Digital Commons Network^™

Two Decades Of Diagnostic Safety Research: Advances, Challenges, And Next Steps, Sundas Khan, Andrea Bradford, Christina L Cifra, Hardeep Singh

Faculty, Staff and Students Publications

Since the National Academies of Sciences, Engineering, and Medicine (NASEM) report Improving Diagnosis in Health Care, various research efforts have accelerated progress to understand and improve diagnostic safety. In this opinion piece, we summarize two decades of progress in methods for identifying and learning from diagnostic errors and provide recommendations for future research. Multiple methods have been used to quantify diagnostic errors in various clinical settings, thereby facilitating a deeper understanding of the nature and magnitude of the problem and enabling studies of contributing factors. However, the use of standardized definitions of a diagnostic error and/or diagnostic safety event, …

Foreword: Addressing Diagnostic Error: The First 10 Years, Mark L Graber, Edward P Hoffer, Hardeep Singh

Faculty, Staff and Students Publications

No abstract provided.

Perceived Benefits And Side Effect Of High-Fiber, High-Protein Meal Replacements In Weight Loss Programs, Esti Nurwanti, Harry Fl Muhammad, Naufal M. Nurdin

Indonesian Journal of Public Health Nutrition (IJPHN)

Obesity is a major risk factor for chronic diseases and early mortality. Although dietary counseling is essential in managing obesity, maintaining a calorie deficit and preventing weight regain remain difficult. Functional foods like high-protein, high-fiber meal replacements may enhance adherence and support weight loss. This randomized controlled trial evaluated the subjective outcomes of a weight loss program incorporating a protein- and fiber-enriched meal replacement among 73 overweight women aged 20–30 years. Participants were randomized to an intervention group (n=38), receiving dietary counseling plus one daily meal replacement, or a control group (n=35), receiving counseling alone. Both groups followed an 8-week …

Sensitivity And Specificity Of The Cobas Liat Ct/Ng/Mg Nucleic Acid Test In A Clinical Laboratory Setting And Point-Of-Care Location, B Van Der Pol, R Arcenas, C Boraas, S Chavoustie, L L. Crane, N D'Empaire, A C. Ermel, G Harnett, F Hinestrosa, S House, Rebecca A. Lillis, J Miller, A Mills, R Poblete, S A. Young

School of Medicine Faculty Publications

Sexually transmitted infections, e.g., Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG), present with similar signs/symptoms and are often treated empirically due to delays in receiving diagnostic test results. This study evaluated the clinical performance of the Cobas Liat CT/NG/MG nucleic acid amplification test (NAAT) in detecting these pathogens in a point-of-care (POC) setting. This non-interventional, multicenter study recruited symptomatic/asymptomatic participants from 13 geographically diverse POC sites across the USA. Prospective clinician- and self-collected specimens (urine/vaginal swabs) were used to determine the sensitivity and specificity of the Cobas Liat CT/NG/MG test relative to the composite reference standard (CRS), …

Screening For Trypanosoma Cruzi In Patients Living With The Human Immunodeficiency Virus (Pwh) In The Peruvian Amazon, Silvia Otero-Rodriguez, Martin Casapia-Morales, Lilia-Lorena Pinedo-Ramirez, Esperanza Merino, Eva H Clark, José-Manuel Ramos-Rincón

Faculty, Staff and Students Publications

Introduction: Chagas disease (CD) - Trypanosoma cruzi infection - in people living with HIV (PWH), particularly those with advanced CD4 T cell depletion, can lead to severe syndromes affecting the central nervous system and the heart.

Methods: We performed a cross-sectional study to screen for CD among PWH in Iquitos, Peru, between October 2023 and May 2024, with the objective of understanding the frequency of infection in this population. Adults with confirmed HIV attending outpatient services at two regional hospitals were enrolled. Two ELISA tests (lysate and recombinant) were used, and discordant results were adjudicated by indirect chemiluminescence immunoassay (CLIA). …

Exploring Public Health Nurses’ Perceptions Of Syringe Services Programs In Southern Rural Areas, Joel Lowery

