Use of in-home video telehealth rapidly expanded in response to the COVID-19 pandemic, including at Veterans Affairs (VA), a forerunner in telehealth. Despite this uptick, differences in use by patient age and rurality created a digital divide that persists to this day. While clinicians frequently cite patients' older age and lack of technical skills as barriers to in-home video telehealth, it remains unclear how clinicians decide whether to offer video visits to patients and to what extent these beliefs may hinder offering video visits to older adults. Gathering perspectives from clinician users of in-home video telehealth may illuminate opportunities to ensure continued access to care through solutions such as telehealth. This study aimed to examine clinician decision-making around the offer of in-home video telehealth to understand how interprofessional clinicians determine to whom they offer in-home video telehealth and what factors (organizational, personal, or attitudinal) influence their decision. We conducted a qualitative study by using semistructured interviews. Participants were interprofessional clinicians (N=16) employed by 11 different VA hospitals and included 1 clinical pharmacist, 6 medical doctors, 2 nurse practitioners, 1 occupational therapist, 3 psychologists, 1 physical therapist, 1 speech-language pathologist, and 1 social worker. All the participants had at least some experience using in-home video telehealth from locations across VA (the largest integrated health care system in the United States) and were interviewed over a 6-month period. Interviews focused on clinicians' use of video telehealth and the decision-making process involved in offering in-home video telehealth. We used directed content analysis with a rapid analytic approach, given the time-pressured nature of our project. This study revealed that clinician decision-making around offering in-home video visits is complex and influenced by several domains, namely, (1) clinician factors, including experience with video and perceived benefits of video; (2) appointment factors, including the visit's clinical goal; (3) clinician-reported patient factors, including age and willingness to try video; (4) patient social context, including caregiver availability; (5) geographical factors, such as availability of reliable high-speed internet and patient distance from the medical center; and (6) health system factors, including technical support and clinician ability to work from home. Access to in-home video telehealth may be facilitated by clinician familiarity and confidence with telehealth technology, strategies to improve patients' technical skills, and support for caregivers. Infrastructure also plays an important role, including device availability, broadband reliability, and clear protocols for matching services to video visits. Findings highlight the importance of clinician competency in telehealth, patient and caregiver digital readiness, and a supportive technology infrastructure to equitable in-home video care. In addition, improved guidance for specific clinical services and awareness of potential biases may enable consistent, accessible telehealth delivery for older adults and medically complex populations.
While compassion is widely recognised as an essential component of high-quality patient care, the compassion needs of clinicians often go unrecognised and unmet. Clinicians face multifaceted sources of workplace suffering, both sources inherent to working with the sick and avoidable sources due to healthcare systems and leadership challenges. Organisational compassion, defined as the continuous and systematic identification, prevention and alleviation of sources of suffering for healthcare workers, offers a paradigm shift in mitigating and preventing clinician suffering and burnout. Yet little is known about how clinicians experience suffering and compassion from their organisations, teams and leaders. Our overarching goal is to develop a clinician-reported experience measure of organisational compassion. The purpose of this study was to explore how clinicians experience suffering and compassion in healthcare organisations. This qualitative study used semistructured interviews of interdisciplinary paediatric hospice and palliative care clinicians from across the USA. A moderator's guide was developed based on the literature of organisational compassion in management and healthcare and validated through practice interviews with clinicians. 22 participants were recruited via national paediatric hospice and palliative care email list serves. Video interviews were conducted via Zoom. Transcripts were analysed using a hybrid grounded theory-thematic analysis methodology to identify themes and to construct a theoretical framework of compassion experiences. Five major themes of experiencing compassion emerged: (1) Feeling cared about, characterised by authentic, empathetic responses to clinician distress; (2) Dignity, encompassing being valued, respected and recognised as a whole person and professional; (3) Proximal (team) compassion, including camaraderie, shared workload and mutual support within teams; (4) Structural (organisational) compassion, reflecting policies, practices and benefits that alleviate or exacerbate suffering and (5) Compassionate leadership behaviours, such as presence, empathy and connection to frontline staff needs. Healthcare work includes sources of both inherent and avoidable suffering for clinicians. In this study, we sought to understand how clinicians experience compassion from their organisations, leaders and team members during times of distress. We found five themes of experiencing compassion in healthcare organisations: feeling cared about; dignity; proximal (team) compassion; structural (organisational) compassion and compassionate leadership behaviours. These qualitative data and results will provide an empiric foundation for the development of a clinician-reported experience measure of compassion for use in healthcare settings. Such a measure will enable future research examining how compassion experiences in healthcare may predict workforce outcomes such as burnout, satisfaction, engagement and thriving. Ultimately, this work may support the design of interventions aimed at strengthening compassionate organisational cultures and improving conditions for the healthcare workforce and both experiences and outcomes of the patients they serve.
