Search

Purpose: Consistent with current literature, which highlights the role of narration as a key tool for exploring the processes by which people construct the meaning of their critical experiences the authors propose a theoretical and methodological model to analyse the narratives of illness and identify any innovative aspects. The generative model of mind presented refers to a semiotic, narrative and socio-constructivist perspective according to which narration constitutes one of the possible processes by which the affective and pre-verbal sense of experience is transformed into a meaning that can be symbolized and shared. Design/methodology/approach: The onset of an illness represents a critical event which interrupts a person's life narrative, shattering his/her biographical continuity and undermining any assumptions of him/herself and the world. In particular, the model proposes a method of analysis, currently absent in literature, of the narrative interview Narrative Function Coding System (NFC) in order to grasp the ways by which four main narrative functions, namely psychic functions, are classified: the search for meaning, the expression of emotions, the temporal organization and the orientation to action. Findings: NFC appears to be able to capture the complexity of the narrative process of construction of illness' sense-meaning making process, identifying both representative modalities of good functioning, which express a gradual process of connection with the variability of the experience, and modalities that express moments of disorganization and rigidity, which can persist throughout the time of treatment. The NFC represents not only a method for analysing illness narratives but also a method for tracking and monitoring the process of clinical intervention and change. Originality/value: The sense-meaning making process perspective within the narrative socio-constructivist and semiotic framework of analysis proposed by NFC is currently absent in the literature. NFC can be a device for analysing the narrative process of sense-meaning making both for its use for clinical and preventive purposes. In addition we believe that this method, which focuses on the "form" and "way" of narratively constructing the subjective experience, rather than on the specific thematic content, can be used with all types of illness narratives, in particular the longitudinal one to explore the changes in sense-meaning making process.

Purpose: This paper presents findings from a qualitative study of healthcare professionals' practice, where learning is taking place when a digital artefact is implemented for identification of patients' cognitive impairment. The use of digital artefacts is increasing in various workplaces, to include professionals in healthcare. This paper aims to explore the following research question: How is the professional learning unfolding in patient-based work when a digital artefact transforms the practice? Design/methodology/approach: Various data collection methods are used for this study, consisting of dialogue meetings, interviews and a reference-group meeting. Thematic analysis is used to inductively bring forth the themes of the collected data. Findings: Professionals' knowledge and experience are of vital importance in learning and changing work practices. Together with their ability to reflect on changes, their knowledge and experience constitute the prefiguration when the introduction of a digital application brings about indeterminacy in the work practice. Originality/value: This paper makes a contribution to practice-based research as it consolidates previous research and identifies professionals knowledge and learning in a healthcare context. This can be used to further explore and advance the field, as well as to establish the evidence-based importance of transforming practices based on implementation of digital artefacts.

Purpose: The purpose of this paper is to describe an example of how universities can develop unique synchronous educational opportunities to engage students in an online environment, especially since study abroad opportunities have slowed or halted due to the COVID-19 pandemic crisis. Design/methodology/approach: Two affiliated universities, in the United States and Scotland, selected a simulated root cause analysis (RCA) of a medical error for a collaborative activity. Findings: Together the students analyzed the event within assumed roles of healthcare professions in a systematic way using the "Swiss Cheese Model," identified opportunities for improvement, debriefed using the Promoting Excellence and Reflective Learning in Simulation (PEARLS) method and submitted a reflective assignment. The RCA resulted in several process improvement suggestions and positive feedback from the participants. Research limitations/implications: The approach was for graduate students from two affiliated universities, in the United States and Scotland, to simulate a RCA of a medical error as a collaborative activity. Practical implications: This example using simulation of healthcare roles demonstrates the application of international collaboration, problem-solving models and methodologies and recognition of the similarities and differences between the United Kingdom and the United States approaches to patient safety. Especially with the ongoing COVID-19 pandemic, the students' ability to internationally collaborate can be limited without such unique opportunities. Social implications: The students were provided with a side-by-side comparison of the patient safety efforts in each country and written and didactic material about an RCA and the Swiss cheese model. Originality/value: Students come from different perspectives of health services administration, nursing and nursing leadership from Scotland and the United States to solve patient safety problems.

Objective: Describe a model for incorporating campus-based Sexual Assault Nurse Examiner (SANE) services. Describe differences in patient satisfaction and utilization of follow-up resources between patients seeking SANE services at a university health center (UHC) compared to an emergency department (ED). Participants: Patients seeking SANE services at the UHC or ED of a large Midwestern university from January 2016-April 2018. Fifty-eight participants completed a satisfaction survey, including 28 students. Twenty-eight participants completed a follow-up survey, including 15 students. Methods: A Qualtrics survey assessed--(1) satisfaction following the SANE exam and (2) use of follow-up services 4-6 weeks later. Descriptive analyses, exact logistic regressions, and OLS regressions were calculated. Results: There were no differences in satisfaction, services received, or follow-up services accessed between patients at the UHC and ED, including between students. Conclusions: Campus-based SANE services meet the expectations of survivors and do not differ significantly from services at the ED.

Background: Prior research indicates that healthcare provider-patient communication influences health outcomes such as patient satisfaction, compliance with diagnosis or treatment, and general health quality. However, little is known about this type of inquiry in the context of healthcare centers on college and university campuses. Aim: The objective of this study was to examine the influence of students' perception of college healthcare providers' affective and instrumental behaviors on student patient satisfaction and perceived quality of healthcare at a university health center. Methods: 349 participants who were college students took an online survey. Regression analyses were conducted. Results: Affective and instrumental behaviors were important communicative behaviors predicting student patient satisfaction and perceived quality of healthcare. However, directions of these predictions differed between student patient satisfaction and perceived quality of healthcare. Conclusion: Healthcare providers at the university health center are recognizing student patients as partners in the healthcare decision-making processes.

Background: Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. Aims: To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs. Methods & Procedures: Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24 h; acute: 24-72 h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Outcomes & Results: Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. Conclusions & Implications: This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia.

Background and Objectives: In Italy, approximately 650 individuals receive a diagnosis of primary progressive aphasia (PPA) every year. Unfortunately, the frequency with which patients are referred to speech-language services is suboptimal, likely due to skepticism regarding the value of speech-language therapy in the context of neurodegeneration. Materials and Methods: We conducted a virtual survey of speech and language therapists (SLTs) across Italy, to collect information about the assessment, intervention and management of patients with PPA. To ensure that as many SLTs as possible received the survey, the Italian Federation of SLTs (Federazione Logopedisti Italiani, FLI) aided in disseminating the survey. Results: In total, 336 respondents participated in the online survey, 140 of whom had previous experience with PPA patients. Respondents indicated having seen a total of 428 PPA patients in the previous 24 months (three patients on average, range: 0-40). SLTs who reported never working with PPA identified underdiagnoses, low referral rates and the rarity of the clinical syndrome as major reasons for their lack of experience with PPA. SLTs with experience working with PPA indicated that patients may not have accessed services because of service dysfunction and geographical barriers. Respondents reported using informal interviews during assessments and tests developed for post-stroke aphasia, while impairment-based/restitutive interventions were utilised most often. Conclusion: Findings may serve to inform health policy organisations regarding the current shortcomings and needed recommendations for improving the care of individuals with PPA in Italy. Improving awareness of the utility of rehabilitation among SLTs and other clinical service providers may serve to facilitate access to intervention, which in turn will serve to better support individuals living with PPA.

Context: Athletic trainers have expressed a lack of knowledge and a desire to learn more about the issues impacting lesbian, gay, bisexual, transgender, queer/questioning, pansexual, intersex, asexual/aromantic/agender, two-spirit, and additional community/identity (LGBTQPIA+) patients, yet little is known about how students are prepared. Objective: The purpose of this study was to explore educational experiences relative to LGBTQPIA+ patient care in Commission on Accreditation of Athletic Training Education-accredited, master's-level professional athletic training programs. Design: Cross-sectional study. Setting: Web-based survey. Participants: Students (N = 333) who were currently enrolled in the last 1 to 2 semesters of their respective programs or had recently graduated from a master's-level professional athletic training program within the last year. Main Outcome Measure(s): The survey asked participants to characterize and evaluate the effectiveness of their learning experiences, then rank their confidence in addressing the needs of LGBTQPIA+ patients. We used additional open-ended responses to characterize effective instructional strategies. Data were analyzed using statistics of central tendency and open-ended responses were inductively coded. Results: Participants reported that their learning experiences about LGBTQPIA+ patient needs were moderately effective for formal (38.2%), informal (42.2%), and clinical education (34.0%). Among the areas where participants reported wishing they had learned more were gender incongruence or dysphoria (39.6%), gender-affirming care (43.5%), and providing inclusive health care forms and documentation (38.4%). Participants reported about 15 6 37 hours (range, 0-500 hours) of time dedicated to LGBTQPIA+ patient issues, although only 23.2% indicated that this was enough time. Participants indicated that they were quite confident in addressing the needs of LGBTQPIA+ patients (mode = 3 ["quite confident"], 33.0%); however, 53.7% of participants were only somewhat, slightly, or not at all confident. In the open-ended responses, participants indicated that informal and clinical education experiences providing authentic interactions with LGBTQPIA+ patients were most meaningful. Conclusions: Professional athletic training programs should incorporate more educational experiences to better prepare students to meet the health care needs of LGBTQPIA+ patients. Participants in our study additionally indicated a strong desire to learn more about equitable patient care

