Physicians have become more responsible for pursuing healthcare efficiency. However, contemporary literature uses multiple terminologies to describe healthcare efficiency. To identify which term is best suitable for medical education to equip physicians to contribute to healthcare efficiency delivery in clinical practice, we performed a narrative review to elucidate these terms' meanings, commonalities, and differences.

The PubMed-database was searched for articles published in 2019-2024 describing healthcare efficiency terminology. Eligible articles conceptually described and applied relevant terminologies for physicians, while empirical studies and practice-specific articles were excluded. The screening was supported by an open-source artificial intelligence tool (ASReview), which prioritizes articles through machine learning. Two reviewers independently screened the resulting articles, resolving disagreements by consensus. Final eligibility was determined through predefined inclusion criteria.

Out of 3,655 articles identified, 26 met the inclusion criteria. Key terminologies: cost-effectiveness, high-value care, low-value care, and value-based healthcare, were identified, and explored into more depth. 'Value' is central in all terms, but our findings reveal that the perspectives herein differ on what constitutes value. Within cost-effectiveness, resource allocation to the population's needs drives decision-making-maximizing value at population-level. Within value-based healthcare, patient-centricity guides decision-making-maximizing value at individual patient-level. High-value and low-value care are somewhat ambiguous, depending solely on cost-effectiveness results or patient preferences to determine whether care is considered as low or high value.

Cost-effectiveness may be too rigid for patient-physician interactions, while value-based healthcare might not ensure sustainable care. As physicians are both stewards of finite societal resources and advocates of individual patients, integrating cost-effectiveness (resource allocation for population needs) and value-based healthcare (individualized care plans) seems necessary. Both terms emphasize delivering high-value care and avoiding low-value care. We suggest that medical education: (1) train (future) physicians to apply healthcare efficiency principles through case-based discussion, (2) use the cost-effectiveness plane to evaluate treatments, (3) deepen knowledge of diagnostic and treatment procedures' costs within evidence-based guidelines, and (4) enhance communication skills supporting a healthcare efficiency-driven open shared decision-making with patients.

Despite the multifaceted negative influences of psychotropic medications on the environment, an overview of such effects and of actions to curtail them is currently lacking. We therefore summarized the most relevant literature on what we refer to as Environmentally Conscious Psychopharmacotherapy (ECP), i.e., prescribing the most appropriate psychotropic medications for patients while at the same time considering the wellbeing of the planet. In our literature appraisal we identified viable actions at the levels of industry, physicians, pharmacists, patients, and policymakers that can reduce the environmental hazards associated with psychotropics. We divided these actions into the following categories: careful treatment selection, curtailing overprescribing, adequate disposal of medication by users, and transparent reporting of environmental risk. For each of these categories, we give examples of practices are in line with ECP, which in turn has the potential to reduce the impact of psychotropic medication prescribing practices on the environment. We note that many such practices result in co-benefits for patients, prescribers and the environment. On the other hand, evidence on environmental impact is lacking for several factors related to these medications, e.g., geographical region of manufacturing, duration of use, pharmacological vs. non-pharmaceutical treatment options, and ecotoxicological data. We conclude that general as well as disorder-specific considerations for clinicians prescribing psychotropics already carry the potential to limit the environmental burden associated with these agents. Future research aimed at filling the knowledge gaps we identified is likely to substantially advance ECP in the near future.

Low-value care is unnecessary care that contributes to inefficient use of health resources and constitutes a considerable proportion of healthcare expenditures worldwide. Factors contributing to patients' demand for low-value care have often been overlooked and are dispersed in the literature. Therefore, the current study aimed to systematically summarize factors associated with patients' demand for low-value care.

In this scoping review, scientific articles were identified based on a search query conducted in Embase and Scopus. We identified articles using search terms related to low-value care and demand-related factors, published in peer-reviewed journals, and written in English or Dutch. The titles, abstracts, results, and conclusions were inspected to only include articles that were deemed relevant for this topic. From these articles we extracted text fragments that contained factors associated with patients' demand for low-value care. Hereafter, a thematic analysis was applied to openly, axially, and selectively code textual fragments to identify themes within the data.

Forty-seven articles were included in this review. We identified eight core themes associated with patients' demand for low-value care: cognitive biases, emotions, preferences and expectations, knowledge-related factors, socio-cultural factors, biomedical and care-related factors, economic factors, and factors related to the interaction with the healthcare provider. Within these core themes, thirty-three subthemes were identified. For example, risk aversion and anticipated regret aversion are sub-themes of cognitive biases, while consumerism and present and future income effects are sub-themes of economic factors.

