Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyA V Dyakov
The article offers systematic consideration of epistemology of psychiatry as section of medicine which examination permits to analyze dispositif of science successfully implementing conceptual theoretical constructs in everyday practice. The various versions and trends in this area are considered, from traditional history of medicine with its positive or negative models of development of psychiatry to historical epistemology and history of ideas striving to create conceptualized picture of permanent scientific revolution or explosive evolution of psychiatry. The number of key moments are marked representing crystallization points of epistemology of psychiatry as systematic form of research: 1) the question about area of knowledge that is provide space for research in this direction; 2) creation of space of reflexive thinking where internal problematization of psychiatric theory and practice will be possible, excluding development of general theory of psychiatry that is externally imposed on it as general guidelines; 3) problematization of modus of openness of psychiatry to related areas of knowledge and public practice, minimizing interference of non-professionals in professional activities of psychiatrists.
BACKGROUND: Educational interventions are widely used to promote guideline-concordant psychiatric practice. However, it remains unclear whether participants' subjective satisfaction translates into actual changes in clinical behavior (CB). This study examined the association between subjective assessment (SA) scores of the EGUIDE training programs for schizophrenia and major depressive disorder (MDD) and CB. METHODS: In this multicenter observational study, we analyzed data from psychiatrists who participated in the EGUIDE training program. SA scores were obtained immediately after training using standardized questionnaires assessing satisfaction with program content, knowledge, skills, and future clinical intentions. CB was evaluated using self-report measures of guideline-concordant practice in general, schizophrenia-specific, and MDD-specific domains. Associations between SA and CB scores were examined using Spearman's rank correlation coefficients. RESULTS: A total of 1399 psychiatrists were included in the analysis. The comprehensive SA score showed a significant positive correlation with the comprehensive CB score (r = 0.19, p < 0.001). Likewise, schizophrenia- and MDD-specific SA scores were positively correlated with all CB domains, including general guideline use and disorder-specific practices (ρ = 0.14-0.19, all p < 0.001). Although effect sizes were small, the associations were consistent across disorders and clinical domains. CONCLUSIONS: Higher satisfaction with guideline-based educational programs was associated with greater self-reported guideline-concordant CBs, suggesting that positive educational experiences may support improvements in psychiatric practice at the national level.
Journal of evaluation in clinical practiceSamuel Atiku, Olufisayo Olakotan
BACKGROUND: The integration of ambient artificial intelligence (AI) scribes into the OpenNotes environment presents a profound governance crisis in healthcare. While patient access to medical records was designed as a transparency reform, the introduction of machine-generated text introduces novel vulnerabilities regarding record integrity, liability, and patients' trust. OBJECTIVE: This study investigates how clinicians discursively negotiate the systemic risks and accountability challenges of patient-facing, AI-assisted documentation. METHODS: Employing a netnographically informed qualitative design, the research conducted a reflexive thematic analysis of 484 relevant comments across 120 threads from eight clinician-oriented subreddits spanning October 2020 to February 2026. RESULTS: The analysis revealed five distinct governance challenges. First, an accountability vacuum exists where the mandatory clinician signature functions merely as a legal shock absorber for institutional AI liability. Second, clinicians frame AI hallucinations as a mathematically inevitable epistemic risk rather than a correctable technical bug. Third, a "dual-audience" problem emerges, as algorithmic optimization compromises both the individual clinical voice needed for peer communication and the empathetic clarity required for patient readers. Fourth, existing privacy frameworks are structurally inadequate to manage commercial data extraction during patient encounters. Finally, institutional productivity demands and AI-driven over-documentation severely threaten the fiscal credibility of the medical record through inadvertent upcoding. CONCLUSIONS: The prevailing regulatory assumption-that a physician's digital signature combined with passive patient visibility guarantees documentation accountability-is a fragile fiction. To protect clinical truth, health systems must transition from models of passive disclosure toward contingent transparency. This requires establishing authoritative, enforceable mechanisms for provenance tracking, error contestation, and vendor accountability.
