Comprehensive Practice Research Articles

Understanding Determinants of Diabetes: Knowledge, Attitudes, and Practices among Non-Diabetic Pakistanis

Objective: To identify the determinants of diabetes-related knowledge, attitudes, and practices among the non-diabetic Population in Pakistan. Methodology: A cross-sectional survey was performed from July to December 2023 using snowball sampling 400 non-diabetic Pakistani nationals were enrolled; the data regarding diabetes knowledge, attitudes, and practice was acquired on a structured online questionnaire distributed through a social media platform. The sociodemographic variables and diabetic characteristics were the exposure of interest, and Diabetes Knowledge Attitude and Practice (KAP) was considered the outcome of interest. The data was analyzed using SPSS version 27, with chi-square testing and regression analysis used to study the relationship between sociodemographic variables and KAP outcomes. Results: The study revealed a high level of general awareness about diabetes (86.75% knew what it was), but specific knowledge about its management and complications was low (<50% were sufficiently informed). Attitudes towards diabetes were proactive regarding diet and family support, yet less than half of the respondents recognized the importance of physical activity and regular glucose monitoring. Practices varied, with 88% avoiding fatty foods but only 18.75% maintaining a healthy weight and 31.5% engaging in regular blood sugar monitoring. Socioeconomic factors and education levels significantly (P<0.05) influenced KAP, with higher education significantly associated with better knowledge and practices. Conclusion: Overall, the non-diabetic Pakistanis have a good general awareness of diabetes. However, there are significant gaps in comprehensive knowledge and practice. Keywords: Diabetes Mellitus; Knowledge Attitudes Practices; Non-diabetic Pakistani

Understanding the Composition of a Comprehensive Otolaryngologist's Practice Through Medicare Reimbursements.

With a rising number of otolaryngology (ORL) graduates completing a fellowship, the number of generalists (also known as comprehensive ORLs [c-ORLs]), arguably the group of ORLs most needed, is likely to decrease. However, the practice and reimbursement patterns of c-ORLs have yet to be examined. Cross-sectional retrospective analysis. 2019 Medicare Provider Utilization and Payment Datasets. All ORLs were isolated (n = 8959), and then a random 10% sample was obtained. These 897 ORLs were queried for fellowship completion, isolating out those who have not completed a fellowship, and characterizing their practice patterns with regards to Medicare, the largest insurer in the US. Within the random sample, 554 (61.8%) were c-ORLs, of which 47 (8.5%) practiced in an academic setting. c-ORLs billed a mean of 52.9 (SD: 26.6) Current Procedural Terminology (CPT), and community-based c-ORLs had a more diverse practice (P < .001). On average, Medicare paid $138,942 ($117,563) to each c-ORL for 1982.2 (2614.7) services for 451.7 (296.9) patients. Ninety-five percent of their total reimbursements were office-based. Of 250 unique CPT codes billed, 52.8% of all c-ORLs reimbursements were from evaluation and management services, 17.8% from rhinology, 9.7% from otology/neurotology, and 9% from laryngology. Though surgery is an integral aspect of all ORLs' training and practice, c-ORLs practice in a largely office-based setting, at least with regard to Medicare patients. While c-ORLs clearly practice with a diverse skill set, their reimbursement patterns suggest rhinology makes up the largest proportion of their procedural practice.

Comprehensive and Focus Practice changes in the Family Physician Workforce in Ontario:1993-2022

Comprehensive and Focus Practice changes in the Family Physician Workforce in Ontario:1993-2022

Executive Summary: Topical Management of Malignant Cutaneous Wounds: Canadian Best Practice Recommendations for Health Care Professionals Developed by Nurses Specialized in Wound, Ostomy and Continence Canada (in collaboration with the Canadian Palliative Care Nursing Association).

Malignant cutaneous wounds pose unique challenges in patient care, requiring specialized attention to alleviate local symptoms and enhance health-related quality of life. As the prevalence of these wounds continues to rise with improving cancer survival rates, it is essential to establish comprehensive best practice recommendations for their topical management. To address this need, a task force was assembled from across Canada, consisting of members from Nurses Specialized in Wound, Ostomy, and Continence Canada and the Canadian Palliative Care Nursing Association. The purpose of these recommendations is to provide a framework for the topical management of malignant cutaneous wounds for health care professionals, emphasizing the substantial role of their support persons. Recognizing the impact of cultural humility and the need to deliver care that respects individual beliefs and practices is crucial in providing effective and equitable care. The 23 presented recommendations aim to guide nurses, the interdisciplinary team, and the health system to enhance the overall quality of malignant cutaneous wound care management.

