Medical Environment Research Articles

Towards the Improvement of Patient Experience Evaluation Items for Patient-Centered Care in Head and Neck Cancer: A Qualitative Comparative Study.

Owing to long-term treatment, frequent consultations, and complications, the evaluation of patients with head and neck cancer (HNC) must be improved. This study explored an opportunity for improving patient experience (PE) evaluation of patients with HNC to achieve a patient-centered, integrative evaluation model based on patient needs. The study comprised four phases: (1) a systematic literature review of PE factors for patient quality of life (QoL) and establishment of PE factor categories as a framework, (2) a review of current cancer or HNC PE evaluation tools, (3) identification of potential PE evaluation items based on patient needs by conducting user research, and (4) suggestion of integrative HNC PE evaluation items through expert validation. As a result, the 39 potential items were initially identified from the literature review and user research. After conducting two survey rounds with experts, 25 items were suggested as HNC PE evaluation items. These underscore the importance of highlighting the patient's participation, the medical staff's comprehensive information delivery, empathy, and collaborative communication, the hospital's support of communication channels, the medical environment for patient emotional support, the education program, and systematic patient satisfaction data management. PE evaluation items that consider the diverse perspectives of stakeholders involved in HNC treatment and factors of comprehensive PE will contribute to improving HNC patient-centered care (PCC).

Non-technical skills of Norwegian medical students at different training sites: a comparative, observational cohort study

PurposeMastering non-technical skills (NTS) is a fundamental part of the training of new physicians to perform effectively and safely in the medical practice environment. Ideally, they learn these skills during medical school. Decentralized medical education is being implemented increasingly worldwide. Two of the three training sites studied, Bodø (a regional hospital) and Finnmark (a rural local hospital), implemented decentralized medical education. The third training site was the main campus in Tromsø, located at an urban university hospital. The training in Finnmark emphasised training in non-technical skills using simulation to a larger extent than the two other university campuses. This study aimed to compare the NTS performance of medical students in their last year of education at three different training sites of the same university.MethodsThis blinded cohort study included students from the three training sites who participated in identical multi-professional simulations over a six-year period. Eight raters evaluated the video recordings of eight students from each training site using the Norwegian Medical Students Non-Technical Skills (NorMS-NTS) tool. The NorMS-NTS tool, which comprises four categories and 13 elements, assesses the NTS of Norwegian medical students and assigns an overall global score. Pairwise significant differences in the NTS performance levels between the training sites studied were assessed using Tukey’s test.ResultsThe overall NTS performance levels of the medical students from Finnmark (mean 4.5) were significantly higher than those of the students from Tromsø (mean 3.8) and Bodø (mean 3.5). Similarly, the NTS performance levels at category-level of the students in Finnmark were significantly higher than those of the students from Bodø and Tromsø. Except for one category, no significant differences were observed between the students from Bodø and Tromsø in terms of the overall or category-level NTS performance.ConclusionThe NTS performance levels of the medical students from Finnmark, which implements rural, decentralized medical education, were significantly higher than those of the students from Tromsø and Bodø.

Clinical practice guidelines for telesurgery 2022

Telesurgery is expected to improve medical access in areas with limited resources, facilitate the rapid dissemination of new surgical procedures, and advance surgical education. While previously hindered by communication delays and costs, recent advancements in information technology and the emergence of new surgical robots have created an environment conducive to societal implementation. In Japan, the legal framework established in 2019 allows for remote surgical support under the supervision of an actual surgeon. The Japan Surgical Society led a collaborative effort, involving various stakeholders, to conduct social verification experiments using telesurgery, resulting in the development of a Japanese version of the “Telesurgery Guidelines” in June 2022. These guidelines outline requirements for medical teams, communication environments, robotic systems, and security measures for communication lines, as well as responsibility allocation, cost burden, and the handling of adverse events during telesurgery. In addition, they address telementoring and full telesurgery. The guidelines are expected to be revised as needed, based on the utilization of telesurgery, advancements in surgical robots, and improvements in information technology.

Categorization, Identification, and Management of Stakeholders in University Hospital of China Based on Public Value Theory

Public hospitals, particularly university hospitals, as the primary suppliers of high-quality healthcare services in China, play an indispensable role in encouraging the development of a healthy China. In the new historical period, university hospitals are faced with the challenge of the continuous development and change of the external environment, as well as the internal structure. The primary cause for this is a lack of understanding of the connotation and definition of hospital stakeholders, as well as neglecting stakeholder requests and failing to build and form a strategic awareness of improving stakeholder management in university hospital. This paper focuses on the stakeholders of university hospitals in China, investigates the classification and identification of stakeholders, five university hospitals designated as "Grade A tertiary hospitals" was carried out. Semi-Interviews were conducted with 33 participants including experts, university hospital leadership level, and basic level. The study revealed that there are ten (10) stakeholders influencing the development of university hospitals in China and discussed the importance of stakeholders for hospital management and operation in the current medical environment and doctor-patient relationship in China. The study revealed that certain stakeholders drive university hospitals to shift their development strategies. The classification and identification of stakeholders in the pattern of interactions is critical for understanding the complexity and dynamics inherent in stakeholder relationship management. A systemic vision is required to address the university hospital issue's complexity from a broader perspective, engage the system's numerous stakeholders, and allow long-term decision-making.

Development of sustainable X-ray shielding materials: An innovative approach using epoxy composite with crab shell, eggshell, and bone waste

This research aimed to study the fabrication of X-ray shielding with a focus on sustainability and applications in the biomedical industry. Combining an epoxy composite with waste components from crab shells, eggshells, and bones, the study aimed to contribute to the advancement of eco-friendly alternative for use in medical-related scenarios. This study investigated the elemental composition of natural waste from crab, egg, and bone using X-ray fluorescence, revealing calcium as the predominant component. The findings suggested that these natural waste products could significantly contribute to developing eco-friendly and calcium-rich radiation shielding, presenting valuable insights for advancements in radiation protection technologies. Incorporating waste not only lowered radiation levels but also boosted radiation attenuation percentages. The epoxy composite, particularly with egg, showed a linear attenuation coefficient of 0.44 at 120 kVp. While lead exhibits superior shielding capabilities, the new material demonstrates promising potential. These results highlight the potential of natural waste in crab, bones, and egg for advanced radiation shielding, suggesting adaptability for diverse medical applications. Despite increased waste concentrations causing structural concerns in scanning electron microscope, the epoxy composite demonstrated significant radiation absorption and linear attenuation in escalating natural waste concentrations, suggesting adaptability for medical radiation environments. Balancing sustainability and high-performance shielding, future research should optimize these composites for practical medical applications.

Evaluation of Overall Survival by Restricted Mean Survival Time of Advanced Biliary Tract Cancer treated with Immunotherapy: A Systematic Review and Meta-Analysis.

For biliary tract cancer (BTC), the addition of immunotherapy (durvalumab or pembrolizumab) to gemcitabine and cisplatin (GemCis) significantly improved overall survival (OS) in phase 3 clinical trials (RCTs). However, the interpretation and magnitude of the treatment effect is challenging because OS Kaplan-Meier curves violate the proportional hazards (PH) assumption. Analysis using restricted mean survival time (RMST) allows quantification of the benefits in the absence of PH. This systematic review and meta-analysis aims to assess the benefit of immunotherapy-based regimens for OS at 24 months using RMST analysis. A systematic review was conducted using studies published up to 8 November 2023. Only phase 3 RCTs evaluating the use of anti-PD-1/PD-L1 combined with GemCis and reporting OS were included. KM curves for OS were digitized, and the data were reconstructed. A meta-analysis for OS by RMST at 24 months was performed. A total of 1754 participants from the TOPAZ-1 and KEYNOTE-966 trials were included. In TOPAZ-1, RMSTs at 24 months were 13.52 (7.92) and 12.21 (7.22) months with GemCis plus durvalumab and GemCis alone, respectively. In KEYNOTE-966, RMSTs at 24 months were 13.60 (7.76) and 12.45 (7.73) months with GemCis plus pembrolizumab and GemCis alone, respectively. Immunotherapy-based regimens showed a mean OS difference at 24 months by an RMST of 1.21 months [(95% CI: 0.49-1.93), p < 0.001, I2 = 0%]. Immunotherapy-based regimens improve OS in advanced BTC. Given this magnitude of benefit, it is essential to weigh up individual patient factors, preferences, and potential risks. RMST analysis provides valuable information to patients and physicians, facilitating decision-making in a value-based medical environment.

On the capacity of artificial intelligence techniques and statistical methods to deal with low-quality data in medical supply chain environments

We illustrate the capacity of Artificial Intelligence (AI) and Machine Learning (ML) techniques to preserve consistent categorization abilities whenever the quality of the data decreases, displaying mistakes or mismatches across matrix entries, while standard statistical methods exhibit significant modifications in the value of the corresponding coefficients. We design algorithms of different complexity to generate a series of comparable profiles. These profiles are compared within environments that allow for an immediate identification of the generating algorithms and within increasingly complex settings involving almost identical profiles derived from different algorithms. AI and ML techniques outperform standard statistical methods when distinguishing the algorithms generating the profiles. Building on these results, we perform a retrospective analysis where AI and ML techniques are applied to two empirical scenarios defined by different data series of patients transplanted through the period 2006–2019. The first scenario contains the variables describing the evolution of patients inputted correctly. In the second, we modify the content of the vectors of characteristics defining the evolution of patients by exchanging the values of a subset of realizations from two categorical variables. AI and ML techniques are consistently accurate when categorizing patients correctly within both scenarios, a feature particularly relevant when the quality of the information sources composing the medical chain varies. This latter problem is exacerbated among hospitals located in developing countries, where the quality of the data gathered limits their identification and extrapolation capacities.

Comparative performance of contact plate metod and swab method for surface microbial contamination on medical fabrics

BackgroundThe contact plate method is widely accepted and used in various fields where hygiene and contamination levels are crucial. Evidence regarding the applicability of the contact plate method for sampling fabric microbial contamination levels in real medical environments was limited. This study aimed to assess the applicability of the contact plate method for detecting microbial contamination on medical fabrics in a real healthcare environment, thereby providing a benchmark for fabric microbial sampling methods.MethodsIn a level three obstetrics ward of a hospital, twenty-four privacy curtains adjacent to patient beds were selected for this study. The contact plate and swab method were used to collect microbial samples from the privacy curtains on the 1st, 7th, 14th, and 28th days after they were hung. The total colony count on each privacy curtain surface was calculated, and microbial identification was performed.ResultsAfter excluding the effects of time, room type, and curtain location on the detected microbial load, the linear mixed-effects model analysis showed that contact plate method yielded lower colony counts compared to swab method (P < 0.001). However, the contact plate method isolated more microbial species than swab method (P < 0.001). 291 pathogenic strains were isolated using the contact plate method and 133 pathogenic strains were isolated via the swab method. There was no difference between the two sampling methods in the detection of gram-negative bacteria (P = 0.089). Furthermore, the microbial load on curtains in double-occupancy rooms was lower than those in triple-occupancy rooms (P = 0.021), and the microbial load on curtains near windows was lower than that near doors (P = 0.004).ConclusionContact plate method is superior to swab method in strain isolation. Swab method is more suitable for evaluating the bacterial contamination of fabrics.

Children’s Hospital Environment Design Based on AHP/QFD and Other Theoretical Models

Spatial environmental factors can effectively alleviate children’s fear of the medical environment when they seek medical treatment. This study focuses on the special environmental space of a children’s hospital, thoroughly considering the emotional needs of and the therapeutic effects on children as a unique group during medical treatment. By analyzing the existing design of children’s hospital environments, this research actively explores more suitable environmental design solutions for children’s healthcare settings. This study summarizes the user demand factors of children’s hospital environmental space design through field research and analysis interviews and calculates the weight indicators of user demand through AHP hierarchical analysis. On this basis, based on the QFD theoretical model, user needs are transformed into technical needs, and a house of quality is drawn to judge the conflicting needs through the positive and negative correlations between the factors. Finally, the forty invention principles of the TRIZ innovation theory are used to propose a solution to the environmental space program of children’s hospitals to obtain the optimal solution to the environmental space design effect. This study shows that incorporating theoretical models of AHP, QFD, and TRIZ into the environmental space design of children’s hospitals can improve and optimize the environmental space of children’s hospitals, and the example of a children’s hospital can be designed to meet children’s emotional needs according to this model. A series of interesting innovative practices, such as personalized digital information diagnosis and treatment, interesting visual guidance, and the implicit healing effect of color, can be realized. The aim is to create a modern, child-friendly medical environment that not only meets medical functional requirements but also effectively alleviates the stress of pediatric patients during diagnosis and treatment. This study preliminarily verifies the scientificity and rationality of the entire design process and provides a reference for the design practices of children’s hospital environments.

Does enteral nutrition require continuity of management: a randomized controlled study.

