Healthcare Department Research Articles

THE IMPACT OF PAEDIATRIC EMERGENCY MANAGEMENT SKILLS ON PATIENT OUTCOMES IN ZARIA

Paediatric emergencies represent a critical challenge in Nigeria, where approximately 2,300 children under the age of five die daily, predominantly from preventable and treatable conditions such as pneumonia, malaria, and diarrheal diseases. Mortality rates are disproportionately higher in rural areas, where primary health care (PHC) centers often serve as the only point of access to medical services. The effectiveness of these centers is largely dependent on the emergency management skills of their healthcare workers. Despite their importance, there has been limited research on how the skills of PHC workers in managing paediatric emergencies impact patient outcomes. This study aimed to assess the proficiency of healthcare workers in primary healthcare centers in Zaria in managing common paediatric emergencies. A cross-sectional descriptive study was conducted among 139 health workers selected through a multi-stage sampling technique in Sabon Gari and Zaria Local Government Areas. Data collection was carried out using a pre-tested semi-structured self-administered questionnaire. The data were analyzed using SPSS version 21, and associations were tested using the chi-square test, with results presented in tables and charts. The findings revealed a significant deficiency in the emergency management skills of healthcare workers. A majority of respondents demonstrated inadequate skills in handling paediatric emergencies, with 66 (48.5%) exhibiting very poor competency in the management of common paediatric emergencies, and 32 (23.5%) displaying poor competency. Only a small fraction, 4 (2.9%) of respondents, demonstrated excellent skills in emergency management. Similarly, 46.7% of the respondents had very poor skills in the treatment of common paediatric emergencies, while only 3.0% exhibited excellent treatment skills. A statistically significant relationship was observed between the level of academic qualification and emergency management skills (p < 0.05). The results underscore the critical need to enhance the skill levels of healthcare workers in PHCs through continuous professional development. This could be achieved through collaborative efforts between the Department of Paediatrics at Ahmadu Bello University Teaching Hospital and the Primary Health Care Departments of Zaria and Sabon Gari local governments, focusing on regular training and workshops. Improving the skills of healthcare workers in managing paediatric emergencies is essential for reducing child mortality and improving health outcomes in the region.

Алгоритмы диагностики дилатации проксимальной грудной аорты в педиатрической практике

Aortic dilation may manifest in childhood subsequently resulting in the formation of an intramural hematoma or dissection. The asymptomatic nature of the disease and the absence of unified echocardiographic algorithms for its detection contribute to its underestimation and the inability to implement timely monitoring of patients. The purpose of this research was to develop algorithms for diagnosing dilation of various parts of the thoracic aorta in children using cardiac ultrasound - echocardiography (ECHO). Materials and methods used: a single-center cross-sectional study had been carried out on the basis of the cardiological department of the Z.A. Bashlyaeva Children’s City Clinical Hospital of the Moscow Department of Healthcare (Moscow, Russia): 11,516 primary ECHO protocols in patients aged 7 and up to 18 y/o, 7.5% (869) of which had records regarding aortic dilation, were identified. 572 with hemodynamically significant CHD were excluded from the study therefore the remaining 297 (76.8% (228) boys) with a median age of 14.2 (11.3; 16.4) y/o were studied for the parameters as follows: internal diameters of the aorta at the level of the sinuses of the Valsalva (SV), sinotubular junction (STJ) and ascending aorta (AAo) in systole. Aortic dilation was defined as a size exceeding 2z at any level, and an aneurysm was defined as exceeding 3z. Results: a total of 116 had a bicuspid aortic valve (BAV), 181 demonstrated a tricuspid valve (TAV) without significant concomitant heart pathology (“idiopathic dilation” (IDAo)). Dilation and AAo aneurysm were more prevalent than in the SV region (73.4% v 28%, р<0.001 and 25.2% v 3.7%, р<0.001, respectively). The presence of BAV was identified as a significant risk factor, in which AAo dilation occurred more frequently than in TAV (1.96 times higher, 95% CI 1.12-3.44, p=0.017) and AAo aneurysm occurred with a 3.07 times higher frequency (95% CI 1.79-5.25 р<0.001). Conclusion: the structure of aortic pathology in children is dominated by AAo dilation. ECHO requires visualization of the entire proximal aorta, not merely the aortic valve and SV that are typically assessed in outpatient practice. Authors represent a diagnostic algorithm and methodological guidelines for assessing the condition of the aorta in children.

