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Objective Given the effectiveness of both in‐person and digital diabetes prevention programs (DPPs), participants have an opportunity to select a delivery mode based on their needs and preferences. The objective of this study was to understand and compare participants’ experiences with digital and in‐person DPPs to identify factors that affected how useful participants perceived these two program delivery modes. Methods Semi‐structured interviews with participants who were enrolled in DPPs as either a digital (n = 23) or in‐person (n = 20) program within one health care system were conducted. Data were analyzed following the template method using the qualitative software NVivo 12. Results Findings from the interviews indicated that creating accountability for weight loss was crucial for all program participants. In the digital program, weight and food tracking played a central role in creating accountability, while in the in‐person program, group interactions fostered accountability. The digital program was perceived to encourage self‐monitoring, oftentimes resulting in participants’ reflection on their habits. The in‐person program provided a platform for group support and mutual encouragement. Conclusions Participants perceived both programs as similarly useful. Yet program characteristics such as the ability to engage with other participants in‐person or to seamlessly track weight on a daily basis appealed to different participants. It may be beneficial to align participants’ preferences with programs’ characteristics and strengths.

Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain.Design Population based randomised controlled trial.Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals).Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles.Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status.Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly.Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.Trial registration Current Controlled Trials ISRCTN28478651.

Depression is highly prevalent among patients newly starting antiretroviral treatment (ART) in Malawi and many other countries. Untreated depression at ART initiation can disrupt the HIV care continuum. Effective approaches for depression screening and treatment exist for low-resource settings, but they are rarely applied. Identifying effective implementation strategies are critical. A pilot program integrated depression screening and treatment into routine HIV care using existing staff at two public health clinics in Malawi in two phases; a screening-only \"control\" phase and an active \"intervention\" phase. During the intervention phase, providers prescribed antidepressants or referred patients for Friendship Bench problem-solving therapy. We evaluated the program's impact on retention in HIV care, viral suppression, and depression remission at 6 months using tabular comparisons and log-binomial models to estimate adjusted risk ratios and mean differences among the intervention group relative to the control group. Nearly all consenting participants were screened for depression appropriately and 25% had mild to severe depressive symptoms. During the intervention phase, 86% of participants with mild depressive symptoms started Friendship Bench therapy and 96% of participants with moderate to severe depressive symptoms started antidepressants. Few participants in the intervention group received consistent depression treatment over their first 6 months in care. In the adjusted main analysis, program exposure did not demonstrably affect most HIV or mental health outcomes, though the probability of currently being on ART at 6 months was significantly lower among the intervention group than the control group [RR 0.6(95%CI: 0.4-0.9)]. While it is feasible to integrate depression screening and treatment initiation into ART initiation, providing ongoing depression treatment over time is challenging. Similar implementation science studies focused on maintaining depression management will be increasingly important as we strive to understand and test the best ways to implement evidence-based depression treatment within HIV care.

To review the current AI applications in healthcare and explore the implications for nurse educators in innovative integration of this technology in nursing education and training programs. There are a variety of Artificial Intelligence (AI) applications currently supporting patient care in many healthcare settings. A nursing workforce that leverages healthcare technology to enhance efficiency and accuracy of patient health outcomes is necessary. Nurse educators must understand the various uses of AI applications in healthcare to equip themselves to effectively prepare students to use the applications. Qualitative synthesis and analysis of existing literature. Generative AI (ChatGPT) was used to support the development of a list of the current AI applications in healthcare. Each application was evaluated for relevance and accuracy. A literature review to define and understand the use of each application in clinical practice was completed. The search terms “AI” and “Health Education” were used to review the literature for evidence on educational programs used for training learners. Ten current applications of AI in healthcare were identified and explored. There is little evidence that outlines how to integrate AI education into educational training for nurses. A comprehensive multimodal educational approach that uses innovative learning strategies has potential to support the integration of AI concepts into nursing curriculum. The use of simulation and clinical practicum experiences to support experiential learning and to offer opportunities for practical application and training. Considerations for ethical use and appropriate critical evaluation of AI applications are necessary.

Seven-year surveillance study (2005–2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. SH events were identified via any primary or principal diagnosis from emergency department or inpatient encounters among African American, Asian, Latino and White adult diabetes patients treated with insulin or secretagogues (Sulfonylureas or Meglitinides), receiving care from integrated healthcare delivery systems across the United States. We calculated age- and sex-standardized annual SH rates and average annual percent change (AAPC) in SH rates. Annual SH rates ranged from 1.8% to 2.1% during this 7-year observation period (2,200,471 person–years). African Americans had consistently higher SH rates compared with Whites, while Latinos and Asians had consistently lower rates compared with Whites in each of the 7 years (all p < 0.01). The trend increased significantly only among African Americans (AAPC = +4.3%; 95% CI: +2.1, +6.5%); in the other groups, the AAPC was not significantly different from zero. Surveillance efforts should monitor the racial/ethnic-specific rates. The factors underlying substantially higher rates of hypoglycemia in African Americans should be evaluated. Clinically and culturally-appropriate strategies to reduce the risk of SH need to be developed and tested.

Background The ageing global population necessitates specialised geriatric/gerontological physiotherapy services (GPTS) to address age-related conditions. We explored the current state of geriatric/gerontological physiotherapy (GPT) academic programmes and clinical practice among World Physiotherapy member nations (WPMNs) and identified factors, including socioeconomic indicators, that predicted the GPTS globally. Methods We conducted an online cross-sectional survey between April 1 and September 19, 2024, inviting official representatives of the 128 WPMNs to answer questions relating to GPT academic programmes and clinical services and practices. We also extracted the Human Development Index (HDI), life expectancy, and Gross National Income (GNI) per capita for each WPMN from the United Nations Development and World Bank databases. Data was analysed using descriptive statistics, a map, bubble charts, and logistic regression models. Results Sixty-seven countries (67/128, 52.3% response rate) completed the survey. Among them, 34 (50.7%) and 19 (28.4%) reported having geriatric/gerontology modules in their entry-level and graduate-level physiotherapy programmes, respectively. Additionally, 20 (29.9%) and 13 (19.4%) reported having entry-level geriatric/gerontology clinical placement and graduate-level clinical training, respectively. Physiotherapists were members of interdisciplinary geriatric/gerontological teams in Africa (9/11, 81.8%), Asia Western Pacific (10/16, 62.5%), Europe (15/27, 55.6%), North America Caribbean (4/7, 57.1%), and South America (5/6, 83.3%), but they can only lead the teams in few countries: Africa (1/11, 9.1%), Asia Western Pacific (4/16, 25.0%), Europe (5/27, 18.5%), North America Caribbean (2/7, 28.6%), and South America (2/6, 33.3%). GPTS were more common in countries with graduate-level geriatric physiotherapy academic programmes ( OR  = 33.47, 95% CI: 1.36, 822.39, p  = 0.032) GPT Availability in Practice Act ( OR  = 41.93, 95% CI: 1.66, 1059.78, p  = 0.023), and higher HDI ( OR  = 5.32e + 07, 95% CI: 49.78, 5.67e + 12, p  = 0.003). Europe and North America Caribbean regions had lower older-adult-to-physiotherapist ratios and a higher life expectancy, HDI, and GPTS availability than other World Physiotherapy regions. Conclusion Geriatric/gerontological PT education and clinical practice are evolving, especially at the entry-level training across WPMNs; however, extra effort is required to enhance graduate specialization to cater to the emerging ageing population.

Although family-focused, evidence-based programs (EBPs) have the potential to reduce disparities in health and behavioral outcomes for youth, access to such programs is severely limited in the most affected areas, including African American communities in the rural South. As expanding the reach of EBPs is the primary goal of translational research, interest is growing in the potential of technology as a viable platform to disseminate services to areas with limited resources. To test whether African American families in the rural South would be willing to engage in a technology-based family-focused EBP to prevent adolescent risk behavior, we examined attendance using data from two arms of a three-arm community-based trial of the Pathways for African American Success (PAAS) program. In the overall study, sixth graders (N = 412) and their primary caregivers were randomly assigned to the following conditions: (a) in-person, small group sessions led by facilitators; (b) self-directed, technology-based sessions; or (c) a literature control with home-mailed educational materials. Results indicated that attendance was higher in the technology condition than in the small group condition. Parental age, education, and socioeconomic status did not limit attendance in the technology condition. We conclude from these results that the use of technology can be an acceptable strategy for disseminating parenting EBPs to African American families in the rural South.