Assessment of the quality and content of clinical practice guidelines for vitamin D and for immigrants using the AGREE II instrument: global systematic review

BackgroundWorldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants. Recommendations in current clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants, and there are...

Interpretation of a clinical practice guideline on the management of chronic pain associated with temporomandibular joint disorders

Temporomandibular disorders (TMD) are a heterogeneous group of diseases that affect the temporomandibular joint, chewing muscle system, dental occlusion, and even various structures throughout the body, with significant characteristics of biological-psychological-social pattern. TMD related chronic pain, as the most important clinical symptom, can result in negative emotions seriously affecting patients' quality of life and physical and mental health. Although a variety of therapies have been previously reported to treat TMD related chronic pain, there is a lack of widely recognized therapies. Professor Jason W Busse (from Michael G DeGroote National Pain Centre, McMaster University, Hamilton ON, Canada) took the lead and collaborated with multiple internationally renowned schools/hospitals of stomatology to develop an international consensus on the management of chronic pain associated with TMD, a clinical practice guideline, which took two years and was published in December 15th, 2023 in a global top journal of clinical research The British Medical Journal. This clinical practice guideline explored the comparative effectiveness of available therapies for chronic pain associated with TMD, conditionally recommended the specific intervention for different treatment or pain relief, proposed a comprehensive, agreed, and standardized clinical practice guideline. This present article describes the methodology and key elements of the clinical practice guideline to help clinicians fully understand and appropriately apply this guidance, which could provide the references for clinical practice of TMD associated chronic pain in China.

Feasibility Theory and Practice of CO2-EOR in High CO2-Content Near-saturated Edge-bottom Water Reservoir

Abstract CO2-EOR technology for low-permeability tight oil and gas reservoir is in the ascendant, and CO2-EOR technology for old oilfields has not been paid enough attention, but the implementation scale has great potential, and the expected effect and implementation conditions are good. The feasibility of CO2-EOR technology in the ultra-high water cut stage of high CO2 content, near saturation pressure and edge-bottom water reservoir was studied theoretically, and the field implementation effect was tracked and evaluated. Via petrophysics, reservoir engineering, and site case analysis, a relatively comprehensive reservoir numerical model was developed, clarifying the impact of periodic gas injection volume, gas injection rate, soak time and liquid production rate on the production effect of CO2 huff and puff were clarified. The key injection-production parameters of CO2 huff and puff test wells were designed, and the feasibility study progress of CO2-EOR in near-saturated edge-bottom water reservoirs with high CO2 content was summarized. The theoretical research shows that the change rules of gas-water dual-drive, CO2 water control and oil increase in the process of CO2 huff and puff in high CO2 near-saturated edge and bottom water reservoirs, and reveals the synergistic mechanism of CO2 huff and puff to suppress water and increase energy. The tracking evaluation shows that the sweep condition of CO2 after huff and puff in the test well is complex, the storage ratio is in the range of 40%-70%, the stage oil increase is in the range of 700t-3000t, and the optimized oil increase and oil change rate can reach 2.7t/t. Based on the comprehensive theory and practice, it is considered that CO2-EOR has good potential for high CO2 near-saturated edge and bottom water reservoirs under fine control. This study has guiding and reference significance for CO2-EOR technology and application in similar oilfields at home and abroad.

