Artificial intelligence and mental capacity legislation: Opening Pandora's modem.

People with impaired decision-making capacity enjoy the same rights to access technology as people with full capacity. Our paper looks at realising this right in the specific contexts of artificial intelligence (AI) and mental capacity legislation. Ireland's Assisted Decision-Making (Capacity) Act, 2015 commenced in April 2023 and refers to 'assistive technology' within its 'communication' criterion for capacity. We explore the potential benefits and risks of AI in assisting communication under this legislation and seek to identify principles or lessons which might be applicable in other jurisdictions. We focus especially on Ireland's provisions for advance healthcare directives because previous research demonstrates that common barriers to advance care planning include (i) lack of knowledge and skills, (ii) fear of starting conversations about advance care planning, and (iii) lack of time. We hypothesise that these barriers might be overcome, at least in part, by using generative AI which is already freely available worldwide. Bodies such as the United Nations have produced guidance about ethical use of AI and these guide our analysis. One of the ethical risks in the current context is that AI would reach beyond communication and start to influence the content of decisions, especially among people with impaired decision-making capacity. For example, when we asked one AI model to 'Make me an advance healthcare directive', its initial response did not explicitly suggest content for the directive, but it did suggest topics that might be included, which could be seen as setting an agenda. One possibility for circumventing this and other shortcomings, such as concerns around accuracy of information, is to look to foundational models of AI. With their capabilities to be trained and fine-tuned to downstream tasks, purpose-designed AI models could be adapted to provide education about capacity legislation, facilitate patient and staff interaction, and allow interactive updates by healthcare professionals. These measures could optimise the benefits of AI and minimise risks. Similar efforts have been made to use AI more responsibly in healthcare by training large language models to answer healthcare questions more safely and accurately. We highlight the need for open discussion about optimising the potential of AI while minimising risks in this population.

The MAPSTROKE project: A computational strategy to improve access to acute stroke care.

BACKGROUND: Global access to acute stroke treatment is variable worldwide, with notable gaps in low and middle-income countries (LMIC), especially in rural areas. Ensuring a standardized method for pinpointing the existing regional coverage and proposing potential sites for new stroke centers is essential to change this scenario. AIMS: To create and apply computational strategies (CSs) to determine optimal locations for new acute stroke centers (ASCs), with a pilot application in nine Latin American regions/countries. METHODS: Hospitals treating acute ischemic stroke (AIS) with intravenous thrombolysis (IVT) and meeting the minimum infrastructure requirements per structured protocols were categorized as ASCs. Hospitals with emergency departments, noncontrast computed tomography (NCCT) scanners, and 24/7 laboratories were identified as potential acute stroke centers (PASCs). Hospital geolocation data were collected and mapped using the OpenStreetMap data set. A 45-min drive radius was considered the ideal coverage area for each hospital based on the drive speeds from the OpenRouteService database. Population data, including demographic density, were obtained from the Kontur Population data sets. The proposed CS assessed the population covered by ASCs and proposed new ASCs or artificial points (APs) settled in densely populated areas to achieve a target population coverage (TPC) of 95%. RESULTS: The observed coverage in the region presented significant disparities, ranging from 0% in the Bahamas to 73.92% in Trinidad and Tobago. No country/region reached the 95% TPC using only its current ASCs or PASCs, leading to the proposal of APs. For example, in Rio Grande do Sul, Brazil, the introduction of 132 new centers was suggested. Furthermore, it was observed that most ASCs were in major urban hubs or university hospitals, leaving rural areas largely underserved. CONCLUSIONS: The MAPSTROKE project has the potential to provide a systematic approach to identify areas with limited access to stroke centers and propose solutions for increasing access to AIS treatment. DATA ACCESS STATEMENT: Data used for this publication are available from the authors upon reasonable request.

Surgical prioritization based on decision model outcomes is not sensitive to differences between the health-related quality of life values estimates of physicians and citizens.

PURPOSE: Decision models can be used to support allocation of scarce surgical resources. These models incorporate health-related quality of life (HRQoL) values that can be determined using physician panels. The predominant opinion is that one should use values obtained from citizens. We investigated whether physicians give different HRQoL values to citizens and evaluate whether such differences impact decision model outcomes. METHODS: A two-round Delphi study was conducted. Citizens estimated HRQoL of pre- and post-operative health states for ten surgeries using a visual analogue scale. These values were compared using Bland-Altman analysis with HRQoL values previously obtained from physicians. Impact on decision model outcomes was evaluated by calculating the correlation between the rankings of surgeries established using the physicians' and the citizens' values. RESULTS: A total of 71 citizens estimated HRQoL. Citizens' values on the VAS scale were - 0.07 points (95% CI - 0.12 to - 0.01) lower than the physicians' values. The correlation between the rankings of surgeries based on citizens' and physicians' values was 0.96 (p < 0.001). CONCLUSION: Physicians put higher values on health states than citizens. However, these differences only result in switches between adjacent entries in the ranking. It would seem that HRQoL values obtained from physicians are adequate to inform decision models during crises.

Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations.

PURPOSE: We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. METHODS: A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. FINDINGS: Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. CONCLUSIONS: Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.

Prevalence of canine impaction in the western province of Saudi Arabia: A cross-sectional survey.

BACKGROUND/AIM: Canine tooth impaction could have a negative influence on the stomatognathic system and could make it difficult for clinicians to manage malocclusions. The aim of this retrospective study was to investigate the prevalence of canine impaction, which could be a cause of malocclusion, in the population in the western province of Saudi Arabia. METHODS: A retrospective analysis of digital orthopantomograms (OPGs) of 400 patients aged 12-40 years, who are citizens of Saudi Arabia residing in the western province and who presented for treatment at the dental clinics of Batterjee Medical College, Jeddah, Saudi Arabia were included. The OPGs and dental records of these patients were reviewed for canine impaction and were categorized based on age, gender, and type of impaction. RESULTS: The prevalence of patients that exhibited canine impaction was found to be 4%. Males had a significantly higher percentage of prevalence than females (P < 0.016), and impaction was significantly higher among patients aged below 18 years (P < 0.001). Moreover, the most commonly observed impaction was mandibular canine impaction (87.5%). CONCLUSIONS: Prevention of malocclusion and maintenance of a normal dentition (better aesthetics and chewing) necessitates early detection of impacted canines.

Implementação do planificasus na atenção primária à saúde: relato de experiência / Implementation of planificasus in primary health care: experience report / Implementación del planificasus en la atención primaria de salud: relato de la experiencia

Objetivo: relatar a experiência da implantação do PlanificaSUS na Atenção Primária à Saúde em uma cidade da fronteira oeste do Rio Grande do Sul. Método: trata- se de um relato de experiência realizado com profissionais da saúde de uma Estratégia Saúde da Família piloto do PlanificaSUS. Participaram do estudo enfermeiros, técnicos de enfermagem, agente comunitário de saúde, odontóloga, auxiliar de saúde bucal, médicos, psicólogo e nutricionista, totalizando cerca de 30 participantes. A experiência ocorreu no período de julho de 2019 à julho de 2021. Foram disponibilizadas tutorias virtuais, reuniões presenciais, workshops e cartilhas informativas sobre a metodologia. Resultados: a implantação do método PlanificaSUS contribuiu de forma significativa na reorganização da assistência em saúde e adaptação dos sistemas de apoio diagnóstico e logístico essenciais durante o atendimento, possibilitando a ampliação do acesso e organização de macroprocessos e microprocessos. Obtiveram-se mudanças na estratificação e classificação de risco no território, por meio do acolhimento, o que possibilitou a organização do processo de trabalho dos profissionais, redução do tempo de espera ao atendimento do usuário e agilidade na resolutividade nos casos, superando a lógica hegemônica das filas de espera. Considerações finais: identificou-se mudanças na reorganização da ESF, pois o PlanificaSUS contribuiu para a qualificação profissional, melhoria da assistência aos usuários, fortalecimento e integração do trabalho da equipe e padronização dos processos junto a rede de saúde municipal.

Objective: to report the experience of PlanificaSUS implementation in Primary Health Care in a city in the western border of Rio Grande do Sul. Method: this is an experience report carried out with health professionals from a pilot Family Health Strategy of PlanificaSUS. Nurses, nursing technicians, community health agents, dentists, oral health assistants, physicians, psychologists and nutritionists participated in the study, totaling about 30 participants. The experiment took place from July 2019 to July 2021. Virtual tutorials, face-to-face meetings, workshops, and informative booklets about the methodology were made available. Results: the implementation of the PlanificaSUS method contributed significantly to reorganizing health care and adapting the essential diagnostic and logistical support systems during care, enabling expanded access and organization of macro and micro processes. Changes were obtained in the stratification and classification of risk in the territory, through the reception, which enabled the organization of the professionals' work process, reduction of the waiting time for the user's care and agility in resolving cases, overcoming the hegemonic logic of waiting lines. Final considerations: changes were identified in the ESF reorganization, because PlanificaSUS contributed to professional qualification, improved care to users, strengthening and integration of the team's work and standardization of processes within the municipal health network.

