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Cyberpsychology, Behavior, and Social NetworkingVol. 23, No. 7 EditorialConnecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:10 Jul 2020https://doi.org/10.1089/cyber.2020.29188.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”." Cyberpsychology, Behavior, and Social Networking, 23(7), pp. 437–438FiguresReferencesRelatedDetailsCited byQuantitative analysis of communication changes in online medication counseling using the Roter Interaction SystemResearch in Social and Administrative Pharmacy, Vol. 20, No. 1“Who Said That?” Applying the Situation Awareness Global Assessment Technique to Social Telepresence13 December 2023 | ACM Transactions on Human-Robot Interaction, Vol. 12, No. 4The good and bad of an online asynchronous general education course: Students’ perceptions18 December 2023 | Psychology Teaching Review, Vol. 29, No. 2Face-to-face more important than digital communication for mental health during the pandemic17 May 2023 | Scientific Reports, Vol. 13, No. 1Videoconference fatigue from a neurophysiological perspective: experimental evidence based on electroencephalography (EEG) and electrocardiography (ECG)26 October 2023 | Scientific Reports, Vol. 13, No. 1The ‘Zoomification’ of Collaboration: How 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and Psychology of the Pandemic November Through the October 2021 | Education, Vol. No. Practice During COVID-19 to and of November 2021 | Vol. 36, No. as the of Exploring and Perspectives of of Telehealth by a Australian Service during COVID-19 October 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. with The of technology and consumer July 2021 | International Journal of Consumer Studies, Vol. 45, No. of June 2021 | Annals of Surgery, Vol. No. and of Virtual in Video and Effects on of the ACM on Human-Computer Interaction, Vol. 5, No. How a Virtual Network during the COVID-19 of the ACM on Human-Computer Interaction, Vol. 5, No. May 2021 | American Journal of Clinical Vol. No. to and Education in the of December 2021 | Journal of Education, Vol. No. between social communication and during the early of September 2021 | Journal of Social and Vol. No. September 2021 | Vol. 11, No. Bir September 2021 | Vol. 5, No. of During the COVID-19 Pandemic by the of Medical of A Survey September 2021 | Frontiers in Medicine, Vol. student under remote learning using digital A June 2021 | Education and Information Vol. No. of the COVID-19 Pandemic on Higher Education: the

No AccessEducationJul 2010Design Thinking for Social InnovationAuthors/Editors: Tim Brown, Jocelyn WyattTim BrownSearch for more papers by this author, Jocelyn WyattSearch for more papers by this authorhttps://doi.org/10.1596/1020-797X_12_1_29SectionsAboutView ChaptersPDF (0.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Designers have traditionally focused on enchancing the look and functionality of products. 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Innovation and Development, Vol.13, August the of service in tourism and Vol.31, August Research A Design Thinking Approach to on Journal of Environmental Research and Public Health, Vol.18, September Innovation Design and Sustainability of in Vol.13, No.173 September of in the design thinking of a Skills and Creativity, Sosyal August 2021Design thinking and innovation: the of Business July 2020Design thinking approach to for the Journal of August Uygulamaları Bilimler August 2021Innovating for through collaborative innovation of Cleaner Production, OF DESIGN AND OF AND of the Design Society, July of Social Innovation through The Case of in Vol.13, August COVID-19 as a for public and The need for robust governance to turbulent Management Review, Vol.23, September and practice of Design Thinking: of and business Journal of Design Creativity and Innovation, Vol.9, May Learning to Support Decision-Making and Creative in Instructional Design Vol.65, No.46 April in Learning through the of Design Thinking in a Vol.13, July methodology design: participatory processes for of Research, a approach to food as in Student case of using a to support Technology as an The and of in Regional Open Innovation Vol.13, June Services during the in of Design, December 2022Supporting and Living through Journal of Environmental Research and Public Health, Vol.18, April de Vol.26, the new on the in public & a April of Design Thinking to in a Vol.13, April Courses of Design on the Light on to Social and Vol.13, April 2021Using human-centred design to develop an female Vol.7, January case study of an of Business No.214 May Innovation in Education and Social Service and Approaches to Social in Education, March Design Thinking Approach for March to the of energy in Research & Social Science, A Conceptual Framework for the and of Youth of and Health, Vol.18, evaluation of innovation: A case of for in Journal of Science, Technology, Innovation and Development, Vol.13, July Novel for Digital Assessment Using A Human-Centered Design Approach (Preprint)JMIR February mental health and in and mental framework for in of Cleaner Production, to Design Thinking to Creative and in Journal of & Design Education, August Theory in An Journal, March 2021Designing and for with January with design thinking: a case study from Journal of Environmental Education, Vol.52, January and the of Design: of Design and Design in No.122 May to Design with A for Design and July Case and the of Design Thinking in Public Education in August to Co-Created Digital to Support Activities for Socially Youth in February Innovation and Exchange a Lessons Learned from a Design Thinking Challenge in May October Sustainable Business and January Analysis of Agile Development Methodology Through Design June Sustainable Design to Environmental of Design November Case for Design May Learning in Design Thinking to April 2021Design Thinking as a Strategy to Learning in Education Across South April Inspection Management with October design methodology for A to community health and health in the Health of and Science, Vol.5, February 2021Using Design Thinking to the Educational of August factors of service design methodology for manufacturing Business & Management, Vol.8, February 2021Design and of an app for September 2021Design Innovation Methodology – Design in Journal, of the Health Mental Health Intervention for in and for a Research Vol.10, June Design Approach to Social a of Public and October Design Thinking in an Interdisciplinary Learning December Design Thinking to Design Thinking to Food Innovation for January of Design Thinking and to Food and January 2021Design Thinking to Engage in Food The January 2021Systemic and Design Towards Participatory The Journal of Design, and Innovation, Vol.7, Design Thinking October Research and Design Thinking for the Health and Social A para de de Vol.16,

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Previous article Next article Convergence Conditions for Ascent Methods. II: Some CorrectionsPhilip WolfePhilip Wolfehttps://doi.org/10.1137/1013035PDFBibTexSections ToolsAdd to favoritesExport CitationTrack CitationsEmail SectionsAboutAbstractSome corrections and amplifications are appended to Convergence conditions for ascent methods, this Review, 11 (1969), pp. 226–235.[1] Philip Wolfe, Convergence conditions for ascent methods, SIAM Rev., 11 (1969), 226–235 10.1137/1011036 MR0250453 0177.20603 LinkISIGoogle Scholar[2] R. Fletcher and , M. J. D. Powell, A rapidly convergent descent method for minimization, Comput. J., 6 (1963/1964), 163–168 MR0152116 0132.11603 CrossrefISIGoogle Scholar[3] Haskell B. Curry, The method of steepest descent for non-linear minimization problems, Quart. Appl. Math., 2 (1944), 258–261 MR0010667 0061.26801 CrossrefGoogle Scholar[4] Philip Wolfe, J. 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Telemedicine and e-HealthVol. 26, No. 9 OpinionFree AccessTechnology Literacy as a Barrier to Telehealth During COVID-19Austin J. Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. HorstAustin J. TrianaVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Roman E. GusdorfVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Kaustav P. ShahVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, and Sara N. HorstAddress correspondence to: Sara N. Horst, MD, MPH, Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building Suite 220, Nashville, TN 37232, USA E-mail Address: [email protected]Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Search for more papers by this authorPublished Online:10 Sep 2020https://doi.org/10.1089/tmj.2020.0155AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail During the ongoing COVID-19 pandemic, there have been many fundamental changes to the health care system, one of which has been the rapid adoption of telehealth.1 Despite technological capability for widespread implementation before the pandemic, telehealth remained limited in many areas of the United States due to state regulations and poor insurance reimbursement.2 When these policies changed in March 2020 with national widespread coverage for telemedicine, traditional clinical workflows attempted to rapidly shift to a virtual format to increase social distancing and protect vulnerable patients. At our institution alone, the number of telehealth visits increased from ∼15 per day to >2,000 per day in a matter of weeks.As the health care system rapidly reorganized and trained physicians on how to host videoconference visits, some patients have struggled to keep up. During these changes, providers reported that many patients were struggling to access their telemedicine appointments. Patients may have difficulty navigating their devices and entering the health care system virtually. Others simply do not have devices or a stable Wi-Fi to connect with providers from home. Technology literacy and access should be viewed as a major driver of health and needs to be on a large scale.As an example, Ms. P is a 70-year-old woman with diabetes and hypertension who knows she is high risk for complications from COVID-19. Taking extra precautions, she cancelled her in-person appointments and scheduled a telehealth visit with one of her providers. She spent an entire afternoon preparing her technology for the visit, but she could not connect to the virtual appointment. Despite a proactive mindset, she had difficulty downloading the necessary software. Recognizing this barrier to care Ms. P and other patients face, we started a medical student-led volunteer initiative to help patients set up and test devices for their telemedicine appointments. We rapidly created systematic processes for recruitment, volunteer training, clinic coverage, and operational support. A standardized phone script helped students guide patients as they downloaded the proper software and understood what to expect at the time of the visit.Within a month, we have had 135 medical student volunteers commit 1,300 h and assist >5,000 patients in preparing for upcoming telehealth visits. Along the way, we have seen a wide range of patient comfort with technology that has advanced our understanding of technology literacy. One patient, a computer programmer, initially scoffed when asked whether he needed help. However, he still appreciated the tip that he received about which web browser to use to access his visit, avoiding a glitch that kept some patients from connecting. For patients low self-reported technology literacy, our impact can be great. Many patients had never downloaded a smartphone application or used videoconferencing software before their first virtual appointment. Wary of hackers and scammers, another patient was strongly opposed to telehealth and wanted to cancel his visit, but after talking about the safety of the process with a student, he downloaded the software and had a successful telemedicine visit with his provider.If a patient cannot connect to the videoconference, the provider is forced to call the patient to troubleshoot over the phone, reschedule the appointment, or simply proceed without video. Prior work has shown that the video component significantly contributes to quality and satisfaction of the visit.3 In addition to the technology itself, patients need to know what to expect for their telehealth appointments. Ideally, a patient will have a medication list and be in a quiet and private location at the time of the visit. Therefore, it is important to communicate these expectations beforehand to avoid a visit that takes place from the grocery store or in the car.With the ability to see patients in their own environments, we also gain insight into their lives. Using videoconferencing, it is possible to see a patient's home, to contextualize their experiences, and to better utilize the biopsychosocial model of health. One patient was blind but wanted to use videoconferencing so that the provider could see him. A volunteer helped the patient and his able-sighted daughter navigate the telehealth process using accessibility features for blindness. As medical students who grew up immersed in technology, we have been humbled by the complexity of teaching others to navigate smartphones, web browsers, and applications, and we have seen the tremendous technology gaps in various patient populations.Outside the context of direct patient care, widespread adoption of telehealth has the potential to improve quality of life and health outcomes through additional synergies. Although many older adults perceive benefits from technology, common barriers include self-efficacy, cost, and privacy concerns.4 Prior research has shown that technology adoption can be improved through education and increasing perceived self-efficacy.5 If patients can better navigate their web browsers and applications, they may feel empowered to message their providers through the patient portal or look up healthy recipes online.Among the drastic changes in health care, we hope that updated regulations and improved insurance coverage will be permanent, improving access for patients by addressing issues related to distance, mobility, or health concerns. Licensure across state lines remains a big question that could drastically impact access for many patients. In addition, it is imperative to further understand and address how to help our patients access and use technology. The transition to telehealth requires time, patience, and resources—an investment that is crucial for patients who are at risk of being left behind.AcknowledgmentsWe thank Drs. Michelle Griffith and Eiman Jahangir for organizational support of this project as well as reviewing and editing drafts.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Smith A, Thomas E, Snoswell C, Haydon H, Mehrotra A, Clemensen J, Caffery Lj. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020. Available at: https://doi.org/10.1177/1357633X20916567 (last accessed May 15, 2020). Google Scholar2. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. Crossref, Medline, Google Scholar3. McLendon SF. Interactive video telehealth models to improve access to diabetes specialty care and education in the rural setting: A systematic review. Diabetes Spectr 2017;30:124–136. Crossref, Medline, Google Scholar4. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018;24:4–12. Crossref, Medline, Google Scholar5. Gatti FM, Brivio E, Galimberti C. "The future is ours too": A training process to enable the learning perception and increase self-efficacy in the use of tablets in the elderly. Educ Gerontol 2017;43:209–224. 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Harlé8 December 2023 | Telemedicine and e-Health, Vol. 29, No. 12The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study19 December 2023 | BMC Health Services Research, Vol. 23, No. 1Evaluation of a Physical Therapist-Delivered Technology Literacy Algorithm and Protocol for Older Adults: A Pilot StudyCureus, Vol. 28Telehealth and telemedicine prenatal care during the COVID-19 pandemic: a systematic review with a narrative synthesis18 November 2023 | Hospital Practice, Vol. 51, No. 5Practical Strategies for Addressing Video Visit Access Barriers in Urology1 September 2023 | JU Open Plus, Vol. 1, No. 9Establishing a Centralized Virtual Visit Support Team: Early Insights8 August 2023 | Healthcare, Vol. 11, No. 16Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study11 August 2023 | BMJ Mental Health, Vol. 26, No. 1A sociotechnical framework for integration of telehealth into clinical workflow15 May 2023 | IISE Transactions on Healthcare Systems Engineering, Vol. 13, No. 3Telemedicina y asma grave en nuestro entorno: reflexiones sobre la experiencia de los profesionales y propuestas para hacerla realidadOpen Respiratory Archives, Vol. 5, No. 3Habit reversal training for excoriation disorder: Differential outcomes of telehealth versus in-person treatmentsPsychiatry Research Case Reports, Vol. 2, No. 1The Risk Mitigation Decision-Making Model for Music Therapy Services During the Covid-19 Pandemic28 April 2023 | Music Therapy Perspectives, Vol. 41, No. 1Competencies for video telemedicine with older adult patients23 March 2023 | Journal of the American Geriatrics Society, Vol. 71, No. 4Using data analytics for telehealth utilization: A case study in Arkansas7 March 2023 | Journal of Telemedicine and Telecare, Vol. 28' Without support CALD patients will be left behind ': A mixed-methods exploration of culturally and linguistically diverse (CALD) client perspectives of telehealth and those of their healthcare providers16 February 2023 | Journal of Telemedicine and Telecare, Vol. 19Determinants of COVID-19 Knowledge, Perception and Attitudes in Indonesia: A Cross-Sectional Survey20 February 2023 | International Journal of Environmental Research and Public Health, Vol. 20, No. 4'The key to this is not so much the technology. 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Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. Horst.Technology Literacy as a Barrier to Telehealth During COVID-19.Telemedicine and e-Health.Sep 2020.1118-1119.http://doi.org/10.1089/tmj.2020.0155Published in Volume: 26 Issue 9: September 10, 2020Online Ahead of Print:May 19, 2020 TopicsCOVID-19e-health and telehealth careTelehealth devices PDF download

Medical Writings6 August 2002“What's Important to You?”: The Use of Narratives To Promote Self-Reflection and To Understand the Experiences of Medical ResidentsDonald W. Brady, MD, Giselle Corbie-Smith, MD, and William T. Branch Jr., MDDonald W. Brady, MDFrom Emory University, Atlanta, GA 30303Search for more papers by this author, Giselle Corbie-Smith, MDFrom Emory University, Atlanta, GA 30303Search for more papers by this author, and William T. Branch Jr., MDFrom Emory University, Atlanta, GA 30303Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-3-200208060-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Too often we hear housestaff speak of residency training as a “test of survival”—getting through the next 3 years so that they may get on with their “real” careers. However, we as faculty physicians know that these years of training are not lived in a vacuum but are inextricably interwoven into the fabric of residents' personal and professional lives. Their experiences—both the highs and the lows—will profoundly influence them as future physicians. For example, when a resident attends to a patient who is dying, how he or she processes that experience will bear markedly on how that resident will react ...References1. Branch W, Pels RJ, Lawrence RS, Arky R. Becoming a doctor. Critical-incident reports from third-year medical students. N Engl J Med. 1993;329:1130-2. [PMID: 8371749] CrossrefMedlineGoogle Scholar2. Hupert N, Pels RJ, Branch WT. Learning the art of doctoring: use of critical incident reports. Harvard Student BMJ. 1995;3:99-100. Google Scholar3. Branch WT, Pels RJ, Harper G, Calkins D, Forrow L, Mandell F, et al . A new educational approach for supporting the professional development of third-year medical students. J Gen Intern Med. 1995;10:691-4. [PMID: 8770723] CrossrefMedlineGoogle Scholar4. Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995;311:299-302. [PMID: 7633241] CrossrefMedlineGoogle Scholar5. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine Publishing; 1967:101-15. Google Scholar6. Denzin NK, Lincoln YS. Handbook of Qualitative Research. Thousand Oaks, CA: Sage; 1994:643. Google Scholar7. Schoen DA. Educating the Reflective Practitioner. San Francisco: Jossey-Bass; 1987. Google Scholar8. Miller SZ, Schmidt HJ. The habit of humanism: a framework for making humanistic care a reflexive clinical skill. Acad Med. 1999;74:800-3. [PMID: 10429589] CrossrefMedlineGoogle Scholar9. Smith CS, Irby DM. The roles of experience and reflection in ambulatory care education. Acad Med. 1997;72:32-5. [PMID: 9008565] MedlineGoogle Scholar10. Branch W. Notes of a small-group teacher. J Gen Intern Med. 1991;6:573-8. [PMID: 1765874] CrossrefMedlineGoogle Scholar11. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278:502-9. [PMID: 9256226] CrossrefMedlineGoogle Scholar12. Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students' self-awareness, personal growth, and well-being. Acad Med. 1999;74:516-20. [PMID: 10353283] CrossrefMedlineGoogle Scholar13. Branch WT Jr. Professional and moral development in medical students: the ethics of caring for patients. Trans Am Clin Climatol Assoc. 1998; 109:218-29; discussion 229-30. [PMID: 9601140] Google Scholar14. Branch WT. The ethics of caring and medical education. Acad Med. 2000;75:127-32. [PMID: 10693842] CrossrefMedlineGoogle Scholar15. Mezirow J. How critical reflection triggers transformative learning.. In: Mezirow J, eds. Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco: Jossey-Bass; 1990:1-20. Google Scholar16. Brookfield S. Using critical incidents to explore learners' assumptions.. In: Mezirow J, eds. Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco: Jossey-Bass; 1990:177-93. Google Scholar17. Bolton G. Reflective Practice: Writing and Professional Development. London: Paul Chapman Publishing/Sage; 2001:117-8. Google Scholar18. Reynolds PP. Professionalism in residency [Editorial]. Ann Intern Med. 1991;114:91-2. [PMID: 1983943] LinkGoogle Scholar19. . American College of Physicians Ethics Manual. Third edition. Ann Intern Med. 1992;117:947-60. [PMID: 1443957] LinkGoogle Scholar20. Stobo JD, Kohen JJ, Kimball HR, LaCombe MA, Schechter GP, Blank LL, et al . Project Professionalism, American Board of Internal Medicine. Philadelphia: American Board of Internal Medicine; 1995. Google Scholar21. Baldwin DC, Daugherty SR, Rowley BD. Unethical and unprofessional conduct observed by residents during their first year of training. Acad Med. 1998;73:1195-200. [PMID: 9834704] CrossrefMedlineGoogle Scholar22. Beaudoin C, Maheux B, Côté L, Des Marchais JE, Jean P, Berkson L. Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents. CMAJ. 1998;159:765-9. [PMID: 9805021] MedlineGoogle Scholar23. Bolton G. Reflective Practice: Writing and Professional Development. London: Paul Chapman Publishing/Sage; 2001:51. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Emory University, Atlanta, GA 30303Acknowledgments: The authors greatly appreciate the participation of all the internal medicine-primary care residents at Emory University and their continued efforts to become self-reflective, compassionate physicians.Corresponding Author: Donald W. Brady, MD, 69 Butler Street SE, Atlanta, GA 30303; e-mail, [email protected]edu.Current Author Addresses: Drs. Brady and Branch: 69 Butler Street, SE, Atlanta, GA 30303.Dr. Corbie-Smith: University of North Carolina at Chapel Hill, Medical School, Wing D, CB#7240, Chapel Hill, NC 27599-7240. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUnderstanding the lived experiences of medical learners in a narrative medicine course: a phenomenological studyHow does narrative medicine impact medical trainees’ learning of professionalism? A qualitative studyApplications of Narrative Medicine to Surgical EducationEffectiveness of reflective learning in skill-based teaching among postgraduate anesthesia students: An outcome-based study using video annotation toolDo critical incidents lead to critical reflection among medical students?A Qualitative Study on the Experiences and Reflections of Junior Doctors During a Palliative Care Rotation: Perceptions of Challenges and Lessons LearntA compass for care: Evaluating first-year pharmacy students' philosophy of practiceReflective Journaling by Second-Year Dental Students During a Clinical RotationThe influence of narrative medicine on medical students’ readiness for holistic care practice: a realist synthesis protocolSelf-Focused Attention and Career Anxiety: The Mediating Role of Career AdaptabilityThe importance of self-awareness: musings of a medical studentNavigating uncertainty: Narrative medicine in pregnancy options counseling educationGrappling with complexity: Medical students’ reflective writings about challenging patient encounters as a window into professional identity formationPalliative Care Education: An OverviewPalliative Care Education: An OverviewFrom concern for patients to a quest for informationTowards Patient Safety: Promoting Clinical Empathy Through an Experiential Curriculum in Care Transitions Among the UnderservedDifferent perceptions of narrative medicine between Western and Chinese medicine studentsImpact of a narrative medicine programme on healthcare providers’ empathy scores over timeWhat Is Art Good For? The Socio-Epistemic Value of ArtDeath as an InternWriting Well: The Long-Term Effect on Empathy, Observation, and Physician Writing Through a Residency Writers' Workshop(How) do medical students regulate their emotions?On Children, Blood, and Cancer: A new section of PBCSelf-Reflection: Using Journal Entries to Enhance Teaching and Orthopedic Resident CommunicationPerson-Centered Psychiatric Education“Where Does the Circle End?”: Representation as a Critical Aspect of Reflection in Teaching Social and Behavioral Sciences in MedicineLearning about maternal death and grief in the profession: a pilot qualitative studyProfessional Identity Formation in Medical Education for Humanistic, Resilient PhysiciansTeaching professional and humanistic values: Suggestion for a practical and theoretical modelA genre analysis of reflective writing texts by English medical studentsUsing Artistic-Narrative to Stimulate Reflection on Physician BiasFostering Professional Formation in Residency: Development and Evaluation of the “Forum” Seminar SeriesThe Utility of Reflective Writing after a Palliative Care Experience: Can We Assess Medical Students' Professionalism?Passing the Baton: A Grounded Practical Theory of Handoff Communication Between Multidisciplinary Providers in Two Department of Veterans Affairs Outpatient SettingsMedthics Graphic NovelA comparison of two methods of teaching reflective ability in Year 3 medical studentsStorytelling as a vehicle for self-awareness: Establishing a foundation for intercultural competency developmentReflection in/and WritingIntegrating Geriatrics into Medical School: Student Journaling as an Innovative Strategy for Evaluating CurriculumReflections on Compassion, Suffering and Occupational StressCase Writing as a Vehicle for Promoting Cultural Competency: A Retrospective, Descriptive Qualitative AnalysisFostering and Evaluating Reflective Capacity in Medical Education: Developing the REFLECT Rubric for Assessing Reflective WritingFactors confounding the assessment of reflection: a critical reviewDevelopment and pilot testing of a reflective learning guide for medical educationHow do healthcare professionals perceive themselves after a mentoring programme? 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Living Beyond – an interactive photographic exhibitBegin the BEGAN (The Brown Educational Guide to the Analysis of Narrative) – A framework for enhancing educational impact of faculty feedback to students’ reflective writingThe Use of Peer Review in Nursing Education and Clinical PracticeA multi‐dimensional model of reflective learning for professional developmentPeer-Facilitated Virtual Action Learning: Reflecting on Critical Incidents During a Pediatric Clerkship‘The Loss of My Elderly Patient:’ Interactive reflective writing to support medical students’ rites of passageThe Impact of Senior Medical Studentsʼ Personal Difficulties on Their Communication Patterns in Breaking Bad NewsStudents of medicine: broadening their studiesReflecting on Reflections: Enhancement of Medical Education Curriculum With Structured Field Notes and Guided FeedbackHouse Calls and the ACGME CompetenciesCritical Events in the Lives of InternsThe impact of prompted narrative writing during internship on reflective practice: a qualitative studyPerspective: The Unintended Consequences of Training Residents in Dysfunctional Outpatient SettingsReliability and validity of reflection exercises for obstetrics and gynecology residentsNarrative Medicine in Surgical EducationViewpoint: Physician, Know Thyself: The Professional Culture of Medicine as a Framework for Teaching Cultural CompetenceUsing videotaped objective structured clinical examination as a tool for reflection on communication skillsInstitutional Leadership and Faculty Response: Fostering Professionalism at the University of Pennsylvania School of MedicineEarly Clinical Experiences from Studentsʼ Perspectives: A Qualitative Study of NarrativesEmpathy and Patient–Physician ConflictsWhat motivates physicians throughout their careers in medicine?A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical centerThe craft of writing: A physician-writer’s workshop for resident physiciansCommentaryPersonal growth during internshipViewpoint:Listening to the voices of medical students in poetry: Self, patients, role-models and beyondA comparison study of career satisfaction and emotional states between primary care and speciality residentsUse of critical incident reports in medical educationMarking criteria for assessing practice-based portfolios at masters’ level???It was haunting ??????: Physicians??? Descriptions of Emotionally Powerful Patient DeathsSelf-Reflection in Multicultural Training: Be Careful What You Ask ForUsing reflective writing within researchPoetic License: Writing Poetry as a Way for Medical Students to Examine Their Professional Relational Systems.The Effects of Sleep Loss and Fatigue on Resident–Physicians: A Multi-Institutional, Mixed-Method StudyWhat Do Doctors Find Meaningful about Their Work?Carol R. Horowitz, MD, MPH, Anthony L. Suchman, MD, William T. Branch Jr., MD, and Richard M. Frankel, PhD 6 August 2002Volume 137, Issue 3Page: 220-223KeywordsEmotionsExerciseForecastingMedical intensive care unitsPatientsResidencyRunningSuicideSurgeonsSurgery ePublished: 6 August 2002 Issue Published: 6 August 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

If you want to know how we practised medicine 5 years ago, read a textbook. If you want to know how we practised medicine 2 years ago, read a journal. If you want to know how we practise medicine now, go to a (good) conference. If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM. – from International EM Education Efforts and E-Learning by Joe Lex 20121 FOAM is ‘free open-access med(ical ed)ucation’.2, 3 As such, FOAM is a dynamic collection of resources and tools for lifelong learning in medicine, as well as a community and an ethos. FOAM is continually evolving and growing rapidly, and from anarchic beginnings is increasingly attracting interest from practicing clinicians, trainees, educators, researchers and publishers alike. This article defines FOAM, details its development and considers its role, particularly in relationship to scientific journals, textbooks and medical education as a whole. FOAM is sometimes considered synonymous with ‘educational social media for medicine’, but it is actually much more than that. Social media refers to the creation and exchange of user-generated content via virtual networks and communities using Internet applications. FOAM resources are predominantly social media based but are ultimately independent of platform or media.2 They include blogs, podcasts, tweets, Google® hangouts, web-based applications, online videos, text documents, photographs, graphics and even anything else you can create with pen and paper. Social media has been a potent catalyst for developing and disseminating FOAM resources but from the sharing of these resources has grown a lively, interactive global community of FOAM users and creators. This FOAM community is bound by the loosely woven philosophy that high-quality medical education resources and interactions can, and should, be free and accessible to all who care for patients and especially those that teach others the art and science of medicine. Importantly, FOAM enthusiasts also encourage the re-use and modification of their resources to suit user requirements and local needs. Ultimately, the glue that holds the community together is an ethos of open sharing and collaboration with attribution and recognition of the work of others. FOAM existed long before the acronym came into being, and the then unnamed FOAM ethos was at the forefront of our minds when we began working on Lifeinthefastlane.com years ago. Joe Lex, at the Social Media and Critical Care (SMACC) Conference in 2013, even argued that the origins of FOAM lie in the Hippocratic Oath itself,4 which states: ‘… and to teach them this art – if they desire to learn it – without fee and covenant’.5 Indeed, members of the medical profession throughout history have been willing to share knowledge with those committed to the craft and to seek learning from far-flung places from whoever is in a position to provide it. In the age of social media, this has never been easier. Yet, names are important when it comes to making ideas stick and making ideas spread. The term FOAM bubbled into existence when one of us (MDC) was, along with emergency physician Sean Rothwell, lamenting the negative connotations of the term ‘Social Media’ in the laggardly minds of practicing physicians. As the venue was the International Conference on Emergency Medicine (ICEM) 2012 in Dublin, the answer was naturally to be found at the bottom of a pint of Guinness®. Since then, FOAM has exploded and grown rampantly, and there are now over 240 blogs and podcasts devoted to free open-access medical education using the FOAM banner in emergency medicine and critical care alone.6 Some of the most established and well-regarded examples are listed in Table 1. There are also numerous other resources that can be considered as FOAM but that do not explicitly embrace the label. Twitter® has been central to the development of the FOAM community.7 This might be surprising to those whose minds meld Twitter® with the marketing machine of Justin Bieber but not to anyone who actually knows how to use this valuable tool. Twitter® is free to access and allows users to selectively follow people who have interesting or useful things to share. Tweets are, notoriously, limited to just 140 characters. This forced brevity ensures users must ‘cut to the chase’ when getting points across or sharing resources. Twitter® users can also follow topics, in addition to individuals, when tweets are labelled with a unifying hashtag. For instance, FOAM tweets can be labelled with a hashtag, allowing them to be rapidly identified by a search for #FOAMed (unfortunately #FOAM leads to not-so-educational tweets). Currently on Twitter® there are 630 people who have registered as followers of FOAM.2 Some that we suggest Australasian emergency physicians would benefit from following are listed in Table 2. FOAM is sometimes portrayed as being at loggerheads with ‘the establishment’, including traditional medical journals. We think this is overstated, and both social media and FOAM have a growing role in the post-publication analysis of scientific research and in bridging the gap between research and practice. There has been a push from some quarters to make FOAM more ‘journal like’, and a common criticism of FOAM is that it is not peer reviewed in the traditional sense.8 However, FOAM is not scientific research. Instead, FOAM is a useful way of disseminating, discussing, dissecting and deliberating over the products of that research – as well as exploring issues where research findings do not apply, or simply do not exist. FOAM is more akin to the editorials and commentary articles that appear in medical journals, usually solicited by editorial request and without traditional peer review – except that FOAM authors do not require invitations from editors-in-chief to share their thoughts. Unlike scientific research, FOAM opinions and arguments live or die by being hammered on ‘the anvil of Truth’ that is free and open debate and discussion. Peer review, although widely held to be central to the scientific process, has significant flaws.9 Many journals are now looking at means of improving this process, including consideration of various forms of post-publication peer review. Indeed, Pubmed® Commons10 is now being trialled and others have argued for a ‘publish then filter’ model of scientific publication, perhaps involving crowd-sourced peer review.11 In a sense, FOAM is already part of this post-publication peer-review process. For example, a blog post on Intensive Care Network12 recently led to a correction in the New England Journal of Medicine.13 Online journal clubs abound, and there are entire blogs dedicated to critical appraisal and discussion of the scientific literature (such as Emergency Medicine Literature of Note14 and EM Nerd15). The significance of, and the caveats to, the scientific literature have never been so widely discussed, disseminated and deliberated on, and never so quickly. This was most evident with widespread FOAM discussion of the negative outcome of the targeted temperature management trial within days of its publication.16 FOAM, because of the media used, is potentially subject to a more pervasive peer-review process that the scientific literature itself. A difference is that this occurs post-publication. The major drawback is that the review process might be ‘hit-and-miss’, with more popular resources, such as EMCrit.org, being subject to great scrutiny and discussion, whereas new blogs and podcasts with few subscribers might have little. A more pertinent criticism of FOAM is the variable degree of scholarship. In its least scholarly form, FOAM is the equivalent of a corridor conversation – some tweets are essentially unreferenced bullets shot from the hip, as are some opinion-based blog posts. Yet other FOAM products, such as Paul Young's ‘Fever, Friend or Foe?’ blog post,17 are extensively referenced and are as scholarly as any other publication. Thus, caveat emptor applies in FOAM, just as it does when we read scientific research or any other source of information – all physicians need to develop critical thinking skills and appraise the merits of whatever information they are using. On the other hand, FOAM creators should strive to produce referenced scholarly works whenever possible, for the sake of their own credibility and to aid the user in making up his or her own mind. As alluded to earlier, knowledge translation continues to be difficult to achieve in medicine, and there remain significant gaps between research and practice.18 Scientific research in the clinical sciences is essentially worthless unless it alters patient outcomes. Social media and FOAM have the potential to play a major role in knowledge translation. This is demonstrated by the rapid dissemination of the ‘delayed sequence intubation’ concept19, 20 and the ‘NODESAT’ approach to apnoeic oxygenation.19, 21 The CRASH2 investigators have also used social media and web-based tools to promote the use of tranexamic acid in trauma,22, 23 whereas tweets about articles appear to correlate with future citations24 and social media releases lead to more downloads of research articles.25 If the rise of open access medical publishing continues as expected, the distinction between FOAM and medical journals might blur. Regardless, it seems inevitable that traditional medical journals will continue to explore the role of social media in their peer review and knowledge translation strategies. So, while FOAM and medical journals complement more than they clash, can the same be said for the relationship between FOAM and textbooks? Even prominent FOAM advocates, such as Joe Lex and Scott Weingart, still advocate that trainees must read at least one of the major emergency medicine textbooks ‘cover to cover’.26 The underlying rationale for this, we believe, is to ensure that ‘all the bases’ are covered – that all the core topics of our specialty are studied by trainees. FOAM is considered too heterogenous, with too much emphasis on ‘sexy topics’, such as awake intubation and the intricacies of surgical airway, with not enough on important topics, such as hand hygiene and cultural competency. It is naïve to believe that any one textbook meets the learning needs of a given trainee. The curriculum and the learning requirements are determined by the colleges, in our case the ACEM.27 Although there are a number of recommended reading texts suggested by ACEM, trainees are entitled to use whatever resources are available to meet these needs. In many cases, FOAM resources are the most accessible, most up-to-date, most engaging and sometimes even the highest quality resources available (targeted temperature management after cardiac arrest is a timely example16). Where this is not the case, interaction with a clinical teacher, exploration of the primary scientific literature or consultation of a text can fill in the gaps. As FOAM continues to grow, the gaps are shrinking. Does this mean that FOAM should have its own curriculum?28 We think not – as the trainee curriculum is clearly defined by the college. FOAM resources can be linked to the ACEM curriculum, for instance, providing a comprehensive base for trainee knowledge needs (e.g. ACEM's Best of Web project29). Importantly, in addition to these basic training requirements, learners need to develop their own personal ‘curriculum’ that will evolve over time according to their changing requirements and those of their patients. By learners, we mean physicians at every stage of their careers, not just trainees. Again, FOAM resources help meet these needs. So is the textbook dead? The monolithic tome of yore certainly should be. Bulky texts that are out-of-date before they are published, with editor-defined content, that are non-learner and non-location centric and are unchallengeable in a public forum have a dwindling role to play in medical education. A textbook of the future needs to integrate many of the characteristics of FOAM resources: instantly updatable, continual post-publication review, user interactivity, multimedia integration, platform independent, cloud based and adaptable to local needs. FOAM is an adjunct to existing medical education approaches, not a replacement. FOAM resources are easily accessible and are portable. This makes them ideally suited to asynchronous learning30 and the ‘flipped classroom’ model.31 Asynchronous learning allows trainees to educate themselves using resources that suit their needs when the time is right for them. This is useful in the emergency medicine setting where shift work is the norm, and trainees have different degrees of knowledge and understanding about different topics. This model is also suited to trainees who are isolated or in remote locations, distant from specialist clinical teachers. A remarkable feature of FOAM is its capacity for tacit knowledge sharing.32 Through, videos, audio discussions and iterative interactions knowledge that is otherwise difficult to express in stand alone texts or lectures can be transferred. FOAM facilitates practical solutions to problems that research has yet to answer and that textbooks have no room to discuss. The ‘flipped classroom’ model31 is a useful way to utilise FOAM. Asynchronous learning resources can be studied by participants prior to each education session and negates the need for lecture preparation. This allows the bulk of the valuable teaching time to be devoted to higher level facilitated peer-group discussion, simulation or other interactive and team-based learning approaches rather than one-way didactic sessions. This guards against FOAM resources being misunderstood by learners if they do not have sufficient base knowledge or clinical experience to appreciate the nuances and ramifications. No single technology or educational resource can replace bedside mentoring by an expert clinician educator, but adjunctive, asynchronous learning combined with a flipped classroom gives learners the best of both worlds. The future of FOAM is exciting. Although currently centred within the realms of emergency medicine – it continues to grow6 and its scope is expanding rapidly (e.g. the rise of subspecialty Twitter® hashtags, such as #FOAMcc for critical care, #FOAMped for paediatrics and #FOAMtox for toxicology). Existing resources are being continually updated, revised and remodelled to create tailored geo-centric and specialty-specific solutions. We hope to see FOAM, where appropriate, improve in its degree of scholarship and become increasingly recognised by employers, academic institutions and specialty colleges. Appropriate referencing of text-based resources is the key to scholarly credibility and should be used where appropriate. We feel it is unlikely that FOAM will ever become truly peer reviewed in the traditional sense, despite experiments, such as the ‘expert peer review’ system used by Academic Life in Emergency Medicine,33 because of the apparent advantages of crowd-sourced post-publication peer review by FOAM users. An important limitation to the expansion of FOAM is the ‘cost of free’. At this time FOAM resources are created largely by altruistic, motivated individuals, in their own time and at their own cost. One solution adopted by Scott Weingart of EMCrit.org is to provide the content for free but require a fee for obtaining CME points.34 Other possible models include jobs boards, advertising, donations and institutional funding to support the cost of hosting and website development. Confidentiality, maintaining patient privacy and obtaining appropriate consent are also key issues to consider when creating online educational resources.35 These factors are especially important as creators of FOAM content do not control the destiny of their educational material. These resources might be modified and reused in ways unimaginable to the original creator. There are also concerns about managing one's online professional persona and the public perception of frank and open debate involving healthcare professionals discussing issues at or beyond the limitations of their knowledge.35 Regardless of whether we are acting in the real world, or in a virtual world online, the principles of medical professionalism still apply. Anonymity is too be avoided and health professionals using social media need to remember that anything they say online will stay online. Cloud conversation is the equivalent of shouting through a megaphone in a stadium full of people during a televised event. It is a challenge to define the value, validity, utility and return-on-investment of FOAM resources.36 As with any educational platform, demonstrations of benefit are elusive. Current metrics are based on the rapid growth in the use of the resources, number of page views and downloads as well as individual testimonials of the benefits of FOAM resources in passing medical examinations and in solving clinical problems. FOAM allows emergency physicians to interact with colleagues around the world, including many of the shining lights of our specialty. For those interested in teaching, it enlarges the classroom of students and helps ensure that many hours of hard work are not limited to a small group teaching session but can be reused in other times and places by anyone. Anyone interested in helping others will be excited by the opportunities provided by the global FOAM community. Finally, we are in the midst of an ongoing war of ideas – some good, some bad – both in the minds of healthcare professionals and trainees as well as patients and the community. We have a to ensure that high-quality resources are accessible to all of these and to do our best to not anyone be on the A to getting in FOAM has been as for FOAM on the as in Table resources that will help the are which a of recommended FOAM resources over the in emergency medicine, critical care and It also to all the listed in Table and many others. For those that following all blogs that have the FOAM from around the world are into one at making this website a for new FOAM resources. Finally, a search for FOAM resources when you need them. FOAM is a dynamic collection of tools and resources, an ethos and an global It is an adjunct to traditional teaching and an aid to knowledge as well as providing accessible and resources that and rapid interaction with the creator. FOAM is not without and but these are recognised and being FOAM can be into an asynchronous learning and ‘flipped classroom’ model of or used to existing educational Importantly, FOAM does not replace the need for an clinical at the Finally, it is to as emergency we have a to part in the ongoing for the and minds of health patients and the community in a of to for the and to all the FOAM community for helping to the ideas in this over the and Lifeinthefastlane.com and now as the that it. is a for Emergency Medicine

Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview examined implementation strategies, defined by EPOC as interventions designed to bring about changes in healthcare organizations, the behavior of healthcare professionals, or the use of health services by healthcare recipients. This overview aimed to synthesize current evidence on implementation strategies in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. We searched the Epistemonikos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to implementation strategies as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR 2 to critically appraise the quality of the reviews. Results were analyzed descriptively and are based on reviews with ratings of high-to-moderate confidence, with low-confidence reviews reported separately. We identified 7882 systematic reviews, of which 15 met our inclusion criteria. Three reviews overlapped substantially with other reviews, and eight received low- or critically low-confidence ratings. Ultimately, four moderate- to high-confidence reviews contributed to the synthesis; two were Cochrane systematic reviews. Most primary studies were from high-income countries; none were from low-income countries. Most strategies targeting healthcare professionals (e.g. guideline dissemination, interactive workshops, opinion leaders, audit and feedback) or healthcare recipients (e.g. structured monitoring, telehealth support, counseling, motivational interviewing) included more than one component. Strategies targeting healthcare recipients' use of health services in cardiac rehabilitation may show small benefits in terms of participation (enrollment, adherence, completion), but effects on other outcomes are uncertain. The effects of strategies targeting older healthcare recipients via telehealth are uncertain. Strategies targeting healthcare professionals may have little to no effect on professional or patient and carer outcomes in stroke rehabilitation. For musculoskeletal conditions, there were no evidence-certainty ratings, so intervention effects are unclear. We found no reviews of strategies targeting health service organizations or specific types of rehabilitation practice. The evidence certainty was generally low; evidence of adverse events was missing or uncertain; and reporting on organizational, implementation, economic, and equity outcomes was scarce. Current evidence on implementation strategies in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Multicomponent, patient-targeted strategies may modestly improve cardiac rehabilitation participation, but effects in other areas remain uncertain. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews of reviews in HPSR should consider including a broader range of study designs, such as observational, qualitative, and mixed-methods evidence, to better capture evidence on implementation strategies in rehabilitation. This Cochrane review was funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The protocol was first published in the European Journal of Physical and Rehabilitation Medicine online on 27 January 2025. The manuscript was received on 11 November 2024 and was accepted on 26 November 2024. DOI 10.23736/S1973-9087.24.08833-6.

