Healthcare Space Research Articles

“Encouraged to be Your True Self”: An Interpretative Phenomenological Study of Medical Students’ Experiences of Role Models in Shaping Sexual Minority Identity in Medical School

Phenomenon: Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalizing SGM presence within healthcare spaces. Approach: Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to participants’ relationship with their bespoke experiences, respecting differing narratives within the broad ‘SGM’ umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. Findings: The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modeling was often experienced more positively than vertical faculty-to-student role modeling. However, as expected, heteronormativity exerted an inhibitory effect on this process. Insights: We built upon existing social cognitive paradigms to develop a ‘double-funnel’ model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of student-led SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining ‘normativity’ in medical schools.

The central role of housing key workers in supporting healthcare interactions for people experiencing homelessness and implications for palliative care: a qualitative study

BackgroundPeople experiencing homelessness access specialist palliative care late in their illness trajectory, if at all. There is also little evidence they receive generalist palliative care or are given opportunities to engage in Advance Care Planning. This qualitative study describes the central role of key workers in supporting access to healthcare in homeless communities and identifies implications for improving palliative care provision.MethodsQualitative data were collected via focus groups and individual interviews with staff working for a key provider of support and housing/accommodation for people experiencing homelessness in an urban area of Aotearoa New Zealand.ResultsThe ability to provide palliative care for people experiencing homelessness is dependent upon supporting engagement with mainstream health services. It is here that we identified the key worker role as central due to the complex and expert work they undertake to facilitate healthcare access for their clients. As a result of the high burden of chronic conditions this community experiences, most of this work related to support managing serious conditions, as well as death and dying. Key workers often went ‘above and beyond’ to support their clients in engaging with mainstream health services, during outpatient appointments, hospital admissions and in emergency department settings. They felt clinicians in these settings did not recognise the knowledge they held about the person, or their skills in terms of providing trauma informed care. The inflexibility of current care provision, as well as people experiencing homelessness feeling stigmatised, and neither valued nor respected in these settings, also created barriers to receiving care.ConclusionsNew models of palliative care are required which recognise the central role of non-health care key support staff and engage them more actively in supporting people experiencing homelessness when they interact with mainstream health services. Such models will need to be responsive to the nature and complexity of palliative care need in this population and facilitate support for people who typically do not see healthcare spaces as safe. The trusted relationships key workers have developed over time are crucial resources for identifying palliative care need and supporting access to palliative care for people experiencing homelessness.

Perceptions of distinctions between patient and healthcare zones among intensive care unit nurses at a Korean tertiary hospital: A cross-sectional study.

Intensive care unit (ICU) patients face higher infection risks from invasive procedures, highlighting the critical role of ICU nurses in infection prevention. Clear differentiation between the patient and healthcare zones is essential for effective hand hygiene and disinfection, yet research on this topic is limited. To assess ICU nurses' perception of the concept of patient and healthcare zones and evaluate their similarity and accuracy in identifying the zones. A descriptive survey was conducted at a 2,732-bed tertiary hospital in Korea from 28 July to 27 August 2022. Participants were recruited from various ICUs through flyers. 225 questionnaires-with illustrations 27 item locations for three ICU scenarios-were made available at nursing stations for voluntary completion. Participants were asked to classify items into the patient zone or the healthcare zone. Similarity scores reflected participant agreement, while accuracy scores measured the proportion of correct answers. Participants' free-text opinions regarding zone classification were analysed thematically. 104 nurses participated voluntarily. Average similarity and accuracy were 84.7% and 82.7%, respectively. The top 8 items, with over 97% similarity and accuracy, were all frequently in contact with ICU patients (e.g., pulse oximeter, Levin tube, central line, urine bag, and patient bed). The bottom 7 items, with less than 80%, included the glucometer, flashlight, trolley, and sink. Participants with higher education levels had significantly higher similarity (p = .044) and accuracy (p = .033), whereas those already familiar with the patient-zone concept had significantly higher accuracy (p = .009). From the free-text analysis, participants considered factors beyond proximity to the patient, such as patient contact, room type, and distance. To address zone classification challenges, clear criteria for patient and healthcare zones, space redesign, and educational programs are recommended. Further research is necessary to improve greater clarity and consensus regarding patient and healthcare zones to enhance infection control practices.

