Service users living with Obsessive compulsive disorder (OCD) often delay or avoid seeking diagnosis or treatment because of a fear of judgement or feelings of shame associated with their obsessions and compulsions. They may feel that their behaviour defies societal norms, which can lead to social isolation, and in turn, further contribute to health inequality. When such individuals present with physical illness and are seen by district nurses, it is imperative that behaviours are understood and approached appropriately. It is important to develop therapeutic relationships and consider their holistic wellbeing. Developing a close working relationship with the mental health team as a multidisciplinary team and using the team as a resource may contribute to the overall health outcome of service users with OCD.

BACKGROUND: A digital decision support system in healthcare is a digital health intervention that assists healthcare professionals in decision-making by providing treatment recommendations and enhancing diagnostic accuracy and quality of care. This will be the first study in Pakistan to assess the system\'s usability, acceptability and effectiveness in improving healthcare outcomes while also evaluating the perceived quality of care. This comprehensive assessment will inform policy development in areas such as the scale-up of digital health interventions, data privacy and technology interoperability. Measures of effectiveness will include changes in clinical outcomes through a patient exit feedback survey. This study aims to evaluate the role of digital decision support systems in healthcare decision-making, which may be integrated into Pakistan\'s tele-primary healthcare system.
METHODS: The study will employ a multimethod approach. The data collection tools are adapted from the WHO\'s digital health intervention monitoring and evaluation framework and include a technology assessment, healthcare provider surveys, patient exit interviews and focus group discussions with healthcare providers. Purposive sampling will be used for qualitative interviews with providers (doctors) and patients. Government stakeholders, private sectors, multilateral, academia and policymakers will be engaged through a consultative meeting. We will also conduct a literature review, as well as a comprehensive analysis of existing studies, documents and data relevant to digital decision support systems and digital health interventions implemented globally, and assess the performance, challenges and opportunities.
BACKGROUND: The study has been approved by the Ethics Review Committee at The Aga Khan University (2023-8514-26533). The dissemination of study findings through scientific publications and seminars will enable programme managers and policymakers to design tools to improve the quality of care provided through telemedicine platforms. This will contribute to efficient decision-making, access and quality of care for primary healthcare in low-income and middle-income countries. This study will also inform policy regarding the scale-up of decision support systems in primary care settings, data privacy and technology interoperability.

The continuous increase in the prevalence of obesity has generated growing concern, having become an important challenge at a global level in economic and public health terms. In Portugal, the treatment of obesity presents significant problems in access to health services. In this context, there is a need to implement new management models that offer more effective responses. Centers of integrated responsibility, already implemented in this area, are a cutting-edge approach, and it is important to evaluate their performance and identify recommendations for improving the model. The main objective of this study is to assess the impact of implementing an obesity center of integrated responsibility on hospital performance. This study was conducted using a comprehensive multiple-case study approach, which was predominantly descriptive but also included explanatory elements. The methodological approach is a well-balanced mix of quantitative and qualitative analyses. The study evaluates various hospital performance indicators, encompassing the dimensions of access, production, efficiency, quality, and economic-financial, both before and after the implementation of the new model. The overall results indicate that the implementation of an obesity center of integrated responsibility led to improvements in hospital performance, particularly in the dimensions of access, production, and efficiency. While these findings are promising, the study also identifies areas for potential improvement in the model, such as organizational, functional, and legal aspects, including the method of granting incentives and the funding process. In the analyzed cases, this new organizational model proved to be a solution for improving hospital performance, particularly around obesity. These units can play a fundamental strategic role in the National Health System, contributing to access to specialized treatments, retention of professionals and financial sustainability.
O aumento contínuo na prevalência da obesidade é um desafio ao nível global, em termos económicos e de saúde pública. Em Portugal, o tratamento da obesidade apresenta problemas acentuados no acesso aos serviços de saúde. Neste contexto, surge a necessidade de implementar e avaliar novos modelos de gestão que ofereçam respostas mais eficazes, como os centros de responsabilidade integrados. Este estudo tem como objetivo principal avaliar o impacto da implementação de um centro de responsabilidade integrado de obesidade no desempenho hospitalar. A pesquisa foi conduzida por meio de um estudo de caso múltiplo, predominantemente descritivo, mas com elementos também explanatórios. A abordagem metodológica é mista, combinando análises quantitativas e qualitativas. São avaliados indicadores de desempenho hospitalar, incluídos na dimensão do acesso, produção, eficiência, qualidade e económico-financeira, antes e após a implementação do novo modelo. Em termos globais a implementação de um centro de responsabilidade integrado de obesidade conduziu a melhorias no desempenho hospitalar nas dimensões avaliadas, sobretudo ao nível do acesso, produção e eficiência. Apesar de promissor, este novo modelo poderá beneficiar de um conjunto de melhorias em termos organizacionais, funcionais e jurídico-legais, como por exemplo no método de concessão de incentivos e no processo de financiamento. Nos casos analisados, este novo modelo de organização demonstrou ser uma solução para incrementar o desempenho hospitalar. Estas unidades podem desempenhar um papel estratégico fundamental no Sistema Nacional de Saúde, contribuindo para o acesso a tratamentos especializados, retenção de profissionais e sustentabilidade financeira.

OBJECTIVE: In 2021, Solent NHS Trust advertised for a fully remote consultant psychiatrist to meet increasing clinical demand. This pilot scheme was evaluated to determine its success. The job applications underwent content analysis, recruitment and support staff were interviewed, and in-depth rolling interviews were conducted with the three now-employed virtual psychiatrists.
RESULTS: We have gained an objective understanding of this new and innovative way of working and, overall, shown that fully remote working in the National Health Service (NHS) is feasible.
CONCLUSIONS: The findings were used to create a step-by-step guide for the remote hiring process, which outlines the necessary steps for conducting it in a safe, swift and successful way. This guide could help other NHS organisations to advertise, recruit and manage fully remote employees.

UNASSIGNED:
UNASSIGNED: To develop a reference standard based on US Food and Drug Administration and stakeholder guidance for pharmaceutical companies\' policies on diversity in clinical trials and to assess these policies.
UNASSIGNED: Development of a reference standard and structured audit for clinical trial diversity policies.
UNASSIGNED: 50 pharmaceutical companies selected from the top 500 by their market capitalizations in 2021 (the 25 largest companies and 25 non-large companies, randomly selected from the remaining 475 companies).
UNASSIGNED: Data from pharmaceutical company websites and annual reports. Policy guidance from the Pharmaceutical Research and Manufacturers of America, International Federation of Pharmaceutical Manufacturers and Associations, Biotechnology Industry Organization, International Committee of Medical Journal Editors, the US Food and Drug Administration, European Medicines Agency, and World Health Organization, up to 15 May 2023.
UNASSIGNED: Multicomponent measure based on distinct themes derived from FDA and stakeholder guidance.
UNASSIGNED: Reviewing FDA and stakeholder guidance identified 14 distinct themes recommended for improving diversity in clinical trials, which were built into a reference standard: (1) enrollment targets that reflect the prevalence of targeted conditions in populations, (2) broad eligibility criteria for trials, (3) diversity in the workforce, (4) identification and remedy of barriers to trial recruitment and retention, (5) incorporation of patient input into trial design, (6) health literacy, (7) multidimensional approaches to diversity, (8) sites with diverse providers and patient populations, (9) data collection after product approval, (10) diverse enrollment in every country where trials are conducted, (11) diverse enrollment should be a focus for all phases of clinical trials, not just later stage or pivotal trials, (12) varied trial design, (13) expanded access, and (14) public reporting of the personal characteristics of participants in trials. Applying this reference standard, 48% (24/50) of companies had no public policy on diversity in clinical trials; among those with policies, content varied widely. Large companies were more likely to have a public policy than non-large companies (21/25, 84% v 5/25, 20%, P<0.001). Large companies most frequently committed to using epidemiological based trial enrollment targets representing the prevalence of indicated conditions in various populations (n=15, 71%), dealing with barriers to trial recruitment (n=15, 71%), and improving patient awareness of trial opportunities (n=14, 67%). The location of the company was not associated with having a public diversity policy (P=0.17). The average company policy had five of the 14 commitments (36%, range 0-8) recommended in FDA and stakeholder guidance.
UNASSIGNED: The findings of the study showed that many pharmaceutical companies did not have public policies on diversity in clinical trials, although policies were more common in large than non-large companies. Policies that were publicly available varied widely and lacked important commitments recommended by stakeholder guidance. The results of the study suggest that corporate policies can be better leveraged to promote representation and fair inclusion in research, and implementation of FDA and stakeholder guidance.

OBJECTIVE: The aim of this project was to set out recommendations for the section 17 leave form to reflect guidance provided in the Mental Health Act 1983: Code of Practice, following local Care Quality Commission feedback. We reviewed guidance in the Code and publicly available leave forms to identify items to include in the leave form. Then, we determined which publicly available leave forms included each item and reviewed whether the item should be included in the leave form and whether any reformulation was needed.
RESULTS: Using the method described, we identified a list of items that should be included in the leave form. When comparing the leave forms of different trusts, there was considerable variation with respect to which items were included in each form.
CONCLUSIONS: We provide some recommendations for future practice regarding section 17 leave forms to facilitate consistency with the Code and between different trusts.