The 1910s were a complex and rapidly changing decade in mental hygiene, marked by institutional innovation, professional development, and the expanding reconceptualization of mental disease and maladjustment. This growth frequently generated friction between practical clinical sciences, particularly psychiatry and consulting clinical psychology. After years of mounting tension, the National Research Council convened a joint conference in 1921 on the "Relations of Psychiatry to Psychology," bringing together 12 representatives to debate and draft resolutions intended to harmonize collaboration. Despite being the first coordinated effort of its kind in the United States, the meeting has been largely overlooked by historians. Yet the conference, especially its unpublished 43-page stenographic transcript and related correspondence, offers a rare window into the conflicts of the 1920s, capturing the tone, immediacy, and strategic maneuvering that more polished publications sideline or obscure. Drawing on these proceedings alongside contemporary publications and archival materials, this article reconstructs the meeting, its background, and its immediate repercussions. I argue that the conference revolved around four intertwined points of contention: (a) the definition and scope of core concepts such as "disease," "diagnosis," and "medical"; (b) psychologists' freedom to conduct clinical research without psychiatric supervision; (c) the hierarchical relationship and division of labor between the professions; and (d) the organization, administration, and authority of psychological clinics. Ultimately, the 1921 meeting saw psychologists pressing for clearer definitions, research autonomy, and practical authority, whereas psychiatrists defended broad conceptual frameworks and professional precedence that confined psychologists to experimental work and narrowly defined psychometric consultation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Journal of evaluation in clinical practiceBeatriz De Faria Sousa
RATIONALE: Contemporary psychiatry increasingly recognises the importance of person-centred, recovery-oriented, and biopsychosocial approaches to care. Yet these frameworks do not fully resolve the methodological question of how clinicians should investigate patients' lived experience in ways that inform ethical psychiatric practice. AIMS AND OBJECTIVES: This paper argues that phenomenology should be understood not merely as a humanistic supplement to psychiatry, but as a methodological foundation for ethically responsible clinical practice. METHODS: A conceptual analysis drawing on phenomenological psychopathology, philosophy of medicine, and clinical ethics is used to examine how attention to lived experience informs psychiatric understanding, therapeutic engagement, and ethical decision-making. RESULTS: Phenomenology contributes a disciplined method of inquiry into subjective experience. It complements diagnostic classification and neurobiological explanation by clarifying how illness reorganises the patient's lived world. A comparative clinical illustration demonstrates how phenomenological inquiry can deepen psychiatric assessment without replacing conventional diagnosis. This enriched understanding strengthens autonomy, informed consent, shared decision-making, diagnostic humility, and psychiatric education. CONCLUSION: Phenomenology does not require psychiatry to abandon diagnostic reliability, neuroscience, or evidence-based treatment. Rather, it provides a method through which psychiatry can more fully realise ethical commitments it already recognises. Attending to lived experience should therefore be regarded as a professional obligation within psychiatric practice.
The issue of psychiatric workforce renewal is no longer merely a human resource problem; it lies at the intersection of professional identity, training structure, and the organizational logic of the healthcare system. International medical education literature describes professional identity formation as a gradual process of socialization in which the novice physician progresses from performing professional tasks to internalizing the vocation itself. This process is strongly influenced by the clinical learning environment, the presence of role models, structured reflection, the gradual transfer of responsibility, psychological safety, and whether the resident is truly able to practice the chosen specialty. A specific challenge in Hungarian psychiatry is that the process of becoming a psychiatrist is often constrained by systemic pressures that lead to blurred professional boundaries, distortion of training, increased risks to patient safety, and erosion of professional self-identity. The aim of this paper is to examine the educational and organizational conditions necessary for psychiatry to become an attractive and sustainable career choice again. The article is based on a synthesis of the international literature on professional identity formation, Hungarian research on psychiatric professional identity, and a qualitative case-based analysis. Orv Hetil. 2026; 167(29): 1142-1151.
