Opportunities and Challenges in Using Smartphone Sensor Data to Capture Surgeon Behavior and Well-Being: A Qualitative Analysis of Surgical Residents' Perspectives.

Enhancing employee retention in nursing homes through non-monetary incentives: Insights from focus groups.

Digital interventions are potentially promising to improve accessibility and efficiency of genetic counseling services. However, current literature on user perspectives toward digital tools for cascade testing is limited. Therefore, this focus-group study aimed to gain insights into the attitude and perspectives of probands, at-risk relatives (ARR), and genetic healthcare professionals (HCP) toward digital innovations for assistance with both pretest and posttest counseling and cascade genetic testing in cardiogenetics. We conducted seven online focus groups, which were transcribed and thematically analyzed. In total, 37 individuals participated (10 probands, 11 ARR and 16 HCP). Thematic analysis of focus group transcripts showed a first theme of (1) acceptability of digital tools. Other identified themes were defined as "domains," where digital tools impact traditional, in-person clinical genetic care, being (2) family communication, (3) decision-making, (4) care relations, and (5) the genetic care system. Participants expressed a predominantly positive attitude toward the digitization of (parts of) the predictive genetic counseling journey in cardiogenetics under the condition that access to human contact is preserved. In the clinical setting of predictive counseling, efforts should be made to ensure access to genetic services for all ARR and to protect in-person involvement of HCP.

Missed nursing care (MNC), the omission or delay of required nursing activities,is closely linked to patient safety, strained work environments and nurse burnout. Although contributing factors such as staffing shortages, workload pressures and teamwork deficits are well established, emerging research shows that MNC also involves intentional prioritization by nurses under constrained conditions. However, less is known about how nurses experience and manage these competing demands in everyday practice, particularly in surgical inpatient settings. This study explores nurses' experiences of MNC and the strategies they employ to maintain and improve nursing care. A qualitative descriptive design was used, based on focus group interviews. Six focus groups were conducted with a convenience sample of 20 nurses from three inpatient wards at one surgical clinic. Transcribed data were analyzed using thematic analysis. Three themes were identified: “ Caught in a tug of war ”, “ Bridging the gap ” and “ Active patients with a seat at the table ”, along with seven sub-themes describing nurses' experiences of MNC and their strategies to reduce it. These strategies involved drawing on clinical experience, providing patient education and helping patients to actively participate in their care. Leadership also emerged as essential, particularly in prioritizing and allocating resources to patients with the greatest care needs to ensure equitable and effective care delivery. This study identified key strategies to reduce MNC and its implications for patient safety and the work environment. Addressing MNC requires adequate staffing, effective teamwork, supportive leadership and active patient involvement. • Nurses experience missed nursing care due to time pressure and competing demands. • Education and effective use of clinical experience are key strategies to reduce missed nursing care. • Active patient participation can support the completion of essential nursing care. • Leadership and resource prioritization are critical for equitable care delivery.

