People with breast cancer are widely encouraged to ‘look on the bright side’ and ‘think positive’ in the face of adversity, and research suggests a positive correlation between patient optimism and health outcomes. However, the promotion of a bright-side disposition has also been criticised because it can be perceived as a moral obligation that implies poor outcomes are a result of individual failure to adopt the correct attitude. In this paper, instead of treating bright-side talk as empirical evidence for a person's mental state, or reporting evidence for or against bright-side thinking, we systematically examine what bright-side talk is doing interactionally, and how it functions in real-time clinical consultations.
Design and Methods
Thirty-three instances of bright sides were identified from a corpus of 73 transcribed video-recordings of clinician-patient consultations (totalling 30+ hours) in a National Health Service breast unit, and analysed using conversation analysis.
Results
Bright sides function as practical, in-the-moment tools to do identity work. Consistently positioned following expressions of dissatisfaction with, or bad news about, treatment outcomes, bright sides manage and deflect potential inferences that patients may be overly upset by, or complaining about the trivialities of what has been lifesaving treatment. Instead, bright sides offer a comparatively ‘upbeat’ counterbalance to the prior negative stance that focuses attention on the ‘bigger picture’ of the patient's survival and its appreciation.
Conclusions
Clinicians and psycho-oncology interventions can usefully deconstruct cultural mandates to ‘look on the bright side’ by encouraging discussion of legitimate patient concerns that may otherwise remain hidden.
{"title":"Look on the Bright Side: The Interactional Construction of a Survivor Identity in the Breast Cancer Clinic","authors":"Stephanie Mace, Susan Speer","doi":"10.1111/hex.70482","DOIUrl":"10.1111/hex.70482","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>People with breast cancer are widely encouraged to ‘look on the bright side’ and ‘think positive’ in the face of adversity, and research suggests a positive correlation between patient optimism and health outcomes. However, the promotion of a bright-side disposition has also been criticised because it can be perceived as a moral obligation that implies poor outcomes are a result of individual failure to adopt the correct attitude. In this paper, instead of treating bright-side talk as empirical evidence for a person's mental state, or reporting evidence for or against bright-side thinking, we systematically examine what bright-side talk is doing interactionally, and how it functions in real-time clinical consultations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>Thirty-three instances of bright sides were identified from a corpus of 73 transcribed video-recordings of clinician-patient consultations (totalling 30+ hours) in a National Health Service breast unit, and analysed using conversation analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Bright sides function as practical, in-the-moment tools to do identity work. Consistently positioned following expressions of dissatisfaction with, or bad news about, treatment outcomes, bright sides manage and deflect potential inferences that patients may be overly upset by, or complaining about the trivialities of what has been lifesaving treatment. Instead, bright sides offer a comparatively ‘upbeat’ counterbalance to the prior negative stance that focuses attention on the ‘bigger picture’ of the patient's survival and its appreciation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clinicians and psycho-oncology interventions can usefully deconstruct cultural mandates to ‘look on the bright side’ by encouraging discussion of legitimate patient concerns that may otherwise remain hidden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare is becoming substantially complex in part due to greater multimorbidity, climate-related health issues, and problems related to access to care. While patient partnership is widely advocated as a strategy to adapt medical practice to the complexity, significant barriers persist.
Aim
We sought to shed light on the ontological and epistemological ‘tensions' generated by the implementation, sometimes by imposition, of the concept of physician–patient partnership in medical practice.
Methods
This reconceptualization of the distinctive ways of knowing is based on illustrative physician-patient interactions used to contrast the fundamental belief-systems that generate ontological and epistemological tensions impeding physician-patient partnership. We contrast knowledge valued by the prevailing positivist paradigm with the kinds of knowledge patients can contribute to ensure optimal healthcare outcomes.
Findings
Identifying the complementarity of evidence-based and experiential knowledges leads to a paradigmatic shift in how we perceive, interpret, and use data in the clinical setting. The two co-existing but distinct ontologies and epistemologies—neither is inherently superior to the other—are essential for a broader and concrete understanding of illness, its experience and its management.
