Retrospective, Multicenter Analysis Comparing Conventional with Oncoplastic Breast Conserving Surgery: Oncological and Surgical Outcomes in Women with High-Risk Breast Cancer from the OPBC-01/iTOP2 Study.

INTRODUCTION: Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). METHODS: Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. RESULTS: A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 ("ink on tumor") in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. CONCLUSIONS: Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.

Antibiotic prophylaxis in breast cancer surgery (PAUS trial): randomised clinical double-blind parallel-group multicentre superiority trial.

BACKGROUND: Participants were patients with invasive breast cancer undergoing primary surgery. The aim was to test whether a single dose of amoxicillin-clavulanic acid would reduce wound infection at 30 days postoperatively, and to identify risk factors for infection. METHODS: Participants were randomised to either a single bolus of 1.2 g intravenous amoxicillin-clavulanic acid after the induction of anaesthesia (intervention) or no antibiotic (control). The primary outcome was the incidence of wound infection at 30 days postoperatively. RESULTS: There were 871 evaluable patients. Of these, 438 received prophylactic antibiotic and 433 served as controls. Seventy-one (16.2 per cent) patients in the intervention group developed a wound infection by 30 days, while there were 83 (19.2 per cent) infections in the control group. This was not statistically significant (odds ratio (OR) 0.82, 95 per cent c.i. 0.58 to 1.15; P = 0.250). The risk of infection increased for every 5 kg/m2 of BMI (OR 1.29, 95 per cent c.i. 1.10 to 1.52; P = 0.003). Patients who were preoperative carriers of Staphylococcus aureus had an increased risk of postoperative wound infection; however, there was no benefit of preoperative antibiotics for patients with either a high BMI or who were carriers of S. aureus. CONCLUSION: There was no statistically significant or clinically meaningful reduction in wound infection at 30 days following breast cancer surgery in patients who received a single dose of amoxicillin-clavulanic acid preoperatively. REGISTRATION NUMBER: N0399145605 (National Research Register).

There is little research about antibiotics in breast cancer surgery. Surgeons are not certain whether or not to use antibiotics for their patients. The aim of the Prophylactic Antibiotic Use in Surgery (PAUS) trial was to ask a question, 'Do preoperative antibiotics have any benefit for patients having surgery for breast cancer?' In the PAUS trial patients were given information to decide whether they wished to take part in the trial or not. Participants were randomly placed in one of two groups. Half were given one dose of the amoxicillin­clavulanic acid antibiotic at the time of their operation. The other half had no antibiotic. Neither the patient nor the surgeon knew which group the patient was in. Patients were carefully checked until 30 days after their operation for signs of wound infection. Altogether, 871 patients agreed to take part in the PAUS trial. Of these, 438 patients had the antibiotic and 433 had no antibiotic. The PAUS trial showed that there was no difference in the number of wound infections when comparing the two groups. Seventy-one patients (16.2 per cent) who had been given the antibiotic developed a wound infection by 30 days versus 83 (19.2 per cent) in the group who had not been given the antibiotic. This trial shows that antibiotics may not be needed for breast cancer surgery. PAUS may help to cut down on unnecessary antibiotic use.

Prognostic role of preoperative circulating systemic inflammatory response markers in primary breast cancer: meta-analysis.

BACKGROUND: Circulating markers of the systemic inflammatory response are prognostic in several cancers, but their role in operable breast cancer is unclear. A systematic review and meta-analysis of the literature was carried out. METHODS: A search of electronic databases up to August 2020 identified studies that examined the prognostic value of preoperative circulating markers of the systemic inflammatory response in primary operable breast cancer. A meta-analysis was carried out for each marker with more than three studies, reporting a HR and 95 per cent confidence interval for disease-free survival (DFS), breast cancer-specific survival (BCSS) or overall survival (OS). RESULTS: In total, 57 studies were reviewed and 42 were suitable for meta-analysis. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with worse overall survival (OS) (pooled HR 1.75, 95 per cent c.i. 1.52 to 2.00; P < 0.001), disease-free survival (DFS) (HR 1.67, 1.50 to 1.87; P < 0.001), and breast cancer-specific survival (BCSS) (HR 1.89, 1.35 to 2.63; P < 0.001). This effect was also seen with an arithmetically-derived NLR (dNLR). Higher platelet-to-lymphocyte ratio (PLR) was associated with worse OS (HR 1.29, 1.10 to 1.50; P = 0.001) and DFS (HR 1.58, 1.33 to 1.88; P < 0.001). Higher lymphocyte-to-monocyte ratio (LMR) was associated with improved DFS (HR 0.65, 0.51 to 0.82; P < 0.001), and higher C-reactive protein (CRP) level was associated with worse BCSS (HR 1.22, 1.07 to 1.39; P = 0.002) and OS (HR 1.24, 1.14 to 1.35; P = 0.002). CONCLUSION: Current evidence suggests a role for preoperative NLR, dNLR, LMR, PLR, and CRP as prognostic markers in primary operable breast cancer. Further work should define their role in clinical practice, particularly reproducible thresholds and molecular subtypes for which these may be of most value.

