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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.

The objective of this study was to delineate and compare enteral nutrition (EN) practices among neonatal units across the Arabian Gulf countries.

A cross-sectional study was conducted by recruiting 255 clinicians working in neonatal units in the Arabian Gulf countries.

Out of 255 invited clinicians, 73 (29%) participated in the survey. Neonatal units used varied EN strategies, where feeding practices exhibited variability. The majority (74%) of units had a local standard feeding protocol, while 18% followed international protocols, and 8% did not adhere to a specific protocol. When maternal milk was not used, the main alternatives were preterm formula (67%) and predigested formula (14%). The age at which the first EN was commenced and the reported advancement rate showed significant variations among different units (p < 0.001). The initiation of fortification was primarily driven by reaching a specific enteral volume (commonly reported as 100 mL/kg/day) and addressing poor postnatal growth. Fortification practices did not differ significantly among professions, except for the initial fortification strength, where none of the dietitians and only 8.3% of neonatologists preferred full strength, compared to 28.6% and 21.4% of medical residents and nurses, respectively (p = 0.033).

This study marks the first exploration of EN practices in neonatal units, examining their local and cross-country variations. It provides valuable insights to guide local trials and foster global collaboration among neonatal units to establish a unified knowledge base, standardized practices and promote research and innovation, ultimately contributing to optimal feeding practices for very preterm infants.

This paper aims to reflect on the outcomes of a community-based video-conferencing intervention for depression, predating the COVID-19 pandemic. The study investigates the potential implications of its findings for enhancing adherence to digital mental health interventions. The primary objective is to present considerations for researchers aimed at minimising the intention-behaviour gap frequently encountered in digital mental health interventions.

A randomised control feasibility trial design was used to implement a telehealth model adapted from an established face-to-face community-based intervention for individuals clinically diagnosed with depression. In total, 60 participants were initially recruited in association with a local mental health charity offering traditional talking-based therapies with only eight opting to continue through all phases of the project. Modifications aligning with technological advancements were introduced.

However, the study faced challenges, with low uptake observed after an initial surge in recruitment interest. The behaviour-intention gap highlighted technology as a barrier to service accessibility, exacerbated by participant age. Furthermore, the clinical diagnosis of depression, characterised by low mood and reduced interest in activities, emerged as a potential influencing factor.

The limitations of the research include its pre-pandemic execution, during a nascent stage of technological mental health interventions when participants were less familiar with online developments.

Despite these limitations, this study's reflections offer valuable insights for researchers aiming to design and implement telehealth services. Addressing the intention-behaviour gap necessitates a nuanced understanding of participant demographics, diagnosis and technological familiarity.

The study's relevance extends to post-pandemic society, urging researchers to reassess assumptions about technology availability to ensure engagement. This paper contributes to the mental health research landscape by raising awareness of critical considerations in the design and implementation of digital mental health interventions.

Reflections from a pre-pandemic intervention in line with the developments of a post-pandemic society will allow for research to consider that because the technology is available does not necessarily result in engagement.

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.

The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.

An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.

The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

The purpose of this paper is to develop a prototype of a wearable medical device in the form of a bandage with a real-time data monitoring platform, which can be used domestically for diabetic patients to identify the possibility of foot ulceration at the early stage.

The prototype can measure blood volumetric change and temperature variation in the forefoot area simultaneously. The waveform extracted using a pulsatile-blood-flow signal was used to assess blood perfusion-related information, and hence, predict ischemic ulcers. The temperature difference between ulcerated and the reference was used to predict neuropathic ulcers. The medical device can be used as a bandage during the application wherein the sensory module is placed inside the hollow pocket of the bandage. A platform was developed through a mobile application where doctors can extract real-time information, and hence, determine the possibility of ulceration.

The height of the peaks in the pulsatile-blood-flow signal measured from the subject with foot ischemic ulcers is significantly less than that of the subject without ischemic ulcers. In the presence of ischemic ulcers, the captured waveform flattens. Therefore, the blood perfusion from arteries to the tissue of the forefoot is considerably low for the subject with ischemic ulcers. According to the temperature difference data measured over 25 consecutive days, the temperature difference of the subject with neuropathic ulcers occasionally exceeded the 4 °F range but mostly had higher values closer to the 4 °F range. However, the temperature difference of the subject who had no complications of neuropathic ulcers did not exceed the 4 °F range, and the majority of the measurements occupy a narrow range from −2°F to 2 °F.

