The aim of this study was to assess the associations of psychometric, biochemical, and genetic parameters of the serotonin and dopamine systems with violent criminal behavior. Male participants who had no criminal records (n=110) and those who had committed interpersonal violent crimes (n=143) were included in the study. Aggression levels were estimated by means of the Buss-Perry questionnaire (BPAQ-24). The Structure of Temperament Questionnaire-Compact (STQ-77), potentially linked to monoamine neurotransmitter activity, was administered to profile temperament traits. Concentrations of monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) were estimated in urine samples. The HTR2A rs6313 and DRD4 rs1800955 polymorphisms were genotyped by real-time PCR. Offenders demonstrated higher levels of aggression, and decreased concentrations of 5-HIAA and HVA as compared with controls. According to the final model of multivariate binary logistic regression, total BPAQ scores (B = 0.047; p < 0.001), HVA concentrations (B = -0.004; p < 0.001), and the STQ-77 Empathy (EMP) scale (B = 0.225; p = 0.004) were the independent markers discriminating violent criminal behavior with an overall classification accuracy of 86.1%. Thus, the complex interplay between heightened aggression, reduced HVA levels, and specific temperament traits constitutes a neurobehavioral signature of violent criminal behavior.
Suicide-loss survivors (SLSs) experience substantial and often enduring psychological burden. These difficulties are compounded by public stigma, underscoring the need for scalable approaches to shift attitudes at the population level. In this study, we examined whether brief survivor-narrative videos can reduce public stigma of SLSs. In a randomized controlled trial, 1351 adults (18-50) completed baseline measures and were allocated to view either a brief SLS narrative or a psychoeducational control. Public stigma toward SLSs and trait impressions were assessed at baseline and postexposure. Relative to control, the SLS video arm showed clear improvements immediately and at 30 days: stigma scores were lower and trait impressions more favorable, with attenuation over time. Item-level analyses indicated sizable immediate reductions for "Disconnected" (-24%) and "Cowardly" (-16%), and smaller but significant decreases for "Immoral" and "Irresponsible" (-12% each). Brief survivor-narrative videos can shift public attitudes toward SLSs and maintain part of that change over 1 month. As a low-cost, scalable complement to postvention, brief video contact offers a practical lever to improve the social climate surrounding SLSs. Deployed widely and reinforced over time, it can move communities from blame to empathy, strengthen everyday support, and advance survivors' recovery.
With increasing costs, and an aging population, it is inevitable that demand for health and social care exceeds the available resources. Policymakers seek to maximise value-for-money and, increasingly, use quantitative economic methods to guide such policy. Current characterisation of value is largely based upon health utility and may not align with societal preferences for attributes such as care processes, autonomy and dignity. The limited concept of value provided by quality adjusted life years (QALY), with other factors adding weight to the QALY or inflating thresholds, may distort funding decisions. This essay explores the limitations of current economic methods and argues that these prioritise cost utility calculations and lack appropriate measures for other attributes of health or social care. Many methods require assumptions and simplifications, such as the equivalence of chosen outcomes, leading to unintended or unconsidered consequences. The choice of perspective, handling of unrelated costs, and methodological choices may conceal implicit value judgements, and the values and preferences used may reflect the preferences of specific stakeholders but fail to represent the interests of those likely to bear the opportunity costs of policy decisions. Areas are identified in which there is the potential for improved alignment of decisions with societal values. Existing methods could be used more extensively to identify and quantify societal preferences in terms of monetary value or equivalent health utility. Changes to decision-making processes to favour a net benefit approach over the use of a variable willingness-to-pay threshold, may reduce the current primacy of cost per QALY calculations, and there is a need for a more rigorous approach to the consideration of opportunity costs. It is concluded that without such changes there is a danger that high-cost new technologies will displace more caring aspects of health and social care that are highly valued by society.
