Clinical Disciplines Research Articles

A Multimodal Educational Boot Camp for Training Fellows in Pediatric Extracorporeal Membrane Oxygenation (ECMO).

Pediatric extracorporeal membrane oxygenation (ECMO) management presents unique challenges in acute care settings, requiring specialized expertise to manage critically ill children. Medical and surgical fellows often manage these patients, but prior residency training rarely provides sufficient ECMO exposure. We developed and evaluated a multimodal pediatric ECMO boot camp for new fellows. This boot camp was implemented during 5-hour sessions in August 2021, August 2022, and August 2023. The curriculum included a 45-minute introductory didactics session, 30-minute hands-on circuit demonstration, and four 30-minute small-group activity stations. To assess knowledge acquisition, pre- and posttests were administered; participants also completed a post-boot camp survey to evaluate their confidence and provide feedback. Forty-nine participants completed the boot camp, including 18 critical care, four cardiology, 11 pediatric surgery, 12 cardiothoracic surgery, and four pediatric emergency medicine fellows. Pre- and posttests demonstrated significant improvement in knowledge of ECMO circuit components and pressures (56% vs. 76%, p < .001). All of our participants agreed or strongly agreed that participating in the boot camp increased their confidence in troubleshooting ECMO emergencies. The inclusion of fellows from various clinical disciplines, offering a rich diversity of perspectives, was particularly valued by participants. Our results demonstrate the feasibility and effectiveness of establishing a pediatric ECMO boot camp to train new surgical and medical fellows. The curriculum not only improved ECMO knowledge but also boosted learners' confidence in managing ECMO-related challenges.

Effects of Mantram Repetition on Spiritual Well-Being: A Systematic Review and Meta-Analysis.

Background: Spiritual well-being is an essential component of whole-person care and is increasingly recognized in various clinical disciplines as positively affecting mental health. Mantram repetition (MR) is an intervention rooted in Eastern spiritual traditions that has been shown to have clinical benefits, including reduction of psychological distress, among individuals with chronic psychological conditions. The central aim of this meta-analysis was to examine the effects of MR on spiritual well-being. Methods: Fifteen databases were searched from their inception year to July 19, 2023. Two independent reviewers extracted and coded data from randomized or quasi-experimental studies with comparison groups, conducted to test MR, measured spiritual well-being, and reported their study in English. Coded data included study quality indicators which were used in moderator analyses. Results: After the initial and updated searches and removal of duplicates, we reviewed 2,072 articles; seven studies met inclusion criteria with a total sample size of 556 (MR = 272, comparison = 284). Overall, MR had a positive effect on spiritual well-being with a pooled effect size of 0.535 with Hartung-Knapp-Sidik-Jonkman adjusted 95% confidence intervals of 0.18 and 0.89 (p = 011). Using moderator analyses, we examined the effect of the quality indicators and intervention characteristics on effect size; only session length was significant. Longer MR intervention sessions (i.e., 90 min) had greater effects than shorter sessions (i.e., 50-60 min). Conclusions: Across these seven studies, MR showed moderate to strong effects on spiritual well-being. Additional studies are needed to determine the reliability of these findings.

