Health Care Professionals Face Research Articles

Medical cyber crises and biotechnological syndromes: a multisite clinical simulation study focused on digital health complaints

BackgroundBiotechnological syndromes refer to the illnesses that arise at the intersection of human physiology and digital technology. Implanted technologies can malfunction (eg, runaway pacemakers, hacked insulin pumps), and consumer technologies can be exploited to impose adverse health effects (eg, technology-facilitated abuse, hacks on epilepsy websites inducing seizures). Through a series of clinical simulation events, our study aimed to (1) evaluate the ability of physicians to respond to biotechnological syndromes, (2) explore gaps in training impeding effective patient care in digital cases, and (3) identify clinical cases due to digital technology arising in the population. MethodsThis was a multisite clinical simulation study. Between Jan 1 and July 1, 2023, four half-day clinical simulation events focused on digital pathologies were delivered across three NHS sites in London and the East Midlands. Participants (n=14) ranged in seniority from clinical medical students through to hospital consultants. Ethics approval was attained from University College London. Participant performance was scored by one researcher, using mark schemes built from the Objective Structured Clinical Examinations (OSCEs) format of UK Medical Schools. Qualitative and quantitative feedback was collected from participants following each of the four scenarios. Participants were asked to identify clinical challenges present in each simulation, discuss cases within their own practice, and evaluate the usefulness of the educational material. FindingsParticipants reported a wide range of examples within their own practice (eg, insulin pumps malfunctioning due to Apple watches, cardiac arrests due to faults in ventilators). Participants described barriers to treatment in simulations, including low diagnostic suspicion of technological failures, little education on biotechnological mechanisms, a lack of available expertise, and uncertainty regarding effective therapeutics. In the subjective feedback, participants reported the lowest levels of confidence when managing cases relating to software issues in medical devices, both in terms of confidence in their own ability to deliver care (mean scores: 3·6/10 junior staff, 5·8/10 senior staff) and in their teams (3·8/10 juniors, 6·8/10 seniors). InterpretationIn our digital society, clinical cases related to technology are likely to increase in the population. At present, a lack of clinical awareness, education, training material, and appropriate guidelines are some of the barriers that health-care professionals face when treating these patients. FundingNone.

Resolution of Resorptive and Compressive Atelectasis without Invasive Manoeuvres: A Case Report

A care challenge that clinicians and other healthcare professionals face very frequently is the complications of bedridden syndrome. Respiratory involvement readily occurs in these patients for whom medical therapy alone is not sufficient. In this clinical case, the authors describe the results of chest physiotherapy in an elderly patient who had developed complete atelectasis of the left lung, attributable to two mechanisms: obstructive, due to mucus plugging, and compressive, due to pleural effusion. The patient was accessed in the authors’ Respiratory Rehabilitation Department, San Raffaele Pisana Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rome, Italy, with dyspnoea at rest and high O2 requirement (venturi mask fraction of inspired O2: 40%), demonstrated by severe respiratory failure on blood gas analysis (partial pressure of O2/fraction of inspired O2: 155). Physical examination revealed marked reduction of lung sounds, especially on the left side, with diffuse rhonchi. A chest CT scan was performed to demonstrate complete left lung collapse that would have required invasive therapeutic procedures, such as bronchoscopy. However, given the high risk of periprocedural complications and the patient’s refusal, a chest physiotherapy programme was started. The lung was able to re-expand 7 days later, as evidenced by X-ray and improved gas exchange. The manuscript describes the physiotherapeutic techniques used and collects the main scientific evidence on them. The main purpose is to highlight the role of respiratory physiotherapy as an effective, safe, co-adjuvant treatment, and sometimes alternative to invasive manoeuvres in the treatment of frail patients.

Healthcare Operations and Black Swan Event for COVID-19 Pandemic: A Predictive Analytics.

