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Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

Drawing on the experiences of healthcare professionals in one paediatric hospital, this paper explores the influence of context and organisational behaviour on the implementation of a person-centred transition programme for adolescents and young adults (AYA) with long-term conditions.

A single embedded qualitative case study design informed by a realist evaluation framework, was used. Participants who had experience of implementing the transition programme were recruited from across seven individual services within the healthcare organisation. The data were gathered through semi-structured interviews (n = 20) and analysed using thematic analysis.

Implementation of the transition programme was influenced by the complex interaction of macro, meso and micro processes and contexts. Features of organisational behaviour including routines and habits, culture, organisational readiness for change and professional relationships shaped professional decision-making around programme implementation.

There exists a significant body of research relating to the role of context and its influence on the successful implementation of complex healthcare interventions. However, within the area of healthcare transition there is little published evidence on the role that organisational behaviour and contextual factors play in influencing transition programme implementation. This paper provides an in-depth understanding of how organisational behaviour and contextual factors affect transition programme implementation.

Computer-Assisted Learning in Pediatrics Program (CLIPP) and National Board of Medical Examiners Pediatric Subject Examination (NBMEPSE) are used to assess students’ performance during pediatric clerkship. International Foundations of Medicine (IFOM) assessment is organized by NBME and taken before graduation. This study explores the ability of CLIPP assessment to predict students’ performance in their NBMEPSE and IFOM examinations.

This cross-sectional study assessed correlation of students’ CLIPP, NBMEPSE and IFOM scores. Students’ perceptions regarding NBMEPSE and CLIPP were collected in a self-administered survey.

Out of the 381 students enrolled, scores of CLIPP, NBME and IFOM examinations did not show any significant difference between genders. Correlation between CLIPP and NBMEPSE scores was positive in both junior (r = 0.72) and senior (r = 0.46) clerkships, with a statistically significant relationship between them in a univariate model. Similarly, there was a statistically significant relationship between CLIPP and IFOM scores. In an adjusted multiple linear regression model that included gender, CLIPP scores were significantly associated with NBME and IFOM scores. Male gender was a significant predictor in this model. Results of survey reflected students’ satisfaction with both NBMEPSE and CLIPP examinations.

Although students did not perceive a positive relationship between their performances in CLIPP and NBMEPSE examinations, this study demonstrates predictive value of formative CLIPP examination scores for their future performance in both summative NBMEPSE and IFOM. Therefore, students with poor performance in CLIPP are likely to benefit from feedback and remediation in preparation for summative assessments.

This chapter qualitatively explored the impact of including parent liaisons (i.e., parents with lived experience caring for a child with complex needs, who support other caregivers in navigating child and family needs) in a case conferencing model for children with complex medical/social needs. Case conferences are used to address fragmented care, shared decision-making, and set patient-centered goals. Seventeen semi-structured interviews were conducted with clinicians and parent liaisons to assess the involvement of parent liaisons in case conferencing. Two main themes included benefits of parent liaison involvement (10 subthemes) and challenges to parent liaison involvement (5 subthemes). Clinicians reported that liaison participation and support of patients reduced stress for clinicians as well as family members. Challenges to liaison involvement included clinical team/parent liaison communication delays, which were further exacerbated by the COVID-19 pandemic. Parent liaison involvement in case conferences is perceived to be beneficial to children with complex needs, their families, and the clinical team. Integration of liaisons ensures the familial perspective is included in clinical goal setting.

This systematic review (SR) aims to investigate plate waste quantity, determinant factors, and food waste costs in Indonesian hospitals.

This SR was conducted by searching for articles published on the Web of Science, PubMed, Emerald insight, ScienceDirect and hand-searching on nationally accredited journals in Indonesia which consist of 29 journals in nutrition, environment and public health. The inclusion criteria in this review were peer-reviewed articles, original research, research locations in hospitals in Indonesia and articles in English or Bahasa (Indonesian language).

There were 21 studies (17 observational studies and 4 experimental studies) included in this systematic review. Results from 17 observational studies showed that the median plate waste was 27.6% (14.8%–88.7%). High plate waste was found in this review, particularly in pediatric patients and patients who receive liquid diet orally. Staple food and vegetables have a high contribution to patients’ plate waste. Economic costs of plate waste were $0.07–$0.5 per capita per day. Determinant factors of patient’s plate waste were patient clinical conditions, food taste and environmental conditions of hospital food service. Results from four experimental studies showed that meal replacement and smaller food portion intervention could reduce significant plate waste. Nevertheless, there is no conclusive evidence for food waste reduction intervention because of small intervention studies in Indonesia.

There was a high disparity in the quantity of plate waste and economic costs between studies included in this review.

Improving food sensory and adjusting food portions particularly for staple food and vegetables can be done as a way to reduce patient’s plate waste.

This SR is the first review of Indonesian hospital plate waste.

Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

Biofeedback is used for regulating vestibular adaptation and balance by providing real-time stimulus to the individual during physical activities. This study aimed at (1) developing a wearable device, which tracks balance, counts the number and the direction of balance losses and provides haptic biofeedback through real-time vibration stimulus (2) investigating device efficacy on an adolescent medulloblastoma patient during static and dynamic tasks.

