To ensure the initiation and maintenance of breastfeeding, health systems need qualified professionals who can advise and support women. There was previously no validated tool to assess midwifery students' confidence in providing breastfeeding support in Türkiye. To adapt the Australian self-efficacy scale for breastfeeding support for midwifery students into Turkish and to psychometrically test its validity among Turkish midwifery students. A scale adaptation approach was used to translate and validate the 34-item scale. The tool was then sent to third- and fourth-year Turkish midwifery students. Psychometric properties were examined using both classical test theory and the Rasch measurement analysis. A total of 382 participants completed the survey. The Turkish version demonstrated excellent internal consistency, strong item functioning, and a largely unidimensional structure, confirming its robustness in the Turkish educational context. The findings indicate that Turkish midwifery students generally reported high self-efficacy for foundational breastfeeding support tasks, while more complex, practice-based skills, such as managing infant behavior during breastfeeding, required higher levels of confidence. This study provides strong evidence for the validity and reliability of the Turkish version of the Self-Efficacy Scale for Breastfeeding Support. Consistent with prior development and validation works, the scale demonstrated strong psychometric properties. These findings extend the scale's applicability to a new cultural and educational context. Overall, this Turkish version is a psychometrically sound tool for self-assessing breastfeeding self-efficacy and may be used to inform curriculum evaluation, guide targeted educational interventions and enable cross-cultural comparison.
The current expansion of Allied Health Profession training places in the UK presents significant challenges for clinical placement provision. Coaching and Peer-Assisted Learning (C-PAL) models have shown success in helping reduce placement pressure in nursing and midwifery, but there is limited evidence around how such approaches might inform traditionally one-to-one physiotherapy placements. Addressing a gap in C-PAL research, which has largely focused on nursing and midwifery, and on learner rather than educator experience, this exploratory qualitative study examined the experiences of Practice Educators (PEs) in implementing a C-PAL intervention during physiotherapy placements in one UK National Health Service trust. An exploratory qualitative study was conducted using semi-structured interviews and Reflexive Thematic Analysis. Ten PEs (seven female, three male; mean 9 years PE experience) participated. All had experience of supervising learners in traditional placements. With institutional ethical approval, interviews were conducted online, recorded and transcribed. Four themes emerged: (1) 'Oversight and Management'-initial concerns about managing multiple learners diminished when PEs observed peer support creating effective self-monitoring mechanisms. (2) 'Teamworking and Learning'-a shift emerged from direct teaching to facilitating peer learning, with the collaborative environment viewed as accelerating professional development. (3) 'Patient Contact'-increased therapeutic contact time and continuity of care were highlighted, though direct supervision of clinical skills was more challenging. (4) 'Collaborative Working and Support Networks'-the intervention facilitated collaborative relationships, though required additional administrative effort. Participants found that C-PAL offered a promising alternative to traditional physiotherapy placement supervision, potentially addressing educational capacity challenges while promoting greater learner autonomy and interdisciplinary skills. They also highlighted complex challenges emerging from managing multiple learners across locations and coordinating with colleagues. Preliminary findings suggest that C-PAL approaches may offer potential for expanding placement capacity while maintaining educational quality, though this warrants investigation across a wider range of clinical contexts. Sufficient preparation time, clear role delineation, and educator development focused on facilitation skills are likely to be important enabling conditions.