COVID-19 pandemic has questioned the way healthcare operations take place globally as the healthcare professionals face an unprecedented task of controlling and treating the COVID-19 infected patients with a highly straining and draining facility due to the erratic admissions of infected patients. However, COVID-19 is considered as a white swan event. Yet, the impact of the COVID-19 pandemic on healthcare operations is highly uncertain and disruptive making it as a black swan event. Therefore, the study explores the impact of the COVID-19 outbreak on healthcare operations and develops machine learning-based forecasting models using time series data to foresee the progression of COVID-19 and further using predictive analytics to better manage healthcare operations. The prediction error of the proposed model is found to be 0.039 for new cases and 0.006 for active COVID-19 cases with respect to mean absolute percentage error. The proposed simulated model further could generate predictive analytics and yielded future recovery rate, resource management ratios, and average cycle time of a patient tested COVID-19 positive. Further, the study will help healthcare professionals to devise better resilience and decision-making for managing uncertainty and disruption in healthcare operations.

<i>AYUSH</i> in Oral Health and Diseases: An Overview

"AYUSH” is an abbreviated form for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. These are the indigenous complementary and alternative medical practices used in India. Oral diseases are significant global health ailments and greatly influence the general life quality. Compromised oral health is connected with numerous systemic chronic diseases. Oral healthcare professionals face many challenges in the management of dental conditions. It is essential for oral healthcare professionals to be abreast of Complementary and Alternative Medicine modalities, as there is a growing need for the amalgamation of these traditional systems with conventional, science-based Dentistry for the holistic management of oral diseases. The present paper highlights the AYUSH medicine systems that can be comprehensively integrated into modern oral healthcare.

The Active Leg Raise Test

Background and Purpose: There are important reasons to provide hospitalized patients with opportunities to move while hospitalized. Yet, it is apparent that, other than actually attempting the task of standing up, there is no predictive test available that would help a hospital professional decide whether the patient has adequate ability to safely attempt standing. The purpose of this research report is to describe a novel test that clinicians can use to help predict whether a patient is anticipated to be capable of standing up with little or no assistance. Approach: Hospitalized patients were requested to lift each lower extremity, one at a time, for 5 seconds, above a minimum height. To determine the predictive ability of the test to identify the ability to stand, results were compared against the “gold standard” of whether the patients were able to stand successfully as part of a physical therapy evaluation performed after the leg raise test. Outcomes: The sensitivity of the test was 0.91 (95% CI = 0.84-0.96) and the specificity was 0.71 (95% CI = 0.48-0.89). The positive predictive value was 0.94 (95% CI = 0.88-0.98) and the negative predictive value was 0.60 (95% CI = 0.39-0.79). Discussion and Conclusion: This test is simple, short, and well suited to the rapid pace of clinical decision-making that health care professionals face on a daily basis. This test is useful in helping acute care professionals answer a clinical question they encounter often, “Is it safe for this patient to try to stand up?”

Impact of Coping Skills and Mental Health in Burnout among Healthcare Professionals during Pandemic COVID-19

Introduction: Healthcare professionals face numerous challenges, such as increased risk of exposure to the SARS Cov-2 and infected patients, heavy workloads, and ethical dilemmas in their daily practice, compounded by a constantly evolving clinical environment. Moreover, the COVID-19 pandemic has exacerbated burnout rates among healthcare professionals due to prolonged working hours and other stressors such as environmental, physiological, and psychological. Methods: This study was designed as a cross-sectional and correlational investigation and included 691 healthcare providers, including physicians and nurses working in public healthcare institutions in Kosovo. The questionnaire comprised four sections: Socio-demographic, General Health Questionnaire-28 (GHQ-28), COPE Questionnaire, and Maslach Burnout Inventory (MBI). Results: The results indicated that healthcare professionals experienced emotional fatigue and depersonalization at average to high levels of 38.7%, respectively 87.0%, specifically, during the pandemic. While 88.0% of healthcare professionals reported experiencing personal success. Furthermore, 50.2% of healthcare professionals had Clinical Somatic Symptoms, 44.4% had Clinical Symptoms of Anxiety and Insomnia, 28.8% had Clinical Social Dysfunction, 34.5% had Clinical Symptoms of Depression, and 43.3% displayed Clinical Symptoms/Distress of GHQ-28 scores. The burnout scales, Emotional fatigue, and Depersonalization were positively and significantly correlated with all General Health Questionnaire scales. Conclusion: The study's findings highlight the critical importance of developing and implementing psychological interventions for healthcare professionals who are struggling with mental health issues and experiencing high levels of burnout. These interventions could be conducted individually or in groups and should be prioritized to support healthcare professionals' recovery. As the pandemic continues to impact healthcare professionals, it is crucial to enhance coping strategies within the workplace to maintain their well-being and potentially mitigate burnout rates for future pandemics. Thus, there is an urgent need to address the mental health challenges faced by healthcare professionals, and proactive measures should be taken to provide them with the necessary support and resources to cope effectively during these trying times.

