Search Results (366)

The modified Rankin Scale (mRS) is a widely used outcome measure for assessing disability in stroke care; however, its administration is often affected by subjectivity and variability, leading to poor inter-rater reliability and inconsistent scoring. Originally designed for hospital discharge evaluations, the mRS has evolved into an outcome tool for disability assessment and clinical decision-making. Inconsistencies persist due to a lack of standardization and cognitive biases during its use. This paper presents design principles for creating a standardized clinical assessment tool (CAT) for the mRS, grounded in human–computer interaction (HCI) and cognitive engineering principles. Design principles were informed in part by an anonymous online survey conducted with clinicians across Canada to gain insights into current administration practices, opinions, and challenges of the mRS. The proposed design principles aim to reduce cognitive load, improve inter-rater reliability, and streamline the administration process of the mRS. By focusing on usability and standardization, the design principles seek to enhance scoring consistency and improve the overall reliability of clinical outcomes in stroke care and research. Developing a standardized CAT for the mRS represents a significant step toward improving the accuracy and consistency of stroke disability assessments. Future work will focus on real-world validation with healthcare stakeholders and exploring self-completed mRS assessments to further refine the tool. Full article

Many hospitals still lack digital traceability in hygiene and cleaning management, leading to operational inefficiencies and inconsistent quality control. This study aims to establish cleaning and hygiene processes in healthcare services that are planned in accordance with standards, as well as to enhance the traceability and sustainability of these processes through digitalization. This study proposes a Hyperledger Fabric-based blockchain architecture to establish a reliable and transparent quality assurance system in process management. The proposed Quality Assurance Model utilizes digital technologies and IoT-based RFID devices to ensure the transparent and reliable monitoring of cleaning processes. Operational data related to cleaning processes are automatically recorded and secured using a decentralized blockchain infrastructure. The permissioned nature of Hyperledger Fabric provides a more secure solution compared to traditional data management systems in the healthcare sector while preserving data privacy. Additionally, the execute–order–validate mechanism supports effective data sharing among stakeholders, and consensus algorithms along with chaincode rules enhance the reliability of processes. A working prototype was implemented and validated using Hyperledger Caliper under resource-constrained cloud environments, confirming the system’s feasibility through over 100 TPS throughput and zero transaction failures. Through the proposed system, cleaning/hygiene processes in patient rooms are conducted securely, contributing to the improvement of quality standards in healthcare services. Full article

Background/Objectives: BRIGHTLIGHT was the national evaluation of adolescent and young adult (AYA) cancer services in England. BRIGHTLIGHT results were not available when the most recent healthcare policy (NHSE service specifications for AYA Cancer) for AYA was drafted and therefore did not consider BRIGHTLIGHT findings and recommendations. We describe the co-development and delivery of a Policy Lab to expedite the implementation of the new service specification in the context of BRIGHTLIGHT results, examining the roles of multi-stakeholders to ensure service delivery is optimised to benefit AYA patients. We address the key question, “What is the roadmap for empowering different stakeholders to shape how the AYA service specifications are implemented?”. Methods: A 1-day face-to-face policy lab was facilitated, utilising a unique, user-centric engagement approach by bringing diverse AYA stakeholders together to co-design strategies to translate BRIGHTLIGHT evidence into policy and impact. This was accompanied by an online workshop and prioritisation survey, individual interviews, and an AYA patient workshop. Workshop outputs were analysed thematically and survey data quantitatively. Results: Eighteen professionals and five AYAs attended the face-to-face Policy Lab, 16 surveys were completed, 13 attended the online workshop, three professionals were interviewed, and three AYAs attended the patient workshop. The Policy Lab generated eight national and six local recommendations, which were prioritised into three national priorities: 1. Launching the service specification supported by compelling communication; 2. Harnessing the ideas of young people; and 3. Evaluation of AYA patient outcomes/experiences and establishing a national dashboard of AYA cancer network performance. An animation was created by AYAs to inform local hospitals what matters to them most in the service specification. Conclusions: Policy and research evidence are not always aligned, so when emerging evidence does not support current guidance, further exploration is required. We have shown through multi-stakeholder involvement including young people that it was possible to gain a different interpretation based on current knowledge and context. This additional insight enabled practical recommendations to be identified to support the implementation of the service specification. Full article