Neuroanatomy is a core component of medical education yet may contribute to neurophobia, in part due to difficulty visualizing three-dimensional structures and applying foundational knowledge to clinical reasoning. Although active learning strategies such as flipped classrooms, case-based learning, and near-peer teaching are increasingly used to teach neuroanatomy, there is limited qualitative exploration describing how learners experience these modalities and how they support learning. This represents an important gap for educators designing learner-centered neuroanatomy instruction. The aim of this curriculum was to enable preclinical medical students to (1) identify and describe major neuroanatomical structures, pathways, and vascular territories; (2) interpret basic neuroimaging to support anatomical localization; (3) distinguish central from peripheral causes of neurologic deficits; and (4) justify lesion localization by integrating clinical history, examination findings, and imaging. We evaluated a six-week preclinical neuroanatomy curriculum within the Harvard Medical School course Mind, Brain, and Behavior, which integrates asynchronous preparatory materials, in-person case-based collaborative learning ("mini-cases"), and hands-on cadaveric ("damp") laboratory sessions facilitated by faculty and resident near-peer instructors. Learners completed required preparatory work before participating in paired in-person sessions emphasizing deliberate practice in anatomical localization. Program evaluation used mixed methods, including anonymous postcourse evaluation survey data and a semistructured focus group. Focus group transcripts were analyzed using a mixed deductive-inductive thematic approach. Of 168 enrolled students, 138 (82.1%) completed the postcourse evaluation. Overall course quality was rated as Excellent or Good by 94% (95% CI 89%-97%). Mini-cases and damp laboratory sessions were rated Excellent or Good by 94% (95% CI 85%-98%) and 74% (95% CI 62%-83%) of respondents, respectively. Twelve students participated in the focus group. Four major themes emerged: acquiring knowledge, applying knowledge, clinical relevance, and opportunities for improvement. Students highlighted the value of repeated case-based practice, near-peer clinical insight, and realistic exposure to neurology practice. An integrated, multimodal neuroanatomy curriculum emphasizing active learning and clinical application was positively received and aligned with stated learning objectives. Key lessons include the importance of structured near-peer preparation, progressive scaffolding of complex anatomy, and repeated opportunities for application. These findings may inform the design of clinically oriented neuroanatomy curricula across institutions.

Obesity care education in Canadian medical schools: A multi-site qualitative study.

Important outcomes for patients with frailty admitted to hospital with peripheral arterial disease, their caregivers and their health professionals: A Nominal Group Technique study.

Engaging people with lived/living experience (PLLEX) and caregivers (-C) is becoming more widely adopted in mental health and substance use health research. Their engagement meaningfully improves the relevance and impact of research outcomes. Yet, authentic engagement can be difficult to achieve without building and maintaining strong relationships with PLLEX-C. This qualitative descriptive study explores the perspectives of PLLEX-C engaged in mental health and substance use health research regarding how to build relationships and rapport. We recruited 18 participants, who were divided into four focus groups conducted virtually. A semi-structured focus group guide, co-created with a PLLEX-C Working Group, was used to guide the focus group discussions. The transcribed discussions were then analyzed using codebook thematic analysis, and results were reviewed with the PLLEX-C Working Group. Data analysis generated three themes: 1) Authentic treatment as colleagues, 2) Spending time together in flexible ways, and 3) Team-building activities. Fostering relationships and rapport with PLLEX-C promotes authentic engagement and knowledge sharing. Building these relationships requires mutual respect, time commitment, and opportunities for connection. Such relational foundations are key to producing meaningful research outcomes and creating cohesive, collaborative teams. • Involving PLLEX-C in mental and substance use health research ensures impactful outcomes. • Building relationships and rapport in engagement contexts can be challenging. • Building healthy relationships and rapport with PLLEX-C promotes meaningful engagement. • Key factors that facilitate relationship building include mutual respect, time commitment, and team building activities.

