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18 pages, 1872 KB  
Article
Consensus-Driven Evaluation of Current Practices and Innovation Feasibility in Chronic Brain Injury Rehabilitation
by Helena Bascuñana-Ambrós, Lourdes Gil-Fraguas, Carolina De Miguel-Benadiba, Jan Ferrer-Picó, Michelle Catta-Preta, Alex Trejo-Omeñaca and Josep Maria Monguet-Fierro
Healthcare 2025, 13(21), 2725; https://doi.org/10.3390/healthcare13212725 - 28 Oct 2025
Viewed by 198
Abstract
Background: Chronic Brain Injury (CBI) is a lifelong condition requiring continuous adaptation by patients, families, and healthcare professionals. Transitioning rehabilitation toward patient-centered and self-management approaches is essential, yet remains limited in Spain. Methods: We conducted a two-phase consensus study in collaboration with the [...] Read more.
Background: Chronic Brain Injury (CBI) is a lifelong condition requiring continuous adaptation by patients, families, and healthcare professionals. Transitioning rehabilitation toward patient-centered and self-management approaches is essential, yet remains limited in Spain. Methods: We conducted a two-phase consensus study in collaboration with the Spanish Society of Physical Medicine and Rehabilitation (SERMEF) and the Spanish Federation of Brain Injury (FEDACE). In Phase 1, surveys were distributed to patients (214 invited; 95 complete responses, 44.4%) and physiatrists (256 invited; 106 valid responses, 41.4%) to capture perceptions of current rehabilitation practices, including tele-rehabilitation. Differences and convergences between groups were analyzed using a Synthetic Factor (F). In Phase 2, a panel of 21 experts applied a real-time eDelphi process (SmartDelphi) to assess the feasibility of proposed innovations, rated on a six-point Likert scale. Results: Patients and professionals showed both alignment and divergence in their views. Patients reported lower involvement of rehabilitation teams and expressed more reluctance toward replacing in-person care with telemedicine. However, both groups endorsed hybrid models and emphasized the importance of improved communication tools. Expert consensus prioritized feasible interventions such as online orthopedic renewal services, hybrid care models, and educational video resources, while less feasible options included informal communication platforms (e.g., WhatsApp) and bidirectional teleconsultations. Recommendations were consolidated into five domains: (R1) systemic involvement of rehabilitation teams in chronic care, (R2) patient and caregiver education, (R3) self-management support, (R4) communication tools, and (R5) socialization strategies. Conclusions: This study demonstrates the value of combining patient and professional perspectives through digital Delphi methods to co-design innovation strategies in CBI rehabilitation. Findings highlight the need to strengthen communication, provide structured education, and implement hybrid care models to advance patient-centered rehabilitation. The methodology itself fostered engagement and consensus, underscoring its potential as a tool for participatory healthcare planning. Full article
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11 pages, 601 KB  
Article
The Development of iA CuffLink for Rotator Cuff Repair Telerehabilitation
by Connor Luck, Rachel E. Roos, Jennifer Lambiase, Michelle Riffitts, Leslie Scholle, Simran Kulkarni, Dharma Parmanto, Vayu Putraadinatha, Made D. Yoga, Stephany N. Lang, Erica Tatko, Jim Grant, Jennifer I. Oakley, Ashley Disantis, Andi Saptono, Bambang Parmanto, Adam Popchak, Kevin M. Bell and Michael P. McClincy
Sensors 2025, 25(20), 6417; https://doi.org/10.3390/s25206417 - 17 Oct 2025
Viewed by 279
Abstract
Proper rehabilitation following rotator cuff repair (RCR) is necessary for successful postoperative outcomes, though the average course of physical therapy (PT) is lengthy and costly. The goals of this study were to (1) develop exercise programs for the CuffLink mHealth system and (2) [...] Read more.
