Search Results (3,123)

Large language models (LLMs) incur prohibitive computational costs when deployed as monolithic systems for multi-domain query processing. This paper proposes Accelerated LLM, a modular architecture that replaces a single general-purpose LLM with an ensemble of task-specialised small language models (SLMs) governed by a neural query router and a Mamdani fuzzy inference system. The router embeds each user query using a frozen sentence encoder and classifies it across four task domains—summarisation, translation, question answering, and text generation—routing confident queries directly to the corresponding SLM. Ambiguous queries are escalated to a three-input fuzzy logic system operating on Query Length, inter-Domain Overlap Score, and Classifier Confidence, enabling principled handling of imprecise inputs. A reinforcement-learning feedback loop, validated through a controlled pilot deployment, continuously refines the routing policy. The complete pipeline, including the sentence encoder, totals approximately 2.14 billion parameters—a 98.8% reduction relative to GPT-3.5 (175 B). The integration of fuzzy logic into the routing stage raises classification accuracy from 91.5% to 94.3% and reduces the hallucination rate to 9.8% (minor) and 6.4% (major). Evaluated on healthcare-augmented benchmarks against ChatGPT-3.5, Claude, Mistral 70B, and two contemporary compact models (GPT-4o-mini and Llama 3.1-8B-Instruct), Accelerated LLM achieves competitive or superior task-specific performance at a fraction of the parameter count. A small-scale pilot evaluation in the legal domain indicates that the routing and fuzzy logic components retain partial effectiveness beyond the primary healthcare setting, though full multi-domain validation remains future work. Full article

Philanthropic hospitals are key providers within Brazil’s public healthcare system and benefit from the Certification of Beneficent Social Assistance Entities in Health (CEBAS-Saúde), a tax relief program designed to incentivize service provision in underserved areas. We analyze a balanced panel of 1641 philanthropic general hospitals from 2005 to 2019, employing a conditional Difference-in-Differences (DiD) model with heterogeneous treatment exposure and entropy balancing to ensure comparability between certified and non-certified hospitals. The results show that certification significantly improved geographic access, mainly by reducing macro-regional patient evasion—the outflow of patients seeking care outside their designated health regions. This effect, most pronounced after ten years of certification, translated into an average annual reduction of approximately 8700 avoided hospitalizations between 2015 and 2019. The reduction was particularly concentrated in small hospitals and in the Northeast region, where access barriers are historically greater. These findings suggest that CEBAS-Saúde is an effective policy instrument for strengthening the regionalization of healthcare provision, reducing geographic inequities, and addressing service gaps in areas with limited healthcare supply. Full article

Background/Objectives: Patient concentration in high-volume tertiary hospitals in the capital region of South Korea has become a major health policy concern. We examined the associations of out-of-region cancer care with healthcare utilization, healthcare expenditure, and clinical outcomes. Methods: We included 303,443 patients newly diagnosed with one of six major cancers between 2012 and 2020 using the Cancer Public Library Database of the Korea Clinical Data Utilization Network for Research Excellence project. Out-of-region cancer care was defined as initial treatment received outside the patient’s residential region. Multivariable regression models evaluated healthcare utilization, healthcare expenditure, and clinical outcomes. Sensitivity analyses considered pretreatment care-seeking fragmentation, and subgroup analyses were performed by cancer stage. Results: Out-of-region cancer care was associated with higher healthcare expenditure (relative risk [RR], 1.02; 95% confidence interval [CI], 1.02–1.03), delayed treatment initiation (odds ratio [OR], 1.19; 95% CI, 1.15–1.22), and lower 1-year (hazard ratio [HR], 0.88; 95% CI, 0.84–0.92) and 5-year (HR, 0.93; 95% CI, 0.91–0.96) all-cause mortality. A modest association with increased emergency department visits was observed in the main analysis (HR, 1.03; 95% CI, 1.01–1.07), although this association was not robust in the sensitivity analyses. These associations with healthcare utilization were stronger among patients with pretreatment care-seeking fragmentation and those with localized or regional cancer. Conclusions: Out-of-region cancer care was associated with lower mortality but higher healthcare utilization. Strengthening regional cancer care capacity and coordinated referral pathways may improve continuity of care while ensuring equitable access to specialized cancer services. Full article

Background: Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. Methods: Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. Results: We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick’s four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. Conclusions: The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outcome-oriented, and where appropriate, mandatory external review should therefore be read as reasoned positions awaiting prospective evaluation rather than as evidence-based recommendations; generating that evidence, with the trainee’s own perspective collected rather than inferred, is the principal task for future research. Full article