Current psychiatry reportsLaura Y Cabrera, Leonard M Fleck, Alik S Widge
PURPOSE OF REVIEW: Mental health disorders are a significant public health problem with profound impacts on individual health, communities and society. Interventional approaches are limited in both utilization and access, despite their strong evidence base in specific disorders. The objective of this review is to describe factors and challenges influencing equity in interventional psychiatry. RECENT FINDINGS: Mental health care inequities are pervasive and persistent. For interventional psychiatry tools, even with current evidence of interventions' cost-effectiveness, inequities in access persist based on geographic context, socioeconomic status, and race, as well as insurers' reluctance to cover some of them. A wide range of social factors impact access and utilization of interventional psychiatry tools. To ensure parity, we need strategies to increase awareness and to address access and utilization disparities found across these interventions, in addition to keeping up-to-date mental health coverage policies based on new safety and effectiveness evidence.
MedEdPORTAL : the journal of teaching and learning resourcesVictoria Ivy Petsinger, Sugapradha Saravanan, Rahul Manne, Ramzi W Nahhas, Bethany Harper, Larrilyn Grant
INTRODUCTION: Intimate partner violence (IPV) is a cyclical pattern of behavior that can cause physical, psychological, and/or sexual harm with significant risks, including posttraumatic stress disorder. The primary aim of IPV is to establish or maintain power over the partner. While many organizations recommend screening for IPV, there is limited exposure to IPV in medical school curricula. This critical gap represents opportunity for further education. Thus, an interactive module on IPV was created for medical students on their psychiatry clerkship to teach skills in assessment, treatment planning, and resources. This study evaluates the module's effectiveness and medical students' readiness in addressing IPV in clinical settings. METHODS: The module provides a structured overview of IPV, including epidemiology, barriers to seeking help, and screening approaches. It incorporates video-based clinical scenarios, allowing learners to observe and practice how to recognize and respond to IPV in real-world settings. Pre- and postmodule surveys were administered to assess changes in knowledge, confidence, and preparedness in addressing IPV. Individual item scores were summed within each domain, and pre- and postmodule total scores were compared using paired t tests. RESULTS: Data were collected from 122 third-year medical students. Students showed statistically significant improvements in knowledge and reported higher confidence and preparedness (P < .001) after completing the module. More students correctly identified risk factors, felt adequately trained, and were more comfortable discussing IPV. DISCUSSION: The IPV module improved students' knowledge, confidence, and preparedness in addressing IPV. Future studies should assess long-term retention and its impact on clinical practice.
PloS oneAmal I Khalil, Alhanouf A Almuhalbidi, Reema T Almutairi, Shahad S Almutairi, Hatun H Alansari, Atheer S Almarri, Shaima K Alzahrani, Joud S Alzahrani
BACKGROUND: Polypharmacy is often crucial for managing complex and treatment-resistant psychiatric disorders, yet it carries risks such as adverse drug interactions, medication non-compliance, and suboptimal health outcomes. Interprofessional perspectives on polypharmacy significantly influence clinical decision-making and prescribing practices. AIM: This research evaluates healthcare providers' knowledge and attitudes regarding psychiatric polypharmacy, comparing the views of psychiatric nurses, psychiatrists, and pharmacists. It also explores how these factors impact prescribing behaviors and interprofessional collaboration. METHODS: A convergent mixed-methods approach was employed at the Erada Complex for Mental Health and Addiction in Jeddah, Saudi Arabia. The study involved 221 healthcare providers, including psychiatrists (n = 32), psychiatric nurses (n = 158), and pharmacists (n = 31). Quantitative data were collected using validated scales to assess knowledge and attitudes, while qualitative insights were gathered through open-ended responses and group discussions. RESULTS: Knowledge levels varied among the professionals, with psychiatrists possessing the most comprehensive understanding (84.2 ± 11.0), followed by pharmacists (81.5 ± 10.0) and psychiatric nurses (79.5 ± 9.8). Attitudes toward polypharmacy also differed, with psychiatrists showing the most favorable views (3.79 ± 0.49), whereas nurses and pharmacists were more cautious due to concerns about adverse effects and medication burden. A significant positive correlation (r = 0.653, p < 0.05) was observed between knowledge and attitude scores. Sociodemographic factors, such as professional experience and confidence in medication management, influenced both knowledge and attitudes regarding medication management. Qualitative findings highlighted interprofessional tensions, with psychiatric nurses advocating for more conservative approaches, psychiatrists emphasizing clinical necessity, and pharmacists focusing on optimizing medication safety. CONCLUSION: Healthcare providers demonstrated varying levels of awareness and attitudes toward psychiatric polypharmacy, shaped by their professional roles and responsibilities. While psychiatrists were more accepting of polypharmacy, psychiatric nurses expressed concerns about patient burden, and pharmacists prioritized safety considerations. Enhancing interprofessional collaboration and ongoing education on polypharmacy practices are essential for improving patient outcomes.
