Background Healthcare literature has proposed that “learning organisations” (LO) or “learning healthcare systems” (LHS) that continuously generate and apply evidence, innovation, quality, and value can provide better care. This is of value to non-acute healthcare settings such as rehabilitation, which are complex, multi-dimensional and multi-disciplinary in nature. Little is known about how these frameworks have been applied to rehabilitation settings. Objective and inclusion criteria The aim of this scoping review is to systematically summarise the literature conceptualising and operationalising LHS and LO in rehabilitation settings. Studies will be included which define a LO or LHS, describe an operating LHS/LO or include the translation of research evidence generated from LHS/LO data into healthcare improvement within a rehabilitation context. All study designs will be included. Methods The guidelines from the Joanna Briggs institute methodology for scoping reviews will be used for this review. The literature search will be performed using a three-step search strategy: an initial limited search of two databases has been performed to identify relevant key words and index terms. The developed search string will be adapted and applied across the following databases: OVID MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and COCHRANE Database of Systematic Reviews. Reference lists of selected sources and relevant data-hubs will also be searched. A draft data extraction framework will be used and updated iteratively to extract data. Data will be extracted and described to address the research question of how LHS and LO have been conceptualised and operationalised in the context of rehabilitation. Discussion and Implications There is potential for rehabilitation focused LHSs to advance global rehabilitation services and facilitate best practice. Little is known about how rehabilitation focused LHSs have been constructed and sustained. This will be the first review to explore LHS application in rehabilitation, guiding future development and research.

Background Research has emphasised the value of a person-centred, interdisciplinary team (IDT) approach to structured goal setting in rehabilitation; yet these approaches are not consistently implemented in clinical practice, limiting the effect that goal setting can have on rehabilitation. The introduction of a new IDT, person-centred goal-setting process to Ireland’s National Rehabilitation Hospital (NRH) offers an opportunity to gain insight into barriers to implementing and normalising IDT goal setting in complex, specialist rehabilitation services. This process was developed prior to, and independently of, the current evaluation by the hospital’s quality improvement (QI) team; this protocol concerns the evaluation of its pilot implementation. Method The study was co-designed by embedded academic researchers and knowledge stakeholders, including the QI team responsible for introducing the new process and two former patients. A mixed-methods approach will capture patient and staff experiences and perspectives of the new process and, secondarily, pilot the feasibility of quantitative outcome measures ahead of a possible future hospital-wide evaluation. Data will be collected by embedded researchers using self-report measures and qualitative interviews with staff and patients. Measures include the Client-Centredness of Goal Setting scale (C-COGS), CollaboRATE, the Interprofessional Socialization and Valuing Scale (ISVS-9B), and the Normalization Measure Development questionnaire (NoMAD), capturing person-centredness of goals, shared decision-making, interprofessional socialisation and process normalisation. Quantitative data will be analysed using descriptive and, where appropriate, inferential statistics; qualitative interview data will be analysed using reflexive thematic analysis. Discussion & Conclusion The study aims to provide a holistic view of patient and staff experiences of the goal-setting process and to identify challenges and potential solutions to implementation within this context. Findings will inform further implementation within the hospital and contribute to rehabilitation practice around implementing IDT goal setting, adding an Irish perspective to the existing rehabilitation goal-setting literature.

Background: Research has emphasized the value of a person-centered, interdisciplinary approach to structured goal setting in rehabilitation; yet these approaches are not consistently implemented in clinical practice, limiting the effect that goal setting can have on rehabilitation. The introduction of a new interdisciplinary, person-centered goal setting process to Ireland’s national rehabilitation hospital offers an opportunity to gain novel insight into barriers to implementing and normalising IDT goal setting in complex, specialist rehabilitation services. Methods: The goal setting process was collaboratively designed based on iterative rounds of patient and staff feedback. It will be piloted in three different units of the hospital. The outlined study was co-designed by embedded academic researchers and knowledge stakeholders (the quality improvement team responsible for introducing the new process; and two former patients). The aim is to use a mixed methods approach to capture patient and staff experiences and perspectives of the new process. Data will be collected by embedded researchers with a combination of self-report measures and qualitative interviews with both staff and patients. Self-report measures focus on capturing person centeredness of goals, shared decision making, interprofessional socialization and process normalization. Quantitative data will be represented using descriptive and inferential statistics; qualitative data will be analysed using reflexive thematic analysis. Discussion & Conclusion: From this data the researchers aim to present a holistic view of the patient and staff experiences of the goal setting process. This may further illuminate challenges and potential solutions to implementing changes to goal setting within this context. Findings will be used to inform implementation within the hospital and will contribute to knowledge for rehabilitation practice around implementing IDT goal setting. This will add an Irish perspective to existing goal setting rehabilitation literature.

