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Background Contact tracing has been essential to reducing spread of COVID-19. Singapore leveraged technology to assist with contact tracing efforts using a Bluetooth-based app and token platform called ‘TraceTogether’. Methods We reviewed the impact of this system during the country’s Delta and Omicron waves (24 August 2021 to 17 February 2022) to identify differences in number of close contacts and time savings between full automation using TraceTogether alone as compared to manual contact tracing supplemented by TraceTogether. Characteristics of digital contact tracing app or token users were reviewed. Thereafter, the number of close contacts identified by manual and digital contact tracing methods, and the number of confirmed COVID-19 cases among contacts were analysed. The difference in time taken for identification of close contacts was also determined. Findings Adoption rate for TraceTogether was high, with 93.3% of cases having a registered device. There was a 9.8 h (34.9%) reduction in time savings for close contacts to be informed using TraceTogether alone compared to manual contact tracing supplemented by TraceTogether. The proportion of close contacts automatically identified through TraceTogether alone and turned positive was 3.6%. For those identified through manual contact tracing supplemented by TraceTogether, this proportion was 12.5% and 6.2% for those served quarantine orders and health risk warnings respectively. Interpretation The high adoption rate of ‘TraceTogether’ suggest that digital solutions remain a promising option to improve contact tracing in future epidemics. This may have been through its concurrent use with vaccine differentiated public health measures and policies which engender public trust. There is future potential for utilising such technology in managing communicable diseases to achieve good public health outcomes.

Sleep is a crucial aspect of geriatric assessment for hospitalized older adults, and implementing AI-driven technology for sleep monitoring can significantly enhance the rehabilitation process. Sleepsense, an AI-driven sleep-tracking device, provides real-time data and insights, enabling healthcare professionals to tailor interventions and improve sleep quality. This study explores the perspectives of an interdisciplinary hospital team on implementing Sleepsense in geriatric hospital care. Using the interpretive description approach, we conducted focus groups with physicians, nurses, care aides, and an activity worker. The Consolidated Framework for Implementation Research (CFIR) informed our thematic analysis to identify barriers and facilitators to implementation. Among 27 healthcare staff, predominantly female (88.89%) and Asian (74.1%) and mostly aged 30–50 years, themes emerged that Sleepsense is perceived as a timesaving and data-driven tool that enhances patient monitoring and assessment. However, barriers such as resistance to change and concerns about trusting the device for patient comfort and safety were noted, while facilitators included training and staff engagement. The CFIR framework proved useful for analyzing implementation barriers and facilitators, suggesting future research should prioritize effective strategies for interdisciplinary team support to enhance innovation adoption and patient outcomes in rehabilitation settings.

Background Lung transplantation (LT) represents a high-risk procedure for end-stage lung diseases. This study describes the outcomes of patients undergoing LT that require massive transfusions as defined by the universal definition of perioperative bleeding (UDPB). Methods Adult patients who underwent bilateral LT at a single academic center were surveyed retrospectively. Patients were grouped by insignificant, mild, or moderate perioperative bleeding (insignificant-to-moderate bleeders) and severe or massive perioperative bleeding (severe-to-massive bleeders) based on the UDPB classification. Outcomes included 1-year survival and primary graft dysfunction (PGD) of grade 3 at 72 h postoperatively. Multivariable models were adjusted for recipient age, sex, body mass index (BMI), Lung allocation score (LAS), preoperative hemoglobin (Hb), preoperative extracorporeal membrane oxygenation (ECMO) status, transplant number, and donor status. An additional multivariable model was created to find preoperative and intraoperative predictors of severe-to-massive bleeding. A p -value less than 0.05 was selected for significance. Results A total of 528 patients were included, with 357 insignificant-to-moderate bleeders and 171 severe-to-massive bleeders. Postoperatively, severe-to-massive bleeders had higher rates of PGD grade 3 at 72 h, longer hospital stays, higher mortality rates at 30 days and one year, and were less likely to achieve textbook outcomes for LT. They also required postoperative ECMO, reintubation for over 48 h, tracheostomy, reintervention, and dialysis at higher rates. In the multivariate analysis, severe-to-massive bleeding was significantly associated with adverse outcomes after adjusting for recipient and donor factors, with an odds ratio of 7.73 (95% CI: 4.27–14.4, p  < 0.001) for PGD3 at 72 h, 4.30 (95% CI: 2.30–8.12, p  < 0.001) for 1-year mortality, and 1.75 (95% CI: 1.52–2.01, p  < 0.001) for longer hospital stays. Additionally, severe-to-massive bleeders were less likely to achieve textbook outcomes, with an odds ratio of 0.07 (95% CI: 0.02–0.16, p  < 0.001). Preoperative and intraoperative predictors of severe/massive bleeding were identified, with White patients having lower odds compared to Black patients (OR: 041, 95% CI: 0.22–0.80, p  = 0.008). Each 1-unit increase in BMI decreased the odds of bleeding (OR: 0.89, 95% CI: 0.83–0.95, p  < 0.001), while each 1-unit increase in MPAP increased the odds of bleeding (OR: 1.04, 95% CI: 1.02–1.06, p  < 0.001). First-time transplant recipients had lower risk (OR: 0.16, 95% CI: 0.06–0.36, p  < 0.001), whereas those with DCD donors had a higher risk of severe-to-massive bleeding (OR: 3.09, 95% CI: 1.63–5.87, p  = 0.001). Conclusion These results suggest that patients at high risk of massive bleeding require higher utilization of hospital resources. Understanding their outcomes is important, as it may inform future decisions to transplant comparable patients.