Walden Dissertations and Doctoral Studies

Public health nurses are potentially key stakeholders in syringe services program (SSP) implementation in rural areas, where they can act as liaisons between public health, private healthcare, and the community. However, little research reflects an in-depth understanding of how public health nurses perceive SSPs in rural areas. The purpose of this qualitative study was to explore the perceptions of syringe services programs held by public health nurses practicing in rural areas with no existing SSPs in southern states and ascertain their potential roles in facilitating harm reduction for people who inject drugs. This study was guided by a conceptual framework …

Association Between Diabetes Mellitus, Hypertension, Obesity, And Diagnosis Of Covid-19 In Puerto Rico, Julian Rene Rivera Rodriguez

Walden Dissertations and Doctoral Studies

The population of Puerto Rico has been heavily affected by chronic diseases; however, data remains limited on the influence of diabetes mellitus (DM), hypertension, and obesity on the probability of COVID-19 diagnosis. The purpose of this quantitative study was to evaluate the association between non-communicable diseases that included DM, obesity, hypertension, and COVID-19 diagnosis, controlling for age and sex and person exposure in Puerto Rico. The sample consisted of 1,463 participants who underwent a polymerase chain reaction (PCR) test for COVID-19 from April 1, 2020, to March 31, 2021. Results from adjusted multivariable logistic regression analyses established that obesity OR …

Large Language Models As Information Providers For Appropriate Antimicrobial Use: Computational Text Analysis And Expert-Rated Comparison Of Chatgpt, Claude And Gemini, Marcello Di Pumpo, Maria Rosaria Gualano, Danilo Buonsenso, Francesca Raffaelli, Daniele Donà, Vittorio Maio, Patrizia Laurenti, Walter Ricciardi, Leonardo Villani

College of Population Health Faculty Papers

OBJECTIVES: Antimicrobial resistance is a critical public health threat. Large language models (LLMs) show great capability for providing health information. This study evaluates the effectiveness of LLMs in providing information on antibiotic use and infection management.

METHODS: Using a mixed-method approach, responses to healthcare expert-designed scenarios from ChatGPT 3.5, ChatGPT 4.0, Claude 2.0 and Gemini 1.0, in both Italian and English, were analysed. Computational text analysis assessed readability, lexical diversity and sentiment, while content quality was assessed by three experts via DISCERN tool.

RESULTS: 16 scenarios were developed. A total of 101 outputs and 5454 Likert-scale (1-5) scores were obtained …

Learning From Covid-19: Clinical Trials, Health Information Technology, And Patient Mortality, Christos Nicolaides, Avinash Collis, Seth Benzell, Indranil Bardhan

Economics Faculty Articles and Research

During the COVID-19 pandemic, deaths per case in the United States decreased from 7.46% in April 2020 to 1.76% in April 2021. One mechanism that could explain this decline is a learning effect associated with testing of new treatments by hospitals. Hospitals that participated in clinical trials developed better organizational capabilities to diagnose and treat COVID-19 patients. Simultaneously, hospitals used health information technologies (IT) that integrated health information across healthcare providers to facilitate greater learning and sharing of best practices. Using US county-level data on clinical trial participation, use of health IT, and COVID-19 cases and deaths, we show that …

Vaccine And Treatment Evaluation Units: A Historical Perspective, Robert B Belshe, David I Bernstein, Kathryn M Edwards, Sharon E Frey, Wendy A Keitel, Myron M Levine, John J Treanor, Peter F Wright

Faculty, Staff and Students Publications

On 27 February 1962, Surgeon General Luther Terry announced a new vaccine development program within the National Institute of Allergy and Infectious Diseases (NIAID). Initially, the plan had three components: (1) special laboratories and facilities for development of prototype vaccines; (2) pilot lot production facilities and preliminary vaccine trial sites; and (3) larger lot production capacity and expanded human testing. Respiratory viruses were targeted as the top priority for vaccine development. Over 5 decades, this program has evolved and expanded to include multiple academic vaccine evaluation sites within the network, now labeled as the Vaccine and Treatment Evaluation Units (VTEUs). …

A Quantitative Analysis Of Postmarketing Safety Events Of Breakthrough Medicines, Richard Judson Davis

Walden Dissertations and Doctoral Studies

Adverse events to medicines pose a risk to the public health of patients. Breakthrough therapy medicines are designed to address unmet medical needs and are often approved on an expedited timeline; however they are also criticized for lacking an adequate understanding of their risk profile at the time of approval. This study examined the relationship between the number of concomitant medicines, as well as the approved therapeutic indication, and the outcomes of reported adverse events associated with medicines approved under the breakthrough therapy designation. The conceptual framework applied in this retrospective, cross-sectional, quantitative study is the process of pharmacovigilance, which …

