Kyoungyee Kang,1 Junesung Lee,1 Ji Won Lee,1 Chang-Yoon Baek,1,2 Dong kyu Kim,1 Jeon Wook Kwon,1 Jae Young Choi,1 Yelim An,1 Joo Youn Kim,3 Hyunsun Lim,3 Woo-Ri Lee,4 Myeonghwan Bang1 1Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; 2Graduate School of Sports Medicine, CHA University, Pocheon, Republic of Korea; 3Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; 4Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of KoreaCorrespondence: Myeonghwan Bang, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang, 10444, Republic of Korea, Tel +82-10-6244-0252, Email relight0222@gmail.comBackground: Multidisciplinary rehabilitation and structured goal setting are strongly recommended in subacute stroke care. However, in clinical practice, regular multidisciplinary goal-setting approaches have not been consistently implemented because of time and logistical constraints.Objective: To develop a structured multidisciplinary goal-setting framework for subacute stroke rehabilitation through a single-center expert consensus process.Methods: A multidisciplinary inpatient rehabilitation framework was developed through a targeted literature review and structured expert consensus meetings. A 12-member multidisciplinary panel held 10 face-to-face meetings at 2-week intervals to define the rehabilitation domains, workflow structure, and implementation strategy. Components were adopted through iterative multidisciplinary discussion until agreement was reached. No formal voting was conducted, and no quantitative consensus threshold was prespecified.Results: The final framework comprised three phases: admission, weekly inpatient cycles, and discharge. It integrated domain-specific assessments and problem lists, with structured inpatient and weekly goals based on the specific, measurable, achievable, relevant, and timed criteria. In the framework, goal attainment is evaluated using goal attainment scaling, supported by weekly progress documentation. An electronic medical record-based asynchronous communication model was proposed for future implementation to support multidisciplinary coordination.Conclusion: This framework was designed to support structured weekly multidisciplinary goal setting after subacute stroke. Its feasibility, usability, and effects on clinical outcomes have not been evaluated, and prospective multicenter validation is required.Keywords: stroke rehabilitation, multidisciplinary care, patient care team, goals, goal attainment scaling, clinical framework
Zeyue Sun, Di Chen, Wenqian Huang, Yan Song, Shanshan Jiang, Xujia Zhai, Tao Liu, Wei Zhu Department of Neurosurgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Wei Zhu, Department of Neurosurgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, People’s Republic of China, Email zhuwei625@163.comPurpose: To examine how adults aged 65 years or older and their primary caregivers interpreted and intended to act on discharge red-flag instructions after intracranial aneurysm treatment, explore neurosurgical nurses’ perspectives on recurrent discharge communication problems, and iteratively refine the instructions for safer transitional care.Patients and methods: This single-center qualitative study used cognitive interviewing in a tertiary neurosurgical unit in China. Twenty-four older patients and 20 primary caregivers completed cognitive interviews across two iterative rounds; eight neurosurgical nurses completed separate contextual interviews. Think-aloud and verbal probing assessed comprehension and intended action. Framework Method analysis of round 1 informed revisions tested with new participants in round 2.Results: Four high-risk communication problems were identified: under-recognition of gradual neurological deterioration, ambiguity created by clinical wording, difficulty mapping symptoms to escalation pathways, and patient–caregiver disagreement about action. Subtle signs, including progressive drowsiness, mild speech change, repeated vomiting, and incomplete limb weakness, were often normalized. Revisions used observable symptom descriptions, explicit action cues, and caregiver-directed prompts. Round 2 suggested fewer recurring comprehension problems and closer alignment between intended responses and clinical intent, although blood pressure guidance remained challenging for some participants.Conclusion: Standard red-flag instructions may not be sufficiently actionable for older adults and caregivers after intracranial aneurysm treatment. Cognitive interviewing can support clearer, caregiver-inclusive discharge tools reinforced by nurse-led teach-back.Plain Language Summary: After treatment for a brain aneurysm, older people and their families must know which changes can be watched at home and which require urgent help. We asked older patients and their primary caregivers to explain routine warning-sign instructions in their own words and describe what they would do. Nurses who routinely provided discharge teaching were also interviewed. Participants usually recognized dramatic emergencies, but subtle changes—such as becoming progressively sleepier, speaking more slowly, vomiting repeatedly, or developing partial weakness—were often mistaken for normal recovery or aging. We revised the instructions by using observable descriptions, pairing each warning sign with a clear action, and speaking directly to caregivers. A second round of interviews indicated that the revised instructions were easier to interpret, although blood pressure advice still caused uncertainty. These findings support a short action sheet and nurse-led teach-back as practical ways to make discharge communication safer. The study assessed understanding and intended action; it did not test whether the revised material reduces emergency visits, delayed care, or readmission.Keywords: cognitive interviewing, discharge communication, intracranial aneurysm, older adults, caregivers, transitional care
Ekansh Seth,1,* Jane Ginther,2 Vedat O Yildiz,3 Laura K Flora,4 Gretchen A McNally4,* 1College of Arts and Sciences, The Ohio State University, Columbus, OH, USA; 2The Ohio State Wexner Medical Center Addiction Medicine Team, Columbus, OH, USA; 3Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA; 4Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University, Columbus, OH, USA*These authors contributed equally to this workCorrespondence: Gretchen A McNally, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W 10th Ave, Columbus, OH, 43210, USA, Email Gretchen.mcnally@osumc.eduAbstract: Stigma towards people with opioid use disorders (OUD) contributes to delayed treatment, dismissed concerns, and reduced equitable care. Although healthcare professionals may recognize these harms, they often underestimate their own susceptibility to bias. Prior studies have primarily focused on addiction-related stigma within individual professions rather than across multidisciplinary teams. The current study compares responses from two studies conducted at The Ohio State University Wexner Medical Center. Study A (2020) included multidisciplinary oncology professionals (n = 773), while Study B (2023) comprised rehabilitation professionals (n = 93), with 42 respondents completing the focal items on the post-intervention evaluation. Both studies assessed agreement with two statements: (1) “I am certain I treat all persons the same, regardless of current or past OUD”, and (2) “In today’s society, I am certain that stereotypes or bias do not impact the quality of care patients receive”. Across the studies, most respondents agreed or strongly agreed that they treat all patients the same regardless of OUD history (Study A: 64.7%, n = 468/723; Study B: 73.8%, n = 31/42), while 22.3% and 14.3% selected neutral, respectively. For the second item, 48.1% of Study A respondents (346/719) and 78.6% of Study B respondents (33/42) disagreed or strongly disagreed that stereotypes or bias do not impact the quality of care patients receive. These findings suggest a gap between clinicians’ confidence in their own equitable treatment and their recognition that bias may influence care. Future research should explore interventions pairing OUD education with structured self-reflection and narrative-based approaches from people in recovery, alongside the development of validated measures of provider bias awareness to support sustained reflective practice across disciplines.Keywords: implicit bias, healthcare professionals, multidisciplinary care, interprofessional practice, healthcare disparities, provider attitudes
Min Fu, Ju Wu, Haiyan Jiang, Zhouyi Su, Yuzhen Zhu, Di Cui, Xijuan Sheng, Yaru Guan, Yuqing Li Department of General Surgery, Department of Thyroid Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of ChinaCorrespondence: Yuqing Li, Email lyq2025@fy.ahmu.edu.cnObjective: To explore the latent profile analysis and factors associated with of learned helplessness and benefit finding among patients after thyroid surgery.Methods: Using convenience sampling, inpatients who had undergone thyroid surgery at a Grade A Level III hospital in Anhui Province were selected as study participants from January 2026 to July 2026. A questionnaire survey was conducted using a demographic information form, Learned Helplessness Scale, Benefit Finding Scale, the Bidirectional Social Support Scale, and the Family Care Support Scale. Latent profile analysis of learned helplessness and benefit finding was performed using Mplus 8.3 software, and multinomial logistic regression was further applied to analyze factors associated with distinct latent profiles among patients after thyroid surgery.Results: Among 257 patients who had undergone thyroid surgery, the mean score of learned helplessness was (46.75 ± 7.62) points, and the mean score of benefit finding was (58.70 ± 11.79) points. The patients could be classified into three latent profiles: the stable adaptation group (59.41%), the negative helplessness group (19.39%), and the active growth group (21.20%). Multinomial logistic regression showed that age, presence of chronic diseases, surgical procedure, occupational status, medical insurance types, the family care index, and two-way social support were associated factors of the latent profiles of learned helplessness and benefit finding among patients after thyroid surgery (P < 0.05).Conclusion: There is heterogeneity in learned helplessness and benefit finding among patients after thyroid surgery. Healthcare providers can implement individualized interventions based on the factors associated with different latent profiles to reduce patients’ learned helplessness and enhance their benefit finding.Keywords: latent profile analysis, learned helplessness, benefit finding, thyroid surgery, social support, family care index
