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Background As the number and complexity of patients living with serious illness continue to rise, delivering care that is both effective and responsive to individual life contexts has become increasingly important. Despite its potential benefits, the implementation of contextualized care in the management of serious illness remains limited and poorly understood. To address this gap, this study aimed to identify barriers and facilitators influencing the delivery of contextualized care for patients with serious illness, as perceived by healthcare professionals (HCPs), and to generate recommendations for improving its implementation. Methods Three focus groups were conducted with 20 HCPs from multiple disciplines and hospital settings in the Netherlands, all involved in the care of patients with serious illness. Discussions were guided and analysed using a directed content analysis informed by the COM-B model (Capability, Opportunity, Motivation–Behaviour) combined with the Theoretical Domains Framework. Factors were mapped to intervention functions from the Behaviour Change Wheel (BCW) to provide recommendations. Results Nine factors influencing contextualized care were identified across COM-B components. Capability-related factors included skills and knowledge to engage with the relevant patient context and the ability to distinguish between general and clinically relevant context. Opportunity-related factors included environmental conditions, fragmented information systems, systemic incentives misaligned with contextual care, a lack of shared team norms, collaboration challenges, and the perceived emotional complexity of contextual conversations in the palliative phase. Motivation-related factors included strong intrinsic commitment to person-centred care and awareness of the consequences of overlooking context for patients, HCPs, and the overall system. Most barriers were concentrated in the Opportunity component, with environmental and team-level constraints often outweighing individual motivation and basic skills. Conclusions Delivering contextualized care for patients with serious illness is not primarily limited by individual willingness or basic capability but by environmental and systemic feasibility. Sustainable implementation requires multilevel strategies targeting team culture, interprofessional collaboration, and a supportive infrastructure. Moving from individual intent to shared norms may improve both patient outcomes and resource efficiency. Key steps include continuous education, embedding contextual care in team culture, adapting workflows and documentation, and integrating contextualization into quality measures and incentives.

In 2020, BLOODPAC recommended 11 pre‐analytical minimal technical data elements for collection and submission of liquid biopsy data to public databases. This article expands on that work by recommending 22 clinical context and 10 patient context data elements. These elements, essential for liquid biopsy data submitted to repositories like the BLOODPAC Data Commons, cover tumor characteristics, disease progression, and patient demographics, supporting biomarker validation, research, and clinical trials.

Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. Recent literature proposes a safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.

There is need for software systems in order to coordinate the activities of healthcare professionals involved in the treatment of a patient, aligning the care delivery around already existing Clinical Practice Guidelines (CPGs). This is being carried out in care organizations by implementing integrated Care Pathways (CPs). Nonetheless, the generation of these care pathways is not trivial, and multiple barriers exist for their development and enactment. In this paper, a knowledge-based architecture is presented that, by means of Knowledge Engineering methods and Artificial Intelligence Planning and Scheduling (AI P&S) techniques, is able to automatically generate these care pathways from a computer-interpretable representation of CPGs, tackling some of these barriers. Firstly, these techniques consider the patient profile, the care organization details as well as the temporal and resource constraints, implicit in a care process, in order to generate a patient-focused care pathway. Moreover, they also allow the enactment of personalized care plans in a web-based format, powered by a workflow runtime engine, thus providing an ubiquitous and interactive execution to healthcare professionals. Finally, the architecture also includes monitoring and replanning techniques in order to check the current health status of patients and adapt care plans when they do not progress as expected. For the experimental evaluation of the architecture, several tests have been carried out in order to simulate a clinical environment where different care plans were automatically executed, monitored and adapted regarding the health conditions of patients as well as the recommendations specified in a real, CPG of the paediatric oncology area. As conclusion, the proposed architecture seems to be an adequate infrastructure for supporting the automated generation as well as the interactive execution and monitoring of patient-focused care pathways.

Patient-centredness (PC) is a key principle in Family Medicine. The term 'patient-centredness' was coined by Balint to emphasise that patients should be treated as unique individuals and was used initially to describe how physicians should interact and communicate with patients. The Institute of Medicine, an American non-profit, non-governmental organisation, advises that PC should be 'responsive to and respectful of the individual patient's preferences, needs and values while ensuring that the patient's values guide clinical decisions'. This is the Eurocentric model of PC which is now taught in Botswana and other non-Western settings. The Eurocentric meaning and operationalisation of PC, though based on research in Western contexts, seems to be accepted universally. The universal appropriateness of the meaning and application of the Eurocentric model of PC needs to be backed by evidence from research in non-Western contexts. This article attempts to show how the understanding and practice of PC may be different in other regions. It also hopes to stimulate debate and research on PC in non-Western contexts.

This chapter contains sections titled: What Is Problem ‐ based Learning? Problems Facilitators/Tutors Small Groups Resources Organisation and Grading Student Evaluation The Theoretical Basis for Problem ‐ based Learning Effectiveness of PBL Summary Acknowledgements References

Zusammenfassung Einführung Die Sicherstellung der besten Therapie – das Heilverfahren (HV) – ist Aufgabe der Deutschen Gesetzlichen Unfallversicherung (DGUV). Das Verletzungsartenverzeichnis ist das Mittel zur Lenkung des HV. Ziele der Arbeit sind die Auswertung der mittelfristigen Entwicklung der Fallzahlen im DAV, VAV und SAV, der Ziffer 11 „Komplikationen“ sowie des möglichen Einflusses durch die COVID-19-Pandemie. Methodik Alle im SAV-Zentrum stationären DAV-, VAV- und SAV-Fälle von Januar 2019 bis Dezember 2021 wurden retrospektiv eingeschlossen. Die Fallzahlen vor und während der Lockdownmaßnahmen wurden verglichen. Der Case-Mix-Index, die Anzahl der durchschnittlichen Operationen, die Saalzeitminuten und die stationäre Verweildauer wurden analysiert. Ergebnisse 67 % aller 2007 stationär behandelten Versicherten gehören dem SAV an. 51 % aller SAV-Fälle sind der Ziffer 11 zuzuordnen. Im Bereich des Schultergürtels und Ellenbogens, an der Hand, am Kniegelenk und im Bereich des Sprunggelenks und Fußes sind viele Fälle der Ziffer 11 behandelt worden. Diese sind wirtschaftlich nur entsprechend der Fälle des VAV abgebildet. Durch die Lockdownmaßnahmen sind die Fallzahlen signifikant zurückgegangen. Das Verhältnis der Fallzahlen im DAV und VAV vs. SAV hat sich nicht verändert. Schlussfolgerung Im Einzugsgebiet des vorliegenden SAV-Zentrums wird die Steuerung des HV in DAV, VAV und SAV erfolgreich verwendet. Der Großteil aller Fälle gehört dem SAV an. Hiervon wiederum ist mehr als die Hälfte der Ziffer 11 zuzuordnen. Der hohe Anteil an Komplikationsfällen der Ziffer 11 wirft die Frage nach der Notwendigkeit einer strukturellen Anpassung des HV auf. Die Kommentierung des aktualisierten Verletzungsartenverzeichnisses bietet entscheidende klärende Definitionen, jedoch sollte die Übersichtlichkeit erhalten bleiben. Graphic abstract

This chapter contains sections titled: Patient errors The context of patient errors Mechanisms and types of error Promotion of patients' safety Conclusion Acknowledgments References

Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.