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ورود به زیرشاخهنقشه موضوعی
جستوجوی دقیقمدیریت و آموزش پزشکی
مدیریت خدمات، آموزش علوم پزشکی و کیفیت مراقبت
زیرشاخهها
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مدیریت بیمارستان
مقالهها، منابع و پژوهشهای تازه حوزه مدیریت بیمارستان
ورود به زیرشاخهکیفیت و ایمنی بیمار
مقالهها، منابع و پژوهشهای تازه حوزه کیفیت و ایمنی بیمار
ورود به زیرشاخهآموزش پزشکی
مقالهها، منابع و پژوهشهای تازه حوزه آموزش پزشکی
ورود به زیرشاخهبرنامهریزی درسی علوم پزشکی
مقالهها، منابع و پژوهشهای تازه حوزه برنامهریزی درسی علوم پزشکی
ورود به زیرشاخهاخلاق پزشکی
مقالهها، منابع و پژوهشهای تازه حوزه اخلاق پزشکی
ورود به زیرشاخهحقوق سلامت
مقالهها، منابع و پژوهشهای تازه حوزه حقوق سلامت
ورود به زیرشاخهتازهترین رکوردها
شواهد مدیریت و آموزش پزشکی
PubMed2027
Extraperitoneal Single-Port Robotic-Assisted Radical Cystectomy with Orthotopic Ne-obladder: Technique and Surgical Considerations.
INTRODUCTION: Radical cystectomy (RC) is the standard therapy for muscle-invasive bladder cancer (MIBC) and refractory high-risk non-muscle-invasive bladder cancer (1-3). Single-port robot-assisted radical cystectomy (RARC) offers notable minimally invasive advantages (4-6), whereas conventional transperitoneal approaches are associated with intestinal and gastrointestinal complications (7). This study evaluated an optimized extraperitoneal single-port RARC with orthotopic neobladder reconstruction for improved surgical safety and clinical outcomes. MATERIALS AND METHODS: A 57-year-old male presented with three months of intermittent painless gross hematuria. Pelvic CT revealed a bladder mass. Preoperative biopsy confirmed high-grade urothelial carcinoma with muscularis propria invasion, and the patient received gemcitabine-cisplatin neoadjuvant chemotherapy before radical surgery. Preoperative MRI identified a 3.2×2.9×2.6 cm bladder lesion without extravesical invasion or lymphadenopathy. During the procedure, the patient was placed in a supine position with buttocks elevated. A 5-cm infraumbilical single incision was made for da Vinci Xi-assisted extraperitoneal RARC, and a single-port multichannel device was deployed through the incision. Robotic instruments including a 30° endoscope, monopolar scissors, bipolar forceps, and a robotic stapler were arranged in a chopstick configuration. Via the extraperitoneal approach, we mobilized the bilateral ureters, bilateral vas deferens, and umbilical artery, dissected the bladder lateral ligaments with vascular ligation, and established a sufficient extraperitoneal working space. Bladder and prostate dissection was performed along the perivesical avascular plane, with careful protection and precise hemostasis of the dorsal venous complex. Standard pelvic lymphadenectomy was concurrently conducted during radical resection of the bladder and prostate (8). A segment of ileum was then harvested to construct an orthotopic neobladder (9), followed by anastomosis with the bilateral ureters and urethral stump. RESULTS: Operative time was 400 minutes with 200 mL blood loss and no transfusion. No perioperative complications occurred, and the patient was discharged on postoperative day 6. Pathological diagnosis was pT2aN0M0 with negative surgical margins and negative lymph nodes. The 12-month follow-up showed no tumor recurrence, normal renal function, complete daytime continence, and mild nocturnal incontinence requiring one nightly pad. CONCLUSIONS: Extraperitoneal single-port RARC with orthotopic neobladder reconstruction is a feasible minimally invasive procedure for MIBC. The optimized infraumbilical single-incision technique preserves peritoneal integrity and avoids intestinal mobilization, effectively reducing abdominal complications. It achieves reliable oncological results and improves patients' postoperative continence and quality of life.
PubMed2027
Robot-Assisted Partial Nephrectomy in a High-Complexity Renal Tumor in a Horseshoe Kidney.
INTRODUCTION: Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION: A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION: In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
PubMed2026
[THE ECONOMIC VIEW UPON MEDICAL CARE SUPPORT OF PATIENTS UNDER MYOCARDIUM INFARCTION IN MEDICAL ORGANIZATIONS OF VARIOUS LEVEL].
The diseases of circulatory system represent one of the main problems of the population health due to corresponding high morbidity and mortality and load on health care. The purpose of the study is to evaluate direct and indirect costs of medical care under acute coronary syndrome depending on level of medical organization. The study used content-analysis, statistical and analytical methods scientific publications on the research topic, copying of data from the medical documentation of the Vologda Regional Clinical Hospital for the period 2012-2021. The significant number of publications confirm that diseases of circulatory system develop due to multitude of risk factors. Also economic and medical effectiveness of timely applied medical care of diseases of the circulatory system is proved. It is demonstrated that medical care and cardiac rehabilitation under acute coronary syndrome are the most resource-wasteful types of medical care, while prevention of development of disease allows to save human, material and financial resources. In the medium perspective, economic damage under the worst scenario of development of disease when disability is set in makes up to about 400.000 rubles and in case of death of patient, more than five million rubles. Under acute coronary syndrome, medical, social and economic efficiency of emergency medical care is higher in medical organizations of the 3rd level. However, it is more economically advantageous to implement preventive measures.
PubMed2026
[THE SECONDARY MEDICAL EDUCATION IN RUSSIA: CHALLENGES OF PRACTICAL TRAINING AND STRATEGIES ENHANCING COMPETITIVE ABILITIES OF GRADUATES AT LABOR MARKET].