Objetivo: relatar la experiencia de implementación del PlanificaSUS en la Atención Primaria de Salud en una ciudad de la frontera oeste de Rio Grande do Sul. Método: se trata de un relato de experiencia realizado con profesionales de salud de una estrategia piloto de Salud de la Familia del PlanificaSUS. Participaron del estudio enfermeros, técnicos de enfermería, agentes comunitarios de salud, odontólogos, auxiliares de salud bucal, médicos, psicólogos y nutricionistas, totalizando cerca de 30 participantes. El experimento ocurrió en el período de julio de 2019 a julio de 2021. Se pusieron a disposición tutoriales virtuales, reuniones presenciales, talleres y folletos informativos sobre la metodología. Resultados: la implementación del método PlanificaSUS contribuyó significativamente a la reorganización de la asistencia sanitaria y a la adaptación de los sistemas esenciales de apoyo diagnóstico y logístico durante la atención, permitiendo la ampliación del acceso y la organización de los macro y microprocesos. Se obtuvieron cambios en la estratificación y clasificación del riesgo en el territorio, a través de la recepción, lo que permitió la organización del proceso de trabajo de los profesionales, reduciendo el tiempo de espera para la atención del usuario y la agilidad en la resolución de los casos, superando la lógica hegemónica de las colas de espera. Consideraciones finales: se identificaron cambios en la reorganización de la ESF, porque el PlanificaSUS contribuyó a la cualificación profesional, a la mejora de la atención a los usuarios, al fortalecimiento e integración del trabajo del equipo y a la estandarización de los procesos dentro de la red municipal de salud.

Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany.

BACKGROUND: Internationally, intensive psychiatric home treatment has been increasingly implemented as a community-based alternative to inpatient admission. Since 2018, the so-called Inpatient Equivalent Home Treatment (IEHT; German: "Stationsäquivalente Behandlung", short: "StäB") has been introduced as a particularly intensive form of home treatment that provides at least one daily treatment contact in the service users' (SU) home environment. Prior research shows that this can be challenging in rural catchment areas. Our paper investigates to which extent the location of the SU home location within the catchment area as well as the distance between the home and the clinic influence the utilisation of inpatient treatment compared to IEHT. METHOD: Routine data of one psychiatric hospital in the federal state of Brandenburg in Germany were analysed for the observational period 07/2018-06/2021. Two comparison groups were formed: SU receiving inpatient treatment and SU receiving IEHT. The SU places of residence were respectively anonymised and converted into geo-coordinates. A geographic information system (GIS) was used to visualise the places of residence, and car travel distances as well as travel times to the clinic were determined. Spatial analyses were performed to show the differences between comparison groups. In a more in-depth analysis, the proximity of SU residences to each other was examined as an indicator of possible clustering. RESULTS: During the observational period, the location of 687 inpatient and 140 IEHT unique SU were mapped using the GIS. SU receiving treatment resided predominantly within the catchment area, and this proportion was slightly higher for SU receiving IEHT than for those treated in inpatient setting (95.3% vs. 84.7%). In the catchment area, the geographical distribution of SU place of residence was similar in the two groups. There was a general higher service provision in the more densely populated communities close to Berlin. SU with residence in peripheral communities were mainly treated within the inpatient setting. The mean travel times and distances to the place of residence only differed minimally between the two groups of SU (p > 0.05). The places of residence of SU treated with IEHT were located in greater proximity to each other than those of SU treated in inpatient setting (p < 0.1). CONCLUSION: In especially peripheral parts of the examined catchment area, it may be more difficult to have access to IEHT rather than to inpatient services. The results raise questions regarding health equity and the planning of health care services and have important implications for the further development of intensive home treatment. Telehealth interventions such as blended-care approaches and an increase of flexibility in treatment intensity, e.g. eliminating the daily visit requirement, could ease the implementation of intensive home treatment especially in rural areas.

[Nurses' perspectives on their potential role in advance care planning in home care: A qualitative study]. / Die Sichtweise von Pflegefachpersonen auf ihre mögliche Rolle bei Advance Care Planning in der ambulanten Pflege.