BACKGROUND: The health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients\' outcomes and ensures efficient use of the resources in such a resource limited country. The study aimed to assess the implementation of the clinical practice guidelines among family medicine doctors working in the primary health care centers in Khartoum and Gezira states to provide baseline data about the current practice in Sudan.
METHODS: Descriptive cross-sectional facility-based survey, conducted from April to December 2021, on 373 of the practicing family-medicine doctors. A total of 101 Primary health care centers were surveyed (77 centers in Khartoum state and 24 in Gezira state). The questionnaire was pilot tested on a small group of physicians to improve clarity and reduce response bias. Descriptive statistics were used to summarize the data and analyzed by frequency tables. Chi square and logistic regression tests were used to determine the association between categorized variables. P value < 0.05 was considered statistically significant.
RESULTS: Most of the practicing family-medicine doctors (98.4%) reported implementation of the guidelines. Moreover, (68.6%) of them received training programs which were organized and funded by the Sudan Ministry of Health. The local Sudanese guidelines were difficult to access and not regularly updated. Services unavailability and inaccessibility (87.1%), health insurance factors (83.9%), and patient factors (81.2%) were the most frequent barriers to guidelines implementation. Service cost (79.9%), lack of regular training programs (79.9%), absence of local guidelines (77.2%), lack of continuity in the comprehensive care process (63.0%), and lack of time (57.1%) were also reported as barriers to guidelines implementation.
CONCLUSIONS: Guidelines implementation is limited by unavailability and inaccessibility of the health services and the health insurance limited coverage. Expansion of the health insurance coverage, organization of continuous training programs, encouragement of regular auditing and issuing regulations to ensure the use of updated guidelines, dissemination of the updated national guidelines along with establishing clinical governance in Sudan can be useful tools for policymakers in the optimum allocation of public health resources.

As healthcare embraces the transformative potential of Artificial Intelligence (AI), it is imperative to safeguard patient and provider safety, equity, and trust in the healthcare system. This article outlines the approach taken by the British Columbia (BC) Provincial Health Services Authority (PHSA) to establish clinical governance for the responsible deployment of AI tools in healthcare. Leveraging its province-wide mandate and expertise, PHSA establishes the infrastructure and processes to proactively and systematically intake, assess, prioritize, and evaluate AI tools. PHSA proposes a coordinated approach in AI tool deployment in collaboration with regional health authorities to prevent duplication of efforts and ensure equitable access to existing and emerging AI tools across the province of BC, incorporating principles of anti-Indigenous racism, cultural safety, and humility. The proposed governance structure underscores the identification of clinical needs, proactive ethics review, rigorous risk assessment, data validation, transparent communication, provider training, and ongoing evaluation to ensure success.

BACKGROUND: The objective of this scoping review is to identify evidence of the impact of hospital managers in top management (c-suite) on hospital performance. Managers generally have various effects on organisational objectives of their organisations. In recent years, the healthcare sector has experienced alterations in hospital governance structures, together with the emergence of new c-suite positions, aligning more closely with those found in private organisations. Their impact on hospital performance (ie, quality of care) is not well known. This scoping review seeks to identify all the available evidence of their impact on the organisational objectives. This scoping review will include primary studies, reviews and commentaries that describe the impact of top management team members on organisational outcomes in a hospital setting.
METHODS: The search strategy aims to locate both published and unpublished documents (ie, grey literature) using a three-step search strategy. An exploratory search of Medline and Google Scholar identified keywords and Medical Subject Headings terms. A second search of Medline (PubMed), Web of Science Core Collection, ScienceDirect, Business Source Premier (EBScoHost), JSTOR, BASE, Lens.org and the Google Search Engine will be performed. The scope of the search will cover 1990-present time using English search terms. Manual searching by two reviewers will be added to the search strategy. The identified documents will be independently screened, selected by two researchers and extracted by one researcher. The data are then presented in tables and graphics coupled with a descriptive summary.
BACKGROUND: As this study neither involves human participants nor unpublished secondary data, an ethics approval is not required. Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal.
BACKGROUND: The protocol was registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/EBKUP).

BACKGROUND: Radical prostatectomy (RP) is a treatment method for prostate cancer (PCa). However, patients usually experience urinary incontinence and a reduction in quality of life after surgery. Seeking a nursing programme is necessary to improve the prognosis of patients undergoing RP. This study aims to explore the effect of the cluster nursing through empowerment education on patients with RP.
METHODS: The general data of 203 patients who underwent RP surgery from June 2021 to June 2023 were collected for a retrospective study. After excluding four patients who changed from RP to laparotomy during surgery, four patients with incomplete clinical data and three patients without normal communication ability, the remaining 192 patients were included in the study. The patients were divided into two groups in accordance with different nursing plans. In this study, 98 patients receiving the cluster nursing through empowerment education were set as the observation group (OG), and 94 patients undergoing routine nursing were included in the reference group (RG). The indicators of postoperative recovery, mental health status and life coping ability were compared between the two groups.
RESULTS: The times to first exhaustion, to start eating, of first off-bed activity and of hospitalisation in the OG were shorter than those in the RG (p < 0.001). No significant difference was found in the total incidence of complications between the two groups (p > 0.05). Before management, no significant difference in the scores of Hospital Anxiety and Depression Scale (HADS) and Activity of Daily Living Scale (ADL) was observed between the OG and RG (p > 0.05). After management, the HADS and ADL scores of the two groups all decreased, and the OG showed a greater reduction in scores than the RG (p < 0.001).
CONCLUSIONS: The cluster nursing through empowerment education can shorten the recovery time of patients after RP surgery and improve their living ability. This effect is beneficial to their mental health and can provide additional directions for the formulation of subsequent clinical nursing programmes.