Analisis Implementasi Rekam Medis Elektronik Terhadap Kelengkapan Dokumentasi Rekam Medis, Novita Purnamasari, Adang Bachtiar

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Completeness of medical records is one of the important factors in improving the quality of health services. Despite its importance, incomplete documentation remains a prevalent issue, and the adoption of Electronic Medical Records (EMRs) is anticipated to address this challenge. This study is a narrative review and utilized the PRISMA 2020 flow diagram for literature selection. Articles were sourced from the ProQuest and Scopus databases for articles published in 2019-2024. From an initial selection of 431 articles, eight articles met the inclusion criteria for this study. The analysis of these studies shows that the implementation of electronic medical records positively …

Changes In Antiviral Prescribing For Children With Influenza In Us Emergency Departments., Tess Stopczynski, Olla Hamdan, Justin Z. Amarin, James W. Antoon, Laura S. Stewart, Haya Hayek, James Chappell, Andrew J. Spieker, Eileen J. Klein, Janet A. Englund, Geoffrey A. Weinberg, Peter G. Szilagyi, John V. Williams, Marian G. Michaels, Julie A. Boom, Leila C. Sahni, Mary Allen Staat, Elizabeth P. Schlaudecker, Jennifer E. Schuster, Rangaraj Selvarangan, Ayzsa Tannis, Heidi L. Moline, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Despite national recommendations, antiviral prescribing in emergency departments (EDs) for children at higher risk of severe influenza, such as those younger than 5 years and those with specific underlying conditions, remains low.

OBJECTIVE: To assess whether there were changes in antiviral prescribing for children at higher risk of severe influenza in academic pediatric EDs before the COVID-19 pandemic (2016-2020) vs the late pandemic period (2021-2023).

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, cross-sectional study included influenza-positive children younger than 18 years presenting to the ED at 1 of 7 US pediatric academic hospitals participating in the Centers for Disease Control …

Fit For Success: Exploring Physical Activity Promotion And Effects On Students At The University Of South Carolina Through A Podcast Series, Maia Schwarzmueller

Senior Theses

College students face unique challenges when trying to maintain physical activity levels, such as time constraints, stress, and lack of proper facilities. The Fit for Success podcast will explore how physical activity is a powerful tool towards enhancing self-perception, academic success, and stress management as well as delve into the specific barriers that University of South Carolina students face to physical activity. The podcast will also explore different aspects of physical activity promotion including group fitness, competition, and built environment. The goal of the podcast is to help students to see physical activity as an important component of many facets …

Evaluating The Impact Of The ‘Blow, Breathe, Cough’ Health Promotion Intervention In Resolving Otitis Media With Effusion In Children: An Adaptive Randomized-Controlled Trial Protocol, Jaimee R. Rich, Michael Dymock, Elke J. Seppanen, Elena Montgomery, Tanisha Cayley, Tamara Veselinović, Greta Bernabei, Anri Lester, Amy Hannigan, Nicole Irvine, Kerryn Gidgup, Edna Ninyette, Steph Bray, Tu Trang Tran, Valerie M. Swift, Melinda Edmunds, Natalie Strobel, Daniel Mcaullay, Julie Marsh, Evelyn Tay, Lea Ann S. Kirkham, Ruth B. Thornton, Robyn S.M. Choi

Research outputs 2022 to 2026

Introduction: Otitis media with effusion (OME) affects hearing, speech development, and quality of life (QoL) in children. The ‘Blow, Breathe, Cough’ (BBC) intervention promotes nasal, respiratory, and middle ear clearance through nose blowing, deep breathing, coughing, and hand hygiene. It shows promise in resolving OME but lacks randomized-controlled trial (RCT) evaluation. This paper presents a RCT protocol evaluating BBC's effect on OME resolution, hearing, speech, and QoL in children aged two to seven years. Methods: This parallel-group, 1:1, outcome assessor-blinded, individual adaptive RCT investigates whether completing the BBC intervention plus hand hygiene twice-daily at home increases OME resolution after 4-to-6 …

