Delivery Experience Research Articles

Reducing oral health inequalities for frail older people by improving access to oral care and integrated oral care.

Background: Oral health among frail home-dwelling older persons in Flanders (Belgium) is often insufficient, partly due to limited access to oral care and insufficient interprofessional collaboration in primary care. 
 Objective: Frail home-dwelling people aged 65 and above have limited access to oral health care due to e.g. problems with transport and mobility, financial constraints, and the lack of knowledge about the importance and added value of oral health care. Furthermore, insufficient interprofessional collaboration between healthcare and welfare professionals (due to e.g. unclear roles and insufficient knowledge and skills) contributes to a fragmented care delivery. However, poor oral health has a negative impact on their overall health and quality of life. The Gerodent Plus project aims to improve oral health care for frail home-dwelling older people by (1) improving the accessibility and continuity of care and (2) better integrating oral healthcare into primary care.
 Methods: This project is conducted in three phases, starting with a needs assessment by using a combination of qualitative (interviews and focus groups) and quantitative (online surveys) methods. In phase two, a complex intervention is being developed using an intervention mapping approach and the updated Medical Research Council framework. Phase three comprises the implementation and evaluation of this intervention. Throughout these three phases, a stakeholder group (frail home-dwelling older people, informal caregivers, healthcare and welfare professionals, organisations, and research groups) provides participant recruitment support and feedback. Recommendations will be provided using Valentijn’s rainbow model.
 Results: For the needs assessment, experiences in health care delivery, accessibility, and interprofessional collaboration are explored among both, frail home-dwelling older people, their informal caregivers, as well as their healthcare and welfare professionals. Results of the broad qualitative exploration and quantitative data will identify the various barriers in oral health care delivery, accessibility, and interprofessional collaboration. These results combined with evidence from the literature, will be used to develop a complex intervention. This intervention will act at the level of frail home-dwelling older people, their (informal) caregivers, as well as their healthcare and welfare professionals. Based on the evaluation, the interventions can be further optimised and implemented on a larger scale. 
 Conclusion: Results will provide insights into the current practices concerning oral health care delivery, accessibility, and interprofessional collaboration. Moreover, it will provide recommendations on how to optimise oral care at all levels of Valentijn’s rainbow model. At micro level, recommendations will relate to how continuity of oral health care can be improved for frail home-dwelling older people. At meso level, these will relate to how collaboration between healthcare and welfare professionals can be improved. Moreover, different organisations act as collaborative partners to exchange essential information. At macro level, recommendations will relate to a health policy that makes it easier for organisations and professionals from different primary care and social care disciplines to work together on oral health improvements. Overarching, a distinction will be made between normative and functional integration.

Classification of Motivation for Orthodontic Treatment: A Review Article

Today more than ever, functional and aesthetic changes during the growth, which have been proven to influence the patient's quality of life for better, remain an essential reason for conducting orthodontic treatment. Understanding the psychological characteristics and motivations of each patient is fundamental and a part of empathy. But these factors must be controlled because they can affect patient’s satisfaction and cooperation. Therefore, there is a need for clinicians to improve the patient experience of treatment delivery and increase the potential for a successful treatment outcome. The aim of the present study is to present a classification of motivation for orthodontic treatment. In fact, the classification proposal is based on more than 10 years of own research on orthodontic treatment motivation and awareness.

Exploring Rehabilitation Provider Experiences of Providing Health Services for People Living with Long COVID in Alberta.