Families face long waits for their child to undergo a diagnostic assessment for possible autism. This study explored the experiences of parents and children/young people (CYP) accessing and professionals providing autism diagnostic assessments in the United Kingdom. This realist evaluation was conducted in three phases: (1) interviews and focus groups with parents, CYP and professionals from six U.K. National Health Service (NHS) childhood autism assessment and diagnosis services; (2) resulting qualitative data were analysed, and programme theories (PTs) explaining how, why and in what contexts childhood autism assessment and diagnosis pathways work well were tested and refined; and (3) recommendations for change were developed by the research team and presented to delegates at six dissemination events including 250 clinicians, managers, parents/carers, commissioners and academics involved in autism assessment and diagnosis. Delegates were invited to select and rank the most important recommendations. There were 121 participants in Phase 1 (18 CYP, 34 parents, 69 professionals). In Phase 2, both families and clinicians confirmed challenges in the assessment and diagnostic process, including increased demand for assessments and insufficient numbers of specialist multidisciplinary team (MDT) practitioners to provide adequately skilled workforces. The need to support families across the whole assessment and diagnostic process was seen as key to providing a quality service but was often not possible. Steps taken to improve the process were identified, and seven PTs covered: improving recognition of children needing referral, referral processes, service organisation, professional skill mix, assessment, feedback/report writing and training/service evaluation. In Phase 3, during consultation, 12 recommendations were selected as most important for change. Several strategies for improving services were identified that may reduce waiting times and increase acceptability and quality of childhood autism assessment and diagnosis services.Lay AbstractWaiting lists for childhood autism assessments are lengthy, meaning families wait a long time for their child to undergo a diagnostic assessment for possible autism. In this study, we explored the experiences of children, young people and parents who have gone through the assessment and diagnosis process in the United Kingdom. We also explored the views of professionals who deliver childhood autism diagnostic assessments. We conducted interviews and focus groups with children, young people, parents and professionals. We recruited participants from six U.K. National Health Service (NHS) assessment and diagnosis services. We wanted to find out how childhood autism assessment and diagnosis processes could be improved. We asked the research participants about their experiences of the autism assessment and diagnosis process to find out what worked well, who it worked well for and under what circumstances. Recommendations for change were developed by the research team and presented to delegates at six dissemination events. Delegates (including 250 clinicians, managers, parents/carers, commissioners and academics involved in autism assessment and diagnosis) were invited to select and rank the most important recommendations. In total, 121 people took part including 18 children and young people, 34 parents and 69 professionals. Participants described their experiences of the assessment and diagnosis process and challenges in the system including increased demand for assessments and there not being enough specialist skilled practitioners available to conduct assessments. Participants also described ways the childhood assessment and diagnosis process could be improved, including better information gathering during referral. The need to support families throughout the whole assessment process (and not just on receiving a diagnosis) was seen as very important. Seven key areas for improvement were identified: accurately recognising when to refer children, the referral process, service organisation, skill mix of autism assessment teams, the diagnostic assessment, feedback and report writing, and training for staff. Twelve recommendations for change were identified by delegates at the dissemination events. The findings can be used to help make recommendations for service development, reduce waiting times and improve the quality of childhood autism assessment services for children, young people and families.

Pancreatic cancer entails poor prognosis and high physical and psychosocial burden for patients and their caregivers. Supportive care needs remain insufficiently addressed. This study aimed to identify supportive care needs and potential directions for future research based on perspectives of patients, caregivers, and healthcare professionals. A qualitative design was applied using focus group interviews. Participants were patients with pancreatic cancer receiving chemotherapy ((neo)adjuvant and palliative), caregivers, and HCPs (oncologists, nurses, physiotherapists, and dieticians). Six focus group interviews were conducted, audio-recorded, transcribed, and analyzed. Identified themes were categorized, described and translated into potential research questions. Nine patients, eight caregivers, and eight health care professionals participated. Twenty-one themes were identified, organized, and consolidated into 10 themes representing patient and caregiver needs. These included: 1) Nutritional guidance beyond generic advice, 2) Information and guidance for self-management of side effects, 3) Supporting caregivers' self-care, 4) Clear information on treatment trajectory and prognosis, 5) Peer support and network, 6) Support for exercise, 7) Existential support, 8) Support and facilitation of family communication, 9) Navigating the treatment trajectory, and 10) Supporting energy management. These themes informed the development of exploratory and interventional research questions intended to guide future supportive care research. The findings highlight a broad range of supportive care needs among patients with pancreatic cancer and their caregivers. While exploratory in nature, the study identifies potential areas for future research and underscores the importance of addressing caregiver burden and family communication within supportive care interventions.

Between routine and relation: midwives' experiences and perspectives of asking about intimate partner violence in maternal healthcare - a qualitative study using thematic analysis.

Nursing Home Nursing Staff Perspective About Using Subepidermal Moisture Technology for Pressure Injury Prevention.