IntroductionThe disabilities associated with dementia make the adjustment to staying in a care setting stressful. Separation from family can exacerbate the effects of stress. The use of touch screen tablets such as an iPad may offer potential to support the person with dementia staying in a care setting. Although electronic devices are used among people with dementia for a variety of purposes, a comprehensive review of studies focusing on their impact in care settings for social connection and patient/resident behaviour is lacking. This scoping review will focus on the use of touch screen tablets to support social connections and reducing responsive behaviours of people with dementia while in a care setting, such as a hospital ward.Methods and analysisThis scoping review will follow Joanna Briggs Institute scoping review methodology. The review team consists of two patient partners and three family partners, a nurse researcher, a research assistant and an academic professor. All authors including patient and family partners were involved in preparing this scoping review protocol. In the scoping review, we will search the following databases: MEDLINE, AgeLine, Cochrane, CINAHL, PsycINFO and IEEE. Google and Google Scholar will be used to search for additional literature. A hand search will be conducted using the reference lists of included studies to identify additional relevant articles. Included studies must report on the impact of using a touch screen technology intervention that involves older adults with dementia in care settings, published in English since 2009.Ethics and disseminationThis review study does not require ethics approval. By examining the current state of using touch screen tablets to support older people with dementia in care settings, this scoping review can offer useful insight into users’ needs (eg, patients’ and care providers’ needs) and inform future research and practice. We will share the scoping review results through conference presentations and an open access publication in a peer-reviewed journal.

Previous investigations into concussions' effects on Major League Baseball (MLB) players suggested that concussion negatively impacts traditional measures of batting performance. This study examined whether post-concussion batting performance, as measured by traditional, plate discipline, and batted ball statistics, in MLB players was worse than other post-injury performance. MLB players with concussion from 2008 to 2014 were identified. Concussion was defined by placement on the disabled list or missing games due to concussion, post-concussive syndrome, or head trauma. Injuries causing players to be put on the disabled list were matched by age, position, and injury duration to serve as controls. Mixed effects models were used to estimate concussion's influence after adjusting for potential confounders. The primary study outcome measurements were: traditional (eg, average), plate discipline (eg, swing-at-strike rate), and batted ball (eg, ground ball percentage) statistics. There were 85 concussed players and 212 controls included in the analyses. There was no significant difference in performance between concussed players and controls. However, concussed players started at a lower level of performance pre-event than the controls, striking out a 9.2% rate vs 8.2% ( =0.042) with an isolated power of 0.075 vs 0.082 ( =0.035). For concussed players, traditional batting statistics decreased before plate discipline metrics. MLB players' performance was lower after return from concussion, but no more than after return from other injuries. The decreased performance prior to concussion suggests that concussion-related performance declines may not be due exclusively to concussion and perhaps point to risk factors predisposing to concussion.