Conclusion
This exploration into the complex nature of physician-patient partnerships provides insights about avenues for strengthening them and making them fulfil their promise to enhance health care access and outcomes for all.
Patient Contribution
The first author is a kidney transplant recipient (2008) and has been actively involved in patient partnership within health research and medical education since 2010. This paper reflects his accumulated insights and observations regarding the barriers that hinder the development of effective partnerships in health care.
{"title":"Fostering Physician-Patient Partnerships: The Importance of Embracing the Ontological and Epistemological Understandings of Knowledge","authors":"Nicolas Fernandez, Joachim P. Sturmberg","doi":"10.1111/hex.70484","DOIUrl":"10.1111/hex.70484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Healthcare is becoming substantially complex in part due to greater multimorbidity, climate-related health issues, and problems related to access to care. While patient partnership is widely advocated as a strategy to adapt medical practice to the complexity, significant barriers persist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We sought to shed light on the ontological and epistemological ‘tensions' generated by the implementation, sometimes by imposition, of the concept of physician–patient partnership in medical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This reconceptualization of the distinctive ways of knowing is based on illustrative physician-patient interactions used to contrast the fundamental belief-systems that generate ontological and epistemological tensions impeding physician-patient partnership. We contrast knowledge valued by the prevailing positivist paradigm with the kinds of knowledge patients can contribute to ensure optimal healthcare outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Identifying the complementarity of evidence-based and experiential knowledges leads to a paradigmatic shift in how we perceive, interpret, and use data in the clinical setting. The two co-existing but distinct ontologies and epistemologies—neither is inherently superior to the other—are essential for a broader and concrete understanding of illness, its experience and its management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This exploration into the complex nature of physician-patient partnerships provides insights about avenues for strengthening them and making them fulfil their promise to enhance health care access and outcomes for all.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient Contribution</h3>\u0000 \u0000 <p>The first author is a kidney transplant recipient (2008) and has been actively involved in patient partnership within health research and medical education since 2010. This paper reflects his accumulated insights and observations regarding the barriers that hinder the development of effective partnerships in health care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Béatrice Durvy, Lukas Schöner, Tamara Reyes Ojopi, Katharina Achstetter, Reinhard Busse, Katherine Carr, Stefan Listl, Orsolya Németh, Amal Skandrani, Stéphanie Tubert-Jeannin, Chris Vernazza, Juliane Winkelmann, Ruth Waitzberg
Introduction
Despite its importance, oral health (OH) is often excluded from comprehensive public health coverage in Europe, resulting in financial hardship and exacerbating OH inequalities. Defining what ‘essential’ means in OH is a prerequisite for developing a public benefits basket to expand public coverage and financial protection.
Method
This qualitative study explored the population's and experts' perspectives on ‘essential’ OH in Europe. Participants were purposively sampled from eight European countries. Data were collected through 37 focus group discussions (FGDs) gathering 228 participants. As data saturation was reached, data from 21 FGDs were analysed using thematic analysis.
Results
‘Essential’ in OH was perceived as a state of good OH, encompassing both performing basic functions and the psychosocial dimension, which aligns with the WHO definition of good OH. Participants highlighted multiple considerations to define an ‘essential’ OH benefits basket, including services' contributions to improving health, economic criteria, societal values, people-centred care and feasibility. Considering OH as part of a broader health system was seen as crucial.
Conclusion
Findings emphasise the fluid and multidimensional nature of the ‘essential’ concept in OH and highlight the myriad considerations for priority-setting in public coverage. This underscores the importance of first defining what is ‘essential’ in each country's context. This study identifies three key lessons relevant for policy-making. First, people's expectations vary between and within countries but remain realistic, as considerations are similar to those used in other health fields. Second, OH should be better integrated into the general health system. Finally, involving patients and potential patients in the decision-making process is key to (re-)defining an OH benefits basket that responds to the health system's goals.
Public Contribution
OH patients and potential patients were at the centre of this study, informing how to conceptualise ‘essential’ in OH in Europe. This is a concrete example of how public participation mechanisms can support decision-making over the definition of an (OH) benefits basket.
