Benchmarking medical laboratory performance on a global scale.

Background and aims: Laboratory performance as a relative concept needs repetitive benchmarking for continuous improvement of laboratory procedures and medical processes. Benchmarking as such establishes reference levels as a basis for improvements efforts for healthcare institutions along the diagnosis cycle, with the patient at its center. But while this concept seems to be generally acknowledged in laboratory medicine, a lack of practical implementation hinders progress at a global level. The aim of this study was to examine the utility of a specific combination of indicators and survey-based data collection approach, and to establish a global benchmarking dataset of laboratory performance for decision makers in healthcare institutions. Methods: The survey consisted of 44 items relating to laboratory operations in general and three subscales identified in previous studies. A global sample of laboratories was approached by trained professionals. Results were analyzed with standard descriptive statistics and exploratory factor analysis. Dimensional reduction of specific items was performed using confirmatory factor analysis, resulting in individual laboratory scores for the three subscales of "Operational performance," "Integrated clinical care performance," and "Financial sustainability" for the high-level concept of laboratory performance. Results and conclusions: In total, 920 laboratories from 55 countries across the globe participated in the survey, of which 401 were government hospital laboratories, 296 private hospital laboratories, and 223 commercial laboratories. Relevant results include the need for digitalization and automation along the diagnosis cycle. Formal quality management systems (ISO 9001, ISO 15189 etc.) need to be adapted more broadly to increase patient safety. Monitoring of key performance indicators (KPIs) relating to healthcare performance was generally low (in the range of 10-30% of laboratories overall), and as a particularly salient result, only 19% of laboratories monitored KPIs relating to speeding up diagnosis and treatment. Altogether, this benchmark elucidates current practice and has the potential to guide improvement efforts and standardization in quality & safety for patients and employees alike as well as sustainability of healthcare systems around the globe.

Toward Sustainable Adoption of Integrated Care for Prevention of Unplanned Hospitalizations: A Qualitative Analysis.

Introduction: Complex chronic patients are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a qualitative analysis performed into the EU initiative JADECARE (2020-2023) to design a digitally enabled integrated care program aiming at preventing unplanned hospitalizations. Methods: A two-phase process with four design thinking (DT) sessions was conducted to analyse the management of complex chronic patients in the region of Catalonia (ES). In Phase I, Discovery, two DT sessions, October 2021 and February 2022, were done using as background information: i) the results of twenty structured interviews (five patients and fifteen professionals), ii) two governmental documents on regional deployment of integrated care and on the Catalan digital health strategy, respectively, and iii) the results of a cluster analysis of 761 hospitalizations. In Phase II, Confirmation, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two additional DT sessions conducted in November and December 2022. Discussion: The qualitative analysis identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during the period 2024-2025, was generated. Conclusions: A digitally enabled adaptive case management approach to foster collaborative work and personalization of care, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations.

[Sustainable residency training in urology in context of current changes in the German healthcare system]. / Nachhaltige Weiterbildung in der Urologie vor dem Hintergrund der aktuellen Veränderungen im deutschen Gesundheitssystem.

Promoting sustainable structures and measures in residency is crucial to meet current and future requirements of the German healthcare system. This process does not only involve the integration of social, ecological, and economic aspects into everyday professional life but also into residency training. Specifically, sustainable structures and measures in residency include initiatives such as structured training curricula, simulation-based training, digital training opportunities, flexible working time models, and gender equality. In addition, consideration of environmental aspects as well as expansion of quality management programs are essential. A holistic approach that considers both the efficiency and the needs of physicians and their patients is the key to sustainable urologic residency programs. This way, urology will remain an attractive specialty for future generations.

Digitalization and job stress: exploring the mediating roles of job and personal aversion risk with gender as a moderator.

