Healthcare Value Research Articles

Hospital Heart Failure Medical Therapy Score and Associated Clinical Outcomes and Costs.

A composite score for guideline-directed medical therapy (GDMT) for patients with heart failure (HF) is associated with increased survival. Whether hospital performance according to a GDMT score is associated with a broader array of clinical outcomes at lower costs is unknown. To evaluate hospital variability in GDMT score at discharge, 90-day risk-standardized clinical outcomes and costs, and associations between hospital GDMT score and clinical outcomes and costs. This was a retrospective cohort study conducted from January 2015 to September 2019. Included for analysis were patients hospitalized for HF with reduced ejection fraction (HFrEF) in the Get With the Guidelines-Heart Failure Registry, a national hospital-based quality improvement registry. Study data were analyzed from July 2022 to April 2023. GDMT score at discharge. Hospital variability in GDMT score, a weighted index from 0 to 1 of GDMT prescribed divided by the number of medications eligible, at discharge was evaluated using a generalized linear mixed model using the hospital as a random effect and quantified with the adjusted median odds ratio (AMOR). Parallel analyses centering on 90-day mortality, HF rehospitalization, mortality or HF rehospitalization, home time, and costs were performed. Costs were assessed from the perspective of the Centers of Medicare & Medicaid Services. Associations between hospital GDMT score and clinical outcomes and costs were evaluated using Spearman coefficients. Among 41 161 patients (median [IQR] age, 78 [71-85] years; 25 546 male [62.1%]) across 360 hospitals, there was significant hospital variability in GDMT score at discharge (AMOR, 1.23; 95% CI, 1.21-1.26), clinical outcomes (mortality AMOR, 1.17; 95% CI, 1.14-1.24; HF rehospitalization AMOR, 1.22; 95% CI, 1.18-1.27; mortality or HF rehospitalization AMOR, 1.21; 95% CI, 1.18-1.26; home time AMOR, 1.07; 95% CI, 1.06-1.10) and costs (AMOR, 1.23; 95% CI, 1.21-1.26). Higher hospital GDMT score was associated with lower hospital mortality (Spearman ρ, -0.22; 95% CI, -0.32 to -0.12; P < .001), lower mortality or HF rehospitalization (Spearman ρ, -0.17; 95% CI, -0.26 to -0.06; P = .002), more home time (Spearman ρ, 0.14; 95% CI, 0.03-0.24; P = .01), and lower cost (Spearman ρ, -0.11; 95% CI, -0.21 to 0; P = .047) but not with HF rehospitalization (Spearman ρ, -0.10; 95% CI, -0.20 to 0; P = .06). Results of this cohort study reveal that hospital variability in GDMT score, clinical outcomes, and costs was significant. Higher GDMT score at discharge was associated with lower mortality, lower mortality or hospitalization, more home time, and lower cost. Efforts to increase health care value should include GDMT optimization.

Blockchain Technology: A Revolutionary Tool Against Counterfeit Pharmaceuticals

Counterfeit pharmaceuticals pose a significant global health threat, with dire consequences ranging from ineffective treatment to severe health complications and death. This paper explores how blockchain technology (BCT) can revolutionize the fight against counterfeit drugs and enhance healthcare integrity. Counterfeit drugs are defined as medications falsely claiming their source, efficacy, or validity, often containing incorrect amounts of active ingredients or harmful substances, leading to various adverse patient outcomes. Counterfeit drugs remain prevalent, especially in countries labeled as LMICs, with 13.6% an estimate of medications being counterfeit, resulting in financial repercussions exceeding $200 billion. Blockchain technology offers a robust solution to these challenges through its decentralized, tamper-proof digital ledger system. Each transaction recorded on the blockchain is immutable and transparent, ensuring data integrity and preventing unauthorized alterations. This technology can significantly enhance drug traceability, allowing stakeholders to verify the authenticity of medications from manufacture to patient delivery. Blockchain technology's promise to enhance transparency, efficiency, and security in healthcare is compelling. Its adoption can lead to a more resilient, equitable, and patient-centric healthcare ecosystem, reducing counterfeit drugs and improving overall patient care. As blockchain solutions mature and gain acceptance, their impact on the healthcare value chain—from drug discovery to patient care—will become increasingly significant, driving innovation and advancing global health and well-being.

