Health Services Optimization, Improvement, and Management: Worldwide Experiences

Background: Lean Management (LM) is recognized for its significant potential to improve efficiency and quality in healthcare. However, despite its promise, widespread and sustainable adoption across healthcare organizations remains paradoxically limited, with many initiatives failing to move beyond localized, short-term successes. This study examines the systemic barriers that hinder the long-term integration of LM in healthcare settings, to understand why a gap persists between its theoretical potential and practical reality. Methods: A systematic literature review was conducted following the PRISMA 2020 guidelines. A search of Scopus, Emerald Insight, PubMed/MEDLINE databases and Google Scholar was performed to identify peer-reviewed articles published in English between 2015 and 2025. The review focused on studies addressing the adoption, implementation, or sustainability of LM in healthcare. Data on measurement frameworks, influencing factors, and reported barriers were extracted and synthesized to develop an explanatory model. Results: The synthesis of the ten included studies yields three thematic clusters, each documented in the reviewed evidence and, in this analysis, connected as mutually reinforcing loops: (1) the Measurement–Accountability Gap, (2) the Tools–Philosophy Disconnect, and (3) the Complexity–Resistance Cycle. The proposed connections among these clusters are elaborated in the Discussion. Conclusions: The principal contribution is the synthesis of these previously reported barriers into an integrated conceptual model in which they are connected as mutually reinforcing mechanisms rather than treated as independent factors, offering healthcare leaders a structured perspective for interpreting the pattern of limited sustained adoption. Full article

Background: Thai obstetric nurses follow WHO gestational weight gain (GWG) guidelines to prevent gestational diabetes mellitus (GDM). However, these Western-derived guidelines misclassify approximately 16% of Thai pregnant women, who carry excess metabolic risk at lower BMI values than Western populations. Objectives: To derive and validate Thai-specific GWG targets using Thai BMI cut-points across five BMI subgroups and assess implications for nursing practice in GDM prevention. Methods: Retrospective cohort study of 1396 Thai singleton pregnancies at a maternal and child hospital (2023–2025). GWG targets were derived as interquartile ranges (P25–P75) from a healthy-outcomes subgroup (n = 706), with validity confirmed by multivariable logistic regression and a 70:30 derivation/validation split. Results: GDM prevalence was 15.8%, with a rising crude trend that was attenuated after accounting for a mid-study change in screening protocol. Provisional Thai-specific GWG targets were underweight/normal weight 11.5–18.0 kg, overweight 9.7–18.0 kg, obesity class I 9.1–16.0 kg, and obesity class II+ 5.8–12.1 kg. Inadequate GWG in obesity class I was associated with a 3.92-fold GDM risk increase (aOR 3.92, 95% CI 2.12–7.24, p < 0.001). Adherence improved from 34.7% (IOM 2009) to 50.2% with Thai-specific targets. Conclusions: These Thai-specific GWG targets are provisional, single-centre pilot estimates. They appear clinically safe and are substantially more achievable than IOM 2009 criteria and are offered to inform BMI-appropriate antenatal counselling and to justify a multi-centre validation study, rather than as ranges that are ready for immediate national adoption. Full article