Antimicrobial Stewardship Programmes: Healthcare Providers’ Perspectives on Adopted Hospital Policies That Combat Antibacterial Resistance in Selected Health Facilities in Uganda

Background: This study aimed to determine healthcare providers’ perspectives on adopted hospital policies that support establishing antimicrobial stewardship programmes (ASPs) in selected health facilities in Uganda. Results: In this study, 63.1% of healthcare providers had a low-level perspective regarding adopting hospital policies to facilitate the establishment of ASPs. The low-perspective was significantly associated with females (aOR: 17.3, 95% CI: 1.28–2.34, p < 0.001), healthcare practitioners aged 50 + years (aOR: 1.92, 95% CI: 1.22–3.01, p = 0.004), individuals in the Obstetrics and Gynaecology department (aOR: 1.73, 95% CI: 1.03–2.90, p < 0.037), and Uganda’s Eastern (aOR: 1.47, 95% CI: 1.03–2.09, p = 0.034) and Northern regions (aOR: 2.97, 95% CI: 1.63–5.42, p < 0.001). Methods: We conducted a cross-sectional study where 582 healthcare providers (response rate (76%) were interviewed using a questionnaire to assess their perspectives on hospital policies that support ASP in 32 selected health facilities. We performed ordinal logistic regression on factors associated with adopted policies, and these were reported with odds ratios (ORs) and 95% confidence intervals (CIs). Conclusions: there was a low-level perspective on adopted hospital policies to support ASPs, which were significantly associated with the sex of healthcare providers, departments, age, and region of the country.

Experience in using artificial intelligence services for diagnosing compression fracture of vertebral body based on computed tomography – from testing to trials

Backgraund:Osteoporosis (OP) is often diagnosed at the stage of complications. Compression fractures (CF) of the vertebral bodies, complications of OP, and predictors of subsequent fractures are often asymptomatic. CF can be detected on CT scan performed for other indications. We have analyzed approaches to using artificial intelligence services (AI services) generated for diagnosing CF of the vertebral bodies. Aims:Testing AI services to identify CF based on chest CT and to assess the possibility of their implementation into the practice of medical facilities of the Moscow Healthcare Department. Materials and methods:For setting a clinical task for AI services, basic diagnostic requirements in the direction of “Osteoporosis” are formed. AI services go through the following stages: self-testing, functional and calibration testing, trial and trial operation. The first three stages of testing are carried out on previously generated datasets. At the stages of trial and trial operation, AI services analyze CT examinations performed in medical facilities. An expert group of radiologists evaluates the diagnostic accuracy and functional capacity of AI services at all stages. The obtained quantitative metrics of the accuracy of AI services are compared with the target values ​​specified in the requirements. Results:From June 2021 to June 2022, two AI services (AI service №1 and AI service №2) which used different methods for identifying a presence of CF were tested. AI services successfully passed the self-testing stage (6), functional (5) and calibration (100) testing. The ROC AUC for AI service №1 was 0.99 and for AI service №2–0.91. The AI service №1 passed the trial stage without any significant remarks, while AI service №2 was sent for revision. After the trial operation stage, the following accuracy metrics were obtained: the ROC AUC for AI service №1 was 0.93; for AI service №2–0.92. At all stages, both AI services showed sufficient metrics for clinical validation. Conclusions:A testing of the performance of AI services in the direction of “Osteoporosis” was carried out. A high quality of diagnosis was demonstrated. AI services can act as an auxiliary tool in the medical decision support system.

Constructing a measure for self-perceived open organizational culture in a university hospital pharmacy.

