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Antibiotics have traditionally been used for growth promotion in the pork industry; however, their use in animal feed has recently been limited because of human health concerns. The intestinal microbiota plays an important role in mediating many physiological functions such as digestion and animal growth. It was hypothesized that use of antibiotics as growth promotants and subsequent variations in intestinal microbiota induce significant changes in the intestinal glycoconjugate composition, which ultimately affects animal growth and disease susceptibility. The aim of this study was to characterize the lectin binding profiles of the ileum of weanling pigs in response to the absence of intestinal microbiota and to the use of the antibiotic chlortetracycline as growth promotant. Eighteen half-sib piglets obtained by cesarean section were divided into 3 treatment groups (n = 6) and maintained as control, antibiotic-fed, and gnotobiotic piglets until 5 wk of age. The glycoconjugate composition of the ileal tissues was examined by lectin histochemistry. Lycopersicon esculentum lectin, Jacalin, Pisum sativum agglutinin, Lens culinaris agglutinin (LCA), and Sambucus nigra lectin showed significant differences (P < 0.05) in binding intensities on the dome and villous epithelium between the treatment groups. Griffonia simplicifolia lectin I, Glycine maxi agglutinin, and Arachis bypogea agglutinin exhibited differences (P < 0.05) between treatment groups in lectin binding on goblet cells. Triticum vulgaris agglutinin, Pisum sativum agglutinin, and LCA showed significant differences (P < 0.05) in binding intensities on dome, corona, and follicular regions of the ileum among treatment groups of animals. Overall, ileal tissues from gnotobiotic piglets expressed significantly weaker (P < 0.05) lectin binding for many lectins compared with control and antibiotic groups. This suggests that the intestinal microbiota plays an important role in the expression of sugar moieties in the intestine. Lectins LCA, Phaseolus vulgaris Leucoagglutinin, and Maackia amurensis lectin II showed significant differences (P < 0.05) in lectin bindings between control and antibiotic-fed piglets. This indicates that chlortetracycline as a growth promotant induces biologically relevant changes in the lectin binding profile of the ileum. These findings will help in further understanding the role of the gut microbiota and the mechanisms of action of antibiotics as growth promotants in pigs. Key words: chlortetracycline, gnotobiotic, growth promotant, intestinal microbiota, lectin, pig

The objectives of this experiment were to evaluate the effect of oil source and peroxidation status on broiler performance and oxidative stress. Broilers (initial BW 85.1 ± 7.8 g) were allotted to 40 cages with 5 birds per cage in a completely randomized design. The 4 × 2 factorial arrangement of treatments consisted of oil source (palm oil, soybean oil, flaxseed oil, and fish oil) and peroxidation status (fresh or peroxidized). Broilers were fed experimental diets for 20 d to measure growth performance; on day 21 of the experiment, plasma and liver samples were harvested for analysis of oxidative stress including thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), 8-hydroxy-2'-deoxyguanosine (8- OH-2dG), glutathione peroxidase activity (GPx) and superoxide dismutase and catalase (CAT). An interaction occurred between oil source and peroxidation status where broilers fed peroxidized oils had reduced ADFI, ADG, G:F, and plasma GPx in all oil sources except for fish oil (P ≤ 0.04). Plasma 8-OH-2dG was increased by feeding peroxidized oils (P = 0.01). An interaction occurred in liver TBARS where broilers fed peroxidized palm oil had greater liver TBARS compared to fresh palm oil (P = 0.09). An interaction was noted for liver PC where broilers fed palm, flaxseed, and fish oil had similar liver PC regardless of peroxidation status, while broilers fed peroxidized soybean oil had increased liver PC compared to the fresh soybean oil diet (P = 0.04). Oil source affected plasma TBARS and 8-OH-2dG (P = 0.01), plasma PC (P = 0.09), liver 8-OH-2dG (P = 0.08), and liver CAT (P = 0.02). Correlations between oil composition with growth performance and oxidative stress markers imply that oil UFA:SFA, p-anisidine value, DDE, total polar compounds, and polymerized triglycerides should be measured as an indicator of oil quality, with growth performance being correlated to plasma TBARS, PC, and GPx. In conclusion, the degree of unsaturation and peroxidation status of dietary oils affected growth performance and markers of oxidative stress in poultry. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine possible interactions between serotonergic and dopaminergic agents lowering core temperature via stimulation of 5-HT1A and dopamine (DA) D2 receptors, respectively. The effects of the 5-HT1A receptor agonist (±)-8-hydroxy-2-(di-n-propylamino)tetralin HBr (8-OH-DPAT) and the DA D2/3 receptor agonist 7-OH-DPAT on core temperature was monitored in adult male Wistar rats, approximately 300 g body weight. The temperature probe was connected to a PC-assisted temperature instrument, and an automated printer device was activated when the temperature reading had stabilized (±0.1 °C) for 10 s. As expected, 7-OH-DPAT [0.5 and 2.0 μmol kg–1 subcutaneous (s.c.)] as well as 8-OH-DPAT (0.15–2.4 μmol kg–1 s.c.), produced a dose-dependent hypothermia. When combined, there were additive effects of the two compounds, although the effects of 7-OH-DPAT were attenuated by 8-OH-DPAT at the higher doses (0.6–2.4 μmol kg–1), in all probability because of emerging DA D2 receptor blocking properties of the latter compound. [ABSTRACT FROM AUTHOR]

An experiment was conducted to evaluate the impact of lipid source on energy and lipid digestibility, and on metabolic oxidation status of nursery pigs fed diets containing 10% of soybean oil (SO), choice white grease (CWG), palm oil (PO), or 1 of 2 different sources of distillers corn oil (DCOl and DCO2). Fifty-four barrows weaned at 28-d of age were fed a common starter diet from d 1 to 7, followed by group feeding their respective experimental diets (either 100% basal or 90% basal + 10% test lipid) from d 8 to 14 to adapt the pigs to their dietary treatments and to optimize subsequent feed intake. For the next 10 d (d 15 to 24), pigs were moved to metabolism crates for continued diet adaptation and to become accustomed to the twice daily feeding regimen in the metabolism crates. Following this period, a 4-d total fecal and urine collection occurred (d 25 to 29, final BW 11.03 ± 0.51 kg) to determine apparent total tract digestibility (ATTD) of energy and lipids, and to determine the DE and ME content of each lipid source. After an overnight fast of 12 h, urine was collected for 5 h, quantified, and subsequently analyzed for thiobarbituric acid reactive substances (TBARS) and isoprostane (IsoP) concentration. Following this collection, serum was obtained and analyzed for TBARS. Soybean oil had greatest (P < 0.05) DE (9388 kcal/kg) content compared with DCOl, DCO2, CWG, PO, and SO containing 8001, 8052, 8531, 8293, and 9388 kcal/kg lipid, respectively. Digestible energy as a percentage of GE was greatest (P < 0.05) for SO when compared to the other lipid sources (P < 0.05). The ATTD of EE averaged 85.0% and varied slightly (84.4% to 85.6%) among treatments. Differences in ME among lipids were similar to that for DE, with ME values for DCOl, DCO2, CWG, PO, and SO containing 7921, 7955, 8535, 8350, and 9408 kcal/kg lipid, respectively. Metabolizable energy as a percentage of DE did not differ between lipid sources. Pigs fed the diets containing lipids had higher (P < 0.05) plasma TBARS compared to pigs fed the control diet, but no differences were noted in urinary TBARS excretion among treatments. Urinary IsoP excretion differed among treatments (P < 0.01), but was highly variable (34.0 to 104.6 pg/ml). These results indicate that DE and ME values vary among lipid sources and appear to have variable effects on metabolic oxidation measures. [ABSTRACT FROM AUTHOR]

Twenty-nine Angus yearling steers (BW=417.3 ±31.3 kg) were used in a 2X2 factorial experiment conducted over 105 d feeding period to determine the effects of Synovex-S and ractopamine on serum concentration of IGF-I, performance and carcass characteristics. Traits analyzed were ADG from 0 d to 105 d after implant (ADG1) and ADG from 70 d to 105 d (ADG2), after starting ractopamine administration, HCW, LM area (LMA), back fat thickness (BF), marbling score (MARB), KPH and Yield Grade (YG), IGF-I and estradiol-17β (E2) concentrations. Treatments included: 1) control (C), 2) ractopamine (R), 3) Synovex-S implant (I) and 4) ractopamine and implant (RI). Weights were collected monthly, while blood samples were drawn on 0, 7, 35, 79 and 105 d. No interactions were found for any trait analyzed. ADG1 were 1.42, 1.55, 1.70 and 1.72 kg/d while ADG2 were 1.43, 1.73, 1.67 and 