Individual Goals Research Articles

How Do Patients Perceive Success and Satisfaction After Vertebral Body Tethering and Fusion for Adolescent Idiopathic Scoliosis? A Qualitative Study.

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among children. Although posterior spinal fusion (PSF) is a commonly used treatment for curves ≥ 45°, anterior vertebral body tethering (VBT) has recently gained traction as an alternative for some patients. Surgeons have established radiographic definitions of success for PSF, with similar efforts underway for VBT. However, these definitions may not align with patient perceptions of success or their satisfaction with achieved outcomes. To enhance patient-centered care and inform subsequent comparative effectiveness research, we asked: (1) How do patients who have undergone VBT or PSF define and perceive treatment success ≥ 3 years after surgery? (2) What are patients' perceptions of their outcomes, specifically regarding satisfaction with symptom relief, side effects, physical function, and physical appearance? Using an approach informed by concepts from phenomenology to capture patients' lived experiences, we conducted semistructured interviews using an interview guide. Inclusion criteria required patients to have (1) progressive AIS with moderate deformity (< 60°) at surgery, (2) undergone VBT or PSF with at least 3 years of follow-up, and (3) reached full skeletal maturity. Patients unable to communicate or schedule interviews were excluded. From 96 eligible patients (VBT n = 47, PSF n = 49), we recruited 40 (20 per cohort). The sample size was guided by qualitative studies in the field and aimed to achieve saturation, defined as the point at which minimal new information and no new coding categories were identified. Participants were treated at a single urban Midwest hospital by the same physician. The VBT cohort (median age 18 years [range 16 to 22]) was 85% women/girls, while the PSF cohort (median age 21 years [range 18 to 27]) was 70% women. Interviews were analyzed using a collaborative content analysis approach in which two researchers independently identified key ideas, assigned codes, and resolved discrepancies through consensus to develop themes and subthemes aligned with the research questions. Patients from both cohorts defined success as achieving pain relief, maintaining physical function, improving appearance, ensuring long-term deformity correction, and alleviating concerns about future health risks. Patient priorities varied; some prioritized flexibility to swim competitively or play musical instruments, while others prioritized pain-free living or improved physical appearance. Overall, both groups expressed satisfaction with symptom relief, physical function, and appearance improvements despite ongoing pain, side effects, and physical limitations. These findings may be used as a guide for preoperative counseling and highlight the importance of incorporating patient perspectives into preoperative counseling for AIS, emphasizing the need to set realistic expectations regarding pain relief, physical function, long-term stability, and emotional well-being. While patients frequently reported positive outcomes in pain reduction, mobility, and appearance, counseling should address potential residual discomfort, physical limitations, and body image concerns to improve satisfaction. Future research should prioritize developing nuanced, patient-centered outcome measures that capture specific priorities such as detailed pain characteristics, functional abilities, and appearance-related concerns. Comparative effectiveness studies should explore granular outcomes to provide evidence that supports shared decision-making and guides patients and clinicians in choosing between VBT and PSF based on individual goals. Additionally, examining how presurgery discussions about tradeoffs and long-term outcomes shape patient expectations and satisfaction can improve alignment between surgical practices and patient priorities. Level III, therapeutic study.

P-1445. Evaluation of Achievement of Metabolic Goals in People with Human Immunodeficiency Virus (HIV) in the Illinois Department of Corrections (IDOC)