An open organizational culture in the workplace represents an environment where information, ideas, and feedback are freely exchanged among all members, regardless of position or rank. Currently, there are no valid survey instruments to measure this culture within a healthcare context. To address this gap, we developed a survey instrument to measure self-perceived open organizational culture at a university pharmacy using a test re-test study design. Data were collected during classroom training on basic mediation skills study. Participants completed the same questionnaire before (test phase) and after the training (validation phase). The questionnaire included statements assessing open organizational culture. The data were analyzed using standardized psychometric methods, including correlations, Exploratory Factor Analysis (structural validity), and construct validity by correlating the open organizational culture scores with the Interpersonal Communication Inventory. In the test phase, 191 participants (161 females, 84%; response rate = 39.7%) contributed to the initial construction of the self-perceived open organizational culture survey instrument. In the validation phase, 81 of the original respondents completed the questionnaire again. Three latent factors were identified, retaining 22 of the 37 items: "enabling systems" (7 items), "open behavior" (8 items), and "trusting and supporting coworkers" (7 items). High correlations were found among the three factors (r > 0.6), and between these factors and the Interpersonal Communication Inventory (r > 0.35). Cronbach's alphas were all above 0.85, indicating good internal consistency. During the validation phase, the factors demonstrated high internal consistency, test/re-test correlations, and agreement. This study presents a 22-item survey instrument for measuring individual differences in self-perceived open organizational culture within a university hospital pharmacy. The instrument demonstrates internal consistency and construct validity. Further validation of its psychometric properties and testing in other healthcare departments are recommended.

Internal Audit of an Oral Pathology Laboratory: Perspectives on Finances and Operational Management.

Background Internal audits are essential tools for enhancing the operational efficiency, quality, and effectiveness of healthcare departments. Audits enable the departments and laboratories to meet the changing needs of the healthcare environment by giving a detailed picture of the department's operations and highlighting areas for possible growth and development. Aims and objectives This study focuses on the biopsies received in the Oral Pathology Department at Saveetha Dental College, aiming to evaluate biopsy trends, financial performance, and resource utilization over one year. Materials and methods The oral pathology department audit covered the period from 1st April 2023 to 31st March 2024. The institutional human ethical committee and scientific review board approved the retrospective audit. It involved a comprehensive analysis of biopsy data, financial records, and material usage. Data on different biopsy types (excisional, incisional, frozen sections), immunohistochemistry, cytology, and special stains were collected and analyzed across four quarters. Financial performance was assessed by comparing total income and expenses, while resource utilization was examined through the use of histopathological blocks and other consumables. Statistical analysis (chi-square) was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). A P-value less than 0.05 was considered statistically significant. Results We received 1100 cases during the study period. Excisional biopsies were the most common, with 474 (43.09%) cases, followed by incisional biopsies with a total of 432 (39.27%). Out of total cases of 1100, the second quarter (July-September 2023) had the highest case volume of 305 (27.72%), while the third quarter (October-December 2023) recorded the lowest of 250 (22.72%) cases. A financial audit revealed an annual deficit of ₹1,03,321 primarily due to higher expenses towards laboratory reagents. The overall expense incurred per case was ₹448.5. Tissue blocks cost ₹85.23 per case (19.00%) of the average cost per case. The chi-square test analysis was insignificant among the different types of biopsies and the reagent consumption across the four quarters. Conclusion The audit identified critical areas for improvement in both clinical workload and financial management. High volumes of biopsies, but net financial deficits highlight the need for better cost management and resource utilization strategies to maintain sustainability without compromising diagnostic quality.

Diagnostic reference levels for the city of Moscow during X-ray examinations

Diagnostic reference levels are one of the effective tools for optimizing patient radiation doses in diagnostic radiology. The staff of domestic radiology departments does not have an understanding of the development process and use of diagnostic reference levels during X-ray examinations, although this tool is a generally accepted in practice abroad. The article shows the experience of forming regional diagnostic reference levels based on measurements provided by the accredited testing laboratory of the Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department. The diagnostic reference levels for radiography in Moscow were developed for eight of the most common types of examinations based on the operation of 216 digital X-ray machines. The resulting levels, expressed in the dose-area product (cGy-cm2) and effective dose (mSv), were compared with the local diagnostic reference levels for the Ryazan region, Russia, and national diagnostic reference levels for other countries. The analysis showed continuity in the values. Some types of studies have been optimized. The developed diagnostic reference levels are the quality performance indicators foe diagnostic radiology departments and will be used to optimize a patient radiation dose during diagnostic studies in Moscow.