With the ever-increasing globalizing of aging, chronic comorbidity has become both common among the old population. The senile comorbidities pose as notable challenges of escalation of medication and medical expenditures, and loss in the quality of life of the mature patients. The increase in medication literacy would help reduce the land of unsafe drug administration, unfavorable feelings, and also improve the treatment rates among persons. But there is variation in the rate of medication literacy among the older adults living with varying comorbidities of chronic diseases. Thus, this paper utilizes latent profile analysis to segment medication literacy in this population group in an attempt to clarify the features that accompany medication Literacy among the older adults who with the presence of chronic comorbidities. Additionally, it discusses factors that contribute to medication literacy when using different types of chronic conditions, hence developing theoretical underpinnings to the upcoming individualized medication literacy interventions programs as per older adults patients with chronic comorbidities. The study is a cross-sectional study of 611 hospitalized patients over the age of 60 years with chronic comorbidities through Grade III hospitals in Shizuishan City in the period between January, 2024 and March, 2024 using the convenience sampling method. The General Data Scale, the Medication Literacy Scale among the Elderly Patients with Chronic Diseases, the Self-perceived Burden Scale and the Technophobia Scale were used to collect information. Latent profile analysis (LPA) disclosed that medication literacy of the older adults patients with chronic diseases could be classified into four different groups namely; high medication literacy (17.02%), medication Literacy-low critical type (38.13%), medication Literacy-high critical type (31.26%), and low medication Literacy (13.58%). Influential factor analysis showed that drinking history, educational level, marital status, occupational status, personal monthly income, family location, caregiver involvement, living style, type of medical insurance, daily exercise time, time duration of disease, number of hospitalizations in the past year, personal view of sleep status, age, and self-perceived burden, technophobia, had significant impact among the varied category of chronic disease patients in terms of medication literacy (p < 0.05). Medication literacy among chronic comorbidity patients is largely heterogeneous. It is advised that clinicians should do more specific interventional programs based on the nature of different levels of medication literacy to achieve better medication literacy rates within this category of population to improve treatment effects.
Often unrecognized and frequently overlooked, the inclusion of social determinants of health in stroke management is critical to improving outcomes. Using the National Institute of Neurological Disorders and Stroke working group Determinants of Inequities in Neurological Disease, Health, and Well-being framework, this article reviews structural, social status, intermediate, intrapersonal, and biological determinants of health inequities and their impact on equity in neurologic health after stroke. It is imperative that social determinants of health are evaluated as a requirement for effective stroke prevention and rehabilitation. To optimize secondary stroke prevention and improve stroke outcomes, it is critical to include social determinants of health as components of poststroke management, starting during the acute hospitalization and continuing through outpatient management. Interdisciplinary services, such as social work, care coordination, behavioral health, physical and occupational therapy, speech and language pathology, and chaplaincy, provide additional resources to help stroke survivors and their caregivers.
To investigate the association between occupational health nurse (OHN) involvement and Bright 500 certification, an indicator of high-performing health and productivity management (HPM), among Japanese small- and medium-sized enterprises (SMEs) using multi-year survey data. This observational study used secondary data from the 2021-2024 HPM Survey. Each annual response was analyzed as a corporation-year observation, and within-corporation correlation was handled with a random intercept for corporations. OHN involvement was defined as the appointment of public health nurses and/or nurses as health promotion officers. Bright 500 certification, obtained from publicly available certification records, was used as an indicator of more advanced HPM. The association was examined using a mixed-effects logistic regression model. The analytical sample comprised 12 847 (2021), 14 401 (2022), 17 316 (2023), and 20 267 (2024) SMEs. OHN involvement increased from 5.1% (2021) to 5.8% (2024). Bright 500 certification was consistently higher in corporations with OHN involvement (10.8% in 2021, 8.4% in 2024) than in those without (2-3% across years). After adjustment for survey year, region, insurer category, industry type, employee size, internal and external dissemination of HPM initiatives, and occupational physician involvement, OHN involvement was independently associated with certification (odds ratio: 2.35, 95% confidence interval: 1.21-4.54, p = 0.011). Across the four survey waves, OHN involvement was positively associated with Bright 500 certification among SMEs. These findings suggest that OHNs may be relevant to advanced HPM implementation in this setting. Future studies should capture OHN staffing arrangements, intensity and roles, and initiative timing to clarify mechanisms and potential causality.
