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The U.S. healthcare system struggles to provide adequate language assistance to medical practitioners and patients. As a result, health providers and patients rely on ad hoc interpreters, including children, to communicate. Bilingual children who regularly interpret for others, whom we refer to as child language brokers, are important linguistic and cultural conduits for their communities and bridge language differences in vital contexts, such as health and medical settings. In this paper, we explore the experiences of 17 adolescent language brokers and consider the settings, tasks, and people they engage with when language brokering for health. Findings illustrate that child language brokering is a real and important component for immigrant family health, that child language brokering for health is not a uniform experience, and that language brokering for health can sometimes have severe ramifications.

This project report describes the process of a team of undergraduate researchers (Chemistry and Nursing majors), who analyzed 20th-century medical kits housed at The Columbus Museum (Columbus, GA, USA). Curators and museum personnel were unfamiliar with the contents and needed assistance in identifying the various chemical contents. Items were identified by the Taylor Lab, which was followed by fully elucidating the chemical information in a chemical report and student-curated exhibit. The intent of this project was to help the museum be aware of how to properly curate and store the medical collections for an extended period. Laboratory analyses were executed to determine the composition of the aged items in the collections. The historical context of these kits and their contents provided knowledge of medicine to the community of Columbus, Georgia, in addition to explaining the use of medically related items in the 20th century.

Successful translation of medical devices requires a clear pathway through the business environment, including regulatory obligations and the protection of intellectual property. Introducing these topics can be challenging for biomedical engineering programs, as students prefer hands-on activities and retain concepts best when directly applied to projects or research. To address this challenge, 10 years ago, we created a two-semester course sequence covering these topics, primarily intended for MS students focused on medical device design. Course content is delivered with a "just-in-time" approach to align with ongoing year-long design projects. In the fall semester, our course covers IP and regulatory topics relevant to the selection of an unmet clinical need for further development. The spring course covers topics related to implementation of a business model for a new product, such as licensing, clinical trials, quality systems, and submission of material to the FDA. Over 10 years, we have added numerous special features, including a regulatory science competition, a mock Pre-Submission Project reviewed by regulatory experts, and an IP presentation modeled after industry practices. In this manuscript, we review course content, structure, and outcomes. A survey was used to obtain feedback from graduates now in widely varying positions in the medical innovation space. In addition, we obtained feedback from a sample of external reviewers. With a response rate of [approximately]50%, the survey identified strong support for the courses and identified chosen career paths. The mock Pre-Submission Project was highly valued by students and their employers, as were other assignments that aligned with ongoing design or research activities. Several opportunities for improvement and possible expansion of the course were identified to further enhance this valuable part of our curriculum.

A challenge in building the biomedical engineering human factors course at Malawi University of Business and Applied Sciences was integrating meaningful direct experiences with medical products. The instructor also noticed a significant gap between the topics in the course and their surrounding clinical context, a low-income setting. Recognizing that devices should be designed and evaluated in the context of the local users' needs and situations, new hands-on modules were created and implemented in this BME human factors course. Students were asked to critically evaluate and make recommendations to improve the human factors aspects of the software and hardware of the IMPALA, a vital signs monitoring device developed for use in Malawi. Engaging with this medical device, students observed and understood many issues discussed in human factors, including the design of ports, controls, and other user interfaces. The collaboration between the course and the IMPALA project harnessed the local expertise of students to improve the design of a new patient monitoring system. Thus, the IMPALA project itself benefited from this collaboration. Second, students greatly benefited from applying the class concepts to the IMPALA. Students were engaged far more during the interactive components than during the lecture components. Many students successfully translated their knowledge on human factors to their final-year design project.

Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton's Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students' performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students' performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students' communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.

Population-adjusted indirect comparison (PAIC) is an increasingly used technique for estimating the comparative effectiveness of different treatments for the health technology assessments when head-to-head trials are unavailable. Three commonly used PAIC methods include matching-adjusted indirect comparison (MAIC), simulated treatment comparison (STC), and multilevel network meta-regression (ML-NMR). MAIC enables researchers to achieve balanced covariate distribution across two independent trials when individual participant data are only available in one trial. In this article, we provide a comprehensive review of the MAIC methods, including their theoretical derivation, implicit assumptions, and connection to calibration estimation in survey sampling. We discuss the nuances between anchored and unanchored MAIC, as well as their required assumptions. Furthermore, we implement various MAIC methods in a user-friendly R Shiny application Shiny-MAIC. To our knowledge, it is the first Shiny application that implements various MAIC methods. The Shiny-MAIC application offers choice between anchored or unanchored MAIC, choice among different types of covariates and outcomes, and two variance estimators including bootstrap and robust standard errors. An example with simulated data is provided to demonstrate the utility of the Shiny-MAIC application, enabling a user-friendly approach conducting MAIC for healthcare decision-making. The Shiny-MAIC is freely available through the link: https://ziren.shinyapps.io/Shiny_MAIC/.

