Group Health Cooperative

Abstract Background Multimodal prehabilitation programs are effective in reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital. Methods In this observational cohort study with multiple case analysis, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise- and three nutrition modalities. Implementation fidelity was investigated by evaluating: 1) coverage (participation rate), 2) duration (number of days between start prehabilitation and surgery), 3) content (delivery of prescribed intervention modalities), and 4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence. Results 58 patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33–84 days). Adherence was high (84–100%) in five and moderate (72–73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled executing the prehabilitation program due to multiple physical and cognitive impairments. Conclusion Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness. Trial registration NCT06438484

BackgroundExposure to chemical mixtures inherent in air pollution, has been shown to be associated with the risk of breast and lung cancers. However, studies on the molecular mechanisms of exposure to a mixture of these pollutants, such as hydrocarbons, in the development of breast and lung cancers are scarce. We utilized in silico toxicogenomic analysis to elucidate the molecular pathways linked to both cancers that are influenced by exposure to a mixture of selected hydrocarbons. The Comparative Toxicogenomics Database and Cytoscape software were used for data mining and visualization.ResultsTwenty-five hydrocarbons, common in air pollution with carcinogenicity classification of 1 A/B or 2 (known/presumed or suspected human carcinogen), were divided into three groups: alkanes and alkenes, halogenated hydrocarbons, and polyaromatic hydrocarbons. The in silico data-mining revealed 87 and 44 genes commonly interacted with most of the investigated hydrocarbons are linked to breast and lung cancer, respectively. The dominant interactions among the common genes are co-expression, physical interaction, genetic interaction, co-localization, and interaction in shared protein domains. Among these genes, only 16 are common in the development of both cancers. Benzo(a)pyrene and tetrachlorodibenzodioxin interacted with all 16 genes. The molecular pathways potentially affected by the investigated hydrocarbons include aryl hydrocarbon receptor, chemical carcinogenesis, ferroptosis, fluid shear stress and atherosclerosis, interleukin 17 signaling pathway, lipid and atherosclerosis, NRF2 pathway, and oxidative stress response.ConclusionsWithin the inherent limitations of in silico toxicogenomics tools, we elucidated the molecular pathways associated with breast and lung cancer development potentially affected by hydrocarbons mixture. Our findings indicate adaptive responses to oxidative stress and inflammatory damages are instrumental in the development of both cancers. Additionally, ferroptosis—a non-apoptotic programmed cell death driven by lipid peroxidation and iron homeostasis—was identified as a new player in these responses. Finally, AHR potential involvement in modulating IL-8, a critical gene that mediates breast cancer invasion and metastasis to the lungs, was also highlighted. A deeper understanding of the interplay between genes associated with these pathways, and other survival signaling pathways identified in this study, will provide invaluable knowledge in assessing the risk of inhalation exposure to hydrocarbons mixture. The findings offer insights into future in vivo and in vitro laboratory investigations that focus on inhalation exposure to the hydrocarbons mixture.

Introduction: The number of complex healthcare problems is increasing, the workforce is diminishing, and healthcare costs are rising. Interprofessional Education and Collaborative Practice is a promising solution, necessitating the cultivation of skills and competencies among health and social care professionals. The central question guiding this study revolves around the possibility of merging interprofessional collaboration, lifelong learning, the International Classification of Functioning, Disability and Health (ICF), and the Rehabilitation Competency Framework (RCF) into a unified competency framework that can be used in both education and in the work field. Method: In total, five modified Delphi rounds were executed during three phases specifically comprising the design, relevance, and report stages. The first contains a literature search, the second includes 11 pilots with surveys, and the last finalized the INPRO Competency Framework (INPRO CF). Results: The primary result is the INPRO CF that is readable, accurate, applicable, and accepted. It contains five domains, 17 competencies, and 200 learning outcomes or behaviors. It exists in four languages (Dutch, Finnish, English, German). Discussion: The INPRO CF is a relevant interprofessional competency framework designed to alleviate deficiencies between education and practice so it is suitable for a lifelong learning process. It demonstrates adaptability across various contexts. Implications for Practice The INPRO Competency Framework provides a structured overview of the learning journey in becoming an experienced interprofessional collaborator and is applicable in both practice and educational settings. The INPRO Competency Framework provides a comprehensive understanding of goals that an individual in a team can work on and structures those that it would like to achieve. The INPRO Competency Framework has the potential to positively impact person centered care by promoting collaboration among health and social care professionals. It simultaneously can contributes to transforming education by shaping curricula and preparing students for interprofessional teamwork in their future careers.

The continuous migration of highly skilled Filipino healthcare professionals to work overseas is an occurrence that has indeed resulted in a significant loss of talent and expertise in the country’s healthcare system. The departure of these healthcare professionals often leaves their previous positions vacant, which leads to an increased workload for the remaining staff and eventually results in work overload, inefficiency, and shortage of personnel, which disrupts the seamless operation of the healthcare system, ultimately affecting the service delivery and the quality of patient care. Thus, further investigation of this perennial concern of Filipino healthcare professionals’ global mobility is imperative to understand its current context fully. Through semi-structured interviews and follow-up interviews, this qualitative study explores how a group of 14 former healthcare professionals in a government hospital in Leyte perceive international migration for work, their perceived factors for migration, and the everyday challenges they have encountered as migrant healthcare workers. The thematic analysis of interview responses revealed the following specific perspectives about former healthcare professionals’ view on international migration for work: further advance professional and career growth, establish a better work environment, aiming for competitive compensation, the problematic healthcare system in the Philippines, and safeguard employees’ mental wellbeing. Further, it was found that the healthcare professional participants considered the factors influencing their decision to work abroad: toxic work culture and work overload, non-competitive compensation and benefits, work inequality and abuse of power, and career development and progression. Three major themes emerged regarding challenges: overcoming culture shock, language barriers, communication gaps, and homesickness.

Avoiding activities posing bodily threat is adaptive. However, spreading of avoidance to safe activities may cause functional disability in people with chronic pain. We investigated whether costly pain-related avoidance would generalize from one activity to another on the basis of real-life categorical knowledge in 40 pain-free people (30 female; mean age = 25 years; university students and public of Maastricht, The Netherlands). In a computer task, participants moved a joystick to complete activities from two categories (gardening and cleaning). During activities from the avoidance category, pain could be avoided at the cost of task efficiency by deviating from a short, pain-associated joystick movement. Activities from the safe category were never painful. Subsequently, we tested generalization of avoidance to novel pain-free activities from both categories. Participants generalized avoidance to novel activities from the avoidance category despite the novel activities not being paired with pain and despite avoidance costs, suggesting that costly (pain-related) avoidance generalizes from one activity to another on the basis of category knowledge and can thus be wide reaching, creating detrimental consequences.

BackgroundThis overview summarizes the best available systematic review (SR) evidence on the health effects of Tai Chi.MethodsNine databases (PubMed, Cochrane Library, EMBASE, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Sino-Med, and Wanfang Database) were searched for SRs of controlled clinical trials of Tai Chi interventions published between Jan 2010 and Dec 2020 in any language. Effect estimates were extracted from the most recent, comprehensive, highest-quality SR for each population, condition, and outcome. SR quality was appraised with AMSTAR 2 and overall certainty of effect estimates with the GRADE method.ResultsOf the 210 included SRs, 193 only included randomized controlled trials, one only included non-randomized studies of interventions, and 16 included both. Common conditions were neurological (18.6%), falls/balance (14.7%), cardiovascular (14.7%), musculoskeletal (11.0%), cancer (7.1%), and diabetes mellitus (6.7%). Except for stroke, no evidence for disease prevention was found; however, multiple proxy-outcomes/risks factors were evaluated. One hundred and fourteen effect estimates were extracted from 37 SRs (2 high, 6 moderate, 18 low, and 11 critically low quality), representing 59,306 adults. Compared to active and/or inactive controls, 66 of the 114 effect estimates reported clinically important benefits from Tai Chi, 53 reported an equivalent or marginal benefit, and 6 an equivalent risk of adverse events. Eight of the 114 effect estimates (7.0%) were rated as high, 43 (37.7%) moderate, 36 (31.6%) low, and 27 (23.7%) very low certainty evidence due to concerns with risk of bias (92/114, 80.7%), imprecision (43/114, 37.7%), inconsistency (37/114, 32.5%), and publication bias (3/114, 2.6%). SR quality was often limited by the search strategies, language bias, inadequate consideration of clinical, methodological, and statistical heterogeneity, poor reporting standards, and/or no registered SR protocol.ConclusionsThe findings suggest Tai Chi has multidimensional effects, including physical, psychological and quality of life benefits for a wide range of conditions, as well as multimorbidity. Clinically important benefits were most consistently reported for Parkinson’s disease, falls risk, knee osteoarthritis, low back pain, cerebrovascular, and cardiovascular diseases including hypertension. For most conditions, higher-quality SRs with rigorous primary studies are required.Systematic review registrationPROSPERO CRD42021225708.

Abstract Understanding the factors controlling nutrient dynamics can help guide forest management plans to promote their long‐term productivity. We used experimental treatments with three levels of biomass removals and two levels of compaction to monitor the impacts to soil biophysical characteristics in an intensively managed forest. Soil temperature, moisture, and respiration observations began 6 mo after treatment installation completion and continued for 2 yr. Compaction had few consistent significant effects on measured variables, and there were negligible differences in volumetric soil water content between whole tree (WT) and bole only (BO) harvesting. Compared with BO, the 10‐cm average and maximum growing season temperatures in WT significantly increased by 1.2 and 2.5 °C, respectively. The effects of WT removals resulted in whole profile (10–100 cm) increases in the average and maximum growing season soil temperatures. The WT removals resulted in an increase of 1.4 times more soil growing degree days (SGDD) at 10 cm and 1.6 times more at 100 cm compared with BO. Despite favorable temperature and moisture conditions, differences in soil respiration could not be explained by biomass or compaction treatments. The uncut reference forest was consistently cooler and drier, but respired more CO 2 throughout both years of observation compared with treated areas. The large physical disturbance of forest harvesting on the site likely masked any incremental treatment differences by homogenizing the microbial response in the ensuing 2‐yr study period. Future research should continue to investigate whether these soil biophysical changes influence site productivity or more sensitive indices of soil C dynamics.