Early Impressions and Adoption of the AtriAmp for Managing Arrhythmias Following Congenital Heart Surgery.

Objective: AtriAmp is a new medical device that displays a continuous real-time atrial electrogram on telemetry using temporary atrial pacing leads. Our objective was to evaluate early adoption of this device into patient care, understand how it affected clinical workflow, and identify unforeseen benefits or limitations. Design: Qualitative study using inductive analysis of semi-structured interviews to identify dominant themes. Setting: Single center, tertiary, academic 21-bed mixed pediatric intensive care unit (PICU). Subjects: PICU multidisciplinary team members (Pediatric intensivists, PICU Nurse Practitioners, PICU nurses and Pediatric Cardiologists) who were early adopters of the AtriAmp (n=14). Results: Three prominent themes emerged from qualitative analysis of the early adopters' experiences. (1) Accelerated time from arrhythmia event to diagnosis, treatment, and determination of treatment effectiveness; (2) Increased confidence and security in the accuracy of providers' arrhythmia diagnosis; and (3) Improvement in the ability to educate providers about post-operative arrythmias where reliance on time consuming consultation is a default. Providers also noted some learning curves with the device; none of which compromised medical care or clinical workflow. Conclusions: Insights from early adopters of AtriAmp signal the need for simplicity and fidelity in new technologies within the PICU. Further research in the qualitative and observational sphere is needed to understand how technologies, such as AtriAmp, find expanded use in the PICU environment. Our research suggests that such technologies can be pivotal to the support and growth of multi-disciplinary teams, even among those who do not participate in early implementation.

Blockchain technology diffusion in tourism: Evidence from early enterprise adopters and innovators.

The use cases of blockchain as an innovative technology have increasingly captured the attention of tourism enterprises. To date, the literature tends to discuss blockchain's advantages rather than how early enterprise adopters and innovators experience and perceive the technology. As such, the extent of technology diffusion is not well understood. This study critically explores the factors influencing blockchain diffusion in tourism and how blockchain innovation is diffused in tourism. We conducted semistructured interviews with founders and senior executives of tourism enterprises in the United States and Europe who are early adopters and innovators of blockchain in tourism. From the thematic analysis, our empirical findings indicate that blockchain has much to offer despite the nascent link between blockchain's business value to an enterprise's strategic plans and the limited success of use cases in tourism. We summarize the findings in a conceptual framework and offer propositions based on the antecedents (motivators and drivers and challenges and barriers) of blockchain diffusion of innovation for enterprises to achieve competitive advantage. The propositions provide a research agenda to guide the strategic implementation of blockchain.

Early technology review: towards an expedited pathway.

OBJECTIVES: Evidence development for medical devices is often focused on satisfying regulatory requirements with the result that health professional and payer expectations may not be met, despite considerable investment in clinical trials. Early engagement with payers and health professionals could allow companies to understand these expectations and reflect them in clinical study design, increasing chances of positive coverage determination and adoption into clinical practice. METHODS: An example of early engagement through the EXCITE International model using an early technology review (ETR) is described which includes engagement with payers and health professionals to better inform companies to develop data that meet their expectations. ETR is based on an early evidence review, a framework of expectations that guides the process and identified gaps in evidence. The first fourteen ETRs were reviewed for examples of advice to companies that provided additional information from payers and health professionals that was thought likely to impact on downstream outcomes or strategic direction. Given that limitations were imposed by confidentiality, examples were genericized. RESULTS: Advice through early engagement can inform evidence development that coincides with expectations of payers and health professionals through a structured, objective, evidence-based approach. This could reduce the risk of business-related adverse outcomes such as failure to secure a positive coverage determination and/or acceptance by expert health professionals. CONCLUSIONS: Early engagement with key stakeholders exemplified by the ETR approach offers an alternative to the current approach of focusing on regulatory expectations. This could reduce the time to reimbursement and clinical adoption and benefit patient outcomes and/or health system efficiencies.