{"title":"Conceptualising Essential Oral Health Benefits Baskets: A Thematic Analysis of Public and Expert Perspectives","authors":"Béatrice Durvy, Lukas Schöner, Tamara Reyes Ojopi, Katharina Achstetter, Reinhard Busse, Katherine Carr, Stefan Listl, Orsolya Németh, Amal Skandrani, Stéphanie Tubert-Jeannin, Chris Vernazza, Juliane Winkelmann, Ruth Waitzberg","doi":"10.1111/hex.70501","DOIUrl":"10.1111/hex.70501","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite its importance, oral health (OH) is often excluded from comprehensive public health coverage in Europe, resulting in financial hardship and exacerbating OH inequalities. Defining what ‘essential’ means in OH is a prerequisite for developing a public benefits basket to expand public coverage and financial protection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This qualitative study explored the population's and experts' perspectives on ‘essential’ OH in Europe. Participants were purposively sampled from eight European countries. Data were collected through 37 focus group discussions (FGDs) gathering 228 participants. As data saturation was reached, data from 21 FGDs were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>‘Essential’ in OH was perceived as a state of good OH, encompassing both performing basic functions and the psychosocial dimension, which aligns with the WHO definition of good OH. Participants highlighted multiple considerations to define an ‘essential’ OH benefits basket, including services' contributions to improving health, economic criteria, societal values, people-centred care and feasibility. Considering OH as part of a broader health system was seen as crucial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings emphasise the fluid and multidimensional nature of the ‘essential’ concept in OH and highlight the myriad considerations for priority-setting in public coverage. This underscores the importance of first defining what is ‘essential’ in each country's context. This study identifies three key lessons relevant for policy-making. First, people's expectations vary between and within countries but remain realistic, as considerations are similar to those used in other health fields. Second, OH should be better integrated into the general health system. Finally, involving patients and potential patients in the decision-making process is key to (re-)defining an OH benefits basket that responds to the health system's goals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Public Contribution</h3>\u0000 \u0000 <p>OH patients and potential patients were at the centre of this study, informing how to conceptualise ‘essential’ in OH in Europe. This is a concrete example of how public participation mechanisms can support decision-making over the definition of an (OH) benefits basket.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fran Hallam-Bowles, Alice Kilby, Adam Gordon, Stephen Timmons, Pip Logan, Lindsay Rees, Will Lawry, CHAFFINCH stakeholder group, Katie Robinson
<div> <section> <h3> Background</h3> <p>Co-production approaches are increasingly used in research but are rarely evaluated in care home settings. This study explored factors influencing key principles of co-production in a series of workshops around falls management in care homes.</p> </section> <section> <h3> Methods</h3> <p>Stakeholders (care home residents and relatives, care home staff, and health and social care staff) participating in co-production workshops as part of a research study were invited to take part in this qualitative evaluation. The workshops were developing a model to implement falls training in care homes as part of a systemic action research study. Non-participant observations of workshops explored stakeholder interactions. Stakeholders participated in reflection meetings about their experiences of co-production. Framework analysis mapped key themes to the National Institute for Health and Care Research's (NIHR) principles of co-production.</p> </section> <section> <h3> Results</h3> <p>Nine themes were identified. Sharing power was affected by two themes: opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and integrating a disjointed system. Including all perspectives and skills was influenced by two themes: involvement of key stakeholders and a flexible approach. Respecting and valuing knowledge was impacted by two themes: respecting and utilising expertise and experience, and confidence. Two themes relating to reciprocity were identified: benefits and potential harms. One theme related to building and maintaining relationships: team dynamics.</p> </section> <section> <h3> Conclusions</h3> <p>Co-production in this context is complex and affected by multiple factors. Separate stakeholder groups, a flexible approach and recognising different experiences and expertise facilitated co-production in line with its key principles. Potential reputational risks, confidence levels and limited involvement of residents, relatives and care home staff in a variety of roles were identified as barriers. Future studies in care homes should consider organisational power dynamics and create safe spaces, providing opportunities for inclusive participation.</p> </section> <section> <h3> Patient and Public Contribution</h3> <p>A collaborator group, including a patient and public involvement and engagement (PPIE) advisor and health and social care professionals, contribute