Background: This time-lagged study delves into the impact of digitalization on job stress. Digitalization is defined as the incorporation of digital technologies into various aspects of work life, fundamentally transforming processes, interactions, and decision-making. Aim: The present research focuses on the mediating roles of job-related risk and personal risk, and the moderating effect of gender. We hypothesized that employees' aversion to risks, both in their professional and personal facets, mediates the relationship between the rapid digitalization of their work environment and the resultant job stress. Regarding gender as a moderator, recent research suggests that gender can influence the experience of workplace stress, with women often experiencing higher levels of stress than men in certain situations. This indicates that gender might also moderate the relationship between digital living, risk perception, and job-related stress. This approach allows for an examination of the ways in which digital technology adoption influences workplace stress, considering the temporally spaced data. Methods: Conducted over three waves of data collection among 795 Chinese employees, the research utilizes Hayes's Model 8, adept at revealing the dynamics of digitalization's influence in the workplace and its effects on individual well-being. Results: The study corroborates Hypothesis 1 by establishing a significant, albeit less pronounced, relationship between digital living and job stress. The findings also support Hypothesis 2 by demonstrating that both job risk and personal risk mediate this relationship. The study's results also validate Hypothesis 3, indicating that gender moderates the relationship between digital living, job risk, personal risk, and job stress. Finally, the significant interaction effects found in the study, particularly the stronger conditional negative effect of digital living on perceptions of job and personal risks for males, despite the absence of statistical significance failed to support Hypothesis 4. Implications: This study sheds light on the dynamics of job stress in the context of a digitalizing work environment. The results have important implications for designing workplace strategies and interventions that are sensitive to risk perceptions and gender differences in the digital era.

[Characteristics of youth's health keeping practices under the digitalization].

The article discusses the problems of health keeping of modern Russian youth under the digitalization. Paying attention to the negative dynamics in the health of young Russians, the authors point out to form and promote a culture of health keeping among the younger generation. However, in order for the implemented measures to be effective, the authors propose to differentiate them taking into account the specifics of the perception of health and practices of caring for it among young people, which is associated with their distinction into two age groups within the framework of generational theory: zoomers and millennials. In this regard, the article presents the results of an empirical study conducted by the authors on the health conservation of Russian youth, which are depicted the characteristics of consumption and practices in the field of health among these age groups. As it states, both categories are quite conscious of their health status. The most common ways to stay healthy are proper nutrition, sleep patterns, and regular exercise. However, certain differences have been identified in the basic practices of caring for it as compared to the traditional model of a healthy lifestyle. Thus, self-tracking based on mobile applications, as well as digital consumption of health information in new media, is popular among zoomers. Millennials appear to be more committed to the primary source of health information, the medical community, which is also reflected in the need for regular health checkups. Based on the findings, a number of practical recommendations are proposed.

[An overview of investments in the development of the Russian Medtech market and the prospects for the impact of digitalization in medicine on the economic performance of companies until 2030].

Today, the topic of digitalization, the introduction of innovations based on Big Data, the complexity of technologies due to the introduction of artificial intelligence in medicine and healthcare is one of the most relevant in this industry, undoubtedly contributing to its rapid development. As a result of this development, there is a huge number of services and applications. Internet resources, not only for health tracking (more than 3,500 applications are available by the end of 2023), but also the development of diagnostic resources, telemedicine, etc. Quite quickly, it was the pandemic and its consequences that changed the format of interaction between doctors, communication in the community of doctors, and their interaction with patients. Saving time when making an appointment with a doctor, visiting him, constant monitoring of the condition of patients, becoming better and more multidirectional day by day, make it possible to provide timely, relevant care to more people. The use of artificial intelligence technologies and digital solutions in the field of Russian healthcare opens up great prospects for both doctors and patients, as well as for many government agencies, since the development of regulatory and legal regulation and state control and management of innovations in the field of medicine and healthcare is important. An important factor is that not only government programs for the development of healthcare, but also investments are extremely important for the development of digital medicine.

[Analysis of the demand for medical services using digital programs in the Russian healthcare system: an overview of trends].

The research conducted in this article has determined that among Russians, preference for private medical services, including through online technologies, is given for the following reasons: the speed of service provision - 45.1%; lack of queues (44%); quality of medical procedure (39.8%); ease of making an appointment (32.1%); high professional level of the doctor (24.4%). Given the fact that the cost of medical services at a personal appointment is increasing, it is safe to say that the types and forms of services in the format of remote medical care will certainly increase in number and may become the most important trend in 2024 and subsequent years. An important factor in the availability and satisfaction of medical services, and hence its demand, is the use of digital technologies and the direction of development of programs using artificial intelligence in medicine. The article provides an overview of the artificial intelligence resources used and implemented in medicine and healthcare in Russia, and the prospects for their development in the short term.