The article analyzes current state of system of secondary vocational medical education in Russia. On the basis of data from government agencies and professional associations key issues are considered: record-breaking outflow of young professionals from industry, irregularity of practical training and low efficiency of existing mechanisms of employment. The particular attention is paid to strategies of increasing competitiveness of graduates, including implementation of tutorship, development of regional educational clusters and elaboration of system of medical training.
PubMed2026
[THE TRADITIONAL AND COMPLEMENTARY MEDICINE IN THE PUBLIC HEALTH SYSTEM OF THE RUSSIAN FEDERATION: ANALYSIS OF EVIDENCE BASE AND LEGAL ASPECTS OF INTEGRATION].
The article considers placement of methods of traditional and complementary medicine in the public health system of the Russian Federation, focusing on prevention and management of chronic non-communicable diseases. The analysis of the evidence base on key methods of traditional and complementary medicine (acupuncture, phytotherapy, homeopathy, manual therapy, osteopathy) was carried out, including differentiated estimate of level of evidence for forms of homeopathy based on the latest systematic review of meta-analyses. The legal framework of its application in Russia are explored. The corresponding collisions and barriers are identified. The following proposals concerning integrative health care model are formulated: differentiated register of methods, clinical guidelines, pilot integration into compulsory health insurance system and enhancement of research.
PubMed2026
Factors Influencing Medication Safety Competence of Nurses According to Clinical Career Stage: A Cross-Sectional Survey.
Medication errors pose a serious threat to patient safety, causing preventable harm and increasing healthcare costs. Nurses' competence in medication safety is critical and develops with clinical experience. This study aimed to identify factors influencing medication safety competence across different clinical career stages, focusing on nursing organizational culture, communication competence, and patient safety culture. A survey was conducted from December 2021 to February 2022 among 757 nurses, categorized as novice, advanced novice, competent, or proficient. Communication competence and patient safety culture consistently emerged as significant predictors of medication safety competence across all career stages. Nursing organizational culture showed differential effects: relationship- and innovation-oriented cultures were significant predictors in the novice group, while a hierarchy-oriented culture was a significant predictor in the competent group. The regression models explained 30.8%-41.4% of the variance. Findings suggest that interventions to enhance medication safety competence should be tailored to nurses' career stages, incorporating relevant cultural and communication factors. Moreover, healthcare organizations should consider nurse-specific organizational culture profiles while designing training programs and selecting preceptors to optimize medication safety outcomes.
PubMed2026
Key Strategies for Improving Psychiatric Home-Based Care in Spain: A Modified Delphi Study.
AIMS: This study aimed to identify and prioritize key strategies for improving a psychiatric home-based care programme, the Crisis Resolution and Home Treatment (CRHT) intervention in Catalonia, Spain. The objective was to incorporate the perspectives of service users, family caregivers and healthcare professionals to guide quality improvement efforts. METHODS: A modified Delphi method was used to reach consensus among stakeholders previously involved in a qualitative evaluation of the CRHT programme. The expert panel included 130 participants: 31 CRHT service users/caregivers and 99 healthcare professionals. Over three rounds of online surveys, participants rated 18 pre-identified improvement strategies across three dimensions: problem significance, change agency and feasibility of change. Service users and caregivers assessed only problem significance. Open-ended responses were also collected and analysed. FINDINGS: Consensus was reached in the third round, with five strategies prioritized: (1) training on CRHT referral and eligibility criteria, (2) standardized discharge and continuity of care protocols, (3) feedback loop between CRHT and referring professionals, (4) scheduling and communication of visiting hours, and (5) available updates for CRHT slots. These areas were rated highest in terms of feasibility and change agency, though not necessarily in problem significance. Notably, the same individuals who participated in the initial qualitative phase contributed to the prioritization process, ensuring continuity and relevance in stakeholder input. CONCLUSION: The study demonstrates the value of collaborative, consensus-based approaches to quality improvement in mental health care. Prioritized strategies reflect feasible and actionable areas for enhancing CRHT services. Involving service users, caregivers and professionals in both evaluation and decision-making processes strengthens the relevance, person-centredness and effectiveness of care. Implementation of these strategies is underway, with further improvements planned based on stakeholder feedback and continuous assessment.
PubMed2026
'HOPtimise' Logic Model: An Organisational Innovation to Improve Nursing Practices in Paediatric Oncology in Québec.
INTRODUCTION: HOPtimise is an organisational innovation in paediatric oncology in the province of Québec (Canada) destined to improve and reinforce best nursing practices through digital training using a serious game and create dashboards focused on indicators sensitive to the quality of care. This complex intervention is led by a quality improvement committee, a joint committee of user partners (former patients and family members) and healthcare providers. The present study aims to demonstrate how innovation and training are co-created with multiple stakeholders. The involvement of patients and their families is at the core of the innovation's design. The aim of this study was to create and elaborate on the components of the logic model of the innovation in order to make it easily understandable for any stakeholder, to set the central roles and activities of the innovative process and to be able to verify the progress of the elaboration and the implementation of the innovation afterwards. The study also intended to generate guidance for future complex interventions in nursing practice improvement. DESIGN: This study has a qualitative, descriptive and participatory design with a mixed data collection destined to create the logic model of the innovation. The qualitative methods used are organised through a three-step timeline: the elaboration of the logic model, the verification phase and validation. Data collection methods involved two focus groups, each one at a different phase of the process (n = 9 and n = 6), semi-structured interviews (n = 4) and verification checklists (n = 9) conducted from June 2022 to June 2024. Data collection guides are based on the Porteus (2009) method for the elaboration of a logic model. Through the process, n = 15 participants took part in at least one data collection (either focus group or interviews). RESULTS: With a 2-year and n = 15 multistakeholder study, the team obtained a logic model of organisational innovation. The HOPtimise logic model is a necessary tool to communicate with all stakeholders from various backgrounds. The study shows that the logic model was clear enough to all the participants (n = 15). As a result, this logic model is a strong base to stabilise the roles and activities of those stakeholders in the elaboration and implementation of the innovation. Indeed, it allowed the building of a stable quality improvement committee. Finally, the logic model became a baseline for the process of identifying barriers and implementation strategies. CONCLUSIONS: The HOPtimise logic model is representative of the complexity of the organisational innovation and the organisational challenges that the project will encounter, and is a necessary tool for evaluation of its implementation in terms of its co-constructive nature. PATIENT AND PUBLIC CONTRIBUTION: This study is a co-creation and is family-centred. It involved the engagement and participation of user partners and organisational members. The research team interacted with them during the three steps of the elaboration of the logic model. They provided opinion and expertise on the content of the innovation, its components, the activities needed to reach the outcomes and implementation strategies.
