University Medical Center Utrecht

• Adaptive performance is important in the constant changing environment of healthcare. • Personality traits – the Big Five – of nursing professionals are possible related to adaptive performance. • Nursing professionals’ rate themselves mostly as agreeable and conscientious. • Agreeableness and conscientiousness are not related to adaptive performance. • Openness is positively and significantly related to adaptive performance. • Neuroticism is negatively and significantly related to adaptive performance Improvements in healthcare are imperative. In response, healthcare professionals should continue to learn and develop innovative solutions. This means healthcare organizations require adaptive performers. Personality traits may be related to adaptive performance. This study investigates this possible relationship. Professionals (N = 583) working in the field of nursing in the Netherlands and the United States completed a survey measuring adaptive performance and the personality traits of agreeableness, conscientiousness, extraversion, openness, and neuroticism. We studied to what extent personality traits were related to adaptive performance. Multiple regression analysis was conducted to test whether personality traits were related to adaptive performance. We found that nurses openness and extraversion were positively related to adaptive performance, while neuroticism was negatively related. We found that nursing professionals characterized themselves predominantly as agreeable and conscientious. These personality traits were not related to adaptive performance. Human resource departments of healthcare organizations could include these outcomes in their assessments and learning and development programs. Healthcare organizations could adopt a strategy that considers the findings of this study when implementing changes. Educational institutions should integrate these findings on adaptive performance when implementing changes.

To explore barriers and facilitators in implementing the Safety Climate Thermometer (SCT), a new tool designed to support team-level safety culture improvement in surgical settings. The SCT acts through visual insights into safety culture themes, acting as a conversation starter, and interdisciplinary team meetings about this topic. It aims to facilitate daily practice changes. The SCT has previously been developed using user-centered design methods, which consisted of a scoping literature review and international survey. A qualitative implementation study using semi-structured interviews and observational data, guided by the implementation outcomes framework. Three surgical teams from Dutch hospitals of varying size participated between 2021 and 2023 and used the SCT's visual input and interdisciplinary team meeting structure for 7 months. Seventeen healthcare professionals, including nurses, surgeons, and managers, took part in the SCT process and subsequent interviews. The SCT facilitated an anonymous, online assessment followed by structured interprofessional discussions and goal-setting for safety improvement. Participants reported high usability and acceptability due to the tool's intuitive design and anonymity. The SCT was adaptable to different surgical contexts, though smaller teams with motivated champions and in-person facilitation appeared most suitable. Key barriers included high turnover and work pressure, competing priorities, lack of trust, and survey fatigue. Facilitators include in-person external facilitation and "protected time." Reported positive effects included strengthened team cohesion and a greater sense of being heard. The SCT is a practice-oriented, user-friendly tool for improving safety culture through team-based reflection and dialogue. Future use should prioritize exploration of contextual factors.

In cartilage tissue engineering, there is a growing interest in dynamic hydrogels that promote spheroid fusion and cartilaginous matrix deposition, while maintaining sufficient stability for long-term construct maturation. In this study, Diels-Alder click chemistry is employed as a dynamic-covalent crosslinking method to create hydrogels composed of hyaluronic acid, gelatin, and PEG. By adjusting the pH during crosslinking, the tuneability of hydrogel stiffness and stability at pH values around the physiological pH of native cartilage is demonstrated. This pH modulation does not compromise hydrogel functionality, as encapsulated equine articular cartilage progenitor cell spheroids remain viable and functional for a culture period of 28 days. The hydrogel environment supports the deposition of cartilaginous extracellular matrix components, including collagens and sulphated glycosaminoglycans. Enhanced chondrogenesis and deposition of collagen type II are observed at higher spheroid concentrations, corresponding to inter-spheroid distances of 100-150µm following hydrogel swelling, compared to lower concentrations at a distance of >500µm. To further improve construct robustness, the hydrogel constructs can be reinforced on day 1 with a melt electrowritten scaffold, increasing the compressive modulus 100-fold by day 28 compared to non-reinforced constructs, highlighting the potential of this system for engineering cartilage implants.

