BACKGROUND: Although uncertainties exist regarding implementation, artificial intelligence-driven generative language models (GLMs) have enormous potential in medicine. Deployment of GLMs could improve patient comprehension of clinical texts and improve low health literacy.
OBJECTIVE: The goal of this study is to evaluate the potential of ChatGPT-3.5 and GPT-4 to tailor the complexity of medical information to patient-specific input education level, which is crucial if it is to serve as a tool in addressing low health literacy.
METHODS: Input templates related to 2 prevalent chronic diseases-type II diabetes and hypertension-were designed. Each clinical vignette was adjusted for hypothetical patient education levels to evaluate output personalization. To assess the success of a GLM (GPT-3.5 and GPT-4) in tailoring output writing, the readability of pre- and posttransformation outputs were quantified using the Flesch reading ease score (FKRE) and the Flesch-Kincaid grade level (FKGL).
RESULTS: Responses (n=80) were generated using GPT-3.5 and GPT-4 across 2 clinical vignettes. For GPT-3.5, FKRE means were 57.75 (SD 4.75), 51.28 (SD 5.14), 32.28 (SD 4.52), and 28.31 (SD 5.22) for 6th grade, 8th grade, high school, and bachelor\'s, respectively; FKGL mean scores were 9.08 (SD 0.90), 10.27 (SD 1.06), 13.4 (SD 0.80), and 13.74 (SD 1.18). GPT-3.5 only aligned with the prespecified education levels at the bachelor\'s degree. Conversely, GPT-4\'s FKRE mean scores were 74.54 (SD 2.6), 71.25 (SD 4.96), 47.61 (SD 6.13), and 13.71 (SD 5.77), with FKGL mean scores of 6.3 (SD 0.73), 6.7 (SD 1.11), 11.09 (SD 1.26), and 17.03 (SD 1.11) for the same respective education levels. GPT-4 met the target readability for all groups except the 6th-grade FKRE average. Both GLMs produced outputs with statistically significant differences (P<.001; 8th grade P<.001; high school P<.001; bachelors P=.003; FKGL: 6th grade P=.001; 8th grade P<.001; high school P<.001; bachelors P<.001) between mean FKRE and FKGL across input education levels.
CONCLUSIONS: GLMs can change the structure and readability of medical text outputs according to input-specified education. However, GLMs categorize input education designation into 3 broad tiers of output readability: easy (6th and 8th grade), medium (high school), and difficult (bachelor\'s degree). This is the first result to suggest that there are broader boundaries in the success of GLMs in output text simplification. Future research must establish how GLMs can reliably personalize medical texts to prespecified education levels to enable a broader impact on health care literacy.

BACKGROUND: In recent years, academics have increasingly acknowledged the importance of involving health service users and community stakeholders as active partners in health research. Yet, the involvement of older adults, the largest group of health service users, as research partners remains limited, possibly due to ageist attitudes that devalue older adults\' contributions. During the three years of our Awakening Canadians to Ageism study, we convened an advisory group consisting of older adults and gerontological experts to discuss issues related to ageism, help interpret the study findings, and develop a range of knowledge mobilization strategies to dispel ageism.
METHODS: To understand the experiences of members of the advisory group and solicit recommendations for improving future groups, we conducted a qualitative descriptive study and interviewed 8 older adults and 6 gerontological experts. Data were content analyzed.
RESULTS: Four categories that were developed to explain participants\' experiences and suggestions for future advisory groups included: organization and management, group experience, suggestions for future advisory groups and moving forward. A key finding was the value that the older adults and gerontological experts ascribed to conversations about the prevalence of ageism and their desire to continue these types of conversations in their personal groups and professional networks. Numerous helpful strategies for future advisory groups were identified, such as enhancing social diversity, both in terms of racial/ethnic/cultural representation and gender. Older adults wanted more \"getting to know you time\" in meetings and gerontological experts wanted more details about the research process and their role.
CONCLUSIONS: This study\'s partnership approach can guide researchers seeking to involve key health service users and community stakeholders in health research and help enact positive social change.
In 2022 we developed an advisory group consisting of older adults and gerontological experts to review the findings of the first stage of our study Awakening Canadians to Ageism and provide guidance on knowledge mobilization and next steps. We interviewed 12 older adults and 6 gerontological experts from our advisory group to learn about their experiences with the group and provide suggestions for future groups. Participants provided feedback on group organization, management and processes, in addition to their experiences and strategies for future advisory groups. Both groups suggested enhancing the social diversity of the group, both in terms of racial/ethnic/cultural representation and gender. Older adults wanted more meeting time dedicated to getting to know the other groups members and gerontological experts wanted more details about the research process and their role.

