ABSTRACT This paper explores how Ghanaian documentary filmmakers manage ethical issues in their daily practices by identifying the guiding ethical principles that shape their decisions. A qualitative research approach was employed for this study, using thirteen documentary filmmakers from Ghana, chosen using purposive and snowball sampling techniques as the sample size. The gathered data was analysed thematically through the lens of Kohlberg’s CMD theory. The findings revealed instances involving delicate participants’ cultural customs that filmmakers regarded as challenges to achieving veracity and comprehensiveness of film stories. It was discovered that emphasising openness, trust, and effective communication were strategies harnessed by some Ghanaian filmmakers to overcome their ethical dilemmas. The study concludes that it is important for documentary filmmakers to have context-specific ethical principles and to regularly reflect on their practices, highlighting the need for integrating ethical reflection into film training and practice in Ghana, as well as developing context-specific ethical codes for filmmakers to eliminate biases and discretionary ethical approaches that are fluid and weaken standards.

Background Health is a holistic phenomenon, yet healthcare often falls short of this ideal due to economic and political pressures. The declared overarching goal of general practice is to provide holistic care, yet in daily practice, GPs face significant challenges due to workload pressures. As a result, certain aspects of patient suffering—particularly those related to existential concerns—remain insufficiently addressed. To help bridge this gap, we initiated an action research project that brought together two traditional and locally connected professional groups: the Parish Ministers (PMs) and General Practitioners (GPs). This article presents data from interviews with GPs and PMs, which we conducted after the first two years of an interdisciplinary network project. Design The intervention was designed as a participatory design, action research project. Method We analyzed the data using Interpretive Phenomenological Analysis (IPA), a hermeneutic and phenomenological method that allowed us to explore the personal and professional experiences of participants during the first two years of interdisciplinary network. Results The action research project introduced an interdisciplinary network that enhanced existential support for patients, which in turn supported GPs in their patientcare. The data consists of 12 interviews conducted in November and December 2023 with Parish Ministers (PMs) and six interviews with General Practitioners (GPs) in Kolding, a Southern Region in Denmark. The network was perceived as a resource in daily practice and provided the GPs with valuable support in patient care as well as fertilized reflections that sharpened the professional practice for both GPs and PMs. Conclusions PMs and GPs perceived an interdisciplinary local network to enhance existential patient care and GPs felt supported in their clinic. Based on these results, the next step is to test the intervention in other parts of Denmark to assess its effectiveness beyond this region.

To investigate patterns of social media (SM) use among dental specialists and to assess SM's perceived role in daily practice and patient care. A cross-sectional pilot paper survey was administered to specialist dentists in Greece (May-June 2024). The 23-item questionnaire covered four domains: demographics, personal SM use, professional-patient communication, and perceived impact on patient care. Descriptive statistics were reported as frequencies, medians (IQR), or means ± SD. Exploratory associations used Fisher's exact or χ² tests for categorical variables and Kruskal-Wallis or Wilcoxon tests for ordinal outcomes, with 95% confidence intervals. Statistical significance was set at p<0.05; all analyses were exploratory. Forty-five dentists participated (66.7% women; median age 30 [IQR 10]); 64.4% were prosthodontists and 35.6% orthodontists. Most respondents (97.8%) had ≥1 SM.

Abstract Introduction Parkinson’s disease is a progressive neurological degeneration of certain cells (called dopaminergic cells) within a specific part of the brain (substantia nigra). (1) Withholding PD medication or a prolonged delay in administering PD medication can lead to an increase in care needs and increases the risk of neuroleptic malignant type syndromes, which can be fatal. (2). Method Prospective data was collected among doctors of different grades working in the Trust using Google forms. Results Baseline data was collected in January 2025. 88.9% responders managed PD patients in their daily practice; majority of them were foundation year doctors (83.3%). 55.6% of the responders did not feel confident in managing patients with PD who were nil by mouth. 72.2% of the responders are not aware of the local pathways to request a specialist review and the OOH support available. A Trust-wide Parkinson’s Guidelines was then developed in reference to Parkinson’s patients who were nil by mouth or had swallowing difficulties; addressing all the concerned areas suggested in the baseline data collection. We then arranged two teaching sessions, first for the resident doctors in Geriatric Medicine department and a second session for Foundation doctors as they were identified as the target group of resident doctors during initial data collection. The second round of data collection was completed following these sessions. Following the sessions, we noted that the confidence level among responders significantly improved. We measured this on a rating scale of 1–5, with 83.3% responders reporting significant improvement in their levels of confidence managing PD patients who are NBM. Conclusion Symptomatic treatment, focused on replacing dopamine, is crucial in optimising patient outcomes and quality of life. (2) Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty. (3).