COVID-19 infection can result in persistent symptoms, known as long COVID. Understanding the provider experience of service provision for people with long COVID symptoms is crucial for improving care quality and addressing potential challenges. Currently, there is limited knowledge about the provider experience of long COVID service delivery. To explore the provider experience of delivering health services to people living with long COVID at select primary, rehabilitation, and specialty care sites. This study employed qualitative description methodology. Semi-structured interviews were conducted with frontline providers at primary care, rehabilitation, and specialty care sites across Alberta. Participants were interviewed between June and September 2022. Interviews were conducted virtually over zoom, audio-recorded, and transcribed with consent. Iterative inductive qualitative content analysis of transcripts was employed. Relationships between emergent themes were examined for causality or reciprocity, then clustered into content areas and further abstracted into a priori categories through their interpretive joint meaning. A total of 15 participants across Alberta representing diverse health care disciplines were interviewed. Main themes include: the importance of education for long COVID recognition; the role of symptom acknowledgement in patient-centred long COVID service delivery; the need to develop recovery expectations; and opportunities for improvement of navigation and wayfinding to long COVID services. Provider experience of delivering long COVID care can be used to inform patient-centred service delivery for persons with long COVID symptoms.

‘I wouldn’t trust it …’ Digital transformation of young people’s sexual health services: a systems-informed qualitative enquiry

IntroductionDigital sexual health technologies for young people, such as websites, texting services and apps, could address some of the sexual health inequalities that many experience, since they have the potential...

Clinical case of delivery of a pregnant woman with large uterine leiomyoma and rehabilitation in the postoperative period

Abstract. Uterine leiomyoma is a benign neoplasm of the smooth muscles of the uterus, which is one of the causes of infertility and miscarriage in women in the modern world. Delivery of pregnant women with large uterine leiomyoma is a current problem, since there is no single and clear opinion regarding the tactics of managing such patients. In the past, most specialists were inclined to perform hysterectomy after cesarean section, as they considered it the safest method of therapy, since myomectomy during cesarean section raised many questions related to complications during surgery and in the postoperative period. This article examines the modern view of specialists and the experience of the authors on organ-preserving tactics for the treatment of large uterine leiomyomas in women during pregnancy and delivery and analyzes rehabilitation in the postpartum period. The aim of the study. The aim of the study was to analyze scientific literature data on the advisability of performing myomectomy during cesarean section and combining the experience of other specialists with our own experience of delivery of pregnant woman with large uterine leiomyoma using a complex of intraoperative preventive measures. Materials and methods. A clinical case of delivery of a pregnant woman with large uterine leiomyoma and rehabilitation in the postoperative period is described. A systematic online study of articles on the topic of myomectomy during cesarean section was conducted. Results and discussion. Data from a significant number of works by other specialists indicate that preliminary substantiation of factors that may complicate surgical intervention (uterine contractility, anatomical localization, number and diameter of fibroids, as well as the presence of large vascular structures), the use of a set of preventive intraoperative measures and modern suture materials can reduce the amount of blood loss and prevent unfavorable postoperative results. Our proposed algorithm of action, including the administration of tranexamic acid before opening the anterior abdominal wall, a long-acting oxytocin agonist and the hemostatic sponge «Surgicel», allows us to minimize the amount of intraoperative bleeding and the risks of uncontrolled bleeding. It should also be noted that the addition of a cesarean section with myomectomy does not affect the course of rehabilitation in the postoperative period. Conclusions. Based on a study of literary sources over the past 10 years and our own research, we can conclude that myomectomy during cesarean section is advisable in the absence of contraindications. A combination of postoperative rehabilitation measures, tactics and techniques of surgical intervention, and prevention of intraoperative blood loss make it possible to ensure high-quality recovery for patients.

Twice-daily versus once-daily vaginal dinoprostone gel for induction of labor at term: A randomized controlled trial