PREVALENCE OF BURNOUT SYNDROME IN HEALTHCARE WORKERS IN NORTH AND SOUTH AMERICA, AND ASIA FROM 2018 TO 2022

The article explores issues concerning prevalence of burnout syndrome in healthcare workers in North and South America, and Asia from 2018 to 2022. Thus for this purpose, a great number of scientific sources that are related to the topic of the research were examined.
 Healthcare professionals face a tremendous strain during the performing of their activities that often may lead to stress and burnout syndrome. In particular, duties of healthcare workers include high responsibility for life and health of a patient, self-discipline, urgent decision-making, empathy, high productivity during extreme conditions, constant psychological and intellectual tension.
 During the past 30+ years, burnout syndrome was studied by scientists, practitioners, and also by general public all around the world. It should be noted, that nowadays a lot of employees (in particular, healthcare workers) are faced with rapid changes in our modern working life, namely, time pressure, pressure of higher productivity/quality of work, need to learn new skills, increasing demands of adaptation to new types of work, hectic jobs, etc., that in result may cause burnout syndrome.
 Burnout syndrome of healthcare workers is usually associated with poor quality of medical care and may lead to medical errors, exhaustion, inefficiency, and conflicts. High levels of burnout syndrome among medical professionals of different countries around the world vary from 7,4% to 66%.
 The issues concerning prevalence of burnout syndrome in healthcare workers in North and South America, and Asia from 2018 to 2022 have not been sufficiently identified and also require more detailed research.
 Research of scientists that used the Maslach Burnout Inventory (hereinafter – the MBI), and the Copenhagen Burnout Inventory (hereinafter – the CBI) to research the burnout syndrome in healthcare workers of different specialties (including "Family Medicine") were included in this article.
 Based on the conducted research, the following conclusions can be reached: the research carried out to identify prevalence of burnout syndrome in healthcare workers in North and South America, and Asia from 2018 to 2022 found out the presence of burnout syndrome in healthcare workers ranging from 1,3% to 82,1%. Moreover, prevalence of burnout syndrome in healthcare workers in North and South America varied from 1,3% to 73,5%, whereas in Asia it varied from 5,2% to 82,1%. Factors that associated with burnout in healthcare workers in North and South America, and Asia were examined. The majority of scientific studies on the identification of the prevalence of burnout syndrome in healthcare workers from 2018 to 2022: a) in North and South America have been conducted in Canada, the United States of America, the Federative Republic of Brazil, and the Argentine Republic, etc., whereas b) in Asia have been conducted in China, Japan, India, Pakistan, Iran, Lebanon, Saudi Arabia, Turkey, Oman, Cyprus, Israel, Jordan, and Kazakhstan, etc. Intensivists, physiatrists, resident physicians, oncologists, general surgeons, internal medicine physicians, and emergency medicine physicians are special categories of healthcare workers who are at a high risk of formation of burnout syndrome that may develop due to the specific of professional activity.

SVEIKATOS PRIEŽIŪROS SPECIALISTŲ KVALIFIKACIJOS TOBULINIMO POREIKIAI IR YPATUMAI

The professional development of health-care workers is a key prerequisite for professional success, and its effectiveness contributes to the quality of health-care services at any level of health-care institution. Health-care professionals face constant changes, as a challenge to adapt to the competitive environment around them. This makes it important to ensure that health-care workers have effective training to meet their professional development needs. Thus, the aim of this study is to analyse the theoretical assumptions of professional development, and to reveal the attitudes of health-care professionals towards the needs and specifics of professional development. The study has indicated that the professional development for health-care workers is result-oriented, yet of insufficient quality, with organisational, financial and other problems. It has been found that the planning and implementation of professional development for health-care professionals is subject to specific requirements. The combination of these requirements and the way they are evolving imply that the needs and specifics of health-care professionals in the field of professional development need to be addressed beyond doubt.