Social capital (SC) is a key determinant of well-being and social participation, yet the magnitude of its individual differences and their neurobiological bases remain poorly understood. Here we showed that social capital (SC) is bimodally distributed across the lifespan and that these modes align with distinct psychosocial and neurobiological profiles. In a nationwide cross‑sectional survey in Japan (N = 2,574; ages 4-87) comprising 731 parent-child dyads and 1,112 adults without children, SC showed a reproducible two‑mode pattern. LASSO regression identified consistent psychosocial predictors of higher SC, including perspective-taking, empathy, and extraversion. In children, SC was strongly associated with parental SC (r = 0.40) and positive parent-child relationships, while parental income and education showed little explanatory value. In an independent neuroimaging cohort (N = 108), higher SC was linked to a more efficient structural covariance network, including greater small-world topology, higher hub centrality, and regional differences in cortical thickness and myelination across social brain regions (e.g., angular and supramarginal gyri, cingulate cortex, ventromedial prefrontal cortex). These findings demonstrate that, in this Japanese sample, SC was bimodally distributed, and each mode was associated with distinct psychosocial and neurobiological profiles, indicating divergent developmental pathways of social connectedness with implications for health and society.
Family caregivers of people with dementia face an elevated risk of abusive behaviors. However, the psychological association linking caring attitudes to abuse risk-specifically the indirect role of resilience-remains underexplored in non-Western contexts. This cross-sectional study examined whether psychological resilience shows an indirect association in this relationship among Chinese dementia family caregivers. This cross-sectional study recruited 133 family caregivers from a dementia research center in central China (June 2023-May 2024). Participants completed measures of resilience, caring attitudes, and abuse risk. Data were analyzed using correlations, binomial logistic regression, and mediation analysis (PROCESS Macro, Model 4; 5,000 bootstrap samples). 66.2% of caregivers screened positive for abuse risk. More positive caring attitudes and higher resilience were each significantly correlated with lower abuse risk (r = -0.71 and r = -0.43, p < 0.001). When abuse risk was defined using a CASE cut-off (≥3 vs. <3), more positive caregiving attitudes were associated with significantly lower abuse risk (OR = 0.11, 95% CI: 0.04-0.27). These results remained consistent across subgroups, with no notable multicollinearity (all VIFs <5). Mediation analysis indicated that resilience had a significant partial indirect effect. Notably, the strength of this indirect effect varied across attitudinal dimensions: it was strongest for maintaining positivity (29.2%) and managing reluctance (22.6%), whereas the association from acute emotional distress (e.g., burnout) to abuse risk remained largely direct. Psychological resilience shows a significant partial and differential indirect association between caring attitudes and abuse risk. These findings suggest a dual-focus intervention-addressing acute distress while building resilience-as a hypothesis-generating strategy for abuse prevention in China's filial-piety-based dementia care.
Callous-unemotional (CU) traits are linked with various psychosocial maladjustments. Scant research has investigated its developmental pattern during the transition from late adolescence to young adulthood, and whether the pattern may function as a mechanism against daily stressors in stressful contexts. This study adopted a multi-timescale approach to elucidate how long-term developmental trajectories of CU traits relate to both socioemotional maladjustment and daily emotion dynamics during the transition period. A three-wave longitudinal study (N = 313; Mage = 18 years, 72% female, 30% White) with two 30-day daily diary bursts embedded over three years was conducted. Latent growth curve modeling revealed a modest group-level increase in CU traits. Higher initial levels and faster increase in CU traits were associated with higher depressive symptoms and peer problems and lower empathy and peer attachment in wave 3. Multilevel modeling showed that individuals with faster growth in CU traits displayed lower daily emotional problems, blunted reactivity to stress, and reduced stress-unrelated emotional fluctuations; these associations persisted over two-and-a-half years. These findings suggest that the developmental growth of CU traits may buffer daily stress reactivity in the short-term but could be maladaptive in the long-term.