Research has promoted the value of person-orientated care & interdisciplinary teamworking (IDT), yet they are not consistently implemented in clinical practice. Patients involved in their own goal setting experience greater improvements in functioning, and they prefer a shared decision-making approach to goal setting. This fosters a culture that supports knowledge translation and change management by enhancing patient communication & individualized care planning. Introduction of an IDT process comes as most goal setting in rehab care is multidisciplinary in nature, therefore this shift represents the blurring of disciplinary boundaries to develop joint service plans and complete shared goals. Introducing a new interdisciplinary, person-centred goal setting to a rehabilitation service offers an opportunity to gain insight into the barriers of implementing and normalising this process in complex services. Researchers used a mixed-methods approach to capture patient and staff experiences and perspectives of a new goal setting process. Staff data was collected via self-report measures at 3 time-points; pre, during, and post implementation process, and through interviews at the final stage. The staff surveys included the Interprofessional Socialisation and Valuing Scale ISVS-9B, measuring interprofessional socialisation and readiness to function in teams, and the NoMAD (Normalisation Measure Development Questionnaire), which measures the normalisation of complex healthcare interventions. Patient data was collected after their goal setting meeting. A semi-structured interview followed midway through their admission in the hospital. The patient survey included the C-Cogs (Client-Centredness of Goal Setting), measuring client-centredness of goal planning, and CollaboRATE, measuring the shared decision-making patients experienced following their goal planning meeting.In total, 133 participants took part in the surveys. 121 staff members completed the survey at least once. At Time 1, 76.9% of staff reported feeling part of the unit team, while at Time 3, this rose to 86.7%. Interviews with 15 staff revealed they viewed the new process as an opportunity for change, and to learn from and work with other disciplines to enhance their ability to deliver patient-centred care. Contrastingly, some felt the burden of a changed process on an increasingly stressed team that continued to face staff shortages & annual leaves. Six patients took part in the interview, and 12 in the survey. There was an overwhelmingly positive response from patients regarding their goal setting experience. Patients noted that they felt grateful for their opportunity to be treated in the hospital. Staff were a source of support which helped patients grow in their beliefs that they could achieve future goals they set for themselves. Goals were discussed regularly, patients felt listened to and included in the process, and empowered to continue in their rehab by their team who provided guidance and reassurance. The study aims to represent a holistic view of the patient and staff experience of the goal setting process. Results illuminate challenges and potential solutions to implementing changes to goal setting within this context. Findings will be used to inform implementation within the hospital and further contribute to knowledge for rehabilitation practice around developing IDT person centred goal-oriented care.

This study aimed to qualitatively explore the experiences of healthcare professionals implementing changes (as change initiators) and operationalizing interdisciplinary teamwork in a rehabilitation service within the Irish healthcare system. Data for this study were collected through focus group discussions with change initiators involved in interdisciplinary team initiatives at a rehabilitation service in Ireland. A reflexive thematic analysis was employed to analyse the focus group data, which involved identifying patterns and themes within the narratives provided by participants. Three overarching themes emerged from the analysis: 1. "Nature of the Battle for Change", 2. "Characteristics of the 'Status Quo' and Contradictions to IDT Working," and 3. "Power and Identity: Threats to Hierarchy and Status". These themes shed light on the challenges faced in implementing interdisciplinary teamwork, particularly the perceived threats to individual power and professional identity within hierarchical healthcare structures. Implementing healthcare changes, especially in historically hierarchical healthcare systems is complex. Interdisciplinary team rehabilitation can challenge the status quo, posing adoption barriers. A nuanced, bottom-up approach is recommended, emphasizing long-term coalition building, continuous professional development, and early discussions about hierarchy and status. These recommendations offer practical guidance for stakeholders seeking to implement interdisciplinary, person-oriented approaches in rehabilitation practices, facilitating better anticipation and resolution of challenges, and ultimately improving care delivery and patient outcomes.