Exploring the Impact of Alginate-PVA Ratio and the Addition of Bioactive Substances on the Performance of Hybrid Hydrogel Membranes as Potential Wound Dressings.

Healthcare professionals face an ongoing challenge in managing both acute and chronic wounds, given the potential impact on patients' quality of life and the limited availability of expensive treatment options. Hydrogel wound dressings offer a promising solution for effective wound care due to their affordability, ease of use, and ability to incorporate bioactive substances that enhance the wound healing process. Our study aimed to develop and evaluate hybrid hydrogel membranes enriched with bioactive components such as collagen and hyaluronic acid. We utilized both natural and synthetic polymers and employed a scalable, non-toxic, and environmentally friendly production process. We conducted extensive testing, including an in vitro assessment of moisture content, moisture uptake, swelling rate, gel fraction, biodegradation, water vapor transmission rate, protein denaturation, and protein adsorption. We evaluated the biocompatibility of the hydrogel membranes through cellular assays and performed instrumental tests using scanning electron microscopy and rheological analysis. Our findings demonstrate that the biohybrid hydrogel membranes exhibit cumulative properties with a favorable swelling ratio, optimal permeation properties, and good biocompatibility, all achieved with minimal concentrations of bioactive agents.

Mental health problems among healthcare professionals during COVID-19 in Africa: a protocol for umbrella review

IntroductionCOVID-19 pandemic is a global health problem. In Africa, healthcare professionals face mental health problems due to COVID-19. But little was done on the prevalence of mental disorders among healthcare...

Technology-based interprofessional collaboration in primary care for home rehabilitation of the older adults: A dutch exploratory study.

Primary healthcare professionals face an increasing number of geriatrics patients, and patient care often involves different disciplines. eHealth offers opportunities to support interprofessional collaboration (IPC). This exploratory study aimed to gain insight in 1) IPC in community-based rehabilitation, 2) facilitators and barriers for technology-based IPC and 3) technological IPC solutions envisioned by the primary healthcare professionals An focus group with six primary healthcare professionals and a design thinking session with four participants were conducted. Data analysis was based upon an IPC model. Results indicate that facilitators and barriers for IPC can be clustered in three categories: human, organization and technology, and provide some requirements to develop suitable IPC technological solutions Primary healthcare professionals recognise the urgency of working collaboratively. Current barriers are understanding each other's professional vocabulary, engaging the older adults, and using technology within the patient's environment. Further research is needed to integrate IPC components in a technological solution.

Comparison of mental health indicators in clinical psychologists with the general population during the COVID-19 pandemic

Mental healthcare professionals face diverse challenges during the COVID-19 pandemic, which may augment their risk of experiencing adverse mental health outcomes themselves. We aimed to compare depressive, anxiety, insomnia, and stress symptoms in Austrian clinical psychologists during the COVID-19 pandemic with the Austrian general population. A total of N = 172 Austrian clinical psychologists (91.9% women; mean age: 44.90 ± 7.97 years) participated in an online survey in spring 2022. A representative sample (N = 1011) of the Austrian general population was surveyed simultaneously. Symptoms of depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10) were assessed. Differences in the prevalence of clinically relevant symptoms were analyzed using univariate (Chi-squared tests) and multivariable (binary logistic regression including covariates age and gender) analyses. Clinical psychologists showed lower adjusted odds for exceeding the cut-offs for clinically relevant depression (aOR 0.37), anxiety (aOR 0.50), and moderate to high stress levels (aOR 0.31) compared to the general population (p < 0.01). No difference was observed for insomnia (aOR 0.92; p = 0.79). In conclusion, clinical psychologists experience better mental health than the general population during the COVID-19 pandemic. Future studies are needed to analyze the underlying reasons.