Nurses' perspectives on their potential role in advance care planning in home care: A qualitative study Abstract. Background: Advance Care Planning (ACP) in long-term care in Germany has been identified as a potential area of nurses' responsibility. In the StAdPlan study (DRKS0016886), an ACP intervention in outpatient care was implemented and evaluated: Trained nurses conducted ACP conversations with patients. A comprehensive process evaluation was part of the study. Aim: A partial result of the process evaluation was analysing the perspective of nurses on their potential role as ACP facilitators for outpatients. Methods: Semi-structured interviews with nursing professionals and nursing service managers (n = 42) were carried out prior to the implementation of the ACP intervention. A qualitative content analysis of the recorded interviews was performed. Results: Participants described the importance of ACP in outpatient care, their personal motivation and competence as well as necessary contextual conditions. Nursing professionals are motivated to offer ACP to patients to be able to care for them according to their wishes. For effective ACP conversations, nurse professionals considered in-depth knowledge of ACP, conversational skills and sufficient time resources as necessary. ACP consultations can be a suitable field of action for nurses as they have access and an established relationship of trust with patients. Conclusions: Under certain conditions, nurses' role in offering guidance on ACP in outpatient care was seen as feasible and beneficial. Prerequisites for implementation are financial resources and training for nurses for this service.

Implementation of initiatives designed to improve healthcare worker health and wellbeing during the COVID-19 pandemic: comparative case studies from 13 healthcare provider organisations globally.

BACKGROUND: Healthcare workers are at a disproportionate risk of contracting COVID-19. The physical and mental repercussions of such risk have an impact on the wellbeing of healthcare workers around the world. Healthcare workers are the foundation of all well-functioning health systems capable of responding to the ongoing pandemic; initiatives to address and reduce such risk are critical. Since the onset of the pandemic healthcare organizations have embarked on the implementation of a range of initiatives designed to improve healthcare worker health and wellbeing. METHODS: Through a qualitative collective case study approach where participants responded to a longform survey, the facilitators, and barriers to implementing such initiatives were explored, offering global insights into the challenges faced at the organizational level. 13 healthcare organizations were surveyed across 13 countries. Of these 13 participants, 5 subsequently provided missing information through longform interviews or written clarifications. RESULTS: 13 case studies were received from healthcare provider organizations. Mental health initiatives were the most commonly described health and wellbeing initiatives among respondents. Physical health and health and safety focused initiatives, such as the adaption of workspaces, were also described. Strong institutional level direction, including engaged leadership, and the input, feedback, and engagement of frontline staff were the two main facilitators in implementing initiatives. The most common barrier was HCWs' fear of contracting COVID-19 / fear of passing COVID-19 to family members. In organizations who discussed infection prevention and control initiatives, inadequate personal protective equipment and supply chain disruption were highlighted by respondents. CONCLUSIONS: Common themes emerge globally in exploring the enablers and barriers to implementing initiatives to improve healthcare workers health and wellbeing through the COVID-19 pandemic. Consideration of the themes outlined in the paper by healthcare organizations could help influence the design and deployment of future initiatives ahead of implementation.

Addressing severe chronic NCDs across Africa: measuring demand for the Package of Essential Non-communicable Disease Interventions-Plus (PEN-Plus).

Severe chronic non-communicable diseases (NCDs) pose important challenges for health systems across Africa. This study explores the current availability of and demand for decentralization of services for four high-priority conditions: insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain. Ministry of Health NCD Programme Managers from across Africa (N = 47) were invited to participate in an online survey. Respondents were asked to report the status of clinical care across the health system. A care package including diagnostics and treatment was described for each condition. Respondents were asked whether the described services are currently available at primary, secondary and tertiary levels, and whether making the service generally available at that level is expected to be a priority in the coming 5 years. Thirty-seven (79%) countries responded. Countries reported widespread gaps in service availability at all levels. We found that just under half (49%) of respondents report that services for insulin-dependent diabetes are generally available at the secondary level (district hospital); 32% report the same for heart failure, 27% for chronic pain and 14% for sickle cell disease. Reported gaps are smaller at tertiary level (referral hospital) and larger at primary care level (health centres). Respondents report ambitious plans to introduce and decentralize these services in the coming 5 years. Respondents from 32 countries (86%) hope to make all services available at tertiary hospitals, and 21 countries (57%) expect to make all services available at secondary facilities. These priorities align with the Package of Essential NCD Interventions-Plus. Efforts will require strengthened infrastructure and supply chains, capacity building for staff and new monitoring and evaluation systems for efficient implementation. Many countries will need targeted financial assistance in order to realize these goals. Nearly all (36/37) respondents request technical assistance to organize services for severe chronic NCDs.