JMIR mental healthRaphael Schuster, Constantin Yves Plessen, Per Carlbring, Andreas Walther
The rapid evolution of large language models has accelerated the development of agentic artificial intelligence (AI) systems capable of pursuing autonomous goals, creating an urgent need for structural frameworks in psychiatry and psychotherapy. While existing classifications often draw parallels to autonomous driving, this paper argues that the mental health domain requires a distinct, domain-specific theoretical foundation, as the 2 domains differ fundamentally in their semantic, ideographic, and epistemological demands. Furthermore, they differ in their end goals, for which we introduce terms such as agentic guidance capability. To guide clinicians and researchers through these developments, we propose a 5-stage taxonomy for language-based AI systems that differentiates technical functionality from clinical effectiveness. The taxonomy progresses from level 1 (knowledge level), in which systems perform static benchmark tasks, to level 2 (elementary level), characterized by dynamic engagement in specific therapeutic microskills. At level 3 (integration level), systems achieve consistency across and within modules, as well as basic case-level conceptualization suitable for blended therapy under human oversight. Level 4 (saturation level) describes therapist-in-the-loop systems capable of autonomous functioning with minimal supervision, whereas level 5 (mastery level) represents AI systems that are technically capable of performing autonomous therapy. By distinguishing technical functionality from clinical effectiveness, we conclude that level 4 or level 5 performance does not automatically translate into full treatment effectiveness, even if high treatment fidelity can be achieved. We conclude by emphasizing the need to shift benchmarking from static knowledge tests to dynamic evaluations of therapeutic capabilities in order to safely navigate the transition toward autonomous care.
PLoS computational biologyLenard Dome, Frank H Hezemans, Kenza Kadri, Ben J Wagner, Andrew Webb, Tobias U Hauser
The Computational Psychiatry Modelling (cpm) toolbox is a Python library for theory-driven modelling in computational psychiatry and cognitive (neuro-)science. cpm integrates a wide range of established approaches into a single framework. It is designed to be accessible to both expert and non-expert modellers in order to conduct cutting-edge computational modelling, while adhering to best practices. The toolbox provides a flexible, modular architecture that adjusts to different needs. It covers a wide range of problems (such as risky decision-making, reward/punishment learning, perceptual metacognition), models (including those based on associative, reinforcement learning, and signal detection theories), and methods (such as hierarchical parameter estimation using empirical and variational Bayesian techniques). Such a customisable toolbox aims to lower the barrier for beginners and to facilitate access to advanced modelling approaches in psychiatry and beyond.