Aim Healthcare providers' beliefs about childbirth, as a natural or medical process, shape labor management and women's birthing experiences. This study aimed to objectively assess providers' attitudes using the Birth Beliefs Scale (BBS). Materials and methods A cross-sectional online survey was conducted during a maternity-care conference at a tertiary center in November 2025. Participants completed a web-based questionnaire based on the BBS. The survey assessed beliefs about birth as a natural process, such as seeing birth as normal, safe, and something women's bodies are designed for, emphasizing trust in the body, acceptance of pain as intrinsic, and minimal intervention unless necessary. Questions on beliefs about birth as a medical process covered perceptions of childbirth as dangerous and risky, safe only in hindsight, requiring medical supervision, and viewing labor pain as unnecessary and manageable pharmacologically. Independent t-tests compared continuous variables between two groups, while one-way ANOVA with Bonferroni post-hoc tests assessed differences across multiple groups. Ordinal alpha coefficients evaluated the internal consistency of both BBS subscales, with statistical significance set at p < 0.05. Given the ordinal nature of Likert-scale items, the ordinal alpha coefficient was employed to assess internal consistency and reliability of the two BBS subscales within this study population, accounting for potential differences from the original validation context. Results Of the 178 respondents, 56 (31.5%) were obstetricians, 52 (29.2%) midwives, 18 (10.1%) nurses, 12 (6.7%) childbirth educators, 11 (6.2%) doulas, and 29 (6.3%) others. Among the respondents, 104 (58.4%) worked in the private sector. Overall, BBS-natural scores were high. However, BBS-medical scores differed significantly by age, profession, and sector. Younger providers, obstetricians, and private-sector clinicians showed stronger beliefs favoring medical intervention during childbirth. Conclusion Participants largely endorsed naturalistic views of birth, but attitudes varied substantially across provider groups, age brackets, and practice settings. These differences reflect the influence of training and institutional culture on childbirth perceptions. Targeted inter-professional education, supportive institutional policies, and strengthened midwifery models may help promote balanced, evidence-based, woman-centered maternity care in India.
The COVID-19 pandemic intensified domestic violence and abuse (DVA) and limited access to face-to-face support, creating urgent challenges for survivors and services. This study explored stakeholder priorities for remote DVA support using a modified Delphi approach with 35 UK participants, including expert survivors, service providers, and commissioners. Findings highlighted increased isolation, stigma, and mental health impacts, alongside varied experiences of remote provision. Stakeholders emphasized safety-by-design, accessibility, and survivor-led decision-making as essential features of remote support. The study recommends blended, trauma-informed models that integrate digital and personal-contact options to enhance responsiveness, safety, and equity in DVA service delivery.
To evaluate the association between integrated midwife-led continuous labor support with postpartum care and maternal and neonatal outcomes, psychological resilience, and labor pain in primiparous women. Medical records of 150 nulliparous women who delivered at Beijing Ditan Hospital between October 2023 and July 2025 were retrospectively reviewed. The observation group received continuous midwife-led support during labor with extended postpartum care, while the control group received standard obstetric care. Outcomes were assessed using the Labor and Delivery Efficiency and Quality Index (LBDI), Connor-Davidson Resilience Scale (CD-RISC), Delivery Pain Assessment System (DPAS), and Pain Tolerance-Recovery Response Index (PTRR). Relevant clinical data were analyzed to explore associated factors. Data were analyzed using SPSS 26.0 and AMOS 24.0. Compared with the control group, the observation group showed higher composite LBDI scores (8.43 ± 0.57 vs. 7.77 ± 0.65, p < 0.001, Cohen's d = 1.09), higher spontaneous vaginal delivery rates (95% vs. 76%, p < 0.001), and higher 5-minute Apgar scores (9.4 ± 0.4 vs. 8.8 ± 0.6, p < 0.001), along with reduced postpartum hemorrhage and lower incidence of fetal distress (all p < 0.05). Psychological resilience and labor pain responses were better in the observation group (p < 0.05). Integrated midwife-led labor support with postpartum continuity of care was associated with better delivery outcomes and higher psychological resilience scores in primiparous women. Prospective studies are needed to confirm causality.