Virtual reality technology for surgical learning: qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK-Uganda partnership.

INTRODUCTION: The extensive resources needed to train surgeons and maintain skill levels in low-income and middle-income countries (LMICs) are limited and confined to urban settings. Surgical education of remote/rural doctors is, therefore, paramount. Virtual reality (VR) has the potential to disseminate surgical knowledge and skill development at low costs. This study presents the outcomes of the first VR-enhanced surgical training course, 'Global Virtual Reality in Medicine and Surgery', developed through UK-Ugandan collaborations. METHODS: A mixed-method approach (survey and semistructured interviews) evaluated the clinical impact and barriers of VR-enhanced training. Course content focused on essential skills relevant to Uganda (general surgery, obstetrics, trauma); delivered through: (1) hands-on cadaveric training in Brighton (scholarships for LMIC doctors) filmed in 360°; (2) virtual training in Kampala (live-stream via low-cost headsets combined with smartphones) and (3) remote virtual training (live-stream via smartphone/laptop/headset). RESULTS: High numbers of scholarship applicants (n=130); registrants (Kampala n=80; remote n=1680); and attendees (Kampala n=79; remote n=556, 25 countries), demonstrates widespread appetite for VR-enhanced surgical education. Qualitative analysis identified three key themes: clinical education and skill development limitations in East Africa; the potential of VR to address some of these via 360° visualisation enabling a 'knowing as seeing' mechanism; unresolved challenges regarding accessibility and acceptability. CONCLUSION: Outcomes from our first global VR-enhanced essential surgical training course demonstrating dissemination of surgical skills resources in an LMIC context where such opportunities are scarce. The benefits identified included environmental improvements, cross-cultural knowledge sharing, scalability and connectivity. Our process of programme design demonstrates that collaboration across high-income and LMICs is vital to provide locally relevant training. Our data add to growing evidence of extended reality technologies transforming surgery, although several barriers remain. We have successfully demonstrated that VR can be used to upscale postgraduate surgical education, affirming its potential in healthcare capacity building throughout Africa, Europe and beyond.

Innovation Diffusion Across 13 Specialties and Associated Clinician Characteristics.

Diffusion of innovations, defined as the adoption and implementation of new ideas, processes, products, or services in health care, is both particularly important and especially challenging. One known problem with adoption and implementation of new technologies is that, while organizations often make innovations immediately available, organizational actors are more wary about adopting new technologies because these may impact not only patients and practices but also reimbursement. As a result, innovations may remain underutilized, and organizations may miss opportunities to improve and advance. As innovation adoption is vital to achieving success and remaining competitive, it is important to measure and understand factors that impact innovation diffusion. Building on a survey of a national sample of 654 clinicians, our study measures the extent of diffusion of value-enhancing care delivery innovations (i.e., technologies that not only improve quality of care but has potential to reduce care cost by diminishing waste, Faems et al., 2010) for 13 clinical specialties and identifies healthcare-specific individual characteristics such as: professional purview, supervisory responsibility, financial incentive, and clinical tenure associated with innovation diffusion. We also examine the association of innovation diffusion with perceived value of one type of care delivery innovation - artificial intelligence (AI) - for assisting clinicians in their clinical work. Responses indicate that less than two-thirds of clinicians were knowledgeable about and aware of relevant value-enhancing care delivery innovations. Clinicians with broader professional purview, more supervisory responsibility, and stronger financial incentives had higher innovation diffusion scores, indicating greater knowledge and awareness of value-enhancing, care delivery innovations. Higher levels of knowledge of the innovations and awareness of their implementation were associated with higher perceptions of the value of AI-based technology. Our study contributes to our knowledge of diffusion of innovation in healthcare delivery and highlights potential mechanisms for speeding innovation diffusion.

Global cone-beam computed tomography adoption, usage and scan interpretation preferences of dentists and endodontists.