PubMed2026
A Retrospective Evaluation of a Pharmacist-Driven Urgent Care Microbiology Review Program.
BACKGROUND: Pharmacist-driven microbiology review programs have been thoroughly described in the emergency department setting. However, there is limited evidence for programs in outpatient settings, especially for urgent care settings. The purpose of this study is to evaluate a pharmacist-driven urgent care microbiology review program to determine the impact of its implementation. METHODS: This retrospective cohort study evaluated urgent care patients who did not receive appropriate treatment based on urine, wound, or respiratory culture, or select sexually transmitted infection testing. A pharmacist-driven microbiology review program at two urgent cares was compared to 11 other urgent cares using only physician/advanced practice provider (APP) review of microbiology results. The primary end point was the time to appropriate treatment in hours from finalized result to prescription of appropriate treatment. Secondary end points included time to appropriate treatment in calendar days and unplanned 30-day revisit rate. RESULTS: A total of 400 patients were included in this study (pharmacist-driven, n = 200; physician/APP, n = 200). Time to appropriate treatment in hours was 11 h in the pharmacist-driven cohort and 13 h in the physician/APP cohort (p = 0.047). Unplanned 30-day revisit rate was similar between the two groups (pharmacist-driven 14% versus physician/APP 12.5%, p = 0.658). CONCLUSION: A pharmacist-driven urgent care microbiology review program achieved a similar time to appropriate antimicrobial treatment compared with a physician/APP process while maintaining comparable clinical outcomes.
PubMed2026
A systematic approach to management of abdominal pain in preverbal and nonverbal children in the emergency department.
Abdominal pain is a common reason for pediatric patients to present to the emergency department. Pain assessment is especially challenging when patients are unable to communicate due to their developmental stage or medical conditions. Preverbal and nonverbal children are at increased risk for complications of delayed or missed diagnosis. Inadequate pain control is also a concern in this vulnerable population. This review provides guidance for assessment of abdominal pain in preverbal and nonverbal children, focusing on behavioral measures, which are more applicable and reliable in these patients, and on the effective use of parental input. Recommendations are given for a graduated approach to pain management, including nonpharmacologic and pharmacologic options.
PubMed2026
An Evaluation of AI-Generated Clinical Notes in the OpenNotes Era: A Thematic Analysis of Clinician Discourse.
BACKGROUND: The integration of ambient artificial intelligence (AI) scribes into the OpenNotes environment presents a profound governance crisis in healthcare. While patient access to medical records was designed as a transparency reform, the introduction of machine-generated text introduces novel vulnerabilities regarding record integrity, liability, and patients' trust. OBJECTIVE: This study investigates how clinicians discursively negotiate the systemic risks and accountability challenges of patient-facing, AI-assisted documentation. METHODS: Employing a netnographically informed qualitative design, the research conducted a reflexive thematic analysis of 484 relevant comments across 120 threads from eight clinician-oriented subreddits spanning October 2020 to February 2026. RESULTS: The analysis revealed five distinct governance challenges. First, an accountability vacuum exists where the mandatory clinician signature functions merely as a legal shock absorber for institutional AI liability. Second, clinicians frame AI hallucinations as a mathematically inevitable epistemic risk rather than a correctable technical bug. Third, a "dual-audience" problem emerges, as algorithmic optimization compromises both the individual clinical voice needed for peer communication and the empathetic clarity required for patient readers. Fourth, existing privacy frameworks are structurally inadequate to manage commercial data extraction during patient encounters. Finally, institutional productivity demands and AI-driven over-documentation severely threaten the fiscal credibility of the medical record through inadvertent upcoding. CONCLUSIONS: The prevailing regulatory assumption-that a physician's digital signature combined with passive patient visibility guarantees documentation accountability-is a fragile fiction. To protect clinical truth, health systems must transition from models of passive disclosure toward contingent transparency. This requires establishing authoritative, enforceable mechanisms for provenance tracking, error contestation, and vendor accountability.
PubMed2026
Caregiver and Care Recipient Perspectives on Paediatric ED Mental Health Presentations: A Qualitative Study.
OBJECTIVE: To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. METHODS: Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. RESULTS: A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. CONCLUSIONS: Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.
PubMed2026
Cross-Cultural Adaptation and Psychometric Validation of the Hospital Survey on Patient Safety Culture Version 2 (HSOPSv2) in Spanish Hospitals.
