Explore the vast range of titles available.

Digital health technologies can be key to improving health outcomes, provided health care workers are adequately trained to use these technologies. There have been efforts to identify digital competencies for different health care worker groups; however, an overview of these efforts has yet to be consolidated and analyzed. The review aims to identify and study existing digital health competency frameworks for health care workers and provide recommendations for future digital health training initiatives and framework development. A literature search was performed to collate digital health competency frameworks published from 2000. A total of 6 databases including gray literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by the reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks. In total, 30 frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, were published since 2016, and were developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains pertained to basic information technology literacy, health information management, digital communication, ethical, legal, or regulatory requirements, and data privacy and security. The Health Information Technology Competencies framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health care workers. Digital health training initiatives should focus on competencies relevant to a particular health care worker group, role, level of seniority, and setting. The findings from this review can inform and guide digital health training initiatives. The most prevalent competency domains identified represent essential interprofessional competencies to be incorporated into health care workers' training. Digital health frameworks should be regularly updated with novel digital health technologies, be applicable to low- and middle-income countries, and include overlooked health care worker groups such as allied health professionals.

Background Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines. Methods We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858. Results Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand–supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models ( n  = 7), utilization models ( n  = 10), needs-based models ( n  = 25), skill-mixed models ( n  = 5), stock-and-flow models ( n  = 40), agent-based simulation models ( n  = 3), system dynamic models ( n  = 7), and budgetary models ( n  = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements. Conclusions This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.

Lack of workforce diversity in medicine has detrimental effects on patients and clinicians. The evolution of the modern quality movement represents a useful parallel for achieving a complicated goal like equitable representation in health care.

Importance Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care. Objective To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce. Evidence review Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN’s 2023 Strategic Plan survey, the ASPN’s Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions. Findings A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member’s time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology. Conclusions and relevance The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information .

•International collaboration produced standard competencies for immunization workers.•The innovative competencies design can be customized based on country needs.•The three-part competency framework links to immunization program objectives.•The framework describes immunization competencies for eight domains at four levels.•Methodical competency modeling is a useful tool for complex immunization systems. Despite global support for immunization as a core component of the human right to health and the maturity of immunization programs in low- and middle-income countries throughout the world, there is no comprehensive description of the standardized competencies needed for immunization programs at the national, multiple sub-national, and community levels. The lack of defined and standardized competencies means countries have few guidelines to help them address immunization workforce planning, program management, and performance monitoring. Potential consequences resulting from the lack of defined competencies include inadequate or inefficient distribution of resources to support the required functions and difficulties in adequately managing the health workforce. In 2015, an international multi-agency working group convened to define standardized competencies that national immunization programs could adapt for their own workforce planning needs. The working group used a stepwise approach to ensure that the competencies would align with immunization programs’ objectives. The first step defined the attributes of a successful immunization program. The group then defined the work functions needed to achieve those attributes. Based on the work functions, the working group defined specific competencies. This process resulted in three products: (1) Attributes of an immunization program described within eight technical domains at four levels within a health system: National, Provincial, District/Local, and Community; (2) 229 distinct functions within those eight domains at each of the four levels; and (3) 242 competencies, representing eight technical domains and two foundational domains (Management and Leadership and Vaccine Preventable Diseases and Program). Currently available as a working draft and being tested with immunization projects in several countries, the final document will be published by WHO as normative guidelines. Vertical immunization programs as well as integrated systems can customize the framework to suit their needs. Standardized competencies can support immunization program improvements and help strengthen effective health systems.

Although the availability and use of mobile mental health apps has grown exponentially in recent years, little data are available regarding their efficacy. This study aimed to evaluate the effectiveness of an app developed to promote stress management and well-being among working women compared with a control app. Female employees at a private hospital were invited to participate in the study via mailing lists and intranet ads. A total of 653 individuals self-enrolled through the website. Eligible participants were randomized between control (n=240) and intervention (n=250) groups. The well-being mobile app provides an 8-week program with 4 classes per week (including a brief theoretical portion and a 15-min guided practice). The active control app also provided 4 assessments per week that encouraged participants to self-observe how they were feeling for 20 min. We also used the app to conduct Web-based questionnaires (10-item Perceived Stress Scale and 5-item World Health Organization Well-Being Index) and ask specific questions to assess subjective levels of stress and well-being at baseline (t ), midintervention (t =4 weeks after t ) and postintervention (t =8 weeks after t ). Both apps were fully automated without any human involvement. Outcomes from the control and intervention conditions at the 3 time points were analyzed using a repeated measures analysis of variance. Among the randomized participants (n=490), 185 participants were excluded at the 4-week follow-up and another 79 at the 8-week follow-up because of noncompliance with the experimental protocol. Participants who did not complete t and t assessments were equally distributed between groups (t : control group=34.6% [83/240] and intervention group=40.8% [102/250]; P=.16; t : control group=29.9% [47/157] and intervention group=21.6% [32/148]; P=.10). Both groups showed a significant increase in general well-being as a function of time (F =5.27; P=.006), but only the intervention group presented a significant increase in work-related well-being (F =8.92; P<.001), as well as a significant reduction in work-related and overall stress (F =5.50; P=.004 and F =8.59; P<.001, respectively). The well-being mobile app was effective in reducing employee stress and improving well-being. Clinicaltrials.gov NCT02637414; https://clinicaltrials.gov/ct2/show/NCT02637414.

Failure to fund education in taxonomy could derail efforts to support conservation in low- and middle-income countries. Failure to fund education in taxonomy could derail efforts to support conservation in low- and middle-income countries.

Background As the complexity of cardiac surgeries increases and patient selection criteria expand, the use of veno-arterial extracorporeal membrane oxygenation for high-risk patients has become more prevalent. Despite its critical role in sustaining life, postcardiotomy ECMO (PC-ECMO) is associated with high in-hospital mortality rates. Intensive care unit (ICU) capacity and staffing are crucial in determining patient outcomes. This study aimed to investigate the relationships among ICU capacity, staffing levels, and outcomes in PC-ECMO patients in China. Methods A multilevel cross-sectional analysis was conducted using data from 586 hospitals that participated in China’s National Quality Improvement Program in 2018. From these hospitals, we selected those that performed PC-ECMO procedures between April 2016 and December 2021. The novel ICU Capacity Comprehensive Index (ICUCCI) was calculated for each hospital, incorporating medical service capacity, technical ability, quality and safety, and service efficiency. ICU staffing was assessed by patient-to-bed, patient-to-physician, and patient-to-nurse ratios. The primary outcome was in-hospital mortality, with secondary outcomes including complications, length of stay (LOS), and hospitalization costs. Results A total of 102 hospitals, encompassing 2,601 patients, were included in the analysis. Higher ICUCCI values were associated with reduced in-hospital mortality (OR: 0.83, 95% CI: 0.70–0.97, P  = 0.025) and fewer complications (OR: 0.82, 95% CI: 0.68–0.99, P  = 0.046). However, higher ICUCCI values correlated with longer LOSs (IRR: 1.14, 95% CI: 1.06–1.22, P  < 0.001) and increased hospitalization costs (IRR: 1.32, 95% CI: 1.24–1.40, P  < 0.001). ICU staffing ratios, including patients per bed, physician, and nurse, were protective against mortality, with the ratio of patients per ICU bed showing the most pronounced effect (OR: 0.69, 95% CI: 0.55–0.87, P  = 0.002). Increased staffing was also associated with longer LOS but did not affect overall complication rates or costs. The ratio of patients per ICU bed was linked to a greater risk of bloodstream infection (OR: 1.96, 95% CI: 1.14–3.46, P  = 0.022). Conclusions This study highlights the critical role of ICU capacity and staffing levels in improving outcomes for patients receiving PC-ECMO. While higher ICU capacity and staffing are associated with reduced mortality, they also correlate with longer hospital stays and/or increased costs, suggesting the need for a balanced approach in resource allocation. Our findings underline the importance of optimizing ICU staffing ratios and enhancing healthcare equity to improve patient care across diverse healthcare institutions.