1.81 kg/d for C, R, I and RI respectively. Synovex-S affected ADG1 (P=0.02) but did not affect ADG2 (P=0.17). Ractopamine tended to increase ADG2 (P=0.06). No significant differences were found for HCW, LMA, BF, MARB, KPH or YG. Average carcass traits were HCW=357.8kg, LMA=83.1cm2, BF=1.12cm, MARB=415 (SM15), KPH=1.93% and YG=2.87. Synovex-S increased mean serum concentrations of E2 by 44% at 7 d (P=0.0003), by 42% at 35 d (P=0.0001), by 46% at 79 d (P=0.0001) and 13% at 105 d (P=0.012). Synovex-S increased mean serum concentrations of IGF-I by 43% at 7 d (P=0.036), by 51% at 5 d (P=0.007), by 60% at 79 d (P=0.011) and 25% at 105 d (P=0.063). Ractopamine did not alter serum concentration of E2 or IGF-I. Results indicate an effect of Synovex-S on IGF-I concentrations as well as on ADG1. Reduced increase on E2 and IGF-I might explain the lack of significance on ADG2 from the implant. Gene expression analysis using microarray will be performed on mRNA extracted from muscle biopsies (79 d) to identify changes in response to ractopamine and Synovex-S. [ABSTRACT FROM AUTHOR]

The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Nocardiosis typically requires a prolonged treatment duration of ≥6 months and initial combination therapy with 2-3 antibiotics. First-line regimens for nocardiosis are associated with considerable toxicity; therefore, alternative therapies are needed. Omadacycline is an aminomethylcycline with broad antimicrobial activity whose in vitro activity against Nocardia species has not been formally assessed. The in vitro potency of omadacycline was evaluated against 300 Nocardia clinical isolates by broth microdilution. The most common Nocardia species tested were N. cyriacigeorgica (21%), N. nova (20%), and N. farcinica (12%). The most common specimens were respiratory (178 isolates, 59%) and wound (57 isolates, 19%). Omadacycline minimum inhibitory concentrations (MICs) across all Nocardia species ranged from 0.06 µg/mL to 8 µg/mL, with an MIC 50 of 2 µg/mL and MIC 90 of 4 µg/mL. The lowest MICs were found among N. paucivorans (MIC 50 = 0.25 µg/mL, MIC 90 = 0.25 µg/mL), N. asiatica (MIC 50 = 0.25 µg/mL, MIC 90 = 1 µg/mL), N. abscessus complex (MIC 50 = 0.5 µg/mL, MIC 90 = 1 µg/mL), N. beijingensis (MIC 50 = 0.5 µg/mL, MIC 90 = 2 µg/mL), and N. otitidiscaviarum (MIC 50 = 1 µg/mL, MIC 90 = 2 µg/mL). The highest MICs were found among N. farcinica (MIC 50 = 4 µg/mL, MIC 90 = 8 µg/mL). In vitro potency differed by species among Nocardia clinical isolates. Further studies are warranted to evaluate the potential clinical utility of omadacycline for nocardiosis., Competing Interests: R.J.B. reports receiving prior research support from Rempex Pharmaceuticals. The other authors have no relevant conflicts of interest to disclose.

Purpose: After hospitalization, older persons may face a decline in physical function and daily independence. In-hospital exercise interventions can mitigate this decline, and continued support from primary healthcare post-discharge may enhance sustainability. This study aimed to explore home rehabilitation therapists' experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay., Methods: This qualitative study was conducted alongside a randomized-controlled trial to investigate prerequisites for a transitional care intervention. Twelve interviews were conducted with physiotherapists, occupational therapists, and managers across seven rehabilitation therapy services in Stockholm, Sweden. Data were analyzed using reflexive thematic analysis., Results: The analysis generated the theme Striving for individualized support for physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. It was based on four subthemes: The starting point is always the patient's current needs, goals, and prerequisites, Continuing the exercise initiated during hospitalization by adapting it to the patient's situation at home, Work premises not tailored to patients with complex care needs, and A home care organization that lacks coordination and unified purpose., Conclusions: Interventions supporting older persons to physical exercise after acute hospitalization need to be tailored to the individual, support motivation, and be adapted to the patient's home situation. Challenges may arise when care recourses lack alignment with the patients' needs, and when the collaboration among care providers is limited. The findings contribute valuable insights for future studies incorporating transitional care interventions in similar context., (© 2024. The Author(s).)