Interprofessional collaboration in palliative care is essential to ensuring high-quality care for seriously ill patients. Education interventions to increase competency in palliative care should incorporate team-building skills to encourage an interprofessional approach. We developed and piloted a virtual educational program named CAPACITI for interprofessional teams to promote a community palliative approach to care. Primary care teams from across Ontario, Canada, participated in CAPACITI which consisted of 10 facilitated sessions that emphasized how to operationalize a palliative care approach as a team. Pre- and post-study questionnaires were completed by each team, including the AITCS-II, a validated instrument that measures interprofessional collaboration. We analyzed individual paired differences in summary scores and in each of three subdomains of the AITCS-II questionnaire: partnership, cooperation, and coordination. Seventeen teams completed the AITCS-II post survey, representing 133 participants. Teams varied demographically and ranged from 5 to 16 members. After CAPACITI, the overall mean AITCS-II summary score among teams increased to 96.0 (SD = 10.0) for a significant paired mean difference increase of 9.4 (p = .03). There were also significant increases in the partnership (p = .01) and in the cooperation subdomains (p = .04). CAPACITI demonstrated the potential for improving collaboration among primary care teams, which can lead to improved provider and patient outcomes in palliative care.

(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians\' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians\' experiences with HIT implementation.

BACKGROUND: Evidence-based practice, in conjunction with optimum care quality, improves patients\' clinical outcomes. However, its implementation in daily clinical practice continues to present difficulties. The aim of this study was to identify the strategies applied by Advanced Practice Nurses (APNs) to foster adherence to clinical practice guideline recommendations.
METHODS: An exploratory qualitative study was conducted with six focus groups at three public hospitals belonging to the Balearic Islands Health Care Service (Spain). The study participants were 32 ward nurses and 5 advanced practice nurses working routinely with inpatients at these hospitals. The study was conducted from November 2020 to January 2021, using thematic analysis, based on the COREQ checklist.
RESULTS: Four major themes related to the facilitation process were identified either by RNs and APNs: the context of the project, APN contribution to nursing team management, healthcare provision on the ward, and the acquisition and application of knowledge.
CONCLUSIONS: The APNs adapted their actions to the characteristics and needs of the local context, employing strategies aimed at improving teamwork, healthcare, and knowledge management. Each of these contributions enhanced the sustainability of the changes made.

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Social media may promote knowledge sharing but what users do with the new knowledge and how it may influence practice remains to be known. This exploratory study used a social constructivist lens to understand how health professions educators and researchers integrate knowledge from social media into their respective practices. We purposively sampled health professions educators and researchers using the hashtags #MedEd, #HPE, and #HealthProfessionsEducation on Twitter/X. We obtained informed consent, conducted interviews via videoconference, and engaged in multiple cycles of deductive and inductive coding and analysis. Participants identified as educators and researchers (n = 12), as researchers (n = 1), or as educators (n = 1) from Canada (n = 8), the United States (n = 3), and Switzerland, Ireland, and China (n = 1, respectively). Eight participants actively used social media (i.e., creating/posting original content); six participants indicated passive use (i.e., reading/retweeting content). They discussed the importance of crafting a consumable message and social media identity to streamline the content shared. Social media\'s accessible, non-hierarchical nature may facilitate knowledge-sharing, whereas the potential spread of misinformation and technological requirements (e.g., internet access, country-specific restrictions on platforms) present barriers to uptake. Participants described using knowledge gained from social media as teaching tools, new research methodologies, new theoretical frameworks, and low-risk clinical interventions. Previous research has demonstrated how social media has empirically been used for diffusion or dissemination rather than as an active process of evidence uptake. Using knowledge translation frameworks, like the Knowledge to Action or Theoretical Domains frameworks, to inform social media-based knowledge sharing activities in health professions education is recommended.