[The use of gadgets in the student environment and their impact on the health of students].

In the information 21st century, almost everyone interacts with technical devices, including gadgets. A gadget is a small device designed to make life easier and better. Gadgets most often include smartphones, computers, tablets, headphones, smartphone speakers, smart watches and much more. In this article, we will focus on the most common gadgets - a smartphone and a computer, and also consider their effect on the student's body. The results of a social survey of students of the Admiral F. F. Ushakov State Maritime University on the indicator of smartphone screen time used and their well-being from this are presented. The authors show that the abuse of time spent in gadgets negatively affects the state of both physical and mental health of students. The article provides recommendations for a painless interaction.

Digital Psychosocial Follow-up for Childhood Critical Illness Survivors: A Qualitative Interview Study on Health Professionals' Perspectives.

Background: Digital solutions have been reported to provide positive psychological and social outcomes to childhood critical illness survivors, a group with an increased risk for long-term adverse psychosocial effects. Objective: To explore health professionals' perspectives on the potential of digital psychosocial follow-up for childhood critical illness survivors. Methods: Using a qualitative approach, expert interviews with six health professionals working at a Norwegian hospital were conducted. Transcribed interviews were analyzed using Braun and Clarke's six-phase thematic analysis framework. Concurrent data collection and analysis using inductive coding was also employed, and a model of codes was constructed. Results: The interview yielded thirteen unique codes regarding the health professionals' perspectives on the potential for digital psychosocial follow-up for childhood critical illness survivors, organized in a model comprising the two main themes: Affecting Factors and Digital Usage. Demographic factors (the child's medical condition, age, gender, and residence) and environmental factors (the child's family and health professionals) tended to affect the current psychosocial follow-up. Hospital limitations concerning a lack of digital solutions, worse relationship building with video communication, and children's already high screen time reflected the current state of digital usage. However, ongoing digitalization, existing successful digital solutions, children's good digital skills, and an ongoing process of creating an artifact are also seen as opportunities for digital usage in future psychosocial follow-up for childhood critical illness survivors. Conclusions: Researchers can build further on these findings to investigate the potential of digital psychosocial follow-up for childhood critical illness survivors, and clinicians can use it as a starting point for improving psychosocial follow-up.

Construction and application of an ICU nursing electronic medical record quality control system in a Chinese tertiary hospital: a prospective controlled trial.

BACKGROUND: ICU nurses provide critical care and meticulously document electronic medical records (EMRs), tracking vital signs, interventions, and medication hourly. Despite China's ICUs effectively integrating real-time monitor and ventilator data into EMRs, challenges persist. Patient movements can introduce inaccuracies, and the demands of critical care may lead nurses to miss assessments like pain and nutrition. Traditional manual EMR verification is inefficient and error-prone, highlighting the urgent need for standardized, technology-aided EMR practices in ICU nursing. OBJECTIVE: This study aimed to describe the development and evaluation of an electronic medical records quality control system implemented in a Chinese tertiary care ICU setting, where current practices impact the accuracy of electronic medical records. METHODS: A prospective controlled trial was conducted with 600 ICU patients in Zhejiang Province from January to December 2023. An automated EMR quality control system was implemented in July 2023, facilitating real-time data collection and quality control for vital signs, medication management, and nursing evaluations. RESULTS: After implementing the ICU nursing electronic medical record quality control system, the prevalence of false data on vital signs decreased from 9 to 1.33%. Additionally, the incidence of incomplete medication administration dropped from 3.33 to 1.67%, and the rate of missing evaluations of assessment items in EMRs was reduced from 8 to 1.33%. Besides, the average time spent on quality control of the electronic medical records was 62 (48,76) seconds per record, which was significantly lower than the 264 (195.5,337.5) seconds using the traditional method. The nurses' satisfaction with the nursing electronic medical record quality control was (105.73 ± 9.31). CONCLUSIONS: The ICU nursing electronic medical record quality control system has led to substantial improvements in the quality and reliability of EMRs. The reduction in false data on vital signs, instances of incomplete medication administration, and missing evaluations of assessment items demonstrates the system's positive impact on nursing documentation practices. These improvements not only enhance the accuracy of patient records but also contribute to better patient care and safety within the ICU setting.

Christian anthropology-based contributions to the ethics of socially assistive robots in care for older adults.

Our society, in general, and health care, in particular, faces notable challenges due to the emergence of innovative digital technologies. The use of socially assistive robots in aged care is a particular digital application that provokes ethical reflection. The answers we give to the ethical questions associated with socially assistive robots are framed by ontological and anthropological considerations of what constitutes human beings and how the meaning of being human relates to how these robots are conceived. Religious beliefs and secular worldviews, each of which may participate fully in pluralist societies, have an important responsibility in this foundational debate, as anthropological theories can be inspired by religious and secular viewpoints. This article identifies seven anthropological considerations grounded in the synthesis of biblical scriptures, Roman Catholic documents, and recent research literature. We highlight the inspirational quality of these anthropological considerations when dealing with ethical issues regarding the development and use of socially assistive robots in aged care. With this contribution, we aim to foster a global and inclusive dialogue on digitalization in aged care that deeply challenges our basic understanding of what constitutes a human being and how this notion relates to machine artefacts.

A practical guide to the implementation of AI in orthopaedic research, Part 6: How to evaluate the performance of AI research?

Artificial intelligence's (AI) accelerating progress demands rigorous evaluation standards to ensure safe, effective integration into healthcare's high-stakes decisions. As AI increasingly enables prediction, analysis and judgement capabilities relevant to medicine, proper evaluation and interpretation are indispensable. Erroneous AI could endanger patients; thus, developing, validating and deploying medical AI demands adhering to strict, transparent standards centred on safety, ethics and responsible oversight. Core considerations include assessing performance on diverse real-world data, collaborating with domain experts, confirming model reliability and limitations, and advancing interpretability. Thoughtful selection of evaluation metrics suited to the clinical context along with testing on diverse data sets representing different populations improves generalisability. Partnering software engineers, data scientists and medical practitioners ground assessment in real needs. Journals must uphold reporting standards matching AI's societal impacts. With rigorous, holistic evaluation frameworks, AI can progress towards expanding healthcare access and quality. Level of Evidence: Level V.

Feasibility of app-based home monitoring after abdominal surgery: A systematic review.

BACKGROUND: Abdominal surgery presents great challenges postoperatively. Considering financial healthcare constraints, the use of mobile applications has received increased interest. This systematic review was conducted to assess and report the feasibility of app-based home monitoring after abdominal surgery. METHODS: MEDLINE, EMBASE, and The Cochrane Library were searched on the October 17, 2023. This systematic review was conducted in accordance with the PRISMA guidelines. RESULTS: Thirty-six articles were included, 17 of these originating from USA or Canada. The response rate varied between 11.9 â€‹% and 100 â€‹%. Bariatric, upper gastrointestinal, and colorectal surgery reported the highest response rates. All included studies had a degree of bias. CONCLUSION: This study found varying response rates. The data indicated that the response rates were high within bariatric surgery, with additional factors potentially affecting this. The degree of bias was generally high, and the quality of the included studies limits the conclusions.

Accuracy of Smartphone-Based Three-Dimensional Facial Scanning System: A Systematic Review.

BACKGROUND: Recently, the integration of 3D face scanning into smartphones has raised vast interest in plastic surgery. With the release of smartphones featuring 3D face scanning technology, users now can capture detailed 3D models of their faces using their smartphones. However, trueness and precision of this system is less well established. METHODS: PubMed, Cochrane Library, Embase, ScienceDirect, Scopus, and Web of Science databases were searched for studies evaluating 3D scanning of smartphone devices and conventional 3D imaging systems from January 1, 2017, to June 1, 2023. A qualitative systematic review was conducted by two review authors after independently selecting studies, extracting data, and assessing the risk of bias of included studies. RESULTS: A total of 11 studies were included, all focusing on the accuracy of smartphone 3D facial scanning. The results show that although smartphones perform poorly on deep and irregular surfaces, they are accurate enough for clinical applications and have the advantage of being economical and portable. CONCLUSIONS: Smartphone-based 3D facial scanning has been basically validated for clinical application, showing broad clinical application prospects in plastic surgery. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

The implications of industry 4.0 for the tourism sector: A systematic literature review.