Abstract Background The UIC-IDOC clinic is an interdisciplinary telemedicine clinic addressing HIV care needs of individuals in custody. The UIC-IDOC care team makes recommendations to medical providers regarding disease states outside of HIV. HIV contributes to increases in cardiovascular (CV) risk, along with diabetes (DM), hypertension (HTN), and hyperlipidemia (HLD). Managing comorbidities in patients with HIV (PWH) can lead to an overall reduction in CV risk. The goal of this study was to provide evidence that follow-up with IDOC telemedicine clinic had positive outcomes on achieving metabolic goals in individuals in custody. Methods This was a pilot retrospective cohort study evaluating the effectiveness of an interdisciplinary approach in achieving A1C, blood pressure, or lipid panels among PWH in custody. Adults diagnosed with HIV, on antiretroviral therapy (ART), and with a diagnosis of DM, HTN, and HLD were included between 1/1/2021 and 6/30/2022. The primary outcome evaluated the achievement of metabolic goals within 1 year compared to baseline, while the secondary outcome assessed medication optimization to guideline-recommended therapy for any diagnoses above. Results 102 patients were included. Baseline characteristics are presented in Table 1. Notably, most PWH reported ART adherence and achieved viral suppression. For the primary outcome, there was no difference in the achievement of metabolic goals 1-year post-follow-up for all disease states, DM (p=0.347), HTN (p=0.833), and HLD (p=0.935). For our secondary outcome, there was a significant difference in the optimization of hypertensive medications by the last visit, Table 2. Conclusion Findings from this study offer insights into optimizing HIV care delivery within correctional settings and enhancing outcomes for this patient population. Based on this data, recommendations being made by the UIC-IDOC telemedicine clinic may not be consistently implemented. However, our study shows an interdisciplinary clinic's role in the medication management of individuals in custody and the potential to assist in reducing cardiovascular risk in PWH, especially in people with HTN. Furthermore, a high degree of viral suppression was demonstrated for this study which may predict adherence to medications for metabolic diagnoses. Disclosures Scott Borgetti, MD, GSK: Grant/Research Support

New insights into the goals of transgender male versus non-binary individuals considering metoidioplasty and phalloplasty gender-affirming surgery.

Understanding patient goals for metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is paramount to achieving satisfactory, preference-sensitive outcomes, yet there is a lack of understanding of MaPGAS priorities and how these may vary between transgender men and non-binary individuals assigned female at birth (AFAB). To understand the surgical goals of transgender men and non-binary individuals AFAB considering MaPGAS. An online survey was created following literature review and qualitative interviews and distributed via social media and a community health center to participants AFAB aged ≥18years who had considered but not yet undergone MaPGAS. We collected demographics, surgical history, Likert ratings of importance of 14 possible MaPGAS goals, and selection of the 5 most important goals. Differences in goal importance ratings were compared using the Mann-Whitney U test. Responses to an open-ended question on additional MaPGAS goal considerations were thematically analyzed by 2 reviewers. A total of 248 eligible participants completed the survey; participants included transgender men (64%) and non-binary individuals (36%). Both groups rated maintaining tactile and erogenous sensations as top priorities. Significant differences emerged in half of the goals, with transgender men more likely to place importance on being seen as male, public restroom comfort, peeing through the tip of the penis, standing urination through the fly, and resolution of gender dysphoria. Non-binary individuals were more likely to place importance on retaining a vaginal canal to receive penetration and for gender identity affirmation. These differences in goal prioritization between the 2 groups were most apparent when individuals provided their top 5 goals. In open-ended responses, aesthetics was a major consideration for transgender men, sexual pleasure was a consideration for non-binary individuals, and complications were cited as major concerns by both groups. Individual MaPGAS goals should be incorporated into preoperative counseling and may vary by gender identity. This is the largest study to our knowledge evaluating patient MaPGAS goals and comparing gender identity cohorts. Our results incorporate qualitative open-ended feedback and underscore the importance of understanding patient-specific MaPGAS goals to better facilitate personalized preoperative counseling. Results will be used to guide decision support tool development. Limitations include the cross-sectional study design and reduced socioeconomic diversity. While maintaining tactile and erogenous sensation and minimizing surgical complications were universally important goals, significant variations emerged between transgender men and non-binary individuals' MaPGAS goals highlighting the need for personalized preoperative counseling.

Building a culture that empowers and motivates mathematics teacher leaders as change agents

AbstractMathematics teacher leaders may play an integral role in supporting change to address inequities in STEM education. To harness this potential, there is a need to identify effective professional development models that empower and motivate mathematics teacher leaders. We examine one such model focused on developing 30 K‐12 mathematics teacher leaders to support and expand teacher leadership within Nebraska, USA. Data analysis from interviews and surveys suggest that the project's focus on building and expanding teacher leaders' professional networks and increasing access to a variety of leadership opportunities contributed to a culture that empowered and motivated teacher leaders. Using the four frames model of organizational change in STEM, we identify several cultural features that contributed to the project's impact, including a cohort model connecting like‐minded educators that supported each other's efforts to enact changes; a distributed leadership philosophy that positioned participants as leaders within the project and at the university in which the project was situated; structural supports (e.g., funding, awards) for participants to engage in leadership; and a tailored approach to support participants based on their individual goals and vision for leadership. These findings have theoretical and practical implications for developing and supporting mathematics teacher leadership.

