Time Constraints Research Articles

Barriers and facilitators of self-management of diabetes amongst people experiencing socioeconomic deprivation: A systematic review and qualitative synthesis.

The number of people living with diabetes is rising worldwide and a higher prevalence of diabetes has been linked to those experiencing socioeconomic deprivation. Self-management strategies are vital and known to reduce the risks of long-term complications amongst people living with diabetes. Lack of knowledge about self-care activity required to manage diabetes is a key barrier to successful self-management. Self-management interventions can be less effective in socioeconomically deprived populations which can increase the risk of exacerbating health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management of diabetes amongst people who are socioeconomically disadvantaged. MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions amongst socioeconomically disadvantaged populations. Relevant papers which focused on diabetes were identified. Data were coded and thematically synthesised using NVivo. From the search results, 79 qualitative studies were identified after full-text screening and 26 studies were included in the final thematic analysis. Two overarching analytical themes were identified alongside a set of subthemes: (1) Socioeconomic barriers to diabetes self-management; healthcare costs, financial costs of healthy eating, cultural influences, living in areas of deprivation, competing priorities and time constraints, health literacy, (2) facilitators of diabetes self-management; lifestyle and having goals, support from healthcare providers, informal support. Self-management of diabetes is challenging for people experiencing socioeconomic deprivation due to barriers associated with living in areas of deprivation and financial barriers surrounding healthcare, medication and healthy food. Support from healthcare providers can facilitate self-management, and it is important that people with diabetes have access to interventions that are designed to be inclusive from a cultural perspective as well as affordable. A patient advisory group contributed to the research questions and interpretation of the qualitative findings by reflecting on the themes developed.

Why Pharmacovigilance of Non-steroidal Anti-inflammatory Drugs is Important in India?

Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are among the drugs that are most regularly administered to manage inflammation and pain. Over-the-Counter (OTC) NSAIDs are widely accessible, particularly in developing countries like India. This casual approach to using NSAIDs may operate as a magnet for NSAID-related adverse drug reactions (ADRs) among patients. As patients in India are less informed about the appropriate use of NSAIDs and consumption patttern, adverse drug reactions, and the importance of reporting ADRs, the current study's objective is to promote patient safety by using pharmacovigilance as a tool to educate patients. A targeted literature methodology was utilized to gather the data pertaining to NSAIDs, their ADRs and their pharmacovigilance. Different scientific databases, such as Science Direct, PubMed, Wiley Online Library, Springer, and Google Scholar, along with authentic textbooks, were explored as reference literature. In general, NSAIDs consumption pattern depends upon the different age groups. Around 1.6 billion tablets of NSAIDs are consumed in India for ailments, such as headaches, arthritis, menstrual cramps, osteoarthritis, back pain, rheumatoid arthritis, gout, osteoporosis, tendinitis, cancer pain and chronic pain. Common ADRs of NSAIDs include nausea, vomiting, headache, gastritis, abdominal pain, and diarrhoea. Also, they can cause renal damage and cardiovascular problems if not consumed in a dose-dependent manner. However, Diclofenac and Ibuprofen have both been linked to depression and dementia. There have been reports of aplastic anaemia, agranulocytosis linked to phenylbutazone, Stevens-Johnson, and Lyell's syndrome linked to isoxicam and piroxicam, as well as the vulnerability of new-borns to Reye's syndrome after aspirin use. Lack of awareness, time constraints and unpredictability, poor training in ADRs identification, etc., are some of the reasons for the under-reporting of ADR of NSAIDs in India. In order to rationally prescribe NSAIDs, it is essential to be aware of probable ADR's and establish prescription guidelines. Prescribers' behaviour can be changed toward excellent prescribing practices by conducting routine prescription assessments dealing with NSAIDs and providing feedback. In the near future, it will be critical to strengthen ADR data management and expand the reach of pharmacovigilance programs, ADR monitoring centers, and healthcare professionals' especially pharmacists' training in rural locations.