Nrf2 Hyperactivation As A Driver Of Radiotherapy Resistance And Suppressed Antitumor Immunity In Head And Neck Squamous Cell Carcinoma, Rutulkumar Patel, Kalil Saab, Lixia Luo, Yan Ma, Rashid Abdullah Osman, Nerissa T Williams, Jeffrey Everitt, Maciej J Zelazowski, Patricia Castro, William K Decker, William H Hudson, Jeffrey N Myers, Vlad C Sandulache, Mitchell J Frederick, Yvonne M Mowery, David G Kirsch

Faculty, Staff and Students Publications

Purpose: Alterations in the KEAP1/NFE2L2 (NRF2)/CUL3 pathway occur in ∼20% of human head and neck squamous cell carcinomas (HNSCC) and are associated with resistance to standard-of-care therapy. However, this pathway's role in radiotherapy resistance in HNSCC has not been well studied.

Experimental design: We generated genetically engineered mouse models and developed primary murine cancer cell lines harboring mutations commonly observed in human HNSCC, including inducible activation of PIK3CA and deletion of Trp53, with or without Keap1 loss. Primary tumors were initiated via 4-hydroxytamoxifen injection ± the tobacco carcinogen benzo[a]pyrene (BAP) into the oral buccal mucosa. Tumors were analyzed by Western …

Ready For Takeoff? Exploring United States Health Care Providers’ Pretravel Consultation Priorities, Gaps, Barriers, And Opportunities, Katherine A. Reifler, Swati S. Sharma, Nicholas A. Bergren, Elizabeth D. Barnett, Lin H. Chen, Jeffery A. Goad, William B. Macleod, Laura Kogelman, Davidson H. Hamer

Pharmacy Faculty Articles and Research

Pretravel consultation by healthcare providers (HCPs) with travel medicine expertise can mitigate travel-related health risks. This analysis aimed to understand US-based HCPs' pretravel consultation educational gaps, priorities, barriers, and opportunities. An electronic survey was conducted May–June 2024, using a convenience sample of HCPs identified through the Med Learning Group and travel specialists from the International Society of Travel Medicine and American Society of Tropical Medicine and Hygiene. In total, 205 HCPs completed the survey, including physicians (50 %), nurse practitioners (19 %), nurses (12 %), pharmacists (11 %), physician associates (7 %). Most (66 %) provided pretravel consultations and only …

Htlv-1 And Atll: Epidemiology, Oncogenesis, And Opportunities For Community-Informed Research In The United States, Adrian D. Altieri, Sean P. Reilly, Abu Mansalay, Alan Khoo, Nettie Johnson, Zafar K. Khan, Amy Leader, Pooja Jain, Pierluigi Porcu

Kimmel Cancer Center Faculty Papers

Human T-cell leukemia virus type 1 (HTLV-1), the first oncogenic human retrovirus, causes adult T-cell leukemia/lymphoma (ATLL), an aggressive neoplasm of mature CD4+ T-cells that is incurable in most patients and is associated with a median survival of less than 1 year. HTLV-1 also causes inflammatory disorders, including HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and uveitis. The estimated lifetime risks of ATLL and HAM/TSP in HTLV-1 carriers are 3-5% and 0.25-1.8%, respectively. Although there is uncertainty about other health effects of HTLV-1, a recent meta-analysis showed an association between HTLV-1 and cardiovascular, cerebrovascular, and metabolic diseases and a 57% increased risk …

Whose Burden, Whose Benefit? Revisiting Ethical Trade-Offs In The Who Guidelines On Scaling Up Mass Azithromycin Administration, Maple Goh, A. M. Viens, Safura Abdool Karim, Aaron S. Kesselheim, Kevin Outterson

Faculty Scholarship

Author summary

• New evidence suggests that mass drug administration of azithromycin (MDAA) can significantly reduce childhood mortality in high-burden, low-resource settings, yet the World Health Organization’s (WHO) 2020 guidelines take a cautious approach due to concerns about antimicrobial resistance (AMR).
• While the WHO guidelines cite ethical principles, they insufficiently address key considerations, such as intergenerational justice, equitable burden sharing, and the structural determinants of health that shape infectious disease vulnerability.
• Global AMR policy often prioritizes conservation over access in ways that disproportionately burden low-income countries, despite high-income countries also bearing significant responsibility for the emergence and spread of AMR.
• A …