Recommendations for empirical syndemics analyses: A stepwise methodological guide

Syndemic theory posits that co-occurring diseases interact in a manner that increases disease transmission, progression, and negative health outcomes. And that adverse socioeconomic and environmental conditions promote this disease or health condition clustering and interaction. The concept offers two important contributions to the health sciences. First, it positions socioeconomic, structural, and environmental conditions as central to disease burdens. Second, as a portmanteau – ‘syn’ for synergy and ‘demic’ for disease epidemics – syndemic theory indicates that in some cases diseases do not merely co-occur but synergistically interact to affect an outcome that is more than the accumulation of the individual disease effects. The difficulty in operationalizing these central elements has resulted in a divergence of scholarship from the centralizing principles of the theory towards a simpler accumulation perspective in which more conditions equate to worse health outcomes. In addition, all empirical syndemic assessments should include robust qualitative assessments of the dynamics, however, much syndemic scholarship focuses only on quantitative analyses. To address these issues, a five-step approach to quantitative analyses of syndemic arrangements is proposed: (1) identifying disease clusters within a defined population; (2) determining the relevant social and structural factors that support disease clustering; (3) determining if clusters are distinct by social/demographic groups within the population; (4) evaluating if the identified disease cluster contributes to worse health outcomes; and (5) assessing for synergy between clustering diseases. This stepwise strategy ensures not only a rigorous assessment of hypothesized syndemic interactions but also presents a closer alignment of scholarship with syndemics theory. As an illustration, the approach is applied to an assessment of a hypothesized HIV/cardiovascular disease syndemic in South Africa. While syndemics theory has proven valuable in guiding public health interventions and policy, progressive improvement must be made in the application of the theory to ensure that it continues to effectively inform comprehensive practice.

Innovative research of comprehensive practice classroom teaching of Chinese reading

The innovative research of comprehensive practical classroom teaching of Chinese reading shows that teachers should pay attention to cultivating students 'interest in reading in the teaching process, improve their information screening and integration ability, and introduce diversified teaching strategies to stimulate students' learning initiative and creative thinking. Through the continuous innovation of teaching methods, we can enrich the reading practice activities, and provide students with a broader space for exploration and thinking. Classroom teaching is an important link in the field of education, and it has a key influence on students' learning effect and development. With the rapid change of society and the reform of education system, the traditional classroom teaching model faces many challenges. Therefore, it is of great theoretical and practical significance to study the innovation of comprehensive practical classroom teaching of Chinese reading and improve the teaching effect. First of all, the innovation of the comprehensive practical classroom teaching can promote the improvement of the quality of Chinese education. Through the exploration and application of the comprehensive practice innovation strategy of different Chinese reading, it can better meet students' learning needs, stimulate their interest and initiative in learning Chinese, and improve the effect and quality of Chinese learning. Secondly, the innovation of comprehensive practical classroom teaching of Chinese reading can promote the professional development of Chinese teachers. Teachers are the main implementers and organizers of classroom teaching, and their teaching ability and level are directly related to the quality and effect of classroom teaching. Studying the practical innovation of classroom teaching can help teachers to continuously improve their teaching ideas, teaching methods and teaching skills, and improve their professional quality and teaching level. In addition, the innovation of studying the comprehensive practical classroom teaching of Chinese reading can also promote the in-depth progress of educational reform. Education reform needs to learn from and introduce new educational ideas, teaching methods and teaching means, and all of these need to be verified and implemented through practical innovation. By studying the innovation of comprehensive practical classroom teaching of Chinese reading, it can provide practical experience and theoretical support for the promotion of educational reform.

REDD+ in Indonesia: An assessment of the international environmental program

AbstractThis paper provides a comprehensive review of the literature and assesses the progress on the effects of Indonesia’s REDD+ program. Due to the significance of Indonesia in terms of global rainforests and the comprehensive implementation practice of REDD+ programs since 2009, focusing on the case study of Indonesia enables interesting insights regarding the challenges and opportunities of REDD+. Indonesia faced challenges during the project’s implementation, but there were also reductions. This success is attributed to the set program design of REDD+. In this paper, we show that without international development cooperation in the field of climate change mitigation, the countries in the Global South lack locally driven forest conservation or restoration incentives. These incentives emanate exogenously from international development cooperation programs in the field of climate change mitigation. The review of the program also shows that despite the rigorous institutional design of REDD+ in Indonesia, not all the stakeholders could benefit from the program appropriately. Because of the de facto weakness of the smallholder farmers, indigenous population groups, and other vulnerable categories in the political process of Indonesia, these groups’ interests have not come fully to their own in Indonesia. Hence, we conclude that international programs that target environmental protection, while addressing inferior institutional quality, bad governance and operate through more accountable NGOs than government agencies would perform better in terms of global environmental targets and the sustainability of local livelihoods.

