To evaluate surgical patients' caregivers' hand hygiene knowledge and to examine the discrepancy between reported knowledge and actual hand cleanliness following caregiving activities. Cross-sectional study. General surgery inpatient clinics of a tertiary university-affiliated hospital in Turkey. Caregivers of patients hospitalised in general surgery inpatient clinics; a total of 128 caregivers participated. The primary outcome was caregivers' hand hygiene knowledge score. The secondary outcome was observed hand cleanliness, assessed using fluorescent simulation gel and ultraviolet light across different hand regions. Among the 128 caregivers (65.6% women; mean age 45.7±14.8 years), hand hygiene knowledge was high (mean score: 98.9±3.9). However, observations under ultraviolet light revealed residual contamination, particularly at the wrist. Caregivers with clean wrists had significantly higher knowledge scores than those with contamination (p<0.05). Although caregivers reported frequent handwashing, only 43% reported receiving encouragement from healthcare staff. Inter-observer reliability was excellent, with Cohen's kappa values ranging from 0.864 to 0.913. Although caregivers of surgical patients demonstrated high hand hygiene knowledge, a gap between knowledge and observed practice was identified, particularly in less visible areas such as the wrists. These findings suggest that strategies beyond knowledge transfer, including visual training tools and increased engagement of healthcare professionals, may help improve practical hand hygiene behaviours and infection prevention.
Hospital-associated infections (HAIs) caused by multidrug-resistant organisms represent a global threat to public health. Despite various strategies, compliance with effective hand hygiene (HH) remains inconsistent. This study examines risk factors influencing hand hygiene compliance (HHC) in surgical clinics of the University Clinical Center Nis, Serbia. A cross-sectional, questionnaire-based study was conducted from August 16 to September 16, 2023, among healthcare professionals in surgical, urgent care, and anesthesia units at UCC Nis. The representative sample size was calculated using G*Power 3.1. Effect sizes were assessed with Hedges' g, Glass's Δ, η2, and R2 for correlations. Regression analyses were performed to model HHC scores. Participants demonstrated relatively good HH knowledge. HHC scores varied most across organizational units, with large effect sizes for subscales (η2 = 0.13-0.2) and intermediate effect for the total score. Total HHC did not significantly correlate with job satisfaction (r = -0.023) or Leadership trait score (r = 0.041), though some subscales showed low but significant correlations. Job satisfaction and Leadership traits were moderately correlated (R = -0.579, p < 0.001). Of seven regression models, only the model predicting "transmission of microorganisms to healthcare workers" achieved R2 > 0.3 (intermediate effect). HH knowledge and practices in surgical settings appear to depend more on the work environment, particularly leadership, than on individual characteristics. Sustained improvements in hand hygiene behavior require comprehensive, tailored educational programs and robust promotional campaigns, while strengthening managerial leadership skills emerges as a critical, evidence-based strategy. Job satisfaction showed only limited influence.
Food insecurity (FI) is recognized as an important social determinant of health (SDH) that may disproportionately affect orthopedic patients. However, there are limited publications evaluating FI within the orthopedic hand population. The objective of this study is to evaluate the incidence of FI among hand clinic patients to identify key SDHs that may inform targeted interventions and improve clinical care for patients with hand pathologies. This prospective cross-sectional study was conducted using patient surveys at outpatient orthopedic hand clinics at an academic institution. Adults ≥18 years with hand or distal upper-extremity pathology were included; excluded were pediatric patients and patients with injuries proximal to the elbow, concomitant nonupper extremity injuries, malignancy, or chronic neuropathy/pain. Surveys included Household Food Security Survey-6 for FI, the Hospital Anxiety and Depression Scale for anxiety and depression, Disabilities of the Arm, Shoulder, and Hand (QuickDASH) for upper-extremity function, and the Risk Analysis Index for frailty. Data collected included demographics, employment, housing status, insurance, zip code, injury characteristics, and secondary outcomes such as infection, reoperation, amputation, and nonunion. Statistical analysis was performed with P < .05 as significant. Of the screened patients, 21% were FI. Those with low or very low food security had higher average scores on the Hospital Anxiety and Depression Scale, QuickDASH score, and Risk Analysis Index compared to those with marginal or high food security. These findings indicate that lower food security status is associated with worse mental health, frailty, and a higher level of disability. This study shows an association between patients experiencing FI and factors known to affect outcomes such as frailty, depression, and anxiety. This is revealed further by a statistically significant difference in QuickDASH scores between food-insecure and food-secure patients. FI is an untapped SDH thar may prove modifiable for an at-risk population. Symptom Prevalence Study IV.