Interventions aimed at reducing restrictive practices are also designed to enhance the service experience in acute mental health units. However, people with experience of coercive engagement with these services are seldom involved as active contributors in evaluative research on interventions to reduce restrictive practices. With the meaningful involvement of lived experience practitioners, this research was aimed at examining care recipients' service experiences and perspectives on nurses' therapeutic responses during the implementation of a de-escalation intervention in three adult inpatient units within New South Wales, Australia, from March 2024 to April 2025. Nested within a larger study employing a mixed concurrent control design, this research evaluated the effectiveness and process of the Safe Steps for De-escalation through comparisons of unmatched measures of empowerment, dehumanisation, and staff actions on violence prevention across three time points, as well as through a reflective thematic analysis of semi-structured interviews. Safe Steps is a structured approach for therapeutic responding, targeting nurses' relationship-promotion behaviours to increase focus on minimising the use of restrictive practices. Eighty-six inpatients completed the unmatched measures, with nine participating in interviews following discharge. No significant changes were noted in quantitative measures over time. Five themes emerged from the qualitative analysis: (i) Clarity calms; confusion harms, (ii) Control cuts deep, (iii) Systems strain; people break, (iv) Connection is treatment in itself, and (v) Meaning-making outweighs medicine. These findings cast acute inpatient units in a light akin to a power circuit, elevating the need to make inpatient admissions more reflective of everyday life outside the units.
This cross-sectional study aimed to investigate privacy concerns, fear of pain (FoP), and health anxiety (HA) among women who had undergone a smear test. The study was conducted with 345 Turkish women between October 15, 2023, and April 14, 2024. Data were collected using the Personal Information Form, the Scale of Body Privacy in Gynecology and Obstetrics (SBPGO), the Fear of Pain Questionnaire (FPQ), and the Health Anxiety Inventory (HAI). Variables associated with SBPGO, FPQ, and HAI total scores were examined using backward linear regression analysis. Privacy concerns were significantly associated with the education level of participant's spouse, participant's age, FPQ total scores, and referral by a health professional (p < 0.001). Higher FoP scores were also significantly associated with higher HA (p < 0.001). Sociodemographic and clinical characteristics, including marital status, reproductive history, and family history of cancer, were found to be associated with variations in privacy concerns, FoP, and HA.
Infectious disease outbreaks pose significant threats to global health security, with resource-limited settings in West Africa bearing a disproportionate burden. Despite sustained investments in field epidemiology training and surveillance system strengthening, no comprehensive systematic synthesis exists of Ghana Health Service preparedness for field epidemiology and applied biostatistics. This protocol addresses the primary research question: What is the current level of preparedness of the Ghana Health Service for field epidemiology and applied biostatistics, as assessed across World Health Organization International Health Regulations core capacity domains? Preparedness is operationally defined as the measurable capacity of the Ghana Health Service to detect, investigate, confirm, and respond to infectious disease events across the eight WHO IHR core capacity domains, including surveillance, human resources, laboratory systems, and response mechanisms. This systematic review follows PRISMA 2020 guidelines and is registered with PROSPERO (CRD420261299788). Searches will be conducted in PubMed/MEDLINE, African Index Medicus, African Journals Online, and grey literature sources for studies published from January 2010 to present. Eligible studies include those describing field epidemiology capacity, surveillance system performance, outbreak investigation preparedness, biostatistical capacity, training program outcomes, infrastructure, or health workforce within the Ghana Health Service. Two independent reviewers will screen citations, extract data, and assess quality using study-design-appropriate tools including the JBI Critical Appraisal Checklist, CASP Qualitative Checklist, and Mixed Methods Appraisal Tool. Primary outcomes are overall field epidemiology preparedness level measured using Joint External Evaluation and State Party Annual Reporting scores, and surveillance system performance with outbreak response capacity. Secondary outcomes include field epidemiology workforce capacity, statistical modeling and biostatistical capacity, and infrastructure and governance systems. Narrative synthesis is the primary analytic approach. Meta-analysis will be conducted where sufficient comparable studies with acceptable methodological homogeneity are identified. This review will provide the first comprehensive assessment of Ghana Health Service field epidemiology preparedness mapped against WHO IHR core capacities, generating actionable evidence-based recommendations applicable to similar resource-limited settings across Africa. No ethical approval is required. Results will be disseminated through peer-reviewed publication, conference presentations, and policy briefs for the Ghana Health Service, Ministry of Health, and international stakeholders. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261299788, identifier CRD420261299788.
The realist approach seeks to understand underlying mechanisms that explain how and why complex interventions, programmes, and policies work in specific contexts, making it particularly valuable in health policy and systems research (HPSR). We draw on reflexive practice of realist evaluations from several realist evaluation practitioners and on insights from an organized session at the Eighth Health Systems Research Symposium in Nagasaki, Japan, in 2024, where we engaged a diverse group of practitioners and researchers on how to use realist approaches in HPSR. Examples from our studies, while situated in distinct contexts, highlight common challenges in applying realist methodologies including identifying and refining context-mechanism-outcome configurations. Building on these examples, we illustrate how realist evaluations, if conducted rigorously and with the purpose of advancing justice in health systems, could do so through exposing structural barriers to health justice, amplifying local voices and fostering epistemic justice in knowledge production.
Equity in maternal health is critical to achieving Sustainable Development Goals and Universal Health Coverage. Unequal distribution of maternal health resources threatens access and outcomes, particularly in Low- and Middle-Income Countries (LMICs) like Iran. This study assesses spatial and socioeconomic inequalities in the availability of human and physical maternal health resources across Iranian provinces in 2023. This cross-sectional study analyzed data from 20 maternal health resource indicators collected in 2023 across all 31 provinces of Iran. Among these, 7 variables represented human resources and 13 represented physical resources. Data aggregation was performed at multiple levels, including provincial boundaries, geographic regions, deprivation categories, and classification of provinces as border or central, to comprehensively assess spatial and socioeconomic disparities. Composite indices for human and physical resources were constructed using min-max normalization followed by averaging relevant variables. Inequality was quantified using the Gini coefficient across provinces and data processing and statistical computations were performed using R software. Findings reveal generally moderate inequalities in maternal health resource distribution (Gini mostly below 0.5) with advantaged and border provinces showing higher resource availability. Specialized facilities and supervisory staff remain concentrated in select regions, while frontline workers show more equitable distribution. The concentration of border‑specific facilities in a limited number of provinces explains part of the observed regional disparities. While important progress has been made in expanding maternal health services, spatial and socioeconomic inequities in the distribution of resources persist across provinces in Iran. Policy efforts should prioritize equity-oriented resource allocation, strengthen services in deprived provinces, and implement continuous inequality monitoring to support more equitable maternal health outcomes.
Trauma patients recovering from coma face significant physical, psychological, and social challenges after returning home, which may adversely affect their daily lives and well-being. Exploring these experiences can inform care needs and guide tailored post-discharge support. Accordingly, this study aimed to explore post-discharge life experiences in trauma patients recovered from coma. This qualitative study was conducted using conventional content analysis. A total of 17 trauma patients who had recovered from coma and had been discharged at least three months prior were selected through purposive sampling. For data collection, 20 face-to-face, semi-structured interviews were conducted until data saturation was achieved. Data analysis followed the Graneheim and Lundman approach. The rigor of the study was ensured using Guba and Lincoln's criteria. The findings revealed that the main theme of post-discharge life experience was characterized as "pleasant freedom with suffering wounds," encompassing three categories: "freedom from captivity of alienation and despair," "dubious pleasure," and "integration of real and imagined disability and helplessness." The initial perception of post-discharge life among trauma patients who recovered from coma is profoundly shaped by the unpleasant experiences endured during ICU hospitalization. The sufferings experienced at home reflect a combination of real complications and imagined concerns arising from the severity of trauma, often accompanied by a false sense of disability and helplessness. These findings underscore the necessity of softening the ICU environment, implementing comprehensive discharge preparation, and providing effective post-discharge follow-up that addresses not only actual physical and psychological problems but also perceived or imagined sufferings.