ObjectiveThe aim of this study was to compare twice-daily versus once-daily administration of intravaginal PGE2 for induction of labor at term. Efficacy, safety, and patient satisfaction were evaluated. Study designFor this single-center, randomized, comparative, open-label, two-arm, and parallel study, pregnant women with term singleton live pregnancies ≥ 37 weeks of gestation, medical indications for induction of labor, and Bishop score ≤ 6 were randomized to either the control group (induction of labor with PGE2 gel with repeat dose after 24 h) or the experimental group (repeat dose after 12 h). The primary outcome was induction-to-delivery interval time. Secondary outcomes were maternal and neonatal outcomes and patient satisfaction. ResultsIn total, 246 women were randomized to the control (n = 121) or experimental groups (n = 125). The mean time for initiation of induction to delivery was 9.4 h shorter in the experimental group compared to controls (p = 0.007). For control vs experimental, there were no differences in tachysystole (19/121, 15.7 % vs 21/124, 16.9 %, respectively; p = 0.79), cesarean section rate (18/121, 14.9 % vs 28/124, 22.6 % respectively; p = 0.12), or other main obstetrical or neonatal outcomes. Patients in the experimental group reported higher satisfaction with their induction (48/96, 50 % with once-daily vs 60/86, 69.8 % with twice-daily; p = 0.010). ConclusionAmong women admitted for induction of labor at term, closer interval of vaginal PGE2 administration was associated with a significantly shorter induction-to-delivery time without increasing maternal or neonatal morbidity. Furthermore, the reduction in induction time was associated with improved patient experience of delivery.

Investigating the consumption behavior of young adults using online food delivery platforms during the COVID-19 pandemic

PurposeOnline food delivery has been prevalent in recent years worldwide, especially during the COVID-19 pandemic, and people's consumption behaviors have changed significantly. This study aims to investigate the consumption behavior of young adults using online food delivery platforms during the COVID-19 pandemic and focuses on the dominant factors influencing their decision to use online food delivery platforms.Design/methodology/approachSemi-structured interviews including 14 young adults aged 18–25 living in Hong Kong were conducted to collect data about their perspectives on online food delivery platforms in five areas. This research adopted the stimulus-organism-response model (S-O-R model) to analyze how the factors influence young adult users' loyalty and satisfaction with online food delivery platforms.FindingsThematic analyses revealed that young adults were attracted to online food delivery platforms for their numerous benefits. They had a high frequency of usage and significant spending. Usability, usefulness, satisfaction and loyalty influenced young adults' behaviors on online food delivery platforms. Participants were overall satisfied with their experiences, but platforms still had room for improvement.Originality/valueFew prior studies investigated the factors affecting the consumer experience and behavioral intention of online food delivery for young adults in Asia. This study contributes to understanding young adults' experiences and problems with online food delivery platforms. It provides practical insights for system engineers and designers to improve the current services and for the governments to enhance the existing regulatory loopholes.

Developing a Comparative Effective Methodology forTechnology Usability During a Simulated Casualty Event.

Future combat environments will be complex, making effective care for multi-domain battlefield injuries more challenging. Technology and resources are essential to reduce provider burden enabling more accurate assessments, decision-making support, expanded treatment, and outcome improvements. Experimentation exercises to evaluate concepts and technologies to incorporate into the Army's future force ensure rapid and continuous integration across air, land, sea, space, and cyberspace domains to overmatch adversaries. A medical lane was first integrated on the communications networks for experimentation in 2022. We describe a project to develop a method for empirically comparing devices intended to support combat casualty care through high-fidelity simulation in preparation for an Army experimentation exercise. Six medics participated in a series of high-fidelity simulation medical casualty injury scenarios with and without technology devices. The participants provided usability information about their care delivery experiences using the System Usability Scale and Adapted Telehealth Usability Questionnaire-Telemedicine and Advanced Technology Research Command and qualitative feedback. A comparative effectiveness design compared the devices regarding their usability, size, weight, and power with the addition of cost, connectivity, and cyber security, and the qualitative feedback this methodology holistically assessed the technologies as they were applied in the combat casualty care scenario. Results were used by decision makers to determine technology inclusion in experimentation exercise, develop proof of concept methodology to scale for the exercise, and provide technology developers feedback for iterative updates of their devices before participation in experimentation exercise. This project supports the body of simulation studies conducted to understand combat casualty care. It is one of few empirical medical technology assessments with medical personnel end user input that has been reported. The methodology incorporates a user-centered design for rapid technology improvements before fielding.