Computer vision can classify inflammatory arthritis on smartphone photographs. We aimed to train, validate and judiciously choose a model for detecting hand synovitis from standardized smartphone photographs in a real-world rheumatology outpatient population. A dataset of 2296 hand photos from 1112 patients attending rheumatology clinics in India was partitioned at the patient level into training (70%), validation (15%) and test (15%) sets. Two deep learning architectures (ConvNeXt V2 and EfficientNetV2) and their weighted ensemble were trained against a ground truth of specialist-detected synovitis and compared using area under the receiver operating characteristic curve (AUROC). In the chosen model, 95% confidence intervals were obtained via patient-level bootstrap in the independent test set. Prespecified subgroup analyses examined model performance by deformity status, age and sex. ConvNeXt V2 outperformed EfficientNetV2 (validation AUROC 0.856 vs 0.831). The ensemble achieved the highest validation AUROC (0.864, α = 0.24), with modest incremental gain over ConvNeXt. On the independent test set, ConvNeXt achieved an AUROC of 0.852 (95% CI: 0.802, 0.896). At the fixed operating threshold, test accuracy was 0.79 (95% CI: 0.75, 0.83), sensitivity 0.76 (95% CI: 0.67, 0.85) and specificity 0.80 (95% CI: 0.75, 0.84). Model performance remained stable across all prespecified subgroups, including patients with hand deformities. A computer vision model trained on standardized smartphone photographs can detect hand synovitis in routine clinical populations including in those with deformities. This validated model on a large, prospectively assembled dataset represent an important step toward scalable decision support in non-specialist settings and reducing diagnostic delay in inflammatory arthritis.
To validate the InGrip® load-cell handgrip dynamometer by comparing its performance with the Takei handgrip dynamometer in measuring handgrip strength (HGS) among healthy adults and patients with stroke. This is a cross-sectional study conducted in community and outpatient clinics, involving 260 healthy adults aged ≥ 50 years and 50 patients with stroke (N = 310). HGS was assessed using the Takei and InGrip® dynamometers following a standardized protocol. Correlation, agreement, and test-retest reliability were evaluated using Pearson's correlation coefficient, Bland-Altman plots, intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest real difference (SRD). No significant differences in HGS measurements were observed between the two dynamometers in any group. The correlation coefficients between the Takei and InGrip® were strong for healthy adults (r = 0.944) and patients with stroke (r = 0.967). Bland-Altman plots demonstrated good agreement, with mean biases of -0.14 kg (healthy adults) and -0.87 kg (patients with stroke). The InGrip® exhibited excellent test-retest reliability, with ICC values exceeding 0.9, SEM below 10%, and SRD under 30% across all groups. The InGrip® load-cell dynamometer demonstrated a high correlation, strong agreement, and excellent test-retest reliability when compared to the Takei dynamometer in both healthy adults and patients with stroke. The InGrip® dynamometer is a valid and reliable instrument for HGS assessment. Further research should explore its applicability across broader clinical and population-based settings.
Background/Objectives: Hand, foot and mouth disease (HFMD) has recently emerged as a serious health threat, as certain serotypes can cause severe illness. Serotype distribution vary by region, and seroprevalence studies helps in developing preventive strategies. This study aimed to determine the seroprevalence of enterovirus type 71 (EV-A71), Coxsackievirus A16 (CV-A16), Coxsackievirus A10 (CV-A10), and Coxsackievirus A6 (CV-A6), the main causative agents of HFMD and to investigate risk factors for seropositivity. Methods: This multicenter, cross-sectional study was conducted across five major cities in Türkiye. Children (6 months-17 years) who presented to outpatient clinics for any reason were included between May 2024 and January 2025. Neutralizing antibodies were measured using a microneutralization assay. Statistical analyses included descriptive methods, appropriate group comparisons (Chi-square/Fisher's Exact), and backward logistic regression to identify factors associated with HFMD seropositivity. Results: The study included 998 participants (mean age: 8.6 ± 5.2 years; 51.3% male). CV-A6 antibodies were detected in 68.5%, EV-A71 in 66.5%, CV-A10 in 60.2%, and CV-A16 in 46.0% of samples. No viral antibodies were detected in 5.3% of serum samples (All-Negative group); antibodies against at least one HFMD agent were detected in 94.7% (Any-Positive group). HFMD seropositivity increased significantly with age. Handwashing habits did not differ between the groups. The any-positive group more often had a household member aged 12-18 years, a mother with lower education, and higher kindergarten attendance. In logistic regression analysis, age, average monthly household income, and mother's education level were the factors influencing seropositivity. Conclusions: The seroprevalence of HFMD-causing viruses in Türkiye is high from six months of age onward. Beyond promoting personal protective measures, the implementation of a vaccination program should also be considered.
To select and prioritize implementation strategies for early hand therapy for children under 2 years old with suspected or confirmed cerebral palsy. This implementation study used a mixed-methods sequential explanatory design guided by the Consolidated Framework for Implementation Research. First, implementation strategies were mapped to previously identified Canadian barriers and facilitators to early hand therapy delivery. Semi-structured interviews regarding these strategies were conducted with three participant groups across Canada: parents of children aged 6 years or younger with cerebral palsy (n = 9); paediatric occupational therapists (n = 10); and leads or managers of paediatric occupational therapy programmes (n = 6). Interview data were analysed thematically. Next, 12 participants (n = 4 per participant group) completed a modified nominal group technique exercise to create actionable descriptions and prioritize strategies. Twenty-one implementation strategies were mapped to identified barriers and facilitators. Thematic analysis of semi-structured interviews identified 11 strategies within three categories based on the source: occupational therapists and clinics; research and community groups; and health care systems. The nominal group technique prioritized the top three strategies: (1) develop a roadmap to therapy; (2) raise awareness; and (3) create a therapy guidebook. Eleven actionable strategies were identified to support early hand therapy delivery for young children with cerebral palsy.
While partial hand amputations are life-altering events, advances in prosthetic technologies have allowed for great strides in optimizing function of the residual hand. The Starfish procedure has further enhanced the capabilities of myoelectric prosthetics by enabling independent digital manipulation. When coupled with thoughtful nerve and soft tissue management, patients can regain meaningful use in an otherwise devastating injury.
Pediatric hand surgery frequently requires precise surgical reconstruction of the upper limb to prevent worsening deformity. However, there is a balance of achieving a perfect radiologic film of the planned surgery and causing inadvertent harm from performing overly aggressive surgery. Precise K-wire placement and immobilization are important for optimal results; however, surgery that is too invasive results in several downsides, including loss of reduction, poor bony healing, loss of blood supply, growth plate failure, and scar contractures from poor wound healing. Here, we review this important concept of "Good Enough" to accept completely adequate results over unattainable perfection in pediatric hand surgery.