Background/Objectives: Rural populations in the United States experienced consistently lower COVID-19 vaccination rates than urban populations during the pandemic. While barriers to vaccination have been well documented, less is known about facilitators of uptake in rural settings. This study aimed to identify facilitators of COVID-19 vaccination in rural communities from the perspectives of Washington State University (WSU) Extension personnel and to examine these factors using the Consolidated Framework for Implementation Research (CFIR) Outer Setting domain. Methods: A qualitative descriptive study was conducted using semi-structured key informant interviews with WSU Extension personnel. Twenty-one participants representing 34 of 40 Extension offices across Washington State were interviewed in Fall 2023. Interviews were transcribed, de-identified, and analyzed using deductive thematic analysis. Findings were organized into the seven CFIR Outer Setting constructs: critical incidents, local attitudes, local conditions, partnerships and connections, policies and laws, financing, and external pressures. Results: Perceived facilitators of COVID-19 vaccination were identified across all CFIR Outer Setting constructs. Trust emerged as a central theme, with participants reporting that vaccine acceptance was higher when information was delivered by trusted local sources, including Extension personnel, healthcare providers, community leaders, and informal networks. Participants described leveraging partnerships with public health agencies, schools, faith-based organizations, and community groups as enhancing outreach and information dissemination. Additional facilitators identified by participants included no-cost vaccine and personal protective equipment availability, accessible community-based vaccination sites, culturally appropriate educational materials, and coordinated communication systems. Conclusions: Rural vaccination efforts were supported by trust, strong community partnerships, and locally tailored strategies. These findings may inform future public health emergency responses in rural communities. Full article

Background: The global healthcare landscape is being increasingly shaped by two pivotal trends: the adoption of international quality frameworks, such as Joint Commission International (JCI) accreditation, and the strategic shift towards resource-efficient models like outpatient surgery. While both areas have been extensively addressed in the healthcare literature, empirical evidence concerning their intersection remains limited. This scoping review aimed to systematically map the available literature, identify critical evidence gaps at the intersection of JCI accreditation and outpatient surgery, and examine implications for healthcare risk management and policy development. Methods: The scoping review was performed in accordance with the PRISMA-ScR guidelines. A dual-track evidence-mapping strategy was implemented across seven electronic databases and platforms (PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, eLIBRARY.ru, CyberLeninka, and Google Scholar) to search for publications published between January 2000 and May 2026. The final database searches were conducted on 15 May 2026. Data extraction was centered on study design, interventions, and key findings related to quality and risk management. Results: A total of 80 publications were included. The evidence comprised two complementary streams: literature concerning JCI accreditation and healthcare quality and safety, predominantly in hospital and general healthcare settings, and literature concerning outpatient, ambulatory, and day-surgery quality, safety, and hospital-substituting technologies. No empirical study directly evaluating the implementation or impact of JCI accreditation within outpatient surgery centers was identified. Conclusions: This scoping review identified a critical empirical evidence gap concerning the integration of accreditation and quality and risk-management frameworks in outpatient surgical settings. A hypothesis-generating conceptual framework is proposed to guide future empirical research evaluating whether and how JCI accreditation influences quality, safety, organizational, and economic outcomes in outpatient surgical settings. Full article

Background/Objectives: Lebanon is undergoing a rapid demographic transition, with older adults projected to exceed one-fifth of the population by 2050. Supporting healthy and independent aging requires a robust evidence base that extends beyond clinical care to encompass community, environmental, psychosocial, and policy dimensions of aging in place. This bibliometric review maps the landscape of gerontology and geriatrics research in Lebanon to identify research trends, gaps, and future priorities for advancing holistic approaches to aging. Methods: A bibliometric review was conducted of gerontology and geriatrics research published between 2015 and 2026. Publications were retrieved from the Scopus database and screened according to predefined eligibility criteria. Results: A total of 403 publications met the inclusion criteria. Research productivity increased steadily over the study period, reaching its highest level in 2025, although publications remained concentrated among a relatively small number of authors and institutions. The literature was predominantly oriented toward clinical, epidemiological, and public health aspects of aging, with comparatively limited attention to community-based aging, psychosocial well-being, age-friendly environments, policy, social participation, and other determinants that support older adults’ ability to age safely and independently within their communities. Research evaluating interventions outside tertiary healthcare settings was particularly scarce. Conclusions: This review provides the first bibliometric mapping of gerontology and geriatrics research in Lebanon and indicates that, despite substantial growth in scientific output, the identified literature is largely centered on diseases and institutional healthcare. Future research should adopt more holistic and multidisciplinary perspectives to promote psychosocial well-being and aging well in one’s community. These priorities may guide researchers, practitioners, and policymakers in developing strategies for aging well in Lebanon. Full article