Gaps in care planning and delivery for patients with liver cancer: Baseline assessment for implementation of 4R Oncology model.

381 Background: Liver cancer is a complex disease, requiring detailed care planning, patient engagement and delivery of comprehensive care, including supportive and health maintenance care. The 4R Oncology Model for patient facing care planning, patient self-management and team based delivery of complex care has the potential to address these needs. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care in breast and lung cancer (Trosman JCOOP 2021; Liu JCOOP 2022). The impact of 4R in liver cancer has not been examined. Ochsner Health’s multi-disciplinary live cancer team is implementing and evaluating 4R. Here we describe the baseline assessment of provider practices and patient experience of care planning and delivery of supportive and health maintenance care. Methods: Surveys of providers and patients on current care planning and delivery in liver cancer were conducted Oct 2022 – Jan 2023. We used 3 metrics of care planning and 3 metrics of care delivery (Table). Results: Survey response rates: providers 55% (33/60), patients 45% (27/60). Providers included physicians, advance practitioners, nurses and navigators from Hepatology, Transplant, Interventional Radiology and Medical Oncology. Patients were 56% female, 63% white, 37% black, 56% < 30k income. In care planning, patient experience was reported at a similar rate as provider practices for informed on goal of care, but significantly higher than providers for informed on next steps in care and receiving a detailed care plan (Table). In care delivery, patient experience and provider referral practices for social and supportive care were similarly low. Rates of patients’ receiving primary care and substance abuse assistance were significantly higher than respective rates of provider referrals. Among providers, 73% give patients a verbal care plan and 27% a hand written plan. The current process to create care plans is satisfactory to 54% of providers. Conclusions: We found substantial gaps in care planning and referrals to supportive and health maintenance care. Higher rates of patients reporting receipt of care planning and services suggest that many patients may resort to their own devices in these aspects of care. Ochsner Health aims to address these gaps by implementing the 4R Oncology model in liver cancer and will share results when available.[Table: see text]

Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

ObjectivesTo design, develop, deliver and assess a training initiative on haemorrhage control for emergency medical services (EMS) staff in Ukraine, in an active wartime setting.DesignUsing the Medical Research Council framework...

Digital transformation at Hall Green Health – A model for modern general practice

Navigating the digital journey in healthcare is marked by both challenges and opportunities. Hall Green Health (HGH), a large family practice in Birmingham, UK, represents an innovative model for digital transformation in general practice. This paper explores HGH's journey towards becoming a digitally advanced healthcare provider, focusing on its strategies, interventions, patient engagement, and reputation management. Through an analysis of the practice's initiatives and outcomes, the paper highlights the potential of digital tools and approaches to enhance healthcare delivery and patient experience. Insights from this study may serve as valuable guidance for other practices aiming to embrace the future of digital healthcare.

Acute Corneal Hydrops in Keratoconus Coinciding With COVID-19 Infection.

