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Purpose: Persistent microvascular obstruction (MVO) after successful percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) has been well‐described. MVO predicts lack of recovery of left ventricular function and increased mortality. Sonothrombolysis utilizing diagnostic ultrasound induced cavitation of commercially available microbubble contrast has been effective at reducing infarct size and improving left ventricular ejection fraction (LVEF) when performed both pre‐ and post‐PCI. However, the effectiveness of post‐PCI sonothrombolysis alone after successful PCI has not been demonstrated. Methods: A prospective randomized controlled trial was performed in 50 consecutive consenting patients with anterior STEMI who underwent a continuous microbubble infusion immediately following successful PCI. Intermittent high mechanical index (MI) impulses were applied only in the sonthrombolysis group. Delayed enhancement magnetic resonance imaging (MRI) was performed at 48 h and again at 6–8 weeks to assess for differences in infarct size, LVEF, and MVO. Results: There were no differences between groups in age, gender, and cardiovascular risk factors. Significant (> 2 segments) MVO following successful PCI was observed in 66% of patients. Although sonothrombolysis reduced the extent of MVO acutely, there were no differences in infarct size, LVEF, or extent of MVO by MRI at 48 h. Twenty‐eight patients returned for a follow up MRI at 6–8 weeks. LVEF improved only in the sonothrombolysis group (∆LVEF 7.81 ± 4.57% with sonothrombolysis vs. 1.77 ± 7.02% for low MI only, p =.011). Conclusion: Post‐PCI sonothrombolysis had minimal effect on reducing myocardial infarct size but improved left ventricular systolic function in patients with acute anterior wall STEMI. [ABSTRACT FROM AUTHOR]

To develop and validate the Insomnia in Response to Sports‐related Stress Test (IRSST) questionnaire, a new specific instrument with the goal of sensitively measuring vulnerability to sport‐specific stressful situations among elite athletes. Five hundred and thirty‐one competitive elite athletes (mean age = 17.6 ± 4.4 years) completed the Ford Insomnia Response to Stress Test (FIRST) questionnaire and the IRSST, a six‐item questionnaire developed to assess the level of sleep disturbance in response to the commonly experienced sport‐specific stressful situations. A development and validation process including substantive, structural, and external stages was used in the present study. One eigenvalue of the exploratory factor analyses was greater than 1.0 (i.e., 2.91, 48.52% of explained variance) whereas the scree test provided evidence for a one‐factor solution, with all the six items achieving a loading of 0.40 or higher on the factor. Cronbach alpha was 0.77 and provided evidence for the reliability of the IRSST score. The correlation between IRSST and FIRST scores was 0.47 (p < 0.001, moderate effect size). These results provide strong evidence for construct validity, indicating that the IRSST is a promising scale for assessing the likelihood of sleep disruption due to sports‐related stressful situations. The results of reliability and correlational analyses provided further evidence of the promising psychometric properties of the IRSST. We believe that the IRSST could provide to the sport and sleep science communities a sleep screening tool for use in this unique population. Highlights: The Insomnia in Response to Sports‐related Stress Test (IRSST) questionnaire is a promising new specific instrument for assessing the likelihood of sleep disruption due to sports‐related stressful situationsThe IRSST could provide to the sport and sleep science communities a sleep screening tool for use in the unique population of competitive elite athletesThe IRSST can be used to identify athletes with sleep difficulties related to sports‐specific stressful situations (e.g., training, competition, injury) [ABSTRACT FROM AUTHOR]

Objective: This novel study sought to understand lived experience and carer perspectives on the use of adaptive trials to evaluate interventions for eating disorders, in addition to understanding the factors and outcomes of most importance in eating disorder research and treatments from a lived experience perspective. Method: A total of 73 people with either lived or carer experience consented, 70 started the questionnaire, and 36 (51%) completed all questions. Participants were asked Likert scale and open‐ended questions to understand what factors and outcomes of eating disorder interventions were most important to them and understand their pre‐existing knowledge of clinical trials. Two videos were then used to explain randomized controlled trials (RCTs) and adaptive trials and participants were asked their opinions, including perceived benefits and concerns, of each trial type. Results: The thematic analysis found two key themes regarding factors important in eating disorder treatment: Person‐centred care and Evidence‐based and effective treatment; and two key themes regarding outcomes of treatment: Sustained, full recovery and The bigger picture. Both RCTs and adaptive trials were viewed favorably, however, there was a slight preference for adaptive trials. Key themes for both demonstrated perceived benefits and ethical, practical, and scientific considerations unique to each. Discussion: Findings demonstrate the support of adaptive trials in eating disorder interventions from people with lived experience and their carers. It is recommended that researchers consider the use of adaptive designs and the incorporation of lived experience perspectives when designing future intervention trials. Public Significance: This novel study found that the use of adaptive trials in eating disorder intervention research is supported by people with lived experience and carers. Furthermore, the factors and outcomes of most importance to participants in this study are comparable to those previously identified in the emerging literature. The use of adaptive designs and the incorporation of lived experience are recommended in further clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta- analysis was to test this hypothesis. Methods: A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta- analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only. Results: Meta- analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders. Conclusions: These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the effect of the therapeutic alliance on both change in social recovery outcomes and usage of a moderated online social therapy platform for first‐episode psychosis (FEP), Horyzons. Design: Secondary analysis of a single group pilot trial. Methods: Clients completed an alliance measure adapted for guided digital interventions at mid‐treatment. A series of multi‐level models evaluated change in outcomes by mid‐ and post‐treatment assessments (relative to baseline) as a function of the overall alliance. Quasi‐Poisson models evaluated the effect of the overall alliance on aggregated counts of platform usage. Exploratory analyses repeated these models in terms of the bond (human–human) or the task/goal (human–program) alliance. Results: Stronger overall alliance at mid‐treatment predicted lower loneliness at mid‐treatment and lower social anxiety at mid‐ and post‐treatment. It was also associated with higher completion of therapy activities and authoring of comments and reactions. A strong bond with an online therapist was associated with lower loneliness and higher perceived social support at mid‐treatment, lower social anxiety at post‐treatment as well as a higher number of reactions made on the social network. Stronger alliance with the platform's tasks and goals facilitated lower social anxiety at both follow‐up assessments and was further associated with higher completion of therapy activities and reactions in the social network. Conclusions: The alliance may impact aspects of social recovery and usage in digital interventions for FEP. Specific aspects of the alliance (human–human and human–program relationships) should be considered in future research. [ABSTRACT FROM AUTHOR]