BMC medical educationJulia Sgrott, Christoph Nikendei, Ede Nagy, Aleksei Smirnov, Josefina Arias Alvarado, Hans-Christoph Friederich, Ivo Dönnhoff
BACKGROUND: International students face numerous challenges in both their academic and social lives when relocating to a new country for their university studies. The foreign language can have an impact on international medical students' performance in patient encounters. Particularly in the context of psychosocial medicine, a deficiency in communication skills can negatively impact the doctor-patient-relationship. This is the first study that uses natural language processing (NLP) as well as traditional rating scales to assess the improvement of international students' communication skills after attending a communication training seminar. METHODS: N = forty-two international students participated in the study, which followed a pre-post-design. Diagnostic interviews with standardized patients (SP) were videotaped before and after the three-day training seminar, which was comprised of short lectures and communication trainings with SPs regarding the topic of psychosomatic medicine. Transcripts of diagnostic interviews were analyzed with NLP. Videotaped clinical encounters were assessed by three raters with binary and global rating instruments. For the comparison between pre- and post-assessment of all NLP communication parameters and rating results, two-way ANOVAs and Wilcoxon tests were calculated, respectively. RESULTS: NLP communication parameter results showed a decrease in talk-turns, interruptions, number of questions and talking over, and an increase in talk-turn-length in post-assessment compared to pre-assessment. There were no significant pre-post changes observed in binary checklist results. Significant pre-post changes were observed in global rating score and ratings from global rating domains 'interview structure' and 'verbal expression'. CONCLUSION: International students significantly improved their communication style in psychosomatic medicine towards a more patient-centered approach. Changes in NLP communication parameters and improved interview style and verbal expression suggest that international students may have listened to patients more carefully. Furthermore, NLP has shown to be a viable tool to evaluate communication parameters in a doctor-patient-relationship and assess the effectiveness of communication training for international students.
Includes an excerpt from: A Study on Depression: Foundations of Dialectical Anthropology. Ediciones Península, Barcelona, 1974. (Introduction, pp. 11-20).
JMIR medical informaticsShuying Rao, Xi'ang Chen, Guifeng Deng, Junyi Xie, Tiecheng Jiang, Tao Li, Yaoyun Zhang, Haiteng Jiang
BACKGROUND: Psychiatric clinical notes in electronic health records (EHRs) provide rich longitudinal information that can support clinical decision-making. Using historical medical data can enable earlier identification of mental illness, better characterization of disease trajectories, and more personalized treatment planning. Natural language processing (NLP) transforms these unstructured notes into analyzable representations for research and care. OBJECTIVE: This study aims to systematically summarize NLP methodologies for psychiatric clinical notes, compare major modeling paradigms and application areas, and highlight emerging large language model (LLM) trends, key challenges, and future research directions. METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, a literature search was conducted for articles on NLP methods based on psychiatric clinical notes published from January 2021 to December 2025 in Ovid MEDLINE, Ovid EMBASE, PubMed, Scopus, Web of Science, the ACM Digital Library, and ScienceDirect. This scoping review analyzed NLP methods applied to psychiatric clinical notes, focusing on major trends, identifying suitable features for traditional machine learning (ML)-based models, applications of pretrained language models (PLMs), and key challenges. Approaches were categorized as rule-based, traditional ML, hybrid, deep learning (DL), and LLM-based methods across information extraction and text classification tasks. RESULTS: In total, 101 studies were eligible for inclusion. Rule-based methods (n=36) and hybrid approaches (n=34) remained the most widely used techniques, largely favored for their interpretability in handling nuanced, subjective clinical notes. These were followed by DL (n=15), traditional ML (n=10), and LLM-based approaches (n=6). Traditional ML studies relied heavily on engineered features, which could be grouped into 5 broad categories: domain knowledge features, lexical and statistical features, vector-based semantic features, emotion-related features, and temporal features. PLMs improved performance mainly through domain adaptation and task-specific fine-tuning, enhancing the handling of psychiatric language, medical terminology, and clinical note structure. LLM-based studies, although still limited in number, indicated a growing shift toward generative and reasoning-based applications. CONCLUSIONS: Hybrid NLP approaches remain dominant, combining domain rules with ML for extraction and classification. DL approaches continue to advance, with domain adaptation supporting medical terminology and clinical semantics. LLMs may further automate complex workflows via zero-shot capabilities and reasoning, alongside growing interest in temporal modeling and multimodal integration. Key future needs include improved generalizability across institutions, privacy protection, and careful attention to ethical implications in clinical deployment.
