey was distributed through professional networks; the patient and caregiver survey through the DMD Families Association and neuromuscular reference centers. Sixty-two physicians (43 pediatric and 19 adult neurologists) from 28 cities and 48 patients and caregivers from 24 of these cities responded. Only 17.7% of physicians reported a systematic institutional transition program, 38.7% prepared individualized transition plans, and 9.7% described true readiness assessment. Joint pretransition consultations were held regularly by only 6.5% of physicians. Among transitioned patients, 72.4% first heard about transition at age 17 or later, and 62.1% considered their preparation inadequate. All physicians reported transferring medical data at transition, most commonly through institutional electronic health records (80.6%); however, 41.4% of patients and caregivers were unaware that any information had been conveyed to the adult team. Physicians, patients, and caregivers all identified the lack of a formal transition protocol, joint pediatric and adult consultations, multidisciplinary integration, and a designated coordinator role as priority areas for improvement. DMD transition care across Turkey lacks consistent structure. Key gaps include limited readiness assessment, delayed discussions, poor patient and caregiver awareness of the transition process, and lack of coordinated multidisciplinary structures. Our study identified common priorities raised by physicians, patients, and caregivers that need to be improved and could inform the development of standardized protocols.

ABSTRACTRoutine blood pressure measurement in children has been proposed for systematic screening, but concerns remain regarding potential harm, including procedural discomfort. This has not previously been studied. The primary aim of this study was to assess the perceived discomfort of routine blood pressure (BP) measurement in children and adolescents, and thereby inform the procedure's suitability for potential systematic screening. Secondly, we aimed to examine whether sex, age, and previous experience with blood pressure measurement were associated with the perceived discomfort. This cross‐sectional study enrolled Danish children aged 5–17 years attending the pediatric outpatient clinic of Gødstrup Hospital between the first of June and the 30th of August 2025. Each child underwent oscillometric BP measurement and rated their discomfort using the Wong‐Baker FACES Pain Rating Scale. The distribution of the reported scores was assessed through descriptive statistics. Odinal logistic regression was used to examine the association between discomfort and sex, age and prior experience with blood pressure measurement. In total, 127 children and adolescents (63 boys, 64 girls) were enrolled in this study. WBS scores were distributed as follows: 63% “No Hurt”, 28% “Hurts a Little Bit”, and 9% across the remaining categories; no child reported “Hurts Worst”. Regression models revealed non‐significant associations with WBS‐score for age, sex and prior experience with blood pressure measurement. In conclusion, oscillometric BP measurement with adaptive cuff inflation was well‐tolerated in this pediatric cohort. This finding supports the feasibility and acceptability of routine oscillometric blood pressure measurement, highlighting its suitability for potential systematic screening programs.

BackgroundEfficient multidisciplinary teams in chest pain centers are critical for ST-segment elevation myocardial infarction (STEMI) outcomes. Simulation-based team training (SBTT) may enhance team performance, but real-world clinical impacts remain under-documented. This study evaluated the association between a systematic SBTT program and treatment processes and clinical outcomes in STEMI patients.MethodsWe conducted a retrospective pre-post analysis at a tertiary center in China. Consecutive STEMI patients undergoing primary percutaneous coronary intervention (May 2020–June 2023) were included. Patients were divided into pre-intervention (May 2020–Dec 2021) and post-intervention (Jan 2022–June 2023) groups, separated by the implementation of a multidisciplinary SBTT program. Primary outcomes were door-to-balloon (D2B) and first-medical-contact-to-balloon (FMC-to-B) times. Interrupted time series (ITS) analysis assessed D2B time changes.ResultsWe included 260 patients (125 pre-intervention, 135 post-intervention). Post-SBTT, median D2B time decreased from 92 to 68 minutes (p < 0.001), and FMC-to-B time from 125 to 95 minutes (p < 0.001). Patients achieving D2B ≤ 90 min increased from 44.8% to 85.2% (p < 0.001). ITS analysis showed an immediate D2B time drop of 23.5 minutes (p < 0.001). In-hospital MACE rates decreased from 12.8% to 5.2% (p = 0.031).ConclusionThese findings suggest that SBTT could be a valuable quality improvement tool in chest pain centers for optimizing the timeliness of reperfusion therapy and clinical outcomes. However, further prospective, multicenter studies are needed to confirm these findings and establish definitive causality before universal adoption can be firmly recommended.