Abstract Background The NHS 10-year plan outlines the ambition to shift care from a hospital-centric model to integrated community-based systems, but little is known about how to implement this change. The integrated frailty crisis multidisciplinary team working across acute and community settings were motivated to improve services but lacked the confidence/knowledge to lead quality improvement (QI). A whole pathway QI practitioner development programme was established with projects aligned to the overarching system strategy to embed the change. Methods A structured training and coaching programme was introduced, aligned to the Trust’s A3 QI methodology and underpinned by testing using Plan–Do–Study–Act (PDSA) cycles. The programme aimed to build sustainable improvement capability across Advanced Clinical Practitioners and Specialty Doctors. A fishbone analysis identified barriers to applying QI in daily practice. Staff received training in QI methods (including driver diagrams, measurement, and PDSA cycles) and were supported to deliver improvement projects. The programme was refined through multiple PDSA cycles and tests of change in coaching methods used. [JA1]. Results Nine MDT members completed projects and achieved QI Practitioner certification. Confidence and knowledge in QI improved significantly (70% reporting limited/no confidence/knowledge at baseline [JA2] vs 85% reporting some/good knowledge/confidence afterwards). Wider impact of the programme through QI initiatives included: Frailty identification in ED increased from 0% to 79%. Use of triage tools with CFS and NEWS2 rose from 0% to 100%. Standardised UCR board rounds improved collaboration and decision-making. A lunch club initiative enhanced patient activity, social connection, and staff morale. Conclusions It is possible to embed a culture of QI and align this to an overarching strategy to improve integrated frailty pathways across previously fragmented services. It is recommended to develop QI practitioner skills among frontline staff to maximise the benefits to transformation of pathways and services. Using QI methodology to design the QI programme and Testing and refining this through PDSA cycles ensured engagement, ownership, and measurable improvement. This model is scalable across any healthcare system.

This study aims to examine the effectiveness of the bandongan method in enhancing students’ comprehension of kitab kuning at Pondok Pesantren Bani Saiman Yusuf. The research employs a descriptive qualitative approach, with data collected through observation, interviews, and documentation. The research subjects consist of teachers and students involved in the learning process of kitab kuning. Data analysis is conducted thematically to depict patterns of teacher–student interaction, student engagement, and levels of understanding of kitab kuning materials. The findings indicate that the bandongan method is proven to be effective in improving students’ understanding of kitab kuning, particularly in terms of Arabic vocabulary mastery, textual meaning comprehension, and the ability to apply the teachings of the texts in daily religious practices. The key factors contributing to the success of the bandongan method include the teacher’s role as a facilitator, active student participation, and a systematic structure of material delivery. Although several challenges were identified such as variations in students’ Arabic literacy skills and decreased concentration during extended learning sessions strategies including material repetition, interactive question-and-answer sessions, and group discussions were found to effectively address these obstacles. Based on these findings, it can be concluded that the bandongan method remains relevant and effective within the context of modern Islamic boarding schools, particularly when integrated with active student engagement, teacher competence, and appropriate instructional management strategies. This study offers significant implications for the development of kitab kuning instructional methods in pesantren and contributes to the existing literature by reinforcing the effectiveness of traditional pedagogical approaches in religious education.