Analysis of the results of personal monitoring to ionizing radiation at workplaces

The paper presents the results of dosimetric measurements routinely performed by the Radiation Protection Department of the Nofer Institute of Occupational Medicine (NIOM) in Łódź in 2022 for people occupationally exposed to X and γ radiation. The evaluation of the effective dose as part of individual dosimetry was provided using the film or thermoluminescent dosimetry (TLD). Additionally, based exclusively on the TLD method, measurements of the ambient dose equivalent H*(10) and personal dose equivalents Hp(0.07) and Hp(3) were performed. In 2022, the dosimetric service of the Radiological Protection Department of the NIOM covered >30 000 workers employed in >4500 laboratories (mainly health care departments). All measurements were performed in accordance with accredited research procedures (number AB 327). In 2022, the average annual dose of Hp(10) was equal to 0.26 mSv, whereas Hp(0.07) measured using ring and wrist dosimetry was equal to 0.63 mSv and 0.78 mSv, respectively. In turn, the average Hp(3) value was 0.21 mSv. In 2022, there was not a single case of exceeding the annual dose limit among people measured by the NIOM. The data collected in the "Dosimetry" database of the NIOM and a detailed analysis of annual doses received by people occupationally exposed to ionizing radiation indicate a well-functioning radiological protection system in Poland. Med Pr Work Health Saf. 2024;75(5).

The changing nature of worry about COVID-19 among the English public: a secondary analysis of 73 national, cross-sectional surveys, January 2020 to April 2022

ObjectivesTo investigate worry about COVID-19 during the pandemic, and whether worry was associated with phase of the pandemic, COVID-19 death and incidence rates, Government interventions (including lockdown and advertising), age,...

Navigating uncertain waters: 12 tips for medical department social media engagement under shifting platform landscapes

Social media has revolutionized how society receives and transmits information in the digital age, including healthcare. While the future of social media platforms remains uncertain, the benefits of social media for healthcare organizations, departments, and divisions are clear when compared to traditional communication methods, including improved recruitment efforts, increased promotion of faculty work, rapid dissemination of information and education innovations, and accelerated professional networking. Consequently, preferred platforms may shift but the benefits of social media likely cement it, in one form or another, in medical education and society at large. The strategic development of a social media presence at the department level can be opaque and overwhelming amidst varying mediums, yet the benefits of use have never been more important. Here, we present 12 tips for developing a successful social media presence as a healthcare department, addressing the creation of a purposeful social media strategy and crucial considerations for any platform, current or future, at all levels of development.

Impact of Long SARS-CoV-2 Omicron Infection on the Health Care Burden: Comparative Case-Control Study Between Omicron and Pre-Omicron Waves.

Following the initial acute phase of COVID-19, health care resource use has escalated among individuals with SARS-CoV-2 infection. This study aimed to compare new diagnoses of long COVID and the demand for health services in the general population after the Omicron wave with those observed during the pre-Omicron waves, using similar assessment protocols for both periods and to analyze the influence of vaccination. This matched retrospective case-control study included patients of both sexes diagnosed with acute SARS-CoV-2 infection using reverse transcription polymerase chain reaction or antigen tests in the hospital microbiology laboratory during the pandemic period regardless of whether the patients were hospitalized. We included patients of all ages from 2 health care departments that cover 604,000 subjects. The population was stratified into 2 groups, youths (<18 years) and adults (≥18 years). Patients were followed-up for 6 months after SARS-CoV-2 infection. Previous vaccination, new diagnoses, and the use of health care resources were recorded. Patients were compared with controls selected using a prospective score matched for age, sex, and the Charlson index. A total of 41,577 patients with a history of prior COVID-19 infection were included, alongside an equivalent number of controls. This cohort encompassed 33,249 (80%) adults aged ≥18 years and 8328 (20%) youths aged <18 years. Our analysis identified 40 new diagnoses during the observation period. The incidence rate per 100 patients over a 6-month period was 27.2 for vaccinated and 25.1 for unvaccinated adults (P=.09), while among youths, the corresponding rates were 25.7 for vaccinated and 36.7 for unvaccinated individuals (P<.001). Overall, the incidence of new diagnoses was notably higher in patients compared to matched controls. Additionally, vaccinated patients exhibited a reduced incidence of new diagnoses, particularly among women (P<.001) and younger patients (P<.001) irrespective of the number of vaccine doses administered and the duration since the last dose. Furthermore, an increase in the use of health care resources was observed in both adult and youth groups, albeit with lower figures noted in vaccinated individuals. In the comparative analysis between the pre-Omicron and Omicron waves, the incidence of new diagnoses was higher in the former; however, distinct patterns of diagnosis were evident. Specifically, depressed mood (P=.03), anosmia (P=.003), hair loss (P<.001), dyspnea (<0.001), chest pain (P=.04), dysmenorrhea (P<.001), myalgia (P=.011), weakness (P<.001), and tachycardia (P=.015) were more common in the pre-Omicron period. Similarly, health care resource use, encompassing primary care, specialist, and emergency services, was more pronounced in the pre-Omicron wave. The rise in new diagnoses following SARS-CoV-2 infection warrants attention due to its potential implications for health systems, which may necessitate the allocation of supplementary resources. The absence of vaccination protection presents a challenge to the health care system.

Women's Health Hubs: a rapid mixed-methods evaluation.

Women's sexual and reproductive health needs are complex and vary across the life course. They are met by a range of providers, professionals and venues. Provision is not well integrated, with inequalities in access. In some areas of the United Kingdom Women's Health Hubs have been established to improve provision, experience and outcomes for women, and to address inequalities and reduce costs. These models were established prior to the national implementation of Women's Health Hubs announced in the English 2022 Women's Health Strategy. To explore the 'current state of the art', mapping the United Kingdom landscape, and studying experiences of delivering and using Women's Health Hubs across England, defining key features and early markers of success to inform policy and practice. A mixed-methods evaluation, comprising three work packages: Mapping the Women's Health Hub landscape and context and developing a definition of Women's Health Hubs, informed by an online national survey of Women's Health Hub leaders, and interviews with regional stakeholders. In-depth evaluation in four hub sites, including interviews with staff and women, focus groups in local communities and documentary analysis. Interviews with national stakeholders and consolidation of findings from work packages 1 and 2. Fieldwork was undertaken from May 2022 to March 2023. The evaluation was initiated prior to the national scale-up of Women's Health Hubs announced in the 2022 Women's Health Strategy. Most areas of the United Kingdom did not have a Women's Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women's Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, commissioning, workforce issues, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging. It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented. It was not possible to develop a typology of Women's Health Hubs as planned due to heterogeneity in models. Existing Women's Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development. Evidence of system-level impact and costs was still emerging. Women's Health Hubs may widen inequalities if models are more accessible to advantaged groups. The important role of committed leaders in existing 'bottom-up' models may limit scalability and sustainability. Findings suggest that national scale-up will take time and requires funding and that it is necessary to design models according to local needs and resources. In 2023, the Department of Health and Social Care announced funding to establish a Women's Health Hub in every Integrated Care System in England. Future evaluation should consider system-level impact and costs, explore unintended consequences and test assumptions. This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135589) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 30. See the NIHR Funding and Awards website for further award information.

Needs Analysis of English for Specific Purposes for Health Sciences Students: A Cross-Sectional Study at a University in the U.A.E.

This paper presents findings from a needs analysis survey to determine the extent to which the current English for Specific Purposes (ESP) course for healthcare students meets the needs of this population. A structured questionnaire was shared with the students (N=180) from different healthcare departments to examine the preferability of different aspects. Many participants gave great value to ESP courses whose importance was mainly to learn medical or pharmaceutical terminology and communicative skills. Yet, the participants preferred the conversational content over the grammatical one. Most participants perceived the four English skills as important. The overall conclusion shows that the main objective of an ESP course is language fluency to be able to communicate and achieve any requirement in their career. Moreover, the study shows that the conventional methods of assessment are less preferred and that students prefer assessments where teamwork is involved. They also preferred to receive the learning materials via online or technological methods, and they preferred class activities and audio/video aids. Yet, a great number did not prefer using an English Language Laboratory. Finally, most of them agreed that being in a mostly English-speaking community at the university is convenient to enhance their communication skills in English.