Background: Patient education materials (PEMs) are often used in health education programs to empower patients to self-manage their disease for better health outcomes. Heart failure (HF) patients wanted more information about self-management and educational materials that were easy to understand. Programs with self-efficacy as the core component have proven to be effective in improving patients' self-management. Purpose: To develop practical, efficacy-enhanced, tailored HF rehabilitation PEMs that satisfy our clients to drive long-lasting behavior change and evaluate the materials' quality (readability, understandability, actionability, and acceptability). Methods: Exploratory mixed methods study involving: (1) semi-structured interviews; (2) evaluation of the PEMs; (3) revision and reevaluation of the PEMs; (4) publication. An appointed panel of experts evaluates content accuracy, understandability, and actionability. The Patient Education Material Assessment Tool assesses content understandability and actionability. The content readability was assessed using Flesch Kincaid Calculator. Clients' acceptability was assessed using Educational Material Acceptability tool. Results: The newly developed PEMs have good understandability, actionability, readability, and acceptance. Discussion: Patient-centered PEMs have good acceptance and satisfaction among clients. However, the effectiveness of tailored efficacy-enhanced PEMs for behavior changes needs further evaluation. Translation to Health Education Practice: All stakeholders should be included in developing PEMs. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars http://portal.shapeamerica.org/trn-Webinars

Background: Though prenatal nutrition information is critical, it is not known whether information is shared equitably by patient race, financial security, or English proficiency. Purpose: To evaluate whether delivery or receipt of ChooseYourFish.org nutrition information in the first prenatal visit differed by patient demographics. Methods: Analysis of clinician-document electronic health record (EHR) or patient-reported surveys compared delivery and receipt of fish-related nutrition information in the first prenatal visit. Inferential statistics were used to compare delivery or receipt and race, ethnicity, payor, or interpreter use. Results: EHR analysis (n = 2,329) revealed Medicaid patients who used an interpreter were half as likely to have the fish nutrition message in their after-visit summary compared to those with Medicaid who did not use an interpreter (OR = 0.54, 95% CL: 0.35-0.84). The same was not true for non-Medicaid patients. Survey analysis (n = 52) showed respondents identifying as Black or African American were 25% less likely to report receiving the after-visit summary compared to respondents who identified as white (p < 0.01). Discussion: The results presented here illustrate how nutrition communication in the prenatal period can differ by patient race, financial security, and language. Translation to Health Education Practice: Culturally humble efforts to understand drivers of healthcare communication are needed to eliminate inequalities. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

This study explores effective care training factors for patients with coronavirus disease 2019 (COVID-19) through social network message combining qualitative and quantitative methods. The research was conducted in two phases. In the first phase, based on the theoretical saturation approach, active social networking audiences were sampled and questioned in the field of COVID-19 learning. In this regard, 38 audiences interviewed and based on thematic analysis 20 non-repetitive features (basic them), five organizing themes, and a thematic network extracted. In the second phase, 11 experts were used to rank these extracted basic and organizing themes using the DEMATEL as a quantitative method. Finally, the results were tested using a one-sample T-test and Spearman correlation by a more significant number of social network users. The thematic analysis results introduce 20 basic themes, five organizing themes, and network themes for effective care training factors for patients with COVID-19 through the social network. Indeed, it can be concluded that the performed network themes and DEMATEL entails a unique model in this context. This model shows useful messages for COVID-19 training in the social network under the influence of five factors: simplicity, multimedia, validity, availability, and generalization.

Augmentative and alternative communication (AAC) has been used by patients with acquired expressive communication disorders as an alternative to natural speech. The use of symbols to express pain, which is intangible, is challenging because designing a series of comprehensible symbols to represent personal experiences such as pain is not straightforward. This study describes (a) the development of symbols to express pain that were derived from Chinese pain-related similes and metaphors for an AAC mobile application developed specifically for this study known as PainDiary and (b) an assessment of the appropriateness of the app compared to conventional methods of collecting pain information. The symbols depicted headache pain and discomfort, which is prevalent among neurosurgical patients. The participants were 31 patients diagnosed with acquired expressive communication disorders who were receiving treatment in a neurosurgery general ward of Chang Gung Memorial Hospital in Taiwan and 14 nurses who worked on the ward. Pain information was collected by nurses using conventional methods and the PainDiary app. Assessment data, including the accuracy and efficiency of and user satisfaction with PainDiary, are compared. The results show that use of the app was effective in reporting pain and that patients required less time to report a pain event. The results further indicate that the PainDiary app was better received by younger individuals than by their older counterparts.

Using a paperless patient registration project, this teaching case demonstrates an application of the six-step approach in developing a business case for an IT investment. More specifically, this case familiarizes students with the process of developing a solid business case by defining business drivers and investment objectives, identifying and structuring benefits and costs, and estimating return on investment (ROI) based on these values. Students learn, step-by-step, the process from raw data collected from organizational records and internet research to complete managerial decisions based on detailed analysis.

We conducted a psychometric synthesis of the internal consistency reliability and internal structure of scores on the English versions of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) in publications between 2012 and 2022. Results supported acceptable-to-strong reliability and validity evidence of scores among a number of samples.