Digestive health problems remain a significant public health concern in urban communities, including Pakal Village, Surabaya. These issues are closely associated with dietary patterns, lifestyle changes, and limited access to affordable functional foods that support gut health. Probiotics are widely recognized for their role in maintaining intestinal microbiota balance and improving digestive function. However, community knowledge and skills related to the production and utilization of probiotics at the household level are still limited. Therefore, community empowerment through locally based probiotic production is considered a strategic and sustainable health promotion effort. This community service program aimed to empower residents of Pakal Village in the production and utilization of household probiotics to improve digestive health and promote independent healthy behavior. The program was implemented using a participatory community-based approach. The methods included health education through structured counseling sessions and interactive discussions, practical training on simple household probiotic production using locally available materials, and continuous mentoring. Evaluation of participants’ understanding was conducted using a pre-test and post-test questionnaire, supported by direct observation during the training activities. The results showed a significant increase in participants’ knowledge and skills. Based on post-test evaluation of 100 participants, 95 individuals (95%) demonstrated good understanding of digestive health concepts and household probiotic utilization, while 5 individuals (5%) showed limited understanding. Participants were also able to independently produce household probiotics and apply them in their daily dietary practices. Increased awareness of preventive digestive health behavior and positive community participation were observed. In conclusion, community empowerment through household probiotic production using education, hands-on training, and systematic evaluation is effective in improving digestive health knowledge, skills, and self-reliance. This model has strong potential to be replicated as a sustainable community-based health intervention.

Background: The European Society of Cardiology (ESC) published the first guidelines on cardio-oncology in 2022. Implementing the 272 proposed recommendations into everyday clinical practice has become a mandatory challenge for countries belonging to the ESC community. Methods: The study aimed to assess cardio-oncology knowledge and the degree of implementation of ESC guidelines among cardiologists registered with the Heart Failure Association of the Polish Cardiac Society and oncologists from the Polish Society of Clinical Oncology. Physicians were invited via email and voluntarily chose to participate by completing a 20-question questionnaire. Results: Among the 104 respondents, half (50%) were cardiologists, and the majority (80%) had more than ten years of clinical experience. A total of 38.8% of specialists practiced outpatient medicine, while 41.7% worked in academic centres. The majority (58.3%) consult fewer than ten cardio-oncology patients per week, with less than 8% of specialists having the greatest experience (&gt;25 consultations per week). Most physicians were familiar with the ESC guidelines on cardio-oncology. Cardiologists more frequently indicated heart failure as the main problem in cancer patients (OR = 5.82; 95% CI: 2.08–16.22; p = 0.0007), ordered echocardiography and ECG together with cardiovascular risk factors control (OR = 4.01; 95% CI: 1.74–9.25; p = 0.001) during long-term follow-up, chose angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) combined with calcium channel blocker (CCB) for treating hypertension (OR = 3.9; 95% CI: 1.56–9.75; p = 0.003), and rarely monitored lipid profile based on the type of cancer therapy (OR = 0.09; 95% CI: 0.03–0.26; p = 0.000009). Oncologists more often observed cardiovascular issues in lung cancer (OR = 3.78; 95% CI: 1.58–9.05; p = 0.002), recognized venous thromboembolism as the most common problem in cardio-oncology (OR = 6.52; 95% CI: 2.7–15.73; p = 0.00002), opted for ACEI/ARB monotherapy in the management of high blood pressure (OR = 11.76; 95% CI: 2.49–55.54; p = 0.002), and significantly more often chose low-molecular-weight heparin in the treatment of asymptomatic incidental pulmonary embolism (OR = 5.93; 95% CI: 2.47–14.24; p = 0.00006). Conclusions: The understanding of cardio-oncology varies significantly between cardiologists and oncologists. Although the survey was conducted only in one country (Poland), its results may serve as a reference point for structural reforms with building implementation strategies of ESC guidelines in daily practice in other countries.

In response to the growing importance of English language proficiency in professional contexts, teacher training for widely used standardized proficiency test such as Test of English as a Foreign Language (TOEFL) has become increasingly essential. Despite the growing number of training, there remains limited understanding of how teachers perceive these programs and what challenges they face in applying the training outcomes to their daily practices. This study aimed to examine teachers’ perceptions of a TOEFL preparation training program and the challenges they encountered in applying its outcomes. An explanatory mixed-methods design was employed, involving 40 teachers from elementary, junior high, and high school levels at an Islamic boarding school in Indonesia. Quantitative data on teachers’ perceptions of the training program and qualitative data on the challenges they experienced were collected through a questionnaire combining closed- and open-ended items. The quantitative data were analyzed descriptively to illustrate the levels of teachers’ knowledge and perceptions, while the qualitative data were analyzed using a thematic approach. The findings revealed that teachers generally held positive perceptions toward the TOEFL preparation training program. However, several challenges emerged in applying the training outcomes, including institutional and environmental challenges, teacher-related challenges, and issues of professional development and sustainability.

