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Decommissioning programmes pose a substantial risk of failure compared to other change processes in healthcare. A better understanding of the challenges associated with change processes initiated by resource scarcity faced by healthcare managers is crucial. This study describes and compares department and unit managers' experiences during the implementation of a large-scale decommissioning programme in a Swedish region. A survey was developed and a cross-sectional study was performed, measuring 172 healthcare managers' experiences of (1) the region's leadership, (2) their own participation and (3) their own commitment and responsibility during the implementation of the decommissioning programme. Respondents were 50 department managers and 122 unit managers (93% and 58% response rate, respectively). There was a significant difference between department and unit managers in their experiences of the region's leadership and their own participation in the decommissioning programme. Unit managers were more dissatisfied with the way it developed compared to department managers. For example, unit managers reported a lower level of leadership support, incentives to participate, and that their knowledge and skills were not fully utilised. Involvement of unit managers in a more fruitful way might enhance the results of decommissioning programmes. This study highlights a key actor in this context: the unit manager.

Introduction: Alzheimer disease (AD) is the most common type of dementia, affecting 70% of patients with dementia. In Japan, over 5 million people aged 65 years and older had dementia in 2018, and this figure is expected to rise to 25% to 30% of this age group by 2045. In Japan, lecanemab, which was approved in 2023, is expected to be a new treatment for AD. However, lecanemab requires stringent management, including amyloid PET scans and MRI monitoring, necessitating specialized facilities, creating concerns regarding the lack of treatment facilities and poor treatment access.

Methods: This study assessed spatial accessibility to lecanemab in Hokkaido, Japan, using geographic information system data. Hospitals were categorized into 3 scenarios based on their capacity to meet the treatment criteria. Service area analysis in each scenario evaluated the population coverage within 30-, 60-, and 120-minute travel times. The inverted two-step floating catchment area method was used to calculate the potential high-demand areas index (PHDI) for each hospital.

Results: Population coverage ranged from 56% to 97%, depending on the scenario and travel time. Coverage for the most feasible scenario (Scenario 1) was 56%, 73.9%, and 88.3% within 30, 60, and 120 minutes, respectively. Northern and southern Hokkaido had the lowest coverage. PHDI analysis identified high-demand areas, with Sapporo facing potential overcapacity issues.

Conclusion: Lecanemab highlights the need for strategic resource allocation to enhance accessibility and capacity. Establishing additional treatment centers, particularly in areas with poor accessibility and capacity, is crucial to maximize the benefits of treatment for dementia.

Background: Pharmacists can play a role in enhancing treatment outcomes of autistic people, but they must possess sufficient knowledge and awareness of autism spectrum disorders (ASD). Current evidence is scant among Nigerian pharmacists. The objectives of this study were to: (1) Describe and compare Nigerian hospital and community pharmacists' ASD knowledge, awareness, and perceptions; (2) Determine if there is a significant correlation between ASD knowledge, awareness, and perceptions; (3) Determine if demographic and practice-related factors are significantly related to pharmacists' ASD awareness.

Method: Hospital and community pharmacists were administered a self-report survey to assess ASD knowledge and awareness, as well as confidence in caring for autistic people, and perceived benefits of ASD training and care. Data were collected from August to December 2021 and analyzed using inferential and descriptive statistics. Cronbach's alphas were used to assess reliability.

Results: Of respondents, (Total N = 383; N = 201 hospital pharmacists from various states) and N = 182 community pharmacists in Lagos state) community pharmacists had significantly higher mean knowledge than hospital pharmacists (58.10% ± 19.00% vs 53.20% ± 20.10%; P = .016). Overall mean awareness score was 2.90 ± 0.80, with no significant difference between community and hospital pharmacists (P = .096). Perception regarding ASD continuing education (CE) was strongly correlated with the perceived benefits of pharmacy services to autistic people in Nigeria (r = .69; P < .0001). Additionally, awareness was positively correlated with knowledge (r = .47, P < .0001) and perceived confidence in ASD medication counseling (r = .54, P < .0001). Multivariate analysis revealed that being a hospital pharmacist, having courses on ASD during pharmacy degree programs, undergoing ASD CE, and having <5 years of practice experience were significantly (P < 0.05) associated with higher ASD awareness.

