Rotterdam University of Applied Sciences

Burnout among Algerian public healthcare workers remains understudied despite staffing shortages, limited resources, and heavy workloads. The present study examined the prevalence and predictors of burnout, focusing on self-compassion and communication skills. A cross-sectional survey of 387 practitioners from public hospitals used validated Arabic measures: Burnout Assessment Tool-Short Version, Self-Compassion Scale-Short Form, and Health Professionals Communication Skills Scale-Short Form. Practitioners aged 31-40 reported the highest burnout and exhaustion (p<0.05). Females showed greater exhaustion than males (p<0.05). Emergency/ICU/surgery staff reported lower burnout (p<0.05). Burnout correlated positively with self-judgment, isolation, and over-identification, and negatively with empathy, respect, and social skills (p<0.05). In regressions, self-judgment (β=0.21) and over-identification (β=0.12) predicted burnout, while empathy (β=-0.14) and social skills (β=-0.10) were protective. Self-judgment was the strongest risk factor, while empathy and social skills were protective. Interventions fostering self-compassion and communication skills may help reduce burnout.

Firms can govern their alliances through contractual agreements or equity joint ventures, the latter involving the shared ownership of a newly formed legal entity. This paper argues that the governance choice in a new alliance can be a lever for a firm to manage interdependencies in its alliance portfolio. We examine two related ideas. The first is that the choice of governance structure for a new alliance depends on the composition of a firm's alliance portfolio. The second is that this governance choice has implications for the nature of the firm's innovation outputs. Using data on U.S.-listed dedicated biotechnology firms, we find that firms are more likely to govern a new alliance through a contractual agreement when the accessed resources are similar to the resources available in their existing alliance portfolio. This choice also increases innovation in these similar resource domains. In contrast, firms are more likely to choose an equity joint venture when the accessed resources are complementary to their existing alliance portfolio, a choice that increases innovation in these complementary resource domains. Our findings extend the alliance-portfolio perspective by linking portfolio interdependencies to the governance choices in new alliances and their implications for innovation. • Firms use governance choice in new alliances to manage alliance portfolio interdependencies. • Contracts are preferred when accessing resources similar as in existing alliances. • Joint ventures are preferred when accessing resources complementary to existing alliances. • Governance choice influences the types of innovation outputs the firm achieves. • Contracts foster innovation in similar domains and JVs in complementary domains.

The HYpofractionated irradiation for PROstate cancer trial was a multicenter, randomized, phase 3, superiority trial comparing dose escalated hypofractionation (HF) with conventional fractionation (CF) for the treatment of localized intermediate- and high-risk prostate cancer. This trial aimed to demonstrate equivalent toxicity of HF. In prior publications, noninferiority of acute and late toxicity could not be established. Here, we report the long-term survival outcomes. We randomly assigned patients (1:1) with intermediate- to high-risk T1b-T4NX-N0MX-M0 localized prostate cancer to receive either HF (64.4 Gy in 19 fractions of 3.4 Gy, 3 fractions per week) or CF (78.0 Gy in 39 fractions of 2 Gy, 5 fractions per week) radiation therapy. The HF schedule was a dose escalation compared with CF, based on a α/β ratio of prostate cancer of ∼1.5 Gy, the equivalent total dose in fractions of 2 Gy is 90.4 Gy for HF versus 78.0 Gy for CF. The primary endpoint of this paper was relapse-free survival at 10 years and secondary outcome was overall survival. Of the 820 patients, 804 were included in the current evaluation, 407 patients received HF and 397 CF radiation therapy. The 10-year relapse-free survival was 64.5% (95% CI, 58.6-69.7) in the HF arm compared with 60.1% (95% CI, 53.9-65.8) in the CF arm (hazard ratio, 0.89; 95% CI, 0.69-1.14; P = .35). The 10-year overall survival in the HF arm was 69.2% (95% CI, 64.1-73.7) versus 61.2% (95% CI, 55.7-66.2) in the CF arm (hazard ratio, 0.82; 95% CI, 0.65-1.05; P = .11). In the updated findings, we could not demonstrate a statistically significant improvement in 10-year relapse-free survival following dose escalated HF compared with CF. Although patients in the HF arm showed a favorable 10-year overall survival, this difference did not remain statistically significant in the multivariable analysis.

Decentralised clinical trial (DCT) approaches are characterised by moving operational procedures from the traditional on-site setting to the participant’s immediate surroundings through the use of digital tools. DCTs have received increased interest in recent years. In this article, a SWOT analysis was carried out to identify the strengths, weaknesses, opportunities, and threats for DCT approaches from an ethical, legal, regulatory and operational perspective, as compared to conventional clinical trials (CCTs). During a two-day workshop organised on 5 and 6 April 2022 at Utrecht University, a group of 10 experts from the IMI project Trials@Home identified 8 key trial activities (KTAs) which operational procedures differ between DCTs and CCTs and carried out a SWOT analysis for each activity separately: implementation of decentralised/remote (electronic) informed consent; decentralised screening of potential trial participants; home health visits; telemedicine visits; participant’s self-monitoring; delivery and return of investigational product; clinical trial oversight; and remote safety monitoring. These analyses were categorised to form an overall SWOT analysis for DCTs. The analysis revealed 48 strengths, 62 weaknesses, 5 opportunities, and 13 threats across the eight KTAs. Categorisation distilled these into 11 strengths, 13 weaknesses, 2 opportunities, and 4 threats for DCTs. The use of digital technologies, lack of face-to-face contact and harmonisation of regulation were the most targeted issues. DCTs offer potential advantages, such as remote participation, greater autonomy in decision-making, simplified monitoring and access to diverse populations. However, challenges include digital technology barriers, reduced face-to-face contact, difficulties in identity verification and privacy issues. Addressing these challenges requires adequate training of participants and healthcare professionals, robust identity verification methods, strong security measures, and adaptation of communication and procedures. A hybrid approach combining traditional and decentralised elements seems feasible at this stage. Future research should explore the identified strengths and weaknesses of DCTs, propose ethical solutions to remaining challenges and ensure the inclusion of diverse stakeholders.

Listening to music, whether live or prerecorded, can benefit health and well-being. Studies have shown that music can alleviate pain and anxiety, improve emotional well-being, and strengthen social connectedness. While research on live music is promising, direct comparisons with recorded settings-specifically in relation to the physical co-presence of performing musicians-are limited. In this randomized controlled pilot study (n = 130), we examined the effects of live music concerts (classical and pop) compared to a simultaneous cinematic livestream, in a parallel design. Psychological and physiological well-being were assessed through self-reported questionnaires and physiological measures, including heart rate (HR) and heart rate variability (HRV). In the live condition, participants reported greater appreciation for the music, felt more moved by the music as indicated by higher kama muta scores, and reported higher arousal and valence compared to the livestream condition. Using linear mixed models, we found that only the mean HR was significantly higher in the live group, whereas other HRV parameters did not show statistically significant differences. In conclusion, the "liveness"-in terms of the musicians being physical present-emerges as an important aspect shaping audience's subjective experiences and physiological responses, particularly HR.

Transitioning from paediatric to adult healthcare is a pivotal phase for adolescents and young adults (AYAs) with chronic conditions. Effective healthcare transition (HCT) supports continued healthcare engagement and stable psychosocial outcomes, reducing risks for patients, their families, and the healthcare system. Yet the determinants of a smooth transition are complex, shaped by the interplay of various biopsychosocial constructs. The ExPeCT study (acronym: Exploring Predictors of a successful healthCare Transition) seeks to: A) examine the relationship between biopsychosocial development, transition readiness, and HCT outcomes, including patients' experiences; and B) identify key predictors of successful HCT in AYAs with chronic conditions. This longitudinal, observational, exploratory cohort study is embedded in the PROactive cohort, which annually measures biopsychosocial well-being of children with chronic conditions. The ExPeCT study supplements the PROactive cohort by collecting additional data on HCT experiences at three time points: once in paediatric care and twice after transfer to adult care.Data will be obtained from a range of chronic disease groups. Advanced statistical modelling will be employed to analyse transition outcomes and experiences, and to investigate associations between biopsychosocial development and transition readiness. This study is expected to fill a critical gap in the field by providing comprehensive understanding of predictors of successful healthcare transition in AYAs with chronic conditions. The insights gained will help improve care strategies and guide healthcare professionals in supporting successful transition to adult care.

People facing incurable cancer need appropriate informal psychosocial care. This study examines the experiences and needs of visitors of IPSO centers (psychosocial supporting centers for life with and after cancer) for people facing incurable cancer in order to optimize the services provided by IPSO centers for this group. Semi-structured interviews were conducted with visitors of IPSO centers, both patients and relatives facing incurable cancer. The interviews were analyzed thematically. Eight themes and two sub themes were identified. In total, 18 patients and 13 relatives and bereaved relatives were interviewed. Participants expressed a strong need for understanding, exchanging information and finding ways to fill their days. They appreciated IPSO's non-obligatory approach and highlight the value of sharing stories with others. Many participants experienced mixed peer groups including both people facing curable and incurable cancer, as uncomfortable. They emphasized the benefit of having separate peer groups for those facing incurable cancer, including able to talk openly about end of life and a deeper sense of understanding and connection. A few participants found these groups inaccessible due to a specific setup. Visitors also experience unpredictability and uncertainty from their illness, making planning difficult, which also affect their IPSO visit. IPSO centers play a crucial role in supporting people facing incurable cancer. To best meet their needs, it is essential to facilitate peer contact by organizing special peer groups or by introducing those facing incurable cancer to each other in another way. It is important to take into account accessibility. Further research should focus on individuals who need IPSO's informal care but are not able to benefit from it due to their burden of disease.