CLINICAL CONFERENCE ON PRACTICAL CLASSES IN DENTAL THERAPY

The modern education reform in Ukraine aims to provide high-quality subject training for specialists while reducing classroom load and increasing access to information. One of the ways to solve this problem is to introduce new, more effective methods and technologies of learning. An essential stage in training of doctors from the first years of study is the formation of clinical thinking, the ability to analyze and synthesize data, determine the criteria for making a diagnosis, and draw up a rational treatment plan. Developing this ability requires knowledge and practical experience, starting in educational institutions and continuing in clinical settings. Technologies and techniques of learning and teaching clinical disciplines are gaining particular relevance and determining importance. The training of dentists at the Department of Dental Therapy of I. Horbachevsky Ternopil National Medical University always meets the requirements of the times. Special attention is paid not only to the high-quality teaching of the discipline but also to the diversification of the organization of practical classes. The early years of medical specialists' training are crucial for developing clinical thinking. This process hones the ability to analyze and systematize data, define criteria for establishing a diagnosis, and compile a plan of effective treatment. At I. Horbachevsky Ternopil National Medical University, special attention is given to the qualitative teaching of the discipline and the diversification of the pedagogical process, with the clinical conference playing a pivotal role in this development. At the Dental Therapy Department, the study of the 'Dental Therapy' discipline concludes with a student clinical conference, a good tradition. This conference, held for the 5th-year students in the X semester, involves three groups of students who are currently completing their study of the subject. In each group, a student-curator who represents a specific clinical case is selected. Students present reports with a visual presentation of the patient's clinical condition, the results of the primary and additional methods of examination, differential diagnosis of the disease, the treatment scheme of the patient and its effectiveness. An important stage at the conference is the performance of prepared opponents, who are appointed from among the students of another group. On the eve of the meeting, the opponents directly familiarize themselves with the work of the student-curator, analyze the sequence of the patient's examinations, the correctness of the diagnosis, the preparation of medical documentation, the differential diagnosis of the disease, evaluate the treatment scheme, ask questions and express observations. The lecturers play a crucial role in this process, providing guidance and doing summaries of the clinical conference, ensuring that the learning objectives are met and the student's progress is acknowledged. Clinical conferences, are not just about deepening and systematizing theoretical knowledge or developing clinical thinking. They also provide a unique and invaluable opportunity for students to gain experience in public speaking. This experience, coupled with the development of personal qualities such as communication and cooperation, prepares students for the challenges they will face in their future careers. This holistic approach to medical education is a key part of the learning process, instilling confidence and readiness in the students.

Developing a Clinical Service in Interventional Radiology: Results from the 2024 CIRSE Clinical Practice Survey.

Engaging in clinical service development is a prerequisite for Interventional Radiology (IR) to prosper as a full clinical discipline. The CIRSE Clinical Services in IR Task Force conducted a survey of CIRSE members worldwide to assess the current status of their clinical practice and to identify areas of practice requiring further support. An online questionnaire with 63 structured items was sent to 7,501 CIRSE members in November 2023. The survey was closed in January 2024 and a statistical data analysis was performed. A total of 520 complete responses were collected. 49.6% of respondents have an IR outpatient clinic, 34.5% have a dedicated IR day-case ward and 19.8% have dedicated inpatient beds. While 62% of respondents treat patients as the primary consultant responsible for their patients' care, 40.3% of respondents currently without their own beds have admitting rights to the hospital. Clinical practice activities are itemised in the work schedule of 41.3% of respondents and 45% routinely perform ward rounds. A total of 40% feel very positive with their personal clinical practice competency. With half of responding IRs having primary patient access and clinical services in place, the results are encouraging; however further engagement by those who are not yet involved is required. The authors advocate a step-wise approach towards clinical services starting with ward rounds, and subsequently taking increasing responsibility for each step in the IR patient pathway.

Transitioning to rural practice together: a rural fellowship model (in 6 Ps).

Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice. To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework. An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills. The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

Effective Clinical Externships for International Medical Students: A Qualitative Study.

International student exchanges are a significant part of medical education, and experiences of North American and European medical students abroad have been extensively examined. By contrast, knowledge of visiting medical students in the United States (US) is limited largely to surveys of administrators and course directors. To understand US attending physicians' thoughts on visiting international student clinical externships. Three clinician-educator physician focus groups were conducted across two US medical schools with broad representation of training backgrounds, clinical disciplines, and career stages. Focus groups and constant comparison analysis of transcripts were performed iteratively to identify emerging themes. Qualitative themes and subthemes. Two main themes emerged from the data: (1) administrative requirements for success: hosting international students requires careful planning and coordination, which is daunting amidst demanding faculty responsibilities. Externships must address experiences of the people directly involved in the clinical setting, leadership, communication, and institutional, financial, physical, and personnel resources. (2) Impact of student qualities: When working with international students, the importance of administrative details and student characteristics increases due to higher student variability overall, inconsistent language and cultural fluency, and the consequent recognition of the student as an ambassador for their home institution and country. Amidst already busy schedules, clinician educators identify the hosting of international medical students as a commitment resembling that for their own trainees. Linguistic and cultural distances, and the overall variability of international students amplify the importance of effective administration. The findings have influenced related processes at the University of Pittsburgh.