AIM: This study investigated the adoption of cone-beam computed tomography (CBCT) by dentists and endodontists around the world, including their preferences in endodontic CBCT usage. METHODOLOGY: An online questionnaire surveyed dental association members in Australia and New Zealand, and endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history, considerations in acquisition/interpretation, access to and usage of CBCT, preferred scan interpreter, and preferred endodontic scan settings. Data were analysed with Chi-squared, independent sample t-tests, Cochran's Q and McNemar's tests. RESULTS: Responses from 578 endodontic specialists or postgraduates (Group E) and 185 non-endodontic dentists (Group NE) were included. Continuing professional education (CPE) was the most common source of CBCT training (69.2%). Factors considered in CBCT acquisition/interpretation included beam hardening (75.4%), radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher CBCT usage (90.8%) than Group NE (45.4%, p < .001) and greater workplace access to CBCT (81.1% vs. 25.9%, p < .001). Scans were interpreted by the respondent in most workplace scans (83.3%) and externally taken scans (60.5%); Group E were significantly more likely to interpret themselves than Group NE. Small field of view (83.6%) and high resolution (86.6%) were most preferred as settings for endodontic CBCTs; Group NE were less likely to choose these settings. There were some geographic variations within Group E. CONCLUSIONS: CBCT training was most commonly acquired via CPE. Endodontic respondents reported very high CBCT usage and access in the workplace. There are educational implications regarding CBCT limitations, appropriate applications and interpretation.

The Educational Impact of Radiology in Anatomy Teaching: A Field Study Using Cross-Sectional Imaging and 3D Printing for the Study of the Spine.

INTRODUCTION: Cross-sectional imaging and 3D printing represent state-of-the-art approaches to improve anatomy teaching compared to traditional learning, but their use in medical schools remains limited. This study explores the utility of these educational tools for teaching normal and pathological spinal anatomy, aiming to improve undergraduate medical education. MATERIALS AND METHODS: A field study was conducted on a cohort of undergraduate medical students who were exposed to anatomy lessons of the spine considering three learning paradigms: traditional learning, cross-sectional imaging examinations, and 3D printed models. 20 students (intervention group) received the three approaches, and other 20 students (control group) received the conventional (traditional) approach. The students were examined through a multiple-choice test and their results were compared to those of a control group exposed to traditional learning matched by age, sex and anatomy grades. In addition, students in the experimental group were assessed for their satisfaction with each learning method by means of an ad hoc questionnaire. RESULTS: Students exposed to cross-sectional imaging and 3D printing demonstrated better knowledge outcomes compared to the control group. They showed high satisfaction rates and reported that these technologies enhanced spatial understanding and facilitated visualization of specific pathologies. However, limitations such as the representativeness of non-bone conditions in 3D printed models and the need for further knowledge on imaging fundamentals were highlighted. CONCLUSION: Cross-sectional imaging and 3D printing offer valuable tools for enhancing the teaching of spinal anatomy in undergraduate medical education. Radiologists are well positioned to lead the integration of these technologies, and further research should explore their potential in teaching anatomy across different anatomical regions.

Survey data of Gen Z customer behaviour using food delivery applications in Vietnam.

This study presents an analysis based on data collected via questionnaire, surveying Gen Z customers using food delivery applications in Vietnam. The purpose of the original research was to investigate factors influencing Gen Z customers' decision to continue using the applications. The data set presented in this paper includes 361 valid responses that were collected by convenience sampling method from Hanoi and Hochiminh City, which are the two most potential regions of e-commerce transactions in Vietnam. After being collected, sorted, and filtered, the data was calculated by SPSS 22 and AMOS 23 software to extract descriptive analysis, Cronbach's Alpha, and confirmatory factor analysis (CFA). The calculation results indicated that this data set ensures reliability, convergent, and discriminant validity, which can serve as a good reference for future studies.