Personalized Precision Medicine for Health Care Professionals: Development of a Competency Framework

Personalized precision medicine represents a paradigm shift and a new reality for the health care system in Spain, with training being fundamental for its full implementation and application in clinical practice. In this sense, health care professionals face educational challenges related to the acquisition of competencies to perform their professional practice optimally and efficiently in this new environment. The definition of competencies for health care professionals provides a clear guide on the level of knowledge, skills, and attitudes required to adequately carry out their professional practice. In this context, this acquisition of competencies by health care professionals can be defined as a dynamic and longitudinal process by which they use knowledge, skills, attitudes, and good judgment associated with their profession to develop it effectively in all situations corresponding to their field of practice. This report aims to define a proposal of essential knowledge domains and common competencies for all health care professionals, which are necessary to optimally develop their professional practice within the field of personalized precision medicine as a fundamental part of the medicine of the future. Based on a benchmark analysis and the input and expertise provided by a multidisciplinary group of experts through interviews and workshops, a new competency framework that would guarantee the optimal performance of health care professionals was defined. As a basis for the development of this report, the most relevant national and international competency frameworks and training programs were analyzed to identify aspects that are having an impact on the application of personalized precision medicine and will be considered when developing professional competencies in the future. This report defines a framework made up of 58 competencies structured into 5 essential domains: determinants of health, biomedical informatics, practical applications, participatory health, and bioethics, along with a cross-cutting domain that impacts the overall performance of the competencies linked to each of the above domains. Likewise, 6 professional profiles to which this proposal of a competency framework is addressed were identified according to the area where they carry out their professional activity: health care, laboratory, digital health, community health, research, and management and planning. In addition, a classification is proposed by progressive levels of training that would be advisable to acquire for each competency according to the professional profile. This competency framework characterizes the knowledge, skills, and attitudes required by health care professionals for the practice of personalized precision medicine. Additionally, a classification by progressive levels of training is proposed for the 6 professional profiles identified according to their professional roles.

SUGGESTIONS TO REDUCE RISK FACTORS AMONG THE HEALTH WORKERS IN AGRA CITY OF UTTAR PRADESH, INDIA

This study was carried out among the HCWs (both males and females) of 30 hospitals of Agra city, Uttar Pradesh, India. There were a variety of HCWs in the study group, including senior residents, junior residents, interns, undergraduate medical students, staff and student nurses, and staff and student laboratory technicians. The study was carried out with participation from 600 HCWs. In Agra, Uttar Pradesh, India, a city tertiary hospital conducted a hospital-based cross-sectional study. Data were collected using a predesigned schedule from 600 respondents (Doctors, nurses, laboratory technicians and staff). Therefore, this study was undertaken to study the awareness of standard occupational safety measures such as universal precautions and compliance in daily practice among paramedical workers. Healthcare professionals (HCP) face risks while providing preventive, curative, and rehabilitation services. Medical science advancements have increased safety to some extent, but contemporary technology has also made healthcare very complex and dangerous. This study was therefore conducted to find out how well-informed paramedical workers were about common workplace safety precautions like general safety measures and how often they followed them. There are numerous risks associated with medical care, including radiation exposure, violence, psychiatric disorders, patient stalking, and suicide. Due to patient handling and the rising number of obese patients, HCP are at a high risk for musculoskeletal disorders. Human immunodeficiency virus-related workload growth has resulted in greater difficulties. Many HCP are unaware of prevention strategies despite the possibility of exposure to hazards. Additionally, the system is not supportive, the prevention policies are unclear or difficult to access, or there is a problem with attitudes. So, HCP still experience problems, especially in developing nations. Health managers must make sure that healthcare is focused on assessing the risks faced by HCP, their causes, and doing everything they can to prevent them.

A Data Acquisition and Consolidation System based on openEHR applied to Physical Medicine and Rehabilitation

Shoulder pathologies are prevalent and reduce the quality of life. Due to the shoulder joint's complexity, healthcare professionals face challenges to evaluate, diagnose, and treat these pathologies. On the other hand, the acquisition, presentation, and analysis of patient data in healthcare is complex and hindered by the absence of standardization and interoperability in Database Management Systems. Hence, in this study, we propose a web platform based on openEHR structures that incorporates user interface forms for registering patient physical examinations. The benefits of implementing this approach include structured and standardized data collection, and better communication and information exchange between different systems.