Background Although cancer-related fatigue (CRF) has gained increased attention in the past decade, therapy remains a challenge. Treatment programs are more likely to be effective if the needs and interests of the persons involved are well represented. This can be achieved by stakeholder engagement. In this paper, different key stakeholders’ experiences and views on the feasibility of treating CRF in the context of supportive care in hospital environments are analyzed. Method In a qualitative study with the aim of developing an integrative treatment program for CRF, a total of 22 stakeholders (6 medical oncologists, 5 nurses, 9 patients, 1 patient family member, 1 representative of the Swiss Cancer League) were interviewed either in a face-to-face ( n  = 12) or focus group setting ( n  = 2). For data analyses, the method of qualitative content analysis was used. Results The stakeholders referred to different contextual factors when talking about the feasibility of treating CRF in the context of supportive care in hospital environments. These included: assessment, reporting and information; treatability; attitude; infrastructure, time-management, costs and affordability; and integrative approach. Conclusions Key factors of a feasible treatment approach to CRF are a coherent, cost effective integrative treatment program facilitated by an interdisciplinary team of health care providers. Furthermore, the treatment approach should be patient orientated, adopting an individualized approach. The major challenges of making the integrative treatment program feasible for CRF are resources and interprofessional collaboration.

Background Obstetric anal sphincter injuries (OASIS) are associated with anal incontinence, dyspareunia and perineal pain. Bimanual perineal support technique (bPST) prevents OASIS. The aim of this study was to assess the effect of two different bPST training-methods on OASIS incidence. Methods This is a prospective-interventional quality improvement study conducted in two Palestinian maternity units between June 1 2015 and December 31 2016. Women having spontaneous or operative vaginal-delivery at ≥24 gestational-weeks or a birthweight of ≥1000 g ( n  = 1694) were recruited and examined vaginally and rectally immediately after vaginal birth by a trained assessor. Data on baseline OASIS incidence were collected during Phase-1 of the study. Subsequently, birth attendants in both maternity units were trained in bPST using two training modalities. A self-directed electronic-learning (e-learning) using an animated video was launched in phase-2 followed by a blended learning method (the animated e-learning video+ structured face-to-face training) in phase-3. OASIS incidence was monitored during phases-2 and 3. Variations in OASIS incidence between the three phases were assessed using Pearson-χ 2 -test (or Fisher’s-Exact-test). The impact of each training-method on OASIS incidence was assessed using logistic-regression analysis. Results A total of 1694 women were included; 376 in phase-1, 626 in phase-2 and 692 in phase-3. Compared to Phase-1, OASIS incidence was reduced by 45% (12.2 to 6.7%, aOR: 0.56, CI; 0.35–0.91, p  = 0.018) and 74% (12.2 to 3.2%, aOR, 0.29, CI; 0.17–0.50, p  < 0.001) in phases-2 and 3, respectively. There was also a significant reduction in OASIS incidence by 52% from phase-2 to phase-3 (6.7% (42/626) to 3.2% (22/692), p  = 0.003). These reductions reached statistical significance among parous-women only (aOR: 0.18, CI; 0.07–0.49, p  = 0.001) after the first training method tested in phase-2. However, the reduction was significant among both primiparous (aOR: 0.39, CI; 0.21–0.74, p  = 0.004) and parous-women (aOR: 0.11, CI; 0.04–0.32, p < 0.001) after implementing the blended learning method in phase-3. Conclusion The animated e-learning video had a positive impact on reducing OASIS incidence. However, this reduction was enhanced by the use of a blended learning program combining both e- learning and face-to-face training modalities. Study registration number ClinicalTrialo.gov identifier: NCT02427854 , date: 28 April 2015.

Low back pain (LBP) is a common, costly, and debilitating condition that creates a heavy socioeconomic burden on the global health care systems. In Western Medicine (WM), the treatment goals are to relieve pain, reduce disability, and enhance rehabilitation. In Traditional Chinese Medicine (TCM), acupuncture is frequently used to rebalance the vital energy \"Qi\". Whilst numerous literatures are available from WM and TCM in the management of LBP, the value of an integrative WMTCM therapy remains unknown. This article aims to introduce an integrative WM-TCM service model for LBP, which is now available at the Hong Kong Institute of Integrative Medicine, the Chinese University of Hong Kong.