Uso de videos como material complementario en la enseñanza de la Otorrinolaringología / Otorhynolaryngology image as supplementary teaching material

Introducción y objetivo: Los videos, como material didáctico complementario, pueden reemplazar parte de las horas de docencia y ayudar en la adquisición de conocimientos en Otorrinolaringología. Para ello se pretende analizar el impacto de la visualización de 4 videos en el resultado de 6 preguntas específicas del examen teórico de la asignatura y evaluar la percepción de estos videos. Método: Estudio analítico cuasi experimental transversal realizado en 213 estudiantes de Otorrinolaringología de la Universidad Autónoma de Madrid divididos en 2 grupos: grupo intervención y grupo control. Las diferencias en el rendimiento en las 6 preguntas entre ambos grupos se determinaron mediante la prueba χ2 o el test exacto de Fisher, con un valor de significación p<0.05. Además, para evaluar la percepción de los estudiantes se revisaron las opiniones registradas en los cuadernos de rotación hospitalaria. Resultados: Los videos tuvieron 883 visualizaciones al momento del análisis de los datos y la mayoría de las opiniones fueron positivas (94.87%). Se observaron diferencias significativas (p<0.01) en el resultado de los estudiantes en dos preguntas: “oído 1” (27.78% de aciertos en el grupo intervención vs. 7.50% en el grupo control) y “cuello 2” (38.89% vs. 81.80%). La mayoría de los comentarios sobre los videos (94.87%) fueron positivos. Discusión y conclusiones: no se pudo demostrar un impacto directo en los resultados académicos pero el fácil acceso a los videos y los comentarios positivos sobre estos evidenciaron su utilidad como una herramienta complementaria para la enseñanza de la asignatura. (AU)

Introduction and objective: Using videos as complementary teaching material can replace part of the teaching hours and be helpful in acquisition of knowledge in Otorhinolaryngology. To evaluate this alternative the impact of visualizations of 4 videos on performance in specific questions of the Otorhinolaryngology exam will be analyzed and students’ perception of these videos will be evaluated. Method: Quasi-experimental analytical study, conducted in 213 students of Otolaryngology of Autonomous University of Madrid divided in two groups (intervention and control). Differences between intervention and control group were analyzed using the chi-square test or the exact Fisher test (p value<0.05 statistically significant). Feedback from students on the videos was collected. Results: The total number of video visualizations was 883. Significant differences were observed (p < 0.01) on performance in question "ear 1" with 27.78% of success rate of the experimental group versus 7.50% of the control group, and in question "neck 2" with 38.89% of success rate of the experimental group compared to 81.80% of the control group. Most opinions about the videos (94.87%) were positive. Discussion and conclusions: No significant impact on performance was found, easy access to videos and positive feedback from students highlight its usefulness as a complementary teaching material to classes in Otorhinolaryngology. (AU)

El renacimiento tecnológico de la Radiología: la revolución open source y la inteligencia artificial

El campo de la radiología ha experimentado avances notables en las últimas décadas, con desarrollos que van desde la mejora de la calidad y digitalización de las imágenes hasta la detección asistida por computadora. Particularmente, la aparición de técnicas de Inteligencia Artificial basadas en Deep Learning y Visión Computacional han promovido soluciones innovadoras en el diagnóstico y el análisis radiológico. Se explora la relevancia de los desarrollos y modelos open source en el progreso de estas técnicas, resaltando el impacto que la colaboración y el acceso abierto han tenido en el avance científico del campo. La investigación tiene un enfoque cualitativo, con alcance descriptivo y retrospectivo, de corte longitudinal. Se realizó un análisis documental de la evolución y el impacto del open source en la Radiología, poniendo de relieve la colaboración multidisciplinar. Se examinaron casos de uso, ventajas, desafíos y consideraciones éticas en relación con la implementación de soluciones basadas en Inteligencia Artificial en Radiología. El enfoque open source ha mostrado ser una influencia positiva en la Radiología, con potencial para influir en la atención médica, ofreciendo soluciones más precisas y accesibles. No obstante, se presentan desafíos éticos y técnicos que requieren atención.