Background/Objectives: Cognitive behavioural therapy (CBT) is an effective intervention for promoting personal recovery among individuals diagnosed with schizophrenia; however, Saudi Arabia has a shortage of healthcare professionals trained to deliver it. Mental health nurses are well positioned to help address this gap. This study explored mental health nurses’ perspectives on a proposed culturally adapted CBT intervention for individuals diagnosed with schizophrenia and identified perceived barriers and facilitators to its implementation. Methods: Situated within the development phase of the Medical Research Council framework for complex interventions, the study examined perceived acceptability and anticipated feasibility rather than efficacy. Three face-to-face focus groups involving 19 mental health nurses were conducted between December 2020 and February 2021 at a tertiary mental health hospital in Riyadh, Saudi Arabia, during the COVID-19 pandemic. The focus group questions were informed by a systematic review of culturally adapted CBT components, and data were analysed using framework analysis. Results: Three themes emerged: acceptability, with nurses recognising the value of CBT in promoting recovery; barriers, including lack of role clarity within mental health nursing policy, dominance of the medical model, and engagement difficulties among individuals diagnosed with schizophrenia; and facilitators, including supportive nursing management, training opportunities, and family involvement. Conclusions: Mental health nurses expressed support for delivering CBT but identified organisational and training-related barriers. Successful implementation will require clear policy frameworks, structured culturally adapted CBT training, ongoing clinical supervision, supportive nursing management, and collaborative approaches that appropriately involve families. Full article

Background: Research on women’s health is essential for addressing sex-specific healthcare needs and informing evidence-based policy. However, women-only health research in Taiwan has not been systematically examined. Methods: We conducted a Scopus-based bibliometric analysis of health research exclusively involving female populations in Taiwan from 2015 to 2025. We included English-language, peer-reviewed journal articles involving only female participants and conducted in Taiwan or using Taiwanese datasets. Mixed-sex studies, including those reporting female-specific or sex-stratified findings, were excluded. Publication trends, citations, international collaboration, secondary data sources, and thematic patterns were analyzed using Biblioshiny and VOSviewer. Results: A total of 1345 publications across 446 journals were included. Publication output increased from 126 articles in 2015 to a peak of 153 in 2021, followed by a decline, with an annual growth rate of −0.4%. The publications involved 3412 authors and received an average of 14.52 citations per document. International co-authorship accounted for 19.48% of publications, with the United States as the leading collaborator. The National Health Insurance Research Database was the most frequently reported secondary data source (n = 371, 27.6%). Research was concentrated in cancer, reproductive health, and mental health, whereas cardiovascular health accounted for a comparatively smaller share of the literature. Conclusions: Women-only health research in Taiwan remained active throughout the study period, despite a decline in publication output after 2021. The extensive use of national health databases and international collaboration further characterized the research landscape. These findings provide an evidence-informed basis for future research priority-setting, including efforts to broaden research across women’s health conditions and life-course stages while considering research activity alongside population health needs. Integrating bibliometric evidence with population health priorities may support a more balanced and comprehensive women’s health research agenda in Taiwan. Full article

Background: The persistent challenge of not having a physician or nurse practitioner for ongoing care for millions of residents imposes a burden on the health economy in Canada and demands a shift in focus from mere system registry to the value-based concept of attachment readiness. With a hypothesis that true attachment is a function of attachment readiness, a relational process shaped by the intersection of patients’ preparation, providers’ capacity, and systemic support, this study aims to investigate the challenges of attachment-creating barriers to meaningful healthcare relationships. Methods: This sequential mixed-methods study was designed to integrate a comprehensive scoping review of academic librarian-guided databases, search engines, grey literature, and snowballing, followed by 360-degree qualitative interviews with experts, service providers, and clients. Qualitative data was analyzed by thematic coding to answer the research questions. Results: Attachment is a function of a multitude of factors from patients and physicians’ “attachment readiness” is a multilevel, process-oriented condition shaped by patient preparedness, provider capacity, and system design more than a single episodic event or individual attribute. Facilitators such as team-based care, patient navigation, culturally responsive outreach, and structured onboarding reinforce readiness as a system-enabled condition. However, persistent system-level barriers delay attachment among motivated patients (readiness decay), leading to frustration, disengagement, and reduced trust. Findings further suggest that attachment is constrained not only by physician supply but also by time-sensitive readiness conditions. Conclusions: This study suggests that attachment to primary care is one leg of a three-legged stool, upheld and sustained by the two others- equity and access. To facilitate true attachment and to move beyond fragmented care and reliance on high-cost emergency departments, Canadian healthcare policy must consider attachment readiness through standardizing onboarding (implementing uniform digital intake processes to reduce repetitive data entry and administrative friction), an equity lens for prioritizing vulnerability (refining centralized waitlist algorithms to account for clinical urgency and social determinants of health), and supporting provider capacity (providing financial and administrative incentives that recognize the labour involved in establishing new longitudinal relationships for patients with complex needs). Full article