Emergency department Nurses’ narratives of burnout: Changing roles and boundaries

PurposeEmergency department nurses work in rapidly changing environments, which can contribute to occupational stress. Emergency department nurses utilise diverse strategies to mediate the impact of stress on their daily lives. There is a paucity of qualitative research which explores emergency department nurses’ experiences and perspectives of burnout. This study aimed to explore emergency department nurses’ experiences of burnout. Further, the study considered how emergency nurses conceptualised burnout and the strategies they used to manage the professional and personal effects of burnout. ProceduresThe COREQ research guidelines were used throughout the study from the design stage through to dissemination. Narrative inquiry was used as the underpinning theoretical framework. The researcher met individually with eight emergency department nurses from NSW hospitals to undertake a face-to-face semi-structured interview. An inductive approach was used to establish major themes within the narrative. FindingsTwo major themes were established: experiencing conflicting emotions and trying to establish a personal sense of control. Emergency nurses felt passionate about their professional roles, yet encountered difficulties due to management structures, time constraints and a sense of underappreciation. The misalignment between their expectations and the reality of emergency department nursing, resulted in experiences of burnout such as dissatisfaction and frustrations at work. Consequently, these nurses adopted diverse strategies within both their professional and personal domains. Principal conclusionsThe conclusions of this study are transferable to a variety of acute health services. Health service management have a role to promote a positive workplace culture for nurses, which advocates for home life balance. This will support nurses to construct clear boundaries between professional identity and their personal lives.

Clip Outliner

Abstract: In today's digital era, the influx of video content inundates online platforms daily, presenting a formidable challenge for users seeking relevant information within these extensive recordings, particularly under time constraints. The process of extracting crucial insights fromlengthy videos often proves daunting and time- consuming. Clip Outliner is an innovative project that offers a versatile solution for summarizing both textual and video content. This tool combinesthe capabilities of a text summarizer with advanced video analysis features, providing users with concise textual summaries while also offeringinsights into video content. Leveraging Python APIs for text transcription and employing natural language processing (NLP)techniques, transcripts are efficiently condensed. The user interface is meticulously crafted using Streamlit serving as the robust open-source framework in Python.

Replacing Face-to-Face Classes with Collegium: Ed-tech platform (Online Platform)

Abstract: The incorporation of technology has sparked a revolutionary change in the way that students interact with instructional materials in today's quickly changing educational environment. This paradigm shift is demonstrated by the creation of collegium, which bridges the gap between cutting-edge technological solutions and conventional learning approaches. Collegium reimagines the educational experience by utilizing cutting-edge frameworks like ReactJS, NodeJS, ExpressJS, and MongoDB, providing a dynamic platform that overcomes time and space constraints.

Assessing Weekly Wellness Sessions: Cordillera Administrative Region's Social Welfare Impact

This literature review examines the efficacy of workplace wellness initiatives, focusing on the Weekly Wellness Sessions (WWS) conducted by the Department of Social Welfare and Development (DSWD) Field Office Cordillera Administrative Region. The study evaluates staff participation rates, the effectiveness of wellness programs, and challenges encountered in availing the WWS. Primary and secondary sources materials were used in the analysis of this literature review. Casual observations were also integrated. Findings reveal coffee sessions as the most popular activity, while limited facilities and costs hindered participation in other activities. The WWS were perceived as highly effective across multiple dimensions of well-being, with minimal variation based on gender or age. However, differences in effectiveness were noted among different positions and offices/divisions. Common challenges included time constraints, financial limitations, and personal barriers. Recommendations include enhancing financial accessibility, tailoring interventions, offering flexible scheduling, promoting awareness, and cultivating a culture of health and wellness. Addressing these recommendations can optimize the impact of the WWS and contribute to a healthier, more productive workforce within DSWD FO CAR.