During drug development, evidence can emerge to suggest a treatment is more effective in a specific patient subgroup. Whilst early trials may be conducted in biomarker-mixed populations, later trials are more likely to enroll biomarker-positive patients alone, thus leading to trials of the same treatment investigated in different populations. When conducting a meta-analysis, a conservative approach would be to combine only trials conducted in the biomarker-positive subgroup. However, this discards potentially useful information on treatment effects in the biomarker-positive subgroup concealed within observed treatment effects in biomarker-mixed populations. We extend standard random-effects meta-analysis to combine treatment effects obtained from trials with different populations to estimate pooled treatment effects in a biomarker subgroup of interest. The model assumes a systematic difference in treatment effects between biomarker-positive and biomarker-negative subgroups, which is estimated from trials which report either or both treatment effects. The systematic difference and proportion of biomarker-negative patients in biomarker-mixed studies are used to interpolate treatment effects in the biomarker-positive subgroup from observed treatment effects in the biomarker-mixed population. The developed methods are applied to an illustrative example in metastatic colorectal cancer and evaluated in a simulation study. In the example, the developed method improved precision of the pooled treatment effect estimate compared with standard random-effects meta-analysis of trials investigating only biomarker-positive patients. The simulation study confirmed that when the systematic difference in treatment effects between biomarker subgroups is not very large, the developed method can improve precision of estimation of pooled treatment effects while maintaining low bias.

Objective: Children report needle procedures as one of their most feared and painful experiences. Negative blood test experiences can lead to lifelong implications. Xploro is an online health information platform (app) that uses age-appropriate self-directed augmented reality (AR) techniques. This study evaluated the acceptability, feasibility and self-reported impact of Xploro on children undergoing a planned blood test. Method: Children aged 6-14 years accessed Xploro at home before attending hospital for a planned blood test. Paper data collection booklets were completed by children, their parents and health professionals. We explored participants' views of using Xploro and the perceived impact on a child's ability to undergo the blood test. Data were analysed using descriptive statistics and content analysis procedures. Results: Notably, 24 children, 24 parents and 6 health professionals participated. Children (96%; n = 23/24) reported that Xploro was 'fun' and 'easy to use' and helped them have their blood test (94%, n = 17/18), as they 'knew what to expect' and what would help them. Parents reported that the app helped 'open up a dialogue about the blood test' with their child and helped their child 'know what would happen during the blood test' and how to 'stay calm'. Health professionals (n = 6) reported that Xploro helped children access information 'at their leisure at home'. Conclusion: Xploro was reported as being a useful and engaging self-directed child-friendly information app for children having a planned blood test which helped children know what was going to happen and improved their experiences of having a blood test.

This intervention study aimed to assess mothers' knowledge of iron-deficiency anemia (IDA). It also measured the impact of a health education program on their level of knowledge and their infants' IDA rates in rural areas of Nablus Governorate. Using a randomized pretest--posttest control group design, the efficacy of 3 months' education program was examined against control group. Assessments were made at baseline and after 3 months of conducting the intervention. A structured interviewing questionnaire was used to assess the knowledge about IDA, and blood samples were collected from infants in both groups. Only 1.9% of mothers in the intervention group and 3.5% of mothers in the control group had good level of knowledge at baseline. After the educational intervention, a significant statistical difference was observed in the mean total knowledge score between the intervention and control groups (33.68 + 5.366 versus 26.12 + 5.243), and the intervention group was seven times more likely to have good knowledge (relative risk = 7.332). Regarding IDA rate, there was a decrease in the infants with IDA in the intervention group (relative risk = 0.671) compared to infants in the control group. The planned health education program was effective in improving mothers' knowledge and reducing the risk of IDA among their infants.

Background: Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. Aim: This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Methods & Procedures: Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Results: Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. Conclusion: These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers.

Background: Individuals with severe motor and intellectual disabilities have become an aging population, and high cancer morbidity and mortality are critical issues affecting their survival. Cancer screening is a crucial method of resolving this issue; however, a suitable screening method for them has not been established. Methods: We used ultrasonography alone and performed breast cancer screening for women over 30 years old in our facility from 2016 to 2023. We observed the outcomes and calculated the recall/detection rate in this screening. Results: Three cases among 379 tested positive in this screening, all of which underwent radical surgery. They are alive and well without relapse present. We detected these breast cancer cases with a low recall rate. Conclusion: We were able to successfully detect breast cancer cases using ultrasonography alone. Ultrasonography is an effective and feasible tool for breast cancer screening in individuals with severe motor and intellectual disabilities.

Deaf patients who communicate in American Sign Language (ASL) experience communication challenges leading to medical errors, treatment delays, and health disparities. Research on Deaf patient communication preferences is sparse. Researchers conducted focus groups based on the Health Belief Model with culturally Deaf patients and interpreters. The ASL focus groups were interpreted and transcribed into written English, verified by a third-party interpreting agency, and uploaded into NVivo. Deductive coding was used to identify communication methods and inductive coding was used to identify themes within each. Writing back-and-forth introduced challenges related to English proficiency, medical terminology, poor penmanship, and tendencies of providers to abbreviate. Participants had various speechreading abilities and described challenges with mask mandates. Multiple issues were identified with family and friends as proxy interpreters, including a lack of training, confidentiality issues, emotional support, and patient autonomy. Video remote interpreter challenges included technical, environmental, and interpreter qualification concerns. Participants overwhelmingly preferred on-site interpreters for communication clarity. While there was a preference for direct care, many acknowledged this is not always feasible due to lack of providers fluent in ASL. Access to on-site interpreters is vital for many Deaf patients to provide full access to critical medical information. Budget allocation for on-call interpreters is important in emergency settings.