SUMMARY Capacity assessments under the Mental Capacity Act 2005 (MCA) are a routine part of daily clinical practice in England and Wales. One element of these is the role of insight within the MCA’s capacity criteria. This article focuses on the issue of insight and capacity in a recent Court of Protection judgment, discussing how to assess insight in clinical practice and elucidating key issues regarding the role and assessment of insight within capacity assessments. The article includes a 10-point checklist for capacity assessments that was presented in the judgment, and a discussion of insight assessments that can guide documentation and be implemented in clinical practice.

Special care dentistry (SCD) education involves acquiring knowledge, skills, and attitudes in managing patients with special healthcare needs (SHCN). This study reports the development of a 2-h face-to-face workshop, designed based on the ADDIE and Gagne's nine events of instruction (GNEI) models, which were integrated to provide undergraduate-level SCD training. The ADDIE model was applied to plan and create a learning activity fulfilling the learning objectives of this subject. This process involved analysing (A), designing (D), developing (D), and implementing (I) the instruction based on standardised guidelines and approved curriculum content. The GNEI model was incorporated at the design (D) stage to enhance students' learning experiences via various stimuli and exercises. The learning activity was evaluated (E) through students' written reflections on their learning experiences. Qualitative data on students' reflections was analysed via thematic analysis. A workshop comprising case-based discussion, demonstration, simulation exercises, and practical training involving six scenarios relating to patients with SHCN was developed. Students found that the session was beneficial in improving their understanding of SCD as it supplemented what was taught in the lectures. The cases discussed were relevant to their daily practice, and the resources developed were useful and reliable. The demonstration, practical, and simulation exercises provided hands-on learning experiences and helped instil disability awareness. Students felt prepared for examinations and clinical practice following this activity. Applying the integrated model ensures effective and structured teaching of SCD for undergraduate students.

Digital educational games (DEGs) have been utilized for some time across various learning domains. In light of the ongoing debate concerning their impact on skills and knowledge, particularly among very young learners, a study was undertaken to assess their effectiveness compared to conventional educational materials. The study involved 81 kindergarten students and followed a between-subjects design. This research focused on basic spatial and mathematical skills, specifically directional concepts (such as "up-down," "left-right," "in front-behind," and "above-below"), as well as students' abilities to organize and compare numbers and quantities up to ten. Evaluation tests and a questionnaire were employed to gather data on students' knowledge acquisition, motivation, enjoyment, and ease of use. The findings indicated that, compared to conventional materials, DEGs significantly enhanced the skills that were examined. Although DEGs were rated higher in terms of enjoyment and motivation, they were perceived as less easy to use. Furthermore, enjoyment emerged as the sole factor having a significant influence on learning outcomes with DEGs. The study calls for further exploration to optimize the usability and efficacy of DEGs and may assist educators in integrating them into their daily practice.

Evaluating the efficacy of transcutaneous electrical nerve stimulation in managing chronic pelvic pain in endometriosis patients.