The field of radiology has seen notable advances in recent decades, with developments ranging from image quality improvement and digitization to computer-aided detection. Particularly, the emergence of Artificial Intelligence techniques based on Deep Learning and Computer Vision have promoted innovative solutions in diagnosis and radiological analysis. This article explores the relevance of open source developments and models in the progress of these techniques, highlighting the impact that collaboration and open access have had on the scientific advancement in this field. This research has a qualitative approach, with a descriptive, retrospective, longitudinal scope. A documentary analysis of the evolution and impact of open source in Radiology was carried out, highlighting multidisciplinary collaboration. Use cases, advantages, challenges and ethical considerations were also examined in relation to the implementation of AI-based solutions in Radiology. The Open Source approach has been shown to be a positive influence in Radiology, with the potential to influence medical care, offering more precise and accessible solutions. However, there are ethical and technical challenges that require attention.

The determinants of public acceptance of telemedicine apps: an innovation diffusion perspective.

With the rapid advancement of information technology, telemedicine apps have gradually become an indispensable tool for providing patients with more convenient, efficient, and accessible healthcare services. However, the successful implementation of these apps largely depends on widespread acceptance among the public. To thoroughly investigate the factors influencing the public's acceptance of these apps and the relationships between these factors, this study developed a theoretical model based on the Diffusion of Innovation theory and the Theory of Perceived Value. To validate this model, we conducted a survey of 387 residents in Beijing, China, and employed structural equation modeling to analyze the collected data. The research findings indicate that attributes of innovation diffusion, including relative advantage, compatibility, complexity, trialability, and observability, significantly and positively influence the public's perceived value. Particularly noteworthy is that perceived value partially mediates the relationship between innovation attributes and public acceptance, emphasizing the crucial role of perceived value in the public decision-making process. This study employed a theory-driven approach to elucidate the acceptance of telemedicine apps and offers fresh insights into the existing literature. By integrating the research paradigms of innovation diffusion and customer perceived value, we provide a coherent explanation of how individual cognitive processes lead to acceptance behavior. In summary, this research enriches the existing theoretical studies on the acceptance of telemedicine apps and holds positive implications for healthcare practice.

The Evolve to Next-Gen ACT Network: An evolving open-access, real-world data resource primed for real-world evidence research across the Clinical and Translational Science Award Consortium.

The ACT Network was funded by NIH to provide investigators from across the Clinical and Translational Science Award (CTSA) Consortium the ability to directly query national federated electronic health record (EHR) data for cohort discovery and feasibility assessment of multi-site studies. NIH refunded the program for expanded research application to become "Evolve to Next-Gen ACT" (ENACT). In parallel, the US Food and Drug Administration has been evaluating the use of real-world data (RWD), including EHR data, as sources of real-world evidence (RWE) for its regulatory decisions involving drug and biological products. Using insights from implementation science, six lessons learned from ACT for developing and sustaining RWD/RWE infrastructures and networks across the CTSA Consortium are presented in order to inform ENACT's development from the outset. Lessons include intentional institutional relationship management, end-user engagement, beta-testing, and customer-driven adaptation. The ENACT team is also conducting customer discovery interviews with CTSA hub and investigators using Innovation-Corps@NCATS (I-Corps™) methodology for biomedical entrepreneurs to uncover unmet RWD needs. Possible ENACT value proposition hypotheses are presented by stage of research. Developing evidence about methods for sustaining academically derived data infrastructures and support can advance the science of translation and support our nation's RWD/RWE research capacity.

Mapping horizon scanning systems for medical devices: similarities, differences, and lessons learned.