Biosynthesis and Extraction of Chlorophyll, Carotenoids, Anthocyanins, and Betalaine In Vivo and In Vitro.

As natural bioactive compounds, plant pigments play crucial roles not only in plant phenotype, growth, development, and adaptation to stress but also hold unique value in biotechnology, healthcare, and industrial applications. There is growing interest in the biosynthesis and acquisition of plant pigments. Thus, this paper explores emerging extraction methods of natural pigments and elucidates the biosynthesis pathways of four key plant pigments, chlorophylls, carotenoids, anthocyanins, and betalaine in vivo and in vitro. We comprehensively discuss the application of solvent, supercritical fluid [extraction], ultrasonic, and microwave-assisted extraction techniques, as well as introducing key enzymes, precursors, and synthetic pathways involved in pigment synthesis. δ-Aminolevulinic acid represents a pivotal initiating enzyme for chlorophyll synthesis, whereas isopentenylpyrophosphate, (IPP) and dimethylallyl pyrophosphate, (DMAPP) are closely associated with carotenoid biosynthesis. Phenylalanine and tyrosine are critical substances for anthocyanin and betalaine synthesis, respectively. Hence, crucial genes such as chlI, crtB, PGT8, CYP76AD1, and BvDODA can be employed for heterologous biosynthesis in vitro to meet the demand for increased plant pigment amount. As a pivotal determinant of plant coloration, an in-depth exploration into the high-quality acquisition of plant pigments can provide a basis for developing superior pigments and offer new insights into increasing pigment yield.

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Improving Detection of Hospital Adverse Events Using Machine Learning on Real-World Narrative EMR Data

ObjectiveAdministrative data often underrepresents hospital adverse events (AEs) due to limitations in International Classification of Diseases (ICD) coding. By leveraging electronic medical records (EMRs), we aim to mitigate these discrepancies and enhance the precision of healthcare surveillance and performance evaluations. To this end, we have developed a machine learning (ML)-based approach that utilizes EMR text data to detect common AEs. MethodsWe sampled adult admissions from four Calgary hospitals (2017 - 2022). Registered nurses assessed charts for 17 AEs, and the results were used as reference standard. We compared two AE detection methods: the standard ICD-based method following Canadian guidelines, and our ML algorithm applied to EMR narratives. Sensitivity, positive predictive value (PPV), negative predictive value (NPV), and specificity for both methods were calculated and compared against the reference standard. ResultsWe analyzed 9,566 patients, of whom 1,506 were identified with AEs. Of the 17 AEs, the sensitivity in ICD-coded data ranged from 0-37%, and in EMRs, it was between 75-100%. Both showed low PPV (0-50% ICD vs.1-34% EMR). ICD data had high specificity ranging from 99-100% and NPV (99%-100%), while EMRs had specificity between 68-94% and an NPV of 100%. Conclusion and ImplicationsML significantly enhances sensitivity for AE detection compared to ICD-10-CA coding, despite both methods experiencing low PPV due to imbalances in EMR data. This marked improvement in sensitivity highlights ML's potential to transform AE surveillance and reporting, promising significant advancements in patient safety and healthcare quality by enabling more accurate and comprehensive identification of AEs.

Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design.

