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.
OBJECTIVE:To investigate adrenal function and the prevalence of glucocorticoid (GC) induced adrenal insufficiency (GIAI) in patients with polymyalgia rheumatica (PMR), the first 18 months after diagnosis. METHODS:Newly diagnosed patients with PMR underwent short corticotropin tests before commencement of GC treatment and after 10 weeks, 6 months, and 12 months. Patients still on GC or with GIAI after 12 months were invited to a test after 18 months. GIAI was defined as a stimulated serum cortisol level <420 nmol/l. RESULTS:: Sixty patients with PMR were enrolled. The mean (S.D.) stimulated cortisol levels declined significantly between baseline (678 ± 95) and month 6 (491 ± 114), followed by an increase at month 12 (549 ± 100). An inverse relationship was found between stimulated cortisol levels and current GC dose (P < 0.001). The proportion of GIAI peaked at month 6 (13/53, 25%) when all patients received GC. By 12 months, adrenal function had recovered in 12/13 (92%) of these patients. At month 12 and month 18, GIAI was present in 1/31 (3%) and 0/12 (0%), who were no longer receiving GC. CONCLUSION:Stimulated serum cortisol levels in patients with PMR did not reach pretreatment levels after cessation of GC treatment. GIAI was frequent but reversible during GC treatment for PMR, which supports the concept of increased GC dosing during stress in these patients. Implementation of routine use of the short corticotropin test for the diagnosis of GIAI after planned cessation of GC treatment in PMR is not justified by our data. TRIAL REGISTRATION:Clinicaltrials.gov, http://clinicaltrials.gov, NCT04519580.
PURPOSE:Neoadjuvant immune checkpoint inhibition has shown promise in localized deficient mismatch repair (dMMR) colorectal cancer, yet the optimal treatment duration, regimen, and methods for response evaluation remain undefined. This trial aimed to investigate the efficacy and safety of neoadjuvant pembrolizumab for patients with localized dMMR colon cancer. METHODS:Participants received a single cycle of pembrolizumab (4 mg/kg, max 400 mg, every-6-weeks dosing regimen), followed by a preoperative endoscopy with biopsies and surgery 3-5 weeks later. The primary end point was pathologic complete response (pCR); secondary and exploratory end points included major pathologic response (MPR), safety, survival, and endoscopic response assessment. RESULTS:From February 2023 to March 2024, 85 patients (median age 74 years) were enrolled. All received pembrolizumab; one patient declined surgery. Among 84 patients, pCR was achieved in 44% (37 of 84; 95% CI, 33 to 55), and MPR in 57% (48 of 84; 95% CI, 46 to 68). Two (2%) patients died of complications within 30 days of surgery. At a median follow-up of 18.4 months (IQR, 16.3-21.1), one patient had a recurrence, resulting in overall and disease-free survival rates of 98% and 96%. Grade 3 adverse events occurred in 11% of patients (9 of 85; 95% CI, 3 to 16), with three treatment-related events. In 81 patients, the sensitivity, specificity, and accuracy of the biopsies for predicting pCR were 68%, 75%, and 72%, respectively. In 76 patients, the sensitivity, specificity, and accuracy of the endoscopic images for predicting pCR were 77%, 93%, and 86%, respectively. CONCLUSION:A single cycle of neoadjuvant pembrolizumab led to pCR in nearly half of patients undergoing surgery for localized dMMR colon cancer. The utility of endoscopic evaluation may inform future strategies for patient selection in nonoperative management pathways.
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.
Background Transitioning from student to newly graduated nurse is challenging, often leading to anxiety, high turnover, and even attrition from the profession. This exacerbates the nurse shortage and compromises health quality. Transition programmes tailored to support newly graduated nurses are essential. The aim was to assess the feasibility of a 2-year transition programme for newly graduated nurses employed at a medical ward, evaluating programme acceptability, demand, implementation, practicality, integration and limited efficacy. Method A feasibility study using triangulation. Data were collected using qualitative semi-structured interviews and registration data collected via a survey. The interviews with newly graduated nurses and providers were conducted between May and August 2023. Interview data were analysed using directed content analysis. The transition programme, developed in 2018, includes elements such as supervision, rotation in outpatient clinics, visiting the nurses in the municipality, followership, skills training and simulation. Of the 23 nurses who provided registration data, 11 were interviewed, along with 12 providers. Results The newly graduated nurses completed 84% of the programme elements planned, with cancellation primarily due to sick leave or time constraints. Participants generally perceived the transition programme as acceptable and suitable for newly graduated nurses and providers. The 4-week rotation in outpatient clinics for patients with gastroenterological and pulmonary diseases, supervision, and visits to the municipality were considered satisfactory. Dissatisfaction appeared when the newly graduated nurses' expectations about planned conversations and followership were unmet. Preceptor presence was crucial for integrating the programme into the daily routine and heightening the nurses' job satisfaction. The 2-year timeframe accommodates the multi-component nature of the programme across two specialties. Conclusion A 2-year transition programme is feasible in a complex setting such as a medical hospital ward, supporting newly graduated nurses' transition into practice and enhancing their confidence.
