Practice Gap Research Articles

4IR Applications in the Transport Industry: Systematic Review of the State of the Art with Respect to Data Collection and Processing Mechanisms

Transportation systems through the ages have seen drastic evolutions in terms of transportation methods, speed of transport, infrastructure, technology, connectivity, influence on the environment, and accessibility. The massive transformation seen in the transportation sector has been fueled by the Industrial Revolutions, which have continued expansion and progress into the fourth Industrial Revolution. However, the methodologies of data collection and processing used by the many drivers of this progress differ. In order to achieve a better understanding of the impact of these technologies, in this study, we methodically reviewed the literature on the subject of the data collection and processing mechanisms of 4IR technologies in the context of transport. Gaps in present practices are identified in the study, especially with regard to the integration and scalability of these technologies in transportation networks. In order to fully reap the rewards of 4IR technologies, it is also necessary to apply standardized methods for data gathering and processing. In this report, we offer insights into current obstacles and make recommendations for future research to solve these concerns through a comprehensive evaluation of the literature, with the goal of promoting the development of intelligent and sustainable transportation systems.

Implementing safety standards in radiographic practices: challenges and solutions

Ensuring the safety of patients and healthcare workers in radiographic practices is a critical concern in modern healthcare. The use of ionizing radiation, while invaluable for diagnostic and therapeutic purposes, carries inherent risks that necessitate stringent safety standards. Despite advances in technology and regulatory frameworks, the consistent implementation of these safety standards remains a challenge across various healthcare settings. The discussion addresses the complexities of navigating diverse regulatory environments, where enforcement and adherence to safety guidelines can vary significantly. These inconsistencies are particularly pronounced in low-resource regions, where limited access to modern radiographic equipment and inadequate training further exacerbate the risks of radiation exposure. Technological advancements in radiography, such as digital radiography, dose-reduction software, and advanced imaging modalities, offer significant benefits in terms of diagnostic accuracy and efficiency. However, they also introduce new challenges in maintaining up-to-date safety protocols. The rapid pace of innovation often outstrips the ability of regulatory bodies to update guidelines, leading to gaps in safety practices. Additionally, the effectiveness of these technologies depends heavily on proper usage and understanding by radiographic professionals, highlighting the need for continuous education and training. A strong safety culture within radiographic practices is essential for minimizing radiation risks. Leadership commitment, ongoing education, effective communication, and the empowerment of radiographic professionals are critical components of this culture. When these elements are in place, they foster an environment where safety is prioritized, and all staff members are actively engaged in maintaining and improving safety standards. The multifaceted approach required to enhance radiographic safety underscores the importance of harmonizing regulatory efforts, investing in modern technologies, and cultivating a safety-first mindset among healthcare professionals. These efforts collectively contribute to the safe and effective use of radiographic technology, ultimately protecting both patients and healthcare workers from unnecessary radiation exposure.

Critical gap in practice-lack of attention to falls and possible fall-related post-concussion symptoms in older adults and individuals with neurodegenerative disease.

Falls in older adults and those with neurodegenerative disease (ND) are a current public health hazard and the primary cause of sustaining a mild traumatic brain injury (mTBI)/concussion. Little is known regarding how post-concussion symptoms present in older adults and patients with ND, even though they are the demographic at highest risk. A combination of under-reporting of falls and a lack of awareness regarding potential consequences of falls, results in the underdiagnosis of post-fall issues and concussions in this population. Our aim was to conduct a quality assessment survey to assess physician practice regarding falls and their general knowledge of concussion symptoms. We sent surveys through email to 1400 North American physicians, mostly those working at university affiliated hospitals, who specialized in seeing older adults and patients with ND. One hundred forty-one physicians completed the survey. 71.4% of all responding physicians either never inquired or inquired in less than 5% of their patients with ND or older adult patients, about history of falls. Over half of the physicians (51.8%) either never ask or do not consider it necessary to ask about concussion symptoms post-fall. The majority of physicians (92%) recognized that concussions can have lasting effects on patients, particularly on mood and demonstrated good knowledge of post-concussion symptoms by correctly identifying them. Additionally, more than 70% of responding physicians believed that patients with ND or older adults can fully recover from a concussion with the same probability as any other age group if treated. Only 50% of physicians felt confident in managing post-concussion symptoms themselves, 53.9% of physicians did not know of, or did not have nearby concussion clinics to refer patients to. The gaps in practice are clearly reflective of the gaps in the literature regarding falls and concussions in older adults and ND patients. There is a very low rate of physician inquiry about history of falls and concussion symptoms in older patients and those with NDs. Failure to recognize a concussion, can lead to missed opportunities for targeted interventions to address reversible symptoms. Additionally, the misattribution of post-concussion symptoms to disease progression in older patients or those with NDs may delay and hinder appropriate management.