(1) Background/Objective: California has one of the highest rates of pediatric dental caries in the nation. One way to combat this problem is through non-dental provider training programs that focus on prevention. However, there are limited data on healthcare provider training program integration and evaluation of oral health curricula focused on prevention of early childhood caries. This study will assess the change in healthcare providers' attitudes, knowledge, and skills by implementing an interprofessional educational (IPE) oral health curriculum in medicine and nurse practitioner programs at one university in Southern California. (2) Methods: A mixed method design was employed using a pre- and post-educational survey, and end-of-program focus group interviews. Descriptive statistics and paired t-tests were used to assess group differences and thematic analyses for the focus groups. (3) Results: A total of 81 students (14 pediatric medicine residents, 18 pediatric, and 49 family nurse practitioners) completed the curriculum and surveys. Attitudes related to oral hygiene remained unchanged, with the nurse practitioner group showing improved clinical skills (all questions; p < 0.021). Knowledge scores significantly improved across all groups (paired t-test; p < 0.001). All focus groups expressed the helpfulness of the educational modules, the usefulness of the skills learned, and the benefits of IPE activities. (4) Conclusion: Healthcare providers showed improved oral health knowledge and clinical skills acquired through the oral health program and can serve as a model to educate across disciplines on the prevention of early childhood caries.

The value-laden nature of decision-making with the never-capacitated patient

The values of individuals who have never had the capacity to express their preferences are often overlooked or even ignored in the decision-making process. The case of “Michael,” a non-verbal young adult with a genetic condition and intellectual disability, is presented to challenge the traditional approach of relying solely on clinical indicators and the “best interest” standard narrowly construed in healthcare decision-making. Michael's interaction with his environment, gleaned through his family's input, illustrates that values and quality of life can be discerned through observed behaviors and preferences, even in the absence of communicative ability. We argue for a broader definition of “values” that encompasses any aspect of life that brings meaning or enjoyment to the individual. This model not only personalizes care for never-capacitated individuals but may also be applied to other incapacitated populations, such as those with dementia, suggesting that past directives may not always align with their evolving values and interests. Underlying this expanded understanding of values in healthcare is a patient-centered approach that accounts for personal elements that contribute to an individual's sense of purpose and satisfaction.

Patients with dementia or frailty undergoing major limb amputation have poor outcomes

ObjectiveMajor lower limb amputation is a disfiguring operation associated with impaired mobility and high near-term mortality. Informed decision-making regarding amputation requires outcomes data. Despite the co-occurrence of both chronic limb-threatening ischemia (CLTI) and Alzheimer’s disease and related dementias (ADRD), there is sparse data on the outcomes of major limb amputation in this population and the impact of frailty. We sought to determine mortality, complications, readmissions, revisions, intensive interventions (eg, cardiopulmonary resuscitation), and other outcomes after amputation for CLTI in patients living with ADRD looking at the modifying effects of frailty. MethodsWe examined Medicare fee-for-service claims data from January 1, 2016, to December 31, 2020. Patients with CLTI undergoing amputation at or proximal to the ankle were included. Along with demographic information, dementia status, and comorbid conditions, we measured frailty using a claims-based frailty index. We dichotomized dementia and frailty (pre-frail/robust = “non-frail” vs moderate/severe frailty = “frail”) to create four groups: non-frail/non-ADRD, frail/non-ADRD, non-frail/ADRD, and frail/ADRD. We used linear and logistic regression via generalized estimating equations in addition to performing selected outcomes analyses with death as a competing risk to understand the association between dementia status, frailty status, and 1-year mortality as our primary outcome in addition to the postoperative outcomes outlined above. ResultsAmong 46,930 patients undergoing major limb amputation, 11,465 (24.4%) had ADRD and 24,790 (52.8%) had frailty. Overall, 55.9% of amputations were below-knee. Selected outcomes among frail/ADRD patients undergoing amputation (n = 10,153) were: 55.3% 1-year mortality 29.6% readmissions at 30 days, and 32.3% amputation revision/reoperation within 1 year. Of all four groups, those in the frail/ADRD had the worst outcomes only for 1-year mortality. ConclusionsFirst, patients with ADRD or moderate/severe frailty suffer an array of very poor outcomes after major limb amputation for CLTI, including high mortality, readmissions, revision, and risks of discharge to higher levels of care. Second, there is a complex relationship between outcome severity and ADRD/frailty status. Specifically, frailty is more often than ADRD associated with the poorest results for any given outcome. These data provide important outcomes data to help align decision-making with health care values and goals.

Clinical Outcomes and Experiences with Prefilled Syringes Versus Vials for Intravitreal Administration of Anti-VEGF Treatments: A Systematic Review.

Anti-vascular endothelial growth factor (VEGF) agents have been the standard treatment for retinal diseases for almost two decades. These treatments are administered via intravitreal injection using single-use vials or prefilled syringes (PFS). In this systematic review, we evaluate health care resource use and clinical outcomes and experiences with PFS for intravitreal injection of anti-VEGF treatments. MEDLINE, EMBASE, and The Cochrane Library were searched from January 1, 2015 to February 8, 2024 to identify literature reporting outcomes regarding procedural efficiency, health care resource use, patient and clinician experiences, and safety for currently approved anti-VEGFs (ranibizumab, aflibercept, brolucizumab) administered using PFS. Comparators were vial-based injections of the same anti-VEGFs. A total of 36 publications met the criteria for inclusion in the systematic literature review; the majority were non-randomized studies, with a small number of reviews, case series, survey studies, and opinion articles. Publications reported that preparation times were significantly shorter for PFS (40.3-57.9s) versus vials (ranibizumab, 62.8-98.0s; aflibercept, 71.9-79.5s), with no differences in product stability between PFS and vials. Clinicians expressed a preference for PFS and thought PFS were faster, easier to use, and had increased safety versus vials. Publications consistently reported significantly lower rates of endophthalmitis per injection with PFS versus vials (ranibizumab PFS, 0-0.02%; aflibercept PFS, 0.01-0.02%; ranibizumab vial, 0.02-0.05%; aflibercept vial, 0.02-0.06%). Four publications reported increased rates of transient vision loss after aflibercept PFS injection versus vial-based injection. No publications reported outcomes regarding health care resource use or patient experiences. The available literature supports the increased procedural efficiency of PFS versus vial-based intravitreal injection of anti-VEGFs. PFS are positively perceived by clinicians and have a safety benefit in the form of a decreased risk of endophthalmitis versus vials.

Education in the National Transplant Law as an ethical pathway for the construction of the health care value in Colombia

The national transplant law in Colombia, Law 1805 of 2016, modified the Colombian legislation regarding how a person accesses an organ transplant, but above all, it changed the donor figure, establishing the term derived from the presumptive consent right. This term implies a person’s hypothetical willingness to be an organ donor as a manifestation of solidarity and charity towards another person in a situation of need and vulnerability concerning his/her health and the dimensions that define it. In the following text, seven moments are considered fundamental facts when constructing a culture about the value of healthcare in the national transplant policy in Colombia.

The gender congruences and life satisfaction scale for transgender and gender-diverse youth (GCLS-Y): a validation study with samples from the UK and US

Background There are currently no good quality psychometric tools available to assess multi-dimensional outcomes for trans and gender diverse youth. A tool is needed to develop a stronger evidence base regarding the evaluation of gender-affirming healthcare for the population. Aim The current study aimed to adapt and validate the Gender Congruence and Life Satisfaction Scale for young trans and gender diverse people (GCLS-Y) with young trans and gender diverse people aged 14-19 living in the United Kingdom (UK) and the United States (US). Method Initially, the GCLS-Y was adapted through expert consultation and discussion with trans and gender diverse youth to ensure it is meaningful and relevant. A survey that included the GCLS-Y and other psychometric measures that assessed gender incongruence, mental health and wellbeing to determine convergent validity and social desirability to examine discriminant validity was completed by 307 trans and gender diverse youth (n = 175 in the US and n = 132 in the UK). Findings Exploratory Factor Analysis supported a 5-factor model that was assessed as conceptually accurate. The final version of the GCLS-Y included 38 items with the following subscales: Psychosocial Implications of Gender Distress, Incongruence and Dysphoria related to Chest, Incongruence and Distress related to Genitalia, Social Perceptions of Gender, and Life Satisfaction. The measure was also found to be valid and reliable. Conclusions The GCLS-Y is a psychometrically sound tool that can be used to assess multidimensional outcomes among trans and gender diverse youth (14-19 years) related to mental health and wellbeing, gender incongruence and distress, and social experiences of gender. The tool can support the development of evidence-based policy, which has implications for legislation, healthcare funding, and broader societal attitudes.

Evaluating Comprehensibility of 157 Patient-Reported Outcome Measures (PROMs) in the Nationwide Dutch Outcome-Based Healthcare Program: More Attention for Comprehensibility of PROMs is Needed.

Patient-reported outcomes measures (PROMs) are increasingly prevalent in healthcare and used for shared decision-making and healthcare quality evaluation. However, the extent to which patients with varying health literacy levels can complete PROMs is often overlooked. This may lead to biased aggregated data and patients being excluded from studies or other PROM collection initiatives. This cross-sectional study evaluates the comprehensibility of 157 well-known and widely used PROM scales using a comprehensibility checklist. Pairs of two independent raters scored 157 PROM scales designed for adults included in the 35 sets of outcome information developed as part of the Dutch Outcome-Based Healthcare Program. The PROM scales were scored on the eight comprehensibility domains of the Pharos Checklist for Questionnaires in Healthcare (PCQH). Interrater agreement of domain ratings was assessed using Intraclass Correlation Coefficients or Cohen's kappa. Subsequently, final ratings were established through discussion and used to evaluate the domain-specific comprehensibility rating for each PROM scale. Comprehensibility of a large number of PROM scales (n = 157), which cover a wide range of diseases and conditions across Dutch medical specialist care, was assessed. While most PROM scales were written at an accessible language level, with minimal use of medical terms, instruction clarity, number of questions, and response options emerged as significant issues, affecting a substantial proportion of PROM scales. Interrater agreement was high for most domains of the PCQH. This study highlights the need for greater attention to the comprehensibility of PROMs to ensure their accessibility to all patients, including those with low health literacy. The PCQH can be a valuable tool in PROM development in addition to qualitative methods and in selection processes enabling comparison of comprehensibility between PROMs. However, the PCQH needs further development and validation for these purposes. Enhancing the comprehensibility of PROMs is essential for their effective incorporation in healthcare evaluation and decision-making processes.

Trends in Bundled Outpatient Behavioral Health Services in VA-Direct Versus VA-Purchased Care.

The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016-2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3million Veterans who registered 60million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services.

Low-fidelity Medical Simulation: Relevance in the Learning of Dental Students in South Africa.

Healthcare embraces simulation's learning boost, from medicine to dentistry. But can it unlock the secrets of intricate fixed prosthodontics? This study takes a pioneering step to find out. To evaluate low-fidelity medical simulation (LFMSim) in fixed prosthodontics by assessing its effectiveness in training corono-radicular preparations and by exploring participants' perceptions of LFMSim as an innovative teaching tool for developing pre-practice skills. A prospective, descriptive study was executed to explore these facets among 6th-year students. The Debriefing Assessment for Simulation in Healthcare (DASH©) evaluation grid, student version, was employed for assessment. The study encompassed one week, from 03/03/2023 to 10/03/2023. The study involved 28 learners with an average age of 23 and a sex ratio of 0.33, half of whom had prior exposure to simulation sessions. Seventy-five percent of participants watched the instructional video a day before the simulation, with nine expressing presession stress. Overall, 19% of students found the session as expected, while 43% considered it better than anticipated. Satisfaction levels varied, with 50% indicating they were "rather satisfied," and 46.4% expressing absolute satisfaction. The Debriefing Assessment using DASH yielded an average score of 4.85. The study's findings shed light on the effectiveness of LFMSim in training corono-radicular preparations and post-space impressions for fixed prosthodontics among 6th-year students. The varied satisfaction levels and the emphasis on debriefing discussions suggest avenues for improving simulation sessions in the future. These insights are pertinent for educators and institutions aiming to enhance dental education through innovative teaching tools like simulation. By refining simulation sessions based on debriefing feedback, educators can better prepare students for real-world clinical scenarios, ultimately improving patient care outcomes. This highlights the practical importance of incorporating simulation-based learning into dental curricula. How to cite this article: Hadyaoui D, Boukhris H, Riahi Z, et al. Low-fidelity Medical Simulation: Relevance in the Learning of Dental Students in South Africa. J Contemp Dent Pract 2024;25(5):463-472.

A robust near-field body area network based on coaxially-shielded textile metamaterial

A body area network involving wearable sensors distributed around the human body can continuously monitor physiological signals, finding applications in personal healthcare and athletic evaluation. Existing solutions for near-field body area networks, while facilitating reliable and secure interconnection among battery-free sensors, face challenges including limited spectral stability against external interference. Here we demonstrate a textile metamaterial featuring a coaxially-shielded internal structure designed to mitigate interference from extraneous loadings. The metamaterial can be patterned onto clothing to form a scalable, customizable network, enabling communication between near-field reading devices and battery-free sensing nodes placed within the network. Proof of concept demonstration shows the metamaterial’s robustness against mechanical deformation and exposure to lossy, conductive saline solutions, underscoring its potential applications in wet environments, particularly in athletic activities involving water or significant perspiration, offering insights for the future development of radio frequency components for a robust body area network at a system level.

Midwifery experiences in rural Southern Aotearoa New Zealand: insights into pre-eclampsia management

aim: This study investigated the experiences of rural midwives in the Southern region of Aotearoa New Zealand, focussing on practices and challenges in caring for pregnant individuals displaying signs of pre-eclampsia (PE). method: Conducted as part of the University of Otago’s Trainee Intern Healthcare Evaluation Project, investigating the efficacy of the soluble FMS-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio test, this exploratory study employed qualitative research methods. Twenty-three midwives from nine locations across the Southern region were interviewed by trainee intern doctors (TIs) using a semi-structured interview protocol. Thematic analysis was applied to the data. results: The study highlighted the challenging context of rural midwifery, emphasising diverse working conditions, geographic complexities and the impact of the midwifery shortage. Midwives’ decision making about PE depended on location, experience, scientific evidence, holistic model of care and the constant concern about PE. A model illustrating midwifery decision making in PE management was developed. conclusion: Rural midwives in Aotearoa New Zealand’s Southern region managing PE cases face complex challenges. The model derived from this study illustrates the delicate balance that rural midwives navigate, emphasising the need for strategies to support their practice and preserve Aotearoa New Zealand’s distinctive maternity care model.

Adopting a stance of vulnerability in healthcare evaluation: Amplifying the patient voice.

This paper argues that one aspect of re-imagining evaluation in health planning and management is for leaders and clinicians to develop comfort with vulnerability when engaging in service evaluations. Starting with an exploration of how the service user voice is traditionally expressed in healthcare evaluation, the paper then proceeds to explore the particular role and challenges faced by clinician-evaluators, including their role as 'privileged interlocutors' in conversations with service users. The tensions in reconciling the role of the clinician as an expert, with the related but different skills needed for effective discourse in qualitative evaluation are explored, and it is asserted that it is important for clinicians and leaders to be comfortable in showing and working with vulnerability when evaluating healthcare interventions. Clinicians are already skilled in holding discourse with service users, and extending the communication repertoire to include the management of emotion and expression of vulnerability is achievable and rewarding. The paper concludes that the ability to hold a vulnerable stance when conducting evaluation can have benefits in reducing defensiveness, encouraging a truer sense of enquiry and amplifying the service user voice.

Immobilized Burkholderia cepacia lipase and its application in selective enrichment of EPA by hydrolysis of fish oil

Eicosapentaenoic acid (EPA), an orally active Omega-3 long-chain polyunsaturated fatty acid, has attracted much attention for its medical and healthcare value. Due to a large amount of polyunsaturated fatty acids (PUFA) including docosahexanoic acid (DHA) in fish oil, the highly specific enrichment of EPA from fish oil is difficult to achieve. In our study, we conducted immobilization studies on Burkholderia cepacia lipase (BCL) and its application in the selective enrichment of EPA in fish oil. BCL was immobilized on resin LX201A by covalent crosslinking, and immobilization conditions including glutaraldehyde concentration, pH, time were optimized. The optimal immobilization conditions were 0.5% glutaraldehyde, 4 h, and pH 8.0. The loading rate of BCL reached to 93.5%, and its activity was up to 68263 U/g under the optimal immobilization conditions. After hydrolysis reaction of fish oil for 15h catalyzed by immobilized BCL, EPA content showed a more increase by 33.2%, while a slight increase by 0.78% in DHA content. Moreover, after recycling use for 10 times, the catalytic efficiency of immobilized BCL remained at 93.0%. These indicated that immobilized BCL possessed good selectivity, reusability and stability, providing great application potential in EPA selective enrichment in fish oil industry.

Microbiological performance and adherence in blood culture protocols: The role of a second anaerobic bottle

BackgroundBacteremia represents high rates of morbidity and mortality, especially in developing countries, highlighting the need for a diagnostic method that allows prompt and appropriate patient treatment. This study compared microbiological performance and adherence of two blood culture protocols for the diagnosis of bacteremia. MethodsQuasi-experimental study conducted between June 2022 and February 2023. Two blood culture protocols were evaluated. Protocol 1 included two aerobic bottles and one anaerobic bottle. Protocol 2 included two aerobic and two anaerobic bottles. Protocols were analyzed in three phases: evaluation of protocol 1 (Phase 1); evaluation of protocol 1 plus educational activities for healthcare staff (Phase 2) and evaluation of protocol 2 (Phase 3). Results342 patients and 1155 blood culture bottles (732 aerobic and 423 anaerobic) were included. Positivity was 17.6 %, 22.8 % and 19.4 % in phases 1, 2 and 3, respectively. Among patients with bacteremia, 84.5 % had positive anaerobic bottles, with 9.9 % showing growth only in this bottle. The contamination rates were 1.9 %, 0.3 %, and 0.8 % for each phase, mainly in aerobic bottles. Median positivity time was 11 h for both bottes aerobic and anaerobic. Overall nursing adherence increased from 13.1 % in Phase 1, 25.9 % in Phase 2, and 28.1 % in Phase 3 (p = 0.009). ConclusionsThe findings indicate that adding a second anaerobic bottle does not enhance blood culture positivity. Rather than increasing bottle quantity, staff training might be a more effective approach to optimize results.

The Governance, Policy, Process, and Capacity of Health Workforce Regulation and Accreditation: Qualitative Policy Analysis and Evidence from Palestine.

The significant health development achieved in Palestine last decades has been lost, in Gaza particularly. This requires fundamental health system reform and rebuilding, including health workforces. Strengthening health workforces involves essential elements: leadership, finance, policy, education, partnership, and management. The current unprecedented catastrophe in Gaza and overall instability in Palestine show the utmost necessity for rethinking and reforming all pillars of the already collapsed health system, including the workforce. Health Workforce Accreditation and Regulation (HWAR) standardizes healthcare evaluations, representing a critical research area in Palestine due to limited existing knowledge. This study aims to enhance understanding of the HWAR in Palestine, and identify gaps and weaknesses, thereby enhancing the HWAR's development and optimization. This qualitative study used an inductive approach to explore the landscape of HWAR. Data were collected from October to November 2019, when 22 semi-structured in-depth interviews - were conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organization sectors. Data analysis, namely, thematic and ground theory, was performed using Excel and MS programs. The study revealed an absence of transparent governance and ineffective communication within HWAR systems. National policies and guidelines are problematic, with HWAR mechanisms fractured and needing reform. Licensing for healthcare workers hinges on local education, while monitoring and evaluation of HWAR are deficient. Some institutions adhere to HWAR standards, yet widespread updates and applications are necessary. Coordination among educational, accreditation, and practice sectors is non-systematic. Adequate human resources exist, but we need to improve HWAR management. Operational and political challenges limit HWAR, leading to a focus on immediate responses over sustainable system integration. Boosting HWAR is critical for Palestine, especially after the ongoing conflict and humanitarian crisis that led to the dysfunction of the entire health system facilities. A collaborative strategy across sectors is needed to improve governance and outcomes. It is essential to foster strategic dialogue among academia, regulatory entities, and healthcare providers to enhance the HWAR system. Further study on HWAR's effectiveness is recommended.