To explore a set of enteral nutrition therapy continuity management programs for intensive care unit patients based on the theoretical study of circadian rhythm mechanism. The control group followed routine nursing management. Patients in the experimental group were implemented with an enteral nutrition continuity management program, and their eating behavior was adjusted 3 days before the end of tube feeding. Food intake was intermittent at 2, 3, and 4h on the first day, the second day, and the third day of intervention, respectively, and all patients stopped eating at night. Abdominal distension assessment, appetite assessment, application of gastric motility drugs, and patient satisfaction were compared between the two groups after tube feeding. Three days after the end of tube feeding, abdominal distention assessment, bowel sound auscultation, and appetite assessment were statistically different (P<0.05) between the two groups. There were differences in the first day (15 vs. 6, P<0.05), the second day (9 vs. 3, P<0.05), and the cumulative number (17 vs. 7, P<0.05) of gastrointestinal drugs, but no differences in the third day (2 vs. 1, P>0.05). There was a statistical difference in nursing intervention (6.0 vs. 7.0, P<0.05) and psychological nursing (6.0 vs. 7.0, P<0.05), but no statistical difference in health education, medical environment, and nursing attitude (P>0.05). Enteral nutrition continuity management program has a good preventive effect on the gastrointestinal symptoms of intensive care unit patients after the end of tube feeding.

Critical therapeutic landscape design elements for cognitive impairments in the Royal Talbot rehabilitation centre

PurposeTherapeutic landscapes can be beneficial for patients recovering from cognitive and behavioural impairments. The therapeutic garden in the Royal Talbot rehabilitation centre (RTRC) located in Kew, Melbourne is a precedent for its nature design outdoor spaces and horticultural therapy (HT) program for patients with cognitive impairments due to brain and spinal cord injuries. There have been no studies into the physical design of the RTRC therapeutic garden.Design/methodology/approachThis case study unveils the critical design themes, and dominant physical elements of the RTRC therapeutic garden through site observation and analysis over the course of two months, a semi-structured interview with a key staff, and graphical representations using integrated photography and collaborative digital tools of AutoCAD and Adobe Photoshop.FindingsSeven critical design themes are identified for the RTRC garden: (1) space layout and organization, (2) physical and visual access, (3) pathway and facility, (4) multisensory vegetation, (5) amenity, wayfinding and seasonal interest, (6) cognitive stimulation, (7) utility and HT. Qualitative and quantitative data analysed in visual and descriptive format reveal multisensory vegetation, amenity, wayfinding and seasonal interest, and utility and HT are the top three most pivotal critical design themes in the RTRC therapeutic garden.Research limitations/implicationsThe findings of this case study can be used to impart knowledge about the design of therapeutic landscape settings for cognitive impairments to design professionals and the public.Originality/valueThere is no case study has been conducted for this precedent of therapeutic garden in the Royal Talbot rehabilitation centre that targets for cognitive impairment patients. With the increasing awareness in medical and healthcare environments, this case study would help to inject mutual understanding, generate knowledge and design awareness among design professionals and public, and to cultivate more good quality healthcare settings.

Case-Based Specialty Training for Medical Students to Elicit Social Determinants of Health.

Without explicit education and training on how social determinants of health (SDoH) impact patient care and health outcomes, medical schools are failing to effectively equip future physicians to serve their patients. We created this workshop on health equity with a focus on SDoH to help students more effectively communicate with diverse populations. Third-year medical students and faculty were provided with class guides, learning objectives, role-play vignettes containing clerkship-specific history and physical exams, schedules, and discussion questions during a 2-hour session centered on SDoH. The workshop's impact was measured through mixed-methods analysis of surveys. Based on pre- and postsurvey results from 87 participants, medical students strongly agreed that (1) SDoH factor more into a patient's health outcomes than the clinical encounter (pre: 67%, post: 87%), (2) it is their duty to gather information about SDoH (pre: 86%, post: 97%), (3) neighborhood safety is one of the key SDoH (pre: 88%, post: 97%), (4) they understood the impact of upstream interventions (pre: 35%, post: 93%), (5) they could efficiently screen all patients for SDoH at every medical encounter (pre: 27%, post: 86%), and (6) they could find preliminary resources to quickly assist patients in need of help regarding particular SDoH (pre: 26%, post: 85%). This was the first iteration of this workshop; challenges involved piloting the content, time restraints, and organizational structure of the workshop design. Future directions include making SDoH curricula an integral part of undergraduate medical education and diverse clinical environments.