Bionic prostheses and vascularized composite allotransplantation represent transformative strategies for upper extremity reconstruction. While both approaches aim to restore function and improve quality of life, they differ significantly in technique, risk profile, resource requirements, and long-term outcomes. This review synthesizes current evidence and expert perspectives on the role of hand allotransplantation in the modern era, particularly considering the expanding capabilities of advanced bionic reconstruction. We explore clinical indications, contraindications, functional and psychosocial outcomes, economic considerations, and ethical implications to support patient-centered decision-making in upper limb reconstruction.
Cold intolerance is frequent after hand injuries and is the worst long-lasting problem that negatively affects other impairments in some patients. Two questionnaires are available to assess cold intolerance (CISS, PWES), but not in French. This study aimed to translate, cross-culturally adapt, and validate these questionnaires in French. Population: outpatient and hospitalized patients between 2019 and 2024. Translation, back translation, cross-cultural adaptation according to standard guidelines. Ten experts evaluated the preliminary French versions for content validity. Preliminary French versions were administered to 30 patients. Final French versions to 70 patients for validation: internal consistency, test-retest reliability, construct validity, and floor or ceiling effect. Translation, back translation, and cross-cultural adaptation were easy with only minor changes. Preliminary French versions well accepted by patients, and all 10 experts rated content validity very good. Internal consistency was good: Cronbach α was 0.90 (95% CI [0.87-0.92]) for CISS; 0.80 (95% CI [0.65-0.95]) for PWES. Factor analysis revealed one factor for each questionnaire. Construct validity was good, 100% of our hypotheses were confirmed for CISS and 75% for PWES. Test-retest reliability was excellent: 0.94 (95% CI [0.91-0.96]) for CISS; 0.90 (95% CI [0.78-0.95]) for PWES. No floor or ceiling effects for either questionnaire. Both questionnaires have good psychometric properties F-CISS could be used with confidence and had to be validated in other populations. For the PWES, due to small sample used for validation, we consider these results as preliminary and need to be confirmed on a larger sample.
A frequently used strategy to improve patient-reported outcome measure (PROM) response rates and reduce patients' burden with PROM completion is item reduction. In this context, a shortened decision tree version of the patient-rated wrist evaluation (DT-PRWE) was developed, reducing the number of items from 15 to 5. The DT-PRWE demonstrated excellent psychometric properties in simulated data; however, its psychometric properties have not yet been evaluated in a real-world clinical setting. (1) What is the interversion reliability and agreement between the DT-PRWE and the patient-rated wrist evaluation (PRWE) in a clinical setting? (2) What is the difference in completion time between the DT-PRWE and the PRWE? We conducted a prospective study at Xpert Clinics in the Netherlands, a multicenter, referral-based outpatient practice, with both urban and regional locations, that specializes in hand and wrist surgery and hand therapy to assess the interversion reliability and agreement between the PRWE and the DT-PRWE. Between January and April 2025, a total of 427 adult patients were treated for wrist-related conditions and completed the PRWE at baseline as part of routine outcome measurement at our clinic. Subsequently, we asked patients to complete the DT-PRWE again 5 to 10 days after the initial assessment. Of those, we considered adult patients with wrist conditions who completed both versions of the PRWE to be potentially eligible. Based on this, 55% (235 of 427) were potentially eligible; a further 27% (116) were excluded because of intervening treatment before completion of the PRWE and the DT-PRWE, including corticosteroid injection (11% [45]), surgery before completion of both versions (6% [25]), other treatment before completion of both versions (5% [23]), and concomitant treatment (5% [23]), leaving 28% (119) for analysis here. Primarily, we evaluated interversion reliability using intraclass correlation coefficients (ICC) as the main outcome; an ICC > 0.75 was considered acceptable for clinical use. We also calculated Pearson correlation coefficients. We assessed the agreement by evaluating paired between-version mean differences, standard error of measurement (SEM), and Bland-Altman plots. Additionally, we compared the SEM values with the minimum important change (MIC) thresholds of the PRWE to assess the level of agreement. Finally, we calculated the median (IQR) completion time and compared completion efficiency between versions using the paired Wilcoxon signed-rank test. The DT-PRWE demonstrated good interversion reliability compared with the PRWE for total score (ICC 0.88 [95% confidence interval (CI) 0.83 to 0.91]), pain subscore (ICC 0.78 [95% CI 0.69 to 0.84]), and hand function subscore (ICC 0.83 [95% CI 0.77 to 0.88]). Additionally, the scores of the PRWE and DT-PRWE were highly correlated (total score r = 0.88 [95% CI 0.83 to 0.92], pain subscore r = 0.81 [95% CI 0.74 to 0.87], hand function subscore r = 0.83 [95% CI 0.77 to 0.88]). The agreement between versions was high, with between-version mean differences of -5.3 (95% CI -7.2 to -3.5) on the total score (score range 0 to 100), -3.4 (95% CI -4.6 to -2.2) on the pain subscore (score range 0 to 50), and -2.0 (95% CI -3.2 to -0.7) on the hand function subscore (score range 0 to 50). The SEM values were 7.1 for the total score, 4.6 for the pain subscore, and 4.9 for the hand function subscore, all falling below the MIC thresholds. The Bland-Altman plots indicated high agreement. The median (IQR) time to complete the PRWE was 3 minutes 33 seconds (2 minutes 20 seconds to 7 minutes 18 seconds), whereas for the DT-PRWE it was 1 minute 5 seconds (50 seconds to 1 minute 29 seconds), representing a 70% reduction with a median difference of 2 minutes 28 seconds (p < 0.001). The DT-PRWE is a reliable alternative to the full-length version, requiring substantially less time for patients to complete. While preserving both pain and function subscores, its simple digital implementation and comparability with existing PRWE data make the DT-PRWE well suited to replace the PRWE in routine clinical practice and for research applications. Future research should focus on cross-cultural validation of the DT-PRWE and test-retest reliability. Also, future research may investigate whether implementing shortened PROMs, such as the DT-PRWE, improves compliance with PROMs. Level I, diagnostic study.
Although non-surgical treatment for trapeziometacarpal joint (TMJ) osteoarthritis (OA) reduces pain, outcomes vary substantially. This study investigated factors associated with pain at 3 months after starting non-surgical treatment for TMJ OA. This secondary analysis from a previous randomized controlled trial included 113 patients (Eaton-Glickel stage ⩾2 TMJ OA) from 18 outpatient hand surgery clinics in The Netherlands, comprising specialized clinics, regional hospitals and one academic hospital. Participants were randomized to orthosis-only or orthosis + exercise groups. Both groups received a standardized custom-made thumb orthosis, and the combined group also received supervised hand therapy with a structured home exercise programme. The primary outcome was the Michigan Hand outcomes Questionnaire (MHQ) pain subscale at 3 months, which was modified so that higher scores indicated less pain. We used linear regression analysis to investigate the association of baseline pain, psychological factors, outcome expectations, adherence to therapy, perceived attention, patient experience with care, treatment frequency and changes in grip and pinch strength with MHQ pain. Better MHQ pain score at baseline, higher baseline outcome expectations and improvement in grip strength after 3 months were associated with better pain outcomes. The MHQ pain baseline score had the strongest independent association. Baseline pain severity, outcome expectations and grip strength are associated with pain at 3 months after the use of orthoses with or without exercise therapy for TMJ OA. II.