Background: Quality perinatal health care depends considerably on health workforce competency. Improving Maternal and Child Health Nurse (MCHN) competency is urgently needed in low–middle-income countries, especially to manage key perinatal conditions related to prevalent poor maternal health outcomes, such as pre-eclampsia and hemorrhage. Objective: This study assesses the competency of MCHNs in addressing severe pre-eclampsia and antepartum hemorrhage. Methodology: A cross-sectional study was conducted from 4 November to 10 December 2022. A structured questionnaire and clinical vignettes concerning severe pre-eclampsia and antepartum hemorrhage were administered to all available MCHNs working at a convenience sample of 80 primary-level health facilities in southern Mozambique. Participant characteristics and competency scores were described using frequency distributions or measures of central tendency, as appropriate. Mixed-effects ordinal regression was used to assess the association between participant characteristics and competency levels. All analyses were performed using Jamovi version 2.6.22 at a 5% significance level. Results: Out of 191 participants, most (61.8%, 118) were mid-level MCHNs, with an average age of 33 years (95% CI: 32.05; 34.2). The majority (82.7%, 158) provided prenatal consultation on the day of the interview, and about half (50.7%, 97) knew the national standards for prenatal consultation. MCHNs scoring above 50 percentage points on competency comprised 44.5% (95% CI: 37.4; 51.6%). A higher level of knowledge about guidelines and equipment was associated with increased odds ratios for having a higher-level competency score (OR = 2.21 for “good” vs. reference “poor” competency; 95% CI: 1.07; 4.57, p < 0.033). Conclusions: About six in 10 MCHNs in Mozambique have poor competency in addressing severe pre-eclampsia and antepartum hemorrhage. The competency level was only associated with knowledge of standards. Full article

Background/Objectives: Improving the prevention and management of pressure injuries requires adequate nursing knowledge. In this context, understanding the current knowledge levels of nurses is important for informing educational and organizational strategies. This study aimed to assess the pressure injury knowledge of nurses at the national level and examine differences according to their educational, professional, and informational characteristics. Methods: A national cross-sectional quantitative study was conducted in public secondary-level hospitals in the Republic of Croatia. A total of 1139 participants from 19 hospitals across all four geographical regions of Croatia participated. The PZ-PUNKT instrument was used, and an analysis was conducted using descriptive and bivariate inferential statistics. Results: Participants with bachelor’s and master’s degrees achieved higher PZ-PUKT scores than those with secondary education (p = 0.026 to < 0.001), although the effect sizes were very small (ε² = 0.008–0.017). Significant differences were observed across clinical departments (p < 0.001; ε² = 0.03–0.04), whereas no statistically significant differences were found according to the frequency of working with patients with pressure injuries (p > 0.05). Participants who reported recently attending educational activities, consulting the professional literature, or searching for information achieved higher knowledge scores across all domains (p < 0.001); however, the effect sizes remained small (ε² = 0.034–0.060; rpb = 0.133–0.214). Conclusions: Although the observed effect sizes were generally small, higher knowledge scores were observed among nurses who reported recent engagement with educational activities, the professional literature, and information-seeking behaviors. No significant differences were identified according to the frequency of working with patients with pressure injuries. These findings provide a national overview of pressure injury knowledge among Croatian nurses and may inform future educational initiatives and research. Full article

Integrated care programs (ICPs) are associated with positive patient experiences, but provider experiences remain understudied. We examined burnout in healthcare providers working in an ICP that facilitates hospital-to-home care transitions for patients. We conducted a mixed-methods evaluation comprising a cross-sectional survey of burnout and provider experience using the Maslach Burnout Inventory, open-ended questions, and semi-structured interviews. Twenty-eight participants completed the surveys (31% response rate). Respondents were 75% female, and, on average, were 42 ± 10 years old, had spent 19 ± 11 months as providers in the ICP and had cared for a median of 170 (IQR = 245) patients. Twenty staff, who were 38 ± 8 years old on average and 95% women, were interviewed. Emotional exhaustion was low (average total score = 14 ± 7 out of 42), depersonalization was moderate (9 ± 6 out of 42), and personal achievement was high (40 ± 5 out of 48), corresponding to low-to-moderate burnout. Respondents cited teamwork as the leading protective factor against emotional exhaustion and positive impact on patients as the leading factor underlying high personal achievement. Perceived under-appreciation was the leading factor for depersonalization, likely moderated by team support and rapport. Burnout was low to moderate in our sample of ICP healthcare providers, who cited several important contextual factors requiring further study. Full article