To investigate the independent association between long-term glycemic variability, measured as the coefficient of variation (CV) of HbA1c, and the presence of diabetic retinopathy (DR) in a cohort of adults with diabetes within a systematic eye screening program. This study screened 379 adults with type 1 and type 2 diabetes. Long-term glycemic variability was calculated as the CV of serial HbA1c measurements. DR was assessed via dilated fundus photography. The association between HbA1c CV and DR was analyzed using multivariable logistic regression adjusting for confounders. DR incidence of 12.4%, mostly mild non-proliferative. The median HbA1c CV was 7.0% (53mmol/mol). In unadjusted bivariate analysis, the incidence of mild DR was higher in the low- glycemic variability group (CV < 5%) compared to the high- glycemic variability group. However, the multivariable logistic regression analysis revealed that higher HbA1c CV was independently associated with the presence of DR (β = 0.643, P = 0.042), alongside diabetes duration (P < 0.001) and age (P < 0.001). In conclusion, in a cohort of individuals with both type 1 and type 2 diabetes and a low incidence of DR, long-term glycemic variability, estimated as HbA1c CV, was independently associated with an increased risk of this complication.

The construction sector faces a dual imperative: managing the escalating volume of construction and demolition (C&amp;D) waste while simultaneously reducing reliance on quarried natural aggregates, both of which carry significant environmental costs. Recycled aggregate concrete (RAC) addresses this dual challenge by substituting demolished concrete debris for natural coarse aggregate; however, RAC is characterized by reduced compressive strength, elevated porosity, and inferior interfacial transition zone (ITZ) quality relative to natural aggregate concrete (NAC), limiting its deployment in structural applications. This investigation presents a systematic experimental programme in which M30-grade RAC employing 100% recycled coarse aggregate (RCA) replacement was reinforced with hybrid combinations of steel fibers (SF, 6 mm hooked-end) and glass fibers (GF, 3 mm alkali-resistant) at total volume fractions of 0+0% (M1 NAC control), 0.5%+0.5% (M2), 1.0%+1.0% (M3), and 1.5%+2.0% (M4). Compressive strength (3, 7, 14, 28 days), split tensile strength, flexural strength, and water absorption were evaluated by IS standards. Relative to the NAC control (M1: CS = 38.43 MPa), the 100% RCA M2 baseline exhibited a 21.7% reduction in compressive strength; however, hybrid fiber additions progressively recovered performance, with M4 achieving 35.40 MPa (−7.9% vs NAC control but +17.6% vs unfiber-reinforced RAC baseline). More significantly, split tensile and flexural strength showed increases of 55.7% and 50.6% above NAC control for M4, respectively, confirming that fiber bridging is disproportionately beneficial for tensiledominated failure modes. The mechanistic basis for these improvements lies in steel fiber crack-bridging arresting macrocrack propagation and glass fiber microcrack suppression refining the ITZ. To extend predictive capability, a multi-output artificial neural network (ANN) with a 6-12-8-12-5 architecture was developed and trained on an N = 190 experimental datasets compiled from this study and published literature. The ANN achieved R² values of 0.987, 0.983, and 0.979 for compressive, split tensile, and flexural strength, outperforming XGBoost, Random Forest, and SVR. SHAP analysis identified RCA replacement percentage, steel fiber content, and glass fiber content as the three dominant predictors, quantitatively confirming the physical mechanisms observed experimentally.