Traumatic finger amputations are common upper-limb injuries, often resulting from accidents involving machinery, workplace incidents, motor vehicle collisions, or sports-related injuries. Epidemiological studies suggest that traumatic finger amputations constitute 3% of emergencies treated in hand clinics, with 40% of cases resulting from workplace accidents. These injuries can range in severity, sometimes requiring partial or full amputation of the affected digits. The loss of 1 or more fingers has profound functional and psychological impacts on patients, affecting hand dexterity, grip strength, and quality of life. Recent advances in prosthetic rehabilitation have enabled customized solutions that address both aesthetic and functional demands. Although myoelectric and surgically integrated prosthetic options offer advanced functionality, their cost complexity, infrastructure requirements often limit accessibility, particularly in low-resource setting. Passive silicone finger prosthesis remains a widely accepted alternative for restoring appearance and providing limited functional assistance. This case report describes the prosthetic rehabilitation of a young male with complete absence of the ring (D4) and little (D5) fingers using a customized silicone prosthesis retained by a dual-ring attachment-supported framework. The design aimed to achieve acceptable aesthetics, secure retention, reduced prosthesis weight, and limited functional support. The clinical outcome, patient's satisfaction, functional utility, and limitations of the prosthesis are discussed in comparison with existing passive, functional, and myoelectric options.
Approximately 70% of survivors of stroke have problems with arm function. Physiotherapists assess arm functional range of motion (ROM) using either a goniometer or functional questionnaires, which lack objective accuracy and require a skilled physiotherapist. We developed the Track-UL algorithm based on a markerless motion capture system to measure arm ROM. This study aimed to measure the agreement between our novel Track-UL algorithm and Kinovea software in assessing arm ROM during functional tasks in the laboratory and home settings. Videos were recorded while 27 survivors of chronic stroke performed 4 functional tasks (forward reaching, arm abduction, moving the hand toward the mouth, and moving the hand toward the head) in the laboratory and at home. The videos were analyzed by 2 independent raters using the Track-UL algorithm and Kinovea software. The limits of agreement and intraclass correlation coefficients were calculated. We found no clinically significant systematic bias in shoulder and elbow angle, with good agreement between the Track-UL algorithm and Kinovea software (assessed via Bland-Altman plots). The 95% limits of agreement were -3.18 to 6.41 degrees for the shoulder joint and -5.35 to 8.78 degrees for the elbow joint in the laboratory setting, and -6.21 to 3.62 degrees for the shoulder joint and -4.06 to 2.53 degrees for the elbow joint in the home setting. There was excellent absolute agreement between the measurement tools across all tasks and joints; intraclass correlation coefficient values ranged from 0.97 (95% CI 0.97-0.99) to 0.99 (95% CI 0.99-0.99; P<.001 for both laboratory and home measurements). The novel Track-UL algorithm is an accurate, valid, and easy tool that can be used to assess upper-limb ROM in survivors of stroke at clinics and potentially at home. This will support physiotherapists in remotely monitoring and adapting rehabilitation programs.
Superficial lesions in anatomically complex areas pose challenges for conventional high-dose-rate (HDR) brachytherapy (BT) techniques. We developed a novel 3D-printed applicator tailored for hand skin cancer, and evaluated its clinical feasibility and advantages. A patient with Merkel cell carcinoma of the right hand, involving the palm, dorsum, and interdigital spaces, was referred for HDR-BT. After initial CT simulation, planning target volume (PTV) was delineated and applicator structure was contoured, to comply with and encompass the PTV. Catheter channels were designed, and the applicator was fabricated as palmar and dorsal components to facilitate setup, using a stereolithography 3D printer with tissue-equivalent, bio-compatible clear resin. The patient underwent a second CT simulation with the applicator and catheters in place, and treatment planning was performed. Pre-treatment dry run confirmed source travel and catheter lengths, and treatment was delivered using a Flexitron HDR-BT afterloader. Twenty-seven catheters achieved PTV coverage of 98.6% at D90% and 96.7% at D95%, with a D0.03cc of 135.6%. Air gaps were less than 5 mm. Treatment was completed in 51 minutes with a 5 Ci iridium-192 (192Ir) source (15 minutes for setup and 36 minutes for delivery). At one-year follow-up, no recurrence or late toxicity was observed. The patient-specific 3D-printed applicator was successfully applied for skin lesions unsuitable for conventional techniques. Reduced air gaps improved dose conformity, and the semi-rigid, translucent resin enhanced setup reproducibility. The workflow substantially optimized staff resources, offering HDR-BT solution for complex superficial lesions in clinics without in-house printing capabilities.