Proper rehabilitation following rotator cuff repair (RCR) is necessary for successful postoperative outcomes, though the average course of physical therapy (PT) is lengthy and costly. The goals of this study were to (1) develop exercise programs for the CuffLink mHealth system and (2) evaluate early prototype efforts at meeting the needs of RCR clients. A panel of 24 clinicians participated in a Delphi study to identify consensus in rehabilitation, key informatic needs, and appropriate interface modalities for client usage. Utilizing the Delphi findings, the iA CuffLink mHealth system was developed, and a pilot evaluation assessed the feasibility and usability of CuffLink through the mHealth App Usability Questionnaire (MAUQ). During the pilot evaluation, the overall MAUQ score was 6.14. All participants (n = 18) viewed messaging the care team and a real time rep counter as “important” or “very important”. All participants either agreed or strongly agreed that quantifying progress would help motivate them to be compliant, and that the app helped them achieve their recovery outcomes compared to the shoulder device alone. Participants were generally pleased with the ease of use, information arrangement, and usefulness of CuffLink. These findings can advance our understanding of the informatics and usability needs in telerehabilitation systems. Full article
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29 pages, 1150 KB  
Review
What Helps or Hinders Annual Wellness Visits for Detection and Management of Cognitive Impairment Among Older Adults? A Scoping Review Guided by the Consolidated Framework for Implementation Research
by Udoka Okpalauwaekwe, Hannah Franks, Yong-Fang Kuo, Mukaila A. Raji, Elise Passy and Huey-Ming Tzeng
Nurs. Rep. 2025, 15(8), 295; https://doi.org/10.3390/nursrep15080295 - 12 Aug 2025
Viewed by 1013
Abstract
Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: [...] Read more.
Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article
(This article belongs to the Section Nursing Care for Older People)
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13 pages, 538 KB  
Article
Stereotactic Body Radiotherapy for the Treatment of Oligometastases Located in the Peritoneum or in the Abdominal Wall: Preliminary Results from a Mono-Institutional Analysis
by Francesco Cuccia, Salvatore D’Alessandro, Marina Campione, Vanessa Figlia, Gianluca Mortellaro, Antonio Spera, Giulia Musicò, Antonino Abbate, Salvatore Russo, Carlo Messina, Giuseppe Carruba, Livio Blasi and Giuseppe Ferrera
J. Pers. Med. 2025, 15(7), 312; https://doi.org/10.3390/jpm15070312 - 14 Jul 2025
Viewed by 845
Abstract
Purpose/Objective(s): Peritoneal carcinosis can occur in several gastrointestinal or gynecological malignancies and its prognosis is usually poor. With the advent of more effective systemic agents, the overall survival of metastatic patients has been revolutionized and isolated peritoneal or abdominal wall metastases might benefit [...] Read more.
Purpose/Objective(s): Peritoneal carcinosis can occur in several gastrointestinal or gynecological malignancies and its prognosis is usually poor. With the advent of more effective systemic agents, the overall survival of metastatic patients has been revolutionized and isolated peritoneal or abdominal wall metastases might benefit from local treatments; Stereotactic Body Radiotherapy (SBRT) might be considered in selected patients with oligometastatic presentation. Materials/Methods: Oligometastases were defined according to recent ESTRO/EORTC consensus. Inclusion criteria were as follows: ECOG PS ≤ 2, written informed consent, up to five lesions to be treated at the same time, patients treated with radiotherapy schedules applying minimum 6 Gy per fraction. The primary endpoint of the study was local control (LC); acute and late toxicity, distant progression-free survival (DPFS), time-to-next systemic treatment (TNST), polymetastatic-free survival (PMFS) and overall survival (OS) were secondary endpoints. Toxicity was assessed according to CTCAE criteria v5.0. Statistical associations between clinical variables and outcomes were assessed using Fisher’s exact test, and Kruskal–Wallis test, as appropriate. Survival outcomes were estimated using the Kaplan–Meier method and compared using the log-rank test. Results: Between April 2020 and September 2024 a total of 26 oligometastatic lesions located in the peritoneum or in the abdominal wall detected in 20 patients received SBRT with Helical Tomotherapy. All cases have been assessed by a multidisciplinary team. Only in three patients out of twenty did more than one lesion receive SBRT: two lesions in two patients, and five lesions in a single case of colorectal cancer with ongoing third-line systemic treatment. Median total dose was 30 Gy (27–35 Gy) in five fractions (3–5). The most frequent primary neoplasm was ovarian cancer