Introduction: Repolarization dispersion in the right ventricular outflow tract (RVOT) contributes to the type‐1 electrocardiographic (ECG) phenotype of Brugada syndrome (BrS), while data on the significance and feasibility of mapping repolarization dispersion in BrS patients are scarce. Moreover, the role of endocardial repolarization dispersion in BrS is poorly investigated. We aimed to assess endocardial repolarization patterns through an automated calculation of activation recovery interval (ARI) estimated on unipolar electrograms (UEGs) in spontaneous type‐1 BrS patients and controls; we also investigated the relation between ARI and right ventricle activation time (RVAT), and T‐wave peak‐to‐end interval (Tpe) in BrS patients. Methods: Patients underwent endocardial high‐density electroanatomical mapping (HDEAM); BrS showing an overt type‐1 ECG were defined as OType1, while those without (latent type‐1 ECG and LType1) received ajmaline infusion. BrS patients only underwent programmed ventricular stimulation (PVS). Data were elaborated to obtain ARI corrected with the Bazett formula (ARIc), while RVAT was derived from activation maps. Results: 39 BrS subjects (24 OType1 and 15 LTtype1) and 4 controls were enrolled. OType1 and post‐ajmaline LType1 showed longer mean ARIc than controls (306 ± 27.3 ms and 333.3 ± 16.3 ms vs. 281.7 ± 10.3 ms, p = .05 and p < .001, respectively). Ajmaline induced a significant prolongation of ARIc compared to pre‐ajmaline LTtype1 (333.3 ± 16.3 vs. 303.4 ± 20.7 ms, p < .001) and OType1 (306 ± 27.3 ms, p < .001). In patients with type‐1 ECG (OTtype1 and post‐ajmaline LType1) ARIc correlated with RVAT (r = .34, p = .04) and Tpec (r = .60, p < .001), especially in OType1 subjects (r = .55, p = .008 and r = .65 p < .001, respectively). Conclusion: ARIc mapping demonstrates increased endocardial repolarization dispersion in RVOT in BrS. Endocardial ARIc positively correlates with RVAT and Tpec, especially in OType1. [ABSTRACT FROM AUTHOR]

Objective: Smartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment. While some data have begun to characterise app users in non‐controlled settings, there is limited information on use of apps in higher levels of care (e.g., partial hospitalisation or residential treatment programs) for EDs. Method: This study aimed to explore metrics of use while in treatment for a commonly used ED‐focused mobile app (Recovery Record) among individuals enroled in intensive outpatient, partial hospitalisation, residential, or inpatient treatments (N = 2042). Results: Results indicated that older individuals and participants with binge eating disorder demonstrated more frequent app engagement compared to younger participants and other ED diagnoses, respectively. Individuals entering at intensive outpatient and partial hospitalisation levels of care, as well as those with routine discharges engaged more frequently with RR compared to individuals entering in inpatient or residential treatment, and those with non‐routine discharges. Conclusions: Our data provide initial descriptions of how RR may be used within higher levels of care for adults with EDs. Further work is needed to establish the benefit of these apps in clinical settings for EDs over and above standard treatment, better characterise for whom these apps provide benefit, and identify how best to tailor the experience to promote engagement across the full spectrum of ED patients. Key points: We characterised naturalistic use of a mobile app in a sample of adults seeing treatment at higher levels of care.Older individuals and those with binge eating disorder (BED) demonstrated more app engagement.Those entering at more intensive levels of care and those discharged administratively had less app engagement. [ABSTRACT FROM AUTHOR]

Objective: A deficit in interoception ‐ the ability to perceive, interpret and integrate afferent signals about the physiological state of the body ‐ has been shown in Anorexia Nervosa (AN), and linked to altered hunger sensations, body dysmorphia, and abnormal emotional awareness. The present high‐density electroencephalography (hdEEG) study aims to assess cardiac interoception in AN and to investigate its neural correlates, using an objective neurophysiological measure. Method: Heartbeat‐evoked potentials (HEPs) were computed from 5 min of resting‐state EEG and electrocardiogram (ECG) data and compared between individuals with AN (N = 22) and healthy controls (HC) (N = 19) with waveform, topographic, and source imaging analyses. Results: Differences in the cortical representation of heartbeats were present between AN and HC at a time window of 332–348 ms after the ECG R‐peak. Source imaging analyses revealed a right‐sided hypoactivation in AN of brain regions linked to interoceptive processing, such as the anterior cingulate and orbitofrontal areas. Conclusions: To the best of our knowledge, this is the first study using hdEEG to localise the underlying sources of HEPs in AN. Results point to altered interoceptive processing during resting‐state in AN. As our participants had a short duration of illness, this might not be the consequence of prolonged starvation. Interventions targeted at interoception could provide an additional tool to facilitate recovery. Highlights: An interoceptive deficit might play a role in the pathogenesis and maintenance of Anorexia Nervosa (AN), but research on neural correlates is lacking.Individuals with AN show altered cortical representation of cardiac signals, as measured with Heartbeat‐evoked potentials (HEPs).Hypoactivation in a right‐sided interoceptive network underlies differences in cardiac signal processing observed at the scalp. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis C virus (HCV)/HIV co‐infection has been identified as a risk for impaired CD4+ T‐cell recovery, possibly mediated by HCV‐induced liver fibrosis and/or immune activation. As HCV direct‐acting antivirals (DAAs) may partially reverse liver fibrosis and immune activation, sustained HCV virological response (SVR) may lead to improved CD4 recovery. We explored the effect of HCV DAA‐induced SVR on CD4 recovery among patients living with both HCV and HIV, including those with poor CD4 recovery on antiretroviral therapy (immunological non‐responders [INRs]). Methods: Subjects aged ≥18 years living with both HIV and HCV who achieved SVR with DAA were included. Pre‐DAA CD4 counts were included only after sustained HIV viral suppression and HIV viral suppression was maintained for the duration of the study. Segmented regression of interrupted time series analysis was used to evaluate changes in median CD4 count in the pre‐DAA period (−36 months) versus the post‐DAA period (+36 months). Results: In total, 156 patients were included. In the full cohort, median CD4 counts increased by 15% (p = 0.002) in the 6‐month period following DAA initiation, whereafter CD4 counts decreased by 2.7% per 6‐month period (p = 0.004). Among the 13 INRs, there was no immediate effect on median CD4 in the first 6 months after DAA initiation, whereafter there was a sustained CD4 increase (4.1% per 6‐month time interval [p = 0.02]). In total, 54% of INRs recorded a post‐DAA CD4 count of >350 cells/mm3. Conclusions: Successful DAA therapy induced a modest immediate CD4 immunological reconstitution among this cohort of patients living with both HIV and HCV, although this effect waned with time. By contrast, among INRs, achieving HCV SVR led to slower but sustained CD4 count recovery. [ABSTRACT FROM AUTHOR]