Building RECOVERY: development of the registry of eating disorders and their co-morbidities OVER time in youth

BackgroundEating disorder (ED) research is limited by the lack of longitudinal cohort studies, particularly those in adolescents, and the lack of inclusion of multiple perspectives and diagnoses. The objective of this study was to describe the development of a longitudinal cohort of adolescents/young adults representing varied ED diagnoses and including perspectives of parents and multi-disciplinary clinicians in addition to those of patients.MethodsPatients of an outpatient ED program who were age 10–27 years, along with their parents and clinicians, were recruited to participate in a longitudinal web-based study. Using univariate, bivariate, and multivariate analyses, we assessed rates of participation among different groups (i.e., parents, patients, different clinical disciplines) as well as factors related to attrition.Results71% of patients, 75% of parents, 56% of adolescent medicine providers, 20% of primary care physicians, 83% of dietitians, and 80% of mental health clinicians invited agreed to participate. At 12 months, 32% of patient participants had not completed their on-line surveys. Attrition rates were higher for parents (55%) and clinicians (45% of nutritionists, 55% of primary care physicians, 51% of Adolescent/Young Adult providers, and 64% of mental health providers) at 12 months.ConclusionsA longitudinal registry of patients with EDs is feasible and efficient when using web-based surveys. However, clinician participation is particularly hard to secure and maintain.

Functional Tricuspid Regurgitation in the Transcatheter Aortic Valve Replacement Population and Emerging Transcatheter Tricuspid Valve Interventions

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic valve disease. However, its success has brought attention to concurrent tricuspid valve disease and the inadequacy of treatments. This review explores the emerging field of transcatheter tricuspid valve interventions (TTVI) after TAVR. We address the pathophysiology and prevalence of post-TAVR tricuspid valve disease and TTVI strategies, including repair, replacement, annuloplasty, and edge-to-edge repair. We also discuss clinical studies assessing TTVI safety and efficacy, including for patients with previous TAVR. Collaboration among clinical disciplines remains crucial for advancing this emerging field to establish best practices regarding patient selection and procedural complexities.

Competency Approach in Nurse Training

In the current conditions of market relations, especially in the context of reforming the medical education system, it is necessary to change the quality of training of specialists in order to train demanded and competitive graduates of secondary vocational educational institutions using a competency approach. The competence approach contributes to the orientation of the young specialist to obtain theoretical knowledge, increasing the level of practical knowledge that a graduate of a medical college should have and his ability to master in the labor market. The opinion of medical college students about the knowledge and practical skills required by the graduate is important. To this end, a questionnaire survey of 84 medical college students was conducted. First-year students do not yet have a clear idea of ​ ​ the competence approach in the learning process and the importance of not only theoretical knowledge, but also clinical disciplines, practical communication skills. Students of the 3rd year have already formed an opinion about the importance of all subjects and motivation for future professional training. The introduction of a competency approach in the training of nurses makes it possible to conduct the educational process at a qualitative level, contributing to the training of highly qualified, competitive specialists in the medical labor market.

Application of a Standard Simulation Module as a Tool for Professional Development of Higher Education Teachers

The cycle of advanced training of the faculty on the basis of the Federal Accreditation Center of Perm State Medical University was created to form the professional competencies of students and the work functions of teachers. To introduce practical classes into the programs of clinical disciplines, a standard simulation module (SIM) was used, which is becoming a mandatory basis for the educational process at the University. The analysis of 106 SIM showed the use of simulation equipment and identified problems that are the basis for further development of the course.

Blended learning: An innovative teaching strategy to teach dermatology to the family medicine residents of a teaching hospital.

Medical educators face different challenges in this digital era with the pressure for clinical practice as well as teaching. In blended learning Internet technologies are used along with face-to-face teaching to deliver learning methodologies. To assess the efficacy of the blended learning dermatology course on Family Medicine residents at a teaching hospital. Methodology: It was interventional (pre and post) study with purposive sampling. All the Family Medicine residents enrolled at The Aga Khan University Hospital participated in the study after giving consents. The course covered most common skin conditions. Multiple slide sessions, online lectures, clinical presentations, case-based scenarios, and quizzes were included in the course. Knowledge was assessed through pre- test by multiple choice questions. Post tests were taken after completion of the modules to assess the improvement in the knowledge of residents about basic dermatological conditions by multiple choice questions. After completion of sessions a survey questionnaire was administered to evaluate the perception of participants about blended learning strategy. The tests scores were significantly higher in the post test. The majority of the residents were satisfied with the course delivery. A statistically significant difference was found between pre and post test results with a P value 0.000. Blended learning is an effective and innovative teaching strategy that helped family medicine residents to enhance their learning more effectively. We recommend that this method of teaching strategy should be used in other clinical disciplines in different contexts.didifferent contexts.

Gut bacterial type III secretion systems aggravate colitis in mice and serve as biomarkers of Crohn’s disease

Mesenteric adipose tissue (mAT) hyperplasia, known as creeping fat, is a pathologic characteristic of Crohn's disease (CD). In our previously reported cohort, we observed that Achromobacter pulmonis was the most abundant and prevalent bacteria cultivated from creeping fat. A whole genomic sequencing and identification of T3SS orthologs of mAT-derived A. pulmonis were used. A functional type III secretion system (T3SS) mediated the pathogenic potential of A. pulmonis invitro and in mouse colitis model. Furthermore, a T3SS Finder pipeline was introduced to evaluate gut bacterial T3SS orthologs in the feces of CD patients, ulcerative colitis and colorectal cancer patients. Here, we reveal that mAT-derived A. pulmonis possesses a functional T3SS, aggravates colitis in mice via T3SS, and exhibits T3SS-dependent cytotoxicity via a caspase-independent mechanism in macrophages and epithelial cells, which demonstrated the pathogenic potential of the T3SS-harboring A. pulmonis. Metagenomic analyses demonstrate an increased abundance of Achromobacter in the fecal of Crohn's disease patients compared to healthy controls. A comprehensive comparison of total microbial vT3SS abundance in various intestine diseases demonstrated that the specific enrichment of vT3SS genes was shown in fecal samples of CD, neither ulcerative colitis nor colorectal cancer patients, and ten T3SS gene-based biomarkers for CD were discovered and validated in a newly recruited CD cohort. Furthermore, treatment with exclusive enteral nutrition (EEN), an intervention that improves CD patient symptomatology, was found associated with a significant reduction in the prevalence of T3SS genes in fecal samples. These findings highlight the pathogenic significance of T3SSs in the context of CD and identify specific T3SS genes that could potentially function as biomarkers for diagnosing and monitoring the clinical status of CD patients. This work is supported by the National Key Research and Development Program of China (2020YFA0907800), the China Postdoctoral Science Foundation (2023M744089), the National Natural Science Foundation of China (32000096), the Shenzhen Science and Technology Programs (KQTD20200820145822023, RCIC20231211085944057, and ZDSYS20220606100803007), National Key Clinical Discipline, Guangdong Provincial Clinical Research Center for Digestive Diseases (2020B1111170004), Qingfeng Scientific Research Fund of the China Crohn's & Colitis Foundation (CCCF) (CCCF-QF-2022B71-1), and the Sixth Affiliated Hospital, Sun Yat-sen University Clinical Research 1010 Program 1010CG(2023)-08. These funding provided well support for this research work, which involved data collection, analysis, interpretation, patient recruitment and so on.

Development of Extemporaneous Compounding as an Initiating Factor in the Transformation of Pharmaceutical Education: International Experience and Current Trends