in 14/20, endometrial in 2/20, while the remaining were colorectal, vaginal, pancreatic and non-small cell lung cancer. Four lesions were located in the abdominal wall, while the remaining twenty-two were located in the peritoneum. Concurrent systemic therapy was administered in 18/20 patients. With a median follow-up of 15 months (range, 6–59), our 1-year LC was 100%, while 1-year DPFS, PMFS, TNTS and OS rates were 54%, 69%, 61% and 83%, respectively. Abdominal wall location and treatment of a subsequent oligometastatic recurrence with a second course of SBRT were both significantly associated with improved OS (p = 0.03 and p = 0.04, respectively). No G ≥ 3 adverse events occurred. Conclusion: Our preliminary data support the use of SBRT in selected cases of oligometastatic disease located in the peritoneum or in the abdominal wall with excellent results in terms of tolerability and promising clinical outcomes. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Treatment of Oligometastatic Disease)
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14 pages, 751 KB  
Article
Comparison of Validity and Reliability of Manual Consensus Grading vs. Automated AI Grading for Diabetic Retinopathy Screening in Oslo, Norway: A Cross-Sectional Pilot Study
by Mia Karabeg, Goran Petrovski, Katrine Holen, Ellen Steffensen Sauesund, Dag Sigurd Fosmark, Greg Russell, Maja Gran Erke, Vallo Volke, Vidas Raudonis, Rasa Verkauskiene, Jelizaveta Sokolovska, Morten Carstens Moe, Inga-Britt Kjellevold Haugen and Beata Eva Petrovski
J. Clin. Med. 2025, 14(13), 4810; https://doi.org/10.3390/jcm14134810 - 7 Jul 2025
Viewed by 1272
Abstract
Background: Diabetic retinopathy (DR) is a leading cause of visual impairment worldwide. Manual grading of fundus images is the gold standard in DR screening, although it is time-consuming. Artificial intelligence (AI)-based algorithms offer a faster alternative, though concerns remain about their diagnostic reliability. [...] Read more.
Background: Diabetic retinopathy (DR) is a leading cause of visual impairment worldwide. Manual grading of fundus images is the gold standard in DR screening, although it is time-consuming. Artificial intelligence (AI)-based algorithms offer a faster alternative, though concerns remain about their diagnostic reliability. Methods: A cross-sectional pilot study among patients (≥18 years) with diabetes was established for DR and diabetic macular edema (DME) screening at the Oslo University Hospital (OUH), Department of Ophthalmology, and the Norwegian Association of the Blind and Partially Sighted (NABP). The aim of the study was to evaluate the validity (accuracy, sensitivity, specificity) and reliability (inter-rater agreement) of automated AI-based compared to manual consensus (MC) grading of DR and DME, performed by a multidisciplinary team of healthcare professionals. Grading of DR and DME was performed manually and by EyeArt (Eyenuk) software version v2.1.0, based on the International Clinical Disease Severity Scale (ICDR) for DR. Agreement was measured by Quadratic Weighted Kappa (QWK) and Cohen’s Kappa (κ). Sensitivity, specificity, and diagnostic test accuracy (Area Under the Curve (AUC)) were also calculated. Results: A total of 128 individuals (247 eyes) (51 women, 77 men) were included, with a median age of 52.5 years. Prevalence of any vs. referable DR (RDR) was 20.2% vs. 11.7%, while sensitivity was 94.0% vs. 89.7%, specificity was 72.6% was 83.0%, and AUC was 83.5% vs. 86.3%, respectively. DME was detected only in one eye by both methods. Conclusions: AI-based grading offered high sensitivity and acceptable specificity for detecting DR, showing moderate agreement with manual assessments. Such grading may serve as an effective screening tool to support clinical evaluation, while ongoing training of human graders remains essential to ensure high-quality reference standards for accurate diagnostic accuracy and the development of AI algorithms. Full article
(This article belongs to the Special Issue Artificial Intelligence and Eye Disease)
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19 pages, 2049 KB  
Review
DSC Perfusion MRI Artefact Reduction Strategies: A Short Overview for Clinicians and Scientific Applications
by Chris W. J. van der Weijden, Ingomar W. Gutmann, Joost F. Somsen, Gert Luurtsema, Tim van der Goot, Fatemeh Arzanforoosh, Miranda C. A. Kramer, Anne M. Buunk, Erik F. J. de Vries, Alexander Rauscher and Anouk van der Hoorn
J. Clin. Med. 2025, 14(13), 4776; https://doi.org/10.3390/jcm14134776 - 6 Jul 2025
Viewed by 1099
Abstract
MRI perfusion is used to diagnose and monitor neurological conditions such as brain tumors, stroke, dementia, and traumatic brain injury. Dynamic Susceptibility Contrast (DSC) is the most widely available quantitative MRI technique for perfusion imaging. Even in its most basic implementation, DSC MRI [...] Read more.