{"title":"A Qualitative Evaluation Exploring Co-Production of Falls Management in Care Homes","authors":"Fran Hallam-Bowles, Alice Kilby, Adam Gordon, Stephen Timmons, Pip Logan, Lindsay Rees, Will Lawry, CHAFFINCH stakeholder group, Katie Robinson","doi":"10.1111/hex.70500","DOIUrl":"10.1111/hex.70500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Co-production approaches are increasingly used in research but are rarely evaluated in care home settings. This study explored factors influencing key principles of co-production in a series of workshops around falls management in care homes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Stakeholders (care home residents and relatives, care home staff, and health and social care staff) participating in co-production workshops as part of a research study were invited to take part in this qualitative evaluation. The workshops were developing a model to implement falls training in care homes as part of a systemic action research study. Non-participant observations of workshops explored stakeholder interactions. Stakeholders participated in reflection meetings about their experiences of co-production. Framework analysis mapped key themes to the National Institute for Health and Care Research's (NIHR) principles of co-production.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine themes were identified. Sharing power was affected by two themes: opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and integrating a disjointed system. Including all perspectives and skills was influenced by two themes: involvement of key stakeholders and a flexible approach. Respecting and valuing knowledge was impacted by two themes: respecting and utilising expertise and experience, and confidence. Two themes relating to reciprocity were identified: benefits and potential harms. One theme related to building and maintaining relationships: team dynamics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Co-production in this context is complex and affected by multiple factors. Separate stakeholder groups, a flexible approach and recognising different experiences and expertise facilitated co-production in line with its key principles. Potential reputational risks, confidence levels and limited involvement of residents, relatives and care home staff in a variety of roles were identified as barriers. Future studies in care homes should consider organisational power dynamics and create safe spaces, providing opportunities for inclusive participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient and Public Contribution</h3>\u0000 \u0000 <p>A collaborator group, including a patient and public involvement and engagement (PPIE) advisor and health and social care professionals, contribute","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12630552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan Armstrong, Alma Jeri-Wahrhaftig, Abi Woodward, Danielle Nimmons, Carolyn A. Chew-Graham, Joanne Protheroe, Fiona Stevenson, Nathan Davies, Kate Walters
Background
Informal carers compose approximately 7% of the UK population and, through their unpaid care, they make important contributions to society and the health care industry. Being an informal carer is higher in people experiencing socioeconomic deprivation; however, no qualitative research has explored the impact of this on the ability to provide care for those with long-term conditions.
Aim
To explore the experiences and challenges of being a carer whilst experiencing socioeconomic deprivation.
Methods
Semi-structured one-to-one interviews with adults experiencing socioeconomic deprivation (n = 12) living in London and Sheffield, United Kingdom. Participants were recruited through social media and community channels. Data were managed in NVivo and analysed using reflexive thematic analysis.
Results
Three analytical themes were developed: (1) Economic insecurity including insecure housing and challenges with financial welfare leading to sacrificing the necessities such as healthy food, water and heating; (2) social and structural barriers such as a lack of opportunities for social mobility due to care impacting employment and educational attainment, as well as area-based barriers and feeling unheard by professionals; (3) the emotional challenges and rewards of being a carer such as managing people with poor mental well-being exacerbated by their socioeconomic situation, whilst finding their caring role meaningful.
Conclusion
Carers experiencing socioeconomic deprivation face additional challenges and barriers in their ability to provide care such as more emotional work, making sacrifices of necessities due to financial constraints and feeling unheard. Policy changes are needed to better support this population financially and to enable social mobility, as well as development of interventions and support resources for carers to use to feel empowered and to maintain good well-being.