"Raising the curtain on the equality theatre": a study of recruitment to first healthcare job post-qualification in the UK National Health Service.

BACKGROUND: UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations. AIM: To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups. METHODS: The study was informed by critical theory and the authors' interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers. RESULTS: Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches. CONCLUSION: These accounts from 12 recruiting managers give a 'backstage' view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to 'raise the curtain on the equality theatre' and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.

Ensuring patient and public involvement in the transition to AI-assisted mental health care: A systematic scoping review and agenda for design justice.

BACKGROUND: Machine-learning algorithms and big data analytics, popularly known as 'artificial intelligence' (AI), are being developed and taken up globally. Patient and public involvement (PPI) in the transition to AI-assisted health care is essential for design justice based on diverse patient needs. OBJECTIVE: To inform the future development of PPI in AI-assisted health care by exploring public engagement in the conceptualization, design, development, testing, implementation, use and evaluation of AI technologies for mental health. METHODS: Systematic scoping review drawing on design justice principles, and (i) structured searches of Web of Science (all databases) and Ovid (MEDLINE, PsycINFO, Global Health and Embase); (ii) handsearching (reference and citation tracking); (iii) grey literature; and (iv) inductive thematic analysis, tested at a workshop with health researchers. RESULTS: The review identified 144 articles that met inclusion criteria. Three main themes reflect the challenges and opportunities associated with PPI in AI-assisted mental health care: (a) applications of AI technologies in mental health care; (b) ethics of public engagement in AI-assisted care; and (c) public engagement in the planning, development, implementation, evaluation and diffusion of AI technologies. CONCLUSION: The new data-rich health landscape creates multiple ethical issues and opportunities for the development of PPI in relation to AI technologies. Further research is needed to understand effective modes of public engagement in the context of AI technologies, to examine pressing ethical and safety issues and to develop new methods of PPI at every stage, from concept design to the final review of technology in practice. Principles of design justice can guide this agenda.

What are friends for? The impact of friendship on communicative efficiency and cortisol response during collaborative problem solving among younger and older women.

Conversation is a skilled activity that depends on cognitive and social processes, both of which develop through adulthood. We examined the effects of age and partner familiarity on communicative efficiency and cortisol reactivity. Younger and older women interacted with familiar or unfamiliar partners in a dyadic collaborative conversation task (N = 8 in each group). Regardless of age, referential expressions among familiar and unfamiliar partners became more efficient over time, and cortisol concentrations were lower for speakers interacting with familiar partners. These findings suggest that communicative effectiveness is largely preserved with age, as is the stress-buffering effect of a familiar partner.

Linking openness to cognitive ability in older adulthood: The role of activity diversity.

Relatively few studies have examined the reasons older individuals participate in activities that may benefit cognition with aging. Personality traits, particularly, openness to experience, are likely to influence how activities are selected. Openness to experience has also reliably shown to relate to cognitive and intellectual capacities. The current study tested whether diversity in activity helped to explain the overlap between openness to experience and cognitive functioning in an older adult sample (n = 476, mean age: 72.5 years). Results suggest that openness is a better predictor of activity diversity than of time spent engaged in activities or time spent in cognitively challenging activities. Further, activity diversity explained significant variance in the relationship between openness and cognitive ability for most constructs examined. This relationship did not vary with age, but differed as a function of education level, such that participating in a more diverse array of activities was most beneficial for those with less formal education. These results suggest that engagement with a diverse behavioral repertoire in late life may compensate for lack of early life resources.