The objective of this study was to determine the optimal assessment of arterial stiffness that relates to diastolic dysfunction. Forty-one patients had measurements of brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), ankle brachial index (ABI), pulse pressure (PP), and augmentation index (AIx). Diastolic dysfunction was evaluated by echocardiographic indices of the ratio of the peak early diastolic mitral valve velocity and the peak late diastolic velocity (E/A ratio), left atrial diameter, and left atrial volume indexes. There was a significant (P<0.05) correlation between baPWV and E/A ratio with an inverse relationship indicating that higher arterial stiffness was associated with greater diastolic dysfunction. In contrast, there was no significant correlation between E/A ratio and cfPWV, PP, ABI, or AIx. After multivariate analysis, the relationship between baPWV and E/A ratio remained significant (P<0.05), independent of age and systolic blood pressure (BP). There were no correlations between any index of vascular stiffness and left atrial dimension or volume. In summary, baPWV correlates with diastolic dysfunction, independent of a patient’s age and BP and is a better indicator of diastolic dysfunction than other indicators of arterial stiffness. baPWV has the utility of infering the presence of left ventricular diastolic dysfunction.

Background: Khoo Teck Puat Hospital & Yishun Community Hospital (KTPH&YCH) is a regional hospital system of the National Healthcare Group (NHG) in northern Singapore, embarking on a whole hospital system transformation. Effective governance is a cornerstone for care integration in regional hospital systems, with performance management being an activity of the Governance & Leadership Subsystem of health systems. KTPH&YCH’s governance transformation focuses on systemic performance management, aiming to enhance accountability, strategic alignment, and performance transparency.  Approach: The HGOS initiative focused on two areas: aligning hospital system performance with NHG and KTPH&YCH system priorities, and ensuring clear accountability at departmental and operational levels within the hospital system. The transformation began by identifying six health system indicators based on Quadruple Aims, inclusive of areas concerning patients’ experience of health, staff wellbeing and operational performance for organizational sustainability. Thereafter, Key Result Areas (KRAs) were chosen by senior leaders to reflect NHG and KTPH&YCH system priorities in advancing population health, fostering people and culture, encouraging strategic growth of health system and enforcing operational and financial stability. Driver diagrams mapping KRAs to the health system indicators were co-created with clinical and operational teams with feedback from mid and senior management, visually connecting service delivery drivers to key outcomes. The second component involved a detailed review of definitions of heads of departments (HOD), cost centers and operational units, which are fundamentals of operations in a regional hospital system. The review assessed the types of cost centers and operational units, mapped them to site-based or microsystem-based (services serving a population of patients) systems of care, and through consultations with HODs, re-assigned them to specific departments for oversight and accountability. Sole and shared accountability structures were further defined to address both site-based and specialty-based outcomes in these systems. Further, the levels of HODs were delineated, ensuring that accountability for results of integrated care could be effectively cascaded from NHG to KTPH&YCH senior management down to all levels of HODs. This structure allowed a clear visualization of how contributions of each HOD flow upwards, supporting their respective higher-level department heads through the impact of departmental actions. Results: Driver diagrams linking service delivery drivers to KRA facilitated a better understanding among leaders in KTPH&YCH of how service performance impacts the health system indicators, ensuring a strategic focus on outcomes. Additionally, the realignment of cost centers and operational units, along with clear delineation of HOD definitions and their accountability, has improved the clarity of departmental responsibilities and resource management, as leaders in KTPH&YCH are supported by visualization of departmental outcomes through performance management dashboards. These changes contributed to a more integrated care delivery and better alignment of operational activities with regional hospital system goals. Implication: The governance transformation within KTPH&YCH established a clear framework for aligning executive leadership, departmental operations, and regional hospital system outcomes that contributes to NHG regional health system outcomes. This approach lays the groundwork for continuous improvements in integrated care delivery and offers valuable lessons for other health systems aiming to enhance their governance and accountability mechanisms.  

