Evaluating the use of systems thinking methods in healthcare: a RE-AIM analysis of AcciMap and Net-HARMS.

There are increasing calls for the application of systems ergonomics methods in healthcare, although evidence for their utility and uptake is limited. In this study, 67 Australian healthcare workers participated in a six-month longitudinal study where they were trained to apply the AcciMap adverse event analysis and Net-HARMS risk assessment methods. Data were gathered in line with the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) evaluation framework, including rates of organisational uptake and method validity, perceived workload, usability, and barriers and facilitators to use in practice.

Clinical practice pattern of Pneumocystis pneumonia prophylaxis in systemic lupus erythematosus: a cross-sectional study from lupus registry of nationwide institutions (LUNA).

Background: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in patients undergoing immunosuppressive therapy, such as glucocorticoid (GC) medication, for systemic autoimmune diseases like systemic lupus erythematosus (SLE). Despite the confirmed effectiveness of PCP prophylaxis, its clinical administration, especially in conjunction with GC dosage, remains unclear. We aimed to describe the clinical practice of PCP prophylaxis in association with SLE in Japan, evaluate the relationship between GC dosage and PCP prophylaxis, and explore the practice patterns associated with PCP prophylaxis.

Recommendations for Clinicians, Technologists, and Healthcare Organizations on the Use of Generative Artificial Intelligence in Medicine: A Position Statement from the Society of General Internal Medicine.

Generative artificial intelligence (generative AI) is a new technology with potentially broad applications across important domains of healthcare, but serious questions remain about how to balance the promise of generative AI against unintended consequences from adoption of these tools. In this position statement, we provide recommendations on behalf of the Society of General Internal Medicine on how clinicians, technologists, and healthcare organizations can approach the use of these tools. We focus on three major domains of medical practice where clinicians and technology experts believe generative AI will have substantial immediate and long-term impacts: clinical decision-making, health systems optimization, and the patient-physician relationship.

Association between discontinuity of care and patient trust in the usual rheumatologist among patients with systemic lupus erythematosus: a cross-sectional study.

Background: Patient trust plays a central role in the patient-physician relationship. This study aimed to determine whether the number of outpatient visits with a covering rheumatologist is associated with patient trust in their usual rheumatologist.

Methods: Japanese adults with systemic lupus erythematosus (SLE) who met the 1997 revised classification criteria of the American College of Rheumatology and had outpatient visits with a covering rheumatologist in the past year were included.

Infection Prevention and Control Response and Escalation Framework: Evaluation and application beyond a pandemic.

Background: The COVID-19 pandemic resulted in constant changes to Infection Prevention and Control (IPAC) recommendations, impacting clinician capacity to stay up to date. The COVID-19 IPAC Response and Escalation Framework (IPAC Framework), rarely reported or evaluated was developed to provide scalable IPAC guidance during the pandemic to health care in New South Wales (NSW), Australia.

Methods: Using a thematic analysis approach, a qualitative study using an online, cross-sectional survey comprising 27 questions was sent to 248 key stakeholders.

Implementation of Contraception Care for Psychiatrically Hospitalized Adolescents: A Hybrid Type 2 Effectiveness-Implementation Study.

Purpose: To examine the implementation and effectiveness of a contraception care intervention for adolescents hospitalized with psychiatric disorders.

Methods: This prospective, observational, hybrid type 2 effectiveness-implementation study examined the effectiveness of the Contraception Care at the Behavioral Health Pavilion (CC@BHP) intervention in 4 inpatient psychiatric units at a quaternary children's hospital. A multifaceted implementation blueprint guided implementation.

Iatrogenic coronary artery dissection extending into the ascending aorta.

One of the most feared complications of percutaneous coronary interventions is coronary artery dissection. Rarely, such dissections can propagate into the ascending aorta, which may then require surgical intervention. We present the case of a 50-year-old patient with new-onset angina and two-vessel coronary artery disease who underwent percutaneous coronary intervention on the right coronary artery, complicated by an iatrogenic coronary dissection extending into the ascending aorta.

The adaptation of a single institution diabetes care platform into a nationally available turnkey solution.

Digital decision support and remote patient monitoring may improve outcomes and efficiency, but rarely scale beyond a single institution. Over the last 5 years, the platform Timely Interventions for Diabetes Excellence (TIDE) has been associated with reduced care provider screen time and improved, equitable type 1 diabetes care and outcomes for 268 patients in a heterogeneous population as part of the Teamwork, Targets, Technology, and Tight Control (4T) Study (NCT03968055, NCT04336969). Previous efforts to deploy TIDE at other institutions continue to face delays.

Mucosa-Associated Lymphoid Tissue Lymphoma as a Rare Mimicker of Relapsing Polychondritis.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B cell extranodal lymphoma characterized by clonal marginal zone lymphocyte proliferation. We report a case of MALT lymphoma with a relapsing polychondritis (RP)-like phenotype, manifesting as rapidly progressive tracheal stenosis requiring tracheotomy.

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial.

Importance: Large language models (LLMs) have shown promise in their performance on both multiple-choice and open-ended medical reasoning examinations, but it remains unknown whether the use of such tools improves physician diagnostic reasoning.

Objective: To assess the effect of an LLM on physicians' diagnostic reasoning compared with conventional resources.

Design, Setting, And Participants: A single-blind randomized clinical trial was conducted from November 29 to December 29, 2023.

Trigeminal neuralgia and risk of cancer: A population-based cohort study.

Background: Evidence of an association between trigeminal neuralgia (TN) and subsequent cancer risk remains sparse. The present study aimed to examine the association between TN and cancer risk in the Danish population.

Methods: A nationwide population-based cohort study using hospital diagnoses collected routinely and prospectively from Danish population-based registries in 1994-2022.

Respiratory Residency: Establishing Excellence for the Newly Licensed Respiratory Therapist.

Background: Workforce issues have highlighted the fact that newly graduated respiratory therapists (RTs) need more support during their transition to practice; however, there are few data on best practices for RT residency programs.

Methods: The aim of this project was to evaluate the feasibility and effectiveness of a residency program for licensed RTs with < 1 y of experience post graduation. The approach to improve new graduate transition to practice included a streamlined clinical-based orientation, didactic learning, evidence-based practice plan, and incorporated simulation.

Practice-Based Models of Pediatric Mental Health Care.

Pediatric primary care is widely available in the United States and can help address the growing public health crisis in child and adolescent mental health by providing integrated behavioral health services. This article provides an overview of 3 common models of behavioral health integration in pediatric primary care settings: 1) the Child Psychiatry Access Program model, 2) the Primary Care Behavioral Health model, and 3) the Collaborative Care Model. Pediatric primary care practices may evaluate the different features of each model before adopting an approach for integration and consider tailoring it to their practice environments.

Neighborhood Disadvantage and Birth Outcomes Among Refugees.

Objective: To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.

Methods: This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance.

India's evolving digital health strategy.

India’s evolving digital health strategy leverages innovative technologies to enhance access to healthcare services. This paper explores the key components of India’s digital health transformation, including the Ayushman Bharat Digital Mission (ABDM) and India’s integration of biometric identification and digital infrastructure to improve healthcare delivery. The lessons learned from India’s large-scale implementation of digital health provide valuable insights for global health markets and digital transformations in healthcare systems.