Parkinson disease (PD) and other Lewy body disorders are leading contributors to carer distress. In clinical settings, carer needs are not well understood or routinely discussed. When addressed, the focus tends to be on caregiver burden, a broad term that may limit clinicians' ability to provide meaningful support. This study aimed to investigate the priorities of key stakeholders, namely, persons with PD (PwP), informal unpaid carers such as spouses of PwP, and paid caregivers, to help facilitate the development of more targeted, holistic carer support. Using a qualitative descriptive research design, virtual semistructured interviews and one focus group were conducted with PwP, informal unpaid carers, and paid caregivers. Data collection and analyses were iterative, and a thematic analysis of coded data was completed. Participants included 10 PwP (60% female, 90% White), 8 informal carers (100% female, 87.5% White), and 6 paid caregivers (75% female, 50% White). Four themes on the perceptions of PD caregiving were identified that highlighted current caregiving priorities. (1) Prior discussions on caregiving roles and expectations are important. Conversations between PwP and carers on the carer's role and individual expectations of caregiving were recognized as foundational to optimal caregiving. (2) The minutiae of caregiving exacerbate caregiver burnout and strain. Routine caregiving tasks and lack of decision-making support contributed to carer burnout and PwP frustrations. (3) Asking for and receiving help with caregiving can be hard for carers and patients. While carers and PwP were reluctant to ask for help, paid caregivers encouraged strategies to do so. (4) Caring and love lie at the core of caregiving. The challenges of PD caregiving were offset by feelings of mutuality of love and care. Focused discussions on carer roles and expectations are foundational to improving caregiving experiences. Providing support for these discussions in clinical settings, offering help, and intentionally shifting the focus from burden to the positive aspects of caregiving may foster purpose and resilience among PD carers. Future research should include perspectives of varied stakeholders engaged in providing and receiving care and explore clinical interventions to address carer priorities.
Large language models (LLMs) are increasingly considered for clinical documentation, referral support, and patient-facing communication. Biomedical accuracy alone may be insufficient for safe deployment if generated plans vary in access navigation, financial-access language, referral specificity, or tone across socially meaningful patient cues. To evaluate whether onomastic and bundled geographic-access signals are associated with differences in LLM-generated pediatric asthma referral plans. We conducted a cross-sectional 2 × 2 factorial audit of seven commercial LLMs. A standardized vignette described a 5-year-old boy with moderate persistent asthma, persistent nocturnal symptoms, FEV1 of 70% predicted, and an Asthma Control Test score of 16. Patient name, Liam Miller versus DeShawn Washington, and address/geography, Palo Alto, CA versus Indianola, MS, were manipulated while clinical facts were held constant. Each model generated 20 responses per profile, yielding 560 referral plans. Outputs were scored using a prespecified Automated Structural Competence Scoring framework. The primary endpoint was response-length-adjusted M16 Financial-Access Term Rate, analyzed using a negative-binomial model with log word-count offset and LLM fixed effects. Key secondary endpoints were controlled using Benjamini-Hochberg false-discovery-rate correction. In the response-level primary model, the DeShawn name signal was associated with a higher financial-access term rate (IRR, 1.47; 95% CI, 1.23-1.77; p < 0.001), as was the bundled geographic-access signal (IRR, 2.40; 95% CI, 2.02-2.85; p < 0.001). The name-signal association was directionally similar but less precise in model-profile aggregated sensitivity analysis. The interaction term was below 1.0 (IRR, 0.79; 95% CI, 0.63-1.00; p = 0.048), indicating no positive multiplicative synergy. Institutional Specificity and Triage Ranking were at ceiling. SDOH Recognition Depth, Location-Friction Acknowledgment, Navigator Recommendation, and Empathy/Subjectivity differed by profile, whereas Access Priority remained low and non-significant after correction. Human validation showed moderate endpoint-specific reliability. LLM-generated pediatric asthma referral plans varied in financial-access, geographic-access, navigation, SDOH-recognition, and selected tone-related framing. These findings do not establish discriminatory intent, clinical equivalence, downstream harm, or positive synergistic interaction, but support evaluating structural and access-related framing alongside biomedical content in clinical LLM audits.