The Intersection of Physical Function, Cognitive Performance, Aging, and Multiple Sclerosis: A Cross-sectional Comparative Study.

OBJECTIVE: To examine the associations between physical function (walking speed and endurance and functional mobility) and cognitive function (information processing speed and verbal memory) in older adults with multiple sclerosis (MS) and healthy controls. BACKGROUND: Older adults with MS have worse physical and cognitive function than older adults without MS and young and middle-aged adults with MS. To date, little is known about the associations between, or coupling of, physical and cognitive function outcomes in older adults with MS. METHODS: We administered physical and cognitive function measures to 40 older adults with MS and 40 demographically matched healthy controls. Pearson product moment correlations were used to examine bivariate linear relationships in the overall sample and in the subsamples of (a) older adults with MS and (b) healthy controls. Linear regression analyses were used to examine the independent associations between demographic characteristics and physical and cognitive function variables in the two subsamples. RESULTS: In the overall sample, all physical function variables were significantly correlated with cognitive function, as measured by information processing speed, and these correlations were mainly due to the subsample of older adults with MS. The linear regression analyses further indicated that information processing speed and years of education consistently explained variance in all physical function variables, beyond the influence of demographic variables, in older adults with MS. CONCLUSIONS: Physical function and information processing speed are strongly correlated in older adults with MS. Future research should examine underlying neurobehavioral mechanisms associated with physical and cognitive function as well as behavioral strategies for jointly improving these functions in older adults with MS.

Doing What Makes You Happy: Health Message Framing for Younger and Older Adults.

Background: Health-related messages, framed in terms of gains or losses, can impact decision-making differently across the adult life span. The focus of this study was on the emotional responses evoked by such framing and their relationship to perceived effectiveness, as mechanisms that may underpin how health messages impact health decisions. Methods: A web-based study using Amazon's Mechanical Turk platform was conducted with a sample of 132 younger adults and 106 older adults. Participants were asked to read exercise-related messages framed in terms of gains or losses, and to rate each message for affect and effectiveness. Results: Relative to younger adults, older adults showed less negative reactions to loss-framed messages and to messages that described undesirable outcomes. Importantly, younger and older adults differentially used affective cues to gauge effectiveness of framed messages: for gain-framed messages (which tended to evoke positive affect), older adults found messages that made them feel good to be more effective; but for loss-framed messages (which tend to evoke negative affect), younger adults found messages that made them feel bad to be more effective. Conclusions: These results suggest that in processing health messages, older adults may be more motivated by positive affect, while younger adults may be more motivated by negative affect.

Age Differences in Language Segmentation.

Reading bears the evolutionary footprint of spoken communication. Prosodic contour in speech helps listeners parse sentences and establish semantic focus. Readers' regulation of input mirrors the segmentation patterns of prosody, such that reading times are longer for words at the ends of syntactic constituents. As reflected in these "micropauses," older readers are often found to segment text into smaller chunks. The mechanisms underlying these micropauses are unclear, with some arguing that they derive from the mental simulation of prosodic contour and others arguing they reflect higher-level language comprehension mechanisms (e.g., conceptual integration, consolidation with existing knowledge, ambiguity resolution) that are common across modality and support the consolidation of the memory representation. The authors review evidence based on reading time and comprehension performance to suggest that (a) age differences in segmentation derive both from age-related declines in working memory, as well as from crystallized ability and knowledge, which have the potential to grow in adulthood, and that (b) shifts in segmentation patterns may be a pathway through which language comprehension is preserved in late life.

Memory and comprehension for health information among older adults: distinguishing the effects of domain-general and domain-specific knowledge.

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60-88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.

Modelling longitudinal changes in older adults' memory for spoken discourse: findings from the ACTIVE cohort.