The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison.

Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs' extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.

Integrating home treatment into the Austrian child and adolescent mental health care system: an implementation science perspective.

BACKGROUND: In Austria, similar to other countries, health care planners have considered implementing home treatment (HT) programs for children and adolescents with mental health problems. However, introducing any new service innovation into the complex environment of the child and adolescent mental health care system requires context and implementation issues to be taken into account in advance. METHODS: We identified implementation themes from international HT models and developed a questionnaire with open-ended implementation-related questions for Austrian professionals. We analysed the qualitative results alongside the domains in the Context and Implementation of Complex Interventions (CICI) framework to detect key implementation challenges for HT in Austria. RESULTS: We found six implementation themes in international HT models, which formed the basis for development of the questionnaire. Within the qualitative data from ten Austrian professionals who responded to the questionnaire, we identified implementation challenges in all eight context and all four implementation domains of the CICI framework. CONCLUSIONS: Key implementation challenges detected highlight the need to address the fit of HT within existing sociocultural norms and limited available human resources. Regional context-specific solutions need to be found on how to embed this new element best into the existing provider and financing structures. This calls for monitoring and evaluation alongside implementation to support decision-making.

The impact of coronavirus disease 2019 pandemic on working dynamics of junior and middle grade doctors in the United Kingdom: Learning from their experience requires immediate improvement in health care planning and management-An outcome analysis of a nationwide survey.

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic had an unprecedented impact on health services across the world resulting in increased demand of intensive care capacity, opening Nightingale hospitals, and mass movement of doctors across various specialities. This unplanned redeployment raised concerns among various health care workers. The objective of the current study is to explore working dynamics and experience of junior and middle grade doctors during current pandemic. METHODS: We organised a nationwide cross-sectional survey of junior and middle grade doctors working in the United Kingdom. The survey was aimed to study their level of participation during coronavirus disease 2019 pandemic and its impact on their clinical practices and well-being. RESULTS: In total, 1564 completed questionnaires with representations from all regions of the United Kingdom were included. The mean age of respondents was 30.64 years (95% confidence interval +1.025; standard deviation = 9.9057). There were 51.5% females with significantly more participants from Black, Asian, and minority ethnic group (n = 835, p = 0.0073); 963 (61.6%, p ⩽ 0.0001) doctors were redeployed outside their primary speciality. The major redeployments were from other specialities to Intensive Therapy Units (41.8%, p ⩽ 0.001); 63.3% of respondents spend more than 8 weeks in redeployed speciality (p ⩽ 0.0001). There was a significant impact of coronavirus disease 2019 on personal, mental, and physical well-being of doctors. The major areas requiring immediate attention include proper leadership and clinical support (64.1%), pre-redeployment planning and induction (48.5%), redeployment according to the skills and/or in familiar specialities (44.6%), and regular mental and physical well-being checks (37%). CONCLUSION: The outcome of the survey concluded with four major recommendations, including the need to have a named supervisor for these doctors, structured induction program, regular well-being checks, and involving them in crisis planning. These recommendations will help to shape future health care policies and management particularly when it is related to redeployment of doctors during any crisis or pandemic.

[The Patient-Centered Emergency Plan - Practical Experiences]. / Der patientenzentrierte Notfallplan ­ Erfahrungen aus der Praxis.

The Patient-Centered Emergency Plan - Practical Experiences Abstract. Most people in Switzerland wish to die at home. This practical report shows how the cooperation of family physicians and a specialized palliative care team as well as the application of an emergency plan individually adapted to the general goal of care and the basic illness of the patient can support the realization of this wish. Good coordination of advance care planning through an individualized patient-centered emergency plan as well as the joint implementation of this care by the interdisciplinary, multiprofessional treatment team and the organization of a good care network are essential components to avoid unwanted emergency hospitalizations at the end of life.

[The effect of education level on intensity of using medical care by women of reproductive age].