DEVELOPMENT OF FIELD WORK PRACTICE MANAGEMENT IN INFORMATICS INTEGRATED SERVICE SYSTEM

Field work practice is crucial for aligning college education with workplace skills, but manual management poses challenges such as time-consuming processes and limited information access, particularly within the Informatics Program at Mulawarman University. This research explores integrating field work practice with mobile technology through Rapid Application Development, resulting in a comprehensive field work practice management mobile app. Data collected from direct observation and student questionnaires inform the app's development. The app covers various field work practice aspects, facilitating efficient student engagement, and Black Box testing confirms its functionality without errors. This research significantly contributes to field work practice management, offering stakeholders an efficient, transparent, and well-integrated solution for field work practice implementation in academic settings, ultimately aiming to enhance convenience and accelerate the field work practice process for all involved parties.

Tracheal Tumors: Clinical Practice Guidelines for Palliative Treatment and Follow-Up.

A substantial portion of patients with advanced cancer cannot be cured, regardless of the therapeutic methods employed. Hence, rational palliative causal treatment becomes crucial. Representative studies specifically addressing the exclusive palliative treatment of patients diagnosed with tracheal cancers have not been identified. In most studies, patients treated palliatively constituted a subset of the overall evaluated group. A thorough literature review was conducted, focusing on three types of palliative treatment: palliative radiotherapy, palliative surgical procedures, and systemic treatment for advanced disease. This review uniquely fills a significant gap in the existing literature by providing the first comprehensive and updated clinical practice guidelines specifically focused on the palliative treatment of tracheal tumors. The proposed guidelines emphasize the unique clinical challenges and treatment strategies pertinent to palliative care in tracheal tumors, which are not adequately covered in existing guidelines for other thoracic malignancies.

Exercise for patients with arthritis

Background: Osteoarthritis and rheumatoid arthritis are major causes of pain and disability globally, and exercise is known to be effective at alleviating symptoms and improving physical function.Current Concepts: Knee osteoarthritis is a common degenerative disease, and comprehensive clinical practice guidelines have been established. Most studies strongly recommend appropriate weight management combined with exercise therapy. Aerobic, strength, resistance, isometric, neuromuscular, and balance training have been used. However, the current evidence is insufficient to recommend specific prescriptions regarding the exercise type and dose. Many guidelines group knee and hip osteoarthritis together for exercise recommendations. Evidence supporting the use of exercise for hand osteoarthritis is relatively scarce, and reports on its adverse effects are rare. Weight loss is not recommended for hand osteoarthritis, because its effectiveness has not yet been established. For patients with polyarticular osteoarthritis, exercise is recommended as a core treatment, with systematic land-based exercises being particularly advised. For rheumatoid arthritis, both general exercises and hydrotherapy are recommended to improve joint flexibility, muscle strength, and functional outcomes.Discussion and Conclusion: Exercise is a powerful treatment tool for various types of arthritis. However, further research is required to develop more specific exercise intervention protocols.

23: Optimizing Extracorporeal Life Support (ECLS) Circuit Change Process: A comprehensive Guideline and Practice Revision for Improved Patient Care and Safety

23: Optimizing Extracorporeal Life Support (ECLS) Circuit Change Process: A comprehensive Guideline and Practice Revision for Improved Patient Care and Safety

Exploring the Impact of Fasting and Fasting-Mimicking Diets on Type 2 Diabetes Management in Adults: A Systematic Review.

Type 2 diabetes poses significant global health challenges, affecting both the quality of life and healthcare systems. This systematic review evaluates the efficacy of fasting and fasting-mimicking diets (FMD) in managing type 2 diabetes, with a focus on their effects on glycemic control, lipid profiles, and overall metabolic health in adult patients. A comprehensive search of PubMed and Cochrane Library databases identified several studies utilizing various fasting protocols, including intermittent fasting and FMD. Data synthesis and bias assessment were conducted using established methodologies, including the Cochrane Risk of Bias 2 (RoB 2) tool. The review found that fasting interventions significantly improve glycemic control and reduce body weight, with some protocols notably lowering HbA1c levels (p<0.05), highlighting the strong potential of fasting in diabetes management. However, the results varied, suggesting that individual differences in metabolic responses and adherence levels influence outcomes. In conclusion, while fasting and FMD show promise for improving metabolic health and managing diabetes, more standardized research is needed to understand the underlying mechanisms, optimize protocols, and confirm long-term benefits. Future research should prioritize larger sample sizes and extended follow-up periods to inform comprehensive clinical practice guidelines.