BMJ openPrisha Mehta, Pratham Mehta, Smitha Rani, Sharanya Bose, Sanchi Kapoor, Mahathi Reddy Busireddy, Shwethashree M, Anitha C
OBJECTIVES: To characterise current practices in adolescent sexual and reproductive health (SRH) assessment during routine clinical encounters in a tertiary care setting and to triangulate these findings with young adults' experiences of adolescent healthcare, identifying gaps between recommended assessment approaches and real-world clinical practice. DESIGN: Qualitative study using semistructured in-depth interviews (IDIs) and group discussions with clinicians, followed by a sequential triangulation phase involving IDIs with young adults. Data were analysed using Braun and Clarke's reflexive thematic analysis. SETTING: A tertiary care hospital in South Karnataka, India. PARTICIPANTS: 33 clinicians across six departments participated in four IDIs and five group discussions (focus-group or small-group discussions). 10 undergraduate young adults were recruited for IDIs in the triangulation phase. Sampling was guided by the information power principle. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Current patterns and practices of SRH assessment, perceived barriers and challenges and concordance between clinician-reported practices and young adults' experiences of care. RESULTS: Three domains emerged: current assessment practices, contextual challenges and improvement strategies. SRH assessment was largely symptom-driven and reactive rather than routinely integrated into consultations. Clinicians described practices shaped by sociocultural stigma, parental presence, privacy limitations and medicolegal uncertainty. In response, many relied on informal strategies such as rapport-building, indirect questioning or referral pathways. Triangulation with young adults' experiences confirmed the reactive nature of SRH enquiry, but revealed critical mismatches: young adults perceived consent processes as opaque, investigations as unexplained and confidentiality as inconsistently protected, contrasting with clinician intentions to be protective and pragmatic. CONCLUSIONS: Adolescent SRH assessment in tertiary care settings remains constrained by sociocultural, infrastructural and communication barriers. Clinicians often compensate through informal practices that lack standardised protocols. Integrating adolescent-focused communication training, standardised assessment approaches and supportive system-level and community interventions may strengthen disclosure and improve adolescent-centred SRH care. By triangulating provider and patient perspectives, this study reveals a systematic gap between clinician adaptive strategies, constructed as protective and adolescents' experiences as opaque, non-participatory care offering contextually grounded implications for strengthening adolescent-centred SRH services in comparable LMIC settings. TRIAL REGISTRATION NUMBER: Not applicable (Qualitative Study).
JMIR mHealth and uHealthChristine Deeney, Anika Sonig, Meghan E Hurley, Birkan Tunç, Eric A Storch, John D Herrington, Jennifer Blumenthal-Barby, Kristin Kostick-Quenet
BACKGROUND: Digital health tools are increasingly used in mental health care to passively collect patient data and analyze health status outside of clinical settings. While technologies such as digital phenotyping, affective computing, and computational behavioral analysis offer new insights into symptom manifestation in daily life, they generate large volumes of potentially sensitive data that raise significant data privacy concerns, requiring high levels of patient awareness and consent. Empirical research is lacking on stakeholder understandings toward the sensitivity of these data and expectations for data stewardship, perspectives that are critical for developing robust informed consent and data protection policies for digital health data use. OBJECTIVE: This study aimed to explore key stakeholder perspectives on the sensitivity of computer perception (CP) data, trust in existing data protections, willingness to share CP data externally, and desire for transparency of CP data transactions outside of the clinical space. METHODS: As part of a larger, multisite study, we conducted qualitative interviews (n=40) via Zoom (Zoom Communications, Inc) with 20 adolescents (aged 12-17 years) familiar with CP tools and their caregivers (n=20). Interviews consisted of a series of open-ended questions regarding stakeholders' perspectives on privacy, data security, and the use and exchange of CP data. We developed a qualitative codebook to identify and label thematic patterns in responses to questions addressing the topics above, using thematic content analysis to identify themes inductively. Each interview was coded by merging work from at least two separate coders, and several team members contributed to qualitative analysis. RESULTS: Most adolescents and caregivers viewed CP data as highly sensitive and expressed a reluctance to share these data beyond their clinical teams. While many participants expressed trust in existing data protections to protect CP data, they often misunderstood or overestimated the extent of protections to safeguard CP data. CONCLUSIONS: Our findings underscore the critical need for clear and effective patient communication and education about the risks, benefits, and protections associated with CP data through informed consent protocols. To promote greater transparency, understanding, and trust, we recommend 5 strategies: educating patients about data protection; studying secondary data exchange and reidentification risks; strengthening transparency regulations; improving data traceability mechanisms, such as distributed ledger technologies, to enhance data traceability and auditability; and adopting dynamic consent models.