The education is often considered as one of the basic social determinants of population health, but its impact on the need for medical care is to be studied. The purpose of the study is to analyze effect of education as health social determinant on intensity of medical care consumption by women of reproductive age. The sampling consisted of 566 non-pregnant women aged 18-49 years residing in Samara and being monitored in municipal antenatal clinics. The level of territorial accessibility of medical care for all women participating in the study did not differ reliably. The data was obtained using anonymous survey with adapted questionnaire "Research of social determinants of health". The first comparison group included 306 women with higher or incomplete higher education (high educational status). The second comparison group included 260 women with secondary or specialized secondary education (lower educational status). Each of the groups was divided into four subgroups based on age characteristic (18-25, 26-34, 35-42, 43-49 years). In the group of women with a high educational status, volume of consumption of out-patient medical care were higher and decreasing of health self-rating was accompanied by decreased rate of visits to ambulatory physicians (r = -0.67). Whereas in women with low educational status, decreasing of health self-rating is accompanied by decreased rates of visits to ambulatory physicians (r=0.5). With age increased, volume of out-patient medical care consumption in group of women with high educational status increases, while in group of women with low educational status this volume decreases. The lower rate of out-patient medical care consumption results in increasing of volume of in-patient medical care consumption in the group of women with low educational status. Despite the same increasing dynamics of volume of consumption of in-patient medical care in women with different educational statuses, gain rate of demand is significantly higher in group of women with low educational status (1.42% versus 2.54% of annual gain in consumption). More significant increase in consumption of emergency medical care was observed in group of women with low educational status (annual increase 3% versus 0.22%).

Changes in Care Provision During COVID-19 Impact Patient Well-Being.

The fast onset and extensive impact of COVID-19 necessitated strict public health measures and temporary diversion of personnel and resources from other types of medical care. This study examined the prevalence of such disruptions and their impacts on patient-perceived well-being using an untargeted survey. The majority of surveyed patients experienced changes in their routine medical care. Of those whose appointments were postponed or canceled, most patients indicated an overall negative impact on their emotional and physical well-being. We highlighted the impact of disruptions in nonurgent medical care during a large-scale public health emergency.

Exploring the status of and demand for palliative day-care clinics and day hospices in Germany: a protocol for a mixed-methods study.

BACKGROUND: To date, the establishment and development of palliative day-care clinics and day hospices in Germany have been completely unsystematic. Research is needed to gain insight into these services and to ensure their accessibility and quality. Accordingly, the ABPATITE research project aims at: (1) identifying the characteristics of palliative day-care clinics and day hospices in Germany, (2) determining demand and preferences for these services, and (3) proposing recommendations (with expert agreement) for the needs-based establishment and development of these services. METHODS: The research is a multi-perspective, prospective, observational study following a mixed-methods approach across three study phases. In phase 1a, qualitative expert interviews will be conducted to capture the facility-related characteristics of palliative day-care clinics and day hospices in Germany; the results will feed into a questionnaire sent to all such institutions identified nationwide. In phase 1b, a questionnaire will be sent to local statutory health insurance providers, to gain insight into their contracts and accounting and remuneration models. In phase 2a, a service preference survey will be conducted with patients and family caregivers. In phase 2b, semi-structured interviews with management staff will explore the factors that promote and hinder the provision of service. In phase 2c, the external perspective will be surveyed via focus groups with local actors involved in hospice and palliative care. In phase 3a, focus groups with representatives from relevant areas will be conducted to develop recommendations. Finally, in phase 3b, recommendations will be agreed upon through a Delphi survey. DISCUSSION: The empirically developed recommendations should enable the establishment and development of day hospices and palliative day-care clinics in Germany to be better managed, more oriented to actual demand, and more effectively integrated into wider health care services. Importantly, the findings are expected to optimize the overall development of hospice and palliative care services. TRIAL REGISTRATION: The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00021446; date of registration: April 20, 2020). The study is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.

Stroke admission rates before, during and after the first phase of the COVID-19 pandemic.

BACKGROUND: There was a significant decrease in stroke admissions during the first phase of the COVID-19 pandemic. There are concerns that stroke patients have not sought medical attention and in the months after the lockdown suffer recurrent severe strokes. The aims of this study were to investigate how stroke admission rates and distributions of severity varied before, during and after the lockdown in a representative Norwegian hospital population. METHODS: All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke from January to September 2020 were identified by hospital chart review. RESULTS: We observed a transient decrease in weekly stroke admissions during lockdown from an average of 21.4 (SD 4.7) before to 15.0 (SD 4.2) during and 17.2 (SD 3.3) after (p < 0.011). The proportion of mild ischemic and haemorrhagic strokes was also lower during lockdown with 66% before, 57% during and 68% after (p = 0.011). CONCLUSION: The period of COVID-19 lockdown was associated with a temporary reduction in total admissions of strokes. In particular, there were fewer with TIA and mild stroke. Given the need to prevent the worsening of symptoms and risk of recurrence, it is necessary to emphasise the importance to seek medical care even in states of emergency.