Mindfulness-based interventions effectively improve mental health among healthcare professionals and foster compassionate care. However, the process of implementing mindfulness and ensuring long-term sustainability within hospital departments remains underexplored. Thus, this study aimed to identify and explore the mental models of healthcare professionals and managers that influence mindfulness implementation in hospital settings, to uncover strategies to support long-term sustainability. Guided by action research, 14 healthcare professionals and eight managers from two hospital departments were engaged in a 2-year mindfulness implementation process. Data collection consisted of four workshops followed by six focus group interviews. A thematic data analysis was conducted using the Immunity to Change model. Three mental models were identified: “Time pressure as a barrier for creating a mindful culture,” “A common understanding as essential,” and “Management support as a prerequisite.” Over the study period, these mental models evolved, with healthcare professionals describing their introduction to mindfulness as a “new way of being,” characterized by increased awareness, presence, and calmness. Psychological safety surfaced as an important factor for successful implementation, alongside the recognition that while management support is crucial, bottom-up initiatives from staff are equally important. Implementing mindfulness in hospital settings requires holistic strategies that address both structural and cognitive elements. This process calls for collaborative efforts that balance top-down support with bottom-up initiatives. Involving enthusiastic mindfulness ambassadors, sharing various strategies for integrating mindfulness into clinical practice, and recognizing the need for psychological safety are essential in promoting collective learning and enhancing implementation and sustainability.
BACKGROUND:Total hip replacement is a successful operation that aims to restore function and quality of life to millions of people globally. Knowing how long a total hip replacement might last is important for patients, surgeons, and health-care institutions for planning and resource allocation. Over the past 20 years, the use of contemporary bearing surfaces for total hip replacement has substantially altered implant wear and, possibly, longevity. To date, there has been no large-scale study that examines survivorship of these modern implants. We aimed to determine the survivorship of contemporary total hip replacements and bearing materials. METHODS:We focused solely on the assessment of modern bearing surfaces: highly cross-linked polyethylene versus metal or third-generation and fourth-generation ceramic heads and ceramic-on-ceramic primary total hip replacement in adult patients. We conducted a search of MEDLINE and Embase from database inception to June 13, 2024, including articles that reported a minimum of 10 years of survivorship, irrespective of fixation method or surgical approach. We then conducted a meta-analysis combining data from eight national joint registries assessing all-cause revision within the various bearing combinations. We extrapolated the extracted data to estimate survivorship to 30 years, using the multivariable random-effects model from the registry data. The primary outcome was survivorship of the hip replacement, defined as time from primary total hip replacement to first all-cause revision, expressed as a percentage of unrevised implants at specific timepoints. This study is registered with PROSPERO (CRD42024572518). FINDINGS:We identified 1 904 237 total hip arthroplasties across 29 clinical studies (n=5203) and eight national joint registries (n=1 899 034). Pooled analysis of the included studies showed an all-cause implant survivorship of 0·97 (0·96-0·98) under the random-effects model. Survivorship estimate based on joint registry data was at 93·6% (95% CI 92·3-94·7) at 20 years. Extrapolating these data indicates a predicted survivorship of 92·8% (91·2-94·2) at 25 years and 92·1% (90·1- 93·7) at 30 years. INTERPRETATION:The estimated 92% 30-year survivorship of contemporary total hip replacement suggests that advances in bearing surface technology have greatly improved the long-term durability of total hip replacements and might influence patient counselling, health-care planning, and device regulation. FUNDING:None.
Background: Research examining whether sustained simulation, embedded in everyday clinical routines, can shift staff perceptions of patient safety culture remains limited. Methods: We conducted a controlled multi-site study across eight pediatric departments in Denmark (four intervention, four control; 2023-2024). Departments in the intervention region integrated simulation-based team training into their duty rosters. Patient safety culture was measured pre- and post-intervention using the Safety Attitudes Questionnaire-Danish version. The primary analysis applied a difference-in-differences approach. Results: Of 2,440 distributed questionnaires, 1,412 were returned (58%), and 1,220 were eligible (947 unique respondents). Intervention sites conducted 244 simulation sessions compared with 84 in control sites (a 2.9-fold difference). Relative to controls, intervention departments reported higher scores for perceptions of management ( + 5.1 points, 95% CI: 0.8-9.5) and working conditions ( + 6.1 points, 95% CI: 2.0-10.2); changes in other dimensions were smaller and not statistically significant. Conclusions: A sustained, locally facilitated simulation program was associated with improved perceptions of management and working conditions-domains closely linked to patient safety culture. These findings suggest that, under supportive conditions, simulation may operate not only as a pedagogical method but also as an organizational practice that can influence how staff perceive the culture of their clinical environment. (c) 2026 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
BACKGROUND:Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic. METHODS:We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. RESULTS:A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography. CONCLUSION:In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access. EDITORIAL COMMENT:This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.
OBJECTIVE:To study the effect of early-onset neonatal infection on long-term cognitive impairment including intellectual disability and special educational needs. METHODS:A nationwide register-based cohort study was conducted including near-term to term children born between 1997 and 2013 with follow-up until 2021. Early-onset infection was defined as an invasive bacterial infection within the first week after birth defined by either physician-assigned diagnoses or bacterial pathogens cultured from blood or cerebrospinal fluid. Outcomes included diagnoses of intellectual disability and special educational needs. Associations were estimated by adjusted HRs (aHR) or unadjusted incidence rate ratios (IRR), when exposures and outcomes were rare. Additional analyses were conducted, including sibling-matched analyses and subgroup analyses considering only children with culture-positive infection. RESULTS:Among 993 363 children, 8267 (0.8%) had sepsis and 152 (<0.1%) had meningitis. Of these, 260 had culture-positive sepsis and 31 had culture-positive meningitis. Early-onset sepsis was associated with an increased risk of intellectual disability (aHR: 2.24, 95% CI 1.93 to 2.59) and special educational needs (aHR: 1.49, 95% CI 1.40 to 1.59). Early-onset meningitis was associated with higher risks of both intellectual disability (IRR: 7.75, 95% CI 3.34 to 15.27) and special educational needs (aHR: 2.95, 95% CI 2.06 to 4.22). The associations remained consistent across multiple additional analyses, including sibling-matched analyses and subgroup analyses limited to culture-positive infections. CONCLUSIONS:Early-onset neonatal infection in near-term to term children was associated with an increased risk of long-term cognitive impairment including both intellectual disability and special educational needs.