MRI perfusion is used to diagnose and monitor neurological conditions such as brain tumors, stroke, dementia, and traumatic brain injury. Dynamic Susceptibility Contrast (DSC) is the most widely available quantitative MRI technique for perfusion imaging. Even in its most basic implementation, DSC MRI provides critical hemodynamic metrics like cerebral blood flow (CBF), blood volume (CBV), mean transit time (MTT), and time between the peak of arterial input and residue function (Tmax), through the dynamic tracking of a gadolinium-based contrast agent. Notwithstanding its high clinical importance and widespread use, the reproducibility and diagnostic reliability are impeded by a lack of standardized pre-processing protocols and quality controls. A comprehensive literature review and the authors’ aggregated experience identified common DSC MRI artefacts and corresponding pre-processing methods. Pre-processing methods to correct for artefacts were evaluated for their practical applicability and validation status. A consensus on the pre-processing was established by a multidisciplinary team of experts. Acquisition-related artefacts include geometric distortions, slice timing misalignment, and physiological noise. Intrinsic artefacts include motion, B1 inhomogeneities, Gibbs ringing, and noise. Motion can be mitigated using rigid-body alignment, but methods for addressing B1 inhomogeneities, Gibbs ringing, and noise remain underexplored for DSC MRI. Pre-processing of DSC MRI is critical for reliable diagnostics and research. While robust methods exist for correcting geometric distortions, motion, and slice timing issues, further validation is needed for methods addressing B1 inhomogeneities, Gibbs ringing, and noise. Implementing adequate mitigation methods for these artefacts could enhance reproducibility and diagnostic accuracy, supporting the growing reliance on DSC MRI in neurological imaging. Finally, we emphasize the crucial importance of pre-scan quality assurance with phantom scans. Full article
(This article belongs to the Special Issue Recent Advancements in Nuclear Medicine and Radiology)
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33 pages, 833 KB  
Systematic Review
Enhanced Recovery After Cardiac Surgery for Minimally Invasive Valve Surgery: A Systematic Review of Key Elements and Advancements
by Simon Goecke, Leonard Pitts, Martina Dini, Matteo Montagner, Leonhard Wert, Serdar Akansel, Markus Kofler, Christian Stoppe, Sascha Ott, Stephan Jacobs, Benjamin O’Brien, Volkmar Falk, Matthias Hommel and Jörg Kempfert
Medicina 2025, 61(3), 495; https://doi.org/10.3390/medicina61030495 - 13 Mar 2025
Cited by 6 | Viewed by 4100
Abstract
Background and Objectives: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into [...] Read more.
Background and Objectives: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into MIVS programs and evaluates their impact on perioperative outcomes and patient recovery. Materials and Methods: A systematic search of PubMed/Medline, conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, identified studies on ERAS in MIVS patients. Coronary and robotic surgery were excluded to prioritize widely adopted minimally invasive valve methods. Studies were included if they applied ERAS protocols primarily to MIVS patients, with at least five participants per study. Data on study characteristics, ERAS components, and patient outcomes were extracted for analysis. Results: Eight studies met the inclusion criteria, encompassing 1287 MIVS patients (842 ERAS, 445 non-ERAS). ERAS protocols in MIVS were heterogeneous, with studies implementing 9 to 18 of 24 ERAS measures recommended by the ERAS consensus guideline, reflecting local hospital practices and resource availability. Common elements include patient education and multidisciplinary teams, early extubation followed by mobilization, multimodal opioid-sparing pain management, and timely removal of invasive lines. Despite protocol variability, these programs were associated with reduced morbidity, shorter hospital stays (intensive care unit-stay reductions of 4–20 h to complete omission, and total length of stay by ≥1 day), and cost savings of up to EUR 1909.8 per patient without compromising safety. Conclusions: ERAS protocols and MIVS synergistically enhance recovery and reduce the length of hospital stay. Standardizing ERAS protocols for MVS could amplify these benefits and broaden adoption. Full article
(This article belongs to the Section Cardiology)
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11 pages, 605 KB  
Article
Palliative Care in the Community and the Relevance of Percutaneous Endoscopic Gastrostomy Placement to Quality of Life and Survival
by Júlia Magalhães, Hugo Ribeiro, Inês Rodrigues, Elisabete Costa, João Rocha Neves, José Paulo Andrade, António Bernardes and Marília Dourado
J. Dement. Alzheimer's Dis. 2025, 2(1), 5; https://doi.org/10.3390/jdad2010005 - 1 Mar 2025
Cited by 1 | Viewed by 1925
Abstract
Introduction: Percutaneous endoscopic gastrostomy (PEG) placement does not generate consensus in palliative care, given the existing doubts about whether it significantly contributes to an improvement in patient outcomes such as survival, quality of life and symptomatic control. Objective: This study explored [...] Read more.