Vascular liver diseases (VLDs) predominantly affect young adults and require lifelong monitoring. The health-related quality of life (HRQoL) of patients with VLDs is deteriorated, with high levels of fatigue and depressive symptoms, but their lived experience and unmet needs remain unknown. To fully integrate the patients' perspective and generate actionable insights, we conducted a qualitative peer-research study. Twelve peer researchers conducted interviews with patients in France, Spain, Switzerland, and the Netherlands. Analysis proceeded in three phases: individual inductive thematic analysis independently made by peer and academic researchers, followed by an international workshop to build a shared thematic framework. Third, directed content analysis, informed by the shared framework, was made by an academic researcher. From 27 interviews, five themes were identified, mapping the disease's impact on quality of life from diagnosis onward, and throughout the patient journey. First, the diagnosis trajectory was characterised by 'uncertainty and biographical disruption'. Then, long-term symptoms were described as impacting daily life through the experience of 'chronic uncertainty, loss of ability and social exclusion'. Participants' accounts also reflected the social impact of VLDs, which resulted in 'renegotiating roles, ties and identities'. All along the care journey, their healthcare experience could be marked by 'relational and institutional gaps shaping illness experience'. Finally, 'the sense of belonging to a community of peers' was highlighted as a potential but lacking resource. Living with a rare VLD involves uncertainty, unpredictable fatigue, stigma, and social disruption, alongside efforts to maintain dignity and autonomy. While patients can demonstrate resilience, this does not negate ongoing needs. Improving quality of life requires addressing not only symptoms such as fatigue, anxiety or sexual dysfunction but requires guidance on physical activity, nutrition or occupational and financial challenges. Ten patients and two caregivers were involved as peer researchers throughout the study, ensuring that priorities, interpretations, and conclusions reflected patient-defined concerns. All peer researchers contributed to the design, data collection and analysis activities. Due to professional and health constraints, about half of the PRs could only participate in the first local analysis phase. PRs were financially compensated.
Work-related musculoskeletal disorders are highly prevalent among healthcare professionals and contribute to disability, reduced productivity and compromised patient care delivery. The Extended Nordic Musculoskeletal Questionnaire is a comprehensive tool used for gathering data on musculoskeletal symptoms and their impact, however its measurement properties have not been validated in Singapore. This study aimed to evaluate the reliability and validity of the extended Nordic Musculoskeletal Questionnaire in measuring musculoskeletal disorders (MSDs) among healthcare professionals in two community hospitals in Singapore. A total of 251 nurses and therapists working in two community hospitals were recruited in a cross-sectional study conducted between March 2024 and August 2024, following the Consensus-based Standards for selection of Health Measurement Instruments framework (COSMIN). Face validity was assessed through cognitive debriefing interviews (CDIs). Construct validity was assessed by testing 5 a priori hypotheses with the EQ-5D-5L instrument, using Spearman's correlation coefficients. Test-retest reliability was evaluated using kappa, observed proportion of agreement and intraclass correlation coefficient (ICC), while the internal consistency was determined using Cronbach's alpha. Among 251 participants (mean age: 34.7, 83.6% females, 7.31 years of working experience), the NMQ-E demonstrated good internal consistency (Cronbach's alpha above 0.81), and excellent test-retest reliability [ICC = 0.987 (95% CI 0.974-0.994)] with moderate to almost perfect reliability (kappa = 0.64-0.95). All a priori were confirmed in convergent validity assessment. Item response rates exceeded 97%, indicating good feasibility. The NMQ-E is a valid and reliable instrument for assessing work-related musculoskeletal symptoms among healthcare professionals in community hospitals within Singapore. Its application may greatly support epidemiological surveillance and inform occupational health interventions in Singapore's healthcare setting.
This study outlines the revision and content validity process for the Domestic and Community Skills Assessment, Third Edition (DACSA-3). The DACSA-3 is an occupational therapy instrumental activities of daily living (IADL) assessment, which can be used to assess a person with a mental health condition. The DACSA-3 was developed by considering past development and research, technology changes, and current occupational therapy theories. Nine content experts (occupational therapists with mental health experience) were involved in a qualitative and quantitative review of the DACSA-3 to establish content validity using the content validity ratio (CVR) and content validity index (CVI), with recommended minimum thresholds of 0.78. The DACSA-3 was reviewed by two content reviewers (professionals with lived mental health experience) to ensure that recovery oriented language was included. The Initial Interview was retained and updated. The Supporting Interview was removed, because it lacked construct validity. The Observation Checklist was renamed to Context List and updated to include environmental and personal factors that may influence task performance. The Objective Assessment subtests were updated and reduced from 17 to 14 subtests. The money handling, personal presentation, and postage handling subtests were removed, because they were no longer relevant or did not fit the occupational category of IADL. The scoring criteria for each subtest were improved by aligning with the rating scale definitions to prevent discrepancies between ratings and clinical judgement. The CVR of DACSA-3 items ranged from 0.78 to 1.00, and the CVI of the DACSA-3 was 0.98. The DACSA-3 is a revised, contemporary occupational therapy assessment of IADL, which has content validity. The CVR and CVI exceeded the minimum recommended thresholds, and thus, the content validity of the DACSA-3 was established. Modifications were made to the DACSA-3 to reduce the administration time and it no longer contains a screening tool. This study describes how the Domestic and Community Skills Assessment, Third Edition (DACSA‐3) was updated. The DACSA‐3 is an occupational therapy test. It can be used to measure the living skills of people with a mental health condition. The update considered earlier research, changes in tasks over time, and current occupational therapy theories. Two content reviewers checked the test to ensure current mental health language was used. Nine occupational therapists then reviewed it step by step to confirm that it was a good measurement of living skills. The Initial Interview was kept and updated. The Supporting Interview was removed because it was not considered a good measurement. The Observation Checklist was renamed the Context List and updated. The subtests were reduced from 17 to 14. The money handling, personal presentation, and postage handling subtests were removed. They were no longer relevant or did not fit with other living skills. The scoring was also improved to reduce differences between ratings and therapist judgement. Overall, the DACSA‐3 is a current test of living skills. It takes less time to complete and no longer includes a screening tool.
Diabetic foot ulcers (DFUs) affect approximately 25% of people with diabetes and are associated with decreased quality of life, high healthcare costs, recurrent wounds, and amputation risk. Standard DFU care emphasizes offloading to promote healing; however, adherence is often poor due to behavioral, psychosocial, and everyday life challenges. These gaps highlight the need for person-centered interventions that support DFU self-management within daily routines. To systematically adapt a Lifestyle Redesign® occupational therapy intervention (LR-OT) for DFU self-management using the ADAPT-ITT framework. An iterative, stakeholder-engaged adaptation process was conducted across the first seven ADAPT-ITT phases: Assessment, Decision, Administration, Production, Topical Experts, Integration, and Training. Activities included targeted literature synthesis, theater testing with individuals with DFUs and DFU care providers, iterative material development, and expert consultation. Adaptation efforts focused on refining intervention content, delivery, and training supports to DFU-specific care demands while retaining alignment with LR-OT core elements. The ADAPT-ITT process yielded an interventionist-ready, DFU-specific LR-OT package, including patient-facing materials, an interventionist resource guide, and a conceptual mapping linking LR-OT theoretical elements to DFU-targeted management activities. Stakeholder input informed coordinated refinements to content, session structure, and delivery to support feasibility within DFU care contexts. Application of the ADAPT-ITT framework supported a transparent, stakeholder-informed, and reproducible process for adapting an evidence-based occupational therapy intervention for a high-risk and medically complex population. This work illustrates how lifestyle-focused interventions can be systematically adapted for specialty care contexts, with subsequent testing needed to evaluate fidelity and effectiveness. #NCT06278935. Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes. They can interfere with daily life, often return after healing, and may lead to amputation. A key part of DFU care is “offloading,” which involves special footwear or casts to reduce pressure on the foot. Many people find it hard to use these devices consistently because everyday responsibilities, discomfort, emotional stress, and limited support. This project focused on adapting an occupational therapy program called Lifestyle Redesign® to better support people managing DFU in their daily lives. Rather than creating a new program, the research team used a structured adaptation process called ADAPT-ITT to modify an existing evidence-based intervention so it better fit the realities of DFU care. The process involved gathering input from people with DFUs, healthcare providers, and clinical experts through focus groups, interviews, review of materials, and expert consultation. The adaptation process resulted in new patient materials and resources for occupational therapists that address offloading use, foot checks, emotional well-being, and integrating DFU care into daily routines. This work shows how occupational therapy interventions can be thoughtfully adapted and integrated into multidisciplinary teams to support DFU self-management in specialty care settings.
This study aimed to develop and validate a tool for assessing communication as a leadership competency among graduate healthcare students. Drawing from the American College of Healthcare Executives 2023 Competencies Assessment Tool and the National Center for Healthcare Leadership Competency Model 3.0, a survey was designed to capture essential domains of communication within leadership contexts. The initial instrument included six domains: relationship management, written communication, facilitation and negotiation, listening skills, verbal communication and effective speaking, and communicating in groups. After initial pilot testing revealed issues with item clarity and scale consistency, the survey was revised to improve content alignment and measurement accuracy. Subsequent testing incorporated exploratory factor analysis (EFA), internal consistency measures, and test-retest reliability analysis. As a result, eight components emerged and ultimately categorized as the following seven domains: communicating in groups, verbal communication and effective speaking, relationship management, written communication, listening skills, ethical collaboration, and respectful interactions. Most domains demonstrated acceptable to excellent psychometric properties, with Cronbach's alpha values and intraclass correlation coefficients (ICC) supporting internal consistency and stability over time. This tool, the Communication Competency Assessment in Health Professions (CCAHP) survey, provides a validated framework for assessing communication competencies in graduate health professions education and offers practical applications for guiding curriculum design, fostering interprofessional development, and sup¬porting professional identity formation.
This study aimed to analyze recent trends in occupational therapy, derive updated job competencies for Korean occupational therapists that reflect recent clinical changes, and confirm their validity. This 5-month expert consensus study, conducted from April to August 2024, used a 3-round online Delphi survey with 20 occupational therapy experts, followed by a focus group meeting with 10 experts, to refine and validate updated job competencies. Considering recent trends in occupational therapy, we adapted the U.S. National Board for Certification in Occupational Therapy practice analysis framework to the Korean context and collected expert feedback. The Delphi panel identified several competency items that required contextualization within the Korean legal scope of practice, particularly items related to physical agent modalities. After the concluding focus group discussion, the superficial thermal agents item (D3-T1-K4) was excluded, and the electrotherapeutic modality item for swallowing disorders (D3-T1-K5) was revised; the remaining competencies were finalized. Updated job competencies for new occupational therapists were derived across 4 domains, 16 tasks, and 62 knowledge items. These competencies may support greater flexibility in international research and strengthen responses to the expansion of occupational therapists' scope of practice in community settings. Therefore, the findings of this study are expected to be actively used in research, education, and practice.
Following the Jeju Air crash in Muan (South Korea) on December 29, 2024, resulting in 179 fatalities, forensic investigators (FIs) were exposed to traumatic scenes while performing disaster victim identification (DVI) procedures. FIs are known to be at significant risk for post-traumatic stress disorder (PTSD) and other mental health issues due to their routine exposure to traumatic scenes. Despite its clinical significance, there remains a paucity of empirical research quantitatively evaluating the psychological ramifications of DVI procedures and associated occupational stressors on FIs. Therefore, the current cross-sectional survey was conducted among a total of 735 FIs, including 224 individuals who had been engaged in the Jeju Air crash site 9 months prior to the study. Mental health outcomes, including probable PTSD (IES-R-K defined), depression (PHQ-9 defined), anxiety (GAD-7 defined), alcohol use (AUDIT-C defined), and suicide risk (MHS: S defined), were evaluated. We used Chi-square tests to compare symptom prevalence between deployed and non-deployed FIs, and applied correlation and adjusted logistic regression analyses to identify MFI site-specific factors associated with probable PTSD. Within the entire sample, the prevalence of probable PTSD and overall mental disorders reached 10.2% [95% CI: (8.0, 12.4)] and 19.7% [95% CI: (16.9, 22.6)]. Engaged FIs experienced significantly more frequent traumatic events and a higher probable PTSD prevalence [15.2, 95% CI: (10.5, 19.9)]. Traumatic experiences on scenes during DVI procedures, identification-related distress, and adverse working conditions were identified as factors significantly associated with probable PTSD. These results offer critical insights into the mental health status and related site-specific factors in disaster contexts. The study supports the implementation of trauma-informed and evidence-based mental health initiatives to protect FIs exposed to MFIs.
Major depressive disorder (MDD) is a prevalent mental illness characterised by persistent sadness, loss of interest in activities and cognitive impairment. While pharmacological and psychotherapeutic treatments remain the standard for MDD management, non-pharmacological interventions, such as aerobic exercise, have gained attention for their potential benefits in reducing depressive symptoms and improving quality of life. Although several studies have explored the effectiveness of aerobic exercise in managing MDD, there is still no comprehensive synthesis of the existing evidence. This study aims to synthesise existing evidence on the effects of aerobic exercise interventions in the management of individuals diagnosed with MDD. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive search will be conducted across Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science and BioMed Central databases. Search terms will be developed using the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework, incorporating keywords and Medical Subject Headings related to 'Major Depressive Disorder', 'Aerobic Exercise', 'Depression', and 'Quality of Life'. Only intervention studies, including randomised controlled trials, quasi-experimental and pre-post intervention studies, will be included involving adults aged 18 years or older diagnosed with MDD according to standardised criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Statistical Classification of Diseases and Related Health Problems -10 (ICD-10)). For included intervention studies, the comparator will be standard care, placebo or no-exercise control groups. The primary outcome is change in depressive symptoms, and secondary outcomes include quality of life, anxiety and stress-related biomarkers. Three independent reviewers will screen studies, extract data using Covidence software (Veritas Health Innovation in partnership with Cochrane) and assess study quality using the updated Cochrane Risk of Bias 2.0 (Rob-2) tool alongside the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. If feasible, a meta-analysis will be conducted using RevMan V.5.4 (Cochrane's Review Manager), with effect sizes determined by mean differences, standardised mean differences or ORs, depending on the outcome type. This study is currently at the proposal stage, with article searches expected to begin in November 2025 and data extraction anticipated to be completed by January 2026. No ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences. CRD420251151897.
Systematic reviews bring together all the evidence on a health topic in an organised and careful way. The People's Review aims to help the public understand what systematic reviews are and why they matter by designing and conducting their own systematic review. The question chosen for The People's Review is: Does resistance training make a difference to quality of life and/or heart health for older adults compared to aerobic exercise? This paper outlines how we will carry out this review. This is a systematic review involving the public throughout. This review will search for, include and summarise: randomised controlled trials, with older adults (50 + years), that compare resistance training (such as lifting weights) with aerobic exercise (such as walking or running), and measure quality of life or heart health. First, the technical team will search research databases to find possible studies. The public will look at summaries of these to find studies that might be relevant. Then, two members of the technical team will read the full studies and decide which ones to include. Next, the public will help collect some of the key information from the included studies. The technical team will record the rest. The public and the technical team will work together to check for biases (or flaws in how the studies were done) in the studies. Finally, if possible, the team will combine the study results using a method called meta-analysis (a way of pooling numbers together). If we can't combine the numbers, we will write a summary of what the studies found. This review will summarise all the available evidence that addresses the review question. This review could support the public to make decisions about what type of exercise to engage in as they age, and influence exercise guidelines, clinical practice and future research.