• Local and circular initiatives are often small and fragmented. • Little is known about how to effectively scale local circular supply chains. • We present 17 factors for scaling across 8 established amplification processes. • We contribute factors to increase the size and transformative impact of initiatives. The fashion and textiles industry operates a global supply chain that causes harm to the environment, emitting pollution and generating waste across all stages of production, consumption and disposal. The implementation of a local circular economy would reduce impact, shorten import and export distances while retaining the value of materials through practices like reuse and recycling. However, current local and circular initiatives operate in a system that is incomplete to provide sufficient support structures for their operations, meaning they are often small, fragmented, and at risk of cessation. To address this, five focus groups with fashion industry stakeholders were conducted where factors for scaling at a local and national level were discussed. Data analysis revealed 17 factors for scaling, two of which were unique to scaling nationally. These offer ways for local circular clothing supply chains to stabilise, speed up, grow, replicate, transfer, spread, scale up and scale deep. The results provide a new insight on how to increase the scale and transformative impact of local circular initiatives emerging in towns and cities across the UK. The research is useful for the industry and policymakers in informing the development of purposive interventions that seek to step beyond current niche and fragmented solutions and build circular systems that can overtake the current linear, energy intensive, pollutive and waste generating system. Significantly, this will facilitate a shift away from global production and distribution, to grow more locally and systemically robust initiatives at the local and national scale.

This study showcases the use of Design-Based Research (DBR) applied to the development of Case-Directed Learning (CDL), a new, clinically contextualized teaching method designed to better support critical thinking, clinical relevance, and self-directed learning. CDL uses small groups to work through cases over several days, using open-ended prompts to guide their learning. Students take the lead in exploring the material and meeting learning objectives, followed by a faculty-led debrief to reinforce key science concepts. The purpose of this study was to use a DBR approach to enhance the effectiveness and design of CDL sessions. First-year medical students at the University of Central Florida College of Medicine participated in CDL during a 20-wk "Structure and Function" module focused on anatomy and physiology. According to DBR principles, the iterative development of CDL cases was guided by the concurrent collection of data from stakeholders. Student feedback was collected via surveys based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model of motivation and focus groups. Faculty involved in CDL design and facilitation were interviewed, and student performance on a CDL assignment was evaluated to assess achievement of learning objectives. The use of DBR produced findings that showed students responded positively to CDL and demonstrated a strong understanding of foundational science content. Feedback from both students and faculty helped to guide improvements to CDL design and delivery during the trial by identifying examples of emerging best practices. The results suggested that CDL is a promising, adaptable approach to integrating clinically relevant, active learning into the preclerkship curriculum, with potential for broader application in Undergraduate Medical Education (UME).NEW & NOTEWORTHY This study uses Design-Based Research to guide the development of Case-Directed Learning (CDL), a fresh approach to teaching basic sciences in preclerkship medical education. Designed to strike a balance between traditional lectures and fully self-directed learning, CDL helps students build a strong foundation in anatomy and physiology while developing the skills they will need to think critically, learn independently, and succeed in clinical settings.

Suicidal risk screening: Oncology nurses' barriers and leverages.

This study examines the impact of the Digital Leader Placement Programme (DLPP), a digital competency-based placement model, on STEM secondary level pre-service teachers’ (PSTs) digital competence and teaching experiences. Grounded in the ICT-TPACK Science Framework, digital competence is explored as a multidimensional construct encompassing pedagogical, ethical, and technical dimensions. A mixed-methods evaluative case study was conducted with two PST cohorts (N = 52), using pre/post-programme questionnaires and focus groups. Results show significant gains in planning, designing, implementing, and technical proficiency, though ethical competence improved less. Focus groups revealed themes such as disparities in school technology access, difficulty integrating digital literacy, and growing ethical awareness. The study highlights the value of low-stakes, reflective placements in developing digital competence and identifies systemic barriers, including the digital divide and inconsistent institutional support. While the DLPP shows promise for embedding digital skills in teacher education, further research is needed to assess its long-term impact and scalability. • DLPP led to gains in all ICT-TPACK Science Framework dimensions. • Reflective, low-stakes placement improved PSTs' self-reported digital competence. • Disparities in school technology access influenced lesson planning and delivery. • DLPP highlighted the need for structured digital literacy in curricula.