Introduction: Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and children, as well as hospitalizations for respiratory infections in the pediatric population, representing a significant public health concern. Nirsevimab, a long-acting anti-RSV monoclonal antibody, has recently been approved by the European Medicines Agency (EMA). The aim of this study is to assess the utility of certain parameters, such as the Number Needed to Immunize (NNI), in supporting decision-makers regarding the introduction of nirsevimab as a universal prophylactic measure. Methods: A literature review was conducted to identify the definition and application of the NNI in the context of infectious disease prevention. The following online databases were consulted: Scopus, MEDLINE, Google Scholar, Web of Science, and Cochrane Library. The search was restricted to English-language texts published between 1 January 2000 and 30 January 2025. Results: The NNI represents the number of individuals who need to be immunized to prevent clinical outcomes such as medical visits and hospitalizations caused by infectious diseases. Six studies were identified that utilized this parameter to outline the benefits of immunization and describe the advantages of using monoclonal antibodies for RSV disease. Finelli and colleagues report that to prevent one RSV-related hospitalization, 37–85 infants aged 0–5 months and 107–280 infants aged 6–11 months would need to be immunized with long-acting anti-RSV antibodies. A recent study by Mallah et al. on the efficacy of nirsevimab estimates that the NNI required to prevent one RSV-related hospitalization is 25 infants. Studies by Francisco and O’Leary report NNI values of 82 and 128 infants, respectively, to prevent one RSV-related hospitalization with nirsevimab. Mallah et al. describe NNI as a metric useful to quantify the immunization effort needed to prevent a single RSV hospitalization. A recent Italian study reports that 35 infants need to be immunized to prevent one hospitalization due to RSV-LRTI and 3 infants need to be immunized to prevent one primary care visit due to RSV-LRTI. The studies indicate that the NNI for anti-RSV monoclonal antibodies is lower than the corresponding Number Needed to Vaccinate (NNV) for vaccines already included in national immunization programs. The main limitations of using this parameter include the absence of a shared threshold for interpreting results and the lack of consideration for the indirect effects of immunization on the population. Conclusions: The NNI is an easily understandable tool that can be used to convey the value of an immunization intervention to a variety of stakeholders, thereby supporting public health decision-making processes when considered in association with the uptake of the preventative strategy. At the current status, the estimated NNI of monoclonal antibodies against RSV results favourable and confirms the use in the first year of life for the prevention of RSV disease. Full article

This study examines the role of public–private partnerships in promoting the sustainable development of travel destinations through a comparative analysis of two emblematic heritage-based hospitality projects: Dar Tantora in Al Ula, Saudi Arabia, and Sextantio Le Grotte della Civita in Matera, Italy. These case studies were analysed through both architectural–urban and economic–legal perspectives to highlight how public–private partnership models can support heritage conservation, community engagement, and responsible tourism development. A mixed-methods approach was employed, combining quantitative indicators—such as projected profitability, tourist volume, and employment—with qualitative insights from interviews with key stakeholders. The analysis reveals that while both models prioritise cultural authenticity and adaptive reuse, they differ significantly in funding structures, legal frameworks, and governance dynamics. Dar Tantora exemplifies a top-down, publicly funded model integrated into Saudi Arabia’s Vision 2030 strategy, whereas Sextantio reflects a bottom-up, private initiative rooted in social enterprise. The findings offer insights into how different public–private partnership configurations can foster sustainable tourism development, depending on local context, institutional frameworks, and strategic goals. The study contributes to the broader discourse on regenerative tourism, architectural conservation, and policy-driven heritage reuse. Full article