Pulsed-wave Doppler ultrasound is a widely used technique for monitoring pregnancies. As ultrasound equipment becomes more advanced, it becomes harder to train practitioners to be proficient in the procedure as it requires the presence of an expert, access to high-tech equipment as well as several volunteering patients. Immersive environments such as mixed reality can help trainees in this regard due to their capabilities to simulate real environments and objects. In this article, we propose a mixed reality application to facilitate training in performing pulsed-wave Doppler ultrasound when acquiring a spectrogram to measure blood velocity in the umbilical cord. The application simulates Doppler spectrograms while the trainee has the possibility of adjusting parameters such as pulse repetition frequency, sampling depth, and beam-to-flow angle. This is done using a combination of an optimized user interface, 3D-printed objects tracked using image recognition and data acquisition from a gyroscope. The application was developed for Microsoft HoloLens as the archetype of mixed reality, while a 3D-printed abdomen was used to simulate a patient. The application aims to aid in both simulated and real-life ultrasound procedures. Expert feedback and user-testing results were collected to validate the purpose and use of the designed application. Design science research was followed to propose the intended application while contributing to the literature on leveraging immersive environments for medical training and practice. Based on the results of the study, it was concluded that mixed reality can be efficiently used in ultrasound training.

It is important to examine women's experiences in the infertility process, as being a woman is perceived as a concept that overlaps with motherhood, and the woman herself is exposed to physical pain during the treatment. In this research, which was carried out with a phenomenological pattern, one of the qualitative methods, the experiences of married women diagnosed with infertility regarding the infertility process were examined, and it was tried to determine the themes that would help psychological counselors in the therapeutic process. The study group consists of 10 women selected by criterion sampling using purposeful sampling methods. The results of the research were discussed under seven headings: infertility experience, stress factors, acquired skills, social support resources, the role of the spouse, coping skills, and belief in the treatment. The theme of the infertility experience includes codes of negativeness, helplessness, frustration, and compelling; the theme of stress factors includes codes of expectations, pressure, uncertainty, the passage of treatment, personal conflicts, against his spouse's liability, failure, and the search for a solution; the theme of acquired skills includes codes of coping with the challenges, obtaining medical information, hoping, common share, body recognition, gender awareness, healthy eating, the theme of social support resources includes codes of, contact, spouse, family, friend, and counselor; the theme of the role of spouse includes codes of support; the theme of coping skills includes codes of, religious beliefs, social activities, the sense of common humanity, work and psychological support; the theme of faith for treatment includes codes of hope and despair.

The present study aimed to explore the role of feedback in the medical workplace in the domain of radiology. Feedback is considered essential for learning, performance, and professional development, as it helps to build knowledge and skills, to correct errors, and to provide safe and autonomous patient care. Fifteen specialists were interviewed about what role feedback played in their own professional development. Moreover, we enquired about how they interact with residents and how they provide feedback in their daily work. Content analysis was used to categorise participants' answers. Results show that specialists see feedback as an omnipresent phenomenon at the workplace and perceive it as central to training. Feedback is usually provided face-to-face to reinforce and transfer knowledge, improve domain-specific knowledge, reduce mistakes, improve the outcome for the patient, change behaviour patterns, or increase social skills. Although feedback at the workplace was considered important for professional development, physicians stressed that there is often not enough time to discuss performance and possibilities for performance improvements. Forming tandems between less and more experienced physicians, so that learning becomes more embedded in medical practice and work activities might be a facilitating condition at the workplace.

The informed consent process is integral to medical procedures, including skin biopsies, which are the definitive method for diagnosing challenging skin lesions. Educational videos are recognized for effective delivery of information for informed consent. This study aimed to evaluate the efficacy of an informed consent process using educational videos to improve patient understanding and reduce preprocedural anxiety. This multicenter, randomized controlled study was conducted during December 2021-June 2023. Participants were randomly assigned to either the video or verbal group in a 1:1 ratio. They completed knowledge and anxiety questionnaires before and after biopsy. The final analysis included 54 participants (verbal group: n=28; video group: n=26) with a mean age of 51.9 years (standard deviation [SD] 18.1), and a balanced gender distribution. Post-intervention knowledge scores (median 10.0; IQR 8.0-10.0) significantly increased compared to pre-intervention scores (median 6.0; IQR 4.0-9.0), p<0.001. Post-intervention Spielberger state-trait anxiety inventory (STAI) scores (median 5.0; interquartile range, IQR 5.0-6.0) significantly decreased compared to pre-intervention scores (median 7.0; IQR 5.0-10.0), p<0.001. Knowledge scores increased more in the video group (median, 2.5; IQR 1.0-5.0) than in the verbal group (median, 1.5; IQR 0.0-4.0), p=0.217. There was no significant difference in STAI score changes between the video group (median 1.0, IQR 0.0-4.0) and the verbal group (median 1.0, IQR 0.0-3.0), p=0.824. Despite statistical insignificance, educational videos exhibited greater effectiveness in enhancing comprehension and demonstrated comparable efficacy in reducing anxiety compared to conventional intervention.