Associations between perceived occupational stressors and symptoms severity of depression, anxiety and stress among academic faculty: First cross-sectional study from Qatar

BackgroundMental health concerns among university faculty are on the rise, with reports of anxiety, depression, and occupational stress, impacting the higher education community. In Qatar, an assessment of faculty mental health has not been previously realized. The objectives of the current study were twofold: Firstly, to evaluate the extent of perceived occupational stress, depression, anxiety, and stress, and secondly, to assess the association among these mental health parameters.MethodsA cross-sectional study was conducted among faculty using an online, self-administered, anonymous, voluntary survey. All faculty were included by sending the survey to their institutional emails. In addition to faculty demographics and general health status, the survey measured perceived stress due to academic job roles using the Faculty Stress Index (FSI) with its five distinct domains, and assessed faculty mental health using the Depression, Anxiety, and Stress Scale-21 items (DASS-21). Modified Poisson regression with robust variance was used to assess how FSI influences levels of depression, anxiety, and stress.ResultsA total of 112 faculty responded to the survey. The highest faculty self-perceptions of mental health conditions were for anxiety (63% at least moderate), followed by depression (30% at least moderate), and least for stress (26% at least moderate). The overall mean FSI score was 48.8 ± 29.4; time constraint and rewards and recognition domains scored highest (18.5 ± 11.4 and 13.3 ± 9.3 respectively) while the departmental influence domain scored least (4.8 ± 4.4). Increased risk of at least moderate levels of self-perceived depression and stress were significantly associated with higher FSI score (p˂0.001). Increased risk of at least moderate levels of depression were less likely among faculty aged 50 years and above (p = 0.034), while increased risk of at least moderate levels of anxiety were more likely among faculty from humanities colleges (p = 0.027).ConclusionsThis is the first investigation of university faculty mental health in Qatar, indicating multifactorial perceived occupational stress, associated with higher perceived severity of mental health conditions. These baseline results establish links between specific occupational stressors for faculty and their mental well-being. As such, assessment of mental health conditions, controlling occupational stress, and developing tailored mental health interventions for faculty, are strategic to implement and foster well-being of academics. Further research into mental health of faculty and designing effective interventions that consider their specific stressors and associated factors are warranted.

The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial.

Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)-based lifestyle coaching program on achieving BP control among adults with hypertension. Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI -7.1 to -4.2; P<.001) and 3.8 mm Hg (95% CI -4.7 to -2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI -12.2 to -6.9; P<.001) and 5.7 mm Hg (95% CI -7.6 to -3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI -10.1 to -6.1; P<.001) and 5.1 mm Hg (95% CI -6.2 to -3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI -17.7 to -10.7; P<.001) and 8.1 mm Hg (95% CI -10.4 to -5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734.

Development and psychometric validation of a brief scale to measure environmental perception based on the 2-major environmental values model in adolescents and adults.

The worldwide ecological crisis, including global climate change, is leading to increased awareness and attitudes towards environmental problems. To address these problems, studies of human attitudes are needed. This study is based on the 2-Major Environmental Values (2-MEV) model, which measures two components of environmental attitudes: Preservation and Utilization. The model has been applied to both, adolescents and adults. After decades of use, it is necessary to review the psychometric scale and update the wording. Developing short or even super-short scales to measure well-established constructs is necessary due to time constraints, compliance or fatigue due to language issues. We applied an exploratory factor analysis (EFA) to a dataset containing 20 items from the 2-MEV model to reduce the scale to 6 items, 3 per dimension using parallel analysis, scree plot examination and eigen-value greater than 0 as criteria. The scale was then applied to adults and the sample was split for EFA and confirmatory factor analysis (CFA). Multigroup confirmatory factor analysis (MGCFA) was then used to assess invariance across age and gender. Finally, regression and linear models were used to examine the effects of age and gender in both, adults and adolescents. The 2-MEV model was replicated in the EFA and CFA and the correlated two-factor model showed the best fit. The scale showed configural and metric invariance across age and gender, and scale invariance across gender. Gender and age effects were replicated in relation to previous studies. The brief scale showed good model indices and convergent validity. The brief scale of the 2-MEV model can be applied in situations where environmental attitudes are important, but time constraints (internet surveys), compliance, or language problems may hinder the use of longer scales.