JMIR medical educationKe-Hsin Chueh, Jeng-Wen Chen, Li-Ang Lee, Hsiang-I Hsu, Yen-Ju Lin, Hsiao-Tzu Wang
BACKGROUND: Taiwan is projected to become a "super-aged" society by 2025, leading to an increasing demand for community psychiatric long-term care (LTC). This demographic shift necessitates frontline professionals equipped with specialized communication skills and deep empathy. However, traditional didactic teaching often fails to adequately prepare students for the complex emotional and practical challenges of real-world psychiatric caregiving. OBJECTIVE: This study aimed to evaluate the effectiveness of the innovative youth-elder co-learning instructional model, which uniquely integrates micro-movie discussions and an intergenerational empathy board game, on adult learners' professional knowledge, communication competence, empathic development, and overall learning satisfaction. METHODS: A mixed methods, single-group, pre-post design was used. The educational intervention was implemented within an 18-week elective community psychiatric LTC course. Participants included 38 adult learners and continuing education students (aged 19-64 years). Notably, the majority of the cohort (n=29, 76.3%) had no prior practical experience in LTC. Quantitative data were collected using self-assessed and peer-evaluated scales for professional knowledge, communication competence, and empathy at pre-, mid-, and post-course time points, alongside an end-of-semester course student feedback survey. Qualitative data were systematically gathered through structured reflective journals and analyzed using a rigorous 6-phase thematic analysis framework. RESULTS: Students reported high course satisfaction rates, ranging from 92.4% to 95.3%. Quantitative analysis revealed a notable divergence: there were significant improvements in peer-evaluated outcomes (P<.001) and self-assessed communication competence (P=.004), but there was more conservative, statistically nonsignificant growth in self-assessed scores for professional knowledge (P=.14) and empathy (P=.09). This discrepancy likely reflects adult learners' heightened awareness of professional complexity and self-reflective humility. Furthermore, the qualitative thematic analysis uncovered the following three narrative shifts: (1) the dismantling of generational stereotypes through authentic, face-to-face interaction with real older adults; (2) an empathic awakening regarding the often-invisible burden of family caregivers, catalyzed by the micro-movies; and (3) the successful translation of theoretical nonviolent communication concepts into real-time clinical problem-solving during board game role-plays. CONCLUSIONS: The youth-elder co-learning model shows promise as an innovative, experiential pedagogical approach. By bridging theoretical frameworks with authentic intergenerational contact, the intervention supported students in translating general empathic concepts into actionable communication competencies. However, given the exploratory nature of this study and the absence of a control group, the quantitative findings must be interpreted cautiously. Future research using randomized controlled trial designs across multiple institutions is warranted to establish definitive causal impacts.
Sensors (Basel, Switzerland)Orestis Maraziotis, Georgios Mantas, Jonathan Rodriguez, Felipe Gil-Castiñeira
Smart Hospitals integrated within 6G edge networks aim to enhance hospital connectivity and operational efficiency by enabling intelligent and personalized e-health services and applications while optimizing resource utilization and maintaining a high degree of autonomy. Nevertheless, the interconnectivity and 6G integration, which comprise core components of Smart Hospitals, are susceptible to a wide range of security threats, posing significant risks to the confidentiality, integrity, and availability of hospital data and operations. Given that security is a critical concern for Smart Hospitals, there is an urgent need to develop novel security mechanisms to safeguard these environments within 6G edge networks. In particular, this work highlights how defining 6G characteristics, such as Ultra-Reliable Low-Latency Communications, massive IoMT connectivity, distributed edge intelligence, and AI-native network operation, not only enable next-generation hospital services but also reshape the security and privacy threat landscape and the requirements of mitigation mechanisms. In this context, the first essential step is to comprehensively understand both existing and emerging threats targeting Smart Hospitals in the 6G edge network ecosystem. Therefore, this article provides a categorization of security and privacy attacks based on their primary targets. Moreover, it presents a survey of mitigation techniques derived from recent literature, specifically designed to counter threats facing Smart Hospitals in 6G edge networks. The intent is to establish a foundation that supports ongoing research towards the development of effective, 6G-aware security countermeasures capable of protecting Smart Hospitals under the stringent latency, scalability, and reliability requirements of future healthcare environments.