Circuit-Level Realization of an Adaptive Trending Prediction Algorithm for Lossless ECG Compression

This paper introduces an advanced approach to the hardware implementation of lossless compression for electrocardiogram (ECG) signals, combining Content Adaptive Golomb Rice (CAGR) coding with Adaptive Trending Prediction (ATP). The CAGR technique dynamically adjusts its parameters based on local signal characteristics, effectively optimizing compression efficiency. Simultaneously, Adaptive Trending Prediction analyzes and predicts signal trends to further minimize redundancy before encoding, enhancing overall compression ratios. The hardware architecture presented in this study is meticulously designed to leverage these techniques, ensuring efficient utilization of resources while maintaining real time performance suitable for medical applications. Design considerations include algorithmic complexity, throughput, and resource utilization metrics tailored to meet the stringent requirements of medical monitoring systems. Experimental evaluations validate the efficacy of the proposed method, demonstrating substantial reductions in data size while preserving clinical fidelity crucial for accurate diagnosis and monitoring. The findings underscore the feasibility and practicality of integrating advanced compression algorithms into dedicated hardware platforms, thereby facilitating more efficient data transmission and storage in medical environments.

Inclusive Human Resource Management and Nurses’ Innovative Behavior during Crisis Events: The Roles of Job Crafting and Shared Leadership

Aims. Building on conservation of resources theory, our study investigates how inclusive human resource management (IHRM) promotes nurses’ innovative behavior through job crafting and further examines the moderating role of shared leadership. Background. Nurses’ involvement in innovation is essential to improve nursing care delivery and accommodate changing medical environments, especially in the face of crisis events like the COVID-19 outbreak. However, knowledge about the relationship between human resource management and nurses’ innovative behavior remains scarce. Methods. We collected three-wave data from 338 on-duty registered nurses at four public hospitals in China from November 2022 to January 2023. We used SPSS 22 to conduct hierarchical regressions to test our hypotheses. Results. IHRM positively predicted innovative behavior of nurses with the mediating role of job crafting. In addition, we found that IHRM was more effective in promoting job crafting and subsequent innovative behavior when nurses perceived high levels of shared leadership. Conclusion. IHRM initiated by the organization and shared leadership style are two collaborative approaches to facilitating nurses’ job crafting, thereby responding to the imperative need to foster nurses’ innovative behavior. Implications for Nursing Management. The present study emphasizes the important roles of IHRM and shared leadership in promoting nurses’ job crafting and subsequent innovative behavior, providing theoretical and practical implications for nursing management in the current dynamic and challenging environment.

Information fusion-based Bayesian optimized heterogeneous deep ensemble model based on longitudinal neuroimaging data

The fusion of multimodal longitudinal data is difficult but crucial for enhancing the accuracy of deep learning models for disease identification and helps provide tailored and patient-centric decisions. This study explores the fusion of multimodal data to detect the progression of Alzheimer’s disease (AD) using ensemble learning. We propose a heterogeneous ensemble framework of Bayesian-optimized time-series deep learning models to identify progressive deterioration of brain damage. Experimental results show that the heterogeneous ensemble of three models with patient’s temporal data outperforms all other variants of ensemble models by achieving an average performance of 95% for accuracy. We also propose a novel explainability approach, which enables domain experts and practitioners to better comprehend the model's final decision. The visual explainability of infected brain regions and the model's robustness is evaluated by our two medical domain experts showing its promising use in real medical environment. To evaluate the model’s generalizability and robustness, our optimized model is tested on a dataset with different distribution. The experiments demonstrate that the proposed model, which was trained on ADNI data, exhibits reliable generalization to NACC data with an average precision of 90%, recall of 91%, F1-score of 89%, AUC of 88%, and accuracy of 88%.