To explore the effectiveness of a systematic epidemic prevention programme on the coping response of nursing staff caring for high-risk COVID-19 patients. A one-group pre-post-test pre-experimental design was used. Through purposive sampling, a total of 84 nursing staff were recruited from a teaching hospital who had experiences in caring for high-risk COVID-19 patients. The participants underwent a systematic epidemic prevention programme. Before the intervention and 1 month, 3 months, and 6 months after the intervention at four time points, the coping response of the nursing staff was measured through three scales-the Impact of Event Scale-Revised, the General Health Questionnaire (GHQ), and the Brief Coping Orientations to Problems Experienced (Brief-COPE). The data were analyzed using descriptive and inferential statistics including generalised estimating equations, Pearson's correlation coefficient, independent samples t-test, and analysis of variance. The systematic epidemic prevention programme significantly improved nursing staff's coping responses. IES-R scores decreased over time but did not reach statistical significance. GHQ scores showed a significant time effect, with reductions observed at 1 and 3 months post-intervention, and the greatest improvement at 3 months. Emotional coping significantly increased at 3 months post-intervention. Overall, the findings demonstrate a sustained improvement in coping responses across time points following the intervention. The study followed the TREND and TIDieR checklists. None.

Implementation of a Systematic Patient Mobility Program Across 5 Hospitals.

Surgical safety is a core patient-safety goal. In our hospital, the rate of accuracy among operating room nurses in preparing for fat grafting surgeries was only 55.4%. The main factors found to influence this issue were: reliance on verbal, experience-based teaching; unfamiliarity with processes and complex instruments; lack of operating manuals and checklists; inadequate in-service education; and lack of standardized operating protocols. This project was developed to establish a systematic education and training program and standardized workflow to improve the accuracy of operating room nurses in preparing for fat grafting surgeries. Following the ADDIE (analysis, design, development, implementation, and evaluation) instructional model, the interventions implemented in this project included: compiling a preparation manual and mind map, planning structured in-service education, producing an interactive e-book, and holding simulation workshops. Also, a preparation-accuracy checklist and knowledge test were used to track outcomes in 20 nurses. In addition, the Objective Structured Assessment of Technical Skill instrument was used to provide real-time feedback during the simulation courses, and maintenance follow-up was conducted from April through May 2025. After the intervention, the preparation accuracy rate increased from 55.4% to 96.5% and the knowledge accuracy rate increased from 45.0% to 94.5%. Notably, the preparation accuracy rate was 100% during the maintenance follow-up period. Conclusions: Combining the ADDIE instructional model with multiple strategies may be an effective strategy for improving preoperative preparation accuracy and professional competence in nurses. Regular interprofessional consensus meetings should be held to allow rolling revisions to be made to the workflow and, accordingly, develop surgical care guidelines as references for clinical practice to further strengthen nursing quality and patient safety.

Minor non-fermenting Gram-negative bacilli in Europe, 2020-2024 (MINOFEu).

Strength training plays an essential role in improving performance and lowering injury incidence among adolescent athletes. However, current training practices often involve premature specialization, insufficient load management, and adult-oriented programming. The periodized National Academy of Sports Medicine's Optimum Performance Training (NASM-OPT) model develops stability, strength, and lower-limb power in a progressive manner, but its long-term effects in adolescents remain unclear. This randomized controlled trial compared NASM-OPT with traditional periodized training to examine the effects on maximal lower-limb strength and explosive power among 42 adolescent athletes randomly allocated to the OPT and CON groups (n = 21 per group). A 26-week intervention was completed in both groups. Squat one-repetition maximum (1RM), countermovement jump (CMJ), squat jump (SJ), pre-stretch augmentation percentage (PSAP), and eccentric utilization ratio (EUR) were assessed at baseline and post-intervention. Repeated-measures ANOVA was used to analyze group×time interactions (α = 0.05). Compared with the CON group, the OPT group demonstrated greater post-intervention values in 1RM (133.1 ± 21.4 vs 119.2 ± 18.0 kg), CMJ (47.4 ± 5.8 vs 39.8 ± 4.0 cm), PSAP (10.63% vs 6.07%), and EUR (1.11 vs 1.06) post-intervention (p < 0.05). The OPT group maintained these improvements throughout the intervention, whereas the CON group showed plateaued values, potentially suggesting enhanced stretch-shortening cycle(SSC) function. Periodized NASM-OPT training efficiently promotes lower-limb strength, explosive power, and SSC function in adolescent athletes. These findings indicate that systematic and progressive programming can optimize performance while minimizing injury risk.