Improving quality of support and staff culture in a supported living service: a practice example of tier 1 positive behaviour support

Purpose This paper aims to describe the approach taken to identify areas for development and to enhance positive practice, in line with a preventative tier 1 positive behaviour support (PBS) approach. The work was conducted within a supported living service, where 10 individuals with a learning disability reside. Design/methodology/approach The intervention was provided through a dedicated behavioural clinical specialist role over nine months. An initial assessment included measures evaluating PBS, active support and staff culture. Narrative themes were also noted from discussions with staff to deepen the understanding of informal staff culture. Together, this informed a programme of work guided by the setting of both individual and service-wide goals. Input included practice leadership, staff training, review of PBS plans and delivery of case workshops. Assessments were then repeated to evaluate the work completed. Findings There were indications of improvements in staff culture and practice following the intervention. Originality/value This practice example may be useful for other organisations to consider when thinking about how to use resources effectively to improve people’s quality of life and implement tier 1 of PBS provision.

Social and goal-related foundations of interpersonal adaptation during joint action.

Collaborative motor interactions (joint actions) require relating to another person (social dimension) whose contribution is needed to achieve a shared goal (goal-related dimension). We explored if and how these dimensions modulate interactive behavior by exploring posterror interpersonal adaptations. In two experiments carried out in 2022 (N₁ = 23; N₂ = 24, preregistered), participants played sequences of notes in turn-taking with a coactor either described as another participant or the computer (human vs. nonhuman coactor, social manipulation) while pursuing shared or individual goals (goal-related manipulation). The coactor was programmed to make a mistake in 50% of the trials. We found that, only in the shared goal condition, participants were slower when interacting with a human than a nonhuman coactor depending on how strongly they believed the human coactor was a real participant. Moreover, the general slowdown following a partner's error was absent when the action required from the participant corresponded to what the coactor should have done (correction tendency effect). This effect was found only in the shared goal condition without differences between coactors, suggesting it was driven by goal-related representations. The social and goal-related dimensions thus independently but significantly shape interpersonal adaptations during joint action. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Геймификация как педагогическая технология повышения мотивации и самореализации обучающихся

The article discusses the main aspects of using gamification in education as a pedagogical technology to increase motivation and self-realization of students (students and cadets of educational institutions of higher education). Gamification today can be represented as a fairly new pedagogical technology, the active growth of which is associated with the development of the Internet and online education in general. The main stages of the preparation of educational projects within the gamification technology are highlighted. The main directions of gamification implementation in educational practice are revealed (using the example of educational institutions of higher education of the Federal Penitentiary Service of Russia). It is emphasized that gamification is a flexible tool for motivating and increasing student engagement in order to achieve high learning outcomes. Gamification turns learning into an exciting game, making it more attractive and accessible to various age categories of students (students, cadets, trainees for advanced training and professional retraining). Educational practice shows that the use of gaming technologies and gamification increases the social activity of students and cadets, increases their learning interest and motivation, allows them to determine the area of immediate professional and personal development of students, significantly complements classical learning, specifies individual and group goals in teaching subjects of educational activity, in a broad sense – forms relevant professional competencies. significant for future professional activity.

The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study.