Despite its growing impact, advanced liver fibrosis (ALF) remains substantially underdiagnosed in both primary and specialized care settings. Since liver cirrhosis is typically preceded by a prolonged phase of asymptomatic fibrosis, early detection of ALF, particularly in high-risk individuals, represents a public health priority. From a laboratory medicine perspective, this prolonged subclinical phase offers an interesting opportunity for early detection of ALF using blood-based noninvasive tests (NITs) that can be implemented in primary and nonhepatology care settings before overt disease develops. By critically appraising the evidence sources in the available literature, this paper provides an overview of blood-based NITs useful for the detection of ALF, with particular emphasis on the aspects and problems related to their implementation in daily laboratory practice. We explore the feasibility of different scenarios using strategies based on routine biochemical parameters and more specialized NITs that incorporate measurements of direct markers of fibrosis activity. Moreover, we highlight discrepancies existing among clinical practice guideline (CPG) recommendations that may hamper their widespread implementation in medical laboratories. Advances in understanding and increase in prevalence of ALF require earlier detection and more accurate risk assessment of this condition. Blood-based NITs may provide a widely accessible diagnostic aid, especially in primary care and resource-limited settings. Multidisciplinary collaboration focusing on their integration into clinical pathways to optimize patient evaluation and specialist referral is required. Harmonization of recommendations in international CPGs will certainly contribute to their more effective use.

BackgroundDespite the demonstrated benefits of evidence‐informed management, such as enhanced patient outcomes, improved working environments and reduced staff turnover, it is reported that nurse managers often fail to incorporate evidence into their management practices. This study explored and described the understanding and experiences of nurse managers regarding the utilisation of evidence‐informed management. Through an examination of their perspectives, the study aimed to identify the barriers and enablers in adopting evidence‐based practices in nursing management.MethodA qualitative explorative–descriptive–contextual study was conducted using five focus group discussions with twenty (n = 20) purposively selected nurse managers. Thematic analysis was used to analyse the data.ResultsThree main themes emerged from the study, namely: (1) Nurse managers communicated the resources and requirements to support using evidence‐informed management practices; (2) nurse managers verbalised the need to establish a process or pathway to use evidence‐informed management; and (3) evidence‐informed management was found to improve organisational performance significantly.ConclusionTo facilitate the uptake of evidence by nurse managers to support their management practices, it is imperative to establish structures, processes and pathways that enable the utilisation of evidence. Additionally, this utilisation of evidence has been shown to improve the quality of patient outcomes and enhance the overall performance of the organisation. Implications for nursing management practice and education include continuous education and training to increase nurse managers’ knowledge and skills in utilising evidence. Moreover, nurse managers should adopt evidence utilisation as a daily management practice. Incorporating evidence‐based informed management into postgraduate education curriculum serves to better prepare prospective nurse managers.

ABSTRACT Informal music learning is growing in popularity among preschool teachers, often favored over formal music education approaches. However, the impact of a learning musical microenvironment within the preschool class focused on informal music learning has not yet been fully explored. This study investigates Greek preschool teachers’ opinions on the relationship between a music corner and children’s informal music learning and the potential impact on daily preschool practices. Particularly, we examined their views on whether informal ways of learning music take place in music corner and whether they use it to enhance children’s music and social skills. Quantitative research was conducted with 318 preschool teachers. A questionnaire, based on the literature review and research questions, was designed and distributed to the participants. Kolmogorov–Smirnov regularity test, Cronbach's alpha reliability test, descriptive statistics and non-parametric tests were also conducted. The findings suggest that preschool teachers recognize music corner as an effective way to emerge children’s informal music learning and as a potential support mechanism for their pedagogical practices. Specifically, children express, practice and explore their music-making ideas, co-operate and communicate with their classmates as well as acquire experiences and knowledge during their free play.

Vascular diseases are the main cause of mortality in Spain, are associated with a high degree of disability and involve high healthcare costs. The Spanish Society of Arteriosclerosis meets this challenge by trying to improve the knowledge, prevention and management of these disorders. For prevention to be effective, the multifactorial nature of atherosclerosis encourages a global approach that addresses all risk factors. This document updates the clinical evidence, summarizes recent progress in research and covers all phases of the vascular patient's journey: initial examination and tests, diagnostic criteria, vascular risk assessment, general and pharmacological recommendations and criteria for referral and discharge. Furthermore, guidelines to set up a vascular risk consultation are issued. The aim is to provide healthcare professionals with a reference handbook for the daily practice in the vascular field.