Through this review we provide a systematic overview of factors associated with the demand for low-value care. We found that patients' demand for low-value care could relate to a multitude of factors that were clustered into eight core themes and thirty-three subthemes. To understand the demand for low-value care from the patient's perspective in greater detail, future research should focus on the interaction between and importance of these factors in different care contexts.

Mobile health applications (mHealth) have become an indispensable tool in the healthcare industry to provide users with efficient and convenient health services. However, information overload has led to significant information overload problems in mHealth applications, which may further lead to overuse of medical services.

The purpose of this study was to explore the relationship between information overload and overuse of medical services in mHealth applications through health belief model (HBM). Data were collected from 1,494 respondents who were sampled through a simple random approach. A structured questionnaire was used as the instrument for data collection from mobile APP users in Guangdong Province between February 4, 2024, and February 20, 2024. Structural equation modeling (SEM) was used to analyze the data to investigate the effects of information overload on users' perceived severity, susceptibility, treatment benefits, barriers, self-efficacy, and action cues, which further influence the overuse of health care services.

The study found that information overload significantly affected users' perceived severity, susceptibility, treatment benefits, barriers, self-efficacy, and action cues, and subsequently affected overuse of health care services. These results provide valuable insights for mHealth application developers, healthcare providers, and policy makers.

This study highlights the importance of effectively managing information delivery in mHealth applications to reduce the risk of overuse of healthcare services. The study not only highlights the dark side of information overload in mHealth applications, but also provides a framework to understand and address the challenges associated with information overload and service overuse in the mHealth context.

There is a growing concern about the sustainability of healthcare and the impacts of 'overuse' on patients and systems. Quaternary prevention (P4), a concept promoting the protection of patients from medical interventions in which harms outweigh benefits, is well positioned to stimulate reflection and inspire solutions, yet has not been widely adopted. We sought to identify enablers and barriers to a P4 approach, according to field experts and advocates in one health system.

Qualitative methodology, using semistructured interviews and a grounded theory approach facilitated thematic analysis and development of a conceptual model.

Virtual interviews, conducted in British Columbia, Canada.

12 field experts, recruited based on their interest and work related to P4 and related concepts.

Four factors were seen as promoting or hindering P4 efforts depending on context: relationship between patient and clinician, education of clinicians and the public, health system design and influencers. We extracted four broad enablers of P4: evidence-based medicine, personal experiences and questioning attitude, public P4 campaigns and experience in resource-poor contexts. There were six barriers: peer pressure between clinicians, awareness and screening campaigns, cognitive biases, cultural factors, complexity of the problem and industry influence.

Elicited facilitators and impediments to the application of P4 were similar to those seen in existing literature but framed uniquely; our findings place increased emphasis on the clinician-patient relationship as central to decision-making and position other drivers as influencing this relationship. A transition to a model of care that explicitly integrates conscious protection of patients by reducing overtesting, overdiagnosis and overtreatment will require changes across health systems and society.

Medical care has undergone remarkable improvements over the past few decades. One of the most important innovative breakthroughs in modern medicine is the advent of minimally and less invasive treatments. The trend towards employing less invasive treatment has been vividly shown in the field of gastroenterology, particularly coloproctology. Parallel to foregut interventions, colorectal surgery has shifted towards a minimally invasive approach. Coloproctology, including both medical and surgical management of colorectal diseases, has undergone a remarkable paradigm shift. The treatment of both benign and malignant colorectal conditions has gradually transitioned towards more conservative and less invasive approaches. An interesting paradigm shift was the trend to avoid the need for radical resection of rectal cancer altogether in patients who showed complete response to neoadjuvant treatment. The trend of adopting less invasive approaches to treat various colorectal conditions does not seem to be stopping soon as further research on novel, more effective and safer methods is ongoing.

The purpose of this research was to study the associations of postural activities and knowledge of the voice of opera singers, recognized in the literature for the specificity of their posture. Additionally, the link between vocal pathologies and body pains on one hand, and posture control on the other hand was investigated.

A questionnaire including 90 questions was distributed to singers in France and overseas during 6 months. Ninety-eight opera singers participated in the survey. Data were analyzed using Excel and Stata software.