Home spirometers have been widely implemented in the treatment of people with cystic fibrosis (CF). Frequent spirometry measurements at home could lead to earlier detection of exacerbations. However, previous research indicates that the long-term use of home spirometry is not well maintained by people with CF. We aimed to gain insight into the long-term uptake of home spirometry in regular multicenter CF care. Home spirometers combined with a remote monitoring platform were introduced in the treatment of people with CF in 5 Dutch CF centers starting in April 2020. Usage data from April 2020 to December 2022 were analyzed retrospectively. Survival analyses were conducted to assess use consistency over time, and t tests were used to evaluate the impact of increased pulmonary symptoms on home spirometry frequency. The effect of the initiation of a new treatment, Elexacaftor/Tezacaftor/Ivacaftor, on use frequency over time was assessed in a subgroup of participants with repeated measures ANOVA. During the observation period, a total of 604 people with CF were enrolled in the remote monitoring platform and 9930 home spirometry measurements were performed. After the initiation of home spirometry use, the number of users declined rapidly. One year after the initiation, 232 (54.2%) people with CF stopped using home spirometry. During the observation period, 67 (11.1%) users performed more than 20 measurements. Furthermore, the number of consistent home spirometry users decreased over time. After 600 days, only 1% of users had measured their lung function consistently every 31 days. Use frequency slightly increased during periods with increased pulmonary symptoms (ΔMean=0.45, t497.278=-4,197; P<.001) and showed an initial rise followed by a decrease after starting treatment with Elexacaftor/Tezacaftor/Ivacaftor (ΔMean=0.45, t497.278=-4,197; P<.001). Consistent uptake of home spirometry in people with CF is low but increases around periods of changing symptoms. A clear strategy for the organization of remote care seemed to improve the long-term uptake of home spirometry. Nevertheless, home spirometry and its intensity are not a goal on their own but should be used as a tool to reach individual goals within local contexts.

Financial freedom of Filipinos in personal finance management

This study investigates the financial freedom of Filipinos through the lens of personal finance management, focusing on cash management, debt management, risk management, and wealth management. Utilizing data from 150 respondents across ten prominent corporations listed on the Philippine Stock Exchange Index, the research adopts a descriptive methodology and linear regression analysis to evaluate the impact of these financial dimensions on achieving financial independence. Findings reveal pervasive financial literacy challenges among Filipinos, rooted in cultural tendencies like the "come-what-may" attitude and a reliance on traditional saving methods. These behaviors often hinder effective budgeting, savings, and investment practices, resulting in low levels of emergency fund preparedness and high debt reliance. The study highlights the role of structured financial planning in enhancing wealth accumulation and mitigating financial stress, advocating for the adoption of comprehensive strategies that align with individual goals and risk tolerance. Furthermore, the research underscores the critical need for tailored financial education programs to foster a culture of financial discipline, particularly among working parents and young professionals. By addressing gaps in financial literacy and promoting awareness of modern financial instruments, the study aims to empower individuals to achieve sustainable financial well-being. This thesis contributes to the discourse on personal finance in the Philippines, offering actionable insights for policymakers, educators, and individuals. It emphasizes the transformative potential of financial literacy as a catalyst for economic stability and growth within households and the broader community.

Clonazepam repurposing in ARID1B patients through conventional RCT and N-of-1 trials: an experimental strategy for orphan disease development

BackgroundClinical trials for rare disorders have unique challenges due to low prevalence, patient phenotype variability and high expectations. These challenges are highlighted by our study on clonazepam in ARID1B patients,...

ENHANCING HEALTHCARE VALUE THROUGH INTEROPERABLE E-CARE PLANS: A FRAMEWORK FOR QUALITY IMPROVEMENT

Abstract Patient-centered data is critical for providing high-value care and assessing quality including functional and cognitive status, goals, and outcomes that matter most to people; these are often missing in Electronic Health Records (EHRs). Furthermore, lack of interoperability makes it challenging to share and aggregate data across clinicians and care settings, leading to fragmented and/or duplicative care. E-care plans (eCP) and data standards that focus on goal setting and outcome management are in development, and hold promise to support person- centered care planning across sites and settings of care. E-Care Plans support care coordination and quality improvement and inform future healthcare value-focused policies—such as those related to equitable coverage, quality improvement, measurement, payment, and innovation model planning. Interoperable eCPs could be integrated into clinical care and across the healthcare ecosystem. This integration will enhance care coordination and facilitate seamless information exchange. In this session, Federal officials from the CMS, VA, and AHRQ will explore the benefits of eCPs and discuss the work underway to support the implementation of these plans in clinical care. This presentation will also discuss efforts to develop value sets and FHIR mappings to enable bidirectional information exchange and the concurrent pilot testing of applications with patient data. E-care plans have the potential improve patient safety, reduce burden, support the efficient exchange of patient data such as cognitive function, physical function, and individual goals to support improving person-centered outcomes, advancing health equity, conducting economic analysis, and tailored program development.

СОВРЕМЕННЫЕ ТЕЧЕНИЯ В МИРЕ ЙОГИ: ОТ ТРАДИЦИОННЫХ СТИЛЕЙ К НОВОМОДНЫМ ПРАКТИКАМ

In the article the authors provide an overview of traditional and innovative styles of yoga, also indicate the key differences between them, and briefly characterize the changes occurring in yoga at the present stage of social development. At the end of the article the authors offer practical advice for choosing the appropriate yoga style. The authors note that when choosing a preferred yoga style, practitioners should take into account individual characteristics, needs and goals.

Management of Horizontal Cleavage Meniscus Tears.

The management of horizontal cleavage meniscus tears (HCT) has evolved in recent years. Historically, HCTs have been treated with partial meniscectomy, but multiple studies have shown the long-term risks of development of arthritic changes in the knee following meniscectomy. These findings have renewed interest in meniscal preservation whenever possible, even in older patients not previously considered for meniscus repair. This article provides an overview of current management of horizontal cleavage meniscus tears and describes modern surgical techniques for repair of HCTs. Current research studies have continued to emphasize the benefits of meniscal preservation on long-term function. Recent data has demonstrated similar success rates following repair of HCTs compared to repair of other types of meniscus tears. Additionally, multiple recent studies have demonstrated the potential benefit of biologic augmentation in decreasing failure rate after meniscal repair. Modern surgical techniques and biologic augmentation have improved outcomes of meniscal repair. However, consideration of a patient's individual goals, activity level, and expectation are important to achieve a successful outcome regardless of treatment modality. While not every patient is a candidate for meniscal repair, current data has shown it should be considered for a growing number of patients.

МОДЕЛИРОВАНИЕ ЦИФРОВОЙ ПЛАТФОРМЫ ИННОВАЦИОННОЙ ПРОИЗВОДСТВЕННОЙ ЭКОСИСТЕМЫ РЕГИОНА

The innovation paradigm defines the ecosystem approach as one of the frontier directions in the theory and practice of the development of complex social and economic systems. A characteristic feature of the current stage is the leading role of the Russian financial sector in the creation of ecosystems. At the same time, in order to achieve technological sovereignty and increase competitive advantages, it is important to introduce an ecosystem approach in the real sector of the economy with the participation of actors belonging to sectors of material production industries (industry and agro-industrial complex). The importance of regional-level innovation ecosystems is increasing, because territories with significant scientific, technological, production, and intellectual potential are becoming the locomotives of current and future transformations. The regional innovative production ecosystem (IPER) is a modern format for interaction between actors that allows for the synergy of partnerships between the state, business, science and the real sector of the economy based on network interactions, which is especially important in the agenda of sustainable innovation-oriented growth. A feature of the IPER in the sphere of agricultural production (and the agro-industrial complex as a whole) is a higher level of systemic complexity, which is due to a significant range of factor influence, including not only complex resource provision, but also natural and climatic conditions. Digital transformation is defined as one of the key national development goals until 2030, the number of projects in this area has increased in Russia by 27% over the past five years, and growth potential remains. The level of achievement of digital maturity at the end of 2023 was 74.7% against the planned indicator of 64.2%. The presented algorithm for the digital transition of IPER involves a step-by-step strategizing of the process with the identification of targets, risk assessment and possible realistic scenarios. The interaction of actors based on the joint of resources, the coordination of interests within the framework of IPER with the prospect of platformization is aimed both at achieving their individual goals and at increasing the sustainability of the entire ecosystem, with a projection on regional development and strengthening positions at the national and international levels.

IMPLEMENTATION OF THE BALANCED SCORECARD WITHIN THE CONTEXT OF BANK MANAGEMENT

The article provides content analysis of scientific literature, namely the theoretical prerequisites for the implementation of a balanced table of strategic efficiency management indicators in the banking industry. The main purpose of this study is to reveal the balanced practice of indicators in the literature. A balanced indicators are a strategic efficiency management system that has brought a holistic approach to measuring efficiency, which is the most important activity of the control function of the administration. Moreover, this study contributes to literature with examples of different regions of the world. An example of the formation of the elements of a balanced indicators for Venture Bancorp. When BSC is used, the real efficiency of the institute over a period of time is measured according to certain indicators in the balanced table of indicators, and this is compared with purposeful efficiency. Instead of focusing on traditional approaches to measuring productivity, such as profit and productivity, the strength of indicators, the speed of learning, innovation, quality, flexibility, reliability and accountability are currently very important elements. Therefore, efficiency and administration measuring systems must be formed, taking into account these elements, and individual or organizational efficiency goals must be developed. The amount of money achieved at the end of the measurement of each performance indicator appears as a result of BSC. The minimum base value, the maximum limiting value and the target value of each performance indicator are also indicated. There is a percentage weight for each measurement in a balanced table of indicators, and the total weight of all measurements is 100%. Each performance indicator is estimated according to the achievement ratio and the target value. After that, the values ​​of performance indicators are multiplied by the determined percentage weight of each performance indicator. Summarizing this, BSC is a comprehensive approach to quality assurance and financial services. It is important to accept innovations in the banking sector, especially for international competitiveness. The conclusions show that it is more profitable to prepare a balanced table of bank indicators than to report financial activities only in terms of evaluating efficiency with a holistic approach.

Defining food well-being from the perspective of young Canadian consumers: an exploratory study

Food well-being (FWB) is fundamental for consumers’ overall well-being. Previous studies have explored FWB through five domains (food socialization, literacy, marketing, availability, and policy) or food-related concepts (e.g., food pleasure, healthiness, and satisfaction). However, the understanding of FWB is limited due to two main issues: (1) the absence of a clear definition and reliable measurement tools for this multifaceted and multidisciplinary phenomenon, and (2) the tendency of studies to focus on individual dimensions rather than examining it as an integrated whole, making it difficult to understand how these dimensions are interconnected. To address these gaps, a qualitative exploratory study was conducted with young Canadian consumers using a focus group and 15 individual interviews. A directed content analysis revealed a disconnect between consumer perceptions and the existing definition of FWB. This study makes three key contributions to understanding FWB: first, it provides a deeper insight into FWB conceptualization by identifying new themes within its domains. These include: (1) food socialization, shaped by family, peers, and meal traditions; (2) food literacy, encompassing both conceptual and procedural knowledge, as well as individual goals; and (3) food marketing, shaped by the impact of marketing activities (the 4Ps) on food experiences. Second, this study presents a comprehensive framework that illustrates the interconnections among FWB domains. It highlights, for example, how food socialization influences food literacy, the interactions between food literacy and food marketing, and the role of policy in shaping FWB. Third, it offers practical implications for enhancing FWB in contemporary consumer society.

The Influence of Cultural Factors on Financial Decision-Making in Ghana

This study investigates the role of cultural factors in shaping financial behaviors in Ghana, focusing on elements such as family obligations, communal traditions, religious beliefs, and traditional practices. It examines how these cultural dynamics influence decisions related to savings, borrowing, investments, and the use of informal financial systems like &amp;quot;susu,&amp;quot; a widely trusted savings method in Ghanaian society. Through a mixed-method approach combining qualitative and quantitative techniques, the research provides a holistic view of the cultural influences driving financial decision-making. The analysis reveals a strong cultural preference for financial practices rooted in community trust and collective responsibility, often favoring informal systems over formal financial institutions. Family structures and societal expectations strongly influence financial priorities, emphasizing the needs of the group over individual goals. Religious values also play a significant role, shaping attitudes toward financial ethics, debt management, and charitable contributions. This reliance on cultural norms reflects the high level of trust in traditional methods that align with familiar and accessible systems. The findings underscore the necessity of culturally tailored financial solutions to bridge the gap between informal practices and formal financial services. Policymakers and financial service providers must consider these cultural intricacies when designing products and strategies to improve financial inclusion. Culturally aligned financial education and services can foster trust and encourage broader participation in formal financial systems, supporting economic growth and stability. This research not only advances academic understanding of the intersection between culture and finance but also offers actionable insights for creating financial policies and services that resonate with the cultural realities of Ghanaian society. By aligning modern financial systems with traditional values and practices, financial inclusion can be enhanced, fostering a more inclusive and equitable financial environment.

Updated and revised Russian consensus on the use of multilevel injections of abobotulinumtoxin A in children

One of the modern components of complex rehabilitation of patients with spasticity is the use of botulinum toxin type A (BTA) preparations. International experience with the use of botulinum therapy in children spans more than 30 years. Abobotulinum toxin A has been used to treat spasticity since 1994. Clinical studies have shown the high efficacy of abobotulinumtoxin A in relieving spasticity of the lower and upper extremities in cerebral palsy (CP) and other disorders, which is associated with a significant increase in muscle tone, thereby increasing motor skills and achieving individual patient goals. The article presents a consensus of Russian experts on the approach to selecting target muscles and calculating the dose of abobotulinumtoxin A in multilevel injections, and discusses the planning of repeat injections, ethical and legal aspects of botulinum therapy in children, the combination of botulinum therapy with other methods of correcting spasticity in CP, the use of BTA in dystonia and sialorrhea, and factors potentially influencing the effectiveness of botulinum therapy. This consensus summarizes the views of Russian experts on creating an injection protocol depending on individual clinical data and treatment goals, which can be used as a guide for practical work.

Current Trends in Treating Malignant Pleural Effusion: Evidence, Guidelines, and Best Practice Recommendations.

Malignant pleural effusion (MPE) is common in individuals with cancer and typically reflects advanced disease. Most cases are symptomatic, with dyspnea and pain having a severe effect on the patient's quality of life (QOL). The management of MPE aims to relieve symptoms, improve QOL, prevent repeated pleural interventions, and minimize hospital admissions. Common treatments for MPE that provide symptomatic relief include thoracentesis, chemical (talc) pleurodesis, or indwelling pleural catheters (IPCs). Talc pleurodesis and IPCs are the mainstay of treatment but represent very different treatment strategies: talc pleurodesis is an inpatient procedure, whereas IPCs are an ambulatory strategy. Given their similar efficacy, treatment decisions in MPE are often determined by other factors, such as the patient's clinical characteristics, individual treatment goals, and preferences for hospital-based or home-based care. We provide a summary of the evidence for different interventions for treating MPE and compare recommendations from the major American, European, British, and Spanish guidelines regarding when to consider each treatment. We highlight specific challenging treatment scenarios and key clinical considerations that may influence treatment decisions for different patients. There are barriers to accessing and receiving evidence-based care. Patients with symptomatic MPE would benefit from early referral from oncology teams to pleural services. We provide best practice recommendations for optimal referral and coordination of care to ensure that patients receive maximum benefits from their interventions.

Early career occupational therapists’ perceptions of occupational justice in practice in Singapore

Introduction: Occupational justice addresses social, political and economic factors influencing occupational participation as a human right. Implementing occupational justice is challenging due to institutional, personal, environmental and cultural barriers, and may be further complicated in non-Western contexts. Early career occupational therapists often struggle to apply these principles while transitioning from education to practice, despite their desire to advocate for justice-focused practices. Methods: This qualitative descriptive study, grounded in social constructivism, explored the experiences of early career occupational therapists applying occupational justice in Singapore. Using snowball sampling of 2020 and 2021 graduates, participants engaged in one-time semi-structured interviews, which were transcribed verbatim and thematically analysed. Findings: Of 140 potential participants, 10 responded and completed the study. Four themes were developed: (1) Feeling uncertain about occupational justice, (2) Perceived relevance in the Singaporean context, (3) Early career challenges and (4) Aspiration to be agents of change. Conclusion: Early career occupational therapists expressed uncertainty in applying occupational justice concepts, often confusing them with occupation-centred practice. Despite recognising individual influences, they felt ill-prepared to tackle systemic barriers and advocate for broader social change. However, participants were aware and willing to support occupational justice ideals, suggesting a need for more guidance to integrate individual therapeutic goals with societal advocacy.