Introduction: Percutaneous endoscopic gastrostomy (PEG) placement does not generate consensus in palliative care, given the existing doubts about whether it significantly contributes to an improvement in patient outcomes such as survival, quality of life and symptomatic control. Objective: This study explored the impact of percutaneous endoscopic gastrostomy placement on survival and quality of life in patients under community palliative care in Northern Portugal. Methods: This observational, retrospective cohort study involved 54 patients monitored by a specialized palliative care team between March 2020 and December 2023. The key outcomes assessed included the survival rates, the main diagnoses leading to PEG requests, and the influence of PEG placement on survival and the place of death. Results: The statistical analysis revealed that the survival time was significantly longer in females compared to males (p = 0.003). The main reason for PEG requests was dysphagia, especially in patients with dementia and oncological diseases. No significant correlations were found between PEG placement and the age at death, survival time, or palliative performance scores (PPS). However, the study identified a moderate positive correlation between the follow-up time and survival after PEG placement (r = 0.457, p < 0.001) and a low rate of complications (11% of patients with minor complications and none with severe complications). Conclusions: This study emphasizes the role of timely PEG placement and social support in improving patient outcomes. Additionally, patients whose PEG was requested by the study’s palliative care team demonstrated better survival outcomes compared to those referred by other teams. The findings underscore the need for individualized decision-making in PEG placement and suggest that this procedure is safe and increases patient longevity and quality of life, avoiding the high rate of complications associated with nasogastric tubes in fragile patients in need of specialized palliative care. Full article
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20 pages, 901 KB  
Article
Exploring a Co-Designed Approach for Healthcare Quality Improvement—Learning Through Developmental Evaluation
by Katharina Kovacs Burns and Marian George
Healthcare 2025, 13(3), 311; https://doi.org/10.3390/healthcare13030311 - 3 Feb 2025
Viewed by 2087
Abstract
Background: Healthcare setting teams were challenged to understand how and what to measure regarding healthcare quality improvement (HQI), who should be involved, and what approach to apply. We aimed to determine if a generic co-design approach involving patients/families, multi-disciplinary care providers, and other [...] Read more.
Background: Healthcare setting teams were challenged to understand how and what to measure regarding healthcare quality improvement (HQI), who should be involved, and what approach to apply. We aimed to determine if a generic co-design approach involving patients/families, multi-disciplinary care providers, and other staff was feasible to apply for HQI across diverse care settings. Developmental evaluation embedded in the co-design approach would determine its effectiveness, challenges, and other experiences across care settings and teams. Methods: Twenty-two acute and community care settings agreed to participate in applying a phased co-design approach to their HQI initiatives, including developmental evaluation. Each care setting team received co-design orientation and support. Semi-structured interviews and focus groups were conducted with patient/family advisors (PFAs) and care setting staff/care providers to gather their experiences with the co-design approach applied to their phased HQI work. Transcripts were thematically analyzed and triangulated with observation notes of care setting team discussions. Experiences were gathered from 17 PFAs and 68 staff/care providers across the 22 participating healthcare settings. Results: Themes for the orientation and each phase emphasized the importance of participants’ understanding, engagement, and ongoing open communication throughout the HQI co-design process. The orientation was viewed as key to facilitating good outcomes. Participants valued working together, gathering real-time experiences to “make a difference”, and having PFA voices involved in co-designing the HQI initiatives. Challenges were identified, including time commitment. Conclusions: Based on the overall developmental evaluation findings, there was consensus that a generic co-design of HQI initiatives was effective, feasible, and sustainable across care settings. Full article
(This article belongs to the Special Issue Improving Healthcare Quality)
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20 pages, 769 KB  
Article
A Critical Success Factors Framework for the Improved Delivery of Social Infrastructure Projects in South Africa
by Alfred R. Rasebotsa, Justus N. Agumba, Oluseyi J. Adebowale, David J. Edwards and John Posillico
Buildings 2025, 15(1), 92; https://doi.org/10.3390/buildings15010092 - 30 Dec 2024
Cited by 2 | Viewed by 3300
Abstract
Social infrastructure projects (SIPs) play a critical role in fostering social and economic development in the public sector. However, SIPs often face significant challenges, partly due to a lack of research on critical success factors (CSFs) specific to these projects. Despite the importance [...] Read more.