This study developed and psychometrically evaluated a brief measure of mental health treatment knowledge (N = 726). Scores from "Knowledge about Treatment" (KaT) demonstrated a unidimensional measure with good model fit, internal consistency reliability, convergent and predictive validity, test-retest reliability, and measurement invariance across gender, ethnicity, education, and poverty status.

Medication errors may arise due to insufficient information on drug use. The purpose of this study was to determine the impact of educational support on standards of medication administration regarding nursing medication errors in Intensive Care Units (ICU). The study's participants included two groups of ICU nurses. Both groups were observed using a checklist, before and two weeks after training. Educational intervention in the form of two two-hour sessions was conducted for the intervention group, while control group received no intervention. No significant differences were found in both groups before intervention (P>0.05). However, the nurses' medication errors significantly decreased in the intervention group compared to the control group (12.7 ± 1.5 vs. 22.7 ± 3.8; p <0.01). Therefore, education of standards can result in a significant reduction in medication errors among ICU nurses. Even for ICU nurses, post-medical education is important for continuing professional education.

Background: Silent aspiration (SA) is common post-stroke and associated with increased risk of pneumonia, length of stay and healthcare costs. Clinical swallow examinations (CSEs) are unreliable measures of SA. There is no consensus on the clinical components that best detect SA. Cough reflex testing (CRT) is an alternative/adjunct whose SA detection accuracy also lacks consensus. Aims: To investigate the feasibility of CSE versus CRT against gold standard flexible endoscopic evaluation of swallowing (FEES) for SA identification and to estimate its prevalence in a hyperacute stroke setting. Methods & Procedures: A single-arm preliminary, prospective, feasibility study of patients less than 72 h post-stroke, over a 31-day period on a hyperacute stroke unit: the Royal Victoria Infirmary, Newcastle-upon-Tyne, UK. Ethical approval for the study was obtained. The study tested the feasibility and acceptability of introducing CRT and developing a standardized CSE. Consent/assent was obtained for all participants. Patients unfit for study were excluded. Outcomes & Results: A total of 62% of patients less than 72 h post-stroke (n = 61) were eligible. A total of 75% of those approached (n = 30) consented. A total of 23 patients completed all tests. The principal barrier was anxiety regarding FEES. Mean test time for CRT = 6 min; CSE = 8 min; FEES = 17 min. Patients rated CRT and FEES on average as moderately uncomfortable. A total of 30% (n = 7) of participants who received FEES presented with SA. Conclusions & Implications: CRT, CSE and FEES are feasible in 58% of hyperacute stroke patients in this setting. FEES anxiety is the main recruitment barrier and is not always well tolerated. Results support further work to establish optimum methods and differential sensitivity/specificity of CRT and CSE in hyperacute stroke for SA identification.

It became necessary to integrate alternative teaching methods having excellent results in the nursing curriculum such as high-fidelity human patient simulation. High fidelity simulation improves nursing students' thinking, and emotional and decision-making capabilities. The pretest-posttest control group design was conducted to examine the effect of high-fidelity simulation (HFS) intervention on clinical decision-making for pediatric nursing students at the Arab American University in Palestine. One hundred fifty participants took part in the present study, where 50% (n = 75) were in each of the intervention and control groups. The intervention group received theory-based learning and high fidelity simulation, while the control group was provided with theory based learning and usual training in the nursing laboratory. Findings showed that after implementing the intervention, a significant change was noticed in means of clinical decision-making between the control and intervention groups. Therefore, high fidelity simulation intervention was effective, thus it could benefit the nursing students by enhancing clinical decision-making. The results support nursing educators and universities especially in developing countries to adopt such an intervention strategy for nursing students.

This study uses bibliometrics and social network analysis methods to investigate the characteristics of the most cited research papers in the Web of Science (WoS) database in virtual patient (VP) studies in interactive learning environments. We identify the most cited studies from the WoS database and then visualize and analyze the research data using bibliometric analysis and VOSviewer. The studies in the dataset were published in 294 different journals in 17 countries between 1989 and 2020. The highest-volume journal was found to be Medical Teacher, and the United States (US) was the country with the highest yield of published studies. The most frequent keywords were virtual patients, simulation, virtual reality, and medical education. The research results show that publishing articles in journals with high impact factors improves the quality of research. The trends in VP research further lay the foundation of bibliometrics for scholars and identify researchers, scientific journals, countries, hot topics, and relevant fields for VP literature. The most cited research uncovers new horizons in the field, providing research inspiration for investigators.

Autistic people are over-represented at gender clinics, but there is limited research to guide clinical practice with this group. We investigated the perspectives of clinicians working with autistic patients who experience gender dysphoria. We asked clinicians about the relationship between autism and gender dysphoria, and whether they work differently with this patient group. We recruited clinicians from young person and adult gender clinics and autism services (n = 16). We analysed the interview transcripts using interpretative phenomenological analysis (IPA). The first overarching theme was clinician understanding of the intertwined experiences of patients, with four subthemes: (a) coming to an individualised understanding of autism, gender dysphoria, and mental health; (b) different ways of thinking about gender; (c) social differences as barriers and facilitators to gender comfort; (d) the challenge of sensory sensitivities and puberty. The second overarching theme was mismatch of patient and clinician communication styles and goals, with three subthemes: (a) different communication of gender needs; (b) changing clinical sessions to overcome barriers; (c) tension between clinician and patient aims and thinking styles. We conclude that autism adaptations should be made in gender settings, by increasing clinician understanding of how autism and gender dysphoria can intersect, as well as by making adjustments to clinic processes.

Purpose: The study refers to a health-care organization engaged in adopting "home health care" as a new object of activity. This study aims to explore how the reconfiguration of the object influences the transformative perspective, affecting not just a service but a broader approach and meaning behind patient care. It also investigates the main contradictions at play and the levers to support inter-organizational learning while facing the new challenges and change processes. Design/methodology/approach: The work is based on a qualitative and ethnographic methodology directed to examine cultural, practical and socio-material aspects. The activity theory is assumed as a powerful approach to understand collective learning and distributed agency processes. Findings: The renewal of the new object of work is analyzed as a trigger for shifts in representations, cultural processes and collective support implemented by the organization. Three agentic trajectories -- technical, dialogical and collaborative agency -- were cultivated by the management to deliver home health care through joint exercises of coordination and control, dialogical spaces and collaborative process. Research limitations/implications: The data collection was disrupted by the pandemic. A follow-up study would be beneficial to inquire how the learning processes shifted or were influenced by the contextual changes. Practical implications: This contribution provides a practical framework for health-care organizations aiming to navigate and explore the physiological tensions and contradictions emerging when the object of work is changed. Originality/value: The paper develops the field of intra- and inter-organizational learning by presenting an intertwined and structural connection between these processes and the renewing of the object of work. It advises that processes of transformation must be handled with attention to the critical and collective dynamics that accompany sustainable and situated changes.

Background: Simulated learning activities are an effective tool for reducing speech-language therapy (SLT) students' anxiety and improving their confidence for clinical placements. Such activities include interacting with patients who are actors, clinical educators or peers and are known to decrease anxiety and increase confidence in SLT students. Screen-simulated patients using video are another alternative, which has not yet been fully evaluated in the education of SLT students. Aims: To compare the effectiveness of (1) modified simulated patient and (2) video simulated learning for increasing self-reported (a) confidence and (b) preparedness and (c) decreasing self-reported anxiety. Methods & Procedures: This study used a randomized crossover design with 127 first-year graduate-entry master's SLT student participants. Students participated in two activities related to a clinical interaction with a paediatric client's carer: (1) a 1-hr modified simulated patient experience with clinical staff as the simulated patient; and (2) a video-learning task, with two videos of a clinician-carer interaction and an accompanying worksheet. Students were randomly allocated to a group of four students and the groups randomly allocated to receive modified simulated patient or video-learning first. Students were not blinded to the activities. The students completed a 19-item questionnaire at three time points: before either activity, after the first activity and after the second activity, to evaluate their self-reported confidence, clinical preparedness and anxiety. Outcomes & Results: A total of 62 students completed modified simulated patient first and 63 completed video-learning first. After either single activity the students had significantly increased confidence and preparedness scores, while only the modified simulated patient significantly reduced student anxiety scores. As a second activity, modified simulated patient resulted in further significant improvements in confidence, preparedness and anxiety; however, adding video learning as a second activity resulted in no significant benefit. Conclusions & Implications: This study demonstrates the effectiveness of two low-resource clinical-learning activities for novice SLT students that can be applied in a range of settings. Of the two activities, modified simulated patient had greater effectiveness, as it was the only activity to decrease anxiety. An investigation of the pedagogical principles within the activities revealed that modified simulated patient activity had more opportunities for peer learning, supervisor feedback and verbal reflection in comparison with video learning that may explain the increased benefits.

Background: Aphasia is often accompanied by impairment of non-language cognitive functions. Assessment of cognitive capacity in people with aphasia (PWA) with standard neuropsychological methods may be problematic due to their language difficulties. Numerous experimental studies indicate that P300 may be considered as an index of cognitive capacity in both healthy and clinical samples. Accordingly, the measurement of event-related potentials enables the investigation of behaviourally non-observable mental processes underlying the cognitive functions that are assessed with neuropsychological tests. Aims: To investigate in PWA the relationship between P300 parameters and cognitive function efficiency measured with neuropsychological methods. Methods & Procedures: A total of 25 PWA after left-hemispheric stroke participated in the study. Electrophysiological (EEG) signals were recorded during the performance of a visual Go-No Go task. P300 was identified on nine electrodes, which were then pooled in three lines: left (F3, C3, P3), central (Fz, Cz, Pz) and right (F4, C4, P4). The neuropsychological assessment of cognitive functions included mental speed, short-term memory, divided attention, executive functions, auditory language comprehension and expression. Outcomes & Results: P300 latency correlated with indices of several cognitive functions: temporal resolution, psychomotor speed, spatial short-term memory, planning, word and sentence comprehension, as well as verbal fluency. Shorter P300 latencies were accompanied by greater efficiency of the abovementioned functions. In contrast, significant correlations between P300 amplitudes and cognitive measures were fragmentary. Conclusions & Implications: In PWA, P300 latency might be related to cognitive functioning, especially to measures that rely heavily on the speed of information processing. However, P300 seems to be unrelated to more complex cognitive functions. P300 latency may be used as a neurophysiological correlate of cognitive efficiency in PWA and might have potential applications in monitoring the effects of therapeutic interventions in this patient group.

Background: Patients with schizophrenia present with both cognitive impairment as well as language difficulties. There are similarities in the language output of patients with schizophrenia and patients with aphasia, thus a differential diagnosis of patients who present with a question of dual diagnoses can be a clinical challenge. This case report highlights the importance of an interdisciplinary approach to a patient with schizophrenia who benefitted from intervention from both psychiatry and speech--language pathology services due to the patient's unique verbal output. Aims: The primary aim of this case report is to highlight the critical importance of interdisciplinary collaboration in this patient population. The secondary aim is to disseminate an interesting and unique clinical phenomenon whereby the patient demonstrated an awareness of two distinct speech patterns and the unique ability to 'code switch' between them, something not commonly appreciated in this clinical population. Methods & Procedures: This case report describes a patient seen as part of routine clinical care. Information shared was solely observational and involved dissemination of information regarding case history, assessment and treatment plan. No interventions were implemented as a part of this study. Outcomes & Results: Interprofessional communication was critical in order to diagnose a patient with schizophrenia with an atypical speech pattern. The patient's language output did not manifest as a true aphasia but rather as two distinct language patterns that the patient could use at will. This ability to 'code switch' between languages is a unique clinical profile that is atypical of patients with schizophrenia.

Background: Primary progressive aphasia (PPA) describes a group of language-led dementias. PPAs are complex, diverse and difficult to diagnose, and therefore conventional models of aphasia and dementia treatment do not meet their needs. The research evidence on intervention for PPA is developing, but to date there are only a few case studies exploring the experiences of people with PPA (PwPPA) themselves. Aims: To explore the experiences and opinions of PwPPA and their communication partners (CPs) to understand how speech and language therapy (SLT) services can better meet their needs. Methods & Procedures: A qualitative research approach was used whereby PwPPA and their friends or family members were recruited to participate in focus groups, via advertisements in the Rare Dementia Support PPA group newsletters. Consenting participants were allocated to attend one of four focus groups hosted on an online video conferencing platform. Participants were asked about their communication difficulties, and how SLT could address these needs. All meetings were transcribed, and data were examined using reflexive thematic analysis. Outcomes & Results: Six PwPPA and 14 CPs representing all three PPA variants and mixed PPA participated in the focus groups. Four main themes were identified during the analysis of the focus group discussions: (1) CPs' burden, (2) adjusting to the diagnosis, (3) communication abilities and difficulties and (4) beyond language. A further 10 subthemes were identified. Conclusions & Implications: This study provides a greater understanding of the experiences and needs of PwPPA and their families in relation to SLT. This work underlines the importance of a person-centred approach that considers the broader needs of both the PwPPA and the people around them. This will enable service providers to deliver SLT that meets the needs of PwPPA and their families and will also inform future research in this field.

Background: In order to conduct research that is meaningful to speech and language therapy services and their patients, it is often desirable to conduct the research within routine clinical services. This can require considerable time and commitment from speech and language therapists (SLTs). It is therefore important to understand the impact that such participation in research can have. Aims To explore the impact of research participation in the Big CACTUS study of self-managed computerized aphasia therapy conducted in 21 UK NHS speech and language therapy departments. Methods & Procedures: An online survey was sent to SLTs who took the lead role for the study at their NHS Trust to evaluate the impact of study participation in three domains: capacity-building, research development and health services. The questionnaire, based on the VICTOR framework for evaluating research impact, included Likert scale statements and closed and open-ended questions. The results from open-ended questions were coded and analysed using framework analysis in NVivo 12 and the data from closed questions were analysed descriptively. Outcomes & Results: A total of 12 SLTs returned the survey. Nine codes were identified from open-ended questions and 20 predefined from the literature. Analysis of the responses demonstrated the perceived impact including improvements in practices and access to therapy, investments in infrastructure, increased SLT profile, and impact on research culture among SLTs. The usefulness of the intervention during the COVID-19 pandemic was also highlighted. Conclusions & Implications: The results suggest participation in Big CACTUS has resulted in improvements in patient care and SLT research capacity and culture in speech and language therapy departments.

Background: Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. Aims: Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. Methods & Procedures: We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non-instrumental assessment, including quality-of-life measures carried out at four different time points (two pre-treatment and two post-treatment). The final assessment was at 3 months post-intervention. Outcome & Results: Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70-5.50) and in pharyngeal residue from saliva (95% CI = 2.14-3.15) and solids (95% CI = 2.4-3.5) post-intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. Conclusions & Implications: An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial.

Modern communication between health care professionals and patients increasingly relies upon secure messages (SMs) exchanged through an electronic patient portal. Despite the convenience of secure messaging, challenges include gaps between physician and patient expertise along with the asynchronous nature of such communication. Importantly, less readable SMs from physicians (e.g., too complicated) may result in patient confusion, non-adherence, and ultimately poorer health outcomes. The current simulation trial synthesizes work on patient physician electronic communication, message readability assessments, and feedback to explore the potential for automated strategy feedback to improve the readability of physicians' SMs to patients. Within a simulated secure messaging portal featuring multiple simulated patient scenarios, computational algorithms assessed the complexity of SMs written by 67 participating physicians to patients. The messaging portal provided strategy feedback for how physician responses might be improved (e.g., adding details and information to reduce complexity). Analyses of changes in SM complexity revealed that automated strategy feedback indeed helped physicians compose and refine more readable messages. Although the effects for any individual SM were slight, the "cumulative" effects within and across patient scenarios showed trends of decreasing complexity. Physicians appeared to learn how to craft more readable SMs via interactions with the feedback system. Implications for secure messaging systems and physician training are discussed, along with considerations for further investigation of broader physician populations and effects on patient experience.

Artificial Intelligence (AI) is a data-driven mathematical process that incorporates machine-based logic, usually in the form of algorithms. The algorithm is the building block of AI (Robert, 2019). Education, training, and competencies are now conducted through virtual reality, robotics, simulation, and technology learning-based platforms by healthcare organizations that can adopt this innovation (B. Webb, personal communication, September 3, 2023). In this article, Bonnette Villalba Webb and Jamie Anne Marcus examine how the adaptability of technology-based learning platforms can impact the quality and efficiency of learning for some of the workforce. Nurses' perception of technology and AI-driven nursing practice may vary based on generational orientation and can be a potential barrier to learning, practicing, and adaptability of this framework. They conclude that the future of nursing leadership must safeguard patient-care delivery and recognize that it is relationship-based with the foundations of human compassion and caring that are crucial to human wellbeing. Patients are in the most vulnerable state when their health is compromised. Compassionate care is part of the healing process. AI is an excellent tool to promote learning and efficiency, but integrating human-artificial intelligence in care delivery is imperative to promote quality care (Morrow et al., 2023).

This study examined whether patients attending cardiac rehabilitation (CR) based on the pedagogical strategy learning and coping (LC) led to improved health-related quality of life (HRQL), reduced symptoms of anxiety and depression and improved self-management 6 and 12 months after the completion of CR compared with patients attending CR based on the pedagogical strategy 'Empowerment, Motivation and Medical Adherence' (EMMA). A pragmatic cluster-controlled trial of two pedagogical strategies, LC and EMMA, including 10 primary health care settings and 555 patients diagnosed with ischaemic heart disease and referred to CR between August 2018 and July 2019 was conducted. In total, 312 patients replied to the questionnaires collected at baseline, 12 weeks, 6 months and 12 months after completing CR. Linear regression analyses adjusted for potential confounder variables and cluster effects were performed. We found clinically relevant and statistically significant improvements in HRQL, anxiety, depression and self-management after completing CR. The improvements were sustained at 6 and 12 months after the completion of CR. We found no differences between the two evidence-based patient education strategies. In conclusion, this study supports the use of evidence-based patient education strategies, but there is no evidence to suggest that one pedagogical strategy is superior to the other.

In this qualitative study, we consider student experiences with and perceptions of teaching methods that are clinical skill-based (e.g., simulation role plays). Focus groups included Master of Social Work students (N = 40) from six universities in the United States. A framework-guided content analysis was used and revealed four discussion areas: (a) classroom-based opportunities for practice observation and feedback, (b) field-based opportunities for practice observation and feedback, (c) other methods such as standardized patient simulations and computer simulations, and (d) attitudes about these methods. Experiences were quite diverse with classroom-based clinical role plays being the most common. Attitudes were generally positive. Student reflections on their experiences yielded several teaching recommendations specific to preparation, the nature of the simulated client role, and feedback.

We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers' reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.

Uncertainty tolerance (UT) is integral to healthcare. Providers' responses to medical uncertainty has ramifications on the healthcare system, the healthcare provider and the patient. Understanding healthcare providers' UT, is important for improving patient-care outcomes. Understanding whether and to what extent it is possible to modulate individuals' perceptions and responses to medical uncertainty, can provide insights into mechanisms for support for training and education. The objectives of this review were to further characterize moderators of healthcare UT and explore moderator influences on the perceptions and responses to uncertainty experienced by healthcare professionals. Framework analysis of qualitative primary literature was conducted on 17 articles, focusing on the impacts of UT on healthcare providers. Three domains of moderators were identified and characterized relating to the healthcare provider's personal attributes, patient-derived uncertainty and the healthcare system. These domains were further categorized into themes and subthemes. Results suggest these moderators influence perceptions and responses to healthcare uncertainty across a spectrum ranging from positive to negative to uncertain. In this way, UT could be a state-based construct within healthcare settings and is contextually determined. Our findings further characterize the integrative model of uncertainty tolerance (IMUT) (Hillen Social Science and Medicine 180, 62-75, 2017) and provide evidence for the relationship between moderators and their influences on cognitive, emotional and behavioral responses to uncertainty. These findings provide a foundation for understanding the complex nature of the UT construct, add to theory development, and provide groundwork for future research exploring appropriate support for training and education in healthcare fields.

Persons with chronic health conditions, such as heart disease, diabetes, hypertension, and others, often experience self-management problems that are not disease-specific. These include disrupted sleep, pain, memory issues, and challenges in working with healthcare providers. These patients may benefit from information and skill development for these problems, but simply providing them information in brief sessions during clinical appointments or in handouts or pamphlets may have little impact on their behavior. Providing information tailored to persons' needs and individual characteristics significantly impacts patients' behavior and may increase their abilities to manage their health. However, creating tailored information for each person is labor intensive, making it difficult to use in everyday clinical practice. Computer-based tailoring is an alternative, allowing automated tailoring of information presented to patients based on their interactions with a computer app. This article describes our process in developing a series of modules for chronic disease self-management for persons 40 or older with one or more chronic health conditions.

Objective: The unique features of college experience make it essential to address escalating mental-health challenges beyond college campuses. In 2010, we launched college-student focused (CSF) care nested within an adult day treatment program in a psychiatric hospital. The CSF care consists of student group therapies, individual consultation services for hospital staff and student-patients, and student-focused mental health guides for patients and families. This study preliminarily examined the clinical impact of CSF care on post-treatment symptoms reduction. Participants and Methods: In 235 college student-patients admitted to the day program between 2011 July to 2013 January, we assessed the targeted outcomes of the CSF care, using a newly developed CSF questionnaire. Results: Higher levels of CSF care-related outcomes predicted reduced post-treatment depression and anxiety, even after controlling for baseline clinical symptoms and post-treatment skills usage. Conclusions: These results highlighted the benefits and need for CSF care on a healthcare system level.

There has been increasing interest in applying integrative data analysis (IDA) to analyze data across multiple studies to increase sample size and statistical power. Measures of a construct are frequently not consistent across studies. This article provides a tutorial on the complex decisions that occur when conducting harmonization of measures for an IDA, including item selection, response coding, and modeling decisions. We analyzed caregivers' self-reported data from the ADHD Teen Integrative Data Analysis Longitudinal (ADHD TIDAL) dataset; data from 621 of 854 caregivers were available. We used moderated nonlinear factor analysis (MNLFA) to harmonize items reflecting depressive symptoms. Items were drawn from the Symptom Checklist 90-Revised, the Patient Health Questionnaire--9, and the World Health Organization Quality of Life questionnaire. Conducting IDA often requires more programming skills (e.g., Mplus), statistical knowledge (e.g., IRT framework), and complex decision-making processes than single-study analyses and meta-analyses. Through this paper, we described how we evaluated item characteristics, determined differences across studies, and created a single harmonized factor score that can be used to analyze data across all four studies. We also presented our questions, challenges, and decision-making processes; for example, we explained the thought process and course of actions when models did not converge. This tutorial provides a resource to support prevention scientists to generate harmonized variables accounting for sample and study differences.

Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann-Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient--peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention.

Children with intellectual disability experience significant challenges in accessing and receiving high-quality healthcare leading to poorer health outcomes and negative patient experiences. Families of these children often report a need for healthcare staff to better understand, communicate, and collaborate for better care while staff acknowledge a lack of training. To address this, we utilised an action research framework with a pre- and post-survey to evaluate an integrated continuing professional development and quality improvement program combining strategies from education, behavioural psychology and quality improvement that was delivered in two departments within a tertiary children's Hospital in Metropolitan Sydney in 2019-2020. Parents reported noticeable changes in the clinical practice of staff, and staff acknowledged and attributed their shift in behaviour to raising awareness and discussions around necessary adaptations. The program demonstrates a novel method for knowledge translation to practice and systems improvements.