The proposed prototype of wearable medical apparatus can monitor both temperature variation and pulsatile-blood-flow signal on the forefoot simultaneously and thereby predict both ischemic and neuropathic diabetes using a single device. Most importantly, the wearable medical device can be used domestically without clinical assistance with a real-time data monitoring platform to predict the possibility of ulceration and the course of action thereof.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

Devices for step estimation are body-worn devices used to compute steps taken and/or distance covered by the user. Even though textiles or clothing are foremost to come to mind in terms of articles meant to be worn, their prominence among devices and systems meant for cadence is overshadowed by electronic products such as accelerometers, wristbands and smart phones. Athletes and sports enthusiasts using knee sleeves should be able to track their performances and monitor workout progress without the need to carry other devices with no direct sport utility, such as wristbands and wearable accelerometers. The purpose of this study thus is to contribute to the broad area of wearable devices for cadence application by developing a cheap but effective and efficient stride measurement system based on a knee sleeve.

A textile strain sensor is designed by weft knitting silver-plated nylon yarn together with nylon DTY and covered elastic yarn using a 1 × 1 rib structure. The area occupied by the silver-plated yarn within the structure served as the strain sensor. It worked such that, upon being subjected to stress, the electrical resistance of the sensor increases and in turn, is restored when the stress is removed. The strip with the sensor is knitted separately and subsequently sewn to the knee sleeve. The knee sleeve is then connected to a custom-made signal acquisition and processing system. A volunteer was employed for a wearer trial.

Experimental results establish that the number of strides taken by the wearer can easily be correlated to the knee flexion and extension cycles of the wearer. The number of peaks computed by the signal acquisition and processing system is therefore counted to represent stride per minute. Therefore, the sensor is able to effectively count the number of strides taken by the user per minute. The coefficient of variation of over-ground test results yielded 0.03%, and stair climbing also obtained 0.14%, an indication of very high sensor repeatability.

The study was conducted using limited number of volunteers for the wearer trials.

By embedding textile piezoresistive sensors in some specific garments and or accessories, physical activity such as gait and its related data can be effectively measured.

To the best of our knowledge, this is the first application of piezoresistive sensing in the knee sleeve for stride estimation. Also, this study establishes that it is possible to attach (sew) already-knit textile strain sensors to apparel to effectuate smart functionality.

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 paper aims to concentrate on recent innovations in flexible wearable sensor technology tailored for monitoring vital signals within the contexts of wearable sensors and systems developed specifically for monitoring health and fitness metrics.

In recent decades, wearable sensors for monitoring vital signals in sports and health have advanced greatly. Vital signals include electrocardiogram, electroencephalogram, electromyography, inertial data, body motions, cardiac rate and bodily fluids like blood and sweating, making them a good choice for sensing devices.

This report reviewed reputable journal articles on wearable sensors for vital signal monitoring, focusing on multimode and integrated multi-dimensional capabilities like structure, accuracy and nature of the devices, which may offer a more versatile and comprehensive solution.

The paper provides essential information on the present obstacles and challenges in this domain and provide a glimpse into the future directions of wearable sensors for the detection of these crucial signals. Importantly, it is evident that the integration of modern fabricating techniques, stretchable electronic devices, the Internet of Things and the application of artificial intelligence algorithms has significantly improved the capacity to efficiently monitor and leverage these signals for human health monitoring, including disease prediction.

Despite much attention being devoted to shared leadership, the negotiation of such arrangements remains underexplored. In parallel, the revival of interest in matrix structures reveals their challenges but neglects the dynamics of shared leadership. In this case study, the author analyzes the tensions experienced by senior managers of a healthcare organization transitioning from a hierarchical to matrix structure as they negotiate their leadership roles in this new arrangement.

The author interviewed 16 senior managers, observed their meetings and analyzed documents. These data were combined with secondary data including previous interviews and observations of this top leadership team. The author then conducted an inductive data analysis.

The author's analysis reveals that the tensions experienced by senior managers as they negotiate their roles reflect the co-existence of leadership surpluses (too much leadership) and deficits (too little leadership) in matrix organizations. The author argues that surpluses and deficits are not mutually exclusive but are interrelated and shows how leadership surpluses can create leadership deficits.

The author’s findings suggest that in contexts of leader abundance, actors should explore leadership voids. Particular attention should be paid to incidents of intrusion and exclusion, moments of transition and intense role negotiation, as those contexts are particularly conducive to leadership deficits.

While previous work on matrix structures focuses on leadership surpluses, the author discusses leadership deficits. The author explores how more leaders do not necessarily mean more leadership, but instead how more leaders may result in leadership voids.