Developing healthcare language model embedding spaces

Pre-trained Large Language Models (LLMs) have revolutionised Natural Language Processing (NLP) tasks, but often struggle when applied to specialised domains such as healthcare. The traditional approach of pre-training on large datasets followed by task-specific fine-tuning is resource-intensive and poorly aligned with the constraints of many healthcare settings. This presents a significant challenge for deploying LLM-based NLP solutions in medical contexts, where data privacy, computational resources, and domain-specific language pose unique obstacles.This study aims to develop and evaluate efficient methods for adapting smaller LLMs to healthcare-specific datasets and tasks. We seek to identify pre-training approaches that can effectively instil healthcare competency in compact LLMs under tight computational budgets, a crucial capability for responsible and sustainable deployment in local healthcare settings.We explore three specialised pre-training methods to adapt smaller LLMs to different healthcare datasets: traditional Masked Language modelling (MLM), Deep Contrastive Learning for Unsupervised Textual Representations (DeCLUTR), and a novel approach utilising metadata categories from healthcare settings. These methods are assessed across multiple healthcare datasets, with a focus on downstream document classification tasks. We evaluate the performance of the resulting LLMs through classification accuracy and analysis of the derived embedding spaces.Contrastively trained models consistently outperform other approaches on classification tasks, delivering strong performance with limited labelled data and fewer model parameter updates. While our novel metadata-based pre-training does not further improve classifications across datasets, it yields interesting embedding cluster separability. Importantly, all domain-adapted LLMs outperform their publicly available, general-purpose base models, validating the importance of domain specialisation.This research demonstrates the efficacy of specialised pre-training methods in adapting compact LLMs to healthcare tasks, even under resource constraints. We provide guidelines for pre-training specialised healthcare LLMs and motivate continued inquiry into contrastive objectives. Our findings underscore the potential of these approaches for aligning small LLMs with privacy-sensitive medical tasks, offering a path toward more efficient and responsible NLP deployment in healthcare settings. This work contributes to the broader goal of making advanced NLP techniques accessible and effective in specialised domains, particularly where resource limitations and data sensitivity are significant concerns.

The application of emotional design in lighting for Chinese healthcare spaces

AbstractWith the development of time, people have more emotional needs for interior spaces. Interior lighting design is an extremely important part of interior design, especially in children's healthcare. In order to meet the needs of child patients and healthcare professionals for ward lighting, it is necessary to comply with various standards while also designing emotionally, emphasizing the positive effects of light on the psychology and health of the user. A literature research approach was used to combine the current status of interior lighting in healthcare spaces, culminating in the integration of the concept of emotional design into the lighting design of children's wards.

Remote asthma monitoring: How and why?

Background: The coronavirus disease 2019 pandemic contributed to substantial advancement in digital technologies in health care. Health-care professionals involved in respiratory care can now tailor their therapy for their patients with asthma, who still account for >1 million emergency department visits annually, with remote monitoring services. Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) are both ways to help patients with chronic asthma and other patients who need respiratory monitoring in pulmonary and in allergy and immunology clinics. RPM and RTM allow clinicians to gain further understanding as to what is going on in the patient’s home on a regular basis. Objectives: To ensure that the populations to monitor are correctly identified, privacy and security measures are in place, staffing resources are sufficient, and billing practices are understood before initiating RPM and RTM. Methods: A review of the current literature (2019‐2023) for RPM and RTM from PubMed, National Center of Biotechnical Information, American College of Allergy, Asthma and Immunology and the U.S. Centers for Disease Control and Prevention as well as practical experiences are outlined to provide an easy-to-follow guide for implementation in practice. Results: RPM and RTM services help identify and address gaps in care for patients such as patients with uncontrolled asthma and to assist with populations of need such as the underserved, the elderly, and rural populations. Conclusion: As artificial intelligence and other technologies continue to grow in the healthcare space, remote monitoring services are expected to transform health-care delivery to new heights yet to be seen.

Culturally safe community agency health promotion capacity for diverse equity-seeking women: a rapid theoretical review

ObjectivesImmigrant and sexually/gender-diverse women (henceforth, women) face inequities in access to and quality of care. As a result, many seek health information from community agencies perceived as culturally safe. We...

The Digital Twin Immersive Design Process and Its Potential Disruption to Healthcare Design through a User-Centered Approach