Patient and family caregiver experience is pivotal for integrated care, providing guidance for care coordination, decision-making, quality improvement, communication, and cultural transformation. By actively obtaining and responding to feedback, healthcare systems can enhance the effectiveness and responsiveness of integrated care, ultimately leading to improved outcomes and satisfaction for patients and their family caregivers. However, there is a notable gap in research addressing the effective utilization of diverse methods for collecting patient experience data to drive healthcare improvements. The aim of this scoping review was to address that gap by exploring the literature to examine the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in post-acute rehabilitation settings. The review followed the JBI guidelines and Arksey & O’Malley methodological framework. A comprehensive search was performed across four databases (OVID MEDLINE; CINAHL; APA PsycINFO; COCHRANE) to capture the extent of the literature on this topic relevant to rehabilitation. Qualitative and quantitative studies (2012-2023) describing collection of patient experience data with the intent of using it for healthcare improvement in post-acute rehabilitation settings were included. After screening and data extraction, qualitative content analysis and thematic mapping were utilised to explore the selected studies. Of 3570 initial records, 160 full texts were screened, and 30 were included in the final analysis. Majority of included studies were conducted among hospital patients, during admission (43.3%) or within three weeks post-discharge (13.3%). Caregiver experiences were gathered in conjunction with patient data in 40% of the studies. Most studies (70%) employed qualitative data collection methods, using semi-structured interviews or focus groups to elicit patient experience data, which indicates the need to speak directly with people regarding their care experience. On four occasions (13.3%), a mixed-methods approach was used, with a questionnaire administered alongside qualitative methods. In six (66.6%) of the quantitative studies, self-developed questionnaires were used rather than validated instruments. This may suggest that the routinely collected patient data are infrequently used for quality improvement initiatives within rehabilitation settings. This evidence synthesis highlights the diverse methods used and contexts in which patient and family caregiver experience has been gathered in post-acute rehabilitation settings. Several papers mentioned quality improvement based on collected patient experience data but did not provide details of quality improvement activities or their corresponding impact. Few papers offered recommendations for policy or practice changes. Studies utilizing patient experience data reported a diverse array of small improvements to specific aspects of care (e.g., changes to discharge process or hospital documentation), or the development of educational materials or toolkits for patient use. This indicates there is underutilized potential for using patient experience data to improve rehabilitation care and services. This scoping review provides a better understanding of how patient experience is being utilised in post-acute settings. However, it demonstrates the need for methodological rigor and transparency in future research when reporting how patient and family caregiver data is used for improving healthcare quality and integration. Future research should clearly articulate Patient and Public Involvement (PPI) in the research process, including implementation and evaluation.

PURPOSE:This study aimed to assess the prevalence of literature applying LHS and learning organisation (LO) concepts to rehabilitation, gather definitions and core features, and document their application and resultant organisational changes. MATERIALS AND METHODS:We searched five electronic databases and included peer-reviewed qualitative, quantitative, and mixed-methods studies, reviews, and grey literature in English. Full texts were screened, resulting in 27 included papers. RESULTS:Most of the included papers discussed the concept of LHS, emphasising key aspects like infrastructure and learning mechanisms. However, only a minority described practical implementation (n = 4) or assessed the effects of applying LHS frameworks within rehabilitation settings (n = 1). CONCLUSIONS:This scoping review highlights the limited empirical focus on implementing and operationalising LHS frameworks in rehabilitation services. Based on the available literature, we offer recommendations for rehabilitation services transitioning to a LHS. Our findings emphasise the need for increased dissemination of knowledge and research on the implementation and evaluation of rehabilitation-focused LHS.