Stroke may affect physical functioning, cognition, and mental and social aspects of one's life. Health literacy and self-efficacy are associated with positive health outcomes and are important factors for managing the diverse consequences of a stroke. However, there is very little literature on the association between health literacy and self-efficacy. This study aimed to investigate the association between health literacy and self-efficacy among stroke survivors 1 year after discharge from hospital. Participants in this cross-sectional study were patients diagnosed with a stroke, mainly a mild stroke, who were referred to rehabilitation in primary care after discharge from hospital in Sweden. Data was collected using questionnaires, performance-based tests, and medical records. Ordinal logistic regression was used to analyze the association between general self-efficacy and health literacy in adjusted models. The analysis revealed that higher levels of general self-efficacy and higher levels of performing activities of daily living were associated with higher levels of health literacy. Stroke survivors with higher general self-efficacy also report higher health literacy 1-year post-discharge from hospital. Future studies should focus on the pathways by which health literacy and general self-efficacy work among stroke survivors and in populations with low health literacy, severe stroke or significant cognitive impairments., (© 2024. The Author(s).)

Introduction: Care transitions following a stroke call for integrated care approaches to reduce death and disability. The proposed research described in this study protocol aims to evaluate the effectiveness of a person-centred multicomponent care transition support and the process in terms of contextual moderators, implementation aspects and mechanisms of impact., Methods: A non-randomized controlled trial design will be used. The intervention includes person-centred dialogue intended to permeate all patient-provider communication, various pedagogical modes of information, a person-centred care and rehabilitation plan, and a bridging e-meeting to prepare patients for homecoming. Patients with stroke or TIA who are to be discharged from the participating hospitals to home and referred to a neurorehabilitation team for continued rehabilitation will be included. Follow-ups will be conducted at one week, 3 months and 12 months. Data will be collected on the primary outcome of perceived quality of the care transition, and on the secondary outcomes of health literacy, medication adherence, and perceived person-centeredness. Data for process evaluation will be collected through semi-structured interviews, focus groups, participatory observations, and the Normalisation Measure Development Questionnaire., Discussion: The study will provide insights on implementation, mechanisms of impact, contextual moderators, and effectiveness of a care transition support, targeting a poorly functioning part of the care trajectory for people with stroke and TIA., Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT05646589., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lindblom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Life after stroke may entail several lifestyle changes and new routines. Hence, it is imperative for people with stroke to understand and make use of health information, i.e. to have sufficient health literacy. This study aimed to explore health literacy and its associations with outcomes at 12-months post-discharge regarding depression symptoms, walking ability, perceived stroke recovery, and perceived participation in people with stroke., Methods: This was a cross-sectional study of a Swedish cohort. Data were collected at 12 months post-discharge using European Health Literacy Survey Questionnaire, the Hospital Anxiety and Depression Scale, the 10-m walk test, and the Stroke Impact Scale 3.0. Each outcome was then dichotomized into favorable versus unfavorable outcome. Logistic regression was performed to assess the association between health literacy and favorable outcomes., Results: The participants, n  = 108, were on average 72 years old, 60% had mild disability, 48% had a university/college degree, and 64% were men. At 12 months post-discharge, 9% of the participants had inadequate health literacy, 29% problematic health literacy, and 62% sufficient health literacy. Higher levels of health literacy were significantly associated with favorable outcomes relating to depression symptoms, walking ability, perceived stroke recovery, and perceived participation in models adjusted for age, sex, and education level., Conclusion: The association between health literacy and mental, physical, and social functioning 12-months post-discharge suggests that health literacy is an important factor to consider in post-stroke rehabilitation. Longitudinal studies of health literacy in people with stroke are warranted to explore the underlying reasons for these associations.