The results showed that the singers who paid more attention to posture, postural work while singing, had knowledge of anatomy and postural role in singing voice, healthy lifestyle, and good body habits, had less vocal discomfort and pathologies, a better vocal preservation, and used more costo-abdominal breathing. On the other hand, knowledge of postural role and postural work was linked with pain and vocal fatigue. Furthermore, a preventive need was revealed concerning the providing of knowledge and skills to singers, but also to singing teachers, speech therapists, and stage workers.

Our study shows that benefits were found in the voice quality of opera singers with anatomical and postural knowledge and who work on posture as part of their vocal work compared to others. Postural work and knowledge increase attention to body pain and vocal fatigue. These results can inform health care providers, opera singers, and their teachers and performers of the benefits of posture on operatic voice quality. Accordingly, this study sparks new ideas for postural work and therapy in lyric voice.

In high-income countries, regular general health check-ups are part of the fabric of the health care systems. The hidden concept of general health check-ups, promoted for more than a century, is to identify diseases at a stage at which early intervention can be effective. However, there has been little evidence to support the benefits of such checkups. Choosing wisely (CW) campaigns may represent a tremendous opportunity to eventually shift patients and physicians away from the non-evidence based yet firmly entrenched practice of the general health check-up. As campaign leaders and members of the CW working group of the European Federation of Internal Medicine, we want to join the discussion by giving our perspective based on the best available evidence.

In recent years, the Choosing Wisely and Less is More campaigns have gained growing attention in the medical scientific community. Several projects have been launched to facilitate confrontation among patients and physicians, to achieve better and harmless patient-centered care. Such initiatives have paved the way to a new "way of thinking." Embracing such a philosophy goes through a cognitive process that takes into account several issues. Medicine is a highly inaccurate science and physicians should deal with uncertainty. Evidence from the literature should not be accepted as it is but rather be translated into practice by medical practitioners who select treatment options for specific cases based on the best research, patient preferences, and individual patient characteristics. A wise choice requires active effort into minimizing the chance that potential biases may affect our clinical decisions. Potential harms and all consequences (both direct and indirect) of prescribing tests, procedures, or medications should be carefully evaluated, as well as patients' needs and preferences. Through such a cognitive process, a patient management shift is needed, moving from being centered on establishing a diagnosis towards finding the best management strategy for the right patient at the right time. Finally, while "thinking wisely," physicians should also "act wisely," being among the leading actors in facing upcoming healthcare challenges related to environmental issues and social discrepancies.

Choosing Wisely (CW) is an international movement comprised of campaigns in more than 20 countries to reduce low-value care (LVC). De-implementation, the reduction or removal of a healthcare practice that offers little to no benefit or causes harm, is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.

Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.

Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not 'patient facing'; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, providing insight into the complexities and nuances of harm, resources and prevalence. Harm from potential or common infections, reactions, or overtreatment was viewed as the most significant types of harm. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.

This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations.

Multicenter, interventional, controlled study.

Twenty-three acute-care hospital wards in Italy.

303 Physicians working in internal medicine wards.

An online educational course.

The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group.

A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52-0.87, p = 0.0005) and at six months (RR: 0.62, 95% CI: 0.46-0.84, p = 0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p = 0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p = 0.081).

A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients' outcomes.

Current care for patients with follicular lymphoma (FL) offers most of them long-term survival. Improving it further will require careful patient selection. This review focuses on predictive biomarkers (ie, those whose outcome correlations depend on the treatment strategy) in FL, because awareness of what patient subsets benefit most or least from each therapy will help in this task. The first part of this review aims to summarize what biomarkers are predictive in FL, the magnitude of the effect and the quality of the evidence. We find predictive biomarkers in the setting of (a) indication of active treatment, (b) front-line induction (use of anthracyline-based regimens, CHOP vs bendamustine, addition of rituximab), (c) post-(front-line)induction (rituximab maintenance, radioimmunotherapy), and (d) relapse (hematopoietic stem cell transplant) and targeted agents. The second part of this review discusses the challenges of precision medicine in FL, including (a) cost, (b) clinical relevance considerations, and (c) difficulties over the broad implementation of biomarkers. We then provide our view on what biomarkers may become used in the next few years. We conclude by underscoring the importance of assessing the potential predictiveness of available biomarkers to improve patient care but also that there is a long road ahead before reaching their broad implementation due to remaining scientific, technological, and economic hurdles.