What outcomes of moral case deliberations are perceived important for healthcare professionals to handle moral challenges? A national cross-sectional study in paediatric oncology

BackgroundIn paediatric oncology, healthcare professionals face moral challenges. Clinical ethics support services, such as moral case deliberation (MCD), aim to assist them in dealing with these challenges. Yet, healthcare professionals can have different expectations and goals related to clinical ethics support services.MethodsIn this study, the perceptions held by healthcare professionals (nursing assistants, registered nurses, physicians, and others) regarding the importance of possible outcomes of MCDs, prior to implementation of MCDs, were investigated. A multisite, cross-sectional, quantitative study was performed at all six Paediatric Oncology Centres in Sweden. Healthcare professionals answered the Euro-MCD instrument with 26 potential MCD outcomes using a scale from Not important (1) to Very important (4). Descriptive and comparative statistical analyses were carried out.ResultsAll outcomes were rated high, i.e., between 3.12 and 3.78. More open communication, developing skills to analyse ethically difficult situations, better mutual understanding, and deciding on concrete actions were rated as most important. Understanding of ethical theories and critical examination of policies were rated less important. Most often nursing assistants rated higher and physicians lower than the other professions did. Women and participants without previous experience of MCDs perceived outcomes as more important. There were differences between centres as one centre had significantly higher, and one centre had significantly lower ratings compared to the others.ConclusionIt is clear that healthcare professionals want MCDs to improve teamwork and skills in order to analyse and manage ethically difficult situations. When comparing to previous research about important MCD outcomes, there were similarities in what healthcare professionals consider to be important when handling moral challenges regardless of country and potential differences in healthcare settings and systems, such as paediatric vs. adult care.

Ethical challenges in clinical practice during the COVID-19 pandemic in an academic healthcare institution in Malaysia: A qualitative study

BackgroundHealthcare professionals (HCPs) face a myriad of ethical challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited literature examining the ethical challenges faced by HCPs in low- and medium-income countries. The research was designed to explore the ethical challenges experienced by HCPs in a Malaysian hospital setting during the pandemic.MethodsSemistructured interviews were conducted via video calls with 10 Malaysian HCPs across different clinical disciplines involved in managing patients diagnosed with COVID-19 infections. The calls were audio-recorded, transcribed verbatim and checked. Thematic analysis with constant comparison across transcripts was carried out to identify categories and themes.ResultsThree main themes emerged. Firstly, there was deprioritisation of care for non-COVID-19 patients resulting from resource limitations. HCPs raised concerns that there was curtailed access to various healthcare services by non-COVID-19 patients. There was also a trade-off between protecting individual patient safety and public health interests. Secondly, patients were disempowered from decision-making; the decision to segregate suspected COVID-19 patients to high-risk areas without seeking patients’ approval may result in an increased risk of infection. Lastly, HCPs expressed internal conflicts when balancing the professional duty of care against concerns about contracting COVID-19 and spreading it to their family members.ConclusionThe study highlighted ethical issues faced by HCPs in Malaysia during the pandemic. It underscores the need for clinical ethics consultation services in hospitals to navigate the various ethical dilemmas.

Barriers to primary care access for asylum seekers and refugees in the UK: a systematic review