Using the technology acceptance model to assess clinician perceptions and experiences with a rheumatoid arthritis outcomes dashboard: qualitative study

BackgroundImproving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (“RA PRO dashboard”). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic.MethodsWe conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM).Results3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients.ConclusionsThe study provides valuable insights into clinicians’ perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

Contribution of Non Governmental Organisations Projects Intervention on Social Economic Growth in Rural Areas. A Case of World Vision Rwanda 2019-2022 Kivuruga Sector, Gakenke Disrtict, Northern Rwanda.

This research is basically done to assess contribution of Non-Governmental Organizations projects intervention on socio economic growth of in rural areas a case study of World Vision Rwanda project in Kivuruga sector. This study had the following specific objectives: to find out the contribution of NGOs on socio economic growth in Kivuruga sector, to elaborate socio economic impacts of NGOs in rural areas especially in Kivuruga sector, to identify the relationship between activities of WVR and socioeconomic growth of its beneficiaries in Kivuruga sector and to give suggestions and recommendation on NGOs activities in rural areas. Due to financial means, time constraints and the need of precision of results, it was impossible to study all population. Target population of this study was 127 beneficiaries of World Vision Rwanda project in Kivuruga sector. A sample of 56 respondents was selected and cluster sampling was used for selecting groups, or clusters, of participants from the population. The clusters were chosen based on distribution of World Vision Rwanda project’s respondents in cells. The study also employed purposive sampling as the sampling technique. Questionnaire, interview and a documentation research were used as tools of data collection. The statistical analysis of the collected data was conducted using Statistical Package for Social Sciences (SPSS). This study assessed the Contribution of WVR in socio-economic growth where the findings indicated that great extent and very great extent make 73.2%. Therefore, the WVR played a big role in economic growth of Rwanda especially in Kivuruga Sector. As conclusion, it has been revealed that the capacity of the beneficiaries to cover basic expenditure and need (such as food, clothing, transport, education and housing, etc.) has been improved over the program/project period. Likewise, the programs executed by WORLD VISION Rwanda have enabled beneficiaries to engage in small businesses, different income generating activities, developing markets through a systems approach and market linkage, promote and increase the saving practice. As a result, beneficiaries of the programs have their source of income and they become self-reliance and empowered. The recommendations to future action planners are to improve livelihood, socio-economic conditions and then to reduce poverty the participation of women.

Analyzing Passenger Experience: A Study On Airline Mishandling Incidents At Ninoy Aquino International Airport Terminal 3

This research delves deep into the complex dynamics of airline mishandling incidents at NAIA Terminal 3, aiming to reveal their intricate effects on passenger experiences. With a focus on understanding the connections between mishandling, flight disruptions, and broader implications for airline operations, the study intends to offer a comprehensive view. Using a precise approach, the researchers adjusted Slovin's formula to pinpoint an exact sample size of 300 respondents, ensuring a detailed exploration of passenger encounters despite time constraints. They achieved a 14% response rate, providing insights into the diverse landscape of travelers. Going beyond traditional surveys, the study incorporated qualitative aspects through interviews with informants, including airport and airline personnel. This dual-method strategy facilitated a nuanced analysis of mishandling incidents, capturing the subtle challenges faced by both passengers and industry professionals. The results emphasized the significant impact of mishandling on operational efficiency, highlighting the need for improved baggage handling and security measures. The study concludes with practical recommendations, advocating for clear communication, technological advancements, and ongoing staff training to enhance the overall airport experience. This research serves as a valuable guide for aviation stakeholders, offering a roadmap to address mishandling incidents and improve passenger satisfaction.