This study aims to emergency medical services(EMS) and their efficacy within the purview of Local Administrative Organizations (LAOs) in Thailand. As the responsibility for EMS has transitioned from public hospitals to LAOs, it has prompted inquiries into their efficiency. This research endeavors to scrutinize the determinants influencing the performance of EMS managed by LAOs. To accomplish this objective, we embraced a quantitative research approach. Data was obtained from 636 individuals who had availed emergency medical services, chosen through purposive sampling. Questionnaires were used to collect data, and the IOC index was employed to ensure data integrity. Descriptive statistics elucidated and assessed various variables. Multiple regression analysis was conducted with a statistical significance level of 0.01 to unearth the associations between administrative factors and the performance of EMS by LAOs. This research uncovers a positive, moderate-level correlation between administrative factors and the performance of EMS by LAOs. Specifically, factors such as community engagement, service preparedness, operational efficiency, budget allocation, resource availability, and staffing levels were identified as noteworthy predictors of EMS success by LAOs, explaining 60.8 percent of the variance. The outcomes of this study have practical implications for EMS management by local authorities, not only in Thailand but also in other regions grappling with analogous challenges. This research contributes to the ongoing endeavors to enhance pre-hospital care and emergency response, ultimately preserving lives and mitigating the repercussions of emergency illnesses and accidents on communities.

Background: Although there are a growing number of studies investigating the benefits of music therapy interventions with patients diagnosed with cancer, few studies have taken an approach that specifically examines indices of perceived well-being in women with breast cancer. Overcoming these challenges can be an important step in the recovery process. Purpose: The purpose of our study was to know the positive influence of responsive music therapy through gong sounds, emitted live, on different areas of well-being of women with breast cancer. Methods: Four individual sessions of responsive music therapy with live gong sounds were conducted in which three women (M = 54; SD = 5.57) participated both in the music therapy program and in the completion of the Functional Assessment of Cancer Therapy-Breast (FACT-B) and a semi-structured interview with ad hoc designed questions about perception of qualitative aspects. Results: The results showed that the music therapy sessions significantly improved, p = 0.043 < 0.05, various domains of perceived well-being in women with breast cancer. Discussion: This article highlights several key benefits associated with music therapy and various indices of well-being in women with breast cancer, identifies the limitations of the study, and discusses the findings. It is considered necessary to replicate this practice in future studies that include a larger sample and age range over longer follow-up periods. Translation for Health Education Practice: The text highlights the importance of considering music therapy as a complementary intervention in comprehensive cancer care programs, which may be relevant to health educators when considering intervention and support approaches for cancer patients. Health education interventions targeting the enhancement of cancer patients' well-being should incorporate music therapy techniques.

Purpose: In light of the world's accelerating march towards a sustainable future, the education for sustainable healthcare must be sufficiently acknowledged in health professions curricula. Early integration of these competences into nursing degree programme emphasizes its importance and applicability. This paper aims to investigate the effectiveness of an educational sustainability intervention in higher education to change nursing students' attitudes towards sustainability and climate change, and environmental awareness. Design/methodology/approach: A quasi-experimental study was performed with repeated measures between September 2019 and May 2023. Undergraduate students were introduced to sustainability and climate change in the context of healthcare using scenario-based learning and augmented reality over the courses in nursing degree. Participants' attitudes and awareness were collected by online questionnaires. Findings: The educational intervention showed effectiveness in significantly improving attitudes towards climate change and sustainability, and the environmental awareness for changing their clinical practice (p < 0.01). However, students struggled to apply sustainability and address unsustainable practices in healthcare settings. Originality/value: This study shows an effective model of curricular sustainability that can be implemented in other universities and health disciplines. The findings highlighting the importance of sustainability education in nursing and its potential to drive positive change in healthcare practice and society at large. Embedding key topics aligned with sustainable development goals in the curriculum prepares nursing or health workforce to address planetary health and implement sustainable practices that provide climate-smart care.

Home care poverty is the inability of older people to access adequate home care services and their unmet needs for home care. With the increasing number of older adults (60 years old and above) with disability in China, the Chinese government pays more and more attention to home care. In this case, it is of great significance to explore whether older adults with the disability face home care poverty and its influencing factors. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 were utilized. SPSS 22.0 was used as a data analysis tool to conduct descriptive statistics and multiple logistic regression analysis on the sample (n = 1932). The study found that in 2018, 48.0% of older adults with disability faced home care poverty. Multiple logistic regression results showed that degree of disability, age, rural and non-eastern regions, income poverty, family caregiver, and reluctant caregivers were positive factors that increased the risk of home care poverty in disabled older adults (p < 0.05). But care duration, care expenditure, social pensions insurance, community daily life care and community medical services are the positive factors to eliminate the home care poverty for older adults with disability (p < 0.05). In order to solve the problem of home care poverty of older adults with disability, based on the research conclusions, the study proposed to establish a long-term care insurance system, formulate supportive policies for family caregivers or their families, and establish a wide variety of community care services.

