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There is widespread concern about low adherence to clinical practice guidelines (CPGs) and the low adoption of new medical technologies. To assist the regulatory response, we propose benchmarking clinical practice on the lower bound on the probability that a recommended treatment/new technology achieves a better outcome. This inequality–probability bound can be estimated from marginal outcome distributions. We illustrate the approach by comparing Swedish cardiologists' adoption of drug-eluting stents (DESs) with the inequality–probability bound on this technology improving outcomes. A substantial fraction of cardiologists are below the benchmark.

This paper aims to understand the clinical practice of physiotherapists and occupational therapists in the Republic of Ireland in the assessment and treatment of spasticity in adults, to inform and improve spasticity management practice. This study also aims to describe therapists’ knowledge, confidence and perceived barriers in the management of spasticity.

A cross sectional survey design study was completed, and respondents were recruited through an online survey.

In total, 92 respondents from a wide range of clinical settings revealed there is considerable variation in services available nationally for adults presenting with spasticity. There were significant inconsistencies across all areas of practice. The majority of respondents (94%) did provide intervention to patients with spasticity, yet three quarters did not have access to a specialist spasticity clinic, and the majority (82%) did not feel they were providing sufficient treatment intensity for spasticity.

These findings provide a unique insight into the assessment and treatment practices of Irish physiotherapists and occupational therapists. These results demonstrate the need for further upskilling and specialist high-quality spasticity services nationally.

The future increase of chronic diseases in the world requires new challenges in the health domain to improve patients' care from the point of view of the organizational processes, clinical pathways and technological solutions of digital health. For this reason, the present paper aims to focus on the study and application of well-known clinical practices and efficient organizational approaches through an innovative model (TALIsMAn) to support new care process redesign and digitalization for chronic patients.

In addition to specific clinical models employed to manage chronic conditions such as the Population Health Management and Chronic Care Model, we introduce a Business Process Management methodology implementation supported by a set of e-health technologies, in order to manage Care Pathways (CPs) digitalization and procedures improvement.

This study shows that telemedicine services with advanced devices and technologies are not enough to provide significant changes in the healthcare sector if other key aspects such as health processes, organizational systems, interactions between actors and responsibilities are not considered and improved. Therefore, new clinical models and organizational approaches are necessary together with a deep technological change, otherwise, theoretical benefits given by telemedicine services, which often employ advanced Information and Communication Technology (ICT) systems and devices, may not be translated into effective enhancements. They are obtained not only through the implementation of single telemedicine services, but integrating them in a wider digital ecosystem, where clinicians are supported in different clinical steps they have to perform.

The present work defines a novel methodological framework based on organizational, clinical and technological innovation, in order to redesign the territorial care for people with chronic diseases. This innovative ecosystem applied in the Italian research project TALIsMAn is based on the concept of a continuum of care and digitalization of CPs supported by Business Process Management System and telemedicine services. The main goal is to organize the different socio-medical activities in a unique and integrated IT system that should be sustainable, scalable and replicable.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

This study aims to explore the knowledge, attitudes, and experiences of PhD students in India regarding research ethics and institutional review boards (IRBs), assess awareness levels, identify training gaps, examine ethical priorities and understand challenges in the IRB application process.

A quantitative approach was used, and a self-evaluator questionnaire was distributed electronically to PhD students. Data collection occurred between 1 March 1 and 30 March 2024, with analysis conducted using SPSS software.

The study reveals a significant gap in formal training on IRB procedures within PhD programs and challenges in completing IRB applications despite recognising ethical priorities such as informed consent and confidentiality.

This study provides insights into PhD students’ perspectives on research ethics and IRBs in India, highlighting the need for enhanced education and awareness initiatives to promote responsible conduct and safeguard research participants.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

This systematic review (SR) aims to evaluate and summarize the effectiveness of using eye movement desensitization and reprocessing (EMDR) intervention among individuals diagnosed with post-traumatic stress disorder (PTSD), as well as to highlight the standardized EMDR-based interventional protocol.

This SR is guided according to preferred reporting items for SRs and meta-analyses standards. Several online databases were used in searching for eligible studies in peer-reviewed journals relevant to the study keywords. The included studies were SRs and clinical trials that used EMDR interventions among patients experiencing PTSD symptoms, older than 18 years and were published in English language from 2015 to 2022. Three researchers independently contributed to study selections, data extraction and study evaluations from different aspects, including quality assessment, risk of bias and study synthesis.

A total of eight published studies met the inclusion criteria and were included in this SR; four articles were randomized controlled trials and four were SR and meta-analysis studies. In all included studies, the EMDR was used as a primary psychotherapy intervention for PTSD symptoms. The results of this extensive and comprehensive review showed that EMDR is an effective psychotherapeutic intervention to reduce and control the severity of symptoms among individuals with PTSD.

It is important to acknowledge several limitations inherent in this study. First and foremost, it is noteworthy to mention that only studies conducted in the English language were included in this review, potentially restricting the overall scope and diversity of the findings. Furthermore, the number of studies incorporated into this review was limited, which may have implications for the comprehensiveness and generalizability of the results. Finally, it is worth noting that certain studies within this review had a relatively small sample size, which could potentially limit the statistical power and precision of the conclusions drawn.