Purpose: Delayed structural and functional recovery after a 20 km graded running race was analyzed with respect to the sex effect. Method s : Thirteen female and 14 male recreational runners completed the race and three test sessions: one before (PRE) and two after, once on Day 1 or 2 (D1‐2) and then on Day 3 or 4 (D3‐4). Muscle damage was assessed indirectly using ultrasonography to quantify changes in cross‐sectional area (CSA) of 10 lower‐limb muscles. Delayed onset of muscle soreness (DOMS) was assessed for three muscle groups. Functional recovery was quantified by kinetic analysis of a squat jump (SJ) and a drop jump (DJ) test performed on a sledge ergometer. Linear mixed models were used to assess control group reproducibility and recovery patterns according to sex. Results: Regardless of sex, DOMS peaked at D1‐2 for all muscle groups and resolved at D3‐4. CSA was increased in each muscle group until D3‐4, especially in the semimembranosus muscle. A specific increase was found in the short head of the biceps femoris in women. Regardless of sex, SJ and DJ performances declined up to D3‐4. Depending on the muscle, positive and/or negative correlations were found between structural and functional changes. Some of these were sex‐specific. Conclusion: Structural and functional recovery was incomplete in both sexes up to D3‐4, although DOMS had disappeared. More emphasis should be placed on hamstring muscle recovery. Highlighting the intermuscular compensations that can occur during multi‐joint testing tasks, the structural‐functional relationships were either positive or negative, muscle‐ and sex‐dependent. [ABSTRACT FROM AUTHOR]

Background: Poor sleep quality is associated with multiple factors in cardiac surgery patients. Aim: To examine the trajectory of sleep quality and its associated factors over 3 months in Taiwanese patients undergoing cardiac surgery. Study Design: A longitudinal study. This study enrolled 95 patients undergoing cardiac surgery in northern Taiwan. Sleep quality was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale before surgery, at discharge, and at 1 month and 3 months postsurgery. Results: The majority of participants reported poor sleep quality before cardiac surgery (76.8%) and at discharge (81.6%), and they showed significant improvements in sleep quality at 1 month (B = −0.93, p =.023) and 3 months postsurgery (B = −1.50, p <.001). Significant daytime sleepiness was reported by 25.3% of patients before cardiac surgery, and this proportion significantly decreased at 3 months postsurgery (B = −2.59, p <.001). The significant predictors of sleep quality in cardiac surgery patients were symptom distress, sleep medications, occupation, left ventricular ejection fraction, ACE‐I drugs and potassium ions, which explained 53.7% of the total variance in sleep quality. Having a nap habit was an independent predictor of daytime sleepiness in cardiac surgery patients, which could explain 3.7% of the total variation. Conclusion: Poor sleep quality was common in patients undergoing cardiac surgery and was associated with multiple factors, including symptom distress, cardiac function, medications, and psychosocial and environmental factors. Relevance to Clinical Practice: Poor sleep quality was observed in cardiac surgical patients before surgery and at discharge postsurgery. Patient education on symptom management, medication adherence and sleep hygiene are suggested to improve sleep quality in patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Context: Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice‐related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. Objective and Population Studied: Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. Methods: A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. Results: Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. Conclusions: Our findings highlight important gaps in the collaborative practices surrounding the management of mental health‐related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. Patients of Public Contribution: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population. [ABSTRACT FROM AUTHOR]

Background: Following stroke, a sense of well‐being is critical for quality of life. However, people living with stroke, and health professionals, suggest that well‐being is not sufficiently addressed within stroke services, contributing to persistent unmet needs. Knowing that systems and structures shape clinical practice, this study sought to understand how health professionals address well‐being, and to examine how the practice context influences care practice. Methods: Underpinned by Interpretive Description methodology, we interviewed 28 health professionals across multiple disciplines working in stroke services (acute and rehabilitation) throughout New Zealand. Data were analysed using applied tension analysis. Results: Health professionals are managing multiple lines of work in stroke care: biomedical work of investigation, intervention and prevention; clinical work of assessment, monitoring and treatment; and moving people through service. While participants reported working to support well‐being, this could be deprioritised amidst the time‐oriented pressures of the other lines of work that were privileged within services, rendering it unsupported and invisible. Conclusion: Stroke care is shaped by biomedical and organisational imperatives that privilege physical recovery and patient throughput. Health professionals are not provided with the knowledge, skills, time or culture of care that enable them to privilege well‐being within their work. This has implications for the well‐being of people with stroke, and the well‐being of health professionals. In making these discourses and culture visible, and tracing how these impact on clinical practice, we hope to provide insight into why well‐being work remains other to the 'core' work of stroke, and what needs to be considered if stroke services are to better support people's well‐being. Patient or Public Contributions: People with stroke, family members and people who provide support to people with stroke, and health professionals set priorities for this research. They advised on study conduct and have provided feedback on wider findings from the research. [ABSTRACT FROM AUTHOR]

Background: This paper aims to explore the impact of recovery education on recovery knowledge, attitudes and the quality of life of students undertaking recovery education, contributing to the evidence base in relation to the impact of recovery education. It also explores the experiences of all stakeholders involved in the co‐facilitation, delivery and participation in recovery education. Setting and Participants: This study evaluates the experiences of stakeholders involved in the co‐facilitation, delivery and participation in recovery education across four recovery colleges in Ireland. Participants included students undertaking recovery education, peer educators, education facilitators, recovery college coordinators and practitioner/service providers. Discussion: Findings from the quantitative survey when compared with extant literature suggest that students had a good understanding of recovery education. The social aspect of empowerment for growth and wellbeing was identified through themes relating to co‐production and facilitating student learning. Support for equitable access to recovery education, including co‐production for both the public and staff, was identified as a challenge for the future. Conclusion: The findings from both the qualitative and quantitative components of the study show the positive impact of recovery education on stakeholders while acknowledging the need for ongoing support for people working in recovery education and the development of services. In particular, there was a high level of recovery knowledge found in students undertaking recovery education. Patient or Public Contribution: This study utilised a co‐created study design. From inception a steering group comprising stakeholders (peer educators, recovery education facilitators including past recovery college students and nonpeer staff involved in the co‐production of recovery education) directed the conduct of the evaluation. This steering group participated in an iterative process of information sharing, suggestions for evaluation process and language. [ABSTRACT FROM AUTHOR]

Background: Atrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long‐term recurrence are lacking. Methods: Patients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis. Results: In a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2–47.5 (p =.03)); greater serum potassium levels (OR 2.3; CI 95% 1.28–4.0 (p <.01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13–4.4 (p =.02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02–40.3 (p <.01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8–15.1 (p <.01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19–1.5 (p =.23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow‐up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm. Conclusions: Recovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow‐up warrants a close follow‐up or PPM implantation at index admission. [ABSTRACT FROM AUTHOR]

Background: Most people with alcohol use disorder (AUD) do not use treatment services, yet the majority ultimately resolve their AUD. As the phenomenon of untreated recovery remains poorly understood, we investigated the strategies used for recovery without treatment. Methods: We conducted semi-structured interviews with 65 adults (27 women, 37 White) with resolved AUD and no history of using specialty services (e.g., inpatient or outpatient rehabilitation, medication-assisted treatment). Using both inductive and deductive coding, we identified and elaborated themes and meanings. We verified our findings through nine member-check sessions with interviewers and interview participants. Results: Majorities of interview participants met criteria for severe lifetime AUD (84.6%), were in long-term recovery (>5 years; 81.5%), and indicated abstinence was their recovery goal (56.9%). Close to half (41.5%) had attended mutual-help groups (e.g., Alcoholics Anonymous). We identified five active strategies (Changing Contexts, Social Connections. Activities, Substitution, and Other Strategies) and four additional factors (Mutual-help Groups, Self-Reliance, Spirituality, and Aging/Maturing) that contributed to their recovery. Most participants employed multiple strategies and were intentional in adopting the ones that best suited them. By far, the two most common strategies were Changing Contexts (reported by 69.2% of participants) whereby people reduced their alcohol exposure by modifying social networks or physical settings and relying on Social Connections (reported by 67.7%), especially connections to people with similar lived experiences and struggles. Notably, Social Connections and Mutual-Help groups were the themes most often discussed jointly. Among other contributing factors mentioned, Spirituality appeared to play an important, but not universal, role as it was invoked by approximately half (49.2%) of participants. Conclusions: Our study confirms that recovery without specialty treatment is possible, and that multiple strategies and contributing factors help to achieve it. These findings may inform novel interventions to support recovery among people unwilling or unable to obtain treatment for AUD. [ABSTRACT FROM AUTHOR]