Challenges in Equipping Learners for the Fourth Industrial Revolution: School Leaders’ and Teachers’ Powerlessness

The work landscape is evolving with the advent of the Fourth Industrial Revolution (4IR), potentially rendering current jobs obsolete and necessitating new skills or retraining of existing occupations for future employment. This revolution is disrupting nearly every sector, including education, highlighting the need for education to address issues like unemployment, poverty, and inequality. However, to adequately prepare learners, this can only be achieved with sufficient material and human resources. Understanding these dynamics is crucial in determining whether school leaders and teachers possess the power or autonomy to develop the necessary knowledge, skills, and competencies to empower learners for the 4IR. Power, the ability to achieve organizational objectives, is essential for school leaders and teachers responsible for information and communication technologies in schools to acquire the resources and competencies needed for the 4IR. Drawing on critical theory, this qualitative study explores how school leaders and teachers experience powerlessness due to the challenges they encounter in preparing learners for the 4IR. Semi-structured interviews facilitated participants’ reflections and meaning-making of their experiences in this regard. The critical analysis of data yielded themes that underscore the complexities of preparing learners for the 4IR in underserved contexts ill-equipped for such endeavours: time constraints; teacher uncertainty; insufficient infrastructure, incapacitating influence of powerful top management; and detrimental control of district circuits. Participants felt constrained within their job descriptions, lacked the freedom to exert authority over their work, and faced obstacles in making independent decisions and implementing necessary changes.

Effects of Sports Participation on Academic Performance in Adolescents

Purpose: The aim of the study was to assess the effects of sports participation on academic performance in adolescents. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study indicate a positive correlation between sports involvement and academic achievement, others highlight potential drawbacks such as time constraints and fatigue. Sports participation has been associated with improved cognitive function, time management skills, and self-discipline, which can positively impact academic performance. However, excessive commitment to sports may lead to neglect of academic responsibilities and increased stress. Furthermore, the influence of sports on academic performance can vary depending on factors such as the type of sport, level of competition, and individual characteristics of the student. Overall, while sports participation can offer various benefits for adolescents, striking a balance between athletic and academic pursuits is crucial for maximizing overall development and success. Implications to Theory, Practice and Policy: Self-determination theory, social learning theory and achievement goal theory may be used to anchor future studies on assessing effects of sports participation on academic performance in adolescents. Educators and school administrators should prioritize the integration of physical activity and sports programs within school curricula to support academic success. Policymakers should recognize the importance of sports participation in promoting holistic youth development and academic success.

Application of real-time overall equipment efficiency indicator in a medium-sized company

Goal: This research investigated the application of real-time Overall Equipment Efficiency (OEE) at three assembly work centers in a medium-sized company. The objective was to demonstrate the feasibility of integrating Industry 4.0 technologies, such as the Internet of Things, Big Data, and Cloud Computing, in manual work center environments. It aimed to underscore the potential improvements achievable through data-driven actions facilitated by Industry 4.0 technologies, while emphasizing the significance of acquiring real-time OEE data. Design / Methodology / Approach: The research involved theoretical exploration, implementation, data collection (Nov 2022–May 2023), and analysis on assembly workstations in a medium-sized Brazilian eyewear manufacturer. Results: Based on the captured data, the factory implemented a series of corrective actions, leading to a reduction in unplanned stops. The obtained results were significant, as the average efficiency of the studied work centers improved by 12.3% in 7 months, with an increase in performance and in availability. Limitations of the investigation: The analysis faces challenges due time constraints, potentially limiting the full assessment of IoT impact. Seasonal variations in eyeglass production and style-specific demand complicate evaluating the true benefits of Industry 4.0 tools, making effective OEE improvement hard to determine. Practical implications: The study demonstrates a method to gauge manual labor efficiency through Industry 4.0 technologies. Originality / Value: This study shows how Industry 4.0 technologies (IoT, Big Data, Cloud Computing) can be integrated into manual workforces, enhancing efficiency and providing real-time OEE for workers to self-assess.