Maternal near-miss (MNM) events impose substantial emotional and professional strain on midwives and obstetricians, yet clinicians' experiences remain underexplored in Italy. This study explored how maternity clinicians experience and make sense of MNM events. We conducted a qualitative interview study underpinned by a contextualist epistemological position and analysed data using contextualist reflexive thematic analysis. Semi-structured interviews were undertaken with 13 clinicians (9 midwives, 4 obstetricians) in a level II maternity unit in Northern Italy between February and September 2024. Interviews were audio-recorded, transcribed verbatim, and analysed iteratively alongside data collection. Trustworthiness was supported through reflexive journaling/memos, iterative team discussions, and end-of-interview participant validation (summary checking). Four interrelated themes were developed: (1) Barriers to trauma processing, including judgmental audit cultures, limited formal support, and fragmented communication, with perceptions consistent with institutional betrayal; (2) Clinical confidence-building and largely informal emotional recovery, including teamwork, mentoring, and informal debriefing, highlighting peer solidarity as a key buffer; (3) Communication challenges, particularly delivering bad news to women and families and navigating interprofessional communication under pressure; and (4) Emotional complexity, characterised by guilt, responsibility, and enduring personal and professional impact. A central interpretive insight was emotional reciprocity, a bidirectional relationship between clinicians' "second victim" distress and perceived women's recovery trajectories. MNM events can have lasting psychological and occupational effects on maternity clinicians. Findings underscore the need for structured organisational responses alongside peer-based support to mitigate second-victim impacts and support workforce wellbeing.
Healthcare professionals working in regional, rural, and remote emergency departments are at increased risk of psychological distress, burnout, and emotional exhaustion due to demanding work environments and ongoing workforce pressures. Poor psychological wellbeing contributes to reduced workforce retention and may compromise the delivery of safe, equitable emergency care. However, evidence regarding their psychological wellbeing in these settings remains fragmented and lacks comprehensive synthesis. An integrative review of global evidence on the psychological wellbeing of healthcare professionals working in regional, rural, and remote emergency departments was undertaken, focusing on challenges, contributing factors, supports, and reported outcomes. Five electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, and Scopus) were systematically searched from inception to June 2025. Seventeen primary studies from ten countries met inclusion criteria and were appraised using the Mixed Methods Appraisal Tool. Findings revealed multifactorial stressors, including workplace violence, excessive workloads, professional isolation, inadequate leadership, moral distress, and limited access to training, with nurses and female staff most affected. Supports were clustered into four domains: education and professional development, peer and social support, organizational support, and individual coping strategies. Most supports were descriptively reported, with outcomes identified as both positive and negative. In only two studies, structured interventions were formally evaluated, including a self-care program and the implementation of a Serenity Room. The review highlights that psychological distress among healthcare professionals working in regional, rural, and remote emergency departments is influenced by context-specific, systemic, and individual factors, yet evidence-based interventions addressing these issues remain scarce. Multi-level, co-designed strategies integrating organisational safety, training, and wellbeing supports are recommended as potential approaches to support healthcare staff psychological wellbeing, workforce sustainability, and equitable, high-quality emergency care in regional, rural, and remote settings. CRD420251079431.
Kefir, a symbiotic fermentation product of yeast and lactic acid bacteria, offers significant health benefits as a functional food. However, its characteristic sour taste limits consumer acceptance, necessitating product innovation. This study evaluated the physicochemical, microbiological, sensory, and economic feasibility of frozen goat milk kefir fortified with Lactobacillus fermentum 1,743 and avocado pulp. A 3 × 3 factorial randomized complete block design (n = 27) was employed with Factor A: lactic acid bacteria (LAB) concentrations (2%, 4%, and 6%) and Factor B: avocado pulp concentrations (0%, 10%, and 20%). The parameters assessed included pH, total titrated acids (TTA), antioxidant activity, proximate composition, total LAB count, sensory attributes (taste, flavor, texture), and income analysis. Significant interactions (p < 0.05) were observed between factors A and B for antioxidant activity and all sensory attributes. The optimal formulation (A2B3: 4% LAB + 20% avocado) achieved superior characteristics: pH 4.20, TTA 0.76%, antioxidant activity 56.88%, probiotic viability 119.6 × 103 CFU/ml, and the highest sensory scores (taste: 4.04/5.0, flavor: 3.78/5.0, texture: 3.54/5.0). Economic analysis demonstrated commercial viability with a net profit of IDR 56,156,850 annually. The integration of 4% L. fermentum 1,743 and 20% avocado pulp produces frozen goat milk kefir with enhanced functional properties, superior sensory acceptance, and positive economic indicators, offering a viable functional food alternative for lactose-intolerant consumers.