The tourism sector is presently facing new challenges resulting from the increasing digitalization of society. Boosted by industry 4.0, new tourism dynamics are emerging. Nonetheless, the real significance of this revolutionary trend and its implications still lack further development. Aiming to assess the state-of-the-art about the digital transformation on the tourism sector, triggered by the 4.0 paradigm, the present study followed a systematic literature review approach, adopting the PRISMA protocol guidelines. A total of 44 manuscripts were considered relevant for analysis. The findings illustrate that the 4.0 paradigm is being embraced from three main perspectives: the visitor-technology interaction and its influence on decision-making, the digital competencies in tourism students, and the technology penetration in different sub-sectors of the supply chain. However, studies conceptualizing the 4.0 paradigm in the tourism sector are lacking, beyond empirical research on areas such as digital skills, pros and cons of industry 4.0 technologies, and spatial consequences.

Nancy S. Jecker, Zohar Lederman, and Anita Ho reply.

This letter replies to the letter "Colonial and Neocolonial Barriers to Companion Digital Humans in Africa," by Luís Cordeiro-Rodrigues, in the same, May-June 2024, issue of the Hastings Center Report.

Colonial and Neocolonial Barriers to Companion Digital Humans in Africa.

This letter responds to the essay "Digital Humans to Combat Loneliness and Social Isolation: Ethics Concerns and Policy Recommendation," by Nancy S. Jecker, Robert Sparrow, Zohar Lederman, and Anita Ho, in the January-February 2024 issue of the Hastings Center Report.

The indirect impact of the technostress subfactors on the satisfaction and desire to work from home.

Introduction: Organizational digitalization is a phenomenon that is becoming more widespread and holistic; that is responsible for more employees being affected by digital work and working from home. While introducing remote work offers numerous economic benefits for organizations, this transition must be aligned with employees' needs rather than in an authoritarian manner. Our research aimed to investigate how sub-factors of technostress, directly and indirectly, influence the satisfaction and desire to work from home. Methods: We conducted a cross-sectional survey with a sample of 361 office workers with at least two years of experience who have spent some time working from home. We checked our hypotheses with a path model. Results: Our research found that techno-insecurity and techno-complexity have a minimal direct influence on the desire to work from home. However, the desire to work from home significantly decreases through various mediation pathways via the status sub-factor (which can be seen as one of the latent benefits of remote work) and through satisfaction with working from home. Our model explains 33.7% of the variance in the desire to work from home. Discussion: This suggests that leaders have a task of great significance: to decrease the technostress employees are exposed to and to draw the attention of researchers to the fact that technostress has more complex indirect effects than previously assumed.

Digitalization in the Emergency Department-An Interview Study of Nurses' Experiences in Norway.

Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses' experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke's six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses' professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.

Design and Implementation of an Ontology for Measurement Terminology in Digital Calibration Certificates.

Digital Calibration Certificates (DCCs) are a key focus in metrology digitalization, necessitating that they satisfy the criteria for machine readability and understandability. Current DCCs are machine-readable, but they are still missing the essential semantic information required for machine understandability. This shortfall is particularly notable in the lack of a dedicated semantic ontology for measurement terminologies. This paper proposes a domain ontology for measurement terminologies named the OMT (Ontology for Measurement Terminology), using a foundation of metrological terms from standards like the International Vocabulary of Metrology (VIM), the Guide to the Expression of Uncertainty in Measurement (GUM), and JJF1001. It also incorporates insights from models such as the SI Reference Point, the Simple Knowledge Organization System (SKOS), and the DCC Schema. The methodology was guided by Stanford's Seven-Step Method, ensuring a systematic development process tailored to the needs of metrological semantics. Through semantic expression capability verification and SPARQL query validations, the OMT has been confirmed to possess essential machine readability and understandability features. It has been successfully integrated into version 3.2.1 of DCCs across ten representative domains. This integration demonstrates an effective method for ensuring that DCCs are machine-readable and capable of interoperating within digital environments, thereby advancing the research in metrology digitization.