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post‐injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self‐efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self‐efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status. [ABSTRACT FROM AUTHOR]

Purpose: In Football, the high‐intensity running bouts during matches are considered decisive. Interestingly, recent studies showed that peak fat oxidation rates (PFO) are higher in football players than other athletes. This study aimed to investigate whether PFO increases following a pre‐season. Secondarily, and due to COVID‐19, we investigated whether PFO is related to the physical performance in a subgroup of semi‐professional male football players. Methods: Before and after 8 weeks of pre‐season training, 42 sub‐elite male football players (18 semi‐professionals and 24 non‐professionals) had a dual‐energy x‐ray absorptiometry scan and performed a graded exercise test on a treadmill for the determination of PFO, the exercise intensity eliciting PFO (Fatmax) and peak oxygen uptake (V̇O2peak). Additionally, the semi‐professional players performed a Yo‐Yo Intermittent Recovery Test level 2 (YYIR2) before and after pre‐season training to determine football‐specific running performance. Results: PFO increased by 11 ± 10% (mean ± 95% CI), p = 0.031, and V̇O2peak increased by 5 ± 1%, p < 0.001, whereas Fatmax was unchanged (+12 ± 9%, p = 0.057), following pre‐season training. PFO increments were not associated with increments in V̇O2peak (Pearson's r2 = 0.00, p = 0.948) or fat‐free mass (FFM) (r2 = 0.00, p = 0.969). Concomitantly, YYIR2 performance increased in the semi‐professional players by 39 ± 17%, p < 0.001, which was associated with changes in V̇O2peak (r2 = 0.35, p = 0.034) but not PFO (r2 = 0.13, p = 0.244). Conclusions: PFO, V̇O2peak, and FFM increased following pre‐season training in sub‐elite football players. However, in a subgroup of semi‐professional players, increments in PFO were not associated with improvements in YYIR2 performance nor with increments in V̇O2peak and FFM. [ABSTRACT FROM AUTHOR]

Anterior Cruciate Ligament (ACL) injuries are serious and potentially career‐ending. Reconstruction surgery and extended rehabilitation typically follow, but some athletes never attain the same level of sport performance. The psychosocial experiences of athletes who sustain ACL injuries and their cognitive appraisal, emotional and behavioral responses to the injury, and reconstruction require further attention during the different recovery phases. The aim is to explore these psychosocial experiences, social support needs and sources thereof of competitive athletes who sustained unilateral ACL ruptures and underwent reconstruction surgery. Semi‐structured interviews with six competitive rugby players (M age: 22.3 ± 2.92 years), elicited information at seven time‐points. We analyzed the qualitative information through thematic analysis. Five common themes emerged: (1) cognitive appraisal, (2) emotional responses (negative and positive affective responses), (3) behavioral responses, (4) social support needs and sources thereof, and (5) adversity‐induced identity expansion (athletic and person‐centered identities). In‐vivo quotes gave a rich description of the athletes' experiences throughout the "long, long journey" to return‐to‐sport. These findings may sensitize and assist sports healthcare professionals, coaches, teammates, family, and friends to explore various psychosocial experiences throughout the injury and recovery period. Phase‐appropriate psychosocial support or referral to sport psychology services is recommended to enhance the recovery process, improve long‐term physical and mental health, and subsequent performance. [ABSTRACT FROM AUTHOR]

Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as "ontological insecurity of inattentiveness". This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. Method: A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider‐based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open‐ended questions. Results: Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral‐level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN. Discussion: Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM‐5‐TR criteria in real‐world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence‐based treatment guidelines for TW and/or other relevant recovery metrics are needed. Public Significance: The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice. [ABSTRACT FROM AUTHOR]

Background: Return to school supports are recommended to facilitate adolescents' re‐entry to school following a concussion. However, little is known as to what school stakeholders prefer for a return‐to‐school process. This study sought to describe the preferences of high school students, parents, and educators for a Return‐to‐School Framework for adolescents following a concussion. Methods: We conducted qualitative semi‐structured, 1‐on‐1 or group interviews with high school students (n = 6), parents (n = 5), and educators (n = 15) from Calgary, Canada. Interviews aimed to describe participants' preferences for a Return‐to‐School Framework for students following a concussion. Interviews were analyzed using conventional content analysis. Results: We organized the data into 4 main themes: (1) purpose of the Return‐to‐School Framework; (2) format and operation of the Return‐to‐School Framework; (3) communication about a student's concussion; and (4) necessity of concussion education for students and educators. Implications for School Health Policy, Practice, and Equity: A Return‐to‐School Framework following concussion should be developed in consultation with families, educators, and students and supports should be tailored to each student. Conclusions: Participants preferred a standardized and consistent Return‐to‐School Framework including ongoing communication between stakeholders as well as feasible and individualized school supports. [ABSTRACT FROM AUTHOR]

The main objective of this project was to compare in the field conditions two strategies of re‐nutrition of children with moderate acute malnutrition (MAM) aged from 6 to 24 months, targeting the microbiota in comparison with a standard regimen. A three‐arm, open‐label, pragmatic randomised trial was conducted in four countries (Niger, CAR, Senegal and Madagascar). Children received for 12 weeks either fortified blended flour (FBF control) = arm 1, or FBF + azithromycin (oral suspension of 20 mg/kg/day daily given with a syringe) for the first 3 days at inclusion = arm 2 or mix FBF with inulin/fructo‐oligosaccharides (6 g/day if age ≥12 months and 4 g if age <12 months) = arm 3. For each arm, children aged from 6 to 11 months received 100 g x 2 per day of flours and those aged from 12 to 24 months received 100 g × 3 per day of FBF. The primary endpoint was nutritional recovery, defined by reaching a weight‐for‐height z‐score (WHZ) ≥ −1.5 within 12 weeks. Overall, 881 children were randomised (297, 290 and 294 in arm 1, arm 2 and arm 3, respectively). Three hundred and forty‐four children were males (39%) and median/mean age were 14.6/14.4 months (SD = 4.9, IQR = 10.5–18.4). At inclusion, the three arms were comparable for all criteria, but differences were observed between countries. Overall, 44% (390/881) of the children recovered at week 12 from MAM, with no significant difference between the three arms (41.4%, 45.5% and 45.9%, in arm 1, arm 2 and arm 3, respectively, p = 0.47). This study did not support the true advantages of adding a prebiotic or antibiotic to flour. When using a threshold of WHZ ≥ −2 as an exploratory endpoint, significant differences were observed between the three arms, with higher success rates in arms with antibiotics or prebiotics compared to the control arm (66.9%, 66.0% and 55.2%, respectively, p = 0.005). Key messages: Re‐nutrition of children with MAM is still a concern as the duration of recovery is always long and recurrences are frequent.Literature suggests that prebiotics and antibiotics show potentially useful properties to speed this process of recovery.However, in this open‐label study, prebiotics and antibiotics did not lead to advantages on the recovery rates defined by reaching the WHZ (−1.5) cut‐off. [ABSTRACT FROM AUTHOR]

Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non‐response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72–0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39–0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27–0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24–59 months) had a shorter mean LOS than younger children (6–23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols. Key messages: There are few differences in recovery outcomes for wasting treatment by age and sex.Though differences are small, mean daily weight gain (g/kg/day) appears to be significantly lower in boys than girls. Likewise, though differences are small, younger children (6–23 months) often have a significantly longer mean length of stay compared with older children (24–59 months).The strength of our evidence does not indicate the need to change current inclusion criteria for wasting treatment programmes on the basis of age and sex but does suggest the need for further research to understand the effects of different confounders on treatment outcomes. [ABSTRACT FROM AUTHOR]

Integrating the dualistic model of passion in the recovery literature, the present study investigates how playing video games after work hours can facilitate recovery from work stress. We predicted that passion for gaming would relate to gaming more hours in the evening. Next, we hypothesized that playing video games in the evening would relate to (a) feeling recovered the next morning through psychological detachment and (b) feeling vigorous the next morning through mastery experiences while gaming. We further hypothesized that harmonious passion would strengthen, and obsessive passion would weaken the links between gaming hours and (a) psychological detachment and (b) mastery. In total, 65 employees filled in short questionnaires in the mornings and evenings of at least five workdays (total n = 502). Results of multilevel hierarchical regression analyses supported the proposed mediation model, indicating that playing video games indeed helps replenish energy resources during leisure time. Findings additionally showed that gaming also predicted feeling recovered in the morning through mastery experiences. Players with a harmonious passion may benefit more from playing video games; harmonious (but not obsessive) passion strengthened the relationship between gaming and mastery experiences. [ABSTRACT FROM AUTHOR]

Customer mistreatment as a common workplace stressor in the service industry has detrimental effects on service employees. Drawing on cognitive theories of rumination, the current study examined the effect of daily customer mistreatment experience on employee recovery outcomes (sleep quality and next‐morning vigor) through affective rumination. Further, we investigated the moderating role of trait mindfulness on the relationship between customer mistreatment and employee affective rumination. With 390 matched time‐lagged daily observations collected from 107 fulltime in‐patient nurses across five working days, our multilevel analyses revealed that daily customer mistreatment experience at work was negatively related to employee sleep quality on the same night and vigor in the next morning via affective rumination and that employee's affective rumination at the end of work and sleep quality at night sequentially mediated the relationship between daily experience of customer mistreatment and morning vigor. Besides, trait mindfulness buffered the relationship between daily customer mistreatment and affective rumination. These findings shed light on the understanding of the mechanisms between customer mistreatment and employee recovery states and potentially malleable individual characteristics that might mitigate the negative effects of customer mistreatment. [ABSTRACT FROM AUTHOR]

Background: Treatment of anorexia nervosa (AN) sometimes requires hospitalisation, which is often lengthy, with little ability to predict individual trajectory. Depicting specific profiles of treatment response and their clinical predictors could be beneficial to tailor inpatient management. The aim of this research was to identify clusters of weight recovery during inpatient treatment, and their clinical predictors. Methods: A sample of 181 inpatients who completed a treatment programme for AN was included in a retrospective study. A latent class mixed model approach was used to identify distinct weight‐gain trajectories. Clinical variables were introduced in a multinomial logistic regression model as predictors of the different classes. Results: A four‐class quadratic model was retained, able to correctly classify 63.7% of the cohort. It encompassed a late‐rising, flattening, moderate trajectory of body mass index (BMI) increase (class 1), a late‐rising, steady, high trajectory (class 2), an early‐rising, flattening, high trajectory (class 3) and an early‐rising, steady, high trajectory (class 4). Significant predictors of belonging to a class were baseline BMI (all classes), illness duration (class 2), and benzodiazepine prescription (class 3). Conclusion: Predicting different kinetics of weight recovery based on routinely collected clinical indicators could improve clinician awareness and patient engagement by enabling shared expectations of treatment response. Highlights: Treatment of anorexia nervosa lacks tailored strategies to optimise individual patients' management.Latent class mixed model approach is a promising strategy to analyse treatment response as a dynamic entity.Baseline body mass index, duration of illness and benzodiazepine prescription are significant indicators of distinct weight recovery profiles. [ABSTRACT FROM AUTHOR]

Objective: Although inpatient treatment is highly effective for patients with bulimia nervosa (BN), some patients show a resurgence of symptoms and relapse after discharge. Therefore, the aim of this study is to evaluate the efficacy of a guided smartphone‐based aftercare intervention following inpatient treatment to support recovery. Method: 172 female patients with BN (DSM‐5: 307.51) will be randomized to receive a 16‐week smartphone‐based aftercare intervention (German version of 'Recovery Record') with therapist feedback as an add‐on element to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline (discharge, T0), during the intervention (after 4 weeks, T1), post‐intervention (after 16 weeks, T2) and at 6‐month follow‐up (T3). Primary outcome will be remission at T2. Moderator and mediator analyses will investigate for whom the aftercare intervention suits best and how it works. Conclusions: This is the first randomized controlled trial to examine a guided smartphone‐based aftercare intervention following inpatient treatment of patients with BN. We expect that this innovative aftercare intervention is highly accepted by the patients and that it has the potential to support recovery after inpatient treatment and thereby could contribute to improving aftercare for patients with BN. Highlights: There are several studies reporting relapse rates for patients with bulimia nervosa (BN) after having received remission or abstinence at the end of treatment.This is the first randomized controlled trial (RCT) to investigate the effects of a guided smartphone‐based aftercare following inpatient treatment of patients with BN.If this innovative aftercare intervention is accepted by the patients and supports recovery after inpatient treatment for patients with BN, it could contribute to improving aftercare for patients with BN. [ABSTRACT FROM AUTHOR]