Introduction: Mercury, a key component of dental amalgam, is a known neurotoxin that can accumulate in the body and impact health. Mercury waste, under the Biomedical Waste Management Rules, 2018, must be safely stored and sent to authorised recyclers, as improper disposal causes neurotoxicity and environmental harm. The rationale of the current study highlights the need to assess the awareness and safety practices among future dentists who use mercury in their dayto-day practice, to minimise exposure and protect community health. Aim: To assess the knowledge, attitudes and practices regarding health hazards of mercury toxicity and evaluate the safety practices of mercury disposal among undergraduate dental students. Material and Methods: A hospital-based descriptive study was conducted among 101 3rd and 4th year undergraduate dental students, who worked with mercury amalgam in their daily practice at Karnataka Lingayat Education Society’s, Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India, from August 1st 2024 to October 30th 2024. Data was collected using a pre-designed and structured questionnaire, entered into Microsoft Excel, and analysed using frequency, percentage, Mean±Standard Deviation (Mean±SD) and multiple linear regression analysis test (p-value&lt;0.05) using IBM Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 19.58±2 years; of 101 students, 76 (75.25%) students were females, 57 (56.44%) students were in 4th year, and 44 (43.56%) students were in 3rd year. The Mean±SD scores were 15.60±3.93 (knowledge), 2.93±1.62 (attitude), and 6.45±2.99 (practice); among the 12 students with “good knowledge,” the subgroup was 22.17±1.20. Lower knowledge was associated with fewer amalgam restorations (&lt;4), while attitudes were more positive among males (p-value=0.012) and 4th year students (p-value=0.045). Practice scores were strongly linked to formal training on mercury waste disposal during Bachelor of Dental Surgery (BDS) (p-value&lt;0.001), though only 58 (57.43%) had attended such training. Notable gaps remained in curriculum adequacy, disposal awareness, and adherence to mercury protocols. Conclusion: Dental undergraduates exhibited good knowledge regarding the health hazards of mercury toxicity, but their mercury safety and disposal practices were poor. Incorporating structured practical training and integration of Minamata Convention guidelines into the dental curriculum is recommended to ensure effective translation of knowledge into safe clinical practice.

This is an observational, descriptive, retrospective, real-world data study conducted in daily practice at the Country Medical Center in Bogotá, Colombia. It involved patients with any type of cancer diagnosis who were receiving chemotherapy, radiotherapy, oncological surgery, and/or hormonal therapy. From 2018 to 2023, protocols for intravenous high dose of sodium ascorbate were applied, resulting in a sample of 92 patients. The administration of sodium ascorbate at dose of 100 to 300 and 300 to 600 mg/kg/day showed statistically significant improvements in quality of life (P = .000). However, only the 300 to 600 mg/kg/day dose demonstrated a statistically significant reduction in pain (P = .0061). It is possible that by controlling or reducing inflammation, pain sensation can be decreased, therefore high dose of an antioxidant such as sodium ascorbate may be an alternative to improve oxidative stress and inflammation as an adjuvant to analgesic prescription according to pain management guidelines for cancer patients.

Colostomy irrigation is a well-established technique used for bowel management in patients with a permanent, left-sided colostomy. When performed routinely every 24-48 hours, it enables stool-free intervals, often allowing the use of only a stoma cap or simple dressing. Scientific evidence has shown significant improvements in health-related quality of life (HRQoL) for patients using this method. This study aimed to evaluate the current application of colostomy irrigation in Germany and Austria and to identify reasons for its limited use, despite known benefits. A specific focus was placed on the perspectives and practices of stoma care nurses. A cross-sectional, retrospective survey was conducted among certified stoma care nurses in both countries. Data were collected anonymously and analysed descriptively, including the use of interval-weighted means. A mean of 39 patients per stoma therapist per year with a permanent colostomy in the descending or sigmoid colon-regions anatomically suitable for irrigation-were reported. However, irrigation had been recommended to only 43.6% of these patients, and just 53% of those adopted it in daily practice. This results in an average of only nine patients per stoma expert using the technique annually. Reported barriers included time constraints, perceived patient reluctance, short inpatient stays and doubts regarding clinical indication. Stoma irrigation therapy has shown potential to improve autonomy, self-image and everyday function. This study contributes valuable insights into under-explored care practices in the German-speaking context and underlines the need for enhanced training and awareness among healthcare professionals to better integrate irrigation therapy into routine care.