Approximately 5% of women will be affected by fetal malposition at full cervical dilatation, with the occiput in transverse or posterior positions. These women are more likely to require assistance to give birth to their babies with either rotational vaginal birth or cesarean birth at full dilatation. Three different rotational methods can be used: rotational (Kielland) forceps, rotational vacuum, and manual rotation. Current evidence supporting the use of the 3 rotational methods is only from observational data. To date, no randomized controlled trial (RCT) of rotational methods has been completed. This study aimed to evaluate whether manual rotation of the fetal head in persistent malposition at full cervical dilatation reduces the risk of severe maternal perineal trauma without substantially increasing the risk of cesarean birth, compared with instrumental rotation. ROTATE is a pragmatic, multicenter, 2-arm parallel group, open-label RCT of manual versus instrumental rotation of the fetal head in malposition at birth with an internal pilot and an embedded qualitative process evaluation. The primary outcome is to evaluate whether manual versus instrumental rotation at full cervical dilatation reduces the risk of severe perineal trauma (superiority outcome), defined as a third- or fourth-degree tear, without substantially increasing the risk of cesarean birth at full dilatation (noninferiority coprimary outcome). A sample size calculation found that 4988 participants are required to detect a clinically meaningful reduction of third- or fourth-degree tears from 6% to 4% with 90% power (α=.05). A total sample size of 5200 participants from approximately 40 sites is anticipated, as loss to follow-up is expected to be about 4%. Neonatal trauma, a composite of potential outcomes relating to intrapartum hypoxia and physical trauma, is a safety signal. The setting is National Health Service consultant-led maternity units across the United Kingdom. Randomization is performed after eligibility has been confirmed and verbal consent has been obtained. Randomization is undertaken via a 24-hour telephone service or web-based system. Participants are randomized at an individual level on a 1:1 ratio to manual or instrumental (forceps or vacuum) rotation. Written consent is sought postnatally. Data collection took place between September 9, 2022, and November 5, 2024. The total number of recruits is 321. The data analysis of primary and secondary outcomes is ongoing at the time of submission. A multicenter RCT of rotational methods has been conducted in the United Kingdom. Although the trial was closed early due to challenges in meeting recruitment targets, the results are still highly anticipated. ISRCTN ISRCTN10193017; https://www.isrctn.com/ISRCTN10193017. DERR1-10.2196/72505.
Nurse-initiated management of antiretroviral therapy (NIMART) has expanded access to life-saving antiretroviral therapy and enhanced the decentralization of HIV care. The psychobiological and psychosocial responses of nurses implementing this strategy have been largely underexplored. This scoping review aims to systematically map the extent, nature, and characteristics of the existing literature on the psychobiological and psychosocial responses of NIMART-trained nurses providing care to people living with HIV. The review will be conducted in accordance with the Joanna Briggs Institute methodology and the population, concept, and context (PCC) framework, which will guide the development of the review question and define the eligibility criteria. A comprehensive search strategy will be used to identify empirical studies published between 2010 and 2026 across electronic databases (PubMed, SABINET, PsycInfo, CINAHL, Scopus, and Google Scholar). Two independent reviewers will screen the titles and abstracts to determine which studies are eligible. If there is any disagreement, a third reviewer will resolve it. Data will be analyzed using narrative synthesis and thematic mapping to identify patterns, knowledge gaps, and implications for future research, practice, and policy. The review is expected to identify the scope, trends, and gaps in the literature on psychobiological and psychosocial responses among NIMART-trained nurses. The estimated outcomes will include a synthesis of existing evidence. The scoping review was initiated in July 2025, and is expected to be completed by the end of July 2026. This scoping review will provide an evidence-based understanding of the psychobiological and psychosocial responses of NIMART-trained nurses, highlighting implications for policy, practice, workforce support, and future research.
PurposeTo develop a professional nursing professional practice model (PPM) to guide performance at a university hospital.DesignSequential multimethod design for theory development.MethodThe study was executed in four sequential phases: (1) identification of the need for a PPM; (2) preliminary model design; (3) internal and peer validation; and (4) evaluation against international standards.FindingsThis PPM prioritizes holistic care for patients and their families to ensure clinical excellence and safety in nursing services. It integrates synergistic management, organizational structures, and continuous quality improvement to address contemporary healthcare challenges within a holistic care philosophy.ConclusionsThe "Bonds that Transform, Care that transcends" model provides a new framework for holistic hospital nursing practice. Grounded in humanistic perspectives, the model posits that therapeutic relationships transcend clinical procedures through high-quality interactions among staff, patients, and families. By fostering mutual growth, this care extends beyond the hospital to transform individuals, strengthen autonomy, and dignify the human condition. Broadly, this framework bridges theoretical holism with clinical pragmatism, promoting nursing leadership, facilitating education, advancing research, and offering a scalable roadmap for humanizing high-complexity healthcare institutions.