INTRODUCTION: Patient safety culture is a key component of healthcare quality. The Hospital Survey on Patient Safety Culture (HSOPS), developed by AHRQ in 2004, has been widely used internationally to assess healthcare professionals' perceptions of safety. In 2019, version 2 (HSOPSv2) was released, with improvements in structure and item clarity. Although a Spanish version for North America exists, it has not yet been validated in the Spanish hospital context. OBJECTIVES: To adapt and validate HSOPSv2 for the Spanish hospital context, ensuring its cultural, linguistic, and psychometric equivalence with the original version, and to assess its suitability for use in Spanish hospitals. METHODS: A cross-cultural adaptation process was conducted, including translation, back-translation, and expert consensus, followed by a cognitive pretest with 20 healthcare professionals. A pilot study was then carried out in four hospitals in Murcia and Alicante, with 369 participants. Internal consistency (Cronbach's α and composite reliability), convergent validity (AVE, factor loadings), and discriminant validity (Fornell-Larcker criterion and HTMT) were assessed through confirmatory factor analysis using the WLSMV estimator. RESULTS: The 10-factor model showed satisfactory fit indices (CFI and TLI > 0.90; RMSEA < 0.06; SRMR < 0.08). Most dimensions presented acceptable reliability (α and CR > 0.70), except for "Staffing and Work Pace" and "Handoffs and Information Exchange." Convergent validity was adequate in seven of the ten dimensions (AVE ≥ 0.50), with some weaker loadings in negatively worded items. The Fornell-Larcker criterion indicated overlap in some communication-related constructs, although HTMT results supported overall discriminant validity. CONCLUSIONS: The Spanish version of HSOPSv2 shows satisfactory psychometric properties, comparable to other international adaptations. Its availability provides Spanish hospitals with a robust tool to assess patient safety culture, identify areas for improvement, and design interventions aimed at reducing adverse events and strengthening patient safety.
PubMed2026
Emergency department management of postthrombolysis intracranial hemorrhage.
Intracranial hemorrhage following intravenous thrombolytic therapy most commonly occurs within 12 hours of administration. Because many patients remain in the emergency department during this period, a structured, time-sensitive approach to recognition and management is critical. This review summarizes current recommendations for the diagnostic workup, use of reversal agents, and escalation of care for postthrombolysis intracranial hemorrhage, with particular attention to guidelines addressing stroke and neurocritical care management. Contraindications to intravenous thrombolysis and risk factors for postthrombolysis intracranial hemorrhage are also discussed.
PubMed2026
Epidemiology of Patients With Chronic Liver Disease Presenting to Emergency Departments in Australia.
OBJECTIVE: To describe the epidemiology, healthcare utilisation and outcomes of patients presenting to emergency departments (EDs) with chronic liver disease (CLD) in Queensland, Australia. METHODS: This statewide data linkage study included adult patients with CLD-related diagnoses across 104 Queensland Health EDs between 1 January 2016 and 31 August 2023. Emergency, inpatient and mortality data were linked. Patients were stratified by cirrhosis status and decompensation. Outcome was 30-day mortality. Poisson regression assessed trends, and Cox regression evaluated mortality. RESULTS: Amongst 15,999,186 ED presentations, 23,578 (0.15%) were related to CLD, involving 11,961 patients. Presentations increased by 2% annually (IRR 1.02, 95% CI 1.02-1.03). Cirrhosis accounted for 18,735 presentations (79.5%). Overall, 20,312 presentations (86.1%) resulted in hospital admission, 918 (4.5%) were admitted to intensive care units (ICU), and 963 (4.1%) resulted in in-hospital death. Amongst patients with cirrhosis, 16,968 (90.6%) resulted in admission, 867 (5.1%) were admitted to ICU and 899 (4.8%) died in hospital. Predictors of 30-day mortality included cirrhosis (adjusted hazard ratio (aHR) 6.92, 95% CI 5.36-8.94), malignancy (aHR 3.21, 95% CI 2.90-3.55), hepatorenal syndrome (aHR 3.15, 95% CI 2.72-3.66), encephalopathy (aHR 2.03, 95% CI 1.78-2.32) and spontaneous bacterial peritonitis (aHR 1.47, 95% CI 1.20-1.80). Presentation to tertiary hospitals was associated with lower mortality (aHR 0.75, 95% CI 0.68-0.82). CONCLUSIONS: CLD-related ED presentations are increasing and place substantial demand on hospital services in Queensland. Decompensation events strongly predict mortality and healthcare utilisation. ED-initiated risk stratification and coordinated care models to improve outcomes for patients with cirrhosis require development and evaluation.
PubMed2026
Experiences and Perceptions of Patient Watch, a Rural Telehealth Case Management Model, for Frequent Presenters to the Emergency Department: A Longitudinal Mixed Methods Study.
OBJECTIVE: To evaluate: (1) patient experiences and perceptions of Patient Watch; and (2) the effect on emergency department (ED) presentations, healthcare use, quality of life and chronic illness care. DESIGN: A prospective longitudinal cohort study using a convergent-parallel mixed methods study design combining: (1) qualitative semi-structured interviews analysed using reflexive thematic analysis and (2) quantitative assessment of Quality of Life-8D, Patient Assessment of Chronic Illness, routinely collected ED clinical data and Patient Watch programme data. SETTING: A large public health service delivering care across the home, community, aged care and hospital, serving a regional centre and small, medium and large rural towns in Western Victoria, Australia. PARTICIPANTS: Forty-five participants were enrolled in the study. A subsample who completed all study requirements enabled baseline and 6-month follow-up analysis (n = 37). INTERVENTION: Patient Watch, a telehealth case management model of care adapted from a metropolitan to a rural context, to manage the care of frequent presenters to the emergency department. RESULTS: Before enrolment, patients reported health system, medical and situational complexity hindered effective care and contributed to high treatment burden, with acute exacerbations leading to increased healthcare use and negative care experiences. Patient Watch improved perceived care coordination, healthcare access and helped participants manage acute exacerbations. ED presentations (p < 0.001), hospital admissions (p < 0.001), general practitioner (p = 0.02) and specialist visits (p = 0.01) decreased at follow-up. CONCLUSIONS: Cohort heterogeneity challenged the effectiveness of a standardised care model, and the evolving nature of Patient Watch complicated impact evaluation. Frequent presenters showed diverse clinical and demographic profiles with high treatment burdens, highlighting the need for tailored care.