This applied research proposes a solution to the static government design process for Thai healthcare architecture to better serve the needs of its elderly society. In its place, a novel real-time design process, termed the Digital Twin Immersive Design Process (DT-IDP), repurposes aspects of digital twin and virtual reality technologies into a ‘unitary’ immersive design system. This system accesses ‘experiential’ user-centered data, helping enhance the design of Thai healthcare space beyond a standardized government response. This text builds a rationale for departing from the current design process by describing the formation and advantages of the DT-IDP process. To test its credibility, the DT-IDP process is used to build and compare two digital versions of an existing healthcare space. In these spaces, participants are immersed (elderly patients n = 30; nursing staff n = 5; government healthcare architects n = 5) to assess visitor experiences based on daylighting, artificial lighting, and views of nature. Following immersion, government healthcare architects are interviewed in-depth to evaluate the process’s efficacy and their willingness to adopt it. Results confirm the potential for this process to capture ‘user-centered’ insights, otherwise unobtainable without immersion. Consequently, healthcare architects express a unanimous preference for DT-IDP, acknowledging its unique capacity to bridge a market gap through an experiential component that could better assist them in creating a superior final product. Ultimately, they assert that demand for these features could have a disruptive impact to the current healthcare design process, helping to re-envisage the design of future Thai healthcare space.

Accidental injustice: Healthcare AI legal responsibility must be prospectively planned prior to its adoption

This article contributes to the ongoing debate about legal liability and responsibility for patient harm in scenarios where artificial intelligence (AI) is used in healthcare.We note that due to the structure of negligence liability in England and Wales, it is likely that clinicians would be held solely negligent for patient harms arising from software defects, even though AI algorithms will share the decision-making space with clinicians.Drawing on previous research, we argue that the traditional model of negligence liability for clinical malpractice cannot be relied upon to offer justice for clinicians and patients. There is a pressing need for law reform to consider the use of risk pooling, alongside detailed professional guidance for the use of AI in healthcare spaces.

Connected and supported: a scoping review of how online communities provide social support for breast cancer survivors.

To (i) assess how and to what extent online communities are used among breast cancer survivors (BCS) as a source of social support, (ii) describe the kind of support BCS access through online communities, and (iii) explore how these communities foster social support for BCS that promotes well-being and reduces the challenges of survivorship. We conducted a scoping review. A professional librarian performed a comprehensive search in multiple databases from January 2010 to May 2023. The review process adhered to the Johana Briggs Institute's method guidelines and the PRISMA-ScR reporting system. Fifteen studies were included. Participants used social media, cancer support communities, message boards, or websites for information and emotional support. Qualitative findings resulted in four themes: to reassure; to empower; to promote equity, diversity, and inclusion; and to demonstrate for BCS the drawbacks of online support. We underscore that a variety of internet websites and social media platforms are valuable for and appreciated by BCS, especially as a source of social support and human connectedness. Our study raises the existing gap in cultural/ethnic representation in this field and shows that institutional and organizational efforts are needed to address gaps in information regarding access to social support for multiethnic BCS women. This data synthesis will empower the BCS community by sharing how they can strengthen and support their peers and community via their participation in online communities that connect and support cancer survivors in healthcare spaces.

Crafting the unsayable: Making meaning out of racialised maternal health-care encounters.

There are persistent and profound racialised inequalities in maternal and reproductive health in the UK. Yet in multiple settings, these disparities have been blamed on class or ethnicity, individuals and communities rather than the structures within which they live. In this study, we draw on narratives told within a 'slow-stitch' craft workshop, organised in southern England for racialised women with reproductive trauma, to show how processes of racialisation and racism shape experiences of maternal and reproductive healthcare. Experiences of reproductive trauma were multiple and cumulative. The burden of knowledge of racialised disparities was carried into health-care spaces, with plans made in advance to self-manage in risky spaces. The constant management of racialised stereotypes and subsequent strategies of bodily and emotional containment ultimately was not protective and there was little agency over levels of care received in health-care spaces. Perceptions surrounding racialised bodies shaped treatment, whilst proximities to whiteness afforded alternative realities. Taking a phenomenological approach we analyse race as a sensory, spatial and relational constellation haunted by long-standing histories of fraught inequality. Bringing together in the crafting circle a group of women racialised in different ways enabled the sharing of "unspeakable" stories surrounding racism and reproductive trauma, and allowed raceto be brought into being as a form of solidarity and connection.

The emotional labour of peer work: encountering stigma in mental healthcare spaces

ABSTRACT This article focuses on the workplace experiences of peer workers with a diagnosis of borderline personality disorder (BPD) in mental healthcare settings in Australia. Our article is located at the intersection of political, social, cultural, and legislative forces that have fostered the development of peer work as a paid profession. We draw on the concept of stigma to analyse findings from qualitative interviews with peer workers conducted in [state], Australia. By examining peer work in the broader context of lifeworlds of BPD, we address the interplay of work and professional identity, and the experience of a profoundly stigmatised diagnosis at this intersection. Our findings demonstrate the physical and emotional effects of stigma and how it produces boundaries and inequalities between peer workers and other health practitioners. These boundaries are reinforced by invisible markers that delineate what is expected, ‘normal’ and deemed professional in the workplace. Moreover, these same medico-socio-political relations help shape peer workers’ identities and experiences. The development of peer workforces in mental healthcare service delivery is a prominent area of reform in Australia and internationally. Our research highlights the urgency of efforts to transform current socio-cultural-political relations that inhibit peer workers in their roles and impact workplace experiences.