Background: Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed. Purpose: The aim of this modified e-Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study. Methods: An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated. Discussion: This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim.

Despite the often-crucial roles played by music within theatre-based public health promotion strategies, theoretical explorations regarding music within applied theatre literatures remain largely underdeveloped. This article highlights musicking -- a reconceptualization of music from an object to a participatory act that can profoundly influence relationships and spaces -- as an approach to understanding the various roles that music can play within applied theatre programmes. The article draws from ethnographic accounts of an HIV/AIDS applied theatre group in South Africa to advocate for increased recognition of musicking as a robust theoretical and methodological component within applied theatre praxis.

Background: Pediatric programs focused on treating chronic pain often do not include an educational liaison (EL) to coordinate services between the patient's medical home and school. As chronic pain in youth can have deleterious effects on school functioning, collaboration between the medical home and the school system are needed to assure these students receive appropriate accommodations. Contributions to Theory: This manuscript describes a model of coordinated care for students with chronic pain that includes a systemic strategy for collaborative care across settings. Specifically, the role of an EL is described in the context of advocating for the patient to receive appropriate educational accommodations. Conclusions: This paper provides a guide for caregivers and professionals to assure appropriate access to support services across settings. Recommendations are included for school accommodations and services to improve academic functioning and outcomes for students with chronic pain.

Objectives: This literature review seeks to identify based on the current literature how the burden of disease for IBD patients manifests itself as this cohort transitions simultaneously from pediatric to adult care and from secondary to post-secondary education. Methods: This paper reviews the current literature regarding postsecondary students with IBD and provides a summary of research regarding key factors in their quality of experience. The research was conducted through databases including Taylor & Francis, PubMed, as well as searches via Google Scholar. Results: Over the course of this search, thirty-three relevant studies were identified. These studies addressed the themes outlined in this paper, including academic performance, social adaptation, transition of care, as well as overall transition to a postsecondary institution. Each of these is further broken down to identify specific determinants of IBD student experience. Conclusions: Although students with IBD can demonstrate resilience and adaptive behavior, the evidence suggests there are significant limitations impacting their perceived experience. The barriers IBD students face impact their ability to experience postsecondary education as they intend to, forcing them to adjust in adaptive or maladaptive manners. This review also attempts to generate possible solutions to specific barriers identified from current research, generating directions of action for students, physicians, and academic supports.

In this paper, we discuss challenges associated with implementing a policy for Ancillary Care (AC) for related and unrelated (serious) adverse events during an Ebola vaccine trial conducted in a remote area of the Democratic Republic of the Congo. Conducting clinical trials in resource-constrained settings can raise context-related challenges that have implications for study participants' health and wellbeing. During the Ebola vaccine study, three participants were injured in road traffic accidents, but there were unexpected difficulties when trying to apply the AC policy. First, because of the nature of the adverse events, the insurer refused to cover the costs. Second, the AC policy did not address treatments by traditional medicine, even though traditional medicines are frequently used and highly trusted in the study community. This highlighted a contrast between the researchers' well-intentioned AC approach and the participants' legitimate preferences. The way in which researchers should address their responsibility to provide AC is not straightforward; it requires contextualization. Our experience highlights the importance of involving community representatives and the local ethics committee to ensure development of an AC policy that is culturally and ethically appropriate. Additionally, the insurance contract should clearly stipulate which adverse events are linked to the trial participation, and thus eligible for coverage, to avoid controversies when claims are made.

Background: A comprehensive multidisciplinary medical guideline for adults with Down syndrome is lacking in the Netherlands. In this study, we aim to explore parents' views on multidisciplinary care and identify which aspects of health care they find most important in the context of developing such a guideline. Method: This qualitative study used semi-structured interviews. Nineteen interviews were conducted with parents of adults with Down syndrome. The main themes and subthemes were identified from the transcripts by using the framework method. Results: Four main themes were identified which should be addressed in the guideline according to the parents: parents' support in medical care, patient-centred care, important medical topics and the organisation of medical care. Conclusions: This study provides insights into parents' opinions about medical care for adults with Down syndrome. These insights are used in the construction of a guideline to improve medical care for adults with Down syndrome.

Primary care health checks, screenings and GP consultations are often the gateway for people with intellectual disabilities to access their physical and mental healthcare. For a population who experience greater levels of health difficulties alongside significant health inequality, improving care quality and access is of major importance. This meta-ethnographic, qualitative review aims to explore people with intellectual disabilities experiences of health checks, screenings and GP visits, while assessing the quality of the current literature and synthesising findings to consider clinical and research recommendations based on third order constructs. A systematic search identified 20 studies that met inclusion criteria. Quality assessment of each paper was conducted. Meta-ethnography methods were used to analyse and synthesis findings. One overarching concept was identified: Include Me, along with seven core concepts; Empowerment and Disempowerment, Communication and Interpersonal Factors, Access and Adaptations and Biased Narratives and Shifting Perspectives. Implications for practice and future direction are discussed.

This study investigates pharmacy students' reasoning while solving a case task concerning an acute patient counselling situation in a pharmacy. Participants' (N = 34) reasoning processes were investigated with written tasks utilizing eye-tracking in combination with verbal protocols. The case was presented in three pages, each page being followed by written questions. Eye movements were recorded during case processing. Success in the task required differentiating the relevant information from the task redundant information, and initial activation of several scripts and verification of the most likely one, when additional information became available. 2nd (n = 16) and 3rd (n = 18)-year students' and better and worse succeeding students' processes were compared. The results showed that only a few 2nd-year students solved the case correctly, whereas almost all of the 3rd-year students were successful. Generally, the average total processing times of the case material did not differ between the groups. However, better-succeeding and 3rd-year students processed the very first task-relevant sentences longer, indicating that they were able to focus on relevant information. Differences in the written answers to the 2nd and 3rd question were significant, whereas differences regarding the first question were not. Thus, eye-tracking seems to be able to capture illness script activation during case processing, but other methods are needed to depict the script verification process. Based on the results, pedagogical suggestions for advancing pharmacy education are discussed.

Despite the routine use of high-fidelity patient simulation (HFPS) in health care disciplines, pharmacy residents' involvement in HFPS is limited. To evaluate pharmacy residents' self-reported confidence in their clinical skills dealing with acute medical scenarios. Three separate HFPS sessions (stroke, Advanced cardiovascular life support [ACLS], and acetaminophen poisoning) were conducted for pharmacy residents at a designated simulation center using a high-fidelity mannequin. The scenarios were facilitated by experienced physicians, nurses, and clinical pharmacists. A questionnaire that addressed 5 clinical skills was administered to the residents pre- and post-HFPS and 6 months afterward. The primary outcome was an assessment of residents' confidence in acute medical scenarios. Fourteen pharmacy residents participated (mean age of 27.7 years; 71.4% female; 57% have [greater than or equal to]3 years of work experience as a pharmacist). Around 85.6%, 78.6%, and 64.3% of the residents had encountered stroke, ACLS, and acetaminophen poisoning cases, respectively, before the HFPS. After the HFPS sessions, the residents felt significantly more confident in making decisions during an emergency in a timely manner (P = 0.006 for stroke; P = 0.02 for poisoning), providing recommendations to the health care team (P = 0.006 for stroke; P = 0.024 for ACLS), and providing optimal patient care during a stressful situation (P = 0.02 for stroke and poisoning). We found no significant difference between post-simulation and 6 months post-simulation scores in most of the domains in all scenarios, indicating residents' confidence was maintained at 6 months. HFPS is a valuable active learning tool for enhancing pharmacy residents' confidence in managing an emergency situation.

Background: Adolescents with overweight or obesity are at greater risk of having physical and psychosocial consequences. With increased disparities and inadequate literature on prevalence of adolescent weight status in rural Appalachia, there is potential for further complications. Unfortunately, adolescent obesity treatment options are often limited, especially in medically underserved regions. Methods: This cross-sectional study of adolescents at eight rural Appalachian schools examined weight status among and associations between body mass index percentile (BMIp) categories and health-related perceptions and weight-control intentions. Previously validated instruments were utilized. Analyses included independent samples t-tests, ANOVA tests, and chi-squared tests. Results: Of 814 adolescents (ages 11-13; 55.0% girls), BMIp revealed 20.8% overweight, 22.7% obese, and 10.6% severely obese. Adolescents with higher BMIp categories reported poorer self-rated health, inaccurate weight perceptions, and greater weight loss intentions (all p < 0.05). Conclusions: Findings, including high prevalence of adolescents with overweight and obesity, emphasize the need for more obesity prevention and treatment options. Schools may be an ideal setting to reach at-risk adolescents and provide obesity prevention and treatment options, especially in medically underserved regions such as rural Appalachia. Opportunities and challenges to apply findings, including school-based obesity programs, are discussed.

Airway management is one of the main situations that required nursing skills. Actual airway management experience on live patients is limited due to few opportunities to perform endotracheal intubation for students and issues related to students' liability. Therefore, this study evaluated the effect of High Fidelity Simulation airway management training program on nursing students' performance, satisfaction, and self-confidence in Palestine. A pre-post-test control group was applied through the recruitment of a 154 nursing students from Arab American University Palestine. The sample distributed randomly to experimental and control groups. Data were collected using the American Heart Association airway management performance checklist and the learner satisfaction and self-confidence for Learning (LSSCL) Questionnaires. Findings showed that there were no significant differences of airway management performance, satisfaction, and self-confidence scores between both groups at pre-test. On the contrary, there were significant differences between both groups of airway management performance, satisfaction, and self-confidence at post-test. Thus, High-fidelity simulation (HFS) was found to be an effective tool to provide a safe and effective learning environment for nursing students, consequently improving their airway management performance and increasing their satisfaction and self-confidence. This study supports the need to integrate HFS into the nursing curriculum.