PubMed2026
Improving Resident Knowledge of Artificial Intelligence Ethics and Prompting for Clinical Use.
BACKGROUND: The rapid introduction of AI into clinical practice shifts how we must teach resident trainees so they may become ethical patient-facing clinicians in an AI-integrated healthcare system. Currently, few published innovations assess outcomes beyond learner attitudes. We developed a pilot curricular innovation to equip postgraduate Internal Medicine resident trainees with the attitudes and knowledge needed to responsibly integrate AI tools into patient care decisions. APPROACH: In the 2025-2026 academic year, we piloted a curricular innovation to teach resident physicians the basics of prompting strategies for AI-assisted clinical reasoning, ethical AI use and legal considerations. The innovation consisted of an initial didactic followed by a hands-on, interactive session integrating AI prompts and outputs into clinical vignettes, thereby leveraging near-peer teaching and situated learning to achieve session objectives. EVALUATION: We assessed perceived knowledge and knowledge using a pre-post intervention strategy using the Wilcoxon Rank-Sum test. Fifty-nine/96 (61.5%) and 52/96 (54.2%) of residents participated in the presession and post-session survey, respectively. Perceived knowledge increased significantly across all five learning objectives with a moderate to large effect size. Fifty-one residents participated in the pre- and post-session knowledge test. The median pre-session score was 6/8 (interquartile range [IQR] 4-8), and the median post-session score was 7/8 (IQR: 5-8); p < 0.001, with a moderate effect size = 0.33. IMPLICATIONS: A combined didactic and small-group interaction session improved residents' perceived understanding and knowledge of ethical and legal considerations related to clinical AI use. Future work developing clinical assessments of trainee skills using AI tools is needed.
PubMed2026
Informed Consent in Orthopaedic Surgery: When a Signature Does Not Mean Understanding: A Prospective Study of 750 Patients Comparing Elective and Trauma Settings.
BACKGROUND: Informed consent is a cornerstone of modern medicine, yet the extent to which patients truly understand surgical information in the perioperative setting remains uncertain, particularly among older and vulnerable populations. Orthopaedic surgery represents a particularly challenging context, as trauma pathways are often characterized by urgency, pain, and emotional stress, whereas elective procedures allow greater opportunity for structured communication. AIMS: To assess real-time patient comprehension of surgical informed consent immediately before orthopaedic surgery and to compare understanding between elective and trauma pathways. METHODS: We conducted a prospective observational study at a single tertiary referral hospital in Northern Italy between January 2023 and December 2024. Approximately 870 adult orthopaedic surgical patients were screened for eligibility. After exclusion of patients with cognitive impairment, severe psychiatric illness, language barriers, refusal to participate, or incomplete questionnaires, 750 consecutive patients were included in the final analysis (460 elective, 290 trauma). All patients had received standard preoperative explanations and completed institutional informed consent procedures. In routine clinical practice, consent discussions generally involved both an orthopaedic resident and the supervising attending surgeon. Comprehension was assessed immediately before transfer to the operating room using a brief standardized four-item tool evaluating understanding of the planned procedure, risks, benefits, and therapeutic alternatives. Responses were independently categorized as absent, vague/partial, or adequate. RESULTS: Overall, 488 patients (65.1%) demonstrated absent comprehension, 188 (25.1%) vague or partial comprehension, and only 74 (9.9%) adequate comprehension. Trauma patients showed significantly lower overall comprehension than elective patients, with fewer patients demonstrating at least partial comprehension (28.3% vs. 39.1%; p = 0.003). Adequate comprehension remained low in both groups (8.3% vs. 10.9%; p = 0.30). Older age and lower educational attainment were associated with poorer comprehension in exploratory analyses. Mean questionnaire completion time was 3.5 ± 1.2 min. DISCUSSION: Despite repeated explanations and signed consent forms, most patients entered the operating room without meaningful understanding of the planned procedure, risks, benefits, or alternatives. The observed deficit was present in both elective and trauma settings, suggesting a systemic limitation of routine consent processes rather than solely a physician-specific communication issue. CONCLUSIONS: Informed consent in orthopaedic surgery frequently fails to ensure patient comprehension. Consent should be reframed as a dynamic verification process rather than a purely administrative requirement, incorporating structured communication pathways, simplified language, and teach-back-based strategies tailored to both elective and trauma settings.
PubMed2026
Initial Laryngoscope Blade Selection and Outcomes in Paediatric Emergency Department Intubations: Miller vs. Macintosh.
BACKGROUND: Optimal initial laryngoscope blade selection for paediatric emergency intubation is uncertain. We examined whether Miller or Macintosh blades are associated with differences in first-pass success (FPS) and adverse events in children < 5 years. METHODS: Prospectively collected data from the Australia and New Zealand ED Airway Registry (ANZEDAR) between March 2010 and March 2024 were analysed for children under 5 years of age. We report demographics, FPS and adverse events by initial blade type. Multivariable models examined factors associated with FPS and hypoxia. RESULTS: Among 201 children, 88 (43.8%) were intubated with a Miller blade and 113 (56.2%) with a Macintosh blade. In unadjusted analyses, children intubated with Miller blades were younger (median 0.4 years, IQR 0.08-1.35 vs. median 1.6 years, IQR 0.75-2.00), p < 0.001), had lower FPS (63.6% vs. 80.5%; OR 0.42, 95% CI 0.22-0.80; p = 0.008) and had a higher incidence of hypoxia (33.0% vs. 17.7%; OR 2.28, 95% CI 1.19-4.46; p = 0.01) compared with children intubated with Macintosh blades. Hypotension rates did not differ. CONCLUSION: In this cohort of young children intubated in the ED, Macintosh blade use was associated with higher FPS and fewer hypoxic events compared with Miller blade. Age was a significant confounder and should be considered when choosing which laryngoscope blade to use in young children.
