Understanding General Activity Motivation for Persons with Stroke—A Reversal Theory Perspective

Introduction: Motivation is the barrier identified for clients with stroke to reintegrate community living. Reversal Therapy may help to understand the pattern of bipolar variations of motivational factors. This study analyzed the general activity motivation of clients with stroke and their relationship with community participation and mental wellbeing. Methodology: Sampling of 115 subjects including 30 stroke clients and 85 normal subjects. Measurements included the validated Chinese version of General Activity Motivation Measure (GAMM), Community Integration Questionnaire (CIQ) & Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Results: In GAMM, the normal group scores (Mean 50.09 SD 5.79) higher then clients with stroke (Mean 46.09; SD 8.00) (p < 0.05). GAMM correlated positively with CIQ and SWEMWBS (p < 0.05). Four factors identified under GAMM namely Means-end, Relationship, Rules and Transactions that identified with Reversal Theory. Reversals between poles of each domain evidenced between two groups. “Acquiring new experiences” was strong predictor for community integration. Conclusion: Reversal Theory is useful to explain motivational changes among clients with stroke. To develop chances of “new experiences”, “feel accomplishment every day”, “get out of house regularly” and “to do the things that they can enjoy” at “their own pace” are the motivators for reintegrate into community living

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries