Recent advances in implantable sensors and electronics using printable materials for advanced healthcare.

This review article focuses on the recent printing technological progress in healthcare, underscoring the significant potential of implantable devices across diverse applications. Printing technologies have widespread use in developing health monitoring devices, diagnostic systems, and surgical devices. Recent years have witnessed remarkable progress in fabricating low-profile implantable devices, driven by advancements in printing technologies and nanomaterials. The importance of implantable biosensors and bioelectronics is highlighted, specifically exploring printing tools using bio-printable inks for practical applications, including a detailed examination of fabrication processes and essential parameters. This review also justifies the need for mechanical and electrical compatibility between bioelectronics and biological tissues. In addition to technological aspects, this article delves into the importance of appropriate packaging methods to enhance implantable devices' performance, compatibility, and longevity, which are made possible by integrating cutting-edge printing technology. Collectively, we aim to shed light on the holistic landscape of implantable biosensors and bioelectronics, showcasing their evolving role in advancing healthcare through innovative printing technologies.

Developing consensus for definitions of key veterinary-specific quality improvement (QI) terms using an eDelphi-study method.

BACKGROUND: Quality improvement (QI) methods are a continuous process of iterative tests to improve the quality of a service or product. Using common language has been linked to the successful implementation of QI in human healthcare. This study aimed to assimilate and achieve consensus on veterinary-specific definitions for terms associated with quality care and QI methods in UK veterinary practice. METHODS: A four-round modified eDelphi process with a panel of 50 UK veterinary practice stakeholders was used to generate consensus. The panel selected or suggested the definition they best felt 'fitted' each term. Consensus was reached if there was >70% agreement, and terms were eliminated if there was <15% selection. RESULTS: Thirty-one panellists completed all three rounds of eDelphi; eight participants completed an optional feedback round. From 14 terms, 10 reached consensus, leaving four unresolved definitions. CONCLUSIONS: A majority of terms reached consensus; 90% were new or amended definitions proposed by panel members. Utilising plain English refined by stakeholders will allow successful implementation of QI in veterinary healthcare. Not all terms achieved consensus, highlighting a need for further research to enable successful integration of QI principles as seen in human healthcare.

Impact of the COVID-19 pandemic: How our response is shaping the future of cystic fibrosis care.

The findings of this body of work are presented in the eight articles included in this supplement. The impact and perspectives of adult and pediatric care teams and patient/families are covered with special attention to mental health care, the financial and personnel impacts within care programs, the experiences of vulnerable and underrepresented patient populations, and implementation of remoting monitoring. Commentaries from colleagues provide a broader perspective, offering reflections on the findings and their implications regarding the future CF care model.

[The impact of the COVID-19 pandemic on health service utilisation in the City of Niamey: a study conducted in 17 health care facilities from January to June 2020]. / Impact de la pandémie de la COVID-19 sur l'utilisation des services de santé dans la ville de Niamey: une analyse dans 17 formations sanitaires de janvier à juin 2020.

COVID-19 pandemic has posed huge challenges for the health system in Africa; however they haven´t been well quantified. The purpose of this study was to assess the impact of COVID-19 pandemic on curative and preventive activities in health care facilities at 17 integrated health centers in Niamey by comparing the first half of 2020 and the first half of 2019. The differences were more pronounced in the second quarter of 2020, with a 34% reduction (95% CI: -47% to -21%) for curative care, 61% (95% CI: -74% to -48%) for pentavalent vaccines 1 and 3 and 36% (95% CI: -49% to -23%) for VAR 1. A nearly zero gain of 1% (95% IC: -2% to 4%) was reported for prenatal care attendance, thus reversing the gains of the first quarter. The COVID-19 pandemic has had negative effects on service deliveries to the most vulnerable groups, such as women and children. New strategies, such as community engagement, are essential.

Spirituality in Nursing and Health: A Historical Context, Challenges, and Way Forward.

This article aims to share the historical context of spirituality in nursing, meanings and expressions of spirituality, and different models of spirituality along with its significance in nursing education and practice. Several challenges and tools for the successful integration of spirituality in education and practice are also discussed.

[The contribution of mindfulness to healthcare]. / De bijdrage van mindfulness aan de gezondheidszorg.

Mindfulness-based interventions can reduce symptoms and improve the quality of life of people with mental and chronic general medical disorders. It is not clear, however, whether mindfulness has a unique contribution to the already existing psychological interventions for such problems, and whether it would be better to develop innovative interventions that are more effective than existing ones. Conflict of interest and financial support: none declared.

Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison.

INTRODUCTION: The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. METHODS: A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. FINDINGS: While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family's health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women's partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. CONCLUSION: This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders' experiences of the rapid changes to health services.

Female healthcare workers and the Covid-19 pandemic in Brazil: a sociological analysis of healthcare work. / Trabalhadoras da saúde face à pandemia: por uma análise sociológica do trabalho de cuidado.

The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.

Este texto tem como finalidade discutir o cuidado de trabalhadoras da área da saúde em face da Covid-19, sob a análise sociológica de autoras que o vêm discutindo enquanto um trabalho que é desempenhado, na sua maioria, pelas mulheres das classes populares, é desvalorizado e sofre baixa remuneração. É uma atividade que envolve as construções sociais das emoções e tem utilizado o corpo como um instrumento de trabalho no cuidado com o outro. Além disso, a precarização do trabalho em saúde na sociedade brasileira acirrada nas últimas décadas, como o aumento de contratos temporários, perdas de direitos trabalhistas, a sobrecarga das atividades, condições de trabalho precárias, dentre outros, soma-se com o aumento dos atendimentos médico-hospitalares diante da pandemia da Covid-19. Neste contexto, as trabalhadoras em saúde vivenciam as ausências de equipamentos de proteção individual, medo de contaminação pelo vírus, preocupações com filhos e familiares, vivências diante da morte e do adoecimento de si e de colegas de profissão. Este texto aponta para a necessidade de atenção governamental, bem como para a gestão do trabalho em saúde e dos órgãos de classe profissional, analisando as condições de trabalho que as trabalhadoras em saúde estão vivendo no enfrentamento da pandemia.

Trabalhadoras da saúde face à pandemia: por uma análise sociológica do trabalho de cuidado / Female healthcare workers and the Covid-19 pandemic in Brazil: a sociological analysis of healthcare work

Resumo Este texto tem como finalidade discutir o cuidado de trabalhadoras da área da saúde em face da Covid-19, sob a análise sociológica de autoras que o vêm discutindo enquanto um trabalho que é desempenhado, na sua maioria, pelas mulheres das classes populares, é desvalorizado e sofre baixa remuneração. É uma atividade que envolve as construções sociais das emoções e tem utilizado o corpo como um instrumento de trabalho no cuidado com o outro. Além disso, a precarização do trabalho em saúde na sociedade brasileira acirrada nas últimas décadas, como o aumento de contratos temporários, perdas de direitos trabalhistas, a sobrecarga das atividades, condições de trabalho precárias, dentre outros, soma-se com o aumento dos atendimentos médico-hospitalares diante da pandemia da Covid-19. Neste contexto, as trabalhadoras em saúde vivenciam as ausências de equipamentos de proteção individual, medo de contaminação pelo vírus, preocupações com filhos e familiares, vivências diante da morte e do adoecimento de si e de colegas de profissão. Este texto aponta para a necessidade de atenção governamental, bem como para a gestão do trabalho em saúde e dos órgãos de classe profissional, analisando as condições de trabalho que as trabalhadoras em saúde estão vivendo no enfrentamento da pandemia.

Abstract The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.

Beyond Screening: Health Systems Invest in Social Determinants of Health.

This is the second of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study. As pioneering health systems begin investing in housing and other services to support individuals and bolster communities, nurses gain new opportunities and responsibilities. On the one hand, nurses should expect their work to entail more tracking and sharing of patient data. On the other, nurses can apply their creativity and holistic approach to care to assist health systems in making an overdue cultural shift.