This study evaluated and enhanced infection control practices in ophthalmology clinics at Magrabi Hospital, Riyadh, through a two-cycle quality improvement project (QIP). In the first cycle, a structured questionnaire assessed staff awareness, training, and implementation of infection prevention protocols, including hand hygiene, personal protective equipment (PPE) use, instrument disinfection, and environmental cleaning. Based on the identified gaps, targeted interventions, such as revised guidelines and online training, were introduced. The second cycle used a follow-up survey to reassess compliance and effectiveness. Results showed significant improvements in protocol awareness, hand hygiene, PPE use, disinfection log maintenance, and a reduction in procedure-related infections. However, challenges persisted, particularly with the exclusive use of multidose eye drops and unclear cleaning responsibilities. The study underscores the need for ongoing education, policy updates, and clear role definitions to maintain high infection control standards in ophthalmic settings.
Veterinary clinical biosecurity is key to preventing infectious diseases in animal clinics, particularly when there is high patient turnover, a mix of species, close contact among animals, or immunocompromised patients that raise the risk of hospital-associated infections (HAIs). This review outlines a practical, evidence-based approach designed to address biohazards, including zoonotic pathogens, and inherent risk factors that elevate HAI incidence in veterinary healthcare settings. It further outlines the principles and components of clinical biosecurity, i.e., bio-exclusion, bio-containment, and procedural hygiene, necessary to establish a robust infection control framework. A suite of actionable strategies is delineated, ranging from rigorous hand hygiene ('Clean hands, strong defense!') and proper cleaning and disinfection protocols to the integration of biosecurity measures with Hazard Analysis and Critical Control Points (HACCP) principles and a continuous Plan-Do-Check-Act (PDCA) cycle for quality improvement. Further, this review emphasizes the importance of regular audits and systematic quantitative monitoring to ensure adherence to biosecurity protocols, recommending practical tools such as compliance scoring systems and standardized checklist evaluations. The integration of artificial intelligence (AI)-based tools for predictive analytics and real-time pathogen surveillance, is proposed to enhance early outbreak detection and emergency response effectiveness. Additionally, tailored biosecurity protocols are detailed for implementation in resource-limited veterinary practices, providing specific, achievable strategies for diverse operational environments. By merging rigorous scientific principles with practical applications, this review delivers actionable, evidence-based guidelines to effectively mitigate HAIs, thereby improving animal welfare and safeguarding public health.
With a view to improving experience outcomes, this section of a broader 2019 study heard dental clinic staff perspectives on student preparedness to undertake student-led rural Indigenous clinical outplacement and staff views on students' skills development during outplacement, including communication and cultural safety training. Additionally, outplacement participants were canvassed on social and economic implications of their outplacement attendance and on the specific learning environment. All eligible university staff supporting the rural Indigenous health service-embedded dental clinics voluntarily participated in semi-structured telephone interviews. Coded content analysis of interview transcripts identified relevant themes and summarised staff perspectives. Current dental students and recent graduates who had attended rural Indigenous outplacements voluntarily participated in a post-outplacement online survey (29/71, 41% response rate). Survey data were stratified by groups and responses described using summary statistics, frequencies, and percentages. Staff considered students adequately prepared for technical clinical aspects. Participants improved non-technical communication skills and gained important first-hand culturally safe practice knowledge. Greater prior awareness of Indigenous culture among future students would enhance patient connection and build community trust. While student survey responses indicated economic burden and limited social connectivity were detractors needing to be addressed by educators, a strongly positive learning environment defined the experience. Considerable community oral health benefit and positive student personal and educational outcomes stem from rural Indigenous health service-embedded dental clinic outplacements. Results further justify model sustainability and argue positively for university measures promoting culturally safe professional practice and for addressing student economic burden.