AI-based Cleft Lip and Palate Surgical Information is Preferred by Both Plastic Surgeons and Patients in a Blind Comparison.

The application of artificial intelligence (AI) in healthcare has expanded in recent years, and these tools such as ChatGPT to generate patient-facing information have garnered particular interest. Online cleft lip and palate (CL/P) surgical information supplied by academic/professional (A/P) sources was therefore evaluated against ChatGPT regarding accuracy, comprehensiveness, and clarity. 11 plastic and reconstructive surgeons and 29 non-medical individuals blindly compared responses written by ChatGPT or A/P sources to 30 frequently asked CL/P surgery questions. Surgeons indicated preference, determined accuracy, and scored comprehensiveness and clarity. Non-medical individuals indicated preference. Calculations of readability scores were determined using seven readability formulas. Statistical analysis of CL/P surgical online information was performed using paired t-tests. Surgeons, 60.88% of the time, blindly preferred material generated by ChatGPT over A/P sources. Additionally, surgeons consistently indicated that ChatGPT-generated material was more comprehensive and had greater clarity. No significant difference was found between ChatGPT and resources provided by professional organizations in terms of accuracy. Among individuals with no medical background, ChatGPT-generated materials were preferred 60.46% of the time. For materials from both ChatGPT and A/P sources, readability scores surpassed advised levels for patient proficiency across seven readability formulas. As the prominence of ChatGPT-based language tools rises in the healthcare space, potential applications of the tools should be assessed by experts against existing high-quality sources. Our results indicate that ChatGPT is capable of producing high-quality material in terms of accuracy, comprehensiveness, and clarity preferred by both plastic surgeons and individuals with no medical background.

Cross-disciplinary mathematical modelling to benefit healthcare - could clinical pharmacology play an enabling role?

Clinical pharmacology is often the nexus in any cross-disciplinary team that is seeking solutions for human healthcare issues. The use and application of real-world data and artificial intelligence to better understand our ecosystem has influenced our view at the world and how we do things. This has resulted in remarkable advancements in the healthcare space and development of personalized medicines with great attributes from the application of models and simulations, contributing to a more efficient healthcare development process. A cross-disciplinary symposium was held in December 2023, whereby experts from different scientific disciplines engaged in a high-level discussion on the opportunities and challenges of mathematical models in different fields, possible future developments and decision making. A strong interlink amongst the disciplines represented was apparent, with clinical pharmacology identified as the one which integrates various scientific disciplines. Deliberate and strategic cross-disciplinary dialogues are required to break out of the silos and implement integration for efficiency and cost-effectiveness of novel interventions.

GP remote consultations with marginalised patients and the importance of place during care: a qualitative study of the role of place in GP consultations.

Since COVID-19 there been an increase in the use of remote consultations in General Practice in the UK. This leads to the displacement of the consultation outside of the physical GP practice, and its 'emplacement' elsewhere, with underexplored consequences for inequities of healthcare in marginalised groups. This paper examines the place-making demands that remote consultations make on patients, and the ways that these affect their experiences of care, with a focus on the impact on patients from marginalised groups. Ethnography and interview study (n=15) undertaken at three sites in London: a foodbank, a community development organisation, and a drop-in advice centre for migrants. Additionally, GPs (n=5) working at practices in London Digital Health Hub staff (n=4) and staff at fieldwork sites (n=3) were interviewed. Ethnographic observation (n=84 hours) and semi-structured interviews (n=27). Interviews were conducted in-person and over the phone and data were analysed through reflexive thematic analysis. The core themes emerging from the data included challenges securing privacy during remote consultations, and the loss of formal healthcare spaces as important places of care. These findings were closely tied to resource access, leading to inequities in experiences of care. Remote GP consultations are not "place-less" encounters, and inequities in access to suitable spaces may lead to inequities in experiences of care. Attention should be given to ensuring that patients without appropriate spaces for remote consultations are offered in-person care, or consultation times made more specific to allow for organisation of private space.