Abstract Background Recent armed conflicts, in addition to the deterioration of humanitarian conditions across the world, has led to the biggest increase in civilian displacement since World War II. Exploration of the barriers and facilitators to primary healthcare access amongst asylum seekers and refugees (ASRs), from the perspective of both service users and service providers, is important for improving policy and practice to ensure more equitable health care. Methods Systematic searches of PubMed, EMBASE, MEDLINE, and CINHL databases were conducted to identify articles until May 2021 using a combination of relevant search terms. Studies were eligible if they were published in English and conducted in ASR populations in primary care settings the UK using qualitative approaches. Literature was thematically analysed using Braun and Clarke’s 6-step process. Quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool. Results Nine studies were included in the review. Key themes identified included: accommodation within services; awareness of service navigation, negotiation and eligibility of care; accessibility; availability of appointments; acceptance; complexity within health needs; and cultural appropriateness. Healthcare professionals encounter barriers and facilitators within the healthcare setting, the overall healthcare system, and with regards to their understanding of migration policy. ASRs experience barriers and facilitators with regards to accessing and understanding the health system, cultural appropriateness of care, cost, stigma and prejudice, and availability of specialist services. Conclusions This study highlights the difficulties ASRs and healthcare professionals face in primary care settings, the need for consistent and unambiguous guidance that supports the cultural competence of the heath service, and the need for further research into the efforts made to eliminate health discrimination within primary care. Key messages • Barriers exist to primary healthcare amongst asylum seekers and refugees. • Specialised and incorporated healthcare and support is needed due to unique social, cultural, and demographical differences of this population.

233.3: Organ Trafficking: The Portuguese Experience in Developing A Legal Framework and a Protocol of Conduct for Health Professionals for the Management of Patients Who Receive an Organ Transplant Abroad and Return Home for Follow-up Care and for Reporting Suspected Cases to Law Enforcement Authorities for Criminal Investigation

The existence of a world-wide illicit trade in human organs for the purposes of transplantation is a well-established fact, and various means have been adopted to combat this criminal activity, in particular the Council of Europe Convention against Trafficking in Human Organs. This Convention is the first international legal instrument that criminalizes all illicit transplant practices. Healthcare professionals who treat patients in pre transplant and post-transplant play a crucial role in prevention, detection and reporting organ trafficking. However, healthcare professionals face with medical, legal, and ethical challenges when confronted with suspected or confirmed cases of organ trafficking due to their duty to preserve medical confidentiality. We present the recently developed Portuguese Model for the implementation of the Convention against Trafficking in Human Organs. Firstly, we present the changes introduced in Portuguese criminal law for the criminalisation of organ trafficking, including the options made with respect to donors and recipients regarding their criminalisation or not, and the solutions adopted to ensure that acts committed outside the country by nationals or residents can also be punished. Secondly, we present a protocol/code of conduct to provide an appropriate framework to prevent and address transplant-related crimes for healthcare professionals. Such protocol provide guidelines for the management of patients, including on how to ensure traceability and biovigilance for patients who travel for transplantation, and indicators for the identification of signs of organ trafficking and/or human trafficking for the purpose of organ removal. Third, we introduce the Portuguese reporting mechanism for the communication of information about such cases to law enforcement authorities for the purposes of criminal investigation. Finally, we present the amendments made to the Medical Code of Ethics to address doctors’ concerns regarding medical confidentiality. The new regulation provide an exception to the duty of medical secrecy in relation organ trafficking and human trafficking for the purpose of organ removal.

Resolution of the III International menopause expert forum

The III International Menopause Expert Forum took place on November 24, 2021. The working group of the expert council included leading experts in endocrine gynaecology from Belarus, Armenia, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine.To date, menopause hormone therapy (MHT) initiated during the “therapeutic window of opportunity” has proved to have a protective effect against various age-associated diseases. Despite this, the percentage of women using MHT remains low and, for example, in Ukraine and Kazakhstan, equals nearly 2%. However, only one in four of these women have been using MHT for more than a year. The main reasons for such low percentage of women using MHT are as follows:1. Low patient adherence to MHT (due to misunderstanding of the menopause factors, menopause symptoms, treatments, hormonophobia, poor communication with healthcare professionals etc.).2. Healthcare professional’s vigilance due to the possible risks associated with MHT (breast cancer, venous thromboembolism, cardiovascular diseases etc.).3. Healthcare professionals face difficulties during the MHT prescription or subsequent patient management (unplanned haemorrhages, concomitant pathologies in a woman, i.e. fibroids, varicose veins, arterial hypertension etc.). Aiming to improve medical care for menopausal women, experts attending the Forum focused on the latest data on the risks of breast cancer and venous thromboembolism, MHT effect on the risk of coronary heart disease and arterial hypertension, the potential of prescribing MHT to patients with uterine myoma and on increasing treatment adherence.