OBJECTIVES: This article presents the mapping of horizons scanning systems (HSS) for medical devices, conducted by the Medical Devices Working Group of the International Horizon Scanning Initiative (IHSI MDWG). It provides an overview of the identified HSS, highlights similarities and differences between the systems, and lessons learned. METHODS: Potentially relevant HSS were identified through literature searches, scan of an overview of EuroScan members, and input from the IHSI MDWG members. Structured information was collected from organizations that confirmed having an HSS for medical devices. RESULTS: Sixteen initiatives could be identified, of which 11 are currently ongoing. The purposes of the HSS range from raising awareness of trends and new developments to managing informed decisions on innovative health services in hospitals. The time-horizon is most often 3 years up to a few months before market entry. Three models of identification of new technologies crystallized: a reactive (stakeholders outside HSS inform), a pro-active (actively searching multifold sources), and a hybrid model. Prioritization is often conducted by separate committees via scoring or debate. The outputs focus either on in-depth information of single technologies or on a class of technologies or on technologies in specific disease areas. CONCLUSIONS: The identified HSS share the common experience that horizon scanning (HS) for medical devices is a resource-intensive exercise that requires a dedicated and skilled team. Insights into the identified HSS and their experiences will be used in the continued work of the IHSI MDWG on its proposal for an IHSI HSS for medical devices.

Utilization of innovative medical technologies in German inpatient care: does evidence matter?

BACKGROUND: The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the type of evidence that was available at the time of introduction of 25 innovative technologies and how this evidence evolved over time, and (2) to explore the relationship between clinical evidence and utilization for these technologies in German inpatient care. METHODS: This study combined different methods. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases, clinical trial registries, resources for clinical guidelines, and health technology assessment-databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital procedures captured in claims data. The body of evidence, funding and safety notices per technology were analyzed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis. RESULTS: The number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomized controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies. CONCLUSIONS: This study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as coverage with evidence development.

Legitimacy of source-separating wastewater systems with Swedish water utilities.

Nutrient management is one of the critical challenges for developing sustainable circular economies in cities. Nutrients such as nitrogen and phosphorus from our food end up in our wastewater and pose an environmental threat when they are released in waterways. Yet, these nutrients are essential for crop production and food security. Hince human excreta contains the bulk of nutrients going through the urban ecosystem. Source separation of excreta from the rest of urban wastewater flows can enable safe and efficient nutrient recovery. Yet, source-separating wastewater systems are not yet common in urban areas. The aim of this study is to assess the legitimacy of source-separating wastewater systems from the perspective of wastewater professionals in Sweden. The study uses interviews and a survey to explore the pragmatic, normative, cognitive and regulatory dimensions of legitimacy and how these aspects can vary between different municipalities. Finally, it looks into possible knowledge-based activities to increase legitimacy. The results from this study show variations in legitimacy levels in urban areas in Sweden. Overall opinion appears to be neutral to the concept rather than negative. Although many see multiple barriers to implementation. Normative legitimacy (moral motivation) was relatively high, while cognitive legitimacy (knowledge & experiences) was lowest. Respondents from organizations where source-separation is being implemented, or they believe that it will be implemented within 10 years, generally saw more drivers and fewer barriers. These innovators were also more interested in knowledge-based activities. Overall recommendations to increase cognitive knowledge regarding source-separating systems among multiple stakeholders seems the most promising path forward to increase legitimacy in the Swedish wastewater sector.

Global survey of endodontic practice and adoption of newer technologies.

AIM: To investigate current endodontic practices, adoption of technologies and continuing education attendance within specialist endodontic practice globally and to identify geographic trends. METHODOLOGY: A web-based survey of endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA on routine treatment preferences, armamentarium and education attendance was conducted. Chi-squared, independent sample t-tests, Cochran's Q test and McNemar's test were performed. RESULTS: The survey was completed by 543 endodontists or endodontic post-graduate students. Almost all respondents used the dental operating microscope (DOM, 91.3%), engine-driven nickel-titanium instruments (NiTi, 97.6%), electronic apex locators (EAL, 93.0%), cone-beam computed tomography (CBCT, 91.2%) and calcium silicate-based materials (CSBMs, 93.7%). Dental dam was always used by 99.1%. Over half used irrigation adjuncts (81.8%), warm vertical compaction (74.6%) and heat-treated NiTi (60.2%). Geographic comparison between AP (Asia-Pacific, n = 78), AM (Americas, n = 402) and EM (Europe and Middle East, n = 63) was performed. AM and EM preferred single-visit treatment more (p < .001) and used higher sodium hypochlorite concentrations than AP. AM had more access to CBCT in the workplace (86.6%) than AP (65.4%, p < .001) and used CBCT for routine preoperative assessment (39.6%) more than EM (7.3%, p < .001). Almost all of EM used irrigation adjuncts (95.2%), more than AM (78.1%, p = .001). AP used steroid/antibiotic medicaments most (p < .001) and had the highest attendance at continuing education programmes. CONCLUSION: Several endodontic-specific armamentaria have reached almost complete adoption within global specialist endodontic practice, whilst the continued uptake of newer technologies should be followed over time. Some practising philosophies varied significantly across different geographic regions.

Creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions: Protocol for the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS).

BACKGROUND: With the increasing prevalence of chronic diseases, partly due to the increase in life expectancy and the aging of the population, the complexity of the approach faced by the structures, dynamics, and actors that are part of the current care and attention systems is evident. The territory of Bages (Catalonia, Spain) presents characteristics of a highly complex ecosystem where there is a need to develop new, more dynamic structures for the various actors in the health and social systems, aimed at incorporating new actors in the technological and business field that would allow innovation in the management of this context. Within the framework of the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS), the aim is to address these challenges through various entities that will develop 7 interrelated operations. Of these, the operation of the IDIAP Jordi Gol-Catalan Health Institute focuses on the creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions in the Bages region, in the form of a database that will collect the most relevant information from the different environments that affect the management of chronic conditions and dependence: health, social, economic, and environment. OBJECTIVE: This study aims to create a laboratory for statistical, dependence, and chronic condition analysis in the Bages region, to determine the chronic conditions and conditions that generate dependence in the Bages area, in order to propose products and services that respond to the needs of people in these situations. METHODS: PECT BAGESS originated from the Shared Agenda initiative, which was established in the Bages region with the goal of enhancing the quality of life and fostering social inclusion for individuals with chronic diseases. This study presents part of this broader project, consisting of the creation of a database. Data from chronic conditions and dependence service providers will be combined, using a unique identifier for the different sources of information. A thorough legal analysis was conducted to establish a secure data sharing mechanism among the entities participating in the project. RESULTS: The laboratory will be a key piece in the structure generated in the environment of the PECT BAGESS, which will allow relevant information to be passed on from the different sectors involved to respond to the needs of people with chronic conditions and dependence, as well as to generate opportunities for products and services. CONCLUSIONS: The emerging organizational dynamics and structures are expected to demonstrate a health and social management model that may have a remarkable impact on these sectors. Products and services developed may be very useful for generating synergies and facilitating the living conditions of people who can benefit from all these services. However, secure data sharing circuits must be considered. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46542.

Identifying Strategies to Reduce Low-Value Preoperative Testing for Low-Risk Procedures: a Qualitative Study of Facilities with High or Recently Improved Levels of Testing.

BACKGROUND: Healthcare agencies and perioperative professional organizations recommend avoiding preoperative screening tests for low-risk surgical procedures. However, low-value preoperative tests are still commonly ordered even for generally healthy patients and active strategies to reduce this testing have not been adequately described. OBJECTIVE: We sought to learn from hospitals with either high levels of testing or that had recently reduced use of low-value screening tests (aka "delta sites") about reasons for testing and active deimplementation strategies they used to effectively improve practice. DESIGN: Qualitative study of semi-structured telephone interviews. PARTICIPANTS: We identified facilities in the US Veterans Health Administration (VHA) with high or recently improved burden of potentially low-value preoperative testing for carpal tunnel release and cataract surgery. We recruited perioperative clinicians to participate. APPROACH: Questions focused on reasons to order preoperative screening tests for patients undergoing low-risk surgery and, more importantly, what strategies had been successfully used to reduce testing. A framework method was used to identify common improvement strategies and specific care delivery innovations. KEY RESULTS: Thirty-five perioperative clinicians (e.g., hand surgeons, ophthalmologists, anesthesiologists, primary care providers, directors of preoperative clinics, nurses) from 29 VHA facilities participated. Facilities that successfully reduced the burden of low-value testing shared many improvement strategies (e.g., building consensus among stakeholders; using evidence/norm-based education and persuasion; clarifying responsibility for ordering tests) to implement different care delivery innovations (e.g., pre-screening to decide if a preop clinic evaluation is necessary; establishing a dedicated preop clinic for low-risk procedures). CONCLUSIONS: We identified a menu of common improvement strategies and specific care delivery innovations that might be helpful for institutions trying to design their own quality improvement programs to reduce low-value preoperative testing given their unique structure, resources, and constraints.