INTIMASY-TBI Guideline: Optimization of INTIMAcy, SexualitY, and Relationships Among Adults With Traumatic Brain Injury.

Traumatic brain injury (TBI) can negatively impact intimacy, relationships, and sexual functioning through changes in physical, endocrine, cognitive, behavioral, and emotional function. Without intervention, diminished intimacy and/or sexual functioning in individuals with TBI may persist. Although most health care professionals agree that sexuality and intimacy in relationships are significant concerns and should be addressed in rehabilitation, these concerns are not typically discussed during rehabilitation and discharge planning for people with TBI. To address this gap, an expert panel of North American clinicians and researchers convened to develop evidence-informed recommendations to assist clinicians in providing a framework and guidance on how clinicians can support individuals after TBI. A systematic search of multiple databases was conducted to identify relevant evidence published from 2010 to 2023. The INTIMASY-TBI Expert Panel developed recommendations for optimizing discussions and interventions related to intimacy and sexuality for people with TBI in rehabilitation and community-based programs. For each recommendation, the experts evaluated the evidence by examining the study design and quality to determine the level of evidence. A total of 12 recommendations were developed that address the following topic areas: (1) interprofessional team training, (2) early education on the effects of TBI on intimacy, relationships, and sexuality, (3) creating individualized interventions, (4) education, assessment, and management of the causes of sexual dysfunction, and (5) providing written materials and relationship coaching to persons with TBI and their partners. Two recommendations were supported by Level A evidence, 1 was supported by Level B evidence, and 9 were supported by Level C (consensus of the INTIMASY-TBI Expert Panel) evidence. A decision algorithm was developed to assist clinicians in navigating through the recommendations. The INTIMASY-TBI Guideline is one of the first comprehensive clinical practice guidelines to offer strategies to trained clinicians to discuss the physical, psychosocial, behavioral, and emotional aspects of intimacy and sexuality with persons with TBI.

Analysis of Career Development Path Based on the Three Comprehensive Practice Education Models of Medical Laboratory Technology

This paper expounds on the connotation of the three complex practical education models of medical laboratory technology and its application in career planning. Through the cooperation and resource sharing of schools, enterprises, and hospitals, the 33 Complex realizes the close integration of theoretical teaching and practice and provides comprehensive preparation for students' clinical practice and employment. This paper further discusses the career planning strategies of medical laboratory technology students based on this model, including personal positioning, goal setting, and career development path analysis. Through the analysis of typical career development cases, the challenges and opportunities in the industry are revealed. Finally, this paper discusses the positive impact of the three complex models on career development, including the promoting role of resource sharing and the advantages of career development under mutual benefit and win-win results. It looks forward to the future trends and challenges.

Comprehensive Practice Education via “Cloud-Based Study Tours”: A Case Study of the Comprehensive Practice Curriculum in the Tianfu New District, Sichuan Province, China

Comprehensive Practice Education via “Cloud-Based Study Tours”: A Case Study of the Comprehensive Practice Curriculum in the Tianfu New District, Sichuan Province, China

Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan.

Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges. This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations. An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process. Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted. The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses.

New Model of College Journalism and Communication Curriculum Reform under the Digital Age

Based on the concrete experience and practice of China's journalism and communication education reform in recent years, this paper discusses the needs of The Times, concept innovation and mode exploration. This paper focuses on how to empower journalism and communication education with "practice", puts forward the concept of "practice view of journalism education", upgrades the "practice education" to "comprehensive practice", promotes the innovation of journalism and communication education model, and promotes the high-quality development of journalism and communication education. The article also discusses the opportunities and challenges of journalism and communication education in the new situation, and how to better adapt to the change of media technology and train excellent journalism and communication talents to adapt to the new communication environment.