This paper, a review of the literature, gives an overview of EMDR effectiveness, provides baseline information and plays a significant role in decreasing the gap in Jordanian literature regarding using EMDR as the strongest evident psychotherapy approach for PTSD treatment to help psychiatrists, psychologists and psychiatric nurses in the health-care sectors to design comprehensive strategies to enhance and improve the quality of health care and patients’ status.

EMDR intervention offers significant alternative treatment opportunities for individuals suffering from PTSD, depression and anxiety. The implementation of EMDR for depression, anxiety and PTSD improves patient outcomes as compared to standard therapeutic modalities in PTSD.

This SR gives an overview and explains strong supportive evidence for the effectiveness of EMDR interventions among individuals with PTSD. Therefore, EMDR therapy could be assumed as one standard treatment option for PTSD, aiming at reducing treatment duration and cost of treatment and restoring the mental well-being and functionality of those suffering from PTSD.

This study, by applying the feedback process of the organizational learning model, examined the relationships among group learning, individuals’ and groups’ internalization of institutionalized evidence-based practice (I-EBP), and nurses’ sustainment of I-EBP.

Twelve hospitals were included in this cross-sectional study, with 1,741 nurses from 59 wards. Anonymous questionnaires were administered from October to December 2021. Participants self-reported their wards’ group learning, internalization of I-EBP, sustainment of I-EBP, EBP beliefs, intra-hospital transfers, and nursing research experiences. The number of nurses and I-EBP introduction length and type of I-EBP were assessed. Internalization of I-EBP of nurses and groups was considered the mediating variable, while group learning and nurses’ sustainment of I-EBP were the independent and dependent variables, respectively. Significant variables in bivariate analyses were used as control variables. Multi-level Mediation Analysis and a significance test of indirect effect using the bootstrap method were conducted.

Responses from 360 nurses in 48 wards from 12 hospitals were analyzed. Groups’ internalization of I-EBP significantly mediated the relationship between group learning and nurses’ sustainment of I-EBP. In contrast, no significant mediating effect of nurses’ internalization of I-EBP was observed.

In the feedback process of organizational learning, group learning and its subsequent effects on individuals and groups have not been previously examined. Regardless of the nurses’ degree of internalization of I-EBP, those who belong to the ward with a high degree of internalization of I-EBP are more likely to sustain it. Conducting group learning may prevent superficial practice, resulting in its sustainability.

This article aims to address the need for a more structured partnership between civilian and military healthcare, particularly in the context of cross-border threats in the EU. While both systems are driven by the same goal of providing high-quality healthcare services and achieving optimal patient outcomes, they operate under different national approaches and resources.

Two recent crises are presented as examples that highlight the necessity of cooperation between civilian and military medical systems. The Covid-19 Pandemic and the Ukrainian Conflict are described based on the experience gathered by the author as a member of the NATO Centre of Excellence for Military Medicine and form the base to shape a broader perspective on the future of civil-military interaction in healthcare at the European Union level.

The ability to deliver coordinated responses during crises depend on the level of interoperability, preparation and mutual understanding. To improve synergies, a structured partnership should be established, prioritizing common standards of care and shared best practices. Integrating military and civilian healthcare pathways can be especially beneficial in situations where patients are moved from the point of injury or sickness across different military and civilian structures to receive the most appropriate treatment and rehabilitation for their conditions.

The relationship between military and civilian healthcare systems is often discussed at multinational level, but a clear focus is lacking concerning their shared mission, distinct functions and potential for cross-border collaboration.

Dyslipidaemia is an established risk factor for cardiovascular diseases. Calorie restriction and adopting a heart-healthy diet like the Mediterranean diet are the main dietary interventions for dyslipidaemia. Other dietary behaviours, such as changes in meal frequency and timing, are not included in the major dietary advice guidelines despite the potential correlation between eating patterns and lipid metabolism. This overview of systematic reviews and meta-analyses aims to summarise the effect of meal timing and frequency on lipid profile and make possible recommendations on which meal timing pattern is superior in reducing lipid levels.

According to the protocol published on PROSPERO (CRD42021248956), five databases were searched for systematic reviews and meta-analyses investigating the effects of meal timing and frequency on lipid profile in adults.

Five reviews were included, with two reviews on breakfast skipping and meal frequency, respectively, and one review on night-time eating. Increasing meal frequency while maintaining the total calorie intake was reported to reduce total cholesterol and low-density lipoprotein (LDL) levels with low- to moderate-quality evidence. There was a correlation between breakfast skipping and an undesirable increase in LDL levels with low-quality evidence. However, there needs to be more high-quality evidence to conclude the effect of dietary behaviours on blood lipid levels.

This overview provides a comprehensive summary of evidence examining the effects of meal timing and frequency on adult lipid profiles. The current low- or moderate-quality evidence could not support the recommendation of alteration of meal frequency as an alternative to conventional non-pharmacological treatments for dyslipidaemia.