Strategies used throughout the scaling-up process of eConsult - Multiple case study of four Canadian Provinces.

BACKGROUND: eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada. METHODS: We conducted a multiple case study with four cases (ON, QC, MB, NL). Data collection methods included document review (n = 93), meeting observations (n = 65) and semi-structured interviews (n = 40). Each case was analyzed based on Milat's framework. RESULTS: The first scaling-up phase was marked by the rigorous evaluation of eConsult pilot projects and the publication of over 90 scientific papers. In the second phase, provinces implemented provincial multi-stakeholder committees, institutionalized the evaluation, and produced documents detailing the scaling-up plan. During the third phase, efforts were made to lead proofs of concept, obtain the endorsement of national and provincial organizations, and mobilize alternate sources of funding. The last phase was mainly observed in Ontario, where the creation of a provincial governance structure and strategies were put in place to monitor the service and manage changes. CONCLUSIONS: Various strategies need to be used throughout the scaling-up process. The process remains challenging and lengthy because health systems lack clear processes to support innovation scaling-up.

Complex implementation mechanisms in primary care: do physicians' beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study.

BACKGROUND: The adoption of digital health technologies can improve the quality of care for polypharmacy patients, if the underlying complex implementation mechanisms are better understood. Context effects play a critical role in relation to implementation mechanisms. In primary care research, evidence on the effects of context in the adoption of digital innovation for polypharmacy management is lacking. STUDY AIM: This study aims to identify contextual factors relevant to physician behavior and how they might mediate the adoption process. METHODS: The physicians who participated in this formative evaluation study (n = 218) were part of the intervention group in a cluster-randomized controlled trial (AdAM). The intervention group implemented a digital innovation for clinical decision making in polypharmacy. A three-step methodological approach was used: (1) a realist inquiry approach, which involves the description of a context-mechanism-outcome configuration for the primary care setting; (2) a belief elicitation approach, which involves qualitative content analysis and the development of a quantitative latent contextualized scale; and (3) a mediation analysis using structural equation modeling (SEM) based on quantitative survey data from physicians to assess the mediating role of the contextualized scale (n = 179). RESULTS: The key dimensions of a (1) context-mechanism-outcome model were mapped and refined. A (2) latent construct of the physicians' innovation beliefs related to the effectiveness of polypharmacy management practices was identified. Innovation beliefs play a (3) mediating role between the organizational readiness to implement change (p < 0.01) and the desired behavioral intent of physicians to adopt digital innovation (p < 0.01; R2 = 0.645). Our contextualized model estimated significant mediation, with a relative size of 38% for the mediation effect. Overall, the model demonstrated good fit indices (CFI = 0.985, RMSEA = 0.034). CONCLUSION: Physician adoption is directly affected by the readiness of primary care organizations for the implementation of change. In addition, the mediation analysis revealed that this relationship is indirectly influenced by primary care physicians' beliefs regarding the effectiveness of digital innovation. Both individual physician beliefs and practice organizational capacity could be equally prioritized in developing implementation strategies. The methodological approach used is suitable for the evaluation of complex implementation mechanisms. It has been proven to be an advantageous approach for formative evaluation. TRIAL REGISTRATION: NCT03430336 . First registration: 12/02/2018. CLINICALTRIALS: gov.