Social infrastructure projects (SIPs) play a critical role in fostering social and economic development in the public sector. However, SIPs often face significant challenges, partly due to a lack of research on critical success factors (CSFs) specific to these projects. Despite the importance of SIPs, scant research focuses upon enhancing SIPs’ performance. Consequently, a CSF framework is developed for improving the delivery of SIPs in South Africa. Through a quantitative survey of 124 construction professionals, the study identified key factors essential for successful SIPs delivery. Data were analysed using descriptive and inferential statistics, revealing a significant consensus among infrastructure stakeholders on CSFs needed for successful SIP delivery. Constituent elements of the framework integrate CSFs related to clients, contractors, projects and project management factors; external factors were excluded from the framework due to a lack of supporting evidence. The study offers a practical understanding for infrastructure stakeholders in South Africa to: overcome the challenges that hinder SIPs’ performance; and enhance the SIP delivery processes. Cumulatively, these palpable deliverables contribute to the nation’s social and economic development objectives. While the research is focused on South Africa, the CSFs framework could inform SIP delivery strategies in similar socio-economic and institutional contexts globally. The study reveals that SIP success depends on the identified factors and offers a structured framework for improving project outcomes. The framework highlights CSFs, including effective monitoring and timely decision-making for clients; subcontractor coordination and quality assurance for contractors; economic stability and advanced technology for projects; and team collaboration and expertise utilisation for project management. This systematic approach could enhance effective planning, execution and evaluation of SIPs, leading to more efficient delivery. However, the study’s focus on the Mpumalanga and Limpopo provinces limits the generalisability of the findings to other regions with different socio-economic and environmental conditions. Therefore, future research could explore the applicability of this framework in diverse social, political, and geographical contexts. Full article
(This article belongs to the Section Construction Management, and Computers & Digitization)
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20 pages, 1777 KB  
Article
Improvements for the Planning Process in the Scrum Method
by Miroslav Žáček, Adéla Hamplová, Jan Tyrychtr and Ivan Vrana
Appl. Sci. 2025, 15(1), 202; https://doi.org/10.3390/app15010202 - 29 Dec 2024
Cited by 1 | Viewed by 2957
Abstract
In today’s dynamic development environments, agile methodologies like Scrum are essential for effective software project management. Despite its popularity, the Scrum framework’s reliance on subjective intuition during the sprint planning process can lead to inconsistencies and project delays. This study aims to enhance [...] Read more.
In today’s dynamic development environments, agile methodologies like Scrum are essential for effective software project management. Despite its popularity, the Scrum framework’s reliance on subjective intuition during the sprint planning process can lead to inconsistencies and project delays. This study aims to enhance the sprint planning phase by integrating the BeCoMe method, which is a mathematical approach designed to optimize task selection through structured compromise solutions. Utilizing a soft systems methodology, this research identifies and analyzes the existing inefficiencies in Scrum’s planning process. The implementation of the BeCoMe method in a real-world case study demonstrated significant improvements in task completion rates and overall project efficiency. The method’s structured process reduces biases, fosters team consensus, and enhances decision-making accuracy. The findings suggest that incorporating the BeCoMe method into Scrum can substantially mitigate risks, save time, and improve project outcomes by ensuring a more objective and data-driven approach to sprint planning. These insights are crucial for developers managing modern software projects, offering a robust framework for enhancing planning efficiency and success rates. Full article
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12 pages, 1614 KB  
Commentary
Wildfire Smoke Exposure During Pregnancy: Consensus-Building to Co-Create a Community-Engaged Study
by Kelsie Young, Kim Alisa Brown, Lynda Crocker Daniel, Katherine Duarte and Diana Rohlman
Int. J. Environ. Res. Public Health 2024, 21(11), 1513; https://doi.org/10.3390/ijerph21111513 - 14 Nov 2024
Viewed by 1571
Abstract
Relative to other Oregon counties, Klamath County experiences worse air quality due to wildfire smoke, as well as elevated rates of infant mortality and low birthweight. Klamath County Public Health (KCPH) raised concerns that wildfire smoke is a contributor to poor infant health. [...] Read more.