Agentic artificial intelligence (AI) systems—software that plans, acts, and decides without step-by-step human approval—are already deployed in finance, healthcare, recruitment, and public services. They differ from earlier AI in one critical way. They do not produce outputs for a human to accept or reject. They take actions. Those actions may be irreversible. They may affect people who never used the system. Existing governance frameworks were not designed for this. Current alignment approaches—including reinforcement learning from human feedback, constitutional AI, and preference aggregation—assume that a well-aligned system satisfies what users ask for. This paper argues that the assumption fails in agentic contexts. What people ask for is not what they value. Preferences are volatile and user-centric. Values are stable, culturally grounded, and other-regarding. This paper proposes the Human Values Alignment Framework for Agentic AI (HVAF-A), grounded in Schwartz’s cross-culturally validated Basic Human Values theory. The framework connects value inputs, three alignment mechanisms (elicitation, arbitration, and propagation), and governance outcomes at individual, organizational, and societal levels. The paper positions the HVAF-A against the main international policy instruments—the EU AI Act, the NIST AI Risk Management Framework, ISO/IEC 42001, and the OECD and UNESCO principles—and specifies an empirical program of constructs, measures, validity tests, and study designs. An illustrative case study of an agentic hiring system shows how the framework would operate. This is a purely conceptual study. No study was conducted and no instrument was administered to validate the model. A dedicated section states the framework’s boundary conditions. Empirical validation is set out as future research. Full article

Digital transformation (DT) is a strategic priority for healthcare systems seeking to improve the quality of care, patient safety, and operational efficiency. In Saudi Arabia, DT is central to Vision 2030; however, evidence regarding its effects on healthcare quality and safety remains dispersed across technologies and healthcare settings. This narrative review aimed to examine the impact of digital transformation on healthcare quality and patient safety in Saudi Arabia and to identify the principal implementation facilitators, barriers, and policy implications. A structured narrative literature search was conducted for publications from January 2010 to March 2026 using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, the Saudi Digital Library, and relevant Saudi governmental and policy documents. In total, 64 peer-reviewed studies, reviews, reports, and policy documents addressing digital health initiatives and outcomes related to quality, safety, efficiency, or patient experience were included. Evidence was synthesized thematically, focusing on electronic health records, digital prescribing, online appointment systems, clinical and pharmacy automation, claims and financial analytics, telemedicine, governance, and workforce factors. The reviewed evidence indicates that Electronic Health Record (EHRs), computerized provider order entry, e-prescribing, barcode-supported medication systems, telemedicine, digital appointment platforms, and automated workflows can improve access to care, documentation, care coordination, medication safety, workflow efficiency, and patient experience. However, the benefits of DT are constrained by fragmented infrastructure, limited interoperability, workforce resistance, insufficient digital literacy, funding limitations, and unclear or fragmented governance and regulatory arrangements. In conclusion, digital transformation has substantial potential to enhance healthcare quality and patient safety in Saudi Arabia. Achieving these benefits requires context-sensitive implementation, interoperable systems, strong governance, sustained investment in infrastructure and workforce capacity, and effective leadership and change-management strategies aligned with Vision 2030. Full article