PubMed2026
Integrated Team-Based Learning in a UK Undergraduate Medical Programme.
BACKGROUND: There is limited published evidence supporting integrated team-based learning (TBL) as an effective method for teaching undergraduate medical students. This study describes student and staff perceptions, assessment outcomes and financial factors after integrated TBL was implemented into Year 1 of a large UK undergraduate medical programme. METHODS: Five methods of data collection were used. An online survey was distributed to students, focus groups held with academic and technical staff, observation of teaching sessions, analysis of student assessment data and calculation of expenses for TBL delivery. Quantitative data were summarised narratively; qualitative survey data were analysed using conceptual content analysis; focus group data were analysed using inductive thematic analysis; and expenses data were summarised narratively and compared with problem-based learning (PBL). RESULTS: A total of 449 participants were involved in this study. Students and staff had overall positive perceptions of TBL, highlighting the engaging and consistent teaching and learning approach, effective teamworking and real-world applicability of the weekly themes. Limitations raised were focused on logistical issues such as using new technology and session timing. Compared with previous cohorts taught through PBL, assessment analysis found mixed results by assessment type. Finally, TBL was found to be more financially viable than PBL through reduced staff time requirements despite initial cost outlays. CONCLUSION: TBL represents a potentially effective and efficient method for teaching undergraduate medical students on a large scale and should be considered by other medical programmes where increasing student numbers may affect the quality of PBL teaching.
PubMed2026
Integrating Spiritual Care Teaching Within the Australian Medical Curriculum.
BACKGROUND: Spiritual care has been shown to be an important component of holistic patient care. However, students have reported it missing from current Australian medical school curricula. The aim of this study was to evaluate the impact of a three-hour spiritual care workshop designed to enable final year medical students to take a spiritual history from their patients. METHODS: We used a prospective pilot study design to evaluate a novel half-day workshop designed to equip final year medical students to assess the spiritual wellbeing of their patients. The impact of the spiritual care workshop was evaluated using video analysis of a formative objective structured clinical examination (OSCE) of a spiritual consultation using a standardised patient prior to and after the teaching episode. Students self-assessed confidence scales pre- and post-workshop. Student characteristics that might facilitate learning in this domain were assessed. RESULTS: Thirty-two final year medical students from four universities participated at two training sites. Video analysis by four independent assessors showed satisfactory inter-rater reliability and demonstrated a statistically significant increase (p < 0.001) in the use of spirituality questions. The students' self-assessed confidence scales pre- and post-workshop demonstrated statistically significant increases in assessing all domains except empathic responsiveness; the greatest improvement was in the spiritual domain. CONCLUSION: Whilst this study was confined to medical students, we believe that the objective and subjective effectiveness demonstrated in this spiritual care workshop will be readily translatable into multidisciplinary holistic communication skills training.
PubMed2026
Key Performance Indicators for Clinical Pharmacy Practice and Administration in Inpatient/Acute Care Settings: An Opinion of the Clinical Administration Practice and Research Network of the American College of Clinical Pharmacy.
Key performance indicators (KPIs) are quantifiable measures that describe critical success factors of an organization. Their vital role in ensuring the delivery of quality health care services necessitates the development of KPIs relevant to inpatient clinical pharmacy practice. This opinion paper from the American College of Clinical Pharmacy (ACCP) Clinical Administration Practice and Research Network (CADM PRN) describes the rationale, methodology, and outcomes of a consensus process to identify a focused set of inpatient/acute care clinical pharmacy KPIs. Leveraging a modified Delphi approach, the CADM PRN convened an Expert Panel of clinical pharmacy leader members to build a consensus-driven set of KPIs reflecting clinical, operational, patient-centered, and financial contributions of clinical pharmacists in the inpatient/acute care setting. From a previous ACCP White Paper, a total of 15 KPIs were identified across four domains: (1) clinical practice and patient safety, (2) clinical outcomes and readmissions, (3) medication education and patient engagement, and (4) financial and operational value. The CADM PRN posits that the establishment and implementation of standardized KPIs are essential for measuring and demonstrating the value of clinical pharmacy services in modern health care, offers pragmatic, consensus-based KPIs for evaluating clinical pharmacy services supporting resource justification, and advancing the visibility and impact of pharmacists in acute care practice. As hospitals shift toward value-based care, robust KPI frameworks will be critical for optimizing patient outcomes, supporting financial sustainability, and justifying appropriate staffing. Future efforts should focus on pilot testing, addressing implementation barriers, and achieving broader acceptance for KPIs across the profession.
PubMed2026
Lived Experience Workforce Perspectives About the Consumers' Experiences of Safewards in Acute Inpatient Mental Health Units: A Qualitative Exploratory Study.
The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma-informed and recovery-oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.
PubMed2026
Management of Adult Closed Head Injury in Rural Queensland Without Hospital-Based CT: A Retrospective Cohort Study.
OBJECTIVE: To describe management, imaging pathways and systems challenges for adult closed head injury presentations to a rural Queensland emergency department without hospital-based CT. METHODS: A retrospective cohort study was conducted at Dalby Hospital from January 2022 to January 2023. Adult patients presenting with closed head injury were identified through manual Emergency Department Information System review. Demographic, clinical, imaging, disposition and documentation variables were extracted from medical records. CT access was categorised as local offsite private radiology or interhospital transfer. RESULTS: A total of 118 patients were included; 73/118 (61.9%) were male and mean age was 48.6 years. CT head was performed in 60/118 (50.8%) patients. Of these, 30/60 (50.0%) underwent CT through an offsite private radiology provider and 30/60 (50.0%) required interhospital transfer. Intracranial haemorrhage was identified in 9/60 (15.0%) imaged patients, comprising 7 subdural and 2 subarachnoid haemorrhages. Documentation of observation and discharge advice was variable. A planned period of observation was documented in 55/118 (46.6%) cases. Among patients discharged from the emergency department or short-stay unit, written patient information was documented in 36/72 (50.0%), red-flag discussion in 32/72 (44.4%), and no-driving advice in 5/72 (6.9%). CONCLUSION: Patients with closed head injury in this rural emergency department had substantial neuroimaging needs despite the absence of hospital-based CT. Imaging was obtained through either local offsite private radiology or interhospital transfer, requiring clinicians to consider both imaging need and pathway safety. Variable documentation of observation and discharge advice highlights an opportunity to strengthen safety-netting in rural head injury care.