Episodic memory shows substantial declines with advancing age, but research on longitudinal trajectories of spoken discourse memory (SDM) in older adulthood is limited. Using parallel process latent growth curve models, we examined 10 years of longitudinal data from the no-contact control group (N = 698) of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomised controlled trial in order to test (1) the degree to which SDM declines with advancing age, (2) the predictors of these age-related declines and (3) the within-person relationship between longitudinal changes in SDM and longitudinal changes in fluid reasoning and verbal ability over 10 years, independent of age. Individuals who were younger, were White, had more years of formal education, were male and had better global cognitive function and episodic memory performance at baseline demonstrated greater levels of SDM on average. However, only age at baseline uniquely predicted longitudinal changes in SDM, such that declines accelerated with greater age. Independent of age, within-person decline in reasoning ability over the 10-year study period was substantially correlated with decline in SDM (r = .87). An analogous association with SDM did not hold for verbal ability. The findings suggest that longitudinal declines in fluid cognition are associated with reduced spoken language comprehension. Unlike findings from memory for written prose, preserved verbal ability may not protect against developmental declines in memory for speech.

Exploring the nature and impact of leadership on the local implementation of the Productive Ward Releasing Time to Care.

PURPOSE: The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care organisations. DESIGN/METHODOLOGY/APPROACH: Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to Care in English hospitals, the paper explores leadership in relation to local implementation. Data were attained from in-depth interviews with senior managers, middle managers and frontline staff (n = 79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership. FINDINGS: Four overall themes were identified: different leadership roles at multiple levels of the organisation, experiences of "good and bad" leadership styles, frontline staff having a sense of permission to lead change, leader's actions to spread learning and sustain improvements. ORIGINALITY/VALUE: This paper offers useful perspectives in understanding informal, emergent, developmental or shared "new" leadership because it emphasises that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader's boundary spanning activities to spread learning and sustain improvements.

Exploring a career pathway for home support workers in Ireland: a systematic scoping review of the international evidence.

Background: In prosperous nations like Ireland, home support workers (HSWs) play an increasingly vital role in providing person-centred care to ageing populations. However, challenges such as workforce shortages, role ambiguity, low pay, and limited career advancement, hinder workforce development and career building. Method: A scoping review using key terms for "HSWs" and "career pathways" was conducted following the Joanna Briggs Institute Methodology, examining electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PscyINFO, Social Care Online, Social Sciences Citation Index). Inclusion criteria were applied, and a thematic analysis followed and inductive-deductive approach. Results: The review encompassed 261 relevant articles from different countries. Four key themes were identified: (1) Data-driven decision-making on the future workforce, (2) Attracting and developing a competent and motivated home support workforce, (3) Enhancing working lives and retention at every stage of career pathways, and (4) Crafting career pathways to improve quality and impact. Discussion: Leadership, collaboration, and data-driven decision-making across policy, research and practice are pivotal for expanding and enhancing home support. Emphasising a shift towards preventative self-management models, supported by digitally skilled and regulated HSWs, could enhance independence and quality of care. Clear career structures, professional development, and inclusive organisational environments are essential to attract, retain, and empower a competent and motivated workforce, fostering quality and impact. Conclusion: This scoping review provides foundational evidence to establish career pathways for HSWs, identifying key areas for development such as data collection, care model transformation, career progression structures, and systems for safety and quality improvement.

Adult age differences in language, communication, and learning from text.

This is an introduction to the special issue "Adult Age Differences in Language, Communication, and Learning from Text." These articles illustrate the great variety of language use through the adult lifespan, tell us a little more-and invite further inquiry. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

StoryAid: Nursing Students' Relational Learning for Adolescents With Intellectual Learning Disabilities.

BACKGROUND: Nursing students express fears and anxieties about caring for people with intellectual learning disabilities (ILDs). Educational storytelling interventions may help overcome these concerns and improve nursing care. METHOD: StoryAid was used and developed in the Heritage-2Health (H2H) Virtual Art and Drama Project. Eight online sessions followed a story about differences and connections. Two trained facilitators and three academic educators supported nursing students (n = 15), adolescents with ILDs (n = 7), their parents (n = 7), and a specialist teacher to deconstruct, reconnect, and rediscover understandings using rights-based ethnographic evaluation and thematic analysis. RESULTS: Themes included relating to the story and characters, participating in the storytelling process, relating to other participants in the storytelling, and relating learning to clinical contexts and professionalism. CONCLUSION: The partnership of StoryAid and H2H created safe spaces for nursing students to engage, challenge assumptions, and develop relational skills. [J Nurs Educ. 2023;62(1):51-57.].