Various teaching methods have been used to train healthcare staff in ventilator-associated pneumonia (VAP) prevention. Despite the positive results of blended learning in increasing nurses' knowledge and performance, there is a lack of robust, generalisable evidence on the medium- or long-term effectiveness of text messages as part of educational packages and microlearning on the sustainability of these outcomes. This study aims to examine the effectiveness of two teaching methods-lecture-based and blended (lecture plus text messages)-on nurses' knowledge and performance in VAP prevention in Kermanshah. Sixty Intensive care unit (ICU) nurses participated in a training session, randomly divided into intervention and control groups. The intervention group received educational messages containing key points from the training session every other day for 2 weeks; the control group did not receive messages. Knowledge and performance were measured before and after using a validated questionnaire to assess changes. The intervention and control groups each had 30 participants. Most nurses were women (n = 40, 66%), over half were over 30 years old (n = 28, 53%) and a significant proportion had less than 10 years of experience (n = 52, 86%). At pre-test, the mean knowledge scores were 21.1 ± 2.9 (intervention) and 20.2 ± 2.9 (control), with performance scores of 120.8 ± 10.4 and 120.1 ± 13.4, respectively. In post-test, the intervention group showed statistically significant improvements in knowledge (20.2 ± 1.5 vs. 22.1 ± 1.9; p < 0.001), performance (126.9 ± 8.2 vs. 120.8 ± 9.7; p < 0.02). Ongoing short message service (SMS) reminders improved nurses' knowledge and performance in VAP prevention. This study demonstrates that a low-cost, affordable educational programme based on continuous repetition with brief content (short reminder short message service [SMS]) can significantly improve intensive care unit (ICU) nurses' knowledge and adherence to ventilator-associated pneumonia (VAP) prevention measures. Implementing such simple, concise interventions within continuing clinical education programmes can sustainably reinforce infection prevention behaviours and, in resource-limited settings, lead to improved clinical outcomes and reduced care costs.
Urinary Autonomic Dysfunction (UAD) is a common complication of Type 2 Diabetes Mellitus (T2DM) that can substantially impair quality of life. It may manifest as loss of bladder control, difficulty initiating or maintaining urination, and incomplete bladder emptying. However, its prevalence and risk factors remain underexplored, particularly in low-resource settings like Zanzibar. This study aimed to determine the prevalence of UAD and its association with pharmacological, clinical, and lifestyle factors among T2DM patients in Zanzibar. A cross-sectional study was conducted among 364 patients with T2DM attending outpatient clinics in Zanzibar. Participants were recruited from local healthcare facilities, and data were collected using structured interviews. UAD symptoms were assessed using the urinary subdomain of the Composite Autonomic Symptom Score-31 (COMPASS-31). Descriptive and inferential statistical analyses were conducted to determine the prevalence and identify factors associated with UAD. The prevalence of urinary autonomic dysfunction (UAD) was 24.5% (89/364). Multivariable logistic regression analysis showed that a history of cigarette smoking was independently associated with higher odds of UAD (AOR = 4.15, 95% CI: 1.73-9.94, p = 0.001). Participants who reported rarely consuming vegetables or consuming only one portion per day had significantly higher odds of UAD than those consuming two or more portions daily (AOR = 3.65, 95% CI: 1.67-7.96, p = 0.001). Use of lipid-lowering medications was also independently associated with higher odds of UAD (AOR = 3.81, 95% CI: 1.83-7.93, p < 0.001). UAD affected nearly one-quarter of patients with type 2 diabetes mellitus in Zanzibar. Cigarette smoking, low vegetable intake, and the use of lipid-lowering medications were significantly associated with increased odds of UAD. These findings support the need for routine assessment of urinary symptoms in patients with T2DM and greater attention to potentially modifiable lifestyle factors. Further longitudinal studies are needed to clarify the temporal and clinical relationship between lipid-lowering medication use and UAD.