PubMed2026
Medical Device Industry Payments to Healthcare Professionals in Japan: A Descriptive Analysis of Scale, Distribution, and Transparency Based on 2019 Disclosure Data.
BACKGROUND: Financial ties between healthcare professionals and the medical-device industry raise conflict-of-interest and transparency concerns; despite Japan's 2012 self-regulatory guidelines, device-related payments receive less scrutiny than pharmaceutical payments globally, including in Japan. OBJECTIVE: To provide the first detailed analysis of honoraria from medical device companies to Japanese physicians in 2019, offering a baseline before the COVID-19 pandemic. METHODS: We retrospectively examined 2019 payment data from the Yen for Docs database, compiled from disclosures by 118 companies affiliated with the Japan Medical Devices Network and other major firms. The analysis focused on honoraria-lecture, consulting, and writing fees-because these are the only categories disclosed with individual healthcare professionals names. Payments were standardized, cleaned, and aggregated at company and recipient levels. Descriptive analyses identified overall volume, company distribution, and top-earning specialties. RESULTS: In 2019, 66 companies disclosed 60,161 honorarium payments totaling USD 46.0 million. Most funds (66.7%) were lecture fees, followed by consulting (28.8%) and writing (4.5%). Payments were highly concentrated: the top 10 companies accounted for 63.3% of the total, led by Medtronic, Terumo, and Johnson & Johnson. Among 24,434 recipients, 66.1% received less than USD 1,000, while only seven physicians received more than USD 100,000. Cardiologists (48.0%) and cardiovascular surgeons (24.0%) dominated the top 50 earners. CONCLUSION: Honoraria from Japan's device industry were modest in scale compared with pharmaceutical companies but highly concentrated among a few firms and cardiovascular specialists. These findings highlight the need for more comprehensive and legally enforceable transparency frameworks to safeguard clinical integrity and public trust.
PubMed2026
Modernizing the Front Door to Care: Evaluation of Veterans Administration Health Connect's Impact on Access, Utilization, and Patient Experience.
OBJECTIVE: To evaluate whether centralized appointment scheduling and same-day virtual clinician evaluation improved appointment timeliness and follow-up after nurse triage. We also assessed whether these changes were associated with differences in downstream utilization, costs, reach, and Veteran experience. STUDY SETTING AND DESIGN: Retrospective quasi-experimental evaluation of Veteran Administration Health Connect (VAHC) modernization across 18 regions between October 1, 2018, and September 30, 2024. Staggered rollout enabled difference-in-differences and event-study analyses comparing outcomes before and after modernization. DATA SOURCES AND ANALYTIC SAMPLE: Data were drawn from the Veterans Administration Corporate Data Warehouse, Telecare Record Manager, and Customer Relationship Management platforms, and VSignals Veteran experience surveys. The analytic sample comprised 11,118,916 encounters (4,560,677 pre-modernization; 6,558,239 post-modernization). PRINCIPAL FINDINGS: Centralized scheduling was associated with modest and mixed improvements in appointment access. Same-day scheduling increased by 14.3 percentage points (95% CI, 10.1 to 18.5). Time from call to scheduled appointment decreased by 0.37 days (95% CI, -0.49 to -0.26), while time to completed appointment increased by 2.9 days (95% CI, 0.2 to 5.7). Following modernization, time from nurse triage to any subsequent care decreased by 0.28 days (95% CI, -0.45 to -0.11), and the proportion of callers receiving no follow-up care within 7 days declined by 2.3 points (95% CI, -4.0 to -0.5). Modernization was not associated with changes in the proportion of all emergency department (ED) visits preceded by a nurse triage call or in total ED visit volume. Seven-day ED visits, admissions, and total costs did not change meaningfully. Veteran satisfaction was high for post-modernization virtual encounters. CONCLUSIONS: VAHC modernization improved appointment access and follow-up after nurse triage but was not associated with short-term changes in ED use or costs, highlighting gains in navigation and experience without immediate shifts in downstream utilization.
PubMed2026
Music-Based Interventions in Clinical Pharmacy Practice: A Narrative Review of Mechanisms, Evidence, and a Framework for Integration.
Music-based interventions (MBIs) have emerged as a promising, nonpharmacologic approach to improving patient care across a variety of clinical settings. This narrative review examines the current evidence describing the mechanistic basis through which music engages biological pathways relevant to clinical pharmacy practice, and the clinical evidence supporting MBIs as adjuncts to pharmacotherapy across clinical outcomes. From this evidence, the review proposes a framework through which MBIs may be integrated into clinical practice that comprises: (1) patient selection, (2) MBI selection, and (3) outcome monitoring. The review does not constitute formal practice guidance, as pharmacy-specific clinical protocols and implementation models remain active areas of research. Additionally, the review synthesizes emerging evidence supporting MBIs as a clinical pharmacy workforce well-being strategy. Collectively, these findings highlight the potential for MBIs to serve as an innovative adjunct to traditional pharmacotherapy that aligns with the clinical pharmacist's existing responsibilities for medication optimization, deprescribing, and holistic, patient-centered care.
PubMed2026
Patient Expectations in High-Risk Abdominal Surgery for Cancer.
