ObjectiveTo define clinical empathy from the perspective of healthcare workers and patients from a multicultural setting.DesignGrounded theory approach using focus group discussions.SettingA health cluster in Singapore consisting of an acute hospital, a community hospital, ambulatory care teams, a medical school and a nursing school.Participants69 participants including doctors, nurses, medical students, nursing students, patients and allied health workers.Main outcome measuresA robust definition of clinical empathy.ResultsThe construct of clinical empathy is consistent across doctors, nurses, students, allied health and students. Medical empathy consists of an inner sense of empathy (imaginative, affective and cognitive), empathy behaviour (genuine concern and empathic communication) and a sense of connection (trust and rapport). This construct of clinical empathy is similar to definitions by neuroscientists but challenges a common definition of clinical empathy as a cognitive process with emotional detachment.ConclusionsThis paper has defined clinical empathy as ‘a sense of connection between the healthcare worker and the patient as a result of perspective taking arising from imaginative, affective and cognitive processes, which are expressed through behaviours and good communication skills that convey genuine concern’. A clear and multidimensional definition of clinical empathy will improve future education and research efforts in the application and impact of clinical empathy.

No abstract

Background Healthcare professionals’ empathetic behaviors have been known to lead to higher satisfaction levels and produce better health outcomes for patients. However, empathy could decrease over time especially during training and clinical practice. This study explored factors that contributed to the development of empathy in the healthcare setting. Findings could be used to improve the effectiveness and sustainability of empathy training. Method A qualitative approach, informed by aspects of grounded theory, was utilized to identify factors that enabled the development of empathy from the perspectives of doctors, nurses, allied healthcare workers and students. Twelve sessions of focus group discussions were conducted with 60 participants from two hospitals, a medical school, and a nursing school. Data was analyzed independently by three investigators who later corroborated to refine the codes, subthemes, and themes. Factors which influence the development of empathy were identified and categorized. This formed the basis of the creation of a tentative theory of empathy development for the healthcare setting. Results The authors identified various personal (e.g. inherent characteristics, physiological and mental states, professional identity) and external (e.g. work environment, life experience, situational stressors) factors that affected the development of empathy. These could be further categorized into three groups based on the stability of their impact on the individuals’ empathy state, contributed by high, medium, or low stability factors. Findings suggest empathy is more trait-like and stable in nature but is also susceptible to fluctuation depending on the circumstances faced by healthcare professionals. Interventions targeting medium and low stability factors could potentially promote the development of empathy in the clinical setting. Conclusions Understanding factors that impact the development of empathy allows us to develop measures that could be implemented during training or at the workplace leading to improve the quality of care and higher clinical work satisfaction.

Objective To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients. Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021. Methods A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis. Results Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported. Conclusion There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

Objective. This study aims to compare older and younger patients with COVID-19 infection in terms of patient characteristics, presenting symptoms, laboratory parameters, complications, treatment received, and outcomes.Methods. Medical records of patients aged ≥12 years who were admitted to Hospital Tengku Ampuan Rahimah between 1 January 2021 and 31 June 2021 with polymerase chain reaction-proven COVID-19 infection were retrospectively reviewed. Data collected included sociodemographic data (age, ethnicity, sex, and residence), comorbidities, COVID-19 presentation (acute presenting symptoms, primary working diagnosis, disease severity, laboratory parameters on admission, and treatment received), and outcomes (complications, length of hospital stay, discharge destination, oxygen support required, and mortality).Results. A total of 259 patients aged 18 to 91 years were admitted to our hospital with COVID-19 infection. Of them, 182 (70.3%) were younger patients and 77 (29.7%) were older patients (aged >60 years). More older patients than younger patients had comorbidities (87.0% vs 49.5%, p<0.001) and presented with delirium (13% vs 0.5%, p<0.001) and lethargy (33.8% vs 15.9%, p=0.001). More older patients had severe COVID-19 infection (72.7% vs 38.5%, p<0.001), with 9.1% necessitating intubation. More older patients were prescribed favipiravir (64.9% vs 32.4%, p<0.001), antibiotics (76.6% vs 44%, p<0.001), and steroid (75.3% vs 40.1%, p<0.001). More older patients required intensive care (32.5% vs 17%, p=0.003). More older patients developed complications such as secondary infection (41.6% vs 17%, p<0.001) and acute kidney injury necessitating dialysis (20.8% vs 8.8%, p=0.005). Older patients had longer length of hospital stay (14 vs 12 days, p<0.001) and higher mortality (18.2% vs 4.4%, p<0.001). Conclusion.Older patients with COVID-19 infection tend to have more severe disease, higher complication rate, and higher mortality. Timely management is essential to minimise morbidity and mortality.