Geriatric rehabilitation (GR) aims to optimise functional capacity and social participation in older adults through multidisciplinary care. Healthcare professionals (HCPs) play a key role, and a deeper awareness of patients' lived experiences may enhance the quality of care. Virtual Reality (VR) offers an innovative way for HCPs to step into the perspective of older adults and experience rehabilitation through their eyes. Recent studies increasingly highlight VR's potential to foster empathy and communication skills. To explore whether a VR movie can enhance HCPs' understanding and empathy regarding older adults' experiences during GR. In a mixed-methods design we combined structured questionnaires and focus groups. HCPs from four GR organisations viewed a 15-minute VR movie showing the rehabilitation process from the viewpoint of an older adult which was scripted based on earlier studies on this topic. After viewing, participants completed a questionnaire or took part in focus groups discussing their experiences. In total, 160 HCPs completed the questionnaire and 18 participated in a total of three focus groups. Most participants (85%) reported increased awareness of older adults' experiences, and 95% indicated that they would recommend the VR movie to colleagues. Thematic analysis identified three key themes reflecting how HCPs, when adopting the older adult's perspective, perceived the rehabilitation experience: (1) feeling overwhelmed, (2) being dependent and vulnerable and (3) lack of clarity in staff routines. Participants additionally suggested practical improvements in daily care. The VR movie appears to be an effective educational tool in raising understanding and empathy among HCPs in GR.
There is a growing concern about shortages of midwives. While limited research found motivational factors for staying in the profession, it remains unclear how these factors differ by experience level or work setting. This study aims to determine the proportion of midwives at two levels of professional experience working in community and hospital settings in the Netherlands who intend to stay in the profession, to explore their reasons why, and to identify associated factors. A cross-sectional quantitative survey was conducted among 984 midwives working in community or hospital settings. Participants were grouped by years of experience (≤15 and >15 years). Descriptive statistics, chi-square tests and logistic regression analyses were conducted. Seventy-one percent (n = 542) of community midwives and sixty-eight percent (n = 148) of hospital midwives intended to stay in the profession, and this intention did not differ significantly between experience groups. Reasons for this intention included passion for midwifery, job satisfaction and job variety. Community midwives emphasised autonomy and working with women, whereas hospital midwives highlighted collaboration with colleagues. Across experience levels, intention to stay factors included alignment with midwifery ideology, a positive work-life balance, and psychological resources. Professional relationships, autonomy, and psychological resources (optimism and hope) varied by setting and experience level and should guide the design and organisation of maternity care. Seventy percent of Dutch midwives intend to stay in the profession, driven by passion, professional values, and work-life balance, with setting-specific differences in the importance of autonomy, relationships with women and teamwork.
Patient safety culture (PSC) is a key determinant of care quality, influencing clinical outcomes, staff functioning, and the resiliency of organizations. While PSC has evolved globally, it remains established in developing countries like Egypt. This study intended to evaluate healthcare workers' perceptions regarding PSC across three public hospitals in Beni-Suef City, Egypt. A cross-sectional design was used, including 497 healthcare workers from University Hospital, governmental, and health insurance hospitals in the Beni-Suef governorate. Convenience sampling technique was used. Data were gathered using modified version of the Survey on Patient Safety Culture (SOPS) Hospital Survey, enhanced with items from the Workplace Safety Supplemental Set. Statistical analysis involved descriptive statistics, correlation, and multivariable linear regression using SPSS v26.0. The study found that the mean age of participants was 28.98 years, with over 40% between 26 and 30 years old. Nurses exhibited significantly higher PSC scores than administrative staff. (Mean ± SD: 79.54 ± 11.36vs. 72.73 ± 16.63, respectively; P value = 0.005). Government hospitals showed higher PSC perceptions toward PSC than university hospitals (Mean ± SD: 82.39 ± 7.01vs. 75.77 ± 14.25, respectively; P value < 0.001). Working 30 h or more per week with (P value = 0.043), having direct patient contact with (P value < 0.001), and Every unit increase in workplace safety score is associated with an increase in patient safety score by 1.99 point. A negative relationship was identified between PSC and burnout with (P value = 0.010). Demographic, occupational, and institutional factors significantly influence PSC. Strategies focusing on improving workplace safety, reducing burnout, and targeting younger staff are essential to strengthening patient safety culture in Egyptian healthcare settings. Not applicable.