Background: As Taiwan transitions into a super-aging society, the government has launched “Long-term Care (LTC) 3.0,” a policy initiative that marks a strategic shift from service expansion to integrated quality verification, digital oversight, and social resilience. This transition demands a robust quality verification mechanism. Ensuring perceptual consistency between service providers and external evaluators is critical for systemic fairness and sustainable service quality. Objective: This study utilized a two-dimensional gap analysis to examine the discrepancy in service quality benchmarks between home-based LTC center managers and assessment committee members, identifying critical divergence zones for institutional improvement. Methods: A cross-sectional evaluative study was conducted, involving center managers (evaluatees, n = 50) and external experts (evaluators, n = 28). The data were collected via a structured instrument covering 20 consensus benchmarks. Results: Significant perceptual gaps were identified across all dimensions (p < 0.001), with “Professional Care Quality” exhibiting the largest effect size (Cohen’s d > 1.5). Benchmarks with low external scores but high internal ratings were categorized into the “Overestimation (Management Blind Spot)” quadrant, signaling a systemic overestimation bias in administrative and clinical risk management. Conclusions: This study provides empirical evidence for the refinement of LTC 3.0 assessment systems. The results offer a strategic roadmap for policymakers to enhance organizational resilience by transitioning from subjective self-perception to objective, data-driven quality management through the two-dimensional gap model. Full article

Background: Management of patients in closed-door intensive care units (ICUs) is often associated with limited family visits and a highly technological environment, which can lead to patient deconditioning through altered circadian rhythms and depersonalization, contributing to psychological distress in addition to physiological distress. In recent years, there has been a shift in trends in the management of ICU patients with an emphasis on more social and psychological support, with the option of an open-door ICU. Objective: This study aims to evaluate the role of humanized care through social and psychological support in improving patients’ outcomes through the concept of open-door ICUs. Methods: This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Six databases were searched (LILACS, SciELO, PubMed, Scopus, ScienceDirect, and Dialnet) using a strategy based on MeSH and DeCS terms. Studies published between 2018 and 2025, in English, Spanish, and Portuguese, were included. Fifty studies were selected and analyzed using open, axial, and selective coding techniques. The review protocol was registered in PROSPERO (CRD420251080952). Results: Three main categories emerged: (1) Patient and Family Perceptions of ICU Care; (2) flexible visitation and technological mediation; and (3) humanization-centered care. These factors were linked to improved emotional well-being, reduced anxiety, enhanced communication, and stronger trust between families and healthcare professionals. Conclusions: Based on the results of our systematic review, we emphasize the importance of adopting humanized care practices in open-door ICUs. In particular, strategies like flexible visitation, emotional and spiritual support, respectful communication, and family involvement contribute to compassionate, patient-centered care. We recommend institutional policies that need to be designed that support humanization for patients and families. Full article

Background/Objectives: To investigate the relationship between dementia and hospital outcomes (in-hospital mortality and prolonged length of stay). Methods: A retrospective study was conducted considering all hospital admissions performed between 1st January 2018 and 31st December 2023 in the Abruzzo region, Italy. The study was conducted on a large sample including all elderly patients admitted to hospital in a Southern Italian region during a six year period. To compare outcomes between patients with and without dementia, a propensity score matching procedure was performed using a multivariable logistic model adjusted for age and gender and comorbidities. Odds ratios for primary and secondary outcomes were computed using logistic regression models. Results: After the matching procedure, 25,476 patients were included in the analyses: 12,738 with dementia and 12,738 controls. Logistic regression models showed that dementia was associated with in-hospital mortality (OR: 2.02; 95% CI 1.91–2.18; p < 0.001) and prolonged length of stay (OR: 1.44; 95% CI 1.29–1.58; p < 0.001). Conclusions: In a large cohort of Italian patients, dementia was associated with in-hospital mortality and prolonged length of stay. Full article