To validate the Richards-Campbell Sleep Questionnaire (RCSQ) relative to actigraphy on general hospital wards and to examine the predictive value of sleep parameters for delirium. This multicenter, prospective observational study was conducted on internal medicine, surgical, and neurology wards across seven healthcare institutions in the Czech Republic. The analysis included 133 patients (424 nights). Individual RCSQ items and corresponding nocturnal actigraphic sleep parameters (MotionWatch 8) were compared using linear mixed-effects models (LMM). Associations with delirium occurrence were evaluated using binary logistic regression. Patients rated their sleep as moderately good on the RCSQ despite objectively impaired sleep on actigraphy. Only the sleep-depth item showed significant associations, with higher scores linked to higher immobile time and lower fragmentation. No significant associations were found for remaining parameters. The RCSQ total score showed only weak associations with sleep efficiency and percent sleep. Subjective sleep ratings did not predict delirium, whereas higher actigraphic sleep efficiency was associated with lower delirium risk. In hospitalized patients, only the RCSQ item assessing sleep depth showed meaningful correspondence with actigraphic measures. The RCSQ total score showed limited concurrent validity against actigraphy and was not useful for predicting delirium, whereas low actigraphy-measured sleep efficiency appeared to be a clinically relevant marker of delirium risk.
Chronic breathlessness causes reduced quality of life (QoL) and high healthcare costs. Accumulating evidence shows that multidisciplinary breathlessness services can ameliorate breathlessness which persists despite guideline-directed treatments. Current literature largely reflects trials of interventions in European settings applied to cancer-predominant populations, raising doubt about broad applicability. The research objective was to evaluate whether Macarthur Breathless Clinic (MBC), a bespoke health service intervention, could reduce the impact of chronic breathlessness for a cohort of Australians with COPD. The MBC intervention was tested in a prospective, single-arm cohort study, targeting recruitment of 92 patients. Eligible patients had chronic breathlessness impacting QoL and at least moderately severe COPD, defined by spirometry. Following detailed case review to ensure optimal medical therapy, an individualized program was developed and implemented by MBC's multidisciplinary team during a nine-week program. Questionnaires assessing breathlessness burden, mental health and QoL were administered at baseline, repeated on program completion and again at 12 months. Eighty-nine eligible subjects were mean age 71 years, 65% female and 10% Aboriginal Australian with 18% reporting breathlessness at rest. Mean FEV1 was 37% predicted. Compared with baseline, the primary outcome, Chronic Respiratory Questionnaire - Mastery Subscale improved after program completion (0.5 at nine and 0.8 at 52 weeks, p<0.0001). Measures of confidence, COPD symptom burden and breathlessness also yielded durable positive results at 12 months. Clinically relevant gains seen after MBC were retained or even increased at 12 months and more reflected enhanced coping skills and confidence than reduced breathlessness intensity. Breathlessness is a distressing, disabling symptom, contributing to high healthcare costs. Hence, addressing breathlessness represents an unmet need for patients and a health system priority. Breathlessness intervention services, largely comprising non-pharmacological strategies have proven beneficial for patients in the short term; largely for those patients with life-limiting disease such as cancer. Chronic obstructive pulmonary disease (COPD) and emphysema are common conditions, increasing in prevalence worldwide. Even with best available treatments, such patients have persistent and pervasive symptom burden, particularly from breathlessness. This research explores the utility of a breathlessness intervention service for durable impact when applied to patients with COPD. We report sustained improvements in breathlessness mastery and related symptom burden at 12 months following a multidisciplinary, home-based breathlessness intervention program in a cohort of Australians with COPD.