Background: Patient experience is routinely collected in the clinical environment in many different ways throughout various person-provider encounters, but so far limited research focused on understanding the methods of using it to improve the quality of healthcare. This paper presents a protocol for a methodological scoping review examining the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in rehabilitation settings. Methods: The scoping review will be conducted according to the guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the methodological framework by Arksey & O’Malley. A comprehensive search of the literature will be performed using a three-step search strategy: an initial limited search of two databases was already performed and helped to identified relevant key words and index terms. The developed search string will be adapted and applied across four databases. This will be followed by search of the reference lists of selected sources and hand-search relevant data-hubs. Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement in rehabilitation context, will be included. A data extraction framework will be developed and piloted to guide the literature screening and data charting. Qualitative content analysis will be employed to address research questions and the results will be presented – beside the descriptive format - as a map of data in chart and tabular formats. Conclusions: This scoping review will show the extent and scope of the literature on the applied methods of collecting, communicating, and using patient experience for quality improvement in post-acute rehabilitation settings and will evaluate and map the evidence on these topics. The findings will inform a research project entitled “An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital”.

Background Patient experience is routinely collected in the clinical environment in many different ways throughout various person-provider encounters, but so far limited research focused on understanding the methods of using it to improve the quality of healthcare. This paper presents a protocol for a methodological scoping review examining the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in rehabilitation settings. Methods The scoping review will be conducted according to the guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the methodological framework by Arksey & O’Malley. A comprehensive search of the literature will be performed using a three-step search strategy: an initial limited search of two databases was already performed and helped to identified relevant key words and index terms. The developed search string will be adapted and applied across four databases. This will be followed by search of the reference lists of selected sources and hand-search relevant data-hubs. Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement in rehabilitation context, will be included. A data extraction framework will be developed and piloted to guide the literature screening and data charting. Qualitative content analysis will be employed to address research questions and the results will be presented – beside the descriptive format - as a map of data in chart and tabular formats. Conclusions This scoping review will show the extent and scope of the literature on the applied methods of collecting, communicating, and using patient experience for quality improvement in post-acute rehabilitation settings and will evaluate and map the evidence on these topics. The findings will inform a research project entitled “An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital”.

Background: Healthcare literature has proposed that “learning organisations” (LO) or “learning healthcare systems” (LHS) that continuously generate and apply evidence, innovation, quality, and value can provide better care. This is of value to non-acute healthcare settings such as rehabilitation, which are complex, multi-dimensional and multi-disciplinary in nature. Little is known about how these frameworks have been applied to rehabilitation settings. Objective and inclusion criteria: The aim of this scoping review is to systematically summarise the literature conceptualising and operationalising LHS and LO in rehabilitation settings. Studies will be included which define a LO or LHS, describe an operating LHS/LO or include the translation of research evidence generated from LHS/LO data into healthcare improvement within a rehabilitation context. All study designs will be included. Methods: The guidelines from the Joanna Briggs institute methodology for scoping reviews will be used for this review. The literature search will be performed using a three-step search strategy: an initial limited search of two databases has been performed to identify relevant key words and index terms. The developed search string will be adapted and applied across the following databases: OVID MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and COCHRANE Database of Systematic Reviews. Reference lists of selected sources and relevant data-hubs will also be searched. A draft data extraction framework will be used and updated iteratively to extract data. Data will be extracted and described to address the research question of how LHS and LO have been conceptualised and operationalised in the context of rehabilitation. Discussion and Implications: There is potential for rehabilitation focused LHSs to advance global rehabilitation services and facilitate best practice. Little is known about how rehabilitation focused LHSs have been constructed and sustained. This will be the first review to explore LHS application in rehabilitation, guiding future development and research.