Mental healthcare spaces, ambivalence of caregiving, and Indian memoirs of psychiatric patients

Mental healthcare spaces, ambivalence of caregiving, and Indian memoirs of psychiatric patients

Sound isolation and speech privacy observations of modular wall construction in healthcare environments

A recent trend in healthcare spaces is emerging where exam room walls are stopping at or just above the ceiling. There are a number of reasons for doing this, including cost, large floor-to-floor heights, desire for prefabricated constructions, and the need for plenum flexibility for building services. The speech privacy at these locations is critically dependent on the noise reduction of the wall, door, and ceiling constructions as well as the sound masking system. Sound masking systems, long delivered directly from manufacturers or their representatives, are now being repackaged and sold by furniture vendors. Measurements and observations from the field will be presented. Locations where sound masking is not recommended and where upgraded construction is required will be discussed.

Two years of innovative dermatological care: the first public health consultation service for the transgender and gender diverse community in Argentina

BackgroundThe LGBTQI + community encounters distinct healthcare challenges due to discrimination and inadequate understanding of their needs. Dermatologists play a crucial role in addressing this by fostering inclusiveness, recognizing individual concerns, and adopting tailored approaches, thereby promoting a more equitable healthcare system. ObjectiveTo address the need for an inclusive healthcare space, the authors established the first dermatological practice exclusively for transgender and non-binary patients. This article presents a comprehensive two-year experience in a public hospital. MethodsThe authors conducted a retrospective and descriptive study, analyzing the medical records of 114 patients evaluated at a specialized dermatological practice between June 2021 and May 2023. Key variables assessed included self-identified gender, age, residence, access to private healthcare, human immunodeficiency virus status, hormonal treatment, surgical interventions, consultation motives, employment stability, and family support during gender expression transition. ResultsThe present study included 114 patients, 49.1% trans men, 39.5% trans women, and 8.8% non-binary individuals. Trans men, on average younger than trans women (p < 0.001), predominantly sought care for body modification-related concerns, particularly acne and androgenetic alopecia. In contrast, trans women exhibited a more diverse range of consultation motives typically unrelated to hormonal or surgical procedures. Study limitationsThis study is retrospective and limited in geographic scope. Additionally, the patient population lacked diversity in terms of Black ethnicity. ConclusionsThe pioneering dermatological practice for transgender and non-binary patients exemplifies healthcare equity and cultural competence. Effective LGBTQI + healthcare requires addressing unique dermatological concerns while fostering inclusiveness and continuous learning within the medical community.

반려동물의 구강관리를 위한 디지털 헬스케어 분야에서 인공지능 활용에 대한 고찰

The growing integration of artificial intelligence (AI) in digital healthcare services presents a promising opportunity for manage oral health of pets within the digital healthcare space. This study explores various applications of AI in management of oral health of pets and discusses the future market directions for this technology. In particular, the expansion of AI-based smart oral health management services and telemedicine offers pet owners the possibility of managing their pet’s oral health without direct face-to-face interactions with veterinarians. The development of dental imaging analysis and oral health management systems using AI technology is expected to aid in the early detection, prevention, and treatment of oral diseases in pets through rapid and accurate diagnosis. Additionally, AI can be utilizedin innovative tools such as genetic analysis and precision medicine to manage the oral health of pets. Therefore, AI can be leveraged in various digital healthcare fields to manage the oral health of pets. By considering aspects such as data privacy, accountability, reliability, and legal compliance, the quality of life for pet owners and their petscan be enhanced significantly.

A Systemic Review on the Adoption of Service Design Practices to Improve the Quality of User Experience and Organization in the Healthcare Environment

Healthcare services and spaces are recognized as complex ecosystems where different user categories interact daily facing often urgent and difficult situations that challenge the established organizational and procedural models. The increasingly evolving needs and conditions influencing the processes affect the capacity to quickly adapt the available operational models as well as spaces to provide a timely and efficient response. This calls for new approaches and methods to enable the managing staff to overcome the conventional silos-based structure and integrate new methods and tools to facilitate interdisciplinary analysis and synergies. Some frontrunning healthcare structures started to adopt Service Design practices, which are largely grounded in the Design Thinking approach, to reshape the conventional models for improving the quality of user experience with remarkable expected impacts on social, economic, and environmental sustainability in the mid-long run. Following the rigorous investigation structure of Systemic Review, the paper explores the adoption of Service Design practices in frontrunner experiences focusing on organizational aspects to draft a reference framework, including successful factors, barriers, and viable pathways, which are currently missing. The main scope of the paper is accordingly to address the detected gaps in clarifying methods tools and goals of Service Design-oriented practices for improving healthcare processes and user experience quality. The main reported findings highlight the importance of introducing Co-Design and participative practices to integrate specialistic perspectives and organizational aspects as well as to engage all the key players at different levels.