Introduction People with dementia may refuse care because they feel overwhelmed by an unfamiliar environment. Everyday technology such as tablets have the potential to support person-centred dementia care in hospitals. Aims We aimed to identify barriers and enabling factors in order to develop a toolkit to support the use of tablets in engaging individual and group activities, especially to play family videos, for hospitalized older people with dementia. Methods A participatory action research approach was employed. We facilitated staff focus groups and conducted interviews with stakeholders. A toolkit was developed based on participants’ perspectives on how to support successful adoption. Results Our analysis identified two enabling factors: users’ engagement in developing a toolkit for support and adapting implementation to meet local needs. Barriers included staff and family inexperience, mechanical instability of hardware, issues around privacy and data access, technology use and personalization of messages. The toolkit includes short videos, a brochure for family caregivers, and a pocket card for staff. Discussion and implications: Staff, family and patients start with varying levels of experience with the use of tablets, making education and support vitally important to implementation. Health organizations should involve staff, patients, and families to find practical solutions.

The objective is to investigate the relationship between arterial stiffness measured by arterial tonometry and echocardiographic indices of diastolic dysfunction—a basis for the diagnosis of heart failure with preserved ejection fraction (HFpEF). OvidSP Medline, Embase and PubMed were systematically searched. Eligible articles correlated arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) or cardio-ankle vascular index (CAVI) with indices of diastolic dysfunction, E / A ratio, peak early mitral annular velocity ( e ′) and E / e ′ ratio. Correlation coefficients were determined using a random-effects model. Twenty-seven studies with 6,626 patients were included. baPWV was significantly correlated with E / A ratio ( r  = −0.434, 95 % CI −0.387 to −0.479), e ′ ( r  = −0.499, 95 % CI −0.448 to −0.548) and E / e ′ ratio ( r  = 0.372, 95 % CI 0.251–0.481). cfPWV was significantly correlated with E / A ratio ( r  = −0.391, 95 % CI −0.304 to −0.470) and E / e ′ ratio ( r  = 0.210, 95 % CI 0.300–0.116), but not e ′. AIx was significantly correlated with E / A ratio ( r  = −0.356, 95 % CI −0.255 to −0.450), e ′ ( r  = −0.313, 95 % CI −0.195 to −0.423) and E / e ′ ratio ( r  = 0.321, 95 % CI 0.250–0.388). CAVI was significantly correlated with E / A ratio ( r  = −0.405, CI −0.324 to −0.481), e ′ ( r  = −0.449, 95 % CI −0.340 to −0.630), but not E / e ′. baPWV showed significantly greater correlation with diastolic dysfunction compared to most other tonometric techniques. Arterial stiffness measured by arterial tonometry is an indicator of diastolic dysfunction with baPWV demonstrated the most consistent and strongest association. These data suggest a refocusing on the impact of arterial stiffness on the left ventricle as a potential causative factor leading to HFpEF.

While the mechanical and material properties of 3D printed denture components have been extensively studied, the accuracy implications of the assembly process, specifically the bonding of separately printed teeth onto the denture base, remain insufficiently investigated. Positional distortion introduced at this stage could potentially result in downstream occlusal discrepancies. This study therefore investigated the accuracy of different 3D printing materials, methods (monoblock versus assembled) and assembly configurations (complete arch versus segmented) in the fabrication of 3D printed dentures. Four groups of dentures (M, T, F, S; n = 15) were fabricated. M and T were printed monoblock units using model resin and tooth-coloured resin, respectively. F and S involved separate printing of denture bases and teeth, followed by bonding. Teeth were fabricated as a full arch in F and in three segments in S. All specimens were produced under standardised conditions. Digitized samples compared to a reference model using a surface-matching software. Tooth positional deviations were assessed as a complete arch and in sextants. Data was analysed using two-way analysis of variance and post-hoc tests (α = 0.05). For complete arch analysis, Groups M and T demonstrated significantly lower deviations than Groups F and S (p = 0.001), with no significant differences within monoblock or assembled groups (p > 0.05). Sextant analysis showed consistent findings across all regions, with monoblock groups demonstrating superior accuracy. Monoblock 3D-printed dentures exhibited greater positional accuracy than assembled dentures. Although deviations were within clinically acceptable thresholds, further clinical studies are required to determine their impact on occlusion and patient outcomes.