People with HIV (PWH) using antiretroviral therapy are at increased risk to develop cardiovascular diseases (CVD). We hypothesized that residual viremia (RV; unquantifiable low, but detectable viral load) increases CVD risk. We enrolled 1895 virally suppressed PWH and compared CVD incidence in participants with and without RV. Extensive multi-omics characterization was performed. Incident CVD was registered after 2-year follow-up and adjusted odds ratios (aOR) calculated accounting for classical CVD risk factors. The numbers of expected and actual CVD events were compared using CVD risk scores. RV, detected in one-third of participants, strongly increased the risk of developing a first cardiovascular event (3.1% vs 1.2%, aOR 2.8,p=0.004). Participants with RV experienced twice the number of events predicted by the SCORE2 riskmodel. The association between RV and CVD was not driven by inflammation, immune activation, gut barrier dysfunction, or lipometabolic perturbations. Residual viremia independently associated with CVD development, highlighting the need for tailored prevention and examination of novel intervention strategies.

Patient-centered communication together with evidence-based practice is seen as the underlying pillars of shared decision making (SDM). However, the application of patient-centered communication in physiotherapy practice has not yet been studied from an observer-based point of view. The purpose was to determine to what extent physiotherapists use patient-centered communication in the first physiotherapy consultations of people with shoulder problems, and to what extent patient-centered communication is related to the level of SDM. In this secondary analysis, 100 audio-recorded initial physiotherapy consultations with people with shoulder problems, obtained through convenience sampling, were analyzed for the level of patient-centered communication using the Four Habit Coding Scheme (4HCS) (0-100, higher 4HCS scores indicate higher level of patient-centered communication). The relation between the level of patient-centered communication and the SDM was analysed in multiple steps. A total of 100 initial physical therapy consultations of 41 participating physical therapists were included. The mean 4HCS score was 45(range 18-90). The correlation between the 4HCS and the OPTION-5 scores was 0.610(CI95 % 0.470 - 0.720). The four categories in the relation between patient-centered communication and SDM show that the most consultations are in the group of low patient-centered communication and low SDM and that there are only two consultations in the low patient-centered communication and high SDM. Our results show that there is room for improvement in the application of patient-centered communication in physiotherapy practice although physiotherapists do apply patient-centered communication more than SDM. Patient-centered communication does not guarantee the application of SDM, although a higher level of SDM does indicate a higher degree of patient-centered communication. Practice implications This study offers clinical guidance on how to improve the integration of patient's perspective, values, and preferences in the decision making.

Hemodynamic instability is a highly prevalent, complex and life-threatening condition in critically ill patients. Its multifactorial nature and patient-specific variability challenge standardised treatment approaches. Computational physiological models (CPMs) offer a promising solution by simulating cardiovascular dynamics to guide individualised hemodynamic management. This systematic review evaluates the current landscape of cardiovascular CPMs, focusing on their design, credibility, and clinical readiness. A systematic search was conducted in MEDLINE ALL, Embase, Scopus, and Web of Science. Original research articles describing zero-dimensional, closed-loop cardiovascular models with (potential) applications in critical care were included. Data were extracted on context of use, model design, and validation. Model credibility was assessed using a risk-based framework and clinical readiness using a nine-level technology maturity scale. Out of 10,704 screened articles, 183 were included. Direct clinical applications were described in 50% of these studies, including diagnosis, decision support, and closed-loop control. Fluid management was the most common application domain (30%). Personalisation of model parameters was reported in 25% of the articles. While 66% of the articles presented model validation, only 21% achieved moderate credibility scores. Reporting of model characteristics was consistently (100%) insufficient. Most models (75%) were at clinical readiness level 3-4 (model prototyping and development), with four studies reaching clinical testing (level 6-8). A substantial body of cardiovascular CPMs exists with promising prospects for relevant applications in critical care, while a large part is currently confined to pre-clinical research settings. Advancing clinical integration requires leveraging existing models, improving transparency in verification and validation, and establishing robust personalisation strategies. PROSPERO - CRD42022300137, registered on February 11, 2022.