Background/Objectives: High turnover and staff shortages in nursing pose challenges to professional integration and compromised patient safety. Structured onboarding programs are considered key strategies to enhance adaptation, reduce clinical errors, and promote retention. This study aimed to evaluate the impact of a structured onboarding program compared with the standard routine on early professional adaptation, safety culture, and satisfaction among newly hired nurses and nursing assistants. Methods: A prospective quasi-experimental study was conducted between 2022 and 2024 in three private hospitals in Madrid. A total of 200 newly hired health professionals (128 nurses and 72 assistants) were assigned alternately to either the intervention group (structured onboarding program) or the control group (usual routine). The intervention comprised three consecutive days of guided training with mentorship, simulation-based learning, and digital tool instruction. Adaptation was assessed with the validated GAML scale, and satisfaction was measured through a Likert survey one month later. Statistical analyses included Mann–Whitney U, Chi-squared tests, and linear regression. Results: The intervention group achieved significantly higher scores across all competency domains for both nurses and nursing assistants, with overall medians of 25 [22–27] and 22 [20–23.25], respectively, compared with notably lower values in the control groups (p < 0.001). The greatest improvements were observed in digital tool management, clinical protocol knowledge, problem-solving and decision-making, and patient safety practices, demonstrating the strong impact of the structured onboarding program. In terms of satisfaction, participants in the intervention group also reported higher ratings for the clarity and completeness of information, particularly regarding hospital structure, service-specific orientation, and occupational risk prevention. However, global satisfaction differences were more pronounced among nurses than nursing assistants. Conclusions: The structured onboarding program demonstrated substantial benefits in professional adaptation, safety culture, and perceived preparedness of newly hired staff. These findings support integrating standardized onboarding plans as part of hospital quality and safety strategies, requiring sustained leadership and resource investment for long-term success. Full article

Background/Objectives: Patients with multimorbidity frequently rely on emergency services when continuity of care is weak. Strengthening communication between emergency and primary care can prevent unnecessary hospitalizations, yet this relationship remains underexplored. The aim of this study was to analyze the relationship between primary health care utilization in patients with multimorbidity and their demand for prehospital emergency services. Methods: An observational, longitudinal, analytical, and retrospective study was conducted in Málaga (Spain) between 2013 and 2017. Adults (>18 years) with multimorbidity who requested prehospital emergency care services at home were included; those with cancer, rare diseases, severe mental disorders, or incomplete electronic records were excluded. Variables encompassed sociodemographic, clinical, and behavioral characteristics, comorbidities, functional status, polypharmacy, resource type, and outcomes (on-site resolution or hospital referral). Primary health care visits before and after prehospital emergency use were extracted from electronic records. Descriptive, bivariate, and multivariate analyses were performed. Results: Among 532 patients, prior primary health care attendance predicted subsequent utilization (β = 0.57; p < 0.001), along with caregiver availability (β = 0.12; p = 0.001) and prehospital emergency services hyper-demand (β = 0.08; p = 0.022). Super-utilizers were younger, had ≥4 comorbidities, polypharmacy, prior family medicine visits, home oxygen therapy, and lower substance or alcohol use. Conclusions: In multimorbid adults, prehospital emergencies demand is influenced by factors beyond severity, including comorbidities, polypharmacy, the use of home medical devices, caregiver availability, and primary health care utilization patterns. Strengthening coordination between prehospital emergencies and primary health care, promoting patient–caregiver education, and implementing early notification pathways may improve care continuity and reduce avoidable emergencies. Full article

Hospitals are complex systems that function most effectively when operations are coordinated and supported by real-time information and feedback loops. Sustained growth, quality improvement, and financial viability increasingly rely on data-based management (DBM), yet adoption and use vary widely across healthcare institutions. This study examined the enabling and hindering factors influencing DBM, with the aim of generating insights to strengthen data use and improve management of eye hospitals. A qualitative multiple case study design was employed in six purposefully selected eye hospitals in India, varying in size and baseline capacity for DBM. At each site, five to six key personnel were interviewed. Data collection involved audio-recorded interviews, transcripts, and field notes, and analysis followed a grounded theory approach using open and axial coding to identify themes, relationships, and develop a conceptual framework. Findings reaffirmed the core enablers—leadership commitment, data availability, and technology adoption. Additional drivers included operational adaptability, regulatory demands, systematic improvement practices, daily reporting, information policies, and the use of communication platforms such as WhatsApp. Key barriers were incomplete data entry, software limitations, inadequate analytical reporting, and inconsistent adherence to processes. Overall, effective DBM requires both foundational enablers and contextual drivers, while addressing barriers to institutionalizing data use and improving outcomes. Full article