{"title":"Experiencing Socioeconomic Deprivation as a Carer in the United Kingdom: A Qualitative Study","authors":"Megan Armstrong, Alma Jeri-Wahrhaftig, Abi Woodward, Danielle Nimmons, Carolyn A. Chew-Graham, Joanne Protheroe, Fiona Stevenson, Nathan Davies, Kate Walters","doi":"10.1111/hex.70502","DOIUrl":"10.1111/hex.70502","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Informal carers compose approximately 7% of the UK population and, through their unpaid care, they make important contributions to society and the health care industry. Being an informal carer is higher in people experiencing socioeconomic deprivation; however, no qualitative research has explored the impact of this on the ability to provide care for those with long-term conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the experiences and challenges of being a carer whilst experiencing socioeconomic deprivation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured one-to-one interviews with adults experiencing socioeconomic deprivation (<i>n</i> = 12) living in London and Sheffield, United Kingdom. Participants were recruited through social media and community channels. Data were managed in NVivo and analysed using reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three analytical themes were developed: (1) Economic insecurity including insecure housing and challenges with financial welfare leading to sacrificing the necessities such as healthy food, water and heating; (2) social and structural barriers such as a lack of opportunities for social mobility due to care impacting employment and educational attainment, as well as area-based barriers and feeling unheard by professionals; (3) the emotional challenges and rewards of being a carer such as managing people with poor mental well-being exacerbated by their socioeconomic situation, whilst finding their caring role meaningful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Carers experiencing socioeconomic deprivation face additional challenges and barriers in their ability to provide care such as more emotional work, making sacrifices of necessities due to financial constraints and feeling unheard. Policy changes are needed to better support this population financially and to enable social mobility, as well as development of interventions and support resources for carers to use to feel empowered and to maintain good well-being.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12630546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patient Classification Systems (PCS) are essential for managing resources and staffing in hospitals. However, existing systems are predominantly nursing-centric and fail to capture the interdisciplinary nature and complexity of care in rehabilitation settings, leading to inaccuracies in workload assessment and resource allocation. This study aims to develop and validate a novel, context-specific PCS for rehabilitation hospitals through a participatory approach that actively engages patients and stakeholders.
Methods
This mixed-methods study protocol comprises three sequential stages. First, a systematic scoping review following Arksey and O'Malley's framework will identify key PCS components from existing evidence. Second, structured expert panel sessions employing a modified Delphi technique will develop a consensus-based preliminary framework. Third, the developed PCS will undergo rigorous validation through pilot implementation, assessing inter-rater reliability using Cohen's Kappa and criterion validity against established tools, including the Functional Independence Measure (FIM) and Barthel Index, with explicit sample size calculation and reliability criteria.
Conclusion
The study will generate a validated PCS specifically designed for rehabilitation hospital settings through systematic integration of evidence and stakeholder insights. The resulting tool is expected to enhance workload measurement accuracy, promote equitable resource distribution, and ultimately improve both care quality and operational efficiency in rehabilitation contexts.
Patient or Public Contribution
Stakeholders, including patients, their families, administrators, and multidisciplinary clinical staff, have been engaged from the initial conception of the study. They contributed to defining the research objectives, formulating the scoping review questions, and are integral participants in the co-design and validation stages, ensuring the resulting system is relevant and applicable to real-world practice.
{"title":"Development and Validation of a Patient Classification System for Rehabilitation Hospitals Based on Patient and Stakeholders Engagement: A Study Protocol","authors":"Shima Shirozhan, Kian Norouzi Tabrizi, Mahdieh Motie, Rouhollah Mirshafiee, Hasan Mohammadi, Amin Ajalli","doi":"10.1111/hex.70505","DOIUrl":"10.1111/hex.70505","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patient Classification Systems (PCS) are essential for managing resources and staffing in hospitals. However, existing systems are predominantly nursing-centric and fail to capture the interdisciplinary nature and complexity of care in rehabilitation settings, leading to inaccuracies in workload assessment and resource allocation. This study aims to develop and validate a novel, context-specific PCS for rehabilitation hospitals through a participatory approach that actively engages patients and stakeholders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This mixed-methods study protocol comprises three sequential stages. First, a systematic scoping review following Arksey and O'Malley's framework will identify key PCS components from existing evidence. Second, structured expert panel sessions employing a modified Delphi technique will develop a consensus-based preliminary framework. Third, the developed PCS will undergo rigorous validation through pilot implementation, assessing inter-rater reliability using Cohen's Kappa and criterion validity against established tools, including the Functional Independence Measure (FIM) and Barthel Index, with explicit sample size calculation and reliability criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study will generate a validated PCS specifically designed for rehabilitation hospital settings through systematic integration of evidence and stakeholder insights. The resulting tool is expected to enhance workload measurement accuracy, promote equitable resource distribution, and ultimately improve both care quality and operational efficiency in rehabilitation contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Stakeholders, including patients, their families, administrators, and multidisciplinary clinical staff, have been engaged from the initial conception of the study. They contributed to defining the research objectives, formulating the scoping review questions, and are integral participants in the co-design and validation stages, ensuring the resulting system is relevant and applicable to real-world practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12627753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia Egwumba, Kaushik Chattopadhyay, Laura Nellums, Manpreet Bains
Introduction
Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom.
Methods
Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
Findings
Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers—especially since treatments are not covered by the NHS.
Conclusion
People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.
{"title":"People With Non-Communicable Diseases Using Ayurveda: A UK-Based Qualitative Study","authors":"Patricia Egwumba, Kaushik Chattopadhyay, Laura Nellums, Manpreet Bains","doi":"10.1111/hex.70494","DOIUrl":"10.1111/hex.70494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers—especially since treatments are not covered by the NHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12627756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kayley Perfetto, Kim Sears, Jane O'Hara, Lenora Duhn
<div> <section> <h3> Background</h3> <p>It is believed that engaging care partners (CPs) in patient safety is a potential strategy to ensure patients' well-being during hospital admissions. When present, CPs who feel comfortable can be ‘safety nets’, monitoring and acting to prevent healthcare-related harm. However, there are limitations in evidence about CPs' perspectives regarding and experiences of safety engagement at the direct care level and the implications if they have restricted access, such as during the Covid-19 pandemic.</p> </section> <section> <h3> Objective</h3> <p>To understand CPs' experiences of patient safety when, due to Covid-19 restrictions, they were unable to be present in the hospital during a patient admission.</p> </section> <section> <h3> Methods</h3> <p>A descriptive, exploratory qualitative study was conducted in an acute care hospital in Ontario, Canada, and four Canadian organisations that support CPs. One-to-one semi-structured interviews and reflexive thematic analysis were completed.</p> </section> <section> <h3> Findings</h3> <p>Twelve CPs participated. Overall, they believed hospital restrictions had consequences on patient safety and was troubling for them and their loved ones, as illuminated in the three main themes: <i>Stress Escalates Amid Disrupted, Ineffective Communications Between CPs and Patients/Healthcare Professionals; CPs' Patient Safety Concerns Change and are Heightened in Their Absence From the Bedside, Calling for New Tactics</i>, and <i>Hospital Access Restriction Negatively Impacts CPs' Well-Being, Necessitating Creative Ways to Bolster Their Strength</i>.</p> </section> <section> <h3> Discussion</h3> <p>The findings give insight into CPs' engagement in patient safety at the direct care level and the importance of being present, given the types of contributions they want to make. Communication was paramount, and the scope of their involvement—the nuances of which became more apparent in their absence—affirmed how connected CPs are and need to be within the health team for successful risk reduction. Disconnecting CPs from engaging in safety diminished the patient's protection, and instead of reducing CP fears related to involvement, it escalated newfound worries and stressors.</p> </section> <section> <h3> Conclusion</h3> <p>This study highlights CPs' experiences with patient safety when they c
{"title":"‘A Forever Imprint on Me…I Couldn't Be There When He Needed Me the Most’: Care Partner Experiences of Patient Safety During Covid-19 Restrictions","authors":"Kayley Perfetto, Kim Sears, Jane O'Hara, Lenora Duhn","doi":"10.1111/hex.70496","DOIUrl":"10.1111/hex.70496","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is believed that engaging care partners (CPs) in patient safety is a potential strategy to ensure patients' well-being during hospital admissions. When present, CPs who feel comfortable can be ‘safety nets’, monitoring and acting to prevent healthcare-related harm. However, there are limitations in evidence about CPs' perspectives regarding and experiences of safety engagement at the direct care level and the implications if they have restricted access, such as during the Covid-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand CPs' experiences of patient safety when, due to Covid-19 restrictions, they were unable to be present in the hospital during a patient admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive, exploratory qualitative study was conducted in an acute care hospital in Ontario, Canada, and four Canadian organisations that support CPs. One-to-one semi-structured interviews and reflexive thematic analysis were completed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Twelve CPs participated. Overall, they believed hospital restrictions had consequences on patient safety and was troubling for them and their loved ones, as illuminated in the three main themes: <i>Stress Escalates Amid Disrupted, Ineffective Communications Between CPs and Patients/Healthcare Professionals; CPs' Patient Safety Concerns Change and are Heightened in Their Absence From the Bedside, Calling for New Tactics</i>, and <i>Hospital Access Restriction Negatively Impacts CPs' Well-Being, Necessitating Creative Ways to Bolster Their Strength</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The findings give insight into CPs' engagement in patient safety at the direct care level and the importance of being present, given