In Ireland interdisciplinary healthcare teams have been recognised as a key component of integrated care and research recognises importance of teamwork for patient care and safety (Leonard, 2004; Manser, 2009; Forse et al., 2011; Sacks et al., 2015). Within rehabilitation care, teamwork is essential in addressing complex health challenges such as chronic impairments, co-morbidities and more complex problems (Ouwens et al., 2005; Wade, 2015). Yet research on teamwork in non-acute settings is far behind that of acute settings (Miller et al., 2018). In rehabilitation, healthcare teams naturally include a wide range of professions, from multiple disciplines (Wade, 2016), often in a multidisciplinary approach with different professions focused on different goals (Koroner, 2010). Little is known about how rehabilitation teams can optimise communication, work together to create common goals and effectively function as an interdisciplinary team. The complexity of creating this type of change and shifting to new models of teamwork is captured in this study, which details the efforts of a self-organised “grassroots” group of healthcare professionals who created and implemented an interdisciplinary teams framework within a national rehabilitation hospital. A focus group was utilised to capture the shared lived experience of the participants and thematic analysis with a critical approach (Braun & Clarke, 2006) was selected as an appropriate method for the purposes of constructing latent themes around key challenges and perceived barriers to change. Participants described resistance to shifting to an IDT model of care as stemming from cultural issues of hierarchy, power and control, disciplinary loyalty and identity. Key learnings are drawn from these experiences to form recommendations for organisational efforts to shift to interdisciplinary and transdisciplinary ways of working. This study is part of a larger action research project, and embedded academic researchers worked collaboratively with the participants as co-researchers to design this study and others focused on teamwork. The co-research team deemed this study’s topic a priority due to its potential significance for other healthcare professionals seeking to create change and collaborative working in their organisations.

Sexual and gender minorities often experience discrimination or stigmatization during health encounters. When patients feel stigmatized, they are more likely to delay seeking help and it affects patient cooperation and compliance, thus undermining therapeutic efficacy itself. We examined knowledge and attitude toward LGBT+ people among Hungarian (n = 743) and foreign (n = 130) medical students of the four Hungarian medical universities and 188 students from other faculties. Homonegativity and inadequate knowledge about sexual minority individuals are correlated with male gender, conservative political views, religiosity, religious behavior, and the absence of LGBT+ acquaintance. Medical students show more negative attitudes than students from other disciplines, although foreign medical students were more accepting than Hungarian program students. Further investigation of sexual minority-related content of the Hungarian medical education and revising the written and hidden curriculum would be desired, as well as collecting data from postgraduate students, physicians, and wide range of university faculties.

Abstract To meet the challenges posed by an aging population and changing health needs, healthcare systems require transformative action at a systemic level. One solution is to create “learning” health systems (LHS) that generate and apply evidence, innovation and quality to improve the provision of care. Given the lack of research focusing on operationalizing LHSs and the predominance of acute care studies, this scoping review aimed to fill this gap by exploring how LHS frameworks have been conceptualized and operationalized in rehabilitation organizations. The review was conducted according to the JBI guidelines and Arksey & O’Malley methodological framework. Comprehensive search was performed across 5 databases to capture the extent of the literature on this topic specific to rehabilitation. Following screening and data extraction, qualitative content analysis and thematic mapping was employed to explore the selected studies (n = 26). Results were reported in accordance with PRISMA guidelines. Studies conceptualised LHS as organizational infrastructure that supports continuous learning by integrating clinical care and research. It aims generate new knowledge by capturing data from every clinical encounter and applying it to practice through iterative learning cycles, characterized by three phases: Data to Knowledge, Knowledge to Performance, and Performance to Data. Four themes emerged regarding the operationalization of LHS in rehabilitation: creating a functioning data infrastructure; facilitating research; promoting an organizational culture of learning; and person-centredness. This study is the first scoping review on LHSs in the context of rehabilitation, employing a systematic and rigorous process to capture the relevant literature. The review identified key transformational steps to become a LHS e.g., generation, dissemination and implementation of new institutional knowledge and early stakeholder engagement. Findings can be applied across non-acute health settings. Key messages • This is the first scoping review on LHSs in the context of rehabilitation. • The findings will aid organisations in non-acute health settings with the transformational process of becoming LHSs.