Traumatic brain injury (TBI) represents the most prevalent debilitating neurological condition among adults. Sensory deprivation, resulting from cerebral damage, prolonged immobilization, social isolation, and critical illness, constitutes a major complication for ICU-admitted TBI patients. Implementing safe, simple stimulation protocols may significantly enhance recovery outcomes. This study investigated the impact of multimodal sensory stimulation on arterial oxygen saturation, hemodynamic parameters (heart rate and blood pressure), and consciousness levels in TBI patients requiring intensive care. In this clinical trial, 64 TBI patients meeting inclusion criteria were enrolled through convenience sampling. Participants were randomly allocated to intervention or control groups using a lottery-based randomization method. The patients in the intervention group attended a regular and periodic sensory stimulation program (consisting of various sensory stimulations including auditory, visual, olfactory, tactile, and vestibular stimulations) conducted by the researcher for two 30-minute sessions per day for 6 days. However, no intervention was performed for the patients in the control group. Arterial blood oxygen, heart rate, blood pressure, and consciousness levels of the patients in the two groups were measured before and after each intervention at similar intervals. Data were collected using a demographic information questionnaire and biophysiological tools such as pulse oximetry, sphygmomanometer, and the Glasgow Coma Scale. The collected data were analyzed with SPSS version 27 and the significance level was set at < 0.05. The mean age of participants was 36.63 ± 15.59 years in the intervention group and 36.59 ± 16.84 years in the control group, with male participants accounting for 57.8% of the sample. The most common cause of TBI was trauma. The average changes in arterial blood oxygen, heart rate, blood pressure, and level of consciousness between the two control and intervention groups and also over time showed a significant difference (P < 0.01). The data revealed that multimodal sensory stimulation positively affected arterial blood oxygen, heart rate, blood pressure, and consciousness level of TBI patients and improved the physiological condition of the patients. Thus, multimodal sensory stimulation can be used as a complementary treatment, which has received less attention due to various reasons, including time constraints, shortage of medical staff, the use of superior technologies, and the increased complexity of the required care.
To assess rural maternal and child health (MCH) workers' virtual patients (VPs)-assessed performance in identifying perinatal depression (PND) using smartphone-based VPs, and to identify factors associated with this performance in rural Hunan, China. A multicentre cross-sectional study was conducted in Hunan Province, China. A standardized questionnaire collected demographic and work-related characteristics of rural MCH workers. Smartphone-based VPs were used to assess PND identification performance in a simulated clinical scenario. An overall score ≥60 was used as a prespecified operational benchmark across consultation, ancillary assessment, diagnosis, management, and health education domains. Data were analyzed using SPSS 26.0. A total of 375 rural MCH workers participated, yielding an effective response rate of 90.4%. Only 25.9% met the prespecified operational benchmark for VP-assessed PND identification performance. The mean accuracy scores for consultation, ancillary assessment, diagnosis, management, and health education were 94%, 48%, 64%, 58%, and 74%, respectively. Complete consultation accuracy was higher among MCH workers from township health centers than among those from county-level MCH hospitals. MCH workers aged 18-39 years showed higher odds of complete diagnostic accuracy for PND than those aged ≥40 years. Smartphone-based VP assessment was feasible in rural MCH settings and revealed suboptimal PND identification performance. Mobile VPs may help identify frontline performance gaps and inform targeted training, but further validation against real-world clinical performance, or standardized patient encounters is needed before large-scale implementation. These findings may support targeted capacity-building for rural MCH workers and more equitable perinatal mental health care.