The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. Data from a feasibility study of a codesigned care transition support for people with stroke was used. Patients who at discharge received both a structured discharge letter and participated in the person-centred communication method Teach Back ( n = 17) were compared with patients receiving standard discharge procedures ( n = 21). Questionnaires were used to compare the groups regarding perceived understanding of information about medical treatment, knowledge of information about medical treatment and medication adherence at 1 week and 3 months. There was a statistically significant difference in perceived understanding of information about medical treatment ( p > 0.01) between the groups in favour of those who participated in Teach Back at the discharge encounter. No differences between groups were found regarding understanding health information about medical treatment and medication adherence. The results indicate that the use of Teach Back at the discharge encounter positively impacts perceived understanding of information about medical treatment in people with stroke. However, considering the nonrandomised study design and the small sample size, a large-scale trial is needed.

Background: There is a lack of knowledge about patients' journeys across the stroke care continuum, especially regarding the transition from inpatient to outpatient care and rehabilitation. Therefore, the aim of the present study was to explore and describe patterns of healthcare use over a one-year period, health outcomes at 3 and 12 months for patients following a referral-based transition to subsequent rehabilitation in the home, and the caregiver burden on their significant others. A further aim was to explore factors associated with the use of rehabilitation and healthcare after the referral-based transition to continued rehabilitation in the home for people recovering from a stroke., Methods: Data regarding healthcare use during the first 12 months post-stroke was collected from the Region Stockholm computerized register. Data on patient characteristics, disease-related data, and functioning were retrieved drawn from medical records and questionnaires. Descriptive statistics were used to present healthcare use, participants' characteristics, disease-related data, and patient functioning. Multivariable regression models were created to explore associations between the total number of outpatient contacts, total visits with the neurorehabilitation team, and the independent variables., Results: The mean age for the 190 participants was 73 years for men and 78 years for women. Twenty-one participants (11%) had an acute rehospitalization within 30 days after discharge, and 41 participants (21%) were re-hospitalized within 90 days. Twenty-two (12%) of the participants had no visits with the neurorehabilitation team, 73 (39%) participants had 1-3 visits, 57 (30%) had 4-16 visits, and 38 (20%) had ≥17 visits. Female sex and length of hospital stay were associated with a higher number of visits with the neurorehabilitation team. Living alone, higher self-rated recovery, and being able to walk independently were associated with a lower number of visits with the neurorehabilitation team. Female sex, having home help services before the stroke, longer length of hospital stay, and more comorbidities were associated with a higher number of outpatient contacts., Conclusions: The findings indicate that there is no generic pattern of healthcare use during the first-year post-stroke in patients receiving referral-based transition to continued rehabilitation in the home. The different patterns of healthcare use seemed to mirror the participants' level of functioning. However, there is a need to further investigate how follow-up and rehabilitation correspond to the needs of patients and their significant others in the short- and long-term perspective., Trial Registration: ClinicalTrials.gov , registration number: NCT02925871 . Date of registration: October 6, 2016., (© 2022. The Author(s).)

Background: Care transitions following stroke should be bridged with collaboration between hospital staff and home rehabilitation teams since well-coordinated transitions can reduce death and disability following a stroke. However, health services are delivered within organisational structures, rather than being based on patients' needs. The aim of this study protocol is to assess the feasibility, operationalised here as fidelity and acceptability, of a codesigned care transition support for people with stroke., Methods: This study protocol describes the evaluation of a feasibility study using a non-randomised controlled design. The codesigned care transition support includes patient information using videos, leaflets and teach back; what-matters-to me dialogue; a coordinated rehabilitation plan; bridged e-meeting; and a message system for cross-organisational collaboration. Patients with stroke, first time or recurrent, who are to be discharged home from hospital and referred to a rehabilitation team in primary healthcare for continued rehabilitation in the home will be included. One week after stroke, data will be collected on the primary outcome, namely satisfaction with the care transition support, and on the secondary outcome, namely health literacy and medication adherence. Data on use of healthcare will be obtained from a register of healthcare contacts. The outcomes of patients and significant others will be compared with matched controls from other geriatric stroke and acute stroke units, and with matched historic controls from a previous dataset at the intervention and control units. Data on acceptability and fidelity will be assessed through interviews and observations at the intervention units., Ethics and Dissemination: Ethical approvals have been obtained from the Swedish Ethical Review Authority. The results will be published open-access in peer-reviewed journals. Dissemination also includes