Relative to other Oregon counties, Klamath County experiences worse air quality due to wildfire smoke, as well as elevated rates of infant mortality and low birthweight. Klamath County Public Health (KCPH) raised concerns that wildfire smoke is a contributor to poor infant health. Thus, we built a multidisciplinary team and designed a community-engaged research (CEnR) project to capture community and individual-level exposure to wildfire smoke contaminants, alongside perinatal health outcomes. Through partnerships, we identified 24 individuals across academic, public health, and community organizations that met five times over three months to develop a study design. We initially used a modified Delphi method, but adjusted our approach to find multidisciplinary areas of agreement across a highly diverse team. Our team used structured meetings, surveys, and iterative feedback to build consensus on a study design. KCPH and our community partners reviewed and approved all proposed activities to ensure community input was integrated. The resultant study, trialed in Klamath County, included the use of environmental, residential, and personal samplers and health surveys with a cohort of pregnant individuals during the wildfire season. We discuss the advantages and challenges of building a multidisciplinary CEnR study in a rural county disproportionately impacted by wildfire smoke and infant mortality. Full article
(This article belongs to the Section Environmental Health)
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19 pages, 4573 KB  
Article
A Real Time Delphi Study on the Challenges and Adverse Events to Percutaneous Osseointegrated Implant Integration and Long-Term Fixation in Limb Amputation
by Kirstin Ahmed and Max Ortiz-Catalan
Prosthesis 2024, 6(5), 1262-1280; https://doi.org/10.3390/prosthesis6050091 - 21 Oct 2024
Cited by 2 | Viewed by 2554
Abstract
Percutaneous Osseointegrated Implants (POI) affix artificial limbs to the body after amputation. Several adverse events challenge mainstream uptake of this technology. This study aims to achieve a consensus regarding “the challenges and adverse events to POI integration and long-term fixation in limb [...] Read more.
Percutaneous Osseointegrated Implants (POI) affix artificial limbs to the body after amputation. Several adverse events challenge mainstream uptake of this technology. This study aims to achieve a consensus regarding “the challenges and adverse events to POI integration and long-term fixation in limb amputation”. We sought a panel of clinical experts divided by profession into surgical, clinical, or clinical academic categories. We used a real time eDelphi method to develop consensus on both the challenges and adverse event items, enabling anonymity, iteration, controlled feedback, and statistical aggregation of group responses. The full panel agreed that the most impactful items are amongst 10 key challenges and eight adverse events. Panellists were in consensus regarding the five most impactful challenges, which were, in decreasing order: patient selection, absence of a multidisciplinary team, design of the implant, soft tissue stability and an experienced surgical team. Panellists considered the five most impactful adverse events, in decreasing order, to be the following: no biological fixation, deep infection, aseptic loosening, no mechanical fixation, and implant breakage. Consensus was obtained on implant breakage and deep infection items. The proportion of consensus from the whole panel across all items was in line with the literature, and we observed an improvement in consensus once the panel was stratified based on job, expertise and implant system. Full article
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21 pages, 1990 KB  
Article
BIM Use to Support the Technical Tasks in Construction Projects: A Case Study
by Wael Abdelhameed and Esam M. H. Ismaeil
Buildings 2024, 14(6), 1534; https://doi.org/10.3390/buildings14061534 - 25 May 2024
Cited by 4 | Viewed by 2728
Abstract
BIM use has proved to be inevitable in construction project phases, starting from the project initiation phase and ending with the project closeout phase. Through the use of 4D/5D/6D models in processes of the construction project such as scheduling, bills of quantities (BoQs), [...] Read more.