The increasing digitalization of everyday life means that digital artifacts persist after death, presenting unique and complex challenges in palliative care. Lacking clear conceptualization, digital legacy raises clinical, ethical, and legal uncertainties. Conceptual clarity is crucial to support palliative care teams in addressing digital legacy issues at the end of life. To examine and clarify the concept of digital legacy in palliative care. A concept analysis was conducted using Walker and Avant's eight-step method. Seven electronic databases (CINAHL, Embase, Medline, PsycInfo, Scopus, Web of Science, CareLit) were searched in May 2025, with no time restrictions and relevant English- and German-language publications were reviewed. Given the conceptual focus, no formal study quality appraisal was conducted. From 373 records, 46 articles were included. Digital legacy comprises the totality of digitally encoded artifacts that endure after an individual's death, manifesting as multidimensional, dynamically reconfigurable formations shaped by varying degrees of purposefulness, curation, meaning, media dependency, and access. Consequences include a broad range of emotional responses, ongoing support needs, transgenerational transmission, and potential risks of misuse. The concept of digital legacy in palliative care offers insights into its attributes, antecedents, and consequences. It clearly demonstrates that digital legacy is a complex, multidimensional phenomenon that extends far beyond technical data storage as an integral component of palliative care. Further research is needed to investigate the dynamics of digital legacy in palliative care.
The current kidney care model - focused on late-stage disease and in-center hemodialysis - is unsustainable because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly's recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, "Kidney Health for All: Caring for People, Protecting the Planet," calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment, and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers, and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.
PurposeTo evaluate early clinical outcomes of targeted muscle reinnervation (TMR) for post-amputation pain in an East Asian population and to describe its utilisation in Hong Kong.MethodsAll patients who underwent major limb amputation with TMR at our institution from January 2017 to December 2024 were reviewed. Fourteen patients (16 TMR procedures) with a minimum of 6 months follow-up were case matched to 16 control patients who underwent major limb amputation without TMR. Primary outcomes were post-amputation pain and analgesic use at latest follow-up (≥6 months). Secondary outcomes included operation time, length of stay (LOS), and 30-day and 90-day readmission and reoperation rates. Territory-wide utilisation of TMR was calculated using Hong Kong Public Hospital data system.ResultsOverall TMR utilisation in Hong Kong was 0.46% (35/7529 major amputations) over 8 years. At latest follow-up, only 5 patients (35.7%) in the TMR group required analgesics, while there were 12 patients (75.0%) requiring analgesics in the control group (P=0.030). Opioid analgesic use (with or without other analgesics) was significantly lower in the TMR group compared with controls (7.1% vs 50.0%; P=0.013). Residual limb pain (RLP), phantom limb pain (PLP) and neuropathic pain were numerically lower in the TMR group but did not reach statistical significance. Operation times, LOS, and 30-day and 90-day readmission and reoperation rates were comparable between groups (P>0.05).ConclusionTMR was associated with significantly reduced analgesic use, especially opioids, without increased surgical complications in our cohort of East Asians, verifying that clinical effectiveness of TMR could be reproduced in an Asian locality. Despite growing international evidence supporting TMR, its utilisation in Hong Kong remained very low. Clinician caring for patient with major limb amputation should be aware of the efficacy of TMR and increase its utilisation.