Educators must understand current practices and gaps in knowledge regarding environmental sustainability in simulation education to reduce the environmental impact of plastic waste while still maintaining fidelity in simulation education. Therefore, a scoping review was conducted to answer the PICO question, “In healthcare institutions and hospitals, what are the environmentally sustainable practices that can be translated into simulation labs as best practice?” Fourteen studies were identified through a search of seven databases, critically appraised, and analyzed. Three key themes emerged: (1) the 5 R’s, (2) getting people motivated, and (3) larger external collaboration. These themes highlight practical strategies and motivational factors for sustainable practices. An expanded 5 R’s framework (reduce, reuse, recycle, research, and rethink) was introduced to guide a holistic approach. The literature highlights the importance of education, stakeholder engagement, and clearly defined standards as key drivers for motivating individuals and teams to engage in sustainable behaviors. These efforts are most effective when supported by interdisciplinary collaboration, regulatory frameworks, national policies, and technological innovation. Sustainability initiatives should extend beyond individual institutions to foster broader systemic change. Full article

Background: The Functional Resonance Analysis Method (FRAM) analyses discrepancies between written protocols (Work-as-Imagined) and real-world practice (Work-as-Done) in healthcare. Work-as-Done is created based on multiple stakeholders, leading to variability in reported functions. No guidance exists how to manage this variability. This study examines between-stakeholder variation in Work-as-Done and its impact on differences from Work-as-Imagined in FRAM visualisations. Methods: Two FRAM studies were analysed: delirium diagnosis and treatment (1) and perioperative anticoagulant management in two hospitals (2). Heatmaps visualised between-stakeholder variability of reported functions in Work-as-Done. We assessed the impact of including only functions shared by multiple stakeholders on Work-as-Imagined versus Work-as-Done comparisons. Results: In study 1, 23 of 33 functions were shared among at least two stakeholders. In study 2, stakeholders shared 30 of 33 functions in Hospital 1 and 29 of 32 functions in Hospital 2. Including or excluding functions, e.g., only mentioned by one stakeholder, influenced the observed differences between Work-as-Imagined and Work-as-Done. Conclusions: Between-stakeholder variability in both studies influenced differences between Work-as-Imagined and Work-as-Done, which often is the starting point improving the process. Showing between-stakeholder variability in FRAM studies enhances transparency in researcher decision-making. This supports more informed analysis and discussion in process improvement efforts. Full article

This study explores how private sector initiatives within the tourism industry can contribute to public health outcomes and Sustainable Development Goal 3 (SDG 3) through sustainable agricultural practices. Using a mixed-methods approach that combines a systematic literature review with an in-depth case study, the research examines how integrated strategies—such as pesticide-free farming, biodiversity enhancement, and edible landscape design—can reduce environmental health risks, improve nutritional quality, and promote local resilience. A series of sustainability interventions are analyzed using key performance indicators (KPIs) related to pesticide use, organic production, pollinator conservation, and community engagement. The findings reveal that business-led sustainability models can support systemic change when grounded in clear metrics and cross-sector collaboration. Although the absence of pre-2019 baseline data and direct health outcome measurements limit causal inference, the study provides a valuable blueprint for aligning private enterprise practices with global health and sustainability objectives. The implications are relevant for policymakers, hospitality operators, and public health stakeholders aiming to foster synergies between tourism, agriculture, and well-being. Full article