BIM use has proved to be inevitable in construction project phases, starting from the project initiation phase and ending with the project closeout phase. Through the use of 4D/5D/6D models in processes of the construction project such as scheduling, bills of quantities (BoQs), and environmental analysis, BIM provides massive assistance to all project participants. In addition, BIM has been utilized in facility management through the use of 7D models. These well-established benefits positively impact construction project variables: cost, time, and quality. Despite these invaluable contributions in construction projects, BIM is not extensively applied in the Gulf Cooperation Council (GCC) of Arab countries, especially in small/medium-scale construction projects. BIM use at these project scales is mainly exclusive to the design phases. The present use of BIM in GCC construction projects leads to the missing of numerous opportunities, which negatively affects project delivery methods, project timelines, and, consequently, project budgets. To shed more light on this subject, this research paper attempts to answer emerging questions, such as the following: How do BIM and other software programs support the technical team of construction projects? Do these software programs have a direct impact on construction project management, in terms of project timelines and work changes? Does BIM add unnecessary cost to the project budget? This research paper proposes four technical task groups used in construction project phases to evaluate the use of BIM and the associated software programs, namely technical work, Time and Accuracy, budget, and BoQ. These four task groups, moreover, have been ratified and are the subject of consensus by project managers and senior engineers in GCC construction projects, who provided the research primary data through interviews and field surveys. Qualitative and quantitative analyses were conducted to investigate and analyze the present status of BIM use in construction projects, and subsequently, to establish a basis to propose improvements to support the technical team of construction projects. Two approaches are proposed to overcome the obstacles that hinder BIM adoption in GCC countries. The first one is a top-down approach, in which BIM use and BIM documents are mandatory in construction projects. The second approach is a bottom-up approach, where having more BIM professionals in the GCC market will facilitate the transformation to BIM. Full article
(This article belongs to the Section Construction Management, and Computers & Digitization)
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15 pages, 3098 KB  
Article
Magnetoencephalography Atlas Viewer for Dipole Localization and Viewing
by N.C.d. Fonseca, Jason Bowerman, Pegah Askari, Amy L. Proskovec, Fabricio Stewan Feltrin, Daniel Veltkamp, Heather Early, Ben C. Wagner, Elizabeth M. Davenport and Joseph A. Maldjian
J. Imaging 2024, 10(4), 80; https://doi.org/10.3390/jimaging10040080 - 28 Mar 2024
Cited by 1 | Viewed by 2745
Abstract
Magnetoencephalography (MEG) is a noninvasive neuroimaging technique widely recognized for epilepsy and tumor mapping. MEG clinical reporting requires a multidisciplinary team, including expert input regarding each dipole’s anatomic localization. Here, we introduce a novel tool, the “Magnetoencephalography Atlas Viewer” (MAV), which streamlines this [...] Read more.
Magnetoencephalography (MEG) is a noninvasive neuroimaging technique widely recognized for epilepsy and tumor mapping. MEG clinical reporting requires a multidisciplinary team, including expert input regarding each dipole’s anatomic localization. Here, we introduce a novel tool, the “Magnetoencephalography Atlas Viewer” (MAV), which streamlines this anatomical analysis. The MAV normalizes the patient’s Magnetic Resonance Imaging (MRI) to the Montreal Neurological Institute (MNI) space, reverse-normalizes MNI atlases to the native MRI, identifies MEG dipole files, and matches dipoles’ coordinates to their spatial location in atlas files. It offers a user-friendly and interactive graphical user interface (GUI) for displaying individual dipoles, groups, coordinates, anatomical labels, and a tri-planar MRI view of the patient with dipole overlays. It evaluated over 273 dipoles obtained in clinical epilepsy subjects. Consensus-based ground truth was established by three neuroradiologists, with a minimum agreement threshold of two. The concordance between the ground truth and MAV labeling ranged from 79% to 84%, depending on the normalization method. Higher concordance rates were observed in subjects with minimal or no structural abnormalities on the MRI, ranging from 80% to 90%. The MAV provides a straightforward MEG dipole anatomic localization method, allowing a nonspecialist to prepopulate a report, thereby facilitating and reducing the time of clinical reporting. Full article
(This article belongs to the Section Neuroimaging and Neuroinformatics)
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