Background: The Communicative Participation Item Bank (CPIB) is a patient-reported outcome measure (PROM) designed to measure the extent of interference, or difficulty, experienced by adults with communication disorders participating in their day-to-day communication activities. To date, there is limited evidence regarding sensitivity of the CPIB for capturing change with intervention in people with Parkinson's disease (PwPD). Aims: The purpose of this study was to examine the following measurement properties of the CPIB in PwPD who received community-based, standard care, speech-language therapy focusing on motor speech concerns: Change over time between treatment and observation groups, comparison to patient-defined ideal and satisfactory targets, comparison of static short form to computerised adaptive testing (CAT), comparison of self to proxy-rated scores, and comparison to other common PROMs. Methods and Procedures: Forty-six PwPD (20 treatment/26 observation) completed data collection upon enrolment (pre-treatment) and 6 months later. In addition to the CPIB, PROMs included the Voice Handicap Index 10-item short form (VHI-10), PROMIS Global Health-Related Quality of Life, Levels of Speech Usage, self-rated speech severity, and Patient Health Questionnaire-9 (PHQ-9). Participants also engaged in qualitative interviews. Forty-four family members completed proxy CPIB ratings. Outcomes and Results: There were no significant differences between treatment and observation groups on the CPIB pre-treatment, but there were significant differences post-treatment. The differences appeared to be largely due to significant gains in the treatment group. No participants reached their ideal CPIB target, and few reached their satisfactory target. Static CPIB short form and CAT scores were not significantly different, with an average of five CAT items administered per participant. Overall group similarities between patient and proxy scores may have obscured wide variability across individual patient-proxy pairs. Associations between CPIB and VHI-10, health-related quality of life, self-reported speech severity, and depression ranged from weak to moderate. Conclusions and Implications: The CPIB appears to be sensitive to capturing change with intervention, and similar results are obtained with the static short form and CAT formats. One clinical caution is that even with gains observed in the treatment group, no participants obtained their ideal communicative participation goals, and few obtained a satisfactory level of communicative participation. Thus, while current interventions are beneficial, they may not meet the full range of clients' communication needs. While responding to the CPIB through a proxy rater may be feasible, caution is warranted due to concerns about maintaining the autonomy of PwPD.

Our goal was to develop non-pharmacologic strategies for addressing sensory challenges that patients with autism spectrum disorder (ASD) face in emergency departments (EDs). Search of five databases for articles written in English and published since 1980 returned 816 citations, of which 28 papers were selected for review. All studies were published in the last nine years, with 92.85% (n = 26) conducted in North America. We developed 26 consolidated strategies, encompassing five major domains, including guiding principles, care processes, people (behavior of staff members), objects, and places (facility design). Sensory-friendly care in ED requires an integrative approach and its success depends on guiding principles that tie various aspects of care and distinguishes ASD care from non-ASD care.

Academic health centers (AHC) both contribute to and are influenced by the communities they serve. As part of a central commitment to improving human health, there is a need for AHCs to acknowledge their history related to race and racism, the resulting impact on current health disparities, and the disparate treatment of racial and minoritized communities. As AHC's care for Black and Brown communities, they have a unique responsibility to redress their respective legacies of bias, discriminatory practices, and experimentation without consent. One way to achieve this is to provide learning opportunities for in-depth engagement with students, faculty, staff, health care providers, and community members in conversations regarding racial equity, which are essential to shaping and impacting change at an individual and institutional level. Virginia Commonwealth University in Richmond, Virginia, launched a new initiative, "History, and Health; Racial Equity," designed to (a) increase awareness of our institution's history, impact, identity, and culture, and (b) support meaningful conversations around history, health equity, structural racism, and health sciences education. Urban and metropolitan universities may learn from and replicate this program and encourage such conversations in their communities.

Academic Medical Centers (AMC) are unique healthcare resources that offer services to their local communities. As societal priorities shift, AMCs are identifying approaches to practice community engagement. Although many examples of AMCs exist in the literature, few have targeted resources for specific health topics like occupational health. This case study identifies examples of community engagement from AMCs around the U.S. It also offers a unique perspective of community engagement from the Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), housed within the Department of Family and Preventative Medicine at the University of Utah. This center is one of eighteen National Institutes for Occupational Safety and Health (NIOSH) Education and Research Centers (ERC). We use the Community Engagement Continuum to consider community engagement across various degrees of relationship between the public and AMCs, including outreach, consulting, involvement, collaboration, and shared leadership. Continuing education, course work connecting students with the community, and multiorganization research projects are approaches RMCOEH uses to engage with communities. Although there are many ways for AMCs like RMCOEH to serve the community, there are opportunities for AMCs to improve community engagement efforts through cultural shifts and community participation in projects. We explore such opportunities specifically for RMCOEH.