Environmentally sustainable emergency medicine.

Emergency clinicians worldwide are demonstrating increasing concern about the effect of climate change on the health of the populations they serve. The movement for sustainable healthcare is being driven by the need to address the climate emergency. Globally, healthcare contributes significantly to carbon emissions, and the healthcare sector has an important role to play in contributing to decarbonisation of the global economy. In this article, we consider the implications for emergency medicine of climate change, and suggest ways to improve environmental sustainability within emergency departments. We identify examples of sustainable clinical practice, as well as outlining research proposals to address the knowledge gap that currently exists in the area of provision of environmentally sustainable emergency care.

Current status and future directions of U.S. genomic nursing health care policy.

BACKGROUND: As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care. PURPOSE: To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation. METHODS: We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health. FINDINGS: Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed. DISCUSSION: Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas. CONCLUSIONS: To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

Digital disruption of dietetics: are we ready?

Digital health is transforming the delivery of health care around the world to meet the growing challenges presented by ageing populations with multiple chronic conditions. Digital health technologies can support the delivery of personalised nutrition care through the standardised Nutrition Care Process (NCP) by using personal data and technology-supported delivery modalities. The digital disruption of traditional dietetic services is occurring worldwide, supporting responsive and high-quality nutrition care. These disruptive technologies include integrated electronic and personal health records, mobile apps, wearables, artificial intelligence and machine learning, conversation agents, chatbots, and social robots. Here, we outline how digital health is disrupting the traditional model of nutrition care delivery and outline the potential for dietitians to not only embrace digital disruption, but also take ownership in shaping it, aiming to enhance patient care. An overview is provided of digital health concepts and disruptive technologies according to the four steps in the NCP: nutrition assessment, diagnosis, intervention, and monitoring and evaluation. It is imperative that dietitians stay abreast of these technological developments and be the leaders of the disruption, not simply subject to it. By doing so, dietitians now, as well as in the future, will maximise their impact and continue to champion evidence-based nutrition practice.

Developing a Common Understanding of Networks of Care through a Scoping Study.

The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multi-method scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low- and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.

Bringing into focus treatment limitation and DNACPR decisions: How COVID-19 has changed practice.

BACKGROUND: The COVID-19 pandemic has introduced further challenges into Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Existing evidence suggests success rates for CPR in COVID-19 patients is low and the risk to healthcare professionals from this aerosol-generating procedure complicates the benefit/harm balance of CPR. METHODS: The study is based at a large teaching hospital in the United Kingdom where all DNACPR decisions are documented on an electronic healthcare record (EHR). Data from all DNACPR/TEAL status forms between 1st January 2017 and 30th April 2020 were collected and analysed. We compared patterns of decision making and rates of form completion during the 2-month peak pandemic phase to an analogous period during 2019. RESULTS: A total of 16,007 forms were completed during the study period with a marked increase in form completion during the COVID-19 pandemic. Patients with a form completed were on average younger and had fewer co-morbidities during the COVID-19 period than in March-April 2019. Several questions on the DNACPR/TEAL forms were answered significantly differently with increases in patients being identified as suitable for CPR (23.8% versus 9.05%; p < 0.001) and full active treatment (30.5% versus 26.1%; p = 0.028). Whilst proportions of discussions that involved the patient remained similar during COVID-19 (95.8% versus 95.6%; p = 0.871), fewer discussions took place with relatives (50.6% versus 75.4%; p < 0.001). CONCLUSION: During the COVID-19 pandemic, the emphasis on senior decision making and conversations around ceilings of treatment appears to have changed practice, with a higher proportion of patients having DNACPR/TEAL status documented. Understanding patient preferences around life-sustaining treatment versus comfort care is part of holistic practice and supports shared decision making. It is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.

Indications for Rituximab Use in an Integrated Health Care Delivery System.