Compassionate nursing practice frequently requires nurses to navigate competing obligations, conflicting patient needs and constrained resources. While compassion motivates responsiveness to suffering, it does not always provide sufficient guidance for determining how such conflicts should be resolved. We argue that contemporary forms of utilitarianism may offer a useful framework for structuring compassionate practice in nursing within ethically pluralistic clinical environments. Drawing on contemporary utilitarian thought, particularly preference utilitarianism, the paper examines how attentiveness to suffering, preservation of dignity and responsiveness to patient vulnerability may be reframed around ethical deliberation under competing demands. Through clinical examples, we explore how compassionate nursing practice often involves the weighing of competing preferences, the prioritisation of morally significant needs and the allocation of finite professional attention. We argue that preference utilitarianism can fruitfully provide a structured ethical resource for evaluating actions according to their capacity to reduce and prevent suffering while respecting individual preferences and circumstances. The paper does not propose a foundational moral theory for nursing. Rather, it argues that preference utilitarianism can function as a complementary ethical resource alongside care ethics, virtue-based approaches and other relational perspectives, particularly in situations where nurses must navigate conflicting ethical duties. It therefore demonstrates how compassionate actions can be morally justified and systematically assessed, supporting a move from isolated acts of care towards more sustained and context-sensitive ethical practices within healthcare systems.
Suicide is a leading cause of death globally and represents a common, resource-intensive duty for police patrol officers (PPOs). Responding to suicidal crises is often traumatic, and PPOs rarely receive comprehensive training, leaving them inadequately prepared. Police authorities frequently assume operational responsibility in such situations, encompassing emotional, legal, tactical and safety considerations. This study aimed to explore and describe the competencies required of PPOs when encountering individuals in suicidal crisis. An exploratory, descriptive design was employed using a modified Delphi technique. Descriptions provided by PPOs of encounters with individuals in suicidal crisis were used to inform the development of items for a two-round questionnaire distributed to an expert panel. Experts were defined as individuals employed by the Swedish Police Authority or a university college, with additional training and/or teaching experience related to managing suicidal crises. Of the 50 experts invited, 43 completed both rounds, yielding a response rate of 86%. Consensus was achieved on 50 items, categorised into knowledge (n = 14), skills (n = 22) and attitudes (n = 14). The findings highlight the wide-ranging competencies required of PPOs, including policing-specific skills related to safety, interpersonal communication and psychiatric knowledge such as understanding mental disorders. Attitudinal competencies, such as demonstrating compassion and adopting a problem-solving approach, were also emphasised.
Diabetic foot disease in end-stage kidney disease (ESKD) represents the convergence of diabetic peripheral neuropathy, accelerated atherosclerosis, medial arterial calcification, uremic immune dysfunction and impaired wound healing. The combination yields amputation rates three- to five-fold higher than in non-uremic diabetics and one-year postamputation mortality approaching 40â?"50%. In this paper we synthesised the current anatomical, diabetological, nephrological and surgical evidence into a practical framework for the surgeon caring for the dialysis-dependent or kidney-transplant recipient with a diabetic foot. We conducted a narrative review of guidelines and consensus statements from the American Diabetes Association (ADA) Standards of Care 2025, KDIGO 2022/2024, the 2023 intersocietal International Working Group on the Diabetic Foot (IWGDF), European Society for Vascular Surgery (ESVS) and Society for Vascular Surgery (SVS) PAD guideline, the 2024 ACC/AHA Lower-Extremity PAD Guideline, the 2019 Global Vascular Guidelines on chronic limb-threatening ischemia (CLTI), and the KDOQI 2019/2020 vascular access update, supplemented by high-quality reviews published through 2026. Anatomical understanding of the tibioperoneal trifurcation, pedal-plantar loop and the angiosomal territories is now central to revascularization planning; belowthe- knee disease in ESKD is diffuse, calcified and pedal-dominant, mandating individualized choice between bypass, endovascular and transcatheter arterialization of the deep veins; perioperative care must integrate dialysis timing, hyperkalaemia control, anaemia and mineral-bone disease management, and ipsilateral vascular-access preservation; the threshold to definitive, well-planned amputation should be lower than in non-uremic diabetics, but only after a structured limb-salvage attempt within a multidisciplinary "toe-and-flow" team.