Strongyloides Seropositivity Among Children Utilizing A Mobile Clinic, Lynda Aririguzo, Aditi Gupta, Norma Castillo, Cassandra Duran, Eva H Clark, Ankona Banerjee, Sanghamitra Misra

Faculty, Staff and Students Publications

Experts recommend screening for or presumptively treating strongyloidiasis in foreign-born immigrant children, though prevalence is unknown. Health care providers encounter barriers to following this recommendation. We aimed to describe Strongyloides seropositivity and risk factors among pediatric patients on a mobile clinic. Participants completed a written survey and provided blood for absolute eosinophil count (AEC) and Strongyloides IgG enzyme-linked immunosorbent assay (ELISA). From October 2022 to June 2023, 206 patients participated; 201 (97.6%) were born outside the United States; 97.1% (n = 200) were Hispanic. Most (68.9%) arrived less than 1 year before study enrollment. Four (1.9%) and 3 (1.5%) had …

Cyp1b1 Mediates Cigarette Smoke-Induced Lipid Accumulation In Alveolar Type 2 Cells, Yin Zhu, Siddhika Gamare, Francesca Polverino, Caroline A Owen, Payaningal R Somanath, Xiaoyun Wang, Duo Zhang

Faculty, Staff and Students Publications

Alterations in lipid profiles have been shown in patients with chronic obstructive pulmonary disease (COPD), but the underlying molecular mechanisms remain unclear. In this study, we aimed to investigate the role of cytochrome P450 family-1 subfamily B member 1 (CYP1B1) in cigarette smoke (CS)-induced lipid accumulation in alveolar type II epithelial (AT2) cells. We observed a steady increase in CYP1B1 protein levels in AT2 cells from COPD patients. Additionally, CS exposure induced CYP1B1 expression in AT2 cells of murine lungs. In vitro, treatment with cigarette smoke extract (CSE) not only upregulated CYP1B1 expression but also triggered lipid accumulation in AT2-like …

Native Hawaiian Culturally Appropriate Substance Use Disorders Formative Program Evaluation, Kelly J. Penn

Walden Dissertations and Doctoral Studies

Substance use disorders (SUDs) disproportionately affects Native Hawaiians, yet conventional treatments often overlook the cultural, spiritual, and relational foundations of well-being for Native Hawaiians. This gap represents a human services problem, as it perpetuates health disparities, limits recovery, and slows social change within Native Hawaiian communities. The purpose of this qualitative single case study was to identify culturally relevant components for an SUD treatment program tailored to Native Hawaiians. The research question guiding this study was, what are culturally appropriate components for a SUD program for Native Hawaiians. The Nā Pou Kihi framework grounded the exploration of Indigenous approaches to …

Covid-19 Infection Prevention And Control Guidelines Of Philippine Physical Therapy Association (Ppta) And Rehabilitation Department Of Select Hospitals In The Philippines: Impact On Infection Trend, Ghiester Marc T. Estrellado, Venize Edanne F. Montecillo, Cristina Faye C. Panopio, Alexandra Marie V. Amistoso, Raymond M. Tosoc

Philippine Journal of Physical Therapy

Introduction: There is a paucity of evidence supporting the need for setting up hospital COVID-19 infection prevention and control (IPC) guidelines for Physical Therapists (PTs) that meet global standards. This study aimed to determine the consistency of IPC guidelines among different rehabilitation departments of hospitals within Region IV-A and the Philippine Physical Therapy Association’s (PPTA) recommendations with the World Health Organization’s (WHO) IPC guidance document. It also compared the hospitals’ consistency scores with the trend of infected PTs per month.

Methods: In this descriptive cross-sectional survey, an online checklist was developed and validated to examine the consistency of the IPC …

“Not Today”: Overcoming Prep Hesitancy, Stigma, And Adherence Barriers With Lenacapavir, Margaret Conrad, Meredith Clement

School of Medicine Faculty Publications

No abstract provided.