BACKGROUND: Rituximab is a top-selling biologic that was first approved by the FDA in 1997 for a non-Hodgkin lymphoma orphan indication. It has since been approved for additional orphan indications, with rheumatoid arthritis as the only FDA-approved, nonorphan indication. Evidence suggests that rituximab is frequently used off-label, but information on its use over time and indications for use in the United States is limited. OBJECTIVE: To assess incident rituximab use over time in an integrated health care delivery system. METHODS: This was a cross-sectional, retrospective study. Data were collected from administrative databases and manual chart reviews. Patients who received their first rituximab infusion between October 1, 2009, and December 31, 2017, and who were not a part of a clinical trial were included. Indication for use (FDA-approved orphan/nonorphan, off-label) was determined. Proportions of use were assessed over time. Multivariable logistic regression modeling was performed to assess factors associated with receiving rituximab for an FDA-approved indication. RESULTS: A total of 1,674 patients were included. The majority (66.4%) of patients had an FDA-approved indication, with lymphoma being the most common approved indication (66.4%). The most common indication for off-label use was neurologic conditions (72.7%), predominantly demyelinating diseases. Off-label indication use increased from 1.2% in 2009 to 55.6% in 2017. Factors associated with rituximab use for an FDA-approved indication included increased age (adjusted odds ratio [AOR] = 1.05, 95% CI = 1.04-1.07) and increased burden of chronic disease (chronic disease score: AOR = 1.07, 95% CI = 1.02-1.12; Charlson Comorbidity Index score: AOR = 3.52, 95% CI = 3.03-4.10). CONCLUSIONS: Off-label use of rituximab grew dramatically over the course of the study. With the recent FDA approval of the rituximab biosimilar and its expected lower price, off-label use will likely continue to rise. Opportunities for cost savings and to ensure appropriate use of these medications should be evaluated. DISCLOSURES: This study was funded by Kaiser Permanente. All authors except Hansen are employed by Kaiser Permanente. Hansen has nothing to disclose. Preliminary results were presented at the Mountain States Conference for Residents and Preceptors in May 2019 in Salt Lake City, UT, and at an encore presentation October 2019 at the American College of Clinical Pharmacy Annual Meeting in New York, NY.

Can Homeopathy, a Particularly Mild Therapeutic Approach, Survive and Grow in a World of Violence?

This short treatise addresses a philosophical question concerning the place of homeopathy in our modern world. The question raised is whether a therapeutic system as peaceful, mild, and non-violent as homeopathy can survive and grow within a society that often displays the opposite characteristics.Much of contemporary society is more interested in fast and impressive cures, even if these may also bring side effects; whereas homeopathy can offer solutions with a personalized approach that requires long hours of case study by the homeopath to find the correct personal remedy that aims to bring about positive results, which the therapy can produce in deep chronic diseases.The conclusion drawn is that homeopathy does not readily fit within a modern and violent society that prefers quick and invasive solutions to its clinical problems.

'Without data, you're just another person with an opinion'.

Introduction: Given the recent impressive digital transformation worldwide, the importance of data has reached a new dimension. It is, therefore, provocative to ask whether data can save healthcare systems from bankruptcy.Areas covered: We reviewed published examples in the search for the evidence on how the growing amount of data could change the way we used to assess the value of healthcare technologies, ensuring a more holistic approach in the decision-making process while reducing the waste in the healthcare.Expert opinion: The growing amount of data will continue to provide a multitude of valuable insights that can save healthcare systems from bankruptcy. Electronic medical records, IoT, wearables, and mobile applications generate constant data streams that can be utilized endlessly thanks to methodological advancements such as SNA, unsupervised and supervised machine learning, and natural language programming. However, interoperability across these multiple data sources still pose a challenge for the future development of data-driven healthcare. Already today however, decision makers can utilize Big Data to develop conditional coverage schemes for very expensive and complicated health technologies suitable for personalized healthcare. More advanced payers may utilize even data analytics even further and develop AI-based pricing schemes.