Impact of Data Governance on Data Quality in Healthcare Institutions

Purpose: The aim of the study was to assess the impact of data governance on data quality in healthcare institutions. Materials and Methods: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study found that institutions with robust data governance protocols experience fewer instances of data inconsistency and errors. This, in turn, improves the reliability of clinical decision-making processes and patient outcomes. Moreover, compliant data governance practices contribute to better data integration across various healthcare systems and departments, facilitating comprehensive patient care and longitudinal health monitoring. By promoting transparency and accountability in data management, healthcare institutions can mitigate risks associated with data breaches and ensure compliance with regulatory standards, thereby fostering trust among patients and stakeholders alike. Implications to Theory, Practice and Policy: Control theory, information theory and agency theory may be used to anchor future studies on assessing the impact of data governance on data quality in healthcare institutions. Healthcare institutions should prioritize the adoption of comprehensive data governance frameworks that integrate policy development, stakeholder engagement, and technological infrastructure. Policymakers should align regulatory frameworks with evolving data governance standards to promote interoperability and data exchange across healthcare networks.

Analysis of remissions in patients with combined addiction to psychostimulants and other psychoactive substances and comorbid psychiatric pathology after rehabilitation

Despite the annual increase in the number of patients with psychostimulant addiction and the presence of comorbid psychiatric pathology, the question of finding effective therapies for these disorders remains open. When developing therapeutic remission, specialists often do not take into account the peculiarities of its duration and quality in these patients. The purpose of the study is to assess the duration and quality of therapeutic remissions in patients with addiction to psychostimulants, combined use of other psychoactive substances, and comorbid psychiatric pathology. Materials and methods. 325 patients with psychostimulant addiction, who underwent a course of medical and social rehabilitation in the Moscow Research and Practical Centre for Narcology of the Moscow Healthcare Department, were examined. Methods: clinical-psychopathological, psychometric ("Addiction Severity Index: Treatnet Version"), anamnestic, catamnestic, and statistical. The results of the study. It was found that the longest remissions were noted in patients only with psychostimulant addiction. Patients with combined addiction to psychostimulants and the presence of comorbid psychiatric pathology are characterized by short remissions. Patients only with psychostimulant addiction have the best dynamics of remission quality. Conclusion. The revealed clinical features of patients, together with quantitative and qualitative features of remissions, will help to increase the effectiveness of care for these patients.

CHARACTERISTICS OF SCIATICA PATIENTS LISTED FOR A SPINAL EPIDURAL STEROID INJECTION AND CLINICAL OUTCOMES: RESULTS FROM THE POISE COHORT STUDY

BackgroundClinical guidelines recommend epidural steroid injection (ESI) for severe sciatica but there is uncertainty of effectiveness. The POiSE study aims to identify factors, routinely collected in clinical practice that predict outcome in patients who have ESI. This presentation describes characteristics and early clinical outcomes of POiSE participants.MethodsProspective cohort study in 19 NHS spinal services in England, inviting patients with sciatica listed for an ESI. Participant baseline characteristics and 6-week follow-up outcomes are presented. Outcomes include pain intensity (0–10 NRS), disability (Oswestry Disability Index 0–100) and global change in symptoms.ResultsOver 24 months, 693 patients were invited to participate and 353 (51%) completed baseline questionnaires. Mean (SD) age 49.0 years (14.4), 60% female, and 46% (n=101) of those in work had certified time-off for sciatica. Mean pain intensity was 7.2 (2.0) and 6.2 (2.7) for leg and back pain respectively and mean disability (ODI) was 46.5 (18). 60% (n=210) had leg pain for &gt;6 months. Average confidence at baseline (0 to 10) that the ESI would help symptoms was 5.7 (2.4).Of 217 patients reaching 6-week follow-up, mean leg and back pain intensity is 5.0 (2.8) and 4.9 (2.9) respectively and ODI 36.6 (20.4), with 57% reporting improvement (completely recovered/much better/better). Follow-up data collection at 6, 12 and 24-weeks post-ESI is ongoing.ConclusionInterim analysis shows only just over half of patients are reporting improvement at 6 weeks post ESI. The POiSE cohort study will help better identify the patients with sciatica who are most likely to benefit from this treatment.Conflicts of interestNoneSources of fundingThis study is supported by Health Education England and the National Institute for Health and Care Research (HEE/ NIHR ICA Programme Clinical Lectureship, Dr Siobhan Stynes, NIHR300441). The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care

Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial

Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. For the Urdu translation of the abstract see Supplementary Materials section.