Background/Objectives: In Brazil, nearly universal access to prenatal care coexists with ongoing negative fetal and infant outcomes. This review explores how the adequacy of prenatal care affects maternal, fetal, and child health, and highlights recurring gaps in service delivery. Methods: A narrative review of Brazilian studies published between 2018 and 2024 was conducted through the Virtual Health Library and PubMed. The initial search (July 2024) was updated in February 2025, and two reviewers independently screened and extracted data, synthesizing clinical outcomes from the findings. Results: A total of thirty-six studies were included in the review. Inadequate prenatal care was consistently linked to higher rates of infant and neonatal mortality, prematurity, low birth weight, congenital syphilis, and neonatal near misses. The studies indicated that counting visits alone does not adequately reflect the quality of care: when evaluated against the Prenatal and Birth Humanization Program (PHPN), most studies met only one of the eight minimum criteria. Common shortcomings included late initiation of care, incomplete diagnostic testing, fragmented follow-up, and insufficient treatment for partners regarding sexually transmitted infections. Conclusions: Adverse outcomes persist in Brazil not due to a lack of access, but rather due to deficiencies in the content and continuity of prenatal care. To improve perinatal outcomes, it is essential to strengthen care through standardized, multidimensional indicators and integrated strategies that combine clinical, educational, and psychosocial support. Full article

Introduction: Little is known about the quality of care for patients with hypertension in primary health care (PHC) facilities in South Africa, where most people receive care. Objectives: To test 46 quality indicators, developed previously, to assess and improve care; to assess the indicators’ clinimetric properties; and to recommend improvement strategies. Methods: A descriptive cross-sectional clinical audit in a purposive sample of 12 South African PHC clinics involving a retrospective review of 295 patient medical records. Results: A total of 45 of the 46 indicators were tested in the main sample (n = 295), of which 9 indicators could not be applied. Of the 36 applicable indicators, 22 could be applied and measured for ≥75% of the sample, while 14 were applicable to ≤50% of the sample. Only five indicators showed a quality of care score for ≥75% of patients. Overall, 82% and 92% of the sample had their blood pressure (BP) recorded in the last 12 months or in the previous 5 years for those aged >40, respectively, and 53.2% had a controlled BP. In the last 12 months, 30% of patients had a cholesterol record, 30% had their BMI recorded, 17% had a hypertension review with a medical practitioner, and 12% had received lifestyle advice. Only 38% received all clinically indicated antihypertensive medicines at their last visit. Conclusion: There were gaps in the quality of care for patients with hypertension, demonstrating the need for greater adherence to evidence-based guidelines, better data quality, and the use of electronic health information systems. Twenty-two indicators are recommended to address these gaps and improve the quality of care, patient outcomes, and the health care system. Full article

Health systems function optimally when accountability principles, legal frameworks, and governance processes are clearly defined, understood, and implemented. Together these elements set norms, standards, and systems for the practice of health professionals, facilities, products, and the provision of quality and safe care. Ghana, like other countries, has these elements in place but could be more effective. When the system fails, the consequences of a lack of accountability are widespread, significant, and impact the poor and vulnerable the hardest. Achieving accountability for the legal and social expectation of high-quality, safe healthcare is an ongoing challenge, for every country, not just Ghana. Hence, a key dual question arises: within Ghana, how can health system accountability be enhanced through examining legal frameworks and their implementation? The following six key elements are identified to promote accountability in health systems: establish and implement effective healthcare governance arrangements; capacity development, understanding, and delineation of stakeholder roles and responsibilities; appropriate financing and resourcing; establishing and maintaining effective management of required infrastructure; undertaking measurement for accountability; and focusing on people-centered care. A clear focus on these six elements enables the delivery of equitable, high-quality, safe care for the population and a better future for all. Full article