Process improvement strategy (PIS) and employee productivity amid COVID-19 pandemic among bank employees

PurposeThis study aims to examine process improvement strategy (PIS) (proxied by remote work, workforce training, and technological innovation), and employee productivity amid the COVID-19 pandemic among bank employees.Design/methodology/approachThe study employed cross-sectional and descriptive design by applying multistage sampling techniques using convenience sampling to select the study organization and stratified and simple random sampling to select 900 respondents for the study. Data were collected by using validated measures of the study variables designed into a questionnaire. Pearson’s correlation and simple regression analysis were employed to establish relationships and causal effects among variables respectively.FindingsResults showed significant relationships between the PIS (work-from-home, workplace training, and technological innovation) and the outcome variable (employee productivity); and predictive capabilities between the PIS and the outcome variables (employee productivity). The study revealed that remote work accounted for the highest variability (R2 = 0.775) in employee productivity, followed by workplace training (R2 = 0.499), and finally investment in technological innovation (R2 = 0.486)] and as such PIS fosters employee productivity and may, therefore, be applied when faced with a similar pandemic in the future.Originality/valueThe study was recognized for its significance in examining how PIS supports enhancing employee productivity in banks and, by extension, other organizations during a pandemic. The research has proven to be crucial in providing insights into bank management in emerging economies and other organizations worldwide that have previously gone unnoticed during a pandemic. It has aided in the extension of existing literature on PIS and employee productivity by carefully developing a framework, thus covering practical knowledge gaps.

Kindergarten teachers’ perspectives on sustainable development practices and observed practices

Purpose: Kindergartens are an important educational environment for the development of children at an early age, and they also play a crucial role in developing the values of sustainable development. The purpose of this study is to investigate kindergarten teachers’ perceptions of observable and sustainable development practices. Design, methodology, approach: Semi-structured interviews were conducted with 302 Saudi kindergarten teachers. Additionally, observation cards were utilized to collect data on actual practices of sustainable development in kindergartens. Data were analyzed using Nvivo12, a qualitative data analysis software, and descriptive analysis methods. The main themes were produced first, and then the perspectives were organized around them. Finding: The impact of social and cultural factors on the development of values, the lack of resources available to implement educational activities, and teacher awareness and training gaps were found to be the main barriers to the development of sustainable development values in kindergartens. Originality, value: To the best of the author’s knowledge, this is the first study in Saudi Arabia that has looked into the environmental and social perceptions of early childhood teachers about sustainable development practices, so the study’s findings can highlight the importance of reorienting teacher education programs toward sustainability in order to bridge knowledge and practice gaps.

Leveraging implementation science theories to develop and expand the use of a penicillin allergy de-labeling intervention

BackgroundPenicillin allergy is the most frequently reported drug allergy, yet most patients can tolerate the drug if challenged. Despite this discrepancy, large scale penicillin allergy de-labeling interventions have not been widely implemented in many health care systems. The application of a multi-method implementation science approach can provide key tools to study this evidence to practice gap and provide insight to successfully operationalize penicillin allergy evaluation in real-world clinical settings.MethodsWe followed a four-step process that leverages qualitative analysis to design evidence-based, actionable strategies to develop an intervention. First, we specified the clinician-perceived barriers to penicillin allergy de-labeling (intervention targets). We then mapped intervention targets onto Theoretical Domains Framework (domains and constructs) and found the root causes of behavior. Next, we linked root causes of behavior with intervention functions (BCW). In the final step, we synthesized participants’ suggestions for process improvement with implementation strategies aligning with the intervention functions.ResultsEvidence-based strategies such as focused education and training in penicillin allergy evaluation can address knowledge and confidence barriers reported by frontline clinicians. Other key strategies involve developing a system of champions, improving communications systems, and restructuring the healthcare team. Implementation mapping can provide a powerful multi-method framework to study, design, and customize intervention strategies. Conclusion: Empowering clinicians beyond allergy specialists to conduct penicillin allergy assessments requires designing new workflows and systems and providing additional knowledge to those clinicians.

Atherosclerotic cardiovascular disease following a diagnosis of idiopathic inflammatory myopathy: analysis from a retrospective cohort in the TriNetX registry.

Idiopathic inflammatory myopathies (IIM) confer an increased risk of morbidity from atherosclerotic cardiovascular disease (ASCVD). While ASCVD risk has been studied in other countries, these results may not be applicable to patients with dermatomyositis (DM) and polymyositis (PM) in the United States. This retrospective analysis of a cohort of patients identified by ICD code from TriNetX investigated the incidence of ASCVD after International Classification of Disease (ICD) codes of DM, PM, dermatopolymyositis (DPM) or juvenile dermatomyositis (JDM). Patients were identified by entry of two ICD codes separated by at least 6months, according to their first diagnosis code; ASCVD was defined as first ICD code for myocardial infarction, ischemic stroke, transient ischemic attack, or peripheral arterial disease. Cox proportional hazards regression modeled time from first IIM ICD code to ASCVD event. A total of 35,554 patients were identified with the mean age at first IIM code of 54 and 26.1% were male. The most common comorbidity for all groups except JDM was hyperlipidemia (39.9%) though 79.2% of patients were on no cholesterol lowering medication. ASCVD occurred in 30.4% of patients with PM, 24.3% of patients with DM and 0.9% of patients with JDM. Patients with PM had a median time to event of 9.7years (95% Confidence interval (CI) 9.1, 10.7) and 14.3years (95% CI 12.6, 14.8) for DM. This study demonstrates that ASCVD is a comorbidity occurring after a median of 12.5years (95% CI 11.9, 13.6) in patients with IIM. ASCVD appears to be a long-term complication for IIM patients occurring in nearly a quarter of US patients without prior ASCVD with at least two ICD codes for IIM, with a median time to event of 12.5years. There appears to be a practice gap in the recognition and treatment of hyperlipidemia in these patients. Key Points • Hyperlipidemia was a common comorbidity identified in patients with IIM though most patients were not on cholesterol lowering medication. • Development of ASCVD appears to be a long-term complication for patients with IIM in the United States.

Evaluation of E-Learning Platforms under the EASTRIP Project: Enhancing Competency-Based Education and Training through Holographic Technology in Dar Es Salaam, Tanzania

This study delved into the use of hologram technology to bridge the practical learning gaps in the Competency-Based Education and Training framework when using E-learning platforms. The study utilized a convergent mixed-method, combining quantitative and qualitative approaches. The study focused on 26 public tertiary learning institutions located in Dar es Salaam. It selected 14 widely used e-learning platforms for a comprehensive analysis, ensuring diverse representation. The study's statistical treatment included descriptive statistics and content analysis. The study concluded that the platforms are crucial in delivering content and in teaching, uploading lecture notes and administering tests. However, the use of technology in final examinations and practical assignments indicates notable gaps that need addressing, requiring advanced technologies such as hologram. Addressing these gaps will require technological advancements and continuous professional development for academic staff to optimize the use of e-learning platforms and ensure they meet the comprehensive needs of modern education. This holistic approach will strengthen the alignment of e-learning practices with the CBET framework, fostering a more effective and inclusive learning environment.

Physicians’ Self-Reported Knowledge and Behaviors Related to Prescribing Opioids for Chronic Pain and Diagnosing Opioid Use Disorder, DocStyles, 2020

IntroductionIn 2016, CDC released the Guideline for Prescribing Opioids for Chronic Pain (2016 CDC Guideline) to improve opioid prescribing while minimizing associated risks. This analysis sought to understand guideline-concordant knowledge and self-reported practices among primary care physicians (PCPs). MethodsData from Spring DocStyles 2020, a cross-sectional, web-based survey of practicing U.S. physicians was analyzed in 2022 and 2023. Demographic, knowledge, and practice characteristics of PCPs overall (N=1,007) and among specific subsets 1) PCPs who provided care for patients with chronic pain (n=600), 2) PCPs that did not provide care for patients with chronic pain (n=337), and 3) PCPs who reported not obtaining or seeking a buprenorphine waiver (n=624) were examined. ResultsA majority of physicians (72.6%) were unable to select a series of options consistent with diagnostic criteria for opioid use disorder (OUD); of those physicians, almost half (47.9%) reported treating at least one patient with medications for OUD. A minority of physicians (17.5%) reported having a buprenorphine prescribing waiver. Among physicians who prescribed opioids for chronic pain (88.5%), 54.4% concurrently prescribed benzodiazepines. About one-third (33.5%) reported not taking patients with chronic pain. ConclusionsThere were critical practice gaps among PCPs related to 2016 CDC Guideline topics. Increasing knowledge of CDC's opioid prescribing recommendations can benefit physician practice, patient outcomes, and public health strategies in addressing the opioid overdose crisis and implementing safer and more effective pain care.

Scoping review protocol: what is the state of evidence for the use of communication apps with immigrant seniors in long-term care and community settings?

First language care is critical for older immigrant adults with limited English proficiency, especially in long-term care settings where most residents require staff assistance and experience complex chronic conditions, resulting in multiple communication interactions where language poses a barrier. Although there are a myriad of cultural-language translation apps and devices available, there is a gap in both research and practice on the acceptability and feasibility of these digital resources within the context of long-term care and community settings for older immigrant adults, from a cultural relevance and digital health equity perspective. Our paper outlines a scoping review protocol to examine the state of the literature on the extent to which cultural-language translation apps are used in long-term care settings and community-based elder care. We will also examine the extent to which such apps bridge or further gaps in equitable, accessible and acceptable care for older immigrant adults with limited English language proficiency. This scoping review protocol will employ an adapted five-stage framework outlined by Arksey and O'Malley guided by enhancements recommended by Levac et al and Colquhoun et al. Using the Joanna Briggs Institute's population, concept and context framework, we defined the scope of the scoping review by identifying the target population, concepts for investigation and the context within which the research is situated. We will conduct a search of the literature from 2005 to 2024 using five bibliographic databases from health sciences (Healthstar OVID, MEDLINE OVID and Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO), engineering (Engineering Village Elsevier) and a cross-disciplinary database (Web of Science Clarivate). The research team will adopt a critical, equity-focused approach for the scoping review by integrating Richardson et al's framework for Digital Health Equity into our analysis of the findings. This will ensure that health and social equity perspectives are integrated within our methodology and analytical lens. Our analysis will specifically examine selected studies for their engagement with health equity and their ability to address issues such as ageism, ableism and the digital divide within geriatric care. Ethics approval is not required for this scoping review as it involves secondary analysis of published works and no primary data collection involving human subjects. Findings of the review will be shared with community partners and disseminated through publications, conferences and peer-reviewed publications.

Awareness, knowledge, attitude, and practice of adverse drug reaction reporting among health workers in primary health centres participating in seasonal malaria chemoprevention campaign in Nigeria in 2022: a cross-sectional survey

BackgroundEvaluating health workers’ knowledge and practice of adverse drug reaction (ADR) reporting is an important step in identifying gaps in quality ADR reporting during public health interventions like the seasonal malaria chemoprevention (SMC) campaign. Pharmacovigilance (PV) monitoring is vital in SMC due to the number of children exposed to malaria medicines for a period of 4 or 5 months during the campaign. In Nigeria more than 10 million children are exposed to SMC medicines every year. The scale of this intervention emphasised the need for efficient and effective safety monitoring during the campaign. Thus, the objective of this study was to evaluate healthcare workers’ (HCW) awareness, knowledge, attitude and practice (KAP) of ADR reporting in health facilities participating in SMC campaign to identify pharmacovigilance gaps which may suggest possible ways to ensure safety during the campaign.MethodsWorld Health Organization’s service availability and readiness assessment (SARA) recommendations were used to sample 2,598 out of 5,195 used as supervising health facilities (HFs) during the 2022 SMC campaign across nine states of the country. Out of the sampled HFs, 2,144 eligible and consented health facility workers (HFWs) were assessed for awareness, and KAP of ADR using the validated 45-item self-administered questionnaire. The data was analysed using descriptive statistics and correlation analysis at p < 0.05.ResultsThe majority of the respondents are males (n = 1,333, 62.2%). The HFWs showed good awareness (n = 2,037, 95.0%) of pharmacovigilance (PV). However, only 809 (37.7%) of them had good knowledge scores. The mean ADR reporting attitude score (85.0 ± 15.3%) was good with many of the respondents (n = 1,548, 72.2%) having a good score. However, the respondents’ ADR practice was suboptimal, only 1,356 (63.2%) of them had encounters with ADR, and a lot of negative perceived barriers to ADR reporting were identified in the study. For example, 493 (23%) believed that ADRs were not reported because they were not serious and life-threatening while 248 (11.6%) reported a fear of liability. Correlation analysis revealed female gender (r = 0.163, p < 0.001), older age (r = 0.207, p < 0.001) and years of practice (r = 0.050, p = 0.021) as factors significantly associated with ADR knowledge and attitude scores.ConclusionThe study indicated that HCWs across health facilities participating in SMC campaigns have ADR reporting knowledge and practice gaps. The study suggest training alone may not be effective in addressing gaps in ADR reporting. In addition to PV training, implementers can include continuous mentoring of health care workers or other similar interventions as part of strategy to improve ADR reporting. Also, context specific strategies to improve ADR reporting among health care worker needs to be implemented to address under-reporting of ADRs during SMC campaigns and other malaria public health interventions.

Improving Person-Centered Depression Screening and Care in an Urban Faith-Based Community.

Background: Depression is a common mental illness that increases the risk of suicide, substance abuse, and chronic pain. Nationally, 21 million adults have had one untreated depressive episode, 1.4 million people have had suicide attempts, and 1 death occurs every 10 minutes. Depression has an annual economic burden of $326 billion for the American economy. Objectives: This quality improvement project aims to review the existing literature on depression, audit local businesses, survey clients, and team members to identify a gap in practice and then collect and analyze data to draw conclusions and make recommendations based on the findings. Methods: This initiative used four Plan-Do-Study-Act rapid quality improvement cycles. Data were collected and analyzed, and the results were used to make iterative changes. Results: Depression screening improved by 90%, and 317 clients were screened over 8 weeks. Twenty-eight percent of those screened had depression and were engaged in managing their symptoms. Both screening and care improved, and the aim of 89% was met. Conclusions: This initiative bridged a gap in depression screening and care. It also demonstrated a positive outcome, had the potential for sustainability, and spread to other faith communities. Implications for Nursing: A system should be put in place for depression screening, care, and referrals.

Surgical Skill Decay as a Result of the COVID-19 Pandemic.

This study aimed to objectively evaluate the impact of the gap in surgical practice caused by COVID-19 on surgical skill decay. This retrospective cohort study enrolled 148 cases of adult patients who were qualified for elective or urgent laparoscopic cholecystectomy. This study compared the period of nine months before the pandemic outbreak and nine months after the end of the pandemic. We analyzed the duration of surgery, the number of intraoperative adverse events (IAEs), postoperative complications (PCs), and differences between the surgeries performed by residents and those performed by specialists. The number of IAEs did not differ significantly between groups (after COVID-19 (AC) and before COVID-19 (BC)). A difficult gallbladder (DGB) was associated with an increased risk of IAEs during surgery in both groups (BC:OR = 2.94, p = 0.049; AC:OR = 2.81, p = 0.35). The multivariate analyses showed no significant differences in IAEs or PCs when the residents performed surgeries compared to specialists. The average duration of surgery was significantly longer in the post-pandemic group (BC-102.4 min vs. AC-119.9 min, p = 0.024). Measurable determinants of surgical skills are the duration of surgery and the number of intraoperative adverse events. By defining this indicators, our study objectively shows that the reduction in the volume of surgeries during COVID-19 resulted in a phenomenon known as surgical skill decay.

Opioid Prescription Practices and Risk Management among Physicians in Morocco

The opioid crisis represents a major public health challenge globally, notably in the United States where it has resulted in significant morbidity and mortality. In Morocco, the patterns of opioid prescription and the factors influencing these practices are not well documented. This study aims to explore the socio-demographic characteristics, professional backgrounds, and opioid prescription practices among physicians in Morocco. Utilizing a cross-sectional survey design, data were collected from 123 physicians across various regions. The findings indicate that specialist doctors, particularly those in urban public sectors, are more likely to prescribe opioids, with codeine, tramadol, and morphine being the most common. These opioids are primarily prescribed for cancer pain, rheumatic pain, and post-operative pain. The study underscores the necessity of targeted interventions to address gaps in opioid prescription practices and to enhance risk management strategies among physicians.

A Scoping Review on the Implementation of Autonomous Learning at the University Level in Kuwait: PAAET as a Case Study

This paper is mainly a scoping review that explores the current body of knowledge related to the presence and growth of autonomous learning at the university level in Kuwait. The review was conducted to answer the research question “Can we implement autonomous learning at the university level in Kuwait?” To support this scoping review, a questionnaire consisting of eight opened-ended questions was designed that asked professors who teach in different colleges in The Public Authority for Applied Education and Learning (PAAET), one of the main and oldest universities in Kuwait, about their opinions on autonomous learning at the university level. The questionnaire served to allow the study to gather valuable primary data that contextualized the scoping review and added real time insights. One of the findings of the paper is that the initiation of the promotion of autonomous learning in Kuwait partially occurred because of the onset of the COVID-19 pandemic. The pandemic required universities to engage in digital and remote learning so students’ academic progress could stay on schedule as much as possible. This phase naturally developed some university students’ ability to study in their own time and complete their assignments without an excessive amount of prodding from teachers. However, the literature published after the pandemic does not present a state of widespread proficiency when it comes to university students’ autonomy. Another finding is that current research stressed the effectiveness of interventions that directly target students’ lack of autonomy. However, there is little knowledge about the frequency in which these interventions are recommended or implemented. From a practical perspective, university level teachers will need to improve their communication skills so they can learn how to connect with students as individual learners. In addition, teachers at the university level should develop a line of communication with secondary school teachers in Kuwait. University students’ lack of preparation for autonomous learning is a sign that they are not being properly developed as scholars in their younger years. Teachers at the university level must communicate with secondary teachers to identify where the current gaps in practice are.

Where’s the Peanut Butter? Journaling about Science Practices in Everyday Life

ABSTRACT Teacher candidates kept journals for one semester, documenting the science content and practices they encountered in their daily lives, while their professor provided detailed written feedback. The objective of this study was to determine gaps in everyday science practices, and to eventually design interventions which might help teacher candidates relate all the NGSS science practices to their students’ lives. The most common NGSS science practices documented were asking questions and obtaining, evaluating, and communicating information. The least documented practices were analyzing and interpreting data and using mathematics and computational thinking. This assignment helped teacher candidates develop their identity as scientists, notice more science in their daily lives, and helped them bridge the gap from everyday applications of science to their classroom lessons. They found the exercise to be empowering, challenging, interesting, and enjoyable. Professor feedback on the journal entries was the most motivating aspect of the assignment. This study revealed gaps in the science and engineering practices that preservice science teachers experience in their lives.

The Evolution of Futures and Options Markets: From Agricultural Roots to High-Frequency Trading

The evolution of futures and options markets from simple agricultural hedging tools to complex financial instruments has been marked by significant technological advancements, particularly the advent of electronic trading and high-frequency trading (HFT). This paper traces the development of these markets, highlighting key milestones and innovations that have shaped their current form. High-frequency trading, while enhancing liquidity and reducing transaction costs, has also introduced significant challenges, including increased market volatility, the potential for market manipulation, and systemic risks, as seen in events like the 2010 Flash Crash. This research provides a comprehensive analysis of the legal and regulatory frameworks governing futures and options markets, with a focus on both Indian and international contexts. It examines the effectiveness of existing regulations in addressing the challenges posed by modern trading practices and explores the need for continuous adaptation in regulatory approaches. Through a detailed review of relevant case laws, statutory provisions, and scholarly literature, the paper identifies gaps in current regulatory practices and proposes recommendations to enhance market transparency, fairness, and stability. The study concludes that while the evolution of futures and options markets has brought undeniable benefits in terms of efficiency and risk management, these markets must be carefully regulated to mitigate the risks associated with high-frequency and algorithmic trading. Adaptive regulatory frameworks, enhanced transparency measures, and international cooperation are essential for ensuring that these markets continue to contribute positively to the global financial system.

Impact of unprecedented drought in intensive subsistence agriculture and food security: issues, policy practice gap and the way forward

Impact of unprecedented drought in intensive subsistence agriculture and food security: issues, policy practice gap and the way forward

Identifying Care Gaps and Referral Patterns in Acute Dermatology at Urgent Care Centers.

Limited urgent access to board-certified dermatologists drives patients to seek dermatologic care at urgent care centers (UCC). UCC are staffed by clinicians with comparatively limited dermatology training, often resulting in lower quality care for acute dermatology conditions. This study investigates health care referral outcomes of patients seeking dermatologic care at UCC, examine the appropriateness of UCC dermatologic care, and assess the feasibility of referral management by eConsult. We utilize a retrospective cohort of 807 patients and a provider survey to examine referral outcomes of patients referred to University of Rochester Dermatology (UR-Derm), a tertiary care university-based teaching hospital, from UR UCC between January 1, 2021, and August 31, 2022. Outcomes for healthcare referrals included patient demographics, referral completion rates, UR-Derm appointment wait times, and diagnostic concordance rates between UCC and UR-Derm. Outcomes from the provider survey included appropriateness of UCC treatment plans, appropriateness of UCC referral to UR-Derm, and feasibility of referral management by eConsult. Patients who utilized UCC were predominately white (77.0%) females (53.9%) with a mean age of 37.9 years. Most patients referred by UCC did not complete an in-person UR-Derm evaluation (58.6%). Of those who did complete a UR-Derm visit, the average wait time was 38.3 days. Only 56% of UCC and UR-Derm diagnoses were concordant. Our surveyed dermatologists deemed 30% of the UCC treatment plans appropriate. The majority of referrals (83.5%) were viewed as manageable with an eConsult with only 10% of referrals requiring in-person visit. Several practice gaps exist in specialty care delivery in UCC and additional inefficiencies exist in the urgent referral process. These gaps could be addressed by targeted educational interventions and availability of dermatology consultation to support urgent care.

Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health.

This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.