BACKGROUND: Despite the central role of expectations in informed consent and surgical shared decision-making, patient expectations frequently remain unelicited or underexplored and are often assumed rather than explicitly addressed. OBJECTIVE: To explore how patients form expectations about high-risk abdominal surgery for cancer and how preoperative expectations influence the experience of surgical recovery and life after surgery. DESIGN: Qualitative study using semi-structured interviews informed by cognitive task analysis and analysed using an abductive thematic framework. SETTING AND PARTICIPANTS: Adults (n = 34) at two U.S. academic hospitals who were either scheduled to undergo, or had recently undergone, high-risk abdominal surgery for cancer; interviews were conducted preoperatively (52.9%) and postoperatively (47.1%). RESULTS: Analysis of the interviews revealed three overarching themes characterising how patients formed, understood, and experienced expectations around high-risk cancer surgery. Theme 1: Origin of Expectations- Expectation development was dynamic, context-dependent, and shaped by multiple information sources. Theme 2: The Complexity of Expectations- Patients varied widely in how much they wanted to know; expectations were often internally inconsistent and frequently conflated with hopes. Theme 3: Contrasting Anticipated and Actual Recovery After Surgery- Postoperative experiences commonly diverged from preoperative expectations, and many patients expressed uncertainty regarding recovery and prognosis, even in medically uncomplicated recoveries. DISCUSSION: The wide variation and inconsistency in patient expectations reflect both the complexity of how patients prepare for high-risk abdominal cancer surgery and their need to navigate uncertainty in ways that align with their individual preferences, values, and tolerance for information. Mismatches between anticipated and actual postoperative experiences underscore the need for structured, patient-centred communication strategies that support realistic preparation for surgical recovery. CONCLUSION: This study provides insight into how patients with cancer form expectations regarding high-risk abdominal surgery and how these expectations shape preparation for the experience of surgical recovery. Expectations were often incomplete, internally inconsistent, and difficult for patients to articulate, contributing to gaps between anticipated and actual recovery. These findings highlight the need for intentional, patient-centred approaches to elicit, clarify, and better align patient and clinician expectations in surgical oncology. Future work should evaluate intervention strategies to support this goal. PATIENT OR PUBLIC CONTRIBUTION: Patients participated in in-depth interviews that form the basis of this study. Caregiver interviews were conducted in parallel as part of a related study but were not included in the present analysis. Patients and/or caregivers were not formally involved in the design of the study or in the analysis of the qualitative data.
PubMed2026
Pelvic Examination in Undergraduate Medical Education: A Scoping Review.
BACKGROUND: Pelvic examination is a core clinical skill in undergraduate medical education, requiring integration of technical competence with communication, consent and patient-centred care. Despite its importance, opportunities to learn pelvic examination are variable, and educational approaches differ widely. Existing reviews have largely focused on short-term learner outcomes rather than broader questions of implementation, cultural context and patient impact. This review aimed to map teaching methods used to teach pelvic examination, examine how effectiveness is defined and evaluated, and identify reported barriers and enablers to implementation. METHOD: A scoping review was conducted in accordance with Arksey and O'Malley's framework and prospectively registered with Open Science Framework. Database searches were undertaken in June 2024 and repeated in May 2026. Studies describing pelvic examination teaching for undergraduate medical students were included. Data were extracted and analysed using inductive qualitative content analysis. Outcomes were mapped to the Kirkpatrick model to enable comparison. FINDINGS: Fifty-five studies were included. Teaching approaches were grouped into received knowledge (e.g., lectures, videos and e-learning) and experiential approaches (e.g., models, professional patients and clinical encounters). Most studies combined multiple modalities. Evaluation predominantly focused on learner-centred outcomes at Kirkpatrick levels 1 and 2, particularly confidence and perceived competence. No studies assessed behavioural change or patient-level outcomes. Implementation was influenced by resource availability, workforce pressures, organisational culture and equity considerations. IMPLICATIONS: Pelvic examination education requires balanced, feasible and culturally sensitive approaches that extend beyond short-term learner outcomes. Future research should prioritise patient perspectives, long-term behavioural change, inclusivity and cost-effective implementation within real-world clinical contexts.
PubMed2026
Powerless or Powerful? Healthcare Professionals' Construction of Agency in Patient and Family Engagement Accounts.
BACKGROUND: Patient safety incidents cause substantial harm globally, with affected patients and families often experiencing additional 'compounded harm' from inadequate organisational responses. Despite policy imperatives emphasising engagement as essential for safety improvement, significant gaps persist in the National Health Service (NHS), where involvement in Serious Incident (SI) investigations is often overlooked or treated as a passive process. While previous qualitative research has primarily used thematic analysis, discourse analytic approaches can offer deeper insights into nuanced patterns of meaning. DESIGN/OBJECTIVE: We conducted discourse analysis on 49 semi-structured interviews with healthcare professionals across six NHS Trusts to examine how staff construct agency in their accounts of engaging patients and families in SI investigations and how these discourses are linked to the broader organisational context. RESULTS: Findings illustrate two prevailing but contested discourses: one depicting staff engagement with patients and families as inconsistent and limited, and the other emphasising their integral role in the investigation process. Interviewees framed themselves as either powerless or powerful, aligning with these respective discourses, while organisational factors, such as professional roles and work relationships, also influenced those constructions. DISCUSSION: A focus on the linguistic construction of agency, control and responsibility provides a powerful lens for understanding persistent gaps in patient and family engagement and highlights the value of incorporating discourse analytic approaches into health policy development and implementation. PATIENT OR PUBLIC CONTRIBUTION: A Citizens' Panel (n = 16) was involved throughout the broader research programme, ensuring public accountability; supporting wider discussions about the emergent findings of the research and their implications for fairness, equality, diversity and inclusion; and supporting the dissemination of findings in creative and accessible ways.