Objective: There is increasing interest around the relationship between clinically defined recovery from Anorexia nervosa (AN), based on a reduction of symptoms and weight normalisation, and personal models of recovery which emphasise factors such as personal growth. The purpose of this mixed methods study was to evaluate the hypothesis that these two approaches are complimentary, with reduced symptoms associated with higher achievement in personal domains. Methods: Eighty‐one adults who self‐defined as fully or partially recovered from AN were recruited into an online study and completed self‐report measures of clinical and personal recovery. Participants were also asked questions about their views on the clinical criteria, and this data was analysed using thematic analysis. Results: People who were clinically defined as fully recovered scored significantly higher on measures of personal recovery compared to those defined as not recovered, and there were strong positive associations between lower behavioural and cognitive symptoms, and personal recovery. There was a weaker relationship between personal recovery measures and BMI. Qualitative data indicated that most participants felt that the clinical criteria were not a sufficient definition of recovery. Conclusions: Implications for the usage of clinical criteria for recovery from AN in research trials and clinical practice are discussed. Highlights: This paper found that fewer self‐reported eating disorder (ED) thoughts and behaviours were associated with higher ratings of personal recovery in people who self‐defined as in recovery from Anorexia nervosa (AN).There was a poorer relationship between personal recovery and BMI.Whilst 64.86% of people who self‐defined as fully recovered met clinical criteria for full recovery, survey data found that most participants felt that the clinical criteria did not reflect their personal experience of recovery. [ABSTRACT FROM AUTHOR]

Background: The enhanced recovery after surgery (ERAS) method is designed for the patient to recover quickly, have less pain and have a more comfortable period after the surgery; that includes preoperative, intra and postoperative processes. ERAS has been started to be applied in cesarean section surgeries as the patients need to recover quickly. In the literature, there is no study about the results of ERAS in cesarean section about pain scores and complications. Objectives: It is aimed to compare the results of cesarean section patients using the ERAS method completely in patients who have had cesarean section without meeting some of the postoperative conditions of the ERAS criteria. Study Design: It is a prospective study designed as postoperative metoclopramide, enema and routine opioids in group 1, enema and metoclopramide in group 2, metoclopramide only in group 3 and nothing in group 4. Postoperative pain scoring was done by using visual analog scale (VAS). Analysis of variance tests and t tests were used for results. Results: There was no difference between groups according to age, parity, and birth weight. As a result, although there was no difference between the groups in terms of discharge time and complications, the VAS score used in pain scoring was found to be significantly lower in group 3 compared to the other groups (p: 0.000). Only metoclopramide group (group 3) had lowest VAS score. Conclusion: It has been revealed that the ERAS procedure does not need to be so detailed in the postoperative period, and the addition of metoclopramide may be sufficient. Since pain can be a subjective factor, other randomized studies are needed in terms of other criteria. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Myalgic encephalomyelitis (ME), also called chronic fatigue syndrome (CFS), is characterised by persistent fatigue, postexertional malaise, and cognitive dysfunction. It is a complex, long‐term, and debilitating illness without widely effective treatments. This study describes the treatment choices and experiences of ME/CFS patients who have experienced variable levels of recovery. Method: Interpretive description study consisting of semi‐structured qualitative interviews with 33 people who met the US Centers for Disease Control (2015) diagnostic criteria for ME/CFS and report recovery or symptom improvement. Results: Twenty‐six participants endorsed partial recovery, and seven reported full recovery from ME/CFS. Participants reported expending significant time and energy to identify, implement, and adapt therapeutic interventions, often without the guidance of a medical practitioner. They formulated individualised treatment plans reflecting their understanding of their illness and personal resources. Most fully recovered participants attributed their success to mind‐body approaches. Conclusion: Patients with ME/CFS describe independently constructing and managing treatment plans, due to a lack of health system support. Stigmatised and dismissive responses from clinicians precipitated disengagement from the medical system and prompted use of other forms of treatment. [ABSTRACT FROM AUTHOR]

Objective: The number of patients with heart failure (HF) and corresponding burden of the healthcare system will increase significantly. The Dutch integrated model, 'Transmural care of HF Patients' was based on the European Society of Cardiology (ESC) guidelines and initiated to manage the increasing prevalence of HF patients in primary and secondary care and stimulate integrated care. It is unknown how many HF patients are eligible for back‐referral to general practitioners (GPs), which is important information for the management of chronic HF care. This study aims to evaluate clinical practice of patients for whom chronic HF care can be referred from the cardiologist to the GP based on the aforementioned chronic HF care model. Design and Methods: A retrospective case record‐based study was conducted, which included all chronic HF patients registered in the cardiology information systems of two different hospitals. Subsequently, 200 patients were randomly selected for evaluation. The following patients were considered eligible for referral to the GP: 1/Stable HF patients with reduced left ventricular ejection fraction (LVEF), 2/Stable HF patients with a recovered LVEF and 3/Stable HF patients with a preserved LVEF, 4/HF, palliative setting. Results: Of the 200 patients, 17% was considered eligible for referral to the GP. This group consisted of 5% patients with a reduced LVEF, 10.5% patients with recovered LVEF and 1.5% patients with a preserved LVEF. Main indicators for HF care by cardiologists were active cardiac disease other than HF (39.5%), recent admission for HF (29.5%) or a recent adjustment in HF medication (7.5%). Conclusion: Applying the chronic HF care model of the 'Transmural care of HF patients' and the ESC‐guidelines, results in an important opportunity to further optimise HF integrated care and to deal with the increasing number of HF patients referred to the hospital. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exploring the perceptions of individuals with traumatic brain injury (TBI) towards their brain injury recovery across the continuum of care may offer insights to support engagement with rehabilitation services. Illness narratives are a potentially valuable avenue for examining perceptions of recovery that may influence engagement. AIMS: The aim of this study is to explore the perspective of individuals with severe TBI towards their communication, brain injury and recovery experiences at 6 months, 1 year and 2 years post‐injury. METHODS & PROCEDURES: Discourse samples were obtained from 12 participants with severe TBI at 6 months, 1 year and 2 years following injury. A standardised protocol was used to elicit responses relating to perceptions of communication, the brain injury narrative, and perceptions of recovery facilitators. A thematic analysis of the discourse samples was completed. OUTCOMES & RESULTS: Three overarching themes were identified: experiences of communication recovery are diverse (Theme 1), varied experiences of recovery and rehabilitation (Theme 2), and continuous and lifelong journey of recovery (Theme 3). Primary communication concerns included presence of anomia, dysarthria, conversational topic difficulties, impacts of fatigue and memory difficulties. Illness narratives revealed the importance of re‐establishing a sense of self and the perceived importance of a strong social network post‐injury. CONCLUSIONS & IMPLICATIONS: The varied nature of communication challenges and recovery after TBI highlights the need for holistic, multidisciplinary support as well as inclusion of family and friends in the recovery process. Social communication intervention is a perceived priority area for individuals with TBI. Illness narratives may also play a valuable role in therapy and help to shape post‐injury identity. Managing the impacts of fatigue on communication and encouraging individuals to take ownership over their recovery and treatment may also help to improve patient outcomes. Supporting individuals to construct positive brain injury narratives that reaffirm a sense of self and include perspectives of family and friends may offer a potential future avenue for rehabilitation. Tailored but flexible, team‐based service delivery models for individuals with TBI that span from acute to long‐term care are warranted. What this study adds?: What is already known on this subject: Communication recovery from traumatic brain injury (TBI) is complex and multifaceted. The perceptions of individuals with TBI toward their communication recovery is largely unknown. To establish rehabilitation services that meet the needs of these individuals, we need to understand how they experience communication recovery. What this paper adds to existing knowledge: Social communication interventions were perceived as a priority for intervention by individuals with TBI. Fatigue was identified as perceived barrier to communication recovery. Taking ownership over one's recovery process was revealed as a facilitator of recovery. Illness narratives were found to strengthen post‐injury identity over time. What are the potential or actual clinical implications of this work?: Speech pathologists should prioritise social communication interventions and fatigue management for communication. Facilitating ownership of the recovery process and offering long‐term supports are key aspects of treatment. Supporting positive illness narratives as part of treatment may facilitate post‐injury identity construction. [ABSTRACT FROM AUTHOR]

Purpose: Acceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well‐being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively. Methods: We present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness‐informed interventions for psychosis. Results: Acceptance and commitment therapy for psychosis is promising as a pragmatic, process‐driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology‐assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact. Conclusions: Over the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence‐based interventions for psychosis. [ABSTRACT FROM AUTHOR]

Background: Mutual‐help organizations (MHOs) are effective community‐based, recovery support options for individuals with alcohol and other drug use disorders (i.e., substance use disorder; SUD). Greater understanding of second‐wave MHOs, such as SMART Recovery, can help build on existing research that has focused primarily on 12‐step MHOs, such as Alcoholics Anonymous, to inform scientific, practice, and policy recommendations. Methods: We conducted a secondary analysis of the National Recovery Study, a representative sample of US adults who resolved a substance use problem (N = 1984). Using survey‐weighted estimates, we examined descriptive statistics for any lifetime, weekly lifetime, and past 90‐day MHO attendance; we compared rates of 12‐step and second‐wave MHO attendance over time by descriptively examining distributions for calendar year of the first meeting attended. We also used two logistic regression models to examine demographic, substance use, clinical, and recovery‐related correlates of weekly lifetime attendance separately for 12‐step (n = 692) and second‐wave MHOs (n = 32). Results: For any attendance, 41.4% attended a 12‐step MHO and 2.9% a second‐wave MHO; for weekly attendance, 31.9% attended a 12‐step MHO, and 1.7% a second‐wave MHO. Two‐thirds (64%) of initial second‐wave attendance occurred between 2006 and 2017 compared to 22% of initial 12‐step attendance during this time frame. Significant correlates of weekly 12‐step MHO attendance included histories of SUD treatment and arrest. Significant correlates of weekly second‐wave MHO attendance included Black identity (vs. White) and history of SUD medication. Conclusions: Attendance at second‐wave MHOs is far less common than 12‐step MHOs, but appears to be on the rise. Observed correlates of second‐wave MHO attendance should be replicated in larger second‐wave MHO samples before integrating these findings into best practices. Enhanced linkages from clinical and criminal justice settings to both second‐wave and 12‐step groups may help to "broaden the base" of MHOs. [ABSTRACT FROM AUTHOR]

Aim: To analyse the ethical pathway as perceived by individuals with stroke (IwS) in the first three post‐stroke months. In the novel concept of ethical pathway, dignity, privacy, and autonomy are considered as dimensions of the ethical pathway while the pathway illustrates their potential change in the post‐stroke time. Furthermore, the focus of interest was on whether the perceived realisation of values is associated with the life situational factors of symptoms diminishing functioning, social environment, and self‐empowerment. Methodological Design and Justification: A follow‐up study with a descriptive correlational design was used to capture the changes in the perceived realisation of values. Ethical Issues and Approval: The study followed the ethical principles of research involving human participants. The study was approved by the ethics committee of the university and one of the university hospitals following national standards. Permission to conduct the study was obtained from the university hospitals. Research Methods and Instrument: Data were collected from IwS after the onset of stroke and 3 months post‐stroke with the Ethical Pathway of Individuals with Stroke instrument and background questions and were analysed statistically. Results: Thirty‐six participants completed the questionnaire at both measurement points. Wide variety in the ethical pathway was detected. IwS' perceived dignity decreased and autonomy increased. Privacy did not change significantly. Of the life situational factors, IwS perceived less symptoms diminishing functioning and stronger self‐empowerment while social environment was perceived as rather stable. Only one association was detected between the dimensions of the ethical pathway and life situational factors: autonomy had a low negative correlation with social environment of health care professionals. Conclusions and Study Limitations: The results provide preliminary evidence of the dynamic nature of the ethical pathway. The ethical pathway was incompletely realised for most participants and requires special attention and improvement in health care. The sample size is small and the results are therefore not generalisable. [ABSTRACT FROM AUTHOR]

Background: Research in Denmark indicates that approximately 30% of people with confirmed COVID‐19 infection experience at least one physical symptom 6–12 months after the acute infection. The lived experiences of undergoing prolonged recovery processes and how these processes unfold need further attention. Aim: To contribute in‐depth knowledge about recovery, as experienced over time by people living with the post COVID‐19 condition. Methods: Within a qualitative research design, nine women and six men were interviewed. Ten of them gave a follow‐up interview. Prompt cards and participant‐generated photographs were included. A phenomenological‐hermeneutic approach inspired by Ricoeur's theory of interpretation guided the data analysis. Findings: Living with long‐term health problems associated with the post COVID‐19 condition involved recovery processes where participants struggled with reduced capacity, new unpredictability and uncertainty in everyday life. Participants continuously searched for improvement and aimed for regaining former health and well‐being. Lack of knowledge, acknowledgement and support made it difficult to find clear directions for improvement. Participants created a protective shield and struggled, often jointly with family and friends, to cope with bodily, cognitive, emotional, existential and social challenges. Over time, some participants realised that they might not be able to fully return to their earlier habitus. However, some of them gained a new foothold and sense of hope for the future. Conclusion: This study provides in‐depth insight into the experience of changing and open‐ended recovery processes while living with the post COVID‐19 condition. Over time, some participants learned to rebuild their lives, adapting to their reduced capacities. Future care and rehabilitation models for these patients must address the complex and challenging nature of recovery processes associated with living with post‐COVID‐19 condition. [ABSTRACT FROM AUTHOR]

Narcotics Anonymous has flourished globally across 143 countries as a key community response to problematic substance use, despite disruptions, including the COVID‐19 pandemic. This research sought to understand how the Aotearoa New Zealand Narcotics Anonymous (NA) community engaged with NA meetings online during the 2020–2021 COVID‐19 pandemic. During in‐depth, semi‐structured interviews, 11 NA members shared their stories of addiction, abstinence‐based recovery, experiences of NA and managing pandemic restrictions. A narrative analysis identified four tropes particularly relating to how community members managed during the pandemic: responding via technology; maintaining recovery connections; creating opportunities; and consistency. Each trope showcases how NA members were able to connect online and garner support for their abstinence‐based recoveries and, more generally, during unprecedented times. In addition, the NA members in this research narrated the opportunities the pandemic restrictions created for them, such as engaging with the NA programme in new ways and improving their quality of life. Members of NA were able to maintain their psychological, physical, spiritual and community wellbeing during the COVID‐19 pandemic primarily due to existing recovery capital—peer‐based support and the principles of the 12‐steps of NA. The implications are that access to peer‐based communities and salient recovery identities are pivotal during ordinary and extraordinary times. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