Occupational therapy plays a crucial role in the rehabilitation and recovery of individuals facing acute psychiatric challenges. However, the practice within acute psychiatric inpatient settings is often fraught with unique challenges that can hinder effective intervention. This qualitative study is aimed at exploring the multifaceted obstacles and challenges that occupational therapists encounter in these environments. This study utilized a qualitative approach with conventional content analysis. A total of 14 participants were involved, comprising active and experienced therapists, individuals currently hospitalized in acute settings, and psychiatrists. After obtaining ethical approval and informed consent, in-depth, unstructured interviews were conducted in accordance with the research objectives. Purposeful sampling and maximum diversity strategies were employed to select and invite participants, who subsequently underwent in-depth, semistructured interviews. The interviews were meticulously recorded and subsequently transcribed. The transcribed texts were subjected to analysis through the inductive qualitative content analysis. The challenges associated with implementing occupational therapy interventions in acute psychiatric inpatient settings were categorized into five main areas: patient engagement, therapist safety concerns, burnout and high work pressure, lack of standard facilities and space, and unawareness of the need for such interventions. Considering the various challenges faced by occupational therapists in acute psychiatric inpatient settings, a comprehensive and coordinated approach is essential. Issues such as patient engagement, therapist safety concerns, burnout and high work pressure, lack of standard facilities, and unawareness of the need for such interventions all impact the effectiveness of therapy. Ongoing training and education, coupled with supervision and mentorship, can empower therapists and promote self-care practices to mitigate burnout. Fostering interdisciplinary collaboration, conducting regular meetings to discuss patient progress, and ensuring role clarity among team members are essential to facilitate comprehensive care. Providing adequate facilities and resources, ensuring safe working conditions, and raising awareness about the importance of occupational therapy are crucial.
Hyperbaric oxygen therapy (HBOT) is an established treatment for pelvic late radiation tissue injuries (LRTIs) in cancer survivors, yet its impact on sexual health outcomes has previously not been examined. To investigate longitudinal changes in sexual health following HBOT in pelvic cancer survivors with LRTIs and to examine whether baseline severity and changes in pelvic LRTI symptoms predict sexual health outcomes, including gender differences. This one-group longitudinal observational study included eight assessment points. A total of 137 cancer survivors with pelvic LRTIs underwent 27-30 HBOT in monoplace chambers, breathing 100% oxygen for 90 min at 2.4 atmospheres absolute. Data were analyzed using latent growth curve modeling. Sexual health was assessed using the EORTC Quality of Life Sexual Health Questionnaire, while pelvic LRTIs (urinary and bowel) were measured using the Expanded Prostate Cancer Index Composite. Sexual health scores did not change significantly over 58 weeks (total change = -0.49, P = .742), despite significant improvements in urinary (total change = 8.98 points; P < .001) and bowel symptoms (total change = 8.25 points; P < .001). Greater early improvement in urinary symptoms predicted higher sexual satisfaction (95% CI = 0.02-0.19; P = .015), with stronger associations observed among men (bmale*change = 3.30, P = .032, CI = 0.38, 6.32). Although HBOT improves pelvic LRTIs, persistent sexual health challenges highlight the need for comprehensive, multidisciplinary survivorship care. Strengths include a relatively large, gender-balanced sample, longitudinal design, validated measures, and a standardized treatment protocol. The absence of a control group limits causal inference. Despite improvement of urinary and bowel symptoms, HBOT does not seem to restore sexual health. Further research is needed to confirm these findings and address other sexual health interventions. ClincalTrials.gov registration number NCT03570229.
Work-related musculoskeletal disorders are highly prevalent among manufacturing workers and represent a major cause of pain, functional limitation, reduced work ability and productivity loss, particularly in textile settings characterized by repetitive upper-limb tasks and sustained postures. Despite recommendations supporting exercise and education as first-line strategies, scalable workplace-embedded programs remain insufficiently implemented. This study aims to evaluate changes associated with an eight-week multimodal intervention integrating health education and app-supported exercise in textile workers. A quasi-experimental single-arm pre-post study will be conducted in a textile manufacturing company in Zaragoza, Spain, including workers aged 18-65 years. The intervention will consist of weekly face-to-face educational workshops and a twice-weekly digitally supported exercise program. Outcomes will be assessed at baseline, post-intervention and one-month follow-up. The primary outcome will be change in musculoskeletal pain intensity, and secondary outcomes will include musculoskeletal symptoms, physical function, physical activity, work ability, sleep quality, psychological distress, health-related quality of life and work productivity. Data will be analyzed using paired statistical tests according to distribution, with a significance level of 0.05. The study has received ethical approval from the Universidad San Jorge Ethics Committee and the Research Ethics Committee of Aragón, and findings will be disseminated through peer-reviewed publications and scientific conferences. ClinicalTrials.gov, identifier (NCT07360626).