A 16-year-old medulloblastoma patient used the device during 10-m walking and single-leg stance tests. The knee joint kinematics and the number and direction of balance losses were recorded for “with” and “without” biofeedback conditions.

The device helped regulate the knee joint kinematics and reduce the number of balance losses of the medulloblastoma patient. The knee joint movement pattern similarity of the control subject was highly correlated (R² = 0.997, RMSE = 1.232). Conversely, medulloblastoma patient knee joint movement pattern similarity was relatively weak (R² = 0.359, RMSE = 18.6) when “with” and “without” biofeedback conditions were compared. The number of balance losses decreased when the medulloblastoma patient was guided with biofeedback.

The major limitation of this pilot study is the lack of a large and homogeneous number of participants. The medulloblastoma patient used the device while walking after she was given enough time to get used to the tactile biological feedback, so the long-term effect of the device and biofeedback guidance were not investigated. Additionally, the potential desensitization with prolonged use of the device was not evaluated.

Biofeedback reduced the number of balance losses; additionally, the knee joint movement pattern was regulated during static and dynamic tasks. This device can be integrated into the physical therapy of patients with balance, vestibular and postural control impairments.

This is compact and has an easy-to-wear design, patients, who have balance and postural control impairments, can practically use the device during their activities of daily living.

The device promotes physical activity adaptation and regulates gait through continuous and real-time balance control. Its design makes it simple for the user to wear it beneath clothing while using the sensor.

The purpose of this study is to provide a framework useful for identifying the elements that aim for success in the construction of collaborative governance and to investigate how international governance systems have characterized the international collaborative projects developed by the International Division of Gaslini Children Hospital in Genoa (Italy). Critical and successful factors in developing partnerships in the healthcare sector have been identified.

A total of 15 projects implemented by the Gaslini Hospital in collaboration with a global network of low and middle-income countries were examined using a content analysis of the project reports. Later, a conceptual framework proposed by Emerson and colleagues was used to design a theoretical map for investigating elements of international governance systems.

A matrix developed in two categories (health cooperation and training, and exchange of best practices) and three branches of medicine (oncology, paediatrics and cardiology) made it possible to cluster the research projects. However, details of the collaborative process often overlooked by research on public-private partnerships emerged from the framework.

The growing demand for higher quality health services in low- and middle-income countries has led to an increasing number of partnerships with industrialized countries to enable access to wider resources and technologies and develop useful skills to adapt to changes in society. Through the application of collaborative governance’s framework to healthcare collaboration, different elements of the collaborative process emerged which have been previously neglected.

Despite significant progress in Iran's immunization programs, vaccine policymaking in the country still faces various challenges and shortcomings. To address these issues and ensure sustained progress toward achieving comprehensive vaccination policies, it is essential to identify the critical factors influencing vaccine policies in Iran. Our study aims to provide evidence-based insights that can inform the development of effective and equitable vaccine strategies, leading to a more sustainable and efficient approach to vaccination in the country.

This mixed-method study aimed to analyze the factors influencing the future of human vaccine policy using Cross Impact Analysis. Firstly, a scoping review was conducted to identify the factors affecting the future of human vaccine development. Secondly, a semi-structured interview was conducted with experts in this field to add more factors and confirm the identified factors within the Iranian context. Finally, a Cross-Impact Analysis (CIA) approach was applied to comprehend the complex relationships between the identified factors. Thematic analysis was used for the qualitative data, and MICMAC analysis was applied to characterize the relationships between the factors.

Seventeen key driving force factors were identified through comprehensive review and interviews. These factors were assigned weighted values ranging from zero to three and subsequently analyzed using MICMAC software. Employing the Cross-Impact Analysis (CIA) technique, the study characterized the impact of each factor on vaccine policy and elucidated the intricate interactions between them. The findings underscored that robust leadership and governance, an innovative ecosystem, and well-established immunization information systems emerged as pivotal driving forces shaping vaccine policy in Iran.

While this study contributes valuable insights into the driving factors influencing vaccine policy in Iran, it is important to acknowledge several limitations. The results rely on the subjective perceptions of a diverse group of specialists, and future research could delve into additional factors in other countries to identify common themes and differences.

This study provides evidence to assist policymakers in making informed decisions regarding vaccines in Iran. The findings suggest that enhancing access to vaccines, fostering trust in the healthcare system, and prioritizing equity in distribution can contribute to increased vaccination rates and a reduction in vaccine-preventable diseases.

This study provides a unique contribution to the field of vaccine policy by utilizing the cross-impact analysis to examine the complex interactions among various factors. The results of this analysis demonstrate that these interactions can significantly impact the overall system, highlighting the need for policymakers to consider multiple factors when formulating effective strategies. By revealing the significance of these interactions, this research offers valuable insights into the development of successful policies that can shape a desirable future for vaccine policy in Iran. Future studies could ratify the findings from this research by applying other methodological approaches.