Enflonsia (Clesrovimab-Cfor): A New Era In Rsv Protection For Infants, Katherine Ghattas Pharmd, Rileigh Smith Pharmd, Amanda Rawa Pharmd

Transformative Medicine

Respiratory Syncytial Virus (RSV) is a leading cause of serious lung infections in infants and young children, especially during the winter months. For decades, preventative options were limited, costly, or only available to babies at high-risk. The FDA approved Enflonsia (clesrovimab-cfor) in June 2025, given as a single injection to protect infants thorough their first RSV season. Since it is designed for broader infant use and can be distributed through programs such as Vaccines for Children, Enflonsia may help close long-standing gaps in RSV prevention.

Cerebral Malaria In Chad- A Case Report Series, Megan W. Szobody, Blaise Djomg Yang, Noel Johnson, Kelsey Potter-Baker

Research Colloquium

Malaria is a serious disease caused by various species of the Plasmodium genus. Among these, Plasmodium falciparum is widely considered the most dangerous, due to its ability to infect both young and mature red blood cells (RBCs). Malarial disease, caused primarily by P. falciparum, is a major cause of morbidity and mortality in Sub-Saharan Africa, and notably in Chad, accounting for over 10,000 deaths each year and with an incidence rate of over 3 million. Anyone can acquire falciparum malaria after being bitten by infected anopheles mosquitoes, but in pregnant women and young children, this disease is often deadly. A …

A Puzzling Case Of Visual Disturbances Leads To A Fatal Neurodegenerative Diagnosis, Courtney J. Austin, Aaron Carrillo, Jennifer Rojas Huen, Victoria Parada

Research Colloquium

Background: Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease in which early diagnosis is complicated by the presence of early non-specific and atypical presentations. Sporadic CJD (sCJD), the most common type of CJD, is caused by the spread of a disease-forming prion known as PrPSc. PrPSc multiplies and binds to the normal form of prion, or PrP, converting it to an abnormal, structurally altered disease form that spreads throughout the brain. sCJD can initially present with six different phenotypes: cognitive, affective, classic, visual (Heidenhain variant), atactic (Oppenheimer-Brownell variant), and indeterminate. The classic presentation of CJD includes rapidly progressive dementia with …

Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study., James W. Antoon, Justin Z. Amarin, Olla Hamdan, Tess Stopczynski, Laura S. Stewart, Marian G. Michaels, John V. Williams, Eileen J. Klein, Janet A. Englund, Geoffrey A. Weinberg, Peter G. Szilagyi, Jennifer E. Schuster, Rangaraj Selvarangan, Christopher J. Harrison, Julie A. Boom, Leila C. Sahni, Flor M. Muñoz, Mary Allen Staat, Elizabeth P. Schlaudecker, James D. Chappell, Benjamin R. Clopper, Heidi L. Moline, Angela P. Campbell, Andrew J. Spieker, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children.

METHODS: We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted …

Health Systems Responsiveness In Low And Middle-Income Countries (L&Mics): Revisiting Its Scope, Meesha Iqbal, Robert Morgan, Cici Bauer, Cecilia Ganduglia Cazaban, Sameen Siddiqi

Faculty, Staff and Student Publications

Introduction: Health systems responsiveness (HSR) addresses the legitimate non-health expectations of the population and plays a vital role in strengthening health systems and enhancing population health. Identifying specific constructs or domains within HSR is particularly important in the context of low and middle-income countries (L&MICs) to facilitate targeted improvement. Following a comprehensive systematic review of the literature, we developed a conceptual framework for HSR. This study was designed to validate our proposed framework through a Delphi process.

Methods: Global HSR experts were contacted via email to participate in the study, and a copy of the proposed framework (12 domains, 53 …

A Scoping Review Of Epilepsy Care In Low-Resource Settings: Addressing Stigma, Healthcare Disparities, And Socioeconomic Barriers, Michael Mncedisi Willie

Journal of Indonesian Health Policy and Administration

Epilepsy affects around fifty million people worldwide, with stigma and limited healthcare access posing significant challenges, especially in low-resource settings. This scoping review aimed to identify key barriers to epilepsy care, focusing on stigma, healthcare access, and socioeconomic factors in sub-Saharan Africa and similar contexts. Using the Arksey and O’Malley framework, a systematic search was conducted across online databases for peer-reviewed studies published. The review found that stigma significantly delayed diagnosis, increased social isolation, and reduced treatment adherence. Healthcare barriers included a lack of trained professionals and inadequate treatment protocols. Socioeconomic challenges, such as poverty and rural residency, were linked …