The equitable allocation of healthcare resources reflects social equity. Previous studies of healthcare accessibility have overlooked the impact of inter-city patient mobility on local residents’ and local residents’ multi-mode travel choices, distorting accessibility calculation outcomes. Taking the area within Beijing’s Sixth Ring Road as an example, this study established a Multi-Mode Accessibility Model for Local Residents (MMALR) to tertiary hospitals, using the proportion of non-local patients to adjust hospital supply capacity and considering the various travel mode shares from residential communities to hospitals to calculate the number of potential patients. We compared the changes in geospatial accessibility under different travel modes and employed the Gini coefficient to evaluate the geospatial equity of accessibility for different regions when using different accessibility methods. The results indicate that the spatial distribution of healthcare accessibility via different methods is similar, and it gradually decreases along subway lines from the urban center to the periphery. We found that the equities in access to high-level healthcare for Dongcheng District, Xicheng District, the area between the Third and Fourth Ring Road, and the area between the Fourth and Fifth Ring Road, display different ranking results across different methods, revealing that an unreasonable analysis framework could mislead the placement decisions for new hospitals or the allocation of medical resources. These findings emphasize the impact of inter-city patient mobility and the diversity of travel mode choices on accessibility. Our model can assist stakeholders in more accurately evaluating the accessibility and equity of local residents in terms of tertiary hospitals, which is crucial for cities with abundant medical resources and superior conditions. Our analytical findings provide a scientific basis for the location decisions of tertiary hospitals. Full article

Although open innovation is not novel within the business sector, it has recently garnered increasing scholarly interest. However, empirical investigations applying this concept to the tourism industry remain scarce. Despite tourism being one of the most significant contributors to the global economy, it continues to face persistent challenges, including political standpoints. Within this context, implementing open innovation emerges as a potentially transformative strategy. This study examines the application of open innovation to the tourism industry. Drawing upon a detailed analysis of 35 peer-reviewed articles retrieved from the Scopus database, the study adopts the PRISMA methodology to ensure methodological rigor and transparency. Articles were retrieved using a predefined search string: “Open innovation” AND “tourism industry” OR “tourism” OR “hospitality” OR “hotels” OR “leisure”. The selection process followed the PRISMA guidelines and included only peer-reviewed journal articles in English within Business and Economics. The findings reveal that open innovation enables stakeholder collaboration, supports service and experience co-creation, and facilitates digital and organizational transformation across diverse tourism contexts. The analysis shows that recent contributions in this field tend to converge around four key thematic areas: the role of open innovation in enhancing destination branding and experiential value; the importance of stakeholder collaboration and co-creation; the internal dynamics of employee empowerment and innovation culture within tourism firms; and the strategic use of digital technologies to drive transformation and resilience in the face of industry challenges. Full article

This paper aims to compare the perceptions of hotel customers and hotel staff regarding the value of green hotel attributes. By examining both stakeholder groups, the study addresses a gap in sustainable hospitality research, which largely overlooks employee perspectives in favour of customer preferences. An exploratory, cross-sectional survey was conducted using structured questionnaires, administered to hotel guests (n = 307) and hotel staff (n = 89) in Porto, Portugal. Respondents rated 15 green hotel attributes using a five-point Likert scale. Demographic data were also collected to analyse perceptual differences across gender, age, income, and education. The results revealed that both customers and staff exhibited environmental awareness, though their prioritisation of specific green practices differed. Customers tended to value visible environmental measures, such as recycling bins, energy-saving light bulbs, and renewable energy signage, while staff placed greater emphasis on operational sustainability aspects, including low-flow plumbing fixtures, refillable soap dispensers, and durable goods used in service areas. These differences reflect the stakeholders’ distinct roles and experiences within the hotel ecosystem. This study enriches the discourse on sustainable hospitality by providing a dual-stakeholder analysis of green hotel attributes using a shared evaluative framework. The findings offer practical insights for hotel managers aligning sustainability strategies with the expectations of both guests and employees, supporting more effective and inclusive green implementation in the lodging sector. Full article