BACKGROUND: This cross-sectional study investigated the online dissemination of Cochrane reviews on digital health technologies.
METHODS: We searched the Cochrane Database of Systematic Reviews from inception up to May 2023. Cochrane reviews with any population (P), intervention or concept supported by any digital technology (I), any or no comparison (C), and any health outcome (O) were included. Data on review characteristics (bibliographic information, PICO, and evidence quality) and dissemination strategies were extracted and processed. Dissemination was assessed using review information on the Cochrane website and Altmetric data that trace the mentions of academic publications in nonacademic online channels. Data were analysed using descriptive statistics and binary logistic regression analysis.
RESULTS: Out of 170 records identified in the search, 100 Cochrane reviews, published between 2005 and 2023, were included. The reviews focused on consumers (e.g. patients, n = 86), people of any age (n = 44), and clinical populations (n = 68). All reviews addressed interventions or concepts supported by digital technologies with any devices (n = 73), mobile devices (n = 17), or computers (n = 10). The outcomes focused on disease treatment (n = 56), health promotion and disease prevention (n = 27), or management of care delivery (n = 17). All reviews included 1-132 studies, and half included 1-10 studies. Meta-analysis was performed in 69 reviews, and certainty of evidence was rated as high or moderate for at least one outcome in 46 reviews. In agreement with the Cochrane guidelines, all reviews had a plain language summary (PLS) that was available in 3-14 languages. The reviews were disseminated (i.e. mentioned online) predominantly via X/Twitter (n = 99) and Facebook (n = 69). Overall, 51 reviews were mentioned in up to 25% and 49 reviews in 5% of all research outputs traced by Altmetric data. Dissemination (i.e. higher Altmetric scores) was associated with bibliographic review characteristics (i.e. earlier publication year and PLS available in more languages), but not with evidence quality (i.e. certainty of evidence rating, number of studies, or meta-analysis performed in review).
CONCLUSIONS: Online attention towards Cochrane reviews on digital health technologies is high. Dissemination is higher for older reviews and reviews with more PLS translations. Measures are required to improve dissemination of Cochrane reviews based on evidence quality.
BACKGROUND: The study was prospectively registered at the Open Science Framework ( https://osf.io/mpw8u/ ).

UNASSIGNED: People with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions.
UNASSIGNED: To understand how an ECHO program for concurrent disorder management impacts nurses\' competency development and clinical practice and uncover key conditions for successful uptake and implementation.
UNASSIGNED: A convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology.
UNASSIGNED: An ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study.
UNASSIGNED: Online surveys completed by the participating nurses (N = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup (n = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena.
UNASSIGNED: We identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one\'s professional role; and (6) Organizational support.
UNASSIGNED: Outcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses\' competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.

BACKGROUND: Interaction between researchers and policymakers is an essential factor to facilitate the evidence-informed policymaking. One of the effective ways to establish this relationship and promote evidence-informed policymaking is to employ people or organizations that can play the role of knowledge brokers. This study aims to analyze the communication network and interactions between researchers and policymakers in Iran\'s health sector and identify key people serving as academic knowledge brokers.
METHODS: This study was a survey research. Using a census approach, we administered a sociometric survey to faculty members in the health field in top ten Iranian medical universities to construct academic-policymaker network using social network analysis method. Network maps were generated using UCINET and NetDraw software. We used Indegree Centrality, Outdegree Centrality, and Betweenness Centrality indicators to determine knowledge brokers in the network.
RESULTS: The drawn network had a total of 188 nodes consisting of 94 university faculty members and 94 policymakers at three national, provincial, and university levels. The network comprised a total of 177 links, with 125 connecting to policymakers and 52 to peers. Of 56 faculty members, we identified four knowledge brokers. Six policymakers were identified as key policymakers in the network, too.
CONCLUSIONS: It seems that the flow of knowledge produced by research in the health field in Iran is not accomplished well from the producers of research evidence to the users of knowledge. Therefore, it seems necessary to consider incentive and support mechanisms to strengthen the interaction between researchers and policymakers in Iran\'s health sector.