Global public healthG Nduku Wambua, Nondumiso Dlamini, Syethemba Nkosi, Thandeka Smith, Mpilonhle Nzuza, Janet Seeley, Alan Stein, Nothando Ngwenya
We examined how adolescents living with HIV in rural KwaZulu-Natal, South Africa, navigate privacy boundaries in disclosure-related issues. We conducted small group discussions with 31 adolescents (aged 16-19 years) recruited from three HIV clinics. Reflexive thematic data analysis was conducted through the lens of communication privacy management theory. Three major themes emerged: (1) ownership and control of private information, in which adolescents demonstrated varying levels of autonomy over their HIV status information, often developing strategies to manage medication discreetly; (2) managing disclosure and privacy boundaries, in which participants developed nuanced privacy rules influenced by stigma, context, and family dynamics; and (3) emotional and social support in disclosure management, highlighting the significant role of support systems in the disclosure process. Overall, participants actively managed privacy boundaries through careful information control, selective disclosure, and strategic coordination with family members and healthcare providers. Our findings show that adolescents in a rural setting actively manage privacy boundaries around their HIV status through well-developed information management strategies. There is a complex interplay between personal agency, family dynamics, and cultural context in shaping disclosure decisions. These insights can provide more effective support interventions for adolescents living with HIV in resource-limited settings.
Patient education and counselingMunita Kaur, Chin Hai Teo, Muhammad Alieff Isqandar Jefnee, Sharon Kaur, Mark Kiak Min Tan, Thangaraj Munusamy, Tan Fong Ang, Dharmendra Ganesan
OBJECTIVES: While innovations such as smartphones and dedicated applications enable patients to record their clinical consultations, concerns about legal implications and privacy continue to influence healthcare providers' willingness to adopt these practices. This systematic review examines healthcare providers' perspectives on the digital recording of clinical consultations, amid ongoing concerns about the legal, privacy, organisational, and workflow implications of such recordings. METHODS: We followed the PRISMA guidelines and included qualitative, quantitative, and mixed-methods studies. Eligible studies were identified through database searches (PubMed, EBSCO, Web of Science, Scopus), backwards reference mining, and expert consultations. Qualitative data were synthesised using the best-fit framework, and quantitative data were compiled and reported descriptively without meta-analysis due to study heterogeneity. RESULTS: Of 6633 records retrieved, 4307 were screened, and 22 studies met the inclusion criteria. The thematic synthesis revealed five key themes: (1) provider attitudes toward consultation recording, (2) impact on patient care, (3) workflow and resource concerns, (4) legal and policy considerations, and (5) implementation strategies. Acceptance levels for consultation recordings among providers ranged from 18.7% to 95.4% (n = 8). Higher acceptance was associated with confidence in the perceived benefits of recordings for communication and patient care, whereas legal, organisational, and workflow concerns often drove resistance. CONCLUSIONS: Healthcare providers are divided and hold mixed attitudes regarding the acceptance of consultation recordings. Acceptance appears to be influenced by contextual, professional, and organisational considerations, whereas scepticism is frequently associated with legal uncertainty and workflow concerns. Consideration of these factors is important when evaluating the integration of digital consultation recording into routine clinical practice. Further research is needed to explore provider perspectives in diverse healthcare settings. PRACTICE IMPLICATIONS: These findings may inform institutional policy development and guide organisational and policy efforts to integrate consultation recording into clinical practice, taking into account providers' concerns and organisational readiness.