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Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.

This study presents an interdisciplinary digital lecture series on human–animal relationships developed at Witten/Herdecke University. The course explored ethical, ecological, and health-related aspects of animal–human interactions within the frameworks of One Health and planetary health. Grounded in Transformative Learning Theory, the 14-week series combined expert-led lectures with live polls, Q&A sessions, and a participatory Barcamp. The course was open to students and the general public. Quantitative data were collected on participation, interaction, and reflective journal submissions. A total of 1382 individuals registered while the mean number of participants per session was 470.5 (SD = 60.9). Sessions on ethically sensitive topics such as animal ethics, hunting or transportation generated particularly high engagement during sessions. In total, 291 journals were submitted, demonstrating reflective depth and personal involvement. The findings underscore the potential of digital lecture series to foster ethical awareness and interdisciplinary dialogue. The model offers a transferable approach for integrating animal ethics into health curricula and advancing bioethical literacy across audiences. This manuscript presents Part 1 of a two-part study focusing on implementation, reach, and engagement; Part 2 will report pre–post survey outcomes using validated instruments to assess learning and perspective change.

Background Delirium is a neuropathological syndrome that is characterised by fluctuating impairments in attention, cognitive performance, and consciousness. Since delirium represents a medical emergency, it can be associated with adverse clinical and economic outcomes. Although nursing home residents face a high risk of developing delirium, health care professionals in this field appear to have limited knowledge of delirium despite the critical role they play in the prevention, diagnosis, and treatment of delirium in nursing homes. Objective The purpose of this realist review is to develop an initial programme theory with the goal of understanding how, why, and under what circumstances educational interventions can improve the delirium-specific knowledge of health care professionals in nursing homes. Methods This realist review was conducted in accordance with the RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines and includes the following steps: (1) search strategy and literature review; (2) study selection and assessment; (3) data extraction; (4) data synthesis; and (5) development of an initial programme theory. It also included stakeholder discussions with health care professionals recruited from nursing home care, which focused on their experiences with delirium. Results From a set of 1703 initially identified publications, ten publications were included in this realist review. Based on these publications, context-mechanism-outcome configurations were developed; these configurations pertained to (1) management support, (2) cognitive impairments among residents, (3) familiarity with residents, (4) participatory intervention development, (5) practical application, (6) case scenarios, (7) support from experts and (8) relevance of communication. Conclusions Educational interventions aimed at improving the delirium-specific knowledge of health care professionals should feature methodological diversity if they are to enhance health care professionals’ interest in delirium and highlight the fundamental contributions they make to the prevention, diagnosis, and treatment of delirium. Educational interventions should also take into account the multidimensional contextual factors that can have massive impacts on the relevant mode of action as well as the responses of health care professionals in nursing homes. The identification of delirium in residents is a fundamental responsibility for nursing home staff. Trial registration This review has been registered at Open Science Framework https://doi.org/10.17605/OSF.IO/6ZKM3

Background In the face of extensive waiting times for outpatient psychotherapy, prescriptible digital health applications (DiGA) are a useful and effective addition to the range of available therapy options for patients with mild to moderate depression. However, older adults face a particular challenge in implementing DiGA since higher age is a decisive predictor of lower digital health literacy. The necessity of an independent use of the prescribed DiGA is therefore associated with challenges for older patients and providers. In practice, it is crucial not to leave patients, especially older adults, alone after prescribing, but to maintain close contact to overcome technical and motivational barriers and to ensure that the novel application is used. However, this is difficult for physicians and psychotherapists due to the critical healthcare system situation in Germany described above. Another support system is needed. Hence, the main hypothesis of this study is that the additional implementation of digital nurses leads to a higher percentage of older patients with depressive symptoms starting DiGA use compared to a prescription and information alone. Methods Two DiGA for mild to moderate depression in older patients were available and permanently approved at the time of the funding application. Using the most suitable one of them, as shown in a pilot study, the feasibility of implementation will be examined within a randomized proof of concept study. In our study, a digital nurse is trained to support patients with depression in using a DiGA. The main outcome is DiGA use (first session started: yes/no) after 8 weeks. Major secondary outcomes are patient-relevant outcomes, feasibility of recruitment and intervention, and factors moderating the effect or predicting DiGA use in the target group. Best practice guidelines will be elaborated on how to support and improve DiGA prescription and successful use in this population. Discussion In Germany, the approved DiGA are currently little used, especially by people with a low digital affinity. This proof of concept study will use the example of older people with depressive disorders to show whether it is possible to increase the usage rate of a DiGA with the support of a digital nurse so that a DiGA can become a serious therapy option. Trial registration DRKS: DRKS00033535. Registered on February 2, 2024.

Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences. Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes. We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved. In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used. This review provides insights into the diversity of health care professionals' involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.