Certification of Ukrainian Doctors of All Eight Stomatological Specialties: Analysis of Certification Sheet, Personal Educational Portfolio with Continuing Professional Development Results, and Certificate

Certification of doctors-stomatologists (i.e., dentists) in Ukraine is a procedure that is not sufficiently covered in English-language articles. Understanding Ukrainian legislation in in matters of сertification is extremely important both for foreing colleagues and for stomatologists in Ukraine. The purpose of this paper is to present the original and translation of three main documents of the Procedure for Certification of Doctors of the Order of the Ministry of Healthcare of Ukraine dated February 22, 2019, No. 446 (as amended by the Order of the Ministry of Healthcare of Ukraine dated August 18, 2021, No. 1753). Namely, certification sheet, personal educational portfolio with continuing professional development (CPD) results, and certificate. Each of the documents is detailed. Document templates can be found in Appendices 1, 2, and 3 to the Order of the Ministry of Health of Ukraine No. 446, freely available on the official website of the Verkhovna Rada of Ukraine. Personal educational portfolio deserves special attention, in which the doctor who is undergoing certification must chronologically indicate the CPD activities for the past year, the place of their implementation, the duration or/and bibliographic reference and the number of accrued CPD points. Also, this document requires to indicate the number of medical services provided by doctor during the reporting period (except for the specialties specified in Appendix 5 to the Procedure for the Certification of Doctors and the specialty “Organization and Management of Health Care”). Another purpose of this article was to provide samples of certificates on the assignment and confirmation of qualification categories to doctors-stomatologists- surgeons. The presented certificates were issued by certification commissions at various health care bodies of Ukraine. Namely, at (1) the Department of Healthcare of the Kyiv Regional State Administration and (2) the Ministry of Healthcare of Ukraine. All three certificates were issued in 2021.

Rare disease 101: an online resource teaching on over 7000 rare diseases in one short course

BackgroundAn estimated 3.5 million people in the UK live with a rare disease however due to the rarity of each individual condition this is not currently reflected in mainstream medical education. As a result, common features of living with a rare condition include diagnostic delay, poor coordination of health and social care and lack of access to specialist care and treatment. This is well documented in reports published by patient advocacy groups collating the patient experience and has been highlighted by the Department of Health and Social Care in its UK Rare Diseases Framework. One of the four priority areas outlined in this policy published in 2021 is ‘increasing awareness amongst healthcare professionals’.Medics4RareDiseases (M4RD), a charity based in the UK, has proposed a disease-agnostic approach to educating doctors about rare disease, focusing on the common challenges experienced across this heterogeneous collection of conditions, rather than on the minutiae of each of the > 7000 rare conditions. A literature search using MEDLINE, PubMed Central and Bookshelf confirmed a lack of broad rare disease teaching in medical literature; none of the 10 final resources identified focused on the topic as a whole.ResultsTo address this, M4RD created the course ‘Rare Disease 101’. It is accessed online using a learning management system that is free, contains interactive lessons, hosts a discussion board and is easily updated. In the 29 months since going live, 942 individuals have registered with 204 having completed the course; early feedback from 33 respondents was unanimously positive (all participants rated at least good (76%: excellent)) demonstrating that both clinicians and patients can benefit from broad rare disease education. The course is freely available to all at https://learn.m4rd.org/.ConclusionsDisease-agnostic training about rare disease as a large patient population, focusing on its unique profile of unmet needs, is required. Rare Disease 101 provides a pragmatic approach to an educational challenge that leads to poor patient outcomes. Early results suggest that the educational programme is well-received but further evaluation and assessment is needed.

A Secure Data E-Governance for Healthcare Application in Cyber Physical Systems

The bio-medical devices gather patient information and communicate it to data consumers via wireless networks to take the appropriate action and decision by informing the doctors. However, IoMT is adopted by healthcare departments with a greater speed, yet the majority of devices are limited to resource constraints and security perspectives. The classical e-healthcare systems that are centric have the inherent problem of single-point failure with low transparency and low control over records. Many proposals have been validated in IoT for addressing the inadequate computing and storage of records through sensors. The main focus of this paper is to propose a novel hybrid architecture called Zero Trust Blockchain Architecture for decentralized E-health-CPS systems to support low latency along with storage and processing of records while monitoring the patients. In addition, a probability distribution function may further draft an accurate and real-time monitoring of patients. The proposed mechanism is analyzed against adequate decision, storage, accuracy and transmission of records.