Performance Analysis of Multi-Tote Storage and Retrieval Autonomous Mobile Robot Systems

Multi-tote storage and retrieval (MTSR) autonomous mobile robots can carry multiple product totes, store and retrieve them from different shelf rack tiers, and transport them to a workstation where the products are picked to fulfill customer orders. In each robot trip, totes retrieved during the previous trip must be stored. This leads to a mixed storage and retrieval route. We analyze this mixed storage and retrieval route problem and derive the optimal travel route for a multiblock warehouse by a layered graph algorithm, based on storage first-retrieval second and mixed storage and retrieval policies. We also propose an effective heuristic routing policy, the closest retrieval (CR) sequence policy, based on a local shortest path. Numerical results show that the CR policy leads to shorter travel times than the well-known S-shape policy, whereas the gap with the optimal mixed storage and retrieval policy in practical scenarios is small. Based on the CR policy, we model the stochastic behavior of the system using a semiopen queuing network (SOQN). This model can accurately estimate average tote throughput time and system throughput capacity as a function of the number of robots in the system. We use the SOQN and corresponding closed queuing network models to optimize the total annual cost as a function of the warehouse shape, the number of robots, and tote buffer positions on the robots for a given average tote throughput time and throughput capacity. Compared with robots that retrieve a single tote per trip, an MTSR system with at least five buffer positions can achieve lower operational costs while meeting given average tote throughput time and tote throughput capacity constraints. Funding: This work was supported by National Natural Science Foundation of China [Grant 72372088] and the Shenzhen Science and Technology Program [Grant GJHZ20220913143003006]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/trsc.2023.0397 .

Communication between Caregivers of Adults with Cancer and Healthcare Professionals: a Review of Communication Experiences, Associated Factors, Outcomes, and Interventions.

Family/unpaid caregivers play an important role in cancer care. This review aims to summarize caregiver communication experiences with healthcare professionals (HCPs). The Caregiver-Centered Communication model defines five core functions that HCPs should achieve when interacting with caregivers, including fostering relationships, exchanging information, recognizing and responding to caregiver emotions, aiding in decision making, and assisting in patient care management. The literature shows that caregivers have both positive and negative communication experiences with HCPs with respect to these five core functions. Factors at the caregiver (e.g., demographic characteristics, information sources, caregiving duration, health status), patient (e.g., demographic and clinical characteristics), and HCP levels (e.g., time constraints in clinical settings, communication skills) are associated with caregiver-HCP communication quality. Studies further show that these communication experiences may affect caregiver outcomes, including quality of life, mental health, resilience, and satisfaction with cancer care. Moreover, poor quality caregiver-HCP communication is associated with patient readmission to the hospital and unmet care needs. Interventions for caregivers or patient-caregiver dyads have been shown to enhance caregiver confidence and increase their engagement in communication with HCPs. Interventions for HCPs have shown efficacy in improving their communication skills, particularly in involving caregivers in decision-making discussions. Given time constraints during medical visits, we suggest conducting a caregiver assessment by navigators prior to visits to understand their communication needs. Additionally, reimbursing HCPs for time spent communicating with caregivers during visits could be beneficial. More research is needed to better understand how to enhance caregiver-HCP communication quality.

Challenges of care coordination for complex patients among family medicine residents in a community ambulatory clinic: a qualitative study

BackgroundCare coordination has been identified as one of five focuses of HealthierSG. Family medicine residents are expected to collaborate with other healthcare professionals for complex patients by the end of residency. However, many residents felt that it was challenging to coordinate care effectively among healthcare stakeholders. However, to date, no qualitative studies have explored these challenges. Therefore, this study aimed to understand the challenges encountered by family medicine residents when coordinating care for complex patients.MethodsThis was a qualitative descriptive study in which semi structured in-depth interviews were conducted and guided by a topic guide. Total population sampling of 15 third-year family medicine residents in the National Healthcare Group Polyclinics was performed. The interviews were performed over Zoom and were transcribed. Thematic analysis was subsequently performed to analyse the transcripts. Coding was performed iteratively by two independent researchers. Disagreements were adjudicated by a third coder. A coding framework was agreed upon. Potential themes were then independently developed based on the coding framework.ResultsSix themes emerged from the data, namely, interprofessional communications, accessibility, personal knowledge, time constraints, patient factors and caregiver dissent.ConclusionChallenges faced by family medicine residents are multifaceted. While a few are systemic and pertain to the broader healthcare framework, others, such as issues of unfamiliarity with institutional workflows, community resources, and confidentiality, pertain to the microcosm of residency itself. These are reversible areas for improvement. These challenges can be addressed during planning of residency curricula to better equip family medicine residents with coordinating care for complex patients in the future.