Anticoagulants - The Past, The Present, The Future - A Systematic Review

Introduction: Anticoagulants have been discovered and developed over past 100 years. At the beginning unfractionated heparin found its applications, just later to fade into the background of newer and more effective drugs. Patients have been treated with more progressive medications – Low-Molecule-Weight Heparin (LMWH), Vitamin K Antagonists (VKA) and Novel Oral Anticoagulants (NOAC). As for today, deemed a turning point in anticoagulant therapy are inhibitors of factor XI. It is a ground-breaking innovation as it ensures high prevention of thrombotic episodes and guarantees intact physiological hemostasis.Current State of Knowledge: The coagulation cascade and molecules part taking in that have been discovered and described extensively and in detail. Unfractionated heparin is the oldest out of all and despite its simple action mechanism and adverse effects, is still a requested drug. Its lighter form, low-molecule-weight-heparin (LMWH) is an enhancement to the previous treatment due to its higher bioavailability and fewer side effects. Vitamin K antagonists (VKAs) are widely spread in medical environment thanks to their expanded mechanism of action, oral administration and reversibility of their overdose, as well as their well-developed anti-side effect therapy. Novel Oral Anticoagulants (NOACs) have been introduced to the market about 10 years ago. In spite of NOACs short period of clinical use, they were a huge change to the previous treating methods. Currently, the newest innovation in anticoagulant therapy are inhibitors of factor XI and its clinical trials outcome is promising for the future.Summary: The present article discusses history of anticoagulant drugs, their mechanism of action and usage but also focuses on the recent perspectives and developments as new anticoagulant drugs are being put to the test in therapeutic trials. The review underlines the importance of improvements in old therapeutic methods and exploring the new, more suitable ones.

Deep neural network model for enhancing disease prediction using auto encoder based broad learning

Bioinformatics and Healthcare Integration Disease prediction models have been revolutionized by Big Data. These models, which make use of extensive medical data, predict illnesses before symptoms appear. Deep neural networks are well-known for their ability to increase accuracy by extending the network's depth and modifying weights through gradient descent. Traditional approaches, however, are hindered by issues such as gradient instability and delayed training. As a substitute, the Broad Learning (BL) system is introduced, which avoids gradient descent in favor of quick reconstruction by incremental learning. However, BL has trouble extracting complicated features from medical data, which makes it perform poorly in cases involving complex healthcare. We suggest ABL, which combines the effectiveness of BL with the noise reduction of Denoising Auto Encoder (AE), to address this. Robust feature extraction is an area in which the hybrid model shines, especially in intricate medical environments. Accuracy of up to 98.50 % is achieved by remarkable results from validation using a variety of datasets. The ability of ABL to quickly adapt through incremental learning suggests that it may be used to forecast diseases in complicated healthcare contexts with agility and accuracy.

Neural digital twins: reconstructing complex medical environments for spatial planning in virtual reality

PurposeSpecialized robotic and surgical tools are increasing the complexity of operating rooms (ORs), requiring elaborate preparation especially when techniques or devices are to be used for the first time. Spatial planning can improve efficiency and identify procedural obstacles ahead of time, but real ORs offer little availability to optimize space utilization. Methods for creating reconstructions of physical setups, i.e., digital twins, are needed to enable immersive spatial planning of such complex environments in virtual reality.MethodsWe present a neural rendering-based method to create immersive digital twins of complex medical environments and devices from casual video capture that enables spatial planning of surgical scenarios. To evaluate our approach we recreate two operating rooms and ten objects through neural reconstruction, then conduct a user study with 21 graduate students carrying out planning tasks in the resulting virtual environment. We analyze task load, presence, perceived utility, plus exploration and interaction behavior compared to low visual complexity versions of the same environments.ResultsResults show significantly increased perceived utility and presence using the neural reconstruction-based environments, combined with higher perceived workload and exploratory behavior. There’s no significant difference in interactivity.ConclusionWe explore the feasibility of using modern reconstruction techniques to create digital twins of complex medical environments and objects. Without requiring expert knowledge or specialized hardware, users can create, explore and interact with objects in virtual environments. Results indicate benefits like high perceived utility while being technically approachable, which may indicate promise of this approach for spatial planning and beyond.

Virtual community medicine in sparsely populated regions: A case study from Northern Sweden

The short case study outlines the potential that Virtual Health Rooms (VHRs) can exhibit to mitigate a lack of public health services and community medicine infrastructure in sparsely populated and demographically ageing regions. Although the VHR idea has its strengths in surmounting a relatively low medical service environment, it is, nonetheless, a technologically driven approach to meet the needs of local residents in rural peripheries. Therefore, the VHR approach has been tested in some Northern Swedish villages and has been evaluated empirically in one of these villages (Storuman). Beyond a dedicated health-driven purpose, Virtual Health Rooms can comprehensively serve as a public meeting point to reduce local social isolation. In this respect, the regional Storuman Hospital functions as a Center for Rural Medicine in a broad sense and aims, among other things, to decentralize public health services to local communities in the rural periphery.

Insights into discrepancies in professional identities and role models in undergraduate medical education in the context of affective burden.

International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.