the types of contributions they want to make. Communication was paramount, and the scope of their involvement—the nuances of which became more apparent in their absence—affirmed how connected CPs are and need to be within the health team for successful risk reduction. Disconnecting CPs from engaging in safety diminished the patient's protection, and instead of reducing CP fears related to involvement, it escalated newfound worries and stressors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights CPs' experiences with patient safety when they c","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12627745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dementia is a growing concern in Sub-Saharan Africa (SSA), particularly Nigeria, where care is hindered by weak infrastructure, stigma, and limited culturally responsive services. Telemedicine offers promise but faces adoption challenges in low-resource settings.
Objective
To evaluate digital interventions for dementia care in SSA and examine how culturally tailored telemedicine is shaped by stakeholder input, it may reduce caregiver burden and improve care delivery.
Methods
Following PRISMA guidelines, 1650 records were screened: across PubMed, Scopus, PsycINFO, and Google Scholar; 20 studies met inclusion criteria. Thematic analysis identified trends across intervention types, populations, and barriers.
Results
Five core themes emerged: barriers to care (30%), telemedicine opportunities (25%), stakeholder involvement (23%), cultural influences (20%) and technological feasibility (17%). Mobile health tools showed potential when culturally adapted. However, poor infrastructure, digital literacy and traditional beliefs constrained adoption. Engaging caregivers, clinicians and community leaders improved solution relevance and uptake.
Conclusions
Culturally informed, co-designed telemedicine models can strengthen dementia care delivery in SSA, stakeholder-driven digital models may serve as a scalable blueprint for other low-resource contexts.
Patient or Public Contribution
This review incorporated studies that engaged patients, informal caregivers, clinicians, policymakers and community leaders in the codesign and implementation of digital dementia care tools. Their lived experiences and cultural insights informed the development of interventions that are not only technologically feasible but also socially and “culturally appropriate”.
{"title":"Telemedicine and Cultural Competency in Dementia Care: Mapping Stakeholder Roles in Digital Toolkit Development in SSA: A Systematic Review","authors":"Abiodun Adedeji, Huseyin Dogan, Festus Adedoyin, Michelle Heward","doi":"10.1111/hex.70489","DOIUrl":"10.1111/hex.70489","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dementia is a growing concern in Sub-Saharan Africa (SSA), particularly Nigeria, where care is hindered by weak infrastructure, stigma, and limited culturally responsive services. Telemedicine offers promise but faces adoption challenges in low-resource settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate digital interventions for dementia care in SSA and examine how culturally tailored telemedicine is shaped by stakeholder input, it may reduce caregiver burden and improve care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, 1650 records were screened: across PubMed, Scopus, PsycINFO, and Google Scholar; 20 studies met inclusion criteria. Thematic analysis identified trends across intervention types, populations, and barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five core themes emerged: barriers to care (30%), telemedicine opportunities (25%), stakeholder involvement (23%), cultural influences (20%) and technological feasibility (17%). Mobile health tools showed potential when culturally adapted. However, poor infrastructure, digital literacy and traditional beliefs constrained adoption. Engaging caregivers, clinicians and community leaders improved solution relevance and uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Culturally informed, co-designed telemedicine models can strengthen dementia care delivery in SSA, stakeholder-driven digital models may serve as a scalable blueprint for other low-resource contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>This review incorporated studies that engaged patients, informal caregivers, clinicians, policymakers and community leaders in the codesign and implementation of digital dementia care tools. Their lived experiences and cultural insights informed the development of interventions that are not only technologically feasible but also socially and “culturally appropriate”.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra Thompson, Victoria Bartle, Elizabeth A. Remfry, Duncan J. Reynolds, Michael R. Barnes, Nick J. Reynolds, Barbara Hanratty
Background
Public and patient involvement and engagement (PPIE) is intended to shape research priorities and improve relevance and impact. However, implementing PPIE in complex fields such as artificial intelligence (AI) and big data health research presents specific challenges. This study explores the issues and barriers to meaningful PPIE using the AI-Multiply project as a case example.
Methods
AI-Multiply is a large, interdisciplinary UK-based research project using AI and routine health data to investigate trajectories of multiple long-term conditions and polypharmacy. PPIE was embedded across all five work packages. We used a mixed-methods approach, drawing on CUBE framework surveys, PPIE feedback forms and impact logs to evaluate involvement. Data were analysed thematically using a ‘follow-a-thread’ approach to identify key issues across sources.
Results
Three themes were identified: (1) differing priorities—public contributors prioritised person-centred outcomes, while researchers focused on data-driven healthcare metrics, often constrained by data availability; (2) movement on both sides—both researchers and contributors expressed early apprehension, but mutual trust and integration developed over time; and (3) the importance of established guidance—many issues raised echoed longstanding PPIE guidance on clarity, feedback and facilitation.
Conclusion
While AI and data-specific challenges exist, many PPIE issues in this context relate to applying existing good practice in complex projects. Strong PPIE leadership, early expectation-setting and consistent facilitation are critical for success. Findings will inform the development of practical tools to support involvement in data-driven research.
Patient or Public Contribution
Public contributors with lived experience of multiple long-term conditions contributed to the interpretation of data and co-authored this manuscript.
{"title":"Public and Patient Involvement in Artificial Intelligence and Big Data Healthcare Research: An Exploration of Issues and Challenges Within the AI-Multiply Project","authors":"Alexandra Thompson, Victoria Bartle, Elizabeth A. Remfry, Duncan J. Reynolds, Michael R. Barnes, Nick J. Reynolds, Barbara Hanratty","doi":"10.1111/hex.70490","DOIUrl":"10.1111/hex.70490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Public and patient involvement and engagement (PPIE) is intended to shape research priorities and improve relevance and impact. However, implementing PPIE in complex fields such as artificial intelligence (AI) and big data health research presents specific challenges. This study explores the issues and barriers to meaningful PPIE using the AI-Multiply project as a case example.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>AI-Multiply is a large, interdisciplinary UK-based research project using AI and routine health data to investigate trajectories of multiple long-term conditions and polypharmacy. PPIE was embedded across all five work packages. We used a mixed-methods approach, drawing on CUBE framework surveys, PPIE feedback forms and impact logs to evaluate involvement. Data were analysed thematically using a ‘follow-a-thread’ approach to identify key issues across sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three themes were identified: (1) <b>differing priorities</b>—public contributors prioritised person-centred outcomes, while researchers focused on data-driven healthcare metrics, often constrained by data availability; (2) <b>movement on both sides</b>—both researchers and contributors expressed early apprehension, but mutual trust and integration developed over time; and (3) <b>the importance of established guidance</b>—many issues raised echoed longstanding PPIE guidance on clarity, feedback and facilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While AI and data-specific challenges exist, many PPIE issues in this context relate to applying existing good practice in complex projects. Strong PPIE leadership, early expectation-setting and consistent facilitation are critical for success. Findings will inform the development of practical tools to support involvement in data-driven research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Public contributors with lived experience of multiple long-term conditions contributed to the interpretation of data and co-authored this manuscript.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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