Background: Transformative system wide action is needed for healthcare systems to meet the needs of an increasing aging population and changing health needs. One idea is that health systems can become “learning organisations” (LO) or “learning healthcare systems” (LHS) that continuously generate and apply evidence, innovation, quality, and value to provide better care. This is of value to non-acute healthcare settings such as rehabilitation, which are complex, multi-dimensional and multi-disciplinary in nature. Little is known about how these frameworks have been applied to rehabilitation settings. Objective and inclusion criteria: The aim of this scoping review is to systematically map and summarise the literature conceptualising and operationalising LHS and LO in rehabilitation settings. Studies will be included which define a LO or LHS; or describe an operating LHS/LO; or include the translation of research evidence generated from LHS/LO data into healthcare improvement within a rehabilitation context will be included. Study designs such as quantitative, qualitative, mixed method studies, and case studies will be included. Methods: The guidelines from the Joanna Briggs institute methodology for scoping reviews will be used for this review. The literature search will be performed using a three-step search strategy: an initial limited search of two databases has been performed to identify relevant key words and index terms. The developed search string will be adapted and applied across the following databases: OVID MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and COCHRANE Database of Systematic Reviews. This will be followed by search of the reference lists of selected sources and relevant data-hubs. A draft data extraction framework will be used and updated iteratively to extract data. Frequency counts and qualitative content analysis will be employed to address the research question of how LHS and LO have been conceptualised and operationalised in the context of rehabilitation.

Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.

Háttér A leszbikus, meleg, biszexuális és transznemű (LMBT) személyek a többi kisebbségi csoporthoz hasonlóan egészségi szempontból veszélyeztetett populációnak számítanak. Megfelelő ellátásukat nehezítheti az egészségügyi személyzet részéről megmutatkozó előítéletesség, amely befolyásolja a megfelelő orvos–beteg kapcsolatot is. Mindezidáig nem készült olyan magyar felmérés, amely az egészségügyben dolgozók LMBT személyekkel kapcsolatos attitűdjeit vizsgálta volna, azért sem, mert nem állt rendelkezésre erre alkalmas validált, magyar nyelvű kérdőív. Célkitűzés A kutatás célja a Modern Homonegativitás Skála (MHS) kérdőív kulturális adaptációja és pszichometriai jellemzőinek vizsgálata. Módszerek Az MHS kérdőív hazai adaptációját hat lépésből álló módszertan szerint végeztük. A magyar nyelvű változatot 194 orvostanhallgató (Semmelweis Egyetem) és gyógypedagógus-hallgató (Eötvös Loránd Tudományegyetem) töltötte ki a keresztmetszeti vizsgálat során (31,8% férfi; átlagéletkor: 22,2 év, SD = 1,60 év, terjedelem: 18–29 év). Eredmények A kérdőívet magas belső konzisztencia jellemezi (Cronbach-α: 0,91, illetve 0,90 a homoszexuális férfiakra (MHS-G) és a leszbikus nőkre (MHS-L) vonatkozó változatokban). Konfirmatív faktoranalízissel igazoltuk a skála egydimenziós struktúráját (MHS-G: χ2 (54) = 135,69; p < 0,001; RMSEA = 0,09; CFI = 0,92; TLI = 0,91; MHS-L: χ2 (54) = 182,45; p < 0,001; RMSEA = 0,11; CFI = 0,89; TLI = 0,86). A három hét időintervallumban mért teszt–reteszt korreláció értéke 0,94. Az MHS mindkét alskáláján mért értékek pozitívan korrelálnak a kérdőív validálásának érdekében felvett, régi típusú homonegativitást vizsgáló Orvostanhallgatói Attitűd Kérdések pontszámaival (MHS-G: r = 0,59; p < 0,001; MHS-L: r = 0,56; p < 0,001). Következtetések Az MHS adaptációja sikeres volt, magyar változata homoszexuális és leszbikus személyekkel kapcsolatos attitűdök vizsgálatára alkalmas mérőeszköznek bizonyult.