INTRODUCTION. Currently, stakeholders across the Russian medical and pharmaceutical community are focusing on the restoration of national pharmaceutical compounding. The Russian pharmaceutical compounding market, with its great potential for growth, requires highly qualified professionals able to ensure the operation of compounding pharmacies and the proper quality of extemporaneous medicinal products. The effectiveness of training for such specialists can be improved by analysing the experience of educational institutions in countries with developed pharmaceutical compounding systems.AIM. This study aimed to analyse the distinguishing features of training for pharmaceutical compounding specialists, as well as determine the main trends in pharmaceutical compounding education in leading international academic institutions.MATERIALS AND METHODS. The study used methods of logical, comparative, structural, and content analysis. The analysis covered 106 pharmacy and pharmacology curricula of the top-25 higher education providers from the QS World University Rankings by Quacquarelli Symonds. The curricula were analysed using open data published online, particularly, on the official websites of the selected universities.RESULTS. The article presents the distinguishing features of pharmaceutical compounding education at different academic qualification levels; these features include the requirements for applicants, time to degree, competence standards, structure of exams, and specifics of students’ professional engagement, with consideration of the national context. The key trends in the education of specialists in pharmaceutical compounding include a decrease in training time for mid-level specialists; a tendency towards concentrating on clinical disciplines due to the expansion of the roles of pharmacy professionals; a growing focus on specialisation in the areas of paediatric, dental, sterile, veterinary, radiopharmaceutical, and orphan drug compounding; increasing use of simulated practice experiences and online learning technologies; and the development of continuing professional education systems.CONCLUSIONS. Pharmaceutical education programmes of leading international educational organisations include disciplines related to extemporaneous compounding. Current international trends—pharmaceutical education with further specialisation in extemporaneous compounding, integration of simulation technologies and online learning into the educational process, and development of continuing professional education—coincide with the development directions of pharmaceutical education in the Russian Federation. Whereas international pharmacy specialists complete additional professional education programmes to gain an additional specialisation in the extemporaneous preparation of paediatric medicinal products, sterile dosage forms, chemotherapy products, radiopharmaceuticals, veterinary products, and dental products, Russian specialists can acquire these additional competencies through further education programmes at the levels of advanced training and residency.

Pediatric dental clinic transformations post-COVID-19 reopening in a public dental school.

To assess the impact of transformations in pediatric dental clinics following reopening during the COVID-19 pandemic on pediatric dentistry procedures performed by dental students. Data were collected from electronic clinical records of Integrated Dental Clinical disciplines (I, II, III, and IV) from 2018 to 2023. The procedures were categorized into phases: prevention/stabilization, restorative/definitive, and maintenance. The data were analyzed descriptively and by t-test considering the pre-pandemic and pandemic periods (α=5%). During the pandemic, Integrated Dental Clinics I and III saw increased prevention/stabilization procedures percentages (92.4% and 74.3%) compared to pre-pandemic (84.9% and 70%), while Integrated Dental Clinic II and IV saw a decline (76.6% and 66.1%) compared to pre-pandemic (79.1% and 67.9%). Restorative/definitive procedures decreased in Integrated Dental Clinic I and III (5.5% and 20.3%) from pre-pandemic period (10% and 24.1%) but increased in Integrated Dental Clinic II and IV (18.3% and 26.2%) from pre-pandemic (15.3% and 25%). Maintenance procedures decreased in Integrated Dental Clinic I, II, and III (2.1%, 5%, and 5.4%) compared to pre-pandemic (5.1%, 5.6%, and 6%), except for Integrated Dental Clinic IV, which saw an increase (7.8% from 7.2%). Despite the percentage changes, no significant differences were found between the periods analyzed (p>0.05). However, when considering the total procedures across all disciplines and phases, there was a significant decrease during the pandemic in phases 1 and 3 (p<0.05). Despite the changes in pediatric dentistry procedures, the transformations within the dental clinic suggest tangible benefits for the teaching-learning process and safe patient care.

WILLINGNESS TO RANDOMIZE PATIENTS TO LUMBAR SPINE FUSION SURGERY OR CONSERVATIVE CARE IN THE FORENSIC-UK AND FORENSIC-AUSTRALIA TRIALS

Background and PurposeThe UK's NIHR and Australia's NHMRC have funded two randomised controlled trials (RCTs) to determine if lumbar fusion surgery (LFS) is more effective than best conservative care (BCC) for adults with persistent, severe low back pain (LBP) attributable to lumbar spine degeneration. We aimed to describe clinicians’ decision-making regarding suitability of patient cases for LFS or BCC and level of equipoise to randomise participants in the RCTs.MethodsTwo online cross-sectional surveys distributed via UK and Australian professional networks to clinicians involved in LBP care, collected data on clinical discipline, practice setting and preferred care of five patient cases (ranging in age, pain duration, BMI, imaging findings, neurological signs/symptoms). Clinicians were also asked about willingness to randomise each patient case.ResultsOf 174 responses (73 UK, 101 Australia), 70 were orthopaedic surgeons, 34 neurosurgeons, 65 allied health professionals (AHPs), 5 others. Most worked in public health services only (92% UK, 45% Australia), or a mix of public/private (36% Australia). Most respondents chose BCC as their first-choice management option for all five cases (81–93% UK, 83–91% Australia). For LFS, UK surgeons preferred TLIF (36.4%), whereas Australian surgeons preferred ALIF (54%). Willingness to randomise cases ranged from 37–60% (UK mean 50.7%), and 47–55% (Australian mean 51.9%); orthopaedic and neuro-surgeons were more willing than AHPs.ConclusionWhilst BCC was preferred for all five patient cases, just over half of survey respondents in both the UK and Australia were willing to randomise cases to either LFS or BCC, indicating clinical equipoise (collective uncertainty) needed for RCT recruitment.Conflicts of interestNoneSources of fundingNo specific funding obtained for the surveys. DB, SA, AG and NEF have funding from the National Institute for Health Research (NIHR) UK (FORENSIC-UK NIHR134859); NEF, DB and SA have funding from the Australian National Health and Medical Research Council (NHMRC FORENSIC-Australia GA268233). AG has funding from Orthopaedic Research UK (combined with British Association of Spine Surgeons and British Scoliosis Society) and Innovate UK. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182).