To the Editor: Acute corneal hydrops (AH), characterized by corneal stromal edema after a Descemet membrane rupture that allows aqueous humor entry, is observed in cases of keratoconus. Patients typically present with rapidly deteriorating visual acuity, photophobia, and pain. A timely diagnosis and management are essential to ruling out other vision-threatening pathologies such as corneal edema, infectious keratitis, uveitis, Fuchs endothelial dystrophy, postoperative edema, and acute transplant rejection. Here we describe a case of AH in a patient with keratoconus coinciding with coronavirus disease 2019 (COVID-19) infection and emphasize the importance of patient education in the context-restricted face-to-face consultations. A 20-year-old healthy man was evaluated regularly every 3 months for keratoconus using visual acuity and refraction assessments and anterior segment optical coherence tomography imaging. He wore corneal rigid gas-permeable contact lenses in both eyes. He also had a mild ocular allergy but no atopy or habit of eye-rubbing. There was no family history of keratoconus. A year earlier, he had an episode of AH in his left eye. While his left eye stabilized after pressure patching, the keratoconus progressed in his right eye. Examination findings at his last visit before the COVID-19 diagnosis included: corrected distance visual acuity with a gas-permeable contact lens of 20/30 (right) and 20/16 (left), anterior keratometry of 66.4 D (right) and 43.5 D (left), the thinnest corneal thickness of 264 mm (right) and 468 mm (left), and posterior “best-fit sphere” 9-mm radius values of 4.88 (right) and 6.46 mm (left). Approximately 2 months after the last follow-up, he developed flu-like symptoms (sore throat and fever) and was diagnosed the next day with COVID-19 on polymerase chain reaction. Two days after symptom onset, he noticed sudden deterioration of vision in his right eye and called our hospital. The cornea specialist in the ophthalmology department made a tentative phone diagnosis of AH based on his ocular history and instructed him to apply a pressure patch with ophthalmic ointment. He was examined at our hospital after 10 days of quarantine. The corrected distance visual acuity of the right eye was 20/2000, while a slitlamp examination revealed corneal protrusion and marked corneal epithelial as well as stromal edema in the right eye. Fluorescein corneal observation showed no epithelial abnormality, and a definitive AH diagnosis was made. Optical coherence tomography imaging revealed a break in Descemet membrane with overlying corneal edema (Supplemental Digital Content Fig. 1, https://links.lww.com/APJO/A179). No abnormality was noted in the left eye. He had received the second COVID-19 vaccine dose 1 month before the viral infection and reported experiencing no vaccine-related complications. On examination a month later, the AH in the right eye had remarkably improved. Various ophthalmic management and care delivery experiences have been reported during the COVID-19 pandemic. Perspectives in corneal crosslinking were reported relating to keratoconus in particular.1,2 To the best of our knowledge, our case is the first of AH with concomitant keratoconus and COVID-19 infection, although it was not possible to demonstrate a clear association among them. A previous history of AH in either eye is a predisposing risk factor for AH.3 This case underscores the importance of informing patients of their disease status and the need to undergo regular examinations. However, patients with COVID-19 may not be able to receive a timely ophthalmic examination. This patient was distressed until the postquarantine ophthalmic examination was performed; however, his previous experience with AH including successful pressure patching was helpful for the clinician and patient, who was better able to understand the extent of his condition and follow the provided instructions. In the absence of a clinical history of keratoconus, effectively managing AH before a face-to-face examination could be performed would have been challenging. Here are summary points of consideration when educating a patient with an acute event during a pandemic setting: Recognize the patient’s distress due to being in isolation during the acute event. Provide clear information about the disease and instructions for its independent management during quarantine. Strict hand hygiene should be thoroughly practiced while applying the pressure patch and patients should keep unwashed hands away from their face at times. Remote management may require conservative management methods. This requires careful consideration, particularly in acute ophthalmic cases. Although keratoconus was previously considered a noninflammatory ectatic corneal disease, recent evidence shows a relationship between its pathogenesis and chronic inflammatory events.4,5 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is known to cause a proinflammatory state.6 There are several reports of corneal graft rejection in patients infected with COVID-19.6–8 Large population-based case-control studies are needed to investigate the possible association between AH in keratoconus and the SARS-CoV-2 cytokine response. Shizuka Koh, MD, PhD*† Takeshi Soma, MD, PhD† Vishal Jhanji, MD‡ Kohji Nishida, MD, PhD†

An exploration of employees’ experiences of online food delivery: evidence from employee reviews

PurposeOnline food delivery service has evolved swiftly and stretched the bounds of the catering business. In the gig economy, being a food delivery rider draws employees with the promise of flexibility and independence. To this end, the purpose of this paper is to explore the main themes shared in online reviews by food delivery riders and which of these themes are linked to positive and negative ratings.Design/methodology/approachThe authors used 729 employee reviews posted on the Glassdoor website. In addition, they used content analysis to examine reviews of Uber Eats online food ordering company shared by food delivery riders on an online platform.FindingsThe results of this study include seven main themes: “earning,” “customers,” “orders,” “tips,” “car,” “flexible schedule” and “app” (navigation). Positive concepts are associated with “earning,” “orders,” “tips” and “flexible schedule.” Negative themes are linked to the “app” (navigation), “car” and “customers.”Practical implicationsManagement should consider online reviews as employees’ opinions and voices. Specifically, management should provide financial support to employees for car maintenance, offer insurance for income stability and arrange training programs to enable them to use several tip-enhancing behaviors.Originality/valueNo research has been conducted using online reviews from an employment search engine to investigate employees’ experiences of online food delivery. To the best of the authors’ knowledge, this study is one of the first attempts using user-generated content from an employment search engine to explore employees’ experiences.

Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study.

Integrating behavioral health services into primary care has a strong evidence base, but how primary care training programs incorporate integrated behavioral health (IBH) into care delivery and training has not been well described. The goal of this study was to evaluate factors related to successful IBH implementation in family medicine (FM) residency programs and assess perspectives and attitudes on IBH among program leaders. FM residency programs, all which are required to provide IBH training, were recruited from the American Academy of Family Physicians National Research Network. After completing eligibility screening that included the Integrated Practice Assessment Tool (IPAT) questionnaire, 14 training programs were included. Selected practices identified 3 staff in key roles to be interviewed: medical director or similar, behavioral health professional (BHP), and chief medical officer or similar. Forty-one individuals from 14 FM training programs were interviewed. IPAT scores ranged from 4 (Close Collaboration Onsite) to 6 (Full Collaboration). Screening, outcome tracking, and treatment differed among and within practices. Use of curricula and trainee experience also varied with little standardization. Most participants described similar approaches to communication and collaboration between primary care clinicians and BHPs and believed that IBH should be standard practice. Participants reported space, staff, and billing support as critical for sustainability. Delivery and training experiences in IBH varied widely despite recognition of the value and benefits to patients and care delivery processes. Standardizing resources and training and simplifying and assuring reimbursement for services may promote sustainable and high quality IBH implementation.

Factors Affecting Women's Attitudes Toward the Use of Epidural Anesthesia During Labor in Riyadh in 2023.

Background Epidural analgesia (EA) is a type of central nerve block achieved by injecting a local anesthetic near the pain-transmitting nerves. It is commonly used to relieve pain during labor. The intensity of pain experienced and the effectiveness of pain relief can affect a woman's labor and delivery experience. Labor pain is a long-lasting and debilitating pain that women experience; therefore, pain relief techniques have become widely available. However, not all women are willing to use EA for pain relief. The factors that influence women's choices regarding EA should be explored. This study aimed to comprehend women's perspectives on EA in Riyadh and clarify the variables influencing their decision-making. Methodology A total of 336 women in their reproductive years participated in this study. An online questionnaire with five sections was used to collect data. The socio-demographic information in the first section covered age, level of education, occupation, income, marital status, pregnancy, maternity, and prenatal care. The second section focused on how painful labor was for women who had already given birth. The third and fourth sections discussed labor pain relief techniques, including epidural anesthesia. The final section assessed the participant's interest in receiving EA during the next delivery. Socio-demographic data were considered to be a predictor, whereas awareness levels and a desire to receive EA were seen as results. The information was cleaned, coded, and entered into SPSS version 29 (IBM Corp., Armonk, NY, USA). The results are presented as frequencies and percentages. A Likert scale was used for data analysis. Statistical significance was established at p-values <0.05. Results In total, 336 Saudi women were included in this study, 86% of whom were between the ages of 30 and 35 years, and 69% of whom had a university education. One-third of the women (32%) had a monthly income of 10,000 to 20,000 SAR, and 55% of them had experienced three or more pregnancies. Fear of pain was the main reason for using epidural anesthesia in more than half of the participants given the choice. The most reinforcing factor was obtaining proper and sufficient information about EA, while the most restrictive factor was the fear of harming the infant. In particular, women aged 30-35 years (i.e., most of the included women) were commonly influenced by negative factors. Marital status and educational level played no significant role in women's use of EA. Conclusions Saudi women showed a good attitude toward EA. However, the awareness of EA was quite low. Fear of labor pain appeared to be the main reason for using EA. Health education programs on EA can increase the knowledge of and intent to use EA among women.