Aged care has recently undergone major transformations due to demographic aging and the concomitant need to manage health care costs. New emerging technologies (ETs) have started to play central roles in the daily management of older adults. For these transformations to effectively promote successful and active aging, it is essential to understand the opinions of older adults on the impact that technology can have on their vulnerabilities and aging process. This work aims to study the ethically related impact of ETs on cognitively healthy older adults' vulnerabilities. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of empirical (qualitative) evidence exploring the relationship between ETs and older adults' vulnerabilities as perceived by older adults (older than 65 years) without cognitive impairments. Five major databases (PubMed, Web of Science, Embase, CINAHL, and Philosopher's Index) were queried on March 1, 2022. After eliminating duplicates, titles, abstracts, and full texts were screened for relevance. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the Qualitative Analysis Guide of Leuven methodology, which involved carefully reading the publications included, identifying significant themes, and constructing conceptual schemes for each paper. The quality of the publications was evaluated by using the Critical Appraisal Skills Program. A total of 11,631 results were obtained. Eventually, 70 articles were included, and of these, 46 articles had a high level of methodological quality. The remaining 24 articles had moderate quality. ETs appeared to have an ambivalent effect, mitigating some already existing vulnerabilities, and at the same time, worsening already existing vulnerabilities or creating new vulnerabilities. For example, unconventional monitoring techniques (eg, wearables) often mitigated relational vulnerability, helping to maintain independence and remain at home and in one's community. Conversely, these same devices may negatively affect moral vulnerability, threatening older adults' privacy linked to data confidentiality. This systematic review, which focused on the perceptions of older adults without cognitive impairments, enriches the vast literature about the everyday management and care of seniors by exploring the ethical implications of ETs. This research is complementary to another systematic review of qualitative evidence, which analyzed the views of older people with cognitive disorders on the same topic. Although a certain ambivalence in the use of ETs was identified by both population groups, it is interesting how cognitively healthy older adults give more importance to some dimensions of vulnerability, such as the moral and relational ones, which, in the case of cognitively impaired older adults, are not as significant. Two important aspects identified were the respect of privacy and data security, and the perceived risk of control and surveillance linked to the use of monitoring technologies.

Postoperative sleep is closely associated with recovery among patients undergoing surgery. This study aimed to analyze the research status and developmental trends in postoperative sleep between 2014 and 2024. Publications were retrieved from the Web of Science Core Collection. Microsoft Excel and VOSviewer were used to analyze the papers in terms of publication trends, countries, institutions, authors, journals, and keywords. A total of 964 papers were obtained for the bibliometric analysis. The number of publications on this topic has increased gradually over the last 10 years. Zhu Junchao was the most prolific author in the field, and Chung Frances had the most citations. China had the most publications, followed by the United States. Scientific institutions in China, such as China Medical University and Capital Medical University, have led the way in terms of publication numbers. A total of 40 journals have published at least 5 papers. BMC Anesthesiology, with 19 publications, ranked first in publication count. The papers published in the British Journal of Anaesthesia, Journal of Clinical Anesthesia, Anesthesia and Analgesia, Journal of Pain, and Journal of Sleep Medicine had higher citation counts on average. The high-frequency keywords were "sleep quality," "postoperative pain," "quality of life," and "surgery," while "lung cancer," "enhanced recovery after surgery," "breast cancer," and "dexamethasone" emerged as new topics in this area. There has emerged a large body of literature on postoperative sleep over the past 10 years. Authors and organizations from China are leading contributors, followed by those from the United States. Anesthesiology is a critical discipline in this field. Postoperative pain is closely related to postoperative sleep and has become a major research focus. Recent studies have mainly focused on lung cancer and breast cancer surgeries. Enhanced recovery after surgery has become an emerging keyword.

To investigate the clinical relationship between the interaction of iron metabolism, neuroinflammation and iron deposition in substantia nigra of Parkinson's disease (PD). 1) 30 PD patients and 30 healthy controls were recruited from the First and Second affiliated Hospitals of Xinjiang Medical University from May 2022 to October 2023. The clinical symptoms (motor symptoms and non-motor symptoms) and clinical severity of PD patients were evaluated by unified Parkinson's disease scale III (UPDRSIII), Hoehn-Yahr (H-Y) stage, Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), mini-mental state assessment scale (MMSE) and Montreal cognitive assessment scale (MoCA). (2) A case-control study was conducted to determine the content of iron in the brain of patients with PD by magnetic sensitive quantitative imaging (QSM) to generate 3DT2, 3DT2* (SWAN), QSM and PostT1Gd, and to study the correlation between iron content and motor symptoms, non-motor symptoms (anxiety, depression, dementia), and clinical severity in PD. (3) Enzyme-linked Immunosorbent Assay (ELISA) was used to detect and compare the levels of iron, DMT1, FPN1, IL-1&#x3b2;, IL-6 and TNF-&#x3b1; in the peripheral blood of both groups, and t-test and Wilcoxon rank-sum test were used to analyze the correlation between peripheral iron metabolism and blood inflammatory factors, clinical symptoms and clinical severity in patients with PD. (4) To analyze the clinical correlation between the interaction of peripheral iron metabolism and neuroinflammation and iron deposition in substantia nigra of Parkinson's brain. 1) The quantitative susceptibility mapping (QSM) values of red nucleus, substantia nigra, putamen and caudate nucleus in PD group were higher than those in control group (P&#x2009;<&#x2009;0.05). The QSM value of red nucleus in PD group was negatively correlated with UPDRSIII score (motor symptoms) and positively correlated with non-motor symptoms depression (P&#x2009;<&#x2009;0.05). The QSM score of substantia nigra in midbrain was positively correlated with disease severity (H-Y stage)(P&#x2009;<&#x2009;0.05). (2) The median levels of serum DMT1, Fe, IL-6 and TNF-&#x3b1; in PD group were higher than those in control group (P&#x2009;<&#x2009;0.05). The median level of serum FPN1 in PD group was lower than that in control group (P&#x2009;<&#x2009;0.001). There was a negative correlation between serum DMT1 and non-motor symptom intelligence (MMSE), and between peripheral blood iron content and anxiety in patients with PD (P&#x2009;<&#x2009;0.05). There was no significant correlation between ferritin and inflammatory factors and other clinical symptoms and severity of PD (P&#x2009;>&#x2009;0.05). (3) The quantitative value of magnetic sensitivity (QSM) of substantia nigra in PD was positively correlated with iron metabolic protein DMT1, peripheral blood inflammatory factor IL-6 and negatively correlated with peripheral blood iron ion (P&#x2009;<&#x2009;0.05). The results of interactive analysis showed that there was interaction among magnetic sensitivity quantitative value of substantia nigra (QSM), iron metabolic protein DMT1, peripheral blood inflammatory factor IL-6 and peripheral blood iron ion. There are iron deposits in the deep nuclei and thalamus of PD patients. Iron deposition in substantia nigra is related to UPDRSIII score (motor symptoms) and disease severity (H-Y stage) in patients with PD. Iron deposition in substantia nigra may be linked to the interaction between iron metabolism and neuroinflammation.

Social isolation and loneliness have considerable health implications. Research indicates that older men are generally more susceptible to social isolation compared with women, highlighting the need to integrate gender-responsive approaches in the development and implementation of interventions for mitigating social isolation and loneliness in later life. This study aimed to conduct a review of intervention programs targeting social isolation and loneliness, focusing on gender-specific considerations. Specifically, it aims to examine the gender composition (male-to-female ratio) of participants in intervention programs and identify and analyze intervention strategies that demonstrate gender-sensitive effectiveness. A scoping review was conducted as per the Joanna Briggs Institute manual for evidence synthesis. A comprehensive literature search, including hand searching, was conducted across 6 English-language databases, PubMed, MEDLINE, Cochrane, CINAHL, ScienceDirect, and Web of Science, for papers and reports published in 2013-2023. The authors, country, subjects, research design, intervention method, results, and mentions of gender for each included document were presented. The study identified 1282 papers and reports, of which 10 were selected for analysis. Only 1 study reported a higher number of male participants compared with female ones; in contrast, all other studies included predominantly female samples. The studies assessed outcomes based on 2 indicators of social isolation, 4 indicators of loneliness, and 29 other indicators. Exercise and workshops proved effective for social isolation and loneliness, while meditation and laughter therapy were effective for loneliness. The intervention with the highest percentage of male participants (264/323, 82%) was a customized meditation program. Conversely, physical activities, social support, and community-based group health classes drew more female participants. In total, 8 studies did not mention gender in the discussion section, and none considered gender-specific issues in formulating research objectives and outcomes. Research on social isolation and loneliness has generally ignored the influence of gender. The review also indicated a gender bias in participant selection, with women markedly overrepresented in study samples. The study found that women tend to prefer interventions emphasizing conversations, shared experiences, and emotional exchange. In contrast, men showed the highest participation in a meditation program focused on self-dialogue, which required minimal interaction. Importantly, interventions aimed at promoting social interaction or participation are unlikely to succeed without consideration of gender-specific issues. Therefore, systematically identifying conditions necessary for effective interventions that target older men is crucial for guiding future research and program development. Open Science Framework 10.17605/OSF.IO/83JQF; hhttps://osf.io/83jqf/overview.