Background: Dissociative Trance Disorder (DTD), is a complex psychological condition characterized by abrupt trance-like states and altered consciousness, commonly seen in young women throughout various regions of India. Currently, there is a lack of research on the experiences of Indian adolescent girls with DTD and how inaccurate medical information affects their quest for suitable care. This study aims to develop a thorough comprehension of the help-seeking patterns and experiences of adolescent girls with DTD, specifically concerning encountering medical misinformation. By identifying the obstacles, they face and the cultural beliefs that shape their decision-making, this research seeks to guide interventions and initiatives aimed at enhancing care and support for this group. Method: Six adolescent girls and young women, who sought therapy at a district hospital in Sikkim were recruited for the study. They were interviewed extensively and their interview data were transcribed verbatim and analyzed using interpretative phenomenological analysis. Result: Three super-ordinate themes that emerged were: challenges in seeking diagnosis and treatment; emotional and psychological struggles; support and healing journey. Conclusion: Misinformation surrounding DTD in India impacts the help-seeking behaviours of adolescent girls, leading to delays in diagnosis and inadequate treatment. Cultural beliefs, reliance on exorcism, and insufficient healthcare professional training contribute to this problem. Awareness campaigns are necessary to correct misconceptions and misinformation and promote accurate understanding among parents, communities, and healthcare providers. Culturally sensitive approaches, accurate information dissemination, and collaboration among stakeholders are crucial for improving care and support for individuals affected by DTD in India. Additionally, it is acknowledged that certain religious beliefs resist empirical evidence, but it is vital to recognize that not all religious beliefs are misinformation solely based on scientific evidence. As we address the impact of cultural beliefs, it is essential to strike a balance between respecting individual faith and promoting evidence-based interventions.

Limited research has explored the experiences of caregivers and their children with autism spectrum disorder (ASD) in medical settings. A qualitative meta-synthesis of studies published between 2000 and 2020 was conducted to understand and summarize the challenges faced by caregivers, their positive experiences, and suggestions for improving medical care. Themes were generated related to caregiver challenges, positive experiences, and suggestions to improve medical care. We suggest additional training of medical professionals, an interdisciplinary approach to care, more support for caregivers, and increased adaptability of the medical environment. Implications for practice, limitations, and future research directions are discussed to ensure the highest quality care to support the needs of children with ASD and their caregivers.

Children with autism spectrum disorder (ASD) have more frequent use of healthcare services, including visits to the emergency department (ED). Medical care for children with ASD can be adversely affected by the highly stimulating environment of the ED. In this study, we gained insights from stakeholders with lived experience (parents of children with ASD, children with ASD, and ED healthcare providers) to create and implement a sensory equipment kit. The kit was evaluated and iteratively improved based on observations of children using the sensory equipment, satisfaction surveys from their parents, and interviews with healthcare providers in the ED. Findings from this study can be used to guide other EDs in creating their own ASD sensory kit.

Biomedical engineering (BME) students typically have a schedule filled with specific course requirements, leaving little room for spending a semester studying abroad. We established a new short-term BME study abroad course, partnering with a non-profit healthcare organization that provides high-quality prosthetic care to underserved populations. This innovative study abroad course was met with great student demand. The impact of this short-term study abroad course is increased by developing year-long BME senior capstone design projects based on the needs identified throughout the experience in Ecuador. Shortly after the conclusion of spring semester, students and two BME faculty/staff traveled to Ecuador. During the work week, the students participated in small teams in patient evaluations, castings, fabrication of prosthetics, device fittings, rapid prototyping-testing iterations, and post-prosthesis gait training with physical therapy. Weekends included guided cultural activities. Each student maintained a journal that reflected observations and insights from these experiences. Upon return to the US, students that registered for an additional course credit created video reflection presentations and wrote project proposal reports based on the needs identified in Ecuador. The project proposal reports were used to develop a BME senior capstone design project. Pre and post course self-assessment surveys showed significant increases in five ABET learning outcomes, three BME learning outcomes, and four course-specific learning outcomes. Students who took the two-credit course reported significant increases in four more learning outcomes than students who took the one-credit course. Many students described the experience as inspiring and life-changing, and the program continues to run each summer.

Contemporary design education seeks to prepare students for the workplace through studiobased learning that replicates real world practice. Design problems in the workplace have become increasingly complex and one example of this is within the area of design for healthcare, which requires multidisciplinary collaboration between various stakeholders to build knowledge in order to create new products, services systems and spaces. The complexity of these roles creates challenges for design educators in preparing students for the workplace. This paper presents a hybrid approach to address this challenge by presenting a real-world approach to design education. This entails a bottom-up approach to facilitate design research in a clinical setting to gather rich insights and needs of the clinical setting along with a top-down industry collaboration with sponsored briefs to guide students through the requirements of developing solutions in a heavily regulated field. The paper outlines examples of this process and how it was achieved in a blended model that was predominantly online in response to the changed environment caused by the COVID-19 pandemic. The advantages of this model are threefold, students gain deep knowledge and skills through collaborating with a variety of stakeholders within health care, they gain the opportunity to validate their designs through testing and feedback with these partners and lastly students develop the connections to create opportunities for further partnerships and employment.

Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.