Recognising the subtle signs of positive emotions is essential for trust, cooperation, and social connections. However, everyday barriers such as face masks can hinder this ability. We tested whether a brief positive mood induction via comedy viewing could enhance the recognition of subtle smiles and whether this depended on mask-wearing and individual traits. Fifty-three adults (22 males, 31 females) completed a within-subject experiment, watching either a comedy performance or a neutral weather broadcast, and then judged the valence of morphed facial expressions (10-30% intensity) with or without a mask. Comedy viewing significantly increased positive mood and reduced negative mood. Recognition accuracy for subtle positive expressions improved after comedy for unmasked faces but not for masked faces. Greater perspective-taking and lower depressive mood were associated with greater improvement in exploratory analyses. These results suggest that a short, enjoyable activity, such as watching comedy, may enhance sensitivity to others' positive emotions, but only when key facial cues are visible.
Intrahospital transport (IHT) of critically ill patients for magnetic resonance (MR) imaging is a high-risk procedure that combines physiological vulnerability with MR-specific hazards. While technical guidelines and checklists exist, less is known about how MR safety is accomplished in everyday clinical practice when critically ill patients undergo MR imaging. This study aimed to explore how MR safety is enacted during IHT. A multisite focused ethnographic design was employed. Fourteen in-person observations were conducted across eight hospitals in Sweden and Portugal. Observations followed critically ill patients from ICU preparation through transport, MR scanning, and return to the ICU. Data consisted of field notes and analysis was conducted using inductive thematic analysis. MR safety emerged as a dynamic, context-dependent accomplishment rather than a fixed protocol. Three themes were identified: (1) the use of written, mental, and visual checklists and time-out procedures to coordinate safety work; (2) adaptation to spatial configurations and zoning practices shaping workflows and risk boundaries; and (3) managing uncertainty related to implants, devices, and incomplete information. Safety was continuously negotiated through interprofessional collaboration, experiential knowledge, and situational judgement, with gaps arising when communication, documentation, or MR-specific expertise were insufficient. MR safety during IHT of critically ill patients is enacted through the integration of structured tools, tacit knowledge, team coordination, and spatial adaptation under conditions of uncertainty. Safety is achieved in action through collective, context-sensitive practices rather than sole reliance on protocols. Radiographers play a central role in coordinating MR safety for critically ill patients. Strengthening layered safety strategies - combining checklists, time-outs, MR-specific education, and attention to spatial design - may reduce risk, support interprofessional collaboration, and enhance patient safety in MR practice.
To examine the association between the provision of compassionate care and patient loyalty and to assess the mediating role of patient satisfaction with nursing care quality in this association between the provision of compassionate care and patient loyalty. A correlational cross-sectional study. A total of 508 hospitalized patients were recruited using stratified proportional random sampling from five hospitals affiliated with Hamadan University of Medical Sciences, Iran, between November 2023 and July 2024. Participants completed the Compassionate Care Assessment Tool, the Patient Satisfaction with Nursing Care Questionnaire, and a patient loyalty questionnaire. Data were analysed using SPSS version 24 for descriptive and inferential statistics, including Pearson's correlation, independent-samples t-tests, one-way analysis of variance and linear regression. Mediation analysis was conducted using AMOS version 24. Structural equation modelling showed that provision of compassionate care was positively associated with patient satisfaction (β = 0.751, p < 0.001) and patient loyalty (β = 0.230, p < 0.001). Patient satisfaction with nursing care quality was positively associated with patient loyalty (β = 0.493, p < 0.001) and partially mediated the association between provision of compassionate care and patient loyalty (indirect β = 0.370, p < 0.001). The model explained 49% of the variance in patient loyalty (R2 = 0.49). Higher levels of perceived compassionate care were positively associated with greater patient loyalty, both directly and indirectly through higher patient satisfaction with nursing care quality. These findings highlight the pivotal role of compassionate care in improving patient satisfaction and fostering patient loyalty. Healthcare organisations should implement evidence-informed strategies to strengthen compassionate nursing care by addressing barriers and enhancing facilitators at the individual, patient and family and organisational levels. Nurses should promote compassionate communication and patient-centred, expectation-sensitive care to improve patient experience, satisfaction and loyalty.