To analyze the current understanding of oral frailty and identify barriers to optimization of interventions for oral frailty in older adults among oral healthcare professionals in China, to inform the development of systematic intervention programs. A Husserlian descriptive phenomenological methodology was adopted to explore the lived experiences and perceptions of oral healthcare professionals regarding oral frailty interventions. A total of 15 oral healthcare professionals from Shenzhen Luohu Hospital Group in Shenzhen, China, were selected by purposive and snowball sampling. Participants underwent semi-structured interviews, and themes were analyzed using Colaizzi's method. Four themes emerged: fragmented understanding of oral frailty, differing views on health education settings, inconsistencies in assessment and management practices, and systemic barriers affecting intervention implementation. Oral healthcare professionals in China exhibited a "high willingness-low initiative" conflict regarding intervention for oral frailty in older adults. These findings suggest that strengthening education and training, developing standardized assessment and intervention tools, promoting multidisciplinary collaboration, and improving policy support may help bridge the gap between understanding and practice and facilitate the implementation of oral frailty interventions for older adults.

Most cancer chemotherapy is delivered at the maximum tolerated dose (MTD) as often as possible, switching to a new combination of drugs upon progression. Clinical trial results have demonstrated that this sequential MTD schedule is not optimal for every patient in every situation; however, there is no systematic program for discovering what the optimal schedule actually is. We developed a simulated-annealing-based algorithm for computing personalized dosing schedules that best achieve treatment objectives. Given a mathematical model of a patient’s drug response, the algorithm returns the optimal schedule for either minimizing tumor burden or maximizing progression-free survival. We tested this algorithm on a simple mathematical model of patient treatment response; we found that there are only three optimal one-drug schedules: continuous therapy and two distinct adaptive therapies. For two drugs, each schedule used in the clinic was found to be optimal for some patient parameters, and the algorithm was able to quantitatively map out the boundaries between these schedules. The optimization algorithm developed here can play a key role in upcoming personalized cancer treatment pipelines.

"Why children with anorectal malformations need urological evaluation: Insights from a retrospective study".

Aedes aegypti is the primary vector of arboviruses, including the dengue virus. Insecticide-based vector control remains a key strategy for reducing mosquito populations and disrupting disease transmission; however, its effectiveness is increasingly challenged by resistance. Identifying resistance mechanisms is crucial for monitoring resistance trends and informing policy decisions for vector control and disease prevention. We aimed to investigate the voltage-gated sodium channel (vgsc) mutations in pyrethroid-resistant Ae. aegypti strains. In this study, we established a cypermethrin-resistant Ae. aegypti strain from field-collected mosquitoes in 2016 and performed whole-genome sequencing to identify resistance-associated vgsc mutations. Additionally, we genotyped field Ae. aegypti collected in 2024 to assess the variation and prevalence of resistance-related mutations. Our findings confirmed that R52H and N868D are associated with resistance, with R52H co-occurring with S989P+V1016G and N868D co-occurring with F1534C. The widespread presence of R52H and N868D, along with their co-circulation with other resistance-associated mutations in the field population, suggests that these mutations have been maintained under intense selection pressure. Furthermore, we identified 12 haplotypes and suggested a potential evolutionary trajectory based on co-occurrence patterns of mutation events. The emergence and persistence of novel vgsc mutations in field populations highlight the ongoing expansion of insecticide resistance in Taiwan and globally, which threatens the efforts for disease vector control. Understanding the functional impact of these mutations is essential for comprehensive monitoring and evaluating pyrethroid resistance dynamics. Systematic surveillance program is required to track resistance trends and guide evidence-based vector control strategies that ensure effective disease prevention and public health protection.

Liver transplantation (LT) is the definitive treatment for end-stage liver disease, acute liver failure, and selected cases of hepatocellular carcinoma. Despite global advances, institutional experience remains critical for optimizing outcomes. This study describes LT outcomes at Changwon Hanmaeum Hospital, South Korea, over a 2.5-year period. A retrospective review was conducted of all LTs performed between January 2023 and July 2025. Demographic characteristics, primary diagnoses, model for end-stage liver disease (MELD) scores, Child-Turcotte-Pugh classifications, ischemic times, graft types, surgical details, postoperative complications, and survival outcomes were analyzed. Outcomes were compared between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT), and between early (2023-2024) and recent (2025) cases. A total of 56 LTs were performed, including 29 LDLT and 27 DDLT procedures. The mean recipient age was 45 years in the LDLT group and 52 years in the DDLT group. Alcoholic cirrhosis (39.3%) and hepatitis B-related cirrhosis (26.8%) were the most common indications. MELD scores were higher in DDLT recipients than in LDLT recipients. Mean cold ischemic time was 141.7 minutes in LDLT and 282.2 minutes in DDLT. Laparoscopic donor hepatectomy was attempted in 17 donors (58.6%), with eight conversions (27.6%) to open surgery. Infectious complications predominated, particularly bacterial pneumonia (8.9%). Overall, 46 patients (82.1%) survived to discharge, with improved outcomes observed in 2025 compared with 2023-2024 (90.5% vs. 77.1%). Recipient operative time decreased from 429 to 360 minutes over the study period. LT outcomes improved progressively over the study period, likely reflecting accumulated surgical expertise, adoption of laparoscopic donor techniques, and optimization of perioperative management. Continued training, multidisciplinary collaboration, and systematic program evaluation remain essential for sustainable program development.

Newborn bloodspot screening (NBS) programs aim to identify babies at risk of developing serious conditions where an effective preventive or ameliorative intervention is available in infancy or early childhood. In recent decades, new testing technologies have been introduced into NBS to expand the number of screened conditions. This now also includes the possible introduction of genomic sequencing. Those who support genomic newborn screening (gNBS) do so on the rationale that a wider range of treatable conditions will be able to be screened for, and that gNBS will enable more equitable communication of actionable information to families. However, significantly increasing the number of conditions screened for may also increase expectations of screening coverage. Within a context of increased expectations of conditions being detected via gNBS, there is also the potential for actual or perceived 'missed cases', a situation where a newborn has (or will soon develop) a genetic condition that was not detected on screening. In this paper, we consider legal and ethical issues pertaining to missed cases in gNBS. We argue that certain missed cases in gNBS constitute neither a legal nor moral harm, especially where gNBS is delivered within a systematic screening program rather than via a commercially marketed test. However, should gNBS be introduced, engaging with key interest-holders such as parents and policy-makers will be vital to ensure that the scope and limitations of gNBS are both appreciated and accepted, and that public trust in this important population screening program is maintained.

ObjectiveTo understand the issues impacting atrial fibrillation (AF) screening and what needs to be considered for a successful national screening programme in Australia.DesignQualitative design using semistructured interviews and thematic analysis.SettingAustralian Health.ParticipantsSix broad stakeholder groups were identified: charities/patient support, healthcare providers, professional bodies, government, research (including Indigenous health) and industry.MethodsSemistructured interviews were conducted with 25 representative participants. Iterative thematic analysis was used. Coding was driven by the research questions (the current context; is a national screening programme warranted and approaches to a national screening programme) and an inductive approach where novel groupings of information were identified.FindingsThe key findings are grouped into four areas. (1) Current opportunistic general practitioner-led screening is ad hoc and fragmented. Issues: poor remuneration; lack of health sector collaboration and prioritisation; consumers lack awareness. (2) Systematic screening of all in-scope patients not considered feasible and concerns over lack of evidence. (3) Alternative approaches to increase screening include innovative approaches inside and outside general practice and use of smart technology. (4) Recommendations: (a) Support general practices and address remuneration and workflows; (b) Ensure a clear pathway to treatment; (c) Address data security, management and integration and sensitivity issues with wearable devices; (d) Promote collaboration between key organisations; (e) Address research gaps and (f) Generate culturally appropriate consumer education to promote consumer demand.ConclusionsMost stakeholders were broadly supportive of AF screening but agreed that current approaches were fragmented and not sufficient. If the forthcoming research evidence supports screening effectiveness on major outcomes, stakeholders envisaged a semi-systematic approach tailored to specific health settings, rather than a formalised systematic national screening programme.