Background: Geriatric dentistry prepares dentists to care for an aging population. Yet, its integration into undergraduate curricula remains inconsistent. Objectives: To map evidence on the barriers to and facilitators of the implementation and development of undergraduate geriatric dental education. Methods: A scoping review was conducted using systematic searches of PubMed, Scopus, and Embase for English-language original research articles published from 1 January 2016 onward. Two reviewers screened titles, abstracts, and full texts independently against eligibility criteria. Studies were included if they examined barriers and/or facilitators related to undergraduate geriatric dental education. Data were extracted independently and synthesized descriptively to identify themes and evidence gaps. No critical appraisal was performed. Results: This review identified 1376 studies and included 11 studies, including seven cross-sectional and four cohort studies. Barriers clustered into three themes: structural and workforce-related barriers (resource constraints and a lack of equipped/trained staff), curricular and regulatory barriers (overcrowded curricula and a lack of curriculum guidelines), and interprofessional and attitudinal barriers (limited interprofessional collaboration and negative attitudes among students and teaching staff towards older adults). Facilitators were grouped into three themes: pedagogical and experiential learning strategies (didactic teaching, clinical training, extramural exposure, simulation-based training, and communication training), curricular and policy enablers (integrated curricula and national guidelines), and institutional and faculty support (staff support). Conclusions: This review identifies the multifaceted, modifiable educational, institutional, and policy factors that influence the implementation and development of geriatric dental education. By consolidating the existing evidence, this review provides a foundation for curriculum development and policy planning to prepare graduates to deliver age-responsive oral healthcare. Full article

Background: Saudi Arabia’s healthcare system serves an increasingly diverse patient population, yet limited qualitative evidence exists regarding how pediatric nurses navigate cultural complexity in their daily practice. Understanding nurses’ day-to-day experiences of cross-cultural care is essential for strengthening culturally sensitive pediatric services. Purpose: This study explored the experiences of pediatric nurses in providing culturally sensitive care to children and their families in Riyadh, Saudi Arabia. Methods: A qualitative descriptive study was conducted in pediatric units of tertiary hospitals in Riyadh City, Saudi Arabia. Eighteen pediatric nurses participated in semi-structured interviews. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Four themes emerged: navigating cultural landscapes, describing nurses’ encounters with diverse cultural beliefs and health practices; communication as a bridge and a barrier, reflecting language challenges and strategies for meaningful engagement; balancing professional standards with cultural respect, highlighting the tension between evidence-based care and cultural accommodation; and the emotional labor of cross-cultural caregiving, capturing the personal toll and resilience involved in culturally diverse practice. Conclusions: Pediatric nurses engage in complex interpretive, relational, and emotional work when providing culturally sensitive care. Institutional support through cultural competence training, multilingual resources, and organizational policies is essential for enhancing culturally responsive pediatric nursing practice in diverse healthcare settings. Full article

The U.S. healthcare delivery infrastructure functions as a complex socio-technical system-of-systems (SoS). In this environment, autonomous, interdependent entities (providers, insurers, and IT networks) must balance local efficiency with system-wide coordination. Existing governance mechanisms frequently fail to prevent operational fragmentation, yet the conditions under which governance pressure generates or inhibits coordination remain poorly understood. This study introduces a three-parameter cost framework. The framework comprises default operational costs, incoherence penalties for structural misalignment, and switching costs associated with modernization. This framework enables the examination of how governance structures shape emergent alignment in healthcare SoS. The three cost components are grounded in the Confluence Interoperability Covenant (CIC), a governance framework that codifies standards for interaction among autonomous healthcare systems and extends it into a computationally tractable form for simulation-based analysis. The contribution lies in jointly operationalizing these three cost components interacting with each other within a healthcare SoS governance framework using agent-based modeling and simulation (ABMS) and examining how their interaction shapes coordination under decentralized, periodic adaptation. Using a stylized exploratory ABMS framework implemented on a network, we analyze how these parameters influence coordination dynamics across a range of simulated governance conditions. The results reveal three emergent patterns. First, higher incoherence costs accelerate the transition from fragmented legacy configurations toward greater alignment. Second, high switching costs can create lock-in dynamics in which inefficient arrangements persist because transition burdens suppress adaptation. Third, the relationship between governance pressure and speed of coordination is non-monotonic: at early review horizons, moderate incoherence costs can produce faster coordination than maximal pressure, whereas stronger pressure eventually produces lower entropy as the simulation progresses. This finding reflects a transient finite-horizon coordination advantage rather than a fixed optimal governance level. This last finding suggests that governance effectiveness is horizon-dependent rather than a simple linear function of regulatory intensity. These findings contribute to a complexity-informed understanding of healthcare governance by showing that alignment in adaptive SoS depends not only on the intensity of interoperability pressure but on its interaction with institutional transition burdens. The model is designed as a mechanism-exploration framework to support future empirically grounded policy analysis and data collection. Full article