Conclusion: Respondents had suboptimal knowledge and awareness of ASD. Including ASD in the pharmacy curriculum and providing CE programs may help improve pharmacists' ability to provide more optimal patient care services for autistic people.

This letter highlights the critical issue of sedentary lifestyles among preclinical and paraclinical doctors in India, which poses significant health risks that are often overlooked. This manuscript reviews research demonstrating the links between prolonged sitting and increased risks of cardiovascular disease, musculoskeletal disorders, mental health issues, and impaired cognitive function in this population. The COVID-19 pandemic is also discussed as a factor that may have exacerbated sedentary behavior. The letter calls for Indian medical institutions, policymakers, and stakeholders to urgently implement strategies to promote healthier work environments for preclinical and paraclinical doctors, including active workstations, structured activity breaks, tailored wellness programs, and educational campaigns. Advocating for policy changes and further research in this area are also emphasized as key priorities to address this overlooked occupational health concern and improve the well-being of these essential members of India's medical academic community.

Objective: The objective was to evaluate the level of knowledge of primary care physicians in Lambayeque, Peru, regarding the diagnosis and treatment of Major Depressive Disorder.

Methods: A cross-sectional analytical study was conducted among 106 primary care physicians in Lambayeque, Peru. Data were collected using a validated questionnaire assessing Major Depressive Disorder diagnosis and treatment knowledge. Physicians' knowledge levels were categorized as inadequate, adequate, or excellent. Poisson regression models were employed to identify factors associated with adequate knowledge.

Results: The response rate was 81.21%. Only 36.79% of physicians demonstrated adequate knowledge, with none achieving excellent knowledge. The median score was 6 (IQR: 5-7). Mental health training, which may reflect the new law's implementation, was significantly associated with higher knowledge levels (PR: 2.42, 95% CI: 1.02 to 5.10). Other factors were not significantly associated with knowledge levels.

Conclusions: The proportion of primary care physicians with adequate Major Depressive Disorder knowledge has doubled since 2014, indicating a positive effect of the mental health law. However, to increase this number, continuous professional development programs are needed.

Introduction: Evidence-informed practice (EIP) is a widely accepted approach to providing rehabilitation services, however there are barriers to implementation. Bright Ideas is an innovative program developed by KidsAbility's Rocket Discovery Centre, aiming enhance uptake of EIP through incubating ideas identified by KidsAbility staff linked to organizational priorities of enhancing service access and outcomes.

Objectives: To evaluate Bright Ideas by identifying perceived successes and challenges associated with the program with the aim of supporting clinical innovation and the adoption of evidence-informed practices in children's rehabilitation centres.

Methods: A developmental evaluation approach was utilized to complete a real-time evaluation of Bright Ideas. Bright Ideas program materials were reviewed to describe the program. A focus group and interview were conducted with staff who led Bright Ideas projects (n = 7) to gain insight into their experiences. Additionally, interviews were conducted with the program coordinators (n = 2) to understand the evolution of the program. Data was analysed using qualitative content analysis.

Results: Successes that drive the Bright Ideas program and roadblocks it has encountered were identified across three dimensions: the personal level (involving Bright Ideas project leads), the programmatic level (focusing on the Bright Ideas program), and the organizational level (pertaining to KidsAbility as a whole). Key roadblocks included a lack of knowledge about the program organizationally, restricted time resources, competing organizational priorities, and an absence of infrastructure to scale ideas from Bright Ideas into the organization.

Conclusions: Bright Ideas is an innovative program aiming to make impactful change by enabling staff to lead implementation-driven projects. Our findings highlight many successes of the program and use the Theoretical Domains Framework and Behaviour Change Wheel to make recommendations to support its sustained implementation at KidsAbility.

[This corrects the article DOI: 10.1177/11786329231198991.].