Understanding collaborative and coordinated care in a mental health and well-being context: Essential elements for effective service integration.

Multiple system reforms in Australia, including the National Disability Insurance Scheme (NDIS), are changing mental health (MH) and disability-related service provision, whilst policy drivers continue to require service integration. This has necessitated service providers discovering new ways of working collaboratively to achieve an integrated model of care. This qualitative study examined what does and does not work to support collaborative and coordinated care (CCC), as essential components of service integration. The study sample (n = 59) included four cohorts: health and community service leaders (n = 16), staff (n = 23); MH service consumers with complex needs (n = 10), and MH carers (n = 10). Thematic analysis from interviews was applied to data from each cohort to identify overarching themes that described the lived experience of current CCC delivery. COREQ and EQUATOR guidelines were applied to reporting the findings. Themes emphasized CCC is enabled by the development and sustainability of positive working relationships, and depth of knowledge across health and community services. Unnavigable service systems, stigmatization, perceived power differentials, multiple and rapid service reforms and Fee-For-Service (FFS) models provide significant barriers to CCC. Recommendations include the need for accessible service navigation, consumer-friendly service environments, a stable workforce, standardization of knowledge across sectors, outcome measures and funding attached to CCC as part of a raft of potential changes.

Stroke Inpatient Rehabilitation Environments: Aligning Building Construction and Clinical Practice Guidelines Through Care Process Mapping.

Stroke inpatient rehabilitation is a complex process involving stroke survivors, staff, and family utilizing a common space for a shared purpose: to optimize recovery. This complex pathway is rarely fully described. Stroke care is ideally guided by Clinical Practice Guidelines, and the rehabilitation built environment should serve to optimize care delivery, patient and staff experience. We aimed to articulate the inpatient stroke rehabilitation process of care in a series of process maps, and to understand the degree to which current stroke clinical and building construction (ie, design) guidelines align to support inpatient stroke rehabilitation. We used the Value-Focused Process Engineering methodology to create maps describing the events and activities that typically occur in the current stroke inpatient rehabilitation service model. These maps were completed through individual and group session consultations with stroke survivors, architects, policy makers, and clinical experts. We then determined which sections of the Australian Stroke Rehabilitation Guidelines and the Australasian Health Facility Design Guidelines could be aligned and applied to the process maps. We present a summary process map for stroke inpatient rehabilitation, alongside detailed process maps for 4 different phases of rehabilitation (admission, a normal weekday, a weekend day, and discharge) using Value-Focused Process Engineering notation. The integration of design and clinical guidelines with care pathway maps revealed where guidelines lack detail to be readily linked to current stroke inpatient care practice, providing an opportunity to design stroke inpatient rehabilitation spaces based on the activities occurring within them. Our findings highlight gaps where clinical and design experts should work together to use guidelines to their full potential; and to improve the process of planning for future stroke rehabilitation units.

Chinese Neonatal Nurses' Lived Experiences of Providing End-of-Life Care in the NICU: A Descriptive Phenomenological Study.