Toward enhanced decentralized palliative care services in Neno District, Malawi: a qualitative study.

BackgroundPalliative care remains key in assisting patients who have life-threatening conditions. In most low- and middle-income countries, it is often offered through a centralized system with limitations, including Malawi. In 2014, the World Health Organization called for improving palliative care access through primary health care and community models. Malawi and Neno District subsequently decentralized palliative care delivery to local health centers. This qualitative study explored the decentralization of palliative care services in Neno District, Malawi.MethodsThe descriptive qualitative study was conducted between 2021 and 2022 in two conveniently selected health centers providing palliative care in the Neno District. Fourteen healthcare workers were purposefully selected to participate in two focus groups. Fifteen patients were conveniently selected and participated in three focus groups. Data was analyzed using deductive and inductive approaches. Focused group discussions were conducted in Chichewa (Malawi’s official local language), audio recorded, transcribed, translated into English, and analyzed thematically.ResultsFour main themes emerged from the focus groups. Patients described positive relationships with healthcare workers built on trust and holistic care over time. Accessing care included transport, social support, time constraints, and distance issues. Facilities effectively responded to needs through coordinated care and follow-up. Decentralization was perceived to benefit patients by reducing travel challenges and improving local access to efficient and inclusive palliative care services. However, challenges with resources, distance, and social support remained. Limitations in sampling and missing participant details necessitate further research with broader sampling.ConclusionOverall, the study provides empirical evidence that can optimize palliative care delivery in similar low-resource contexts by informing policies to address barriers through decentralized approaches.

#935 Exploring the impact of sensory-feedback in foot on physical activity in frail hemodialysis patients: a randomized controlled trial

Abstract Background and Aims Patients undergoing hemodialysis (HD) often face fatigue, time constraints, and impaired mobility, contributing to reduced physical activity and frailty. Intradialytic electrical stimulation (E-stim), particularly targeting the plantar region of the feet, is suggested as an alternative to traditional exercise programs. This study aims to investigate the association between sensory feedback in the foot and physical activity characteristics to demonstrate the efficacy of plantar electrical nerve stimulation (PENS) during HD in patients with frailty. Method 43 participants with pre-frail to frail levels based on the Fried frail criteria were enrolled. They were randomized to either an intervention group (IG: n = 21, age=55.5 ± 14.3 years, BMI = 28.5 ± 6.0 kg/m2, female = 28.6%, pre-frail=38.1%, frail=61.9%) receiving PENS or a control group (CG: n = 22, age = 61.0 ± 7.8 years, BMI = 30.7 ± 6.2 kg/m2, female = 45.5%, pre-frail = 36.4%, frail = 63.6%). The IG received 1-hour PENS during HD session (3 sessions/week), while CG received an identical but non-functional device for 12 weeks. The maximum Vibratory Perceptual Threshold (VPT) value was measured to assess sensory-feedback in foot, and daily life physical activity was assessed using the wearable pendant at the baseline and 12-weeks. The delta values (Δ) between 12-weeks and baseline were calculated to explore the association between VPT and physical activity. This study was supported by the Qatar National Research Foundation (QNRF, Award #NPRP10-0208-170400I). Results Age, gender, demographics, and other baseline characteristics were similar among IG and CG. 95% of participants completed 12 weeks regimen. In the IG, Δ walking duration (rho = −0.458, p = 0.037) and total step numbers (rho = 0.484, p = 0.026) were negatively correlated with Δ maximum VPT value, whereas there was no correlation in the CG. Conclusion Our study suggests that 12 weeks of E-stim therapy may enhance foot sensory feedback in the IG, potentially boosting walking-related activities in HD patients. Thus, we advocate for this practical therapy, especially for HD patients with frail symptoms, to promote increased physical activity.