Healthcare is a dynamic and ever-changing phenomenon and is subject to multiple challenges, particularly concerning sustainability and cost issues. The literature identifies bed space and problems related to the lack of hospital beds as being directly or indirectly related to both admission and discharge processes, with delays in in-patient discharges being identified as a variable of significance when it comes to a health system’s overall performance. In this respect, the aim of this research was to explore factors related to delayed discharges in an acute hospital setting in Malta, a small European member state, through the perspectives of health professionals. This study followed a qualitative approach. Semi-structured interviews (n = 8) and focus groups (n = 2) were conducted with a diverse group of experienced health professionals. Informed consent was obtained from all participants, and all data were treated with strict confidentiality throughout the study. The sample was limited to professionals working in adult, non-specialized healthcare settings. Manual thematic analysis was carried out. Codes were grouped to derive seven main themes, which were identified after carrying out the thematic analysis process on the transcripts of the interviews/focus groups. The derived themes are the following: (a) a faulty system, which is open to abuse and inefficiency, (b) procedural delays directly impacting delayed discharges, (c) long-term care/social cases as a major cause of delayed discharges, (d) the impact of external factors on delayed discharges, (e) stakeholder suggestions to management to counteract delayed discharges, (f) the impact of COVID-19 on delayed discharges, and (g) inter-professional relationships. Factors related to delayed discharges and the effects of delayed discharges on the hospital emerged from the main findings, together with specific potential interventions to minimise delays in discharge. Health professional interactions and the effects of inter-professional relationship setbacks on delayed discharges were explored, and the impact of the COVID-19 pandemic on hospital dynamics and additional delays were also addressed. This information is intended to provide hospital administrators with data-driven internal organisational evidence to guide them through changes and to inform future decisions regarding hospital performance and efficiency from a discharge delay perspective. Full article

The present study explores residents’ perceptions of Stintino (Sardinia, Italy) as a tourist destination. The municipality is predominantly known for La Pelosa beach, widely regarded as one of the most attractive coastal sites in Europe. However, its popularity has raised critical issues related to carrying capacity and seasonal overcrowding, contributing to a tourism model centered almost exclusively on beach-related activities. This study aims to investigate how locals conceptualize their place beyond the dominant seaside narrative, particularly considering Stintino’s identity as a former fishing village with a strong maritime tradition. As part of Italy’s designated inner areas, Stintino also embodies a deep-rooted connection to cultural heritage, further reinforcing the need for its preservation. Adopting a photovoice-based participatory visual methodology, this study engaged 15 local stakeholders from key sectors (hospitality, fishing tourism, retail, gastronomy, and cultural institutions) who produced and discussed photographic representations of their lived experience of the territory. The visual material was thematically analyzed using a conceptual framework informed by theories of place perception and social representations. The findings suggested a multifaceted territorial storytelling rooted in local heritage, symbolic spaces, and everyday practices. Tourism governance strategies could incorporate community-based approaches, such as participatory mapping and inclusive narrative development, to foster more sustainable and place-sensitive promotion models. Full article

Teachers with mental illness are vulnerable to work-related triggers that can lead to relapse, affecting their mental health and ability to recover, stay employed, and deliver quality education. This empirical study explored such triggers among public school teachers in Limpopo Province, South Africa. Using Bronfenbrenner’s Ecological Systems Theory, a qualitative phenomenological design was adopted. Semi-structured face-to-face interviews were conducted with 14 participants that were purposively selected across four hospitals. Data were audio-recorded, transcribed verbatim, and analyzed using Tesch’s eight-step open-coding method. Findings revealed being gossiped about by colleagues, excessive workload, limited leadership and parental support, classroom management challenges, high performance expectations without support, and inadequate teacher mental health policies in schools. These triggers can lead to frequent absenteeism and poor teaching outcomes. They will further increase the risk of medication resistance and long-term cognitive decline due to progressive structural brain damage as a result of multiple relapses. The study highlights the urgent need for multi-stakeholder collaboration, including clinicians, academic institutions, union representatives, and the Department of Basic Education, to co-develop effective, context-sensitive strategies to mitigate work-related triggers of mental illness relapse. These strategies are not only essential for enabling long-term workforce participation but also advancing sustainable mental health and well-being. Full article

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems. Full article