presentation at national and international conferences., Discussion: The care transition support addresses a poorly functioning part of care trajectories in current healthcare. The development of this codesigned care transition support has involved people with stroke, significant other, and healthcare professionals. Such involvement has the potential to better identify and reconceptualise problems, and incorporate user experiences., Trial Registration Number: http://www.clinicaltrials.gov id: NCT02925871. Date of registration 6 October 2016., Protocol Version: 1., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In the present study we describe a way of working to overcome oral administration challenges in an early preclinical project. As candidate drugs were obtained, the preclinical delivery route was replaced by the intended route of the product and resources were allocated to optimize the oral absorption. Two main approaches were followed in order to formulate a selected weak acid, AZ'403, for oral administration in large scale toxicological studies and the early clinical phases. Both approaches relies on the suppression of precipitation from obtained supersaturated solutions achieved either by amorphous solid dispersions (using hydroxypropyl methylcellulose acetate succinate, HPMC-AS) or crystalline salts (sodium and potassium salts). In vivo studies in rodents were performed to evaluate oral AZ'403 absorption from amorphous and crystalline formulations, using nano- and micro crystalline particles of the neutral form, as references. The oral absorption of AZ'403 formulated using both approaches was significantly higher compared with the references. The improvements in overall exposures were 7-100 times during the investigated conditions. The pharmacokinetic profiles implied that both solid dispersions and crystalline salts of AZ'403 generated supersaturation in the small intestine in rodents and indicated that both approaches may be ways forward for subsequent late stage product development., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Despite intentions to increase user participation in the development of health services, the concept of participation and how it unfolds within studies with a participatory design has rarely been addressed., Objective: The aim of this study was to describe how user participation manifests itself within a co-design process involving patients, significant others and health-care professionals, including potential enablers or barriers., Methods: This study was conducted in the context of a co-design process of a new person-centred transition from a hospital to continued rehabilitation in the home involving three patients with stroke, one significant other and 11 professionals. Data were collected by observations during the workshops, semi-structured interviews and questionnaires., Results: Four categories: 'Composition of individuals for an adaptive climate'; 'The balancing of roles and power'; 'Different perspectives as common ground for a shared understanding'; and 'Facilitating an unpredictable and ever-adaptive process', with all together nine subcategories, resulted from the analysis. Participation varied between individuals, groups and steps within the process, and on the topic of discussions and the motivation to contribute., Discussion/conclusion: Participation is not something that is realized by only applying participatory design methodology. Participation manifests itself through the interaction of the participants and their skills to handle different perspectives, roles and assignments. Participation is enabled by individual, group and facilitating aspects. Co-design processes should allow for varying levels of participation among the participants and throughout the process., Patient or Public Contribution: Patients, significant others and health-care professionals participated as co-designers of a care transition model between hospital and home., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: The cororavirus disease 19 (COVID-19) pandemic has strained intensive care unit (ICU) material and human resources to global crisis levels. The risks of staffing challenges and clinician exposure are of significant concern. One resource, telecritical care (TCC), has the potential to optimize efficiency, maximize safety, and improve quality of care provided amid large-scale disruptions, but its role in pandemic situations is only loosely defined. Planning and Preparation Phase: We propose strategic initiatives by which TCC may act as a force multiplier for pandemic preparedness in response to COVID-19, utilizing a tiered approach for increasing surge capacity needs. The goals involved usage of TCC to augment ICU capacity, optimize safety, minimize personal protective equipment (PPE) use, improve efficiencies, and enhance knowledge of managing pandemic response. Implementation Phase: A phased approach utilizing TCC would involve implementing remote capabilities across the enterprise to accomplish the goals outlined. The hardware and software needed for initial expansion to cover 275 beds included $956,670 for mobile carts and $173,106 for home workstations. Team role deployment and bedside clinical care centering around TCC as critical care capacity expand beyond 275 beds. Surge capacity was not reached during early phases of the pandemic in the region, allowing refinement of TCC during subsequent pandemic phases. Conclusions: Leveraging TCC facilitated pandemic surge planning but required redefinition of typical ICU staffing models. The design was meant to workforce efficiencies, reduce PPE use, and minimize health care worker exposure risk, all while maintaining quality care standards through an intensivist-led model. As health care operations resumed and states reopened, TCC is being used to support shifts in volume and critical care personnel during the pandemic evolution. The lessons applied may help health care systems through variable phases of the pandemic.