This study introduces Inf.P, a novel method for determining optimal cut-off points using the inflection point approach in the absence of a gold standard. It models the nonlinear relationship between raw scores and latent class probabilities with a cubic polynomial function, offering a data-driven boundary that reflects the underlying latent structure. Inf.P enhances diagnostic precision of scale-based assessments by providing more accurate thresholds for distinguishing different levels of latent attributes. To evaluate the Inf.P, high- and low-attribute groups were created for benchmarking. The method was compared to the traditional Youden Index through a comprehensive simulation study, exploring variations in sample sizes and item numbers. Real-world data were also employed to assess its applicability. Performance was assessed using accuracy, bias, and mean squared error (MSE). The Inf.P method demonstrated lower bias and MSE compared to the Youden Index, especially when specificity was prioritized. Both methods yielded similar accuracy in larger samples, but Inf.P provided more reliable cut-off points. In smaller samples, the difference between estimated cut-off points increased with the number of items but decreased in larger samples. These findings suggest that studies with small sample sizes should consider limiting the number of items to maintain optimal cut-off precision. Inf.P offers a robust and reliable approach for defining optimal cut-off in scale-based assessments of complex latent traits, supported by real data, with an interactive web tool available for practical use ( https://spapp.shinyapps.io/InfPcutoff/ ). It promises to enhance diagnostic accuracy and clinical decision-making, particularly in the assessment of psychological and neurological disorders, as well as in determination of quality of life. In this study, we proposed a new method called Inf.P to determine optimal cut-off points in scale-based assessments. A cut-off point is the score that separates people into different groups, such as mild or severe, patient or healthy. In many cases, there is no absolute &#x201c;gold standard&#x201d; or reference test to guide this decision for scales, so a new approach is needed. Inf.P examines how scores change and identifies the point where the pattern of change shifts most clearly, helping to determine a meaningful cut-off. We compared Inf.P performance with a commonly used method called the Youden Index, using both simulations and real patient data. The results showed that both methods had similar accuracy. However, Inf.P performed better in larger groups to provide more reliable results with fewer errors. It also has the advantage of being applicable even when a gold standard is not available, with an interactive web tool available for practical use ( https://spapp.shinyapps.io/InfPcutoff/ ). This method has significant potential to improve diagnosis and support decision-making in healthcare, psychology, and other fields where clearly distinguish between groups or severity levels is important.

In the current digital landscape, ensuring optimal usability is one of the most crucial factors determining the success of any mobile app. Questionnaire-based usability evaluations represent a highly prevalent methodology for this purpose. To date, questionnaires have been developed to assess the general system usability; however, there are hardly any questionnaires specifically designed to assess the usability of mobile health (mHealth) apps. The most widespread, the mHealth App Usability Questionnaire (MAUQ), has been developed in 4 versions according to the type of app (interactive or standalone) and the target user (patient or provider). The objective of this study was to translate and validate the English version of the MAUQ (standalone, for patients) into a Spanish version (S-MAUQ). The methodology used here follows that proposed by Sousa and Rojjanasrirat, which comprises 4 stages. The initial stage of the process entails a translation, harmonization, and adaptation procedure. The second and third entailed content validation (by 10 experts) and face validation (by 12 target users), respectively, which were conducted to evaluate the relevance and clarity of the questionnaire items. The item-level content validity index, scale content validity index (S-CVI), item-level face validity index, and scale face validity index (S-FVI), as well as the modified kappa statistic (&#x3ba;) were used to evaluate interrater agreement among the raters, considering the probability of agreement by chance (Pc). The fourth and final stage of the process involved the assessment of the questionnaire's reliability. A sample of 61 young adult participants installed an mHealth app (the Yazio app), used it, and responded to the S-MAUQ. The Cronbach &#x3b1; value for the entire questionnaire and its subscales were then calculated. For the second stage, the S-CVI was initially 0.778. We removed items #14 and #15 from the Spanish version as they were unclear and not relevant. The S-CVI changed to 0.881. The third stage had an S-FVI of 0.927, indicating that the items are clear and straightforward for the nonexpert target user to understand. Furthermore, with each &#x3ba; value >0.74, the validity of the instrument is supported. The fourth stage demonstrated the reliability of the S-MAUQ with a Cronbach &#x3b1; value of 0.87. The final version of the S-MAUQ met the validation criteria, demonstrating reliability and validity that are comparable with those of the original version. Consequently, the S-MAUQ is suitable for evaluating the usability of mHealth apps for young Spanish adults. Further research involving larger and more diverse samples is recommended.

Dementia is a global public health concern, with prevalence projected to reach 78 million individuals by 2030 and 139 million by 2050. Most persons living with dementia reside in community settings and are supported by family caregivers. As caregiving demands grow, caregivers experience significant psychosocial, emotional, and financial burden, including high rates of stress, social isolation, and depressive symptoms. Access to effective support services remains limited, highlighting the urgent need for innovative and accessible caregiver interventions. This pilot study first aims to assess the feasibility, acceptability, and tolerability of VR-SIM Carers, a virtual reality (VR)-based psychoeducational training program for family caregivers or care partners of people living with dementia. Second, it will aim to provide a preliminary evaluation of potential impact on caregiver outcomes, including caregiver competence, stress, resilience, empathy, and quality of life. The study is not designed to support causal inference regarding the effectiveness of VR-SIM Carers. A mixed methods design will be used with a sample of 30 family caregivers of people living with dementia. Participants will complete 3 immersive, self-paced VR caregiving scenarios-Managing Apathy, Crisis Response, and Refusal of Care-receiving real-time feedback from simulated characters, including clinician and person living with dementia avatars. Primary outcomes (feasibility and educational impact) include recruitment, retention, adherence, usability, acceptability, and tolerability and caregiver competence (Pearlin Caregiving Competence Scale), perceived stress (Cohen Perceived Stress Scale), resilience (Connor-Davidson Resilience Scale), and empathy (Empathy Assessment Scale). Secondary outcomes (preliminary efficacy) include caregiver quality of life (Adult Carer Quality of Life Questionnaire), caregiver burden (Burden Questionnaire), and behavioral symptoms (Neuropsychiatric Inventory, Center for Epidemiologic Studies Depression Scale Short Form) assessed at baseline, postintervention, and 1-month follow-up. Feasibility and user engagement will be evaluated via the 18-item Gaming Use Engagement and Severity Scale, Igroup Presence Questionnaire, qualitative interviews, reflection notes, and open-ended feedback. Quantitative data will be analyzed using repeated-measures ANOVA and paired 2-tailed t tests, while qualitative data will be analyzed using an inductive thematic coding framework. Data analyses are descriptive and exploratory only, and no causal claims regarding intervention effectiveness will be made. Consistent with CONSORT (Consolidated Standards of Reporting Trials) guidance for pilot and feasibility studies, caregiver outcomes (eg, competence, stress, resilience, empathy) are treated as exploratory. The findings from this study will inform the feasibility, acceptability, and educational value of immersive VR for caregiver training, while providing preliminary evidence regarding the efficacy of VR-SIM Carers as a training tool to improve psychoeducation outcomes for family caregivers of people living with dementia and reduce caregiving burden. Data collection commenced in March 2024 with a projected end date of March 2026. As of the submission of the manuscript (December 2025), 21 participants have been enrolled. Data analysis will be completed in April 2026, and the results are expected to be published in fall 2026. VR-SIM Carers represents an innovative, scalable intervention designed to enhance caregiver preparedness, psychosocial outcomes, and sustainable community-based dementia care. This pilot study will provide critical evidence to guide further development and implementation of VR-based caregiver support programs.

Dance is a complex mode of physical activity (PA) behavior and an art form, and one's participation in dance may occur across discrete contexts throughout the lifespan. To further advance the study of lifetime participation in dance behavior, reliable questionnaires are needed. This study aimed to develop and test the reliability of a self-report, online questionnaire for surveilling lifetime participation in professionally led dance classes among adults. Community-dwelling adults (N=373) completed the Lifetime Dance Exposure Questionnaire for Professional Training (LDEQ-T) at baseline (T1), and 150 adults repeated the LDEQ-T after an 8-week delay (T2). Test-retest reliability for self-reported dance training frequency, duration, and PA intensity was analyzed for the LDEQ-T between T1 and T2. Reliability for the LDEQ-T item on total years of professional dance training was assessed using intraclass correlation coefficients (ICCs; 2-way, random effects); linearly weighted kappa (&#x1d73f;w) was used for ordinal variables on dance class duration, intensity, and frequency; an unweighted kappa (&#x1d73f;) statistic was used to test the reliability of 3 dance training exposure groups (no or low, homogenous, or variable lifetime exposure to professional dance training). The significance level was set a priori with &#x3b1;=.05. Adults reported having no or low (n=92), homogenous (n=196), or variable (n=85) lifetime exposures to professional dance classes at T1. Among adults who self-reported homogenous exposures to dance training throughout the lifespan, years of dance training were found to be reliable across all age periods (ICC range 0.83-0.94); as were weeks/month, months/year, and hours/week of dance training (&#x1d73f;w range 0.35-0.61); but not any measure of PA intensity. Among adults who self-reported variable exposures to dance training, years of dance training across all age periods (ICC=0.70-0.96); classes/week, weeks/month, months/year, and hours/week (&#x1d73f;w range 0.32-0.56); and some estimates of PA intensity (&#x1d73f;w range 0.30-0.41) were found to be sufficiently reliable. The LDEQ-T appears to be a reliable instrument for quantifying lifetime participation in professional dance training among adults with self-reported low, homogenous, or variable exposures to professional dance classes throughout the lifespan. Among adults, researchers may surveil lifetime exposure to dance training in early childhood, childhood, adolescence, young adulthood, and middle or older adulthood using the LDEQ-T.

First Nations people in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve the mental health outcomes of First Nations Australians. However, evidence on the effectiveness of DMH services for First Nations people in Australia is yet to be synthesized. This systematic scoping review aims to fill this gap and to identify the facilitators and barriers that influence the implementation of DMH services among First Nations people in Australia. A systematic search was conducted across 6 academic databases to search for studies related to DMH services for First Nations people in Australia. Search terms relating to First Nations people, geographic terminologies of Australia, mental health, and DMH services were used. Studies were included if they assessed the effectiveness of DMH services or the determinants of the facilitators and barriers of implementing DMH interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, and were then synthesized using a thematic analysis framework. In total, 22 studies met the inclusion criteria. DMH services were used to support and treat First Nations Australians and conduct psychological assessments in these individuals. Evidence of effectiveness was stronger for nonsevere mental health conditions. The determinants of the facilitators and barriers of the implementation of DMH services included the following: (1) organizational and administrative factors; (2) cultural appropriateness; (3) accessibility; (4) integration of DMH services in the existing health system; (5) engagement between clients and service providers; (6) coverage of different conditions and clients; (7) acceptability to DMH services; (8) digital literacy; and (9) efficiency. Evidence on the use of DMH services for First Nations Australians remains heterogeneous in terms of study design and outcome measurement. DMH services appear to be most effective for managing nonsevere mental health conditions. Successful implementation requires multilevel structural support, including policy and organizational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians.

Postacute care (PAC) services are important to ensure functional recovery and provide adequate care for geriatric inpatients in acute care. The choice between different PAC options can be challenging, and predictors for the most appropriate among diverse discharge options are warranted. We conducted a scoping review to identify predictors of appropriate discharge destinations for older adults (&#x2265;65 y) in acute care transitioning to different PAC settings and extract the most relevant predictors for different PAC settings as well as a generalizable set of predictor domains. The databases of Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Emcare were systematically searched for English or German literature published until February 25, 2022. A total of 3 researchers screened, extracted, and categorized the data according to domains, discharge destinations, mean age, and health care systems origin, focusing on predictors that increase the likelihood of a discharge destination (positive predictors). The Jaccard index was calculated to compare the similarity between different possible domain combinations and existing literature. Of 22,382 records screened, 171 quantitative and 10 qualitative studies were included. After separating combined discharge destinations, we found 1047 predictors for different discharge destinations including nursing home (n=297, 28%), skilled nursing facility (n=223, 21%), inpatient rehabilitation (n=206, 20%), home with (n=97, 9%) or without (n=74, 7%) support, assisted living (n=63, 6%), and early inpatient rehabilitation (n=21, 2%). Of all positive predictors (n=723), age was the most frequently reported predictor (80/723, 11%). Geriatric syndromes were found more often in patients 80 years or older (121/192, 63%) and in non-US studies (174/285, 61%). The top reported predictors for discharge to nursing homes were diagnosed dementia (9/297, 3%) and deficits in instrumental activities of daily living (ADL; 10/297, 3%); for discharge to rehabilitation, the top predictors were longer length of stay (11/205, 5%) and existent cardiopulmonary disease (10/205, 5%); and for back home without support, the top predictors were good ADL (10/74, 14%) and mobility assessments (9/74, 12%). Among 20 predictor domains, 8 were most concordant with the literature: cognitive impairment, ADL, demographics, social support, hospitalization data, multimorbidity, mobility, and primary diagnosis. This scoping review provides a comprehensive overview of predictors for appropriate discharge decisions in older adults in acute care, stratified by destination, age, study origin, and the predictor domains most concordant with the literature. The results will be valuable to inform the choice of features for clinical decision support systems, including the training of machine learning algorithms.

In December 2022, in light of the weakened pathogenicity of the new variants and other scientific considerations, China optimized its zero-COVID policy. As the situation evolved, the virus spread more widely across the country. This study aims to explore the public's sleep status and its association with purchasing behavior of COVID-19 medicine after the adjustment of zero-COVID policy in China. A cross-sectional, internet-based survey among residents aged 18-69 years was conducted in Zhejiang province, China, from December 16 to 30, 2022, to collect data on sociodemographic characteristics, COVID-19 drug purchasing behavior, sleep disturbance levels, etc. Chi-square tests, univariate analyses, and multivariate analyses were used to explore the associations among these factors. Out of 38,480 participants, 20,803 (54.1%) reported sleep disruption after China's COVID-19 response policy adjustment. The degree of impact varied, with 10,964 (52.70%) reporting "slight," 3105 (14.93%) "moderate," 3493 (16.79%) "significant," and 3241 (15.58%) "very significant" impacts. Only 20.90% (782/3742) of those who deemed purchasing unnecessary had sleep disruptions, compared to 45.19% (6214/13,752) of those who acquired medications and 65.79% (13,807/20,986) of those who tried but failed to obtain them. Sleep disturbance levels were significantly associated with sociodemographic factors like age, education levels, occupation, marital status, and presence of family members diagnosed with COVID-19 (P<.05). By age, sleep disturbance proportions differed notably: 36.32% (409/1126) for those under 20 years, 54.81% (19,714/35,970) for the 20 to 60 age group, and 49.13% (680/1384) for individuals over 60 years. For education level, the proportions were 57.44% (517/900, primary school), 54.34% (3928 /7229, junior high school), 54.27% (3808/7017, senior high school), 53.99% (11,974/22,180, junior college/undergraduate), and 49.91% (576/1154, master's degree), showing a clear downward trend as education level increased. By occupation, farmers had the highest rate (855/1447, 59.09%), followed by business/service industry workers and stay-at-home/unemployed individuals (13,925/24,750, 56.26%) and government staff (4161/7712, 53.95%), while 1242 out of 3049 (40.73%) health workers and 620 out of 1522 (40.74%) students had lower rates. Married participants had a 55.21% (17,143/31,053) sleep disturbance rate, and those with COVID-positive family members had the highest rate (2023/2873, 70.41%). Multivariate logistic regression, adjusting for these sociodemographic factors, showed that compared to those who thought purchasing COVID-19 medications was unnecessary, those who acquired medications were 3.11 times (adjusted odds ratio 3.11, 95% CI 2.85-3.39) more likely, and those who tried but couldn't get medications were 7.11 times (adjusted odds ratio 7.11, 95% CI 6.53-7.74) more likely to experience sleep disturbance. The adjustment of China's zero-COVID policy affected the sleep health of the public, which was closely linked to drug-purchasing status, especially among the older people, those with lower education levels, and those with family members diagnosed with COVID-19. It highlights the need to develop and deploy interventions aimed at promoting better sleep health in times of crisis.