In case of crisis, the salvation of injuries depends on the timely provision of medical goods, relief supplies, and equipment. The aim of this study is to present a mathematical model for the supply chain network of perishable medical goods in crisis situation considering the uncertain environment. In this paper, a three-level supply chain including suppliers, intermediate warehouses, and final customers is developed for perishable medical items. The uncertainty of customer demand for service and the spent time in the intermediate warehouses are considered using the exponential distribution functions. Also, it is assumed that the life-cycle of perishable medical goods follow the Weibull distribution function. The model attempts to minimize the total costs of the supply chain and total presence time of perishable items in the whole chain. The LP-Metric method is employed for solving small-sized problems. Due to the NP-Hardness of the problem, the modified Multi-objective Particle Swarm Optimization (MOPSO) and Non-dominated Sorting Genetic Algorithm (NSGA-II) are utilized as 2 well-known and efficient meta-heuristic algorithms for solving large-sized problems. The findings indicate that the meta-heuristic algorithms are efficient in achieving close to the optimal solution for large-size problems in a reasonable time. Also, the results demonstrate that NSGA-II outperforms MOPSO in terms of the high quality solution. Finally, the applicability of the model to real-world problems is demonstrated using a real case study. This paper can assist the planners and decision-makers of perishable drugs supply chain networks in crisis conditions with on-time supplying and distributing the required emergency items.

Background: During the COVID-19 lockdown in spring 2020, Switzerland restricted non-urgent healthcare services to safeguard capacity. While prioritization of care was supposed to be driven by medical urgency, demographic factors or economic incentives might have influenced the hospitals' resource allocation decisions.

Objectives: This study investigates potential determinants of procedure prioritization in hospitalized patients during the lockdown period.

Design: Quasi-experimental retrospective study of hospital data in Switzerland.

Methods: We analyzed 496 456 adult patients with known insurance status and a recorded procedure, admitted for cardiovascular, orthopedic/musculoskeletal or oncological reasons from January 2017 (3 years before the COVID-19 outbreak) to mid-April 2020 (in the first year of the COVID-19 pandemic), to obtain admission rate ratios (ARRs, "lockdown" admission rates divided by "normal" rates) from negative binomial regression analysis of fortnightly admissions for frequent procedure-diagnosis combinations. Quade and Wilcoxon signed-rank tests compared ARRs between sex×age, insurance and comorbidity strata.

Results: Admission rates showed significant reductions for 29 of 53 procedure-diagnosis combinations. Reductions varied strongly by emergency, with largest decreases in orthopedic procedures for arthrosis (osteoarthritis) and non-arthritic joint disorders, and the smallest in cerebral imaging for stroke patients and surgical procedures for malignant neoplasms. The only difference in ARRs between strata was a stronger decrease in admission rates for cardiovascular combinations for patients with private versus basic health insurance.

Conclusion: While medical procedures were affected to varying degrees by the ban on non-urgent healthcare during the COVID-19 lockdown, we found no robust evidence that factors other than medical urgency influenced healthcare prioritization.

The transition of patients with complex needs from hospital to municipal rehabilitation following moderate and severe brain injury is challenging. This qualitative study explored the municipal service allocation processes within such transitions. The caseworkers' comprehensive task of combining patients' preferences and needs, healthcare providers' recommendations and municipal guidelines and service allocation were analysed. Data comprised of patients' health records, meeting observations and semi-structured interviews with municipal staff, patients and next of kin. Results demonstrated that the issue of most concern was the location of where the patient was to continue municipal rehabilitation. Municipal caseworkers gathered extensive information, including recommendations from healthcare providers and preferences of patients and next of kin. These were frequently in contrast to the municipal guidelines' requirements and the services' organisational structure. The discrepancies led to tension, which was difficult to manoeuvre. This study indicates that incorporating individually tailored services into the daily service allocation practice can be demanding and even dilemmatic. The designated focus on the transition of patients with complex rehabilitation needs gives insights into how service allocation, user involvement and coordination policies are acted out in practice and may directly influence rehabilitation trajectories.