Background: Stroke survivors and their family caregivers face substantial burdens resulting from a complex interplay of clinical, functional, and psychosocial factors. Community-based resources and social networking are critical for alleviating caregiver burden and improving outcomes for both caregivers and stroke survivors. Objectives: To assess the Saudi population’s readiness to use social platforms for stroke survivors’ recovery and caregiver support. Methods: A cross-sectional descriptive design was employed between March and June 2025 to collect data from community-dwelling individuals using sociodemographic and Technology Readiness Index (TRI) questionnaires. Results: A convenience sample of 576 participants was enrolled in this study. Overall, the participants showed a high level of technology readiness, with a total TRI mean score of M = 3.65, SD = 0.86. Optimism had the highest mean score, followed by innovativeness, insecurity, and discomfort. Significant differences in technology readiness were identified based on age, educational level, employment status, familiarity with modern technology, and healthcare provider status. Conclusions: This study demonstrates a high level of technological readiness across the Saudi population, indicating strong potential for integrating social connection platforms into stroke recovery and caregiver support. These findings align with Saudi Arabia’s Vision 2030 goals for digital transformation in the healthcare sector. Future research should focus on conducting feasibility studies to better understand the desirable features of e-health services and digital solutions within the Saudi community. Full article

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary pediatric hospital. Methods: The study sample comprised 158 malpractice claims received by Meyer Children’s Hospital from 1 January 2010 to 31 December 2023, which were managed by the Claims Management Committee (CMC) responsible for civil liability within the hospital. In this observational retrospective study, the following variables were analyzed: (1) The characteristics of the patients (age–sex) and the manner in which they interacted with the hospital, ultimately resulting in the compensation claim (method of access, area of specialty, outcomes based on the International Classification of Patient Safety (ICPS)). (2) Medico-legal factors: the details of the compensation claim, the significant issues noted in various cases, and the findings of the medico-legal inquiry conducted by the CMC. In cases of ADR (Alternative Dispute Resolution), we evaluated the nature of the procedure, the results, and the amount of compensation awarded. Results: We conducted a descriptive statistical analysis to delineate the trend of claims and identify specific deficiencies within structures or departments over time. Invasive procedures and surgical operations were identified as the leading causes of accidents, resulting in heightened mortality rates and serious injuries. The most common errors observed were diagnostic and therapeutic. Conclusions: The data that emerged highlighted a low rate of claims (11.28/year) and a low claim/service ratio (0.0002%), suggesting a high level of safety of patient care at the hospital. The acceptance rate (32%), the percentage of rejected cases (48/158~30% of total, or 48/99~49% of resolved claims), the average compensation (EUR 68,312), and the percentage of cases (92%) with judicial opinions consistent with those of the CMC indicate a tendency to pursue exploratory compensation requests and the effectiveness of CMC’s activity. Meanwhile, the predominant error types (surgical and diagnostic) are in accordance with national and international data. Finally, the scarcity of disputes concerning informed consent reflects the impressive effectiveness of the communication strategies utilized by the pediatricians at this center. Full article