The individualisation of risk and responsibility for retirement planning, with the requirement to make ‘good saving decisions’, is an essential feature of the financialisation of pensions. Individuals are encouraged to become active financial subjects to ensure their own economic welfare. Additionally, concepts such as individual responsibility, risk management and financial planning are presented as moral obligations. This narrative has become an intrinsic part of neoliberal policies implemented over the last four decades in the UK, aimed at further privatising retirement. This paper examines the views and attitudes of young women towards individual responsibility and risk, within the context of retirement planning in the UK. The study presents a gendered analysis of financialisation of the pension system. It draws from the concept of ‘individual investor’ to critically discuss its shortcomings, using interviews and a focus group with young British women. The findings show how deep-rooted the idea of personal responsibility is amongst respondents, but also that the concept of managing risk and uncertainty is not adequately recognised, despite its centrality to investment practices.

To explore stakeholders' perspectives on (1) the cultural and linguistic appropriateness of the Greek, Italian and Spanish versions of the iSupport for Dementia program and (2) strategies to implement the iSupport program in Australia. A qualitative descriptive study was applied. Data were collected from focus groups with family carers of people with dementia from Greek-, Italian- and Spanish-speaking backgrounds and bilingual and bicultural health and social care professionals in community aged care settings in Australia. The reflective thematic analysis method was used to identify themes from the data. The COREQ checklist for qualitative research was followed to report this study. We found that stakeholders would like to see inclusive language used in the iSupport program to empower and engage carers in the program. They also suggested that the iSupport program should meet diverse learning needs and preferences for carers. They would like to see bilingual and bicultural staff deliver the iSupport program to carers and coach carers based on their individual needs. They suggested that the methods used in carer peer support should be socially inclusive in the digital age. In addition, they would like to see the iSupport program integrated into aged care services. Implementing the iSupport for Dementia program in multiple languages that incorporates peer support and coaching activities for carers is an opportunity to address health inequalities for people with dementia and their carers from culturally and linguistically diverse backgrounds. Training and supporting bilingual and bicultural health and social care professionals is vital for embedding the iSupport program in aged care services.

Approximately 20% of youth undergoing major surgery develop chronic postsurgical pain (CPSP). However, preventive interventions for CPSP have yielded mixed results, partly due to the limited involvement of patients and caregivers in the intervention development process. Single-session interventions (SSI) are well-suited in this context, as they are time- and cost-efficient. This study investigates the perioperative needs of patients and caregivers, and utilizes these insights to co-develop a preventive psychological SSI for post-surgical pain. Two rounds of focus groups were conducted with patients and caregivers to (1) gather information on the perioperative experience of patients and caregivers to develop the content of a preventive SSI, and (2) gather feedback on the draft of the intervention. Participants' experiences were analyzed applying structural content analysis. Based on these results, the content of a digital intervention was developed, which was then presented to participants for evaluation, and feedback was analyzed using participatory observation. Five adolescent patients and four mothers took part in the focus groups. In total, 5 superordinate categories were identified: Consequences of context (i.e., contextual components), looking after yourself (i.e., self-care related components), limitations of healthcare system (i.e., healthcare system-based components), requests for medical staff (i.e., specific expectations directed toward providers) and child as primary focus (i.e., child-focused components). The intervention draft was well accepted by participants, and minor suggestions for improvement were implemented. Our study identifies core topics of importance for patients undergoing major surgery and their caregivers, and informs the development of a preventive psychological intervention.

Problem-solving tools to encourage cancer screening among low health literacy populations in Western New York.