Development of a Train-the-Trainer Quality Improvement Curriculum.

Quality improvement (QI) curricula are required for clinical disciplines at all training levels. Despite this, faculty educators often feel inadequately prepared to perform QI functions and thus lack the skills necessary to teach QI to learners. We aimed to improve faculty QI skills so they could oversee didactic curricula and experiential QI projects. We developed a train-the-trainer curriculum for faculty within medicine, nursing, and allied health that was delivered as a 2-hour interactive workshop. Core concepts included QI methodologies, measurement, implementation, and scholarship. Prior to the workshop, attendees completed a baseline knowledge test and a self-assessment of their confidence in teaching QI. Both assessments were repeated 1 month and 6 months postworkshop. Participants also completed a course evaluation. We report on our experience after two workshops with 23 participants total. Baseline median knowledge test percentage correct was 36%. This increased to 77% at 1 month and remained at 57% at 6 months. Self-assessment ratings of QI teaching skills increased consistently from baseline to 1 month to 6 months, with all respondents reporting feeling some confidence or very confident by the end of the study period. The course overall was rated very good or excellent by 91% of attendees. A focused QI train-the-trainer curriculum can sustainably improve faculty knowledge and self-ratings of QI teaching skills. Participants rated the interactive 2-hour workshop highly. Its materials can be easily adapted across disciplines and clinical departments to increase the number of faculty competent to facilitate didactic and experiential QI training.

Clinician Perceptions of Family-Centered Care in Pediatric and Congenital Heart Settings

Family-centered care recognizes families as central to child health and well-being and prioritizes clinician collaboration with families to ensure optimal pediatric care and outcomes. Clinician interpersonal sensitivity and communication skills are key to this approach. To examine perceptions of and factors associated with family-centered care among clinicians working in pediatric and congenital heart care. In this cross-sectional study, participants from diverse clinical disciplines (pediatric cardiology, cardiothoracic surgery, nursing, anesthesia, neonatology, intensive care, psychology, and others), completed an online survey between June 2020 and February 2021. Participants included physicians, surgeons, nurses, and allied and mental health professionals at an Australian quaternary pediatric hospital network. Statistical analysis was performed from August 2022 to June 2023. Family-centered care across 4 domains (showing interpersonal sensitivity, treating people respectfully, providing general information, and communicating specific information) was measured using the validated Measure of Processes of Care for Service Providers. Clinician burnout (emotional exhaustion, depersonalization, and personal accomplishment), confidence responding to families' psychosocial needs, and psychological, clinical role, and sociodemographic factors were also assessed. Informed by theory, hierarchical linear regression was used to identify factors associated with family-centered care. There were 212 clinicians (177 women [84.3%]; 153 nurses [72.2%], 32 physicians [15.1%], 22 allied and mental health professionals [10.4%], 5 surgeons [2.3%]; 170 [80.2%] aged 20-49 years) who participated (55% response rate). Of the 4 family-centered care domains, scores for treating people respectfully were highest and associated with greater clinician confidence responding to families' psychosocial needs (effect size [β], 0.59 [95% CI, 0.46 to 0.72]; P < .001), lower depersonalization (β, 0.04 [95% CI, -0.07 to -0.01]; P = .02), and a greater sense of personal accomplishment at work (β, 0.02 [95% CI, 0.01 to 0.04]; P = 0.04). Greater interpersonal sensitivity was associated with greater confidence responding to families' psychosocial needs (β, 0.80 [95% CI, 0.62 to 0.97]; P < .001), a greater sense of personal accomplishment at work (β, 0.03 [95% CI, 0.01 to 0.05]; P = .04), and lower use of approach-based coping, such as problem-solving (β, 0.37 [95% CI, -0.71 to -0.02]; P = .04). In this cross-sectional study, burnout and confidence responding to families' psychosocial needs were associated with clinicians' perceptions of family-centered care. These findings suggest that targeted interventions to address these factors may benefit clinicians and also potentially strengthen the practice of family-centered care in pediatric and congenital heart settings.