Aim: The purpose of this study was to explore the broad experience of continuous glucose monitoring from the perspective of patients diagnosed with type 1 diabetes mellitus, including not only their emotions and feelings but also the lifestyle changes, perceptions, and social aspects associated with its use. Design: This is a phenomenological qualitative study. Patient or Public Contribution: The sample consisted of 10 adult patients diagnosed with type 1 diabetes who had been using the continuous glucose monitoring system for at least 6 months and were patients of the Endocrinology and Nutrition Service of the University Hospital Complex of Ourense. Methods: The recorded interviews were conducted in November 2024. The conversations were audio-recorded with the participants’ consent, and then transcribed for thematic analysis. Results: Three main categories were identified: “experience prior to continuous glucose monitoring” (accessibility, prior knowledge, and expectations), “experience with the use of continuous glucose monitoring” (perception of healthcare support, concerns, strengths, and alarm management), and “experience regarding the disease” (self-management of the disease and safety). Despite the fact that diabetes mellitus is a complex chronic disease, all participants provided a positive assessment of their progress and improved control through continuous glucose monitoring. Conclusions: All participants felt more secure and protected with continuous glucose monitoring, improving their quality of life. The main concern among the subjects was the possibility of the sensor failing. They positively valued the alarm system in case of hypoglycemia. The CGM is a highly effective tool for the management and self-control of diabetes and promotes the relationship between patients and professional health. Impact: The findings of this study have important implications for clinical care, highlighting the need for more training and more health education at the first level of health care, such as health centers. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Background/Objectives: Generating real-world data on the efficacy of multidisciplinary care in cardiometabolic risk management is essential to ensure that guidelines are both applicable and effective, especially in public healthcare settings, where organizational structures may impede healthcare professionals’ agility. This study aimed to generate data on patient follow-up and cardiometabolic risk management during the early years of a public university family medicine group in Québec (Canada) that provides multidisciplinary care to adults with cardiometabolic conditions, in order to evaluate the implementation and effectiveness of its care model. Methods: This was a retrospective longitudinal study. Patients treated at the clinic from 31 January 2020 (clinic opening) to 8 May 2024 (n = 96) were invited to consent to the use of their medical data for research. Results: A total of 52 patients consented and were included in the study. Upon entry at the clinic, >90% of patients had anthropometry and blood pressure (BP) measured, but plasma glucose and lipids were assessed among 50% and 79% of patients, respectively. A total of 36 patients completed the personalized multidisciplinary care program. No evidence of associations between the total number of appointments or appointments with the registered dietitian specifically with changes in BMI, waist circumference, and BP was found. However, each pharmaceutical intervention was associated with a −0.51 cm (95%CI: −1.03, 0.02; p = 0.06) change in waist circumference and a −1.49 mm Hg (95%CI: −2.56, −0.43, p = 0.01) change in diastolic BP. Conclusions: These data highlight the challenges of implementing a research-oriented clinic within Québec’s public healthcare system. Full article

Background and Objectives: Healthcare payment systems face challenges such as fraud and overbilling, which often require costly and resource-intensive detection tools. In response, the utility of simple statistical tests was explored in this study as a practical alternative for identifying irregularities in dermatology service payments within the Health Insurance Institute of Slovenia (HIIS). Materials and Methods: Ten-year-old anonymized billing data from 30 dermatology providers in Slovenia (with a population of 2 million) were analyzed to evaluate the effectiveness of the proposed methodology while aiming to avoid reputational harm to current providers. The dataset from 2014 included variables such as the “number of services charged”, “total number of points charged” (under Slovenia’s point-based tariff system at the time), “number of points per examination”, “average examination values (EUR)”, “number of first examinations”, and “total number of first/follow-up examinations”. Data credibility was assessed using Benford’s Law (for calculating χ² values and testing null hypothesis rejection at the 95% level), and Grubbs’ test, Hampel’s test, and T-test were used to identify outliers. Results: An analysis using Benford’s Law revealed significant deviations for the “number of services charged” (p < 0.005), “total number of points charged” (p < 0.01), “number of points per examination” (p < 0.0005), and “average examination values (EUR)” (p < 0.005), suggesting anomalies. Conversely, data on the numbers of “first” (p < 0.7) and “total first/follow-up examinations” (p < 0.3) were found to align with Benford’s Law, indicating authenticity. Outlier detection consistently identified two institutions with unusually high values for points per examination and average examination monetary value. Conclusions: Simple statistical tests can effectively identify potential irregularities in healthcare payment data, providing a cost-effective screening method for further investigation. Identifying outlier providers highlights areas needing detailed scrutiny to understand anomaly causes. Full article