In the literature, relational recovery after infidelity is often described as a process going through different consecutive stages towards a reconciliation. We interviewed 25 injured partners and invited them to look back and talk about what helped them to recover from the pain and the conflicts caused by the relational infidelity of their partner. From their stories—through thematic analysis—four themes emerged: 1. talking, 2.the truth, 3. trust and 4. ethical imbalance. It furthermore struck us how the participants described their recovery process as an experience of being oscillated between connection and disconnection. These findings pointed us in the direction of developing a dual process model that fits with our participants' experiences of recovering after infidelity, while emphasizing the dynamic nature of their stories. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common and serious neuropsychiatric disorder. The prognosis of delirium in older patients living at home has not been studied often before. The aim of this study is to examine the prognosis of delirium in patients attending a memory clinic of a psychiatric hospital. Method: The study population consisted of 85 outpatients diagnosed with delirium between October 2013 and October 2014. Seventeen patients had already been diagnosed as having dementia. Three months after the diagnosis, consenting patients underwent a follow‐up visit. We recorded delirium status (remitted or not), new dementia diagnosis, subjective cognitive functioning compared to baseline and to before delirium, level of daily functioning, and place of residence. Results: After 3 months, 45 (53%) had recovered from delirium, 19 (22,4%) had persistent/recurrent delirium, 12 (14%) patients had died, and another nine (11%) could not be revisited for other reasons than death. None of the 64 re‐examined patients reported that their cognitive functioning had recovered to the pre‐delirium level, and the mean level of daily functioning did not substantially improve either. The rate of diagnosed dementia increased to 63.8%, and 18 patients (28.1%) had moved to a nursing home. Conclusions: Delirium in older outpatients has a poor prognosis. A larger study on the risk factors of the prognosis of delirium in older persons living at home is advised. [ABSTRACT FROM AUTHOR]

Background: The recovery of walking capacity is of great significance in stroke rehabilitation. We evaluated changes in post‐stroke gait function after low‐frequency repetitive transcranial magnetic stimulation (LF‐rTMS) treatment. Methods: Stroke patients were randomly assigned to control (conventional treatment)/LF‐rTMS (LF‐rTMS treatment based on conventional treatment) groups. Gait spatiotemporal parameters/affected side joint motion angle/affected side dynamic parameters were analyzed by 3D gait analyses. Motor evoked potential (MEP)/central motor conduction time (CMCT) changes were detected. Correlations between MEP latency/CMCT and gait parameters after LF‐rTMS were analyzed by Pearson analysis. Results: The two groups exhibited boosted stride speed/frequency/length, affected side stride length/swing phase percentage/hip/knee/ankle joint plantar flexion angle, and affected side ahead ground reaction force/ upward ground reaction force (AGRF/UGRF)/ankle joint plantar flexion moment, along with reduced affected side gait period/stance phase percentage after treatment, and the LF‐rTMS group manifested better efficacy. MEP latency/CMCT of stroke patients treated with LF‐rTMS was adversely linked to stride speed, affected side stride length/swing phase percentage/knee flexion angle, AGRF and UGRF, and positively correlated with affected side stance phase percentage. Conclusion: LF‐rTMS significantly improved gait spatiotemporal parameters/affected joint motion angles/neurophysiologic parameters (MEP latency/CMCT) in patients with post‐stroke walking dysfunction. MEP latency/CMCT after LF‐rTMS treatment were prominently correlated with gait parameters. Relative to the traditional scale assessment, we provided a more accurate, objective and reliable evaluation of the effects of LF‐rTMS on lower limb mobility and functional recovery effects in stroke patients from the perspective of 3D gait analysis and neurophysiology, which provided more evidence to support the clinical application of LF‐rTMS in post‐stroke walking dysfunction treatment. [ABSTRACT FROM AUTHOR]

Medical staff fatigue leads to accidents and mistakes and puts patient safety at risk. A measure of fatigue in the workplace may help to quantify, predict, and manage fatigue. This review aimed to evaluate instruments used to measure fatigue in medical staff within hospitals. A systematic review following the JBI methodology was undertaken. A search for articles was conducted in 2021. Included articles (all validation studies) were assessed for methodological quality using the COSMIN checklist. Measurement property data was evaluated for Quality of Evidence using GRADE methodology. Ten studies representing five instruments were reviewed: Occupational Fatigue Exertion and Recovery scale (now superseded); Occupational Fatigue Exertion and Recovery scale (15-item); Multidimensional Fatigue Inventory; Need for Recovery Scale; and the Swedish Occupational Fatigue Inventory. Four instruments show promise for measuring fatigue in hospital medical staff, however, there is limited certainty in the measure property estimates. The Quality of Evidence for measurement properties for all instruments is insufficient. Further validation studies following the COSMIN standards are needed before recommendations for use can be made. [ABSTRACT FROM AUTHOR]

Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long‐term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North‐central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health‐care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio‐structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income‐generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs. [ABSTRACT FROM AUTHOR]

In this article, we take forward sociological ways of knowing care‐in‐practice, in particular work in critical care. To do so, we analyse the experiences of staff working in critical care during the first wave of the COVID‐19 pandemic in the UK. This moment of exception throws into sharp relief the ways in which work and place were reconfigured during conditions of pandemic surge, and shows how critical care depends at all times on the co‐constitution of place, practices and relations. Our analysis draws on sociological and anthropological work on the material culture of health care and its sensory instantiations. Pursuing this through a study of the experiences of 40 staff across four intensive care units (ICUs) in 2020, we provide an empirical and theoretical elaboration of how place, body work and care are mutually co‐constitutive. We argue that the ICU does not exist independently of the constant embodied work of care and place‐making which iteratively constitute critical care as a total system of relations. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the impact of funding provided to support the well‐being of rural health practitioners and their practice staff following the 2019–2022 bushfires. Objective: To assess the benefits and implications of grant funding for rural practices to aid recovery following bushfires in NSW, Australia. Design: An explanatory sequential mixed method design consisted of a survey and a thematic analysis of semi‐structured Interviews. Findings: Five key themes emerged from analysis: (1) the disasters altered the role of the practice and therapeutic relationships; (2) the funding had a positive impact on access to professional development; (3) the training had a positive impact on staff well‐being and resilience; (4) the professional development had a positive impact on rural practitioner's sense of capability; and (5) important elements of future grant opportunities. Discussion: The findings indicate the importance of recovering funding to facilitate access to professional development for rural health practioners during natural disasters which improved their mental health and wellbeing, capability and support to clients. Conclusion: Recovery funding facilitated improvement in workforce capability, professional resilience, mental health and well‐being in the face of natural disasters and emergencies. There was a link between training and maintaining the capability of rural health care practitioners and their practice staff. Capability was an important factor in the well‐being and resilience of the health workforce and their ability to support clients. [ABSTRACT FROM AUTHOR]