Although end-of-life care (EOLC) has been well-studied, the experience of neonatal intensive care unit (NICU) nurses in China, where little EOLC training is provided, requires further investigation. To explore the lived experience of EOLC delivery among NICU nurses, to provide evidence to enhance nurses' EOLC skills and improve their overall quality. This qualitative study adopted a phenomenological approach. A total of 11 NICU nurses participated in semistructured in-depth interviews between June and July 2022 at the First Affiliated Hospital of University of Science and Technology of China (USTC). Colaizzi's 7-step method was used to analyze the data. Five main themes were identified: (a) multiple emotions are experienced during EOLC delivery; (b) EOLC delivery is stressful from various sources for nurses; (c) expressing empathy and compassion is important; (d) ethical and clinical decision-making are key components of EOLC delivery; and (e) there are challenges in improving neonatal EOLC understanding and delivery. The experience of EOLC among Chinese NICU nurses is multidimensional and intensive. Institutions or units must establish and implement related protocols and guidelines to address differences between clinical practice and ideal protocols for neonatal EOLC. Educational programs that consider nurses' personal and interpersonal factors, including local culture, must be developed. Neonatal nurses in Western countries encountering Chinese-born parents who have lost their infants can gain an understanding of parents' perceptions from this study. Future research should focus on developing and testing interventions to train and support NICU nurses working with end-of-life neonates.

The effect of an adapted Mindfulness-Based Stress Reduction program on mental health, maternal bonding and birth outcomes in psychosocially vulnerable pregnant women: a study protocol for a randomized controlled trial in a Danish hospital-based outpatient setting

BackgroundStress and mental disorders in pregnancy can adversely affect the developing fetus. Women with a preconception history of mental disorders or of psychosocial vulnerabilities are at increased risk of experiencing perinatal stress or mental health problems. Mindfulness-Based-Stress-Reduction (MBSR) is an acceptable intervention for pregnant women and has a growing evidence-base with meta-analyses consistently pointing to reductions in symptoms of stress, anxiety and depression. This study protocol aim to address the need for a wider array of evidence-based and non-pharmacological options during pregnancy to reduce stress and improve mental health in a psychosocially highly vulnerable group of women.MethodsPregnant women with a preconception history of mental disorders or psychosocial vulnerabilities (n = 240) will be recruited from an obstetric ambulatory clinic at Copenhagen University Hospital, Hvidovre, Denmark. Recruitment for the study began in March 2022 and will continue until the desired number of participants is reached. Consenting pregnant women will be randomized to one of two study arms, an adapted MBSR program as add on to usual care or usual care alone. The primary outcome is mental wellbeing at nine months post-randomization. Secondary and exploratory outcomes include stress, anxiety, depression, and maternal antenatal attachment, experience of childbirth, delivery and mode of delivery. Mindfulness and self-compassion are examined as possible mediators of the effect on outcomes.DiscussionTeaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to improve mental health and wellbeing during pregnancy, reduce stress and support the transition to parenthood. Mindfulness-Based Stress Reduction does not target a particular group, and results from the study is thus of potential relevance for pregnant women in general as a means of reducing stress and improving perinatal mental health and wellbeing.Trial registrationClinicalTrials.gov: NCT05300646. Registered March 29, 2022.

Top Ten Tips Palliative Care Clinicians Should Know About Dignity-Conserving Practice.

The acknowledgment and promotion of dignity is commonly viewed as the cornerstone of person-centered care. Although the preservation of dignity is often highlighted as a key tenet of palliative care provision, the concept of dignity and its implications for practice remain nebulous to many clinicians. Dignity in care encompasses a series of theories describing different forms of dignity, the factors that impact them, and strategies to encourage dignity-conserving care. Different modalities and validated instruments of dignity in care have been shown to lessen existential distress at the end of life and promote patient-clinician understanding. It is essential that palliative care clinicians be aware of the impacts of dignity-related distress, how it manifests, and common solutions that can easily be adapted, applied, and integrated into practice settings. Dignity-based constructs can be learned as a component of postgraduate or continuing education. Implemented as a routine component of palliative care, they can provide a means of enhancing patient-clinician relationships, reducing bias, and reinforcing patient agency across the span of serious illness. Palliative care clinicians-often engaging patients, families, and communities in times of serious illness and end of life-wield significant influence on whether dignity is intentionally integrated into the experience of health care delivery. Thus, dignity can be a tangible, actionable, and measurable palliative care goal and outcome. This article, written by a team of palliative care specialists and dignity researchers, offers 10 tips to facilitate the implementation of dignity-centered care in serious illness.