High expression of STAT3 within the tumour-associated stroma predicts poor outcome in breast cancer patients.

INTRODUCTION: Triple-negative breast cancer (TNBC) patients have the poorest clinical outcomes compared to other molecular subtypes of breast cancer. IL6/JAK/STAT3 signalling is upregulated in breast cancer; however, there is limited evidence for its role in TNBC. This study aimed to assess the expression of IL6/JAK/STAT3 in TNBC as a prognostic biomarker. METHODS: Tissue microarrays consisting of breast cancer specimens from a retrospective cohort (n = 850) were stained for IL6R, JAK1, JAK2 and STAT3 via immunohistochemistry. Staining intensity was assessed by weighted histoscore and analysed for association with survival/clinical characteristics. In a subset of patients (n = 14) bulk transcriptional profiling was performed using TempO-Seq. Nanostring GeoMx® digital spatial profiling was utilised to establish the differential spatial gene expression in high STAT3 tumours. RESULTS: In TNBC patients, high expression of stromal STAT3 was associated with reduced cancer-specific survival (HR = 2.202, 95% CI: 1.148-4.224, log rank p = 0.018). TNBC patients with high stromal STAT3 had reduced CD4+ T-cell infiltrates within the tumour (p = 0.001) and higher tumour budding (p = 0.003). Gene set enrichment analysis (GSEA) of bulk RNA sequencing showed high stromal STAT3 tumours were characterised by enrichment of IFNγ, upregulation of KRAS signalling and inflammatory signalling Hallmark pathways. GeoMx™ spatial profiling showed high stromal STAT3 samples. Pan cytokeratin (panCK)-negative regions were enriched for CD27 (p < 0.001), CD3 (p < 0.05) and CD8 (p < 0.001). In panCK-positive regions, high stromal STAT3 regions had higher expression of VEGFA (p < 0.05). CONCLUSION: High expression of IL6/JAK/STAT3 proteins was associated with poor prognosis and characterised by distinct underlying biology in TNBC.

Implementing large-scale quality improvement: lessons from The Productive Ward: Releasing Time to Care.

PURPOSE: This paper aims to focus on facilitating large-scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to Care programme in English hospitals. DESIGN/METHODOLOGY/APPROACH: The study upon which the paper draws was a mixed-method evaluation that aimed to capture the perceptions of three main stakeholder groups: national-level policymakers (15 semi-structured interviews); senior hospital managers (a national web-based survey of 150 staff); and healthcare practitioners (case studies within five hospitals involving 58 members of staff). The views of these stakeholder groups were analysed using a diffusion of innovations theoretical framework to examine aspects of the innovation, the organisation, the wider context and linkages. FINDINGS: Although The Productive Ward was widely supported, stakeholders at different levels identified varying facilitators and challenges to implementation. Key issues for all stakeholders were staff time to work on the programme and showing evidence of the impact on staff, patients and ward environments. RESEARCH LIMITATIONS/IMPLICATIONS: To support implementation, policymakers should focus on expressing what can be gained locally using success stories and guidance from "early adopters". Service managers, clinical educators and professional bodies can help to spread good practice and encourage professional leadership and support. Further research could help to secure support for the programme by generating evidence about the innovation, and specifically its clinical effectiveness and broader links to public expectations and experiences of healthcare. ORIGINALITY/VALUE: This paper draws lessons from the implementation of The Productive Ward programme in England, which can inform the implementation of other large-scale programmes of quality improvement in health care.

Research practices for a robust psychological science of adult development and aging.

This first issue of 2022 marks the transition of Psychology and Aging in adopting a transparency and openness promotion (TOP) framework. The journal has always had high standards for theoretically meaningful research conducted with methodological and analytic rigor. As the Open Science movement has gathered steam, authors are increasingly submitting papers that fully meet TOP standards at Levels 1 or 2, and those who do not, have generally been quite happy to respond to the gentle nudges of the journal's editors. Thus, in practical terms, the changes at this point are actually quite modest. In what follows, Stine-Morrow addresses questions about the new standards: (a) Why now? and (b) What are they? (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review.

Background: Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored. Objectives: The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare? Materials and methods: A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice. Results: Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships. Conclusion: There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships. Implications: In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.