IntroductionThe prevalence of mental health problems is increasing worldwide, particularly in the vulnerable group of older people. The limited availability of therapists, long wait periods and increasing shortage of healthcare resources limit adequate care. As a result, digital applications are becoming more commonplace as an alternative to human therapists. However, these tend to be used by younger people with higher education, digital health literacy and experience. In Germany, applications that are approved by the health authorities, so-called digital health applications (DiGAs), can be prescribed by physicians and psychotherapists. It remains unclear to the extent older people are experienced with, are willing and can use a DiGA. Therefore, this research aims to identify specific challenges of older people’s accessibility, user experience and engagement with DiGA for depressive disorders. The DiGA4Aged project consists of: (1) a pilot study on usability, (2) a screening study on potential participants for a randomised controlled trial (RCT) evaluating the digital experience of the target population and (3) an RCT to test the effectiveness of a digital nurse as individualised user support in the intervention group. This paper focuses on the pilot study and the screening study.Methods and analysisThe instrumental components in preparing for the RCT are a mixed-method pilot and observational quantitative screening study, which are described in this manuscript. The pilot study includes questionnaires (covering sociodemographic data, user experience, health literacy, electronic health literacy, media affinity, severity of depression and perceived usability of DiGA), a concurrent think aloud method and a semistructured interview to evaluate two applications with regard to their usability for, acceptance by and needs of older people. The observational screening study collects data of older patients consecutively admitted to an acute care geriatric hospital ward using various questionnaires to identify which clinical and medical factors are associated with the access to, experience with and (non-)use of digital media. Data from the comprehensive geriatric assessment is collected as well as data on their digital media experience and digital health literacy.Ethics and disseminationThe overall project DiGA4Aged received ethical approval on 17 November 2023 from the ethics committee of the Medical Faculty of Ruhr-University Bochum (registration number 23-7901). Results will be disseminated within the scientific community via publication in peer-reviewed journals as well as presentation at national conferences. The findings from the pilot study and the observational screening study will determine the selection of the DiGA and the recruitment strategy for the subsequent RCT.Trial registration numbersThe pilot study has been prospectively registered in the German Clinical Trials Register (DRKS00033640, registered on 18 March 2024, available from https://drks.de/search/de/trial/DRKS00033640). Likewise, the observational screening study has been prospectively registered in the German Clinical Trials Register (DRKS00032931, registered on 29 November 2023, available from https://drks.de/search/de/trial/DRKS00032931).

BackgroundDelirium is a neuropathological condition that impairs cognitive performance, attention and consciousness and can be potentially life-threatening. Nursing home residents are particularly vulnerable to developing delirium, but research thus far tends to focus on the acute hospital setting. Healthcare professionals (HCPs) working in nursing homes seem to be little aware of delirium. To improve healthcare for affected or at-risk individuals, increasing knowledge among HCPs is highly relevant. Using the realist review method helps to understand how and why an educational intervention for HCPs on delirium in nursing homes works.Methods and analysisIn accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist syntheses, the review process will include the following five steps: (1) search strategy and literature review; (2) study selection and assessment; (3) data extraction; (4) data synthesis and (5) development of an initial programme theory. The literature search will be conducted in the databases Medline (PubMed), CINAHL (Ebsco), Scopus, Web of Science, GeroLit and Carelit. Additional focuses are on snowballing techniques, hand research and grey literature. Studies of any design will be included to develop the initial programme theory. The literature will be selected by two researchers independently. In addition, the experiences of HCPs from nursing homes will be reflected in group discussions. To this end, Context–Mechanism–Outcome configurations (CMOcs) will be established to develop an initial programme theory.Ethics and disseminationThe results will be disseminated within the scientific community. For this purpose, presentations at scientific conferences as well as publications in peer-reviewed journals are scheduled. In the next step, the CMOcs could serve for the development of a complex educational intervention to increase the knowledge of HCPs on delirium in nursing homes.Registration detailsThis protocol has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/HTFU4).

Higher education can promote environmental awareness and action through hidden curricula. This study at the Witten/Herdecke University examined the impact of the Human–Animal Studies course on students’ environmental awareness and behavior, comparing participants with the general student population. A cross-sectional and longitudinal survey was conducted using a 12-question Likert-scale questionnaire. Course participants were surveyed three times, while the general student body was surveyed once. In addition, reflective writing was qualitatively analyzed to assess changes in attitudes and behaviors. The results showed that both groups exhibited high levels of environmental awareness and behavior, exceeding the German population average. Female students showed greater commitment than male students. While no significant differences were found between course participants and other students, reflections indicated that the course promoted personal awareness and behavioral change and that the course encouraged participants to think about changes in their attitudes and behaviors toward the environment. These findings suggest that courses such as Human–Animal Studies can promote environmental awareness and self-reflection among students.

Digital health applications (DiGA) have been integrated into Germany's health care system since 2019, offering certified medical devices for various health conditions. This study focuses on deprexis and Selfapy, the first 2 permanently approved DiGA for depressive disorders in Germany, to evaluate their usability for people ≥60 years. The study's significance is underscored by the underrepresentation of older people in previous DiGA studies, accompanied by an emergent risk of inequalities in distribution for this vulnerable population. This study assessed the usability of DiGA deprexis and Selfapy for adults aged ≥60 years with mild to moderate depression. The more user-friendly option will be chosen for the DiGA4Aged project's upcoming randomized controlled trial. The prospective observational study uses the People at the Centre of Mobile Application Development (PACMAD) usability model in a mixed methods design. The study's multistage data collection encompasses sociodemographic data and quantitative questionnaires about health literacy (European Health Literacy Survey Questionnaire [HLS-EU-Q16]), electronic health literacy (revised German eHealth Literacy Scale [GR-eHEALS]), media affinity, depressive symptoms (9-item Patient Health Questionnaire [PHQ-9]), and perceived usability (System Usability Scale [SUS]), as well as a qualitative think-aloud and semistructured interview. Participants were equally allocated to use either deprexis or Selfapy. Recruitment of 18 participants was conducted at 3 hospital departments (ie, psychiatry, psychosomatics, and geriatrics) in spring 2024. Participants were eligible if they were aged ≥60 years, were diagnosed with mild or moderate depressive disorder, owned a digital device, and gave written consent to participate. Quantitative analysis revealed age, gender, depressive severity, and health literacy parity between both groups. Selfapy users displayed marginally lower technical proficiency and lower usability scores. Qualitative data showed lower usability among participants in the Selfapy group due to design-related errors and higher cognitive load. Despite visual, psychomotor, and cognitive challenges, participants endorsed both DiGA for older users, stressing the importance of assistance and practicing the usage. Reported difficulties in usability may help to improve future DiGA development for older people, especially as the willingness to use DiGA exists.

Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.