Modern Trends in Development of Educational and Scientific Discipline ‘Public Health and Healthcare’: Its Methodological Role and Integrative Function

INTRODUCTION: In modern conditions of social development, there is a change of emphasis in definitions concerning not only public, but also individual health. Preserving and strengthening the health of the population is a complex task that implies the interaction of various specialists. This integration, the complexity of interaction in issues concerning preserving and strengthening the health of the population, should undoubtedly be reflected in the training of specialists, and, first of all, in higher medical education. AIM: To determine the role of the discipline ‘Public Health and Healthcare’ (PHH) in teaching population health issues and in the integration of departments of various profiles in the study of individual, group and population health in modern conditions. The article presents a discussion about modern trends in the development of the educational and scientific PHH discipline based on the opinions of students, teachers and the experience of Sechenovskiy University. Thus, students of profiles ‘General Medicine’, ‘Pediatrics’, ‘Medical and Preventive Care’ think that studying public health issues is the task of doctors of all clinical specialties (69.4%–76.7%), of hygienists ( 60.0%), of epidemiologists ( 30.0%). Integration in the teaching of PHH issues, according to teachers of PHH departments, in such types of activities as academic work, educational work, general scientific projects, joint printed works, textbooks and teaching aids, joint innovative projects, is mainly carried out with teachers of preventive educational disciplines, to a much lesser extent with teachers of clinical and fundamental disciplines. CONCLUSION: An integrative approach to definitions, terms, and concepts is needed in the study of the health of individuals, population groups and population with a significant variety of disciplines and departments teaching them. The methodological role in teaching these issues is the prerogative of the PHH discipline.

“An excellent servant but a terrible master”: Understanding the value of wearables for self-management in people with cystic fibrosis and their healthcare providers – A qualitative study

BackgroundWearables hold potential to improve chronic disease self-management in conditions like cystic fibrosis (CF) through remote monitoring, early detection of illness and motivation. Little is known about the acceptability and sustainability of integrating wearables into routine care from the perspectives of people with CF (pwCF) and their treating clinicians. MethodsA cross-sectional qualitative study involving semi-structured interviews with adult pwCF and focus groups comprising members of a CF multidisciplinary team (MDT) were conducted at a specialist CF centre in Australia. A phenomenological orientation underpinned the study. Inductive thematic analysis was performed using the Framework method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. ResultsNine pwCF and eight members of a CF MDT, representing six clinical disciplines, participated in the study. Eight themes were inductively generated from the data, of which four were identified from each group. PwCF valued wearables for providing real-time data to motivate healthy behaviours and support shared goal-setting with healthcare providers. Wearables did not influence adherence to CF-specific self-management practices and had some hardware limitations. Members of the CF MDT recognised potential benefits of remote monitoring and shared goal-setting, but advised caution regarding data accuracy, generating patient anxiety in certain personality traits, and lack of evidence supporting use in CF self-management. ConclusionsPerspectives on integrating wearables into CF care were cautiously optimistic, with emerging risks related to patient anxiety and lack of evidence moderating acceptance.

Multidisciplinary rehabilitation following recreational nitrous oxide (N2O) misuse: evaluating service provision and rehabilitation outcomes in a cohort with serious disability

Purpose: Recreational nitrous oxide (N2O) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from N2O misuse. Methods: A retrospective audit of hospitalised patients referred for rehabilitation for N2O toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected via medical record audit and analysed via descriptive and non-parametric statistics. Results: 16 eligible cases were identified, aged 18–43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75–93] to 117[112–123], p < .001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Conclusions: Demand for inpatient rehabilitation for disabling N2O toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge.