Implementation Of Such Recommendations Research Articles

Healthcare Practitioners’ Perceptions of the Barriers to Prescribing or Promoting Exercise in the Treatment of People with Mental Illness: A Scoping Review

Contemporary healthcare for those experiencing mental illness requires healthcare practitioners (HCPs) to effectively incorporate the prescription of exercise in their treatment, in accordance with clinical guidelines. However, there has been a lack of effective implementation of such recommendations. The purpose of this review was to identify barriers to exercise prescription in the treatment of people diagnosed with mental illness as perceived by HCPs. APA PsycINFO, CINAHL, MEDLINE, and PubMed electronic databases were searched for relevant articles published in the period from January 2005 to September 2023. A total of 18 papers were included for thematic synthesis. Four key themes were identified across the qualitative (8), quantitative (6), and mixed method (4) papers, including a lack of knowledge and confidence of HCPs in prescribing exercise; role and responsibility; HCPs’ misconceptions of client barriers; and systemic issues impacting exercise prescription practices. A lack of knowledge or confidence was the most common barrier. Some HCPs indicated a desire to develop their skills in exercise prescription, while others indicated a preference for an exercise professional to take responsibility for this aspect of treatment. Systemic barriers were spread across a range of issues, with lack of time, excessive workload, and difficulties accessing qualified staff most commonly cited. This review provides further insight into the barriers to exercise prescription faced by HCPs and makes recommendations regarding how to address these barriers in order to better implement clinical guidelines and thus improve the quality of treatment provided to people diagnosed with a mental illness.

Impact of a pediatric infectious disease consultation service on timely step-down to oral antibiotic treatment for bone and joint infections

PurposeIn recent years an earlier step down to oral antibiotic therapy has been advocated for numerous infections. Trained infectious disease specialists regularly consulting their colleagues may speed up the implementation of such recommendations into clinical practice and thus may improve treatment.MethodsWe retrospectively analyzed bone and joint infections in children admitted to the University Hospital of Cologne between 2010 and 2021. We assessed clinical, imaging, and microbiological findings and treatment modalities. Additionally, we assessed both the impact of a newly implemented pediatric infectious diseases consultation service and publications on revised treatment recommendations by comparing antibiotic therapy in two periods (2010–2016 versus 2017 to 2021).ResultsIn total, 29 children presented with osteomyelitis, 16 with bacterial arthritis and 7 with discitis. In period 2 (2017–2021) we observed shorter duration of intravenous treatment (p = 0.009) and a higher percentage of oral antibiotic treatment in relation to the total duration of antibiotics (25% versus 59%, p = 0.007) compared to period 1 (2010–2016).Yet, no differences were identified for the total length of antibiotic treatment. Additionally, biopsies or synovial fluid samples were retrieved and cultured in more children in period 2 (p = 0.077). The main pathogen identified in osteomyelitis and bacterial arthritis was Staphylococcus aureus (MSSA), diagnosis was confirmed predominantly with MRI.ConclusionRecent guidelines addressing the safety of an earlier step-down (to oral) antibiotic therapy have influenced clinical practice in the treatment of bone and joint infections in our hospital. A newly implemented pediatric infectious diseases consultation service might have accelerated this progress resulting in a faster step down to oral treatment.

Strategies to Combat Drug Crime under Modern Conditions in Vietnam

Abstract The article is devoted to drug combating issues in modern Vietnam. The author identified a range of reasons that have influenced the state of drug crimes. Current conditions require significant changes in Vietnamese drug prevention policy. At the same time, special attention is paid to creating a new state strategy to combat drug crime. The study purpose is to develop recommendations for determining approaches aimed at ensuring the process of combating drug crime in the future. According to the author, the implementation of such recommendations can improve the effectiveness of drug prevention activities. In this study, the author used a systematic approach, a statistical analysis of practical results, and a dialectical method of cognition. The author concludes that for a successful fight against drug crime it is necessary to implement the measures listed by the author in the article.

Research on Improving the Quality of Online Teaching Based on Big Data under the COVID-19 Coronavirus Epidemic

In 2020, the global COVID-19 outbreak came out of the blue and caught people and businesses by surprise, including the education sector. In order to ensure the “suspension of classes”, schools at all levels in China implement online teaching. How to ensure the quality of online teaching is an important issue. Based on the big data of online teaching, it is of great practical significance to analyze the factors affecting the quality of online teaching, so as to improve the path of improving the quality of online teaching. With the help of big data analysis, the index system of online teaching quality improvement is constructed and applied. Through questionnaire survey and SPSS software analysis, it can be concluded that the teaching quality of online teaching can be improved from three aspects: the behavior level of school, the learning level of students and the behavior level. Therefore, the following Suggestions are put forward: improve the hardware environment, perfect the teaching organization, strengthen the teaching supervision, strengthen students’ mastery of knowledge and skills, strengthen students’ active inspection and team learning. It is hoped that the implementation of such recommendations will further improve the quality of online teaching in the context of COVID-19.

Research of the possibility of application of the means of efficient client data management in a credit organization for the purpose of fulfilling regulatory requirements

This article is dedicated to the problem of effective use by credit organization of the own client data due to their heterogeneity. The object of this research is the client data of a credit organization. The subject is the possibility of application of the means of efficient client data management in a credit organization for the purpose of fulfilling regulatory requirements  The main goal of this work consists in the analysis and formulation of recommendations with regards to modification of client data model, as well as improvement of quality of client data by means of data management based on the DAMA-DMBOK body of knowledge in the context of the key areas of data management. The article reviews the key areas of data management and the methods of application of rules and recommendations of each of them to the data management process of the credit organization. The relevance of this article is substantiated by legislative requirements pertaining to monitoring of services provided for private and legal entities from the sanctioned territory. The scientific novelty consists in application of data management knowledge to the relevant issue on the need for automatic determination of territorial affiliation of the client in order to comply with the requirements of normative legal acts. The research methods are content analysis, structural analysis, and modeling. The main conclusions consist in recommendations for modification client data model of the bank, namely methods and principles for expanding the data model using standardized data parameters, which significantly improves the quality of data. The implementation of such recommendations would allow a financial organization to reduce the risks associated with payment of fines and revoke of licenses due to noncompliance with the regulatory requirements.

Barriers to and Facilitators of the Implementation of Environmental Recommendations to Encourage Physical Activity in Center-Based Childcare Services: A Systematic Review.

Identifying factors influencing the implementation of evidence-based environmental recommendations to promote physical activity in childcare services is required to develop effective implementation strategies. This systematic review aimed to: (1)identify barriers and facilitators reported by center-based childcare services impacting the implementation of environmental recommendations to increase physical activity among children, (2)synthesize these factors according to the 14 domains of the "Theoretical Domains Framework," and (3)report any associations between service or provider characteristics and the reported implementation of such recommendations. Electronic searches were conducted in 6 scientific databases (eg,MEDLINE) and Google Scholar to identify studies reporting data from childcare staff or other stakeholders responsible for childcare operations. Included studies were based on childcare settings and published in English. From 2164 identified citations, 19 articles met the inclusion criteria (11 qualitative, 4 quantitative, and 4 mixed methods). Across all articles, the majority of factors impacting implementation fell into the "environmental context and resources" domain (eg,time, equipment, and space; n = 19) and the "social influences" domain (eg,support from parents, colleagues, supervisors; n = 11). The current review provides guidance to improve the implementation of environmental recommendations in childcare services by addressing environmental, resource, and social barriers.

Quality of health care with regard to detection and treatment of mental disorders in patients with coronary heart disease (MenDis-CHD): study protocol

BackgroundMental disorders (MD), such as depression, anxiety, and cognitive impairment, are highly prevalent in patients with coronary heart disease (CHD). Current guidelines on cardiovascular diseases recommend screening and appropriate treatment of MD; however, the degree of implementation of such recommendations in clinical practice is unknown. This study aims to analyze the quality of health care of patients with CHD and MD. Specifically, we aim to analyze (1) the quality of care, (2) trajectories of care, and (3) barriers regarding the detection and treatment of MD. Moreover, we want to identify potentials of changes in health care delivery towards more patient-centered care. The results of this study shall be the first step towards value-based care of people with CHD and comorbid mental disorders.MethodsWe aim to include the following participants: adult patients with CHD (n = 400), their relatives (n = 350) and physicians (n = 80). A particular focus will be on the vulnerable subgroups of patients with CHD and congestive heart failure (left ventricular ejection fraction < 40%) and on the underrepresented group of women with CHD. We will apply a mixed-method approach with a quantitative and a qualitative part.Patient-related outcomes (e.g., health-related quality of life, needs, and preferences regarding health care, reasons for non-detection, and lack of treatment of MD) will be explored in a multi-perspective approach including patients, relatives, and physicians’ perspectives. Furthermore, routine data from four statutory health insurance funds (SHI) will be analyzed regarding the frequency and treatment of MD in CHD patients.DiscussionMenDis-CHD will provide important insights into the trajectories of health care, quality of health care, barriers, patient needs and preferences as well as expectations and satisfaction with health care in patients with CHD and MD. Potential implications of MenDis-CHD are to enable health care providers to redesign care pathways concerning the treatment of mental comorbidity in patients with CHD by proposing value-based changes in health care and by understanding the barriers to and facilitators of change towards patient-centered care.Trials registrationGerman clinical trials register (Deutsches Register Klinischer Studien, DRKS) ieRegistration Number: DRKS00012434, date of registration: May 11th, 2017.

OPTIMIZATION OF AUTOMOBILE TRANSPORTATION COSTS IN INDUSTRIAL ENTERPRISE

Introduction.The authors prove the relevance of the costs’ reducing for motor transportation service in different departments of the industrial enterprise. The organizational and technological features of the industrial motor transport enterprise functioning and defining inexpediency of transfer of motor transportation function on outsourcing in full are revealed. The economic-mathematical model and the algorithm of decisions development on optimization of the automobile transportations costs in the industrial enterprise, which provide balance of interests of the customer to lower costs of motor transportation services and of the carrier to increase business profitability are offered. The expediency of implementation of such recommendations is proved on the example of motor transportation department of the large metallurgical company in Chelyabinsk region.Materials and methods. The analysis and systematization of the specialized scientific, standard, legal literature, economic-mathematical modeling of transport processes, and statistical technical and economic analysis of production information is conducted.Results.The following results are reached:- having scientific novelty: criterion of optimality and system of restrictions of the choice of decisions on cutting of costs for automobile transportations; mathematical apparatus of assessment of reserves of use of motor transport;- having the practical importance: the algorithm of development of decisions on optimization of costs of automobile transportations based on balance of interests of carrier and the customer of motor transportation services.Discussion and conclusions.The methodical recommendations about coordination of the customer and supplier interaction of motor transportation services are received. The implementation of such recommendations would provide the systematic 3-5% per year budget optimization in the industrial enterprise departments.

Antibiotic Resistance in Syria: A Local Problem Turns Into a Global Threat

Pharmaceutical sector of Syrian Arab Republic before the war was characterized by bold and successful development since the late 1980s. With the beginning of war in the country back in March 2011, momentum has changed significantly. Traumatism, communicable diseases related to morbidity and mortality as well as wound infections became particularly hot public health concern. This relates not only to the direct victims of military conflict but also to the displaced civilians, refugees, and ordinary citizens alike. Evolving legislative framework in Syria since 1980s tolerated dispensing of antibiotics without appropriate prescription. Such practice led to spreading of antibiotic resistance among the local bacteria frequently causing both community-acquired and nosocomial infections. Laboratory findings of resistant bacteria strains among the Syrian refugees in some European countries serve as evidence of concern spreading far beyond Middle East. Practice of self-diagnosis and self-medication with antibiotics by patients themselves and restraint to pharmacist advice is widespread. A number of recommendations is presented to stakeholders to compact antibiotic resistance after the peace is established in the country. The successful implementation of such recommendations is the way to preserve shrinking golden reserve of highly potent antibiotics as it is the last defense line against resistant bacterial strains causing severe life—threatening infections.

Efficacy Outcome Measures for Pediatric Procedural Sedation Clinical Trials: An ACTTION Systematic Review.

Objective evaluations comparing different techniques and approaches to pediatric procedural sedation studies have been limited by a lack of consistency among the outcome measures used in assessment. This study reviewed those existing measures, which have undergone psychometric analysis in a pediatric procedural sedation setting, to determine to what extent and in what circumstances their use is justified across the spectrum of procedures, age groups, and techniques. The results of our study suggest that a wide range of measures has been used to assess the efficacy and effectiveness of pediatric procedural sedation. Most lack the evidence of validity and reliability that is necessary to facilitate rigorous clinical trial design, as well as the evaluation of new drugs and devices. A set of core pediatric sedation outcome domains and outcome measures can be developed on the basis of our findings. We believe that consensus among all stakeholders regarding appropriate domains and measures to evaluate pediatric procedural sedation is possible and that widespread implementation of such recommendations should be pursued.

Barriers and enablers to the delivery of psychological care in the management of patients with type 2 diabetes mellitus in China: a qualitative study using the theoretical domains framework.

BackgroundChina has the largest number of type 2 diabetes mellitus (T2DM) cases globally and individuals with T2DM have an increased risk of developing mental health disorders and functional problems. Despite guidelines recommending that psychological care be delivered in conjunction with standard T2DM care; psychological care is not routinely delivered in China. Community Health Centre (CHC) doctors play a key role in the management of patients with T2DM in China. Understanding the behavioural determinants of CHC doctors in the implementation of psychological care recommendations allows for the design of targeted and culturally appropriate interventions. As such, this study aimed to examine barriers and enablers to the delivery of psychological care to patients with T2DM from the perspective of CHC doctors in China.MethodsTwo focus groups were conducted with 23 CHC doctors from Shenzhen, China. The discussion guide applied the Theoretical Domains Framework (TDF) that examines current practice and identifies key barriers and enablers perceived to influence practice. Focus groups were conducted with an interpreter, and were digitally recorded and transcribed. Two researchers independently coded transcripts into pre-defined themes using deductive thematic analysis.ResultsBarriers and enablers perceived by doctors as being relevant to the delivery of psychological care for patients with T2DM were primarily categorised within eight TDF domains. Key barriers included: CHC doctors’ knowledge and skills; time constraints; and absence of financial incentives. Other barriers included: societal perception that treating psychological aspects of health is less important than physical health; lack of opinion leaders; doctors’ intentional disregard of psychological care; and doubts regarding the efficacy of psychological care. In contrast, perceived enablers included: training of CHC doctors in psychological skills; identification of afternoon/evening clinic times when recommendations could be implemented; introduction of financial incentives; and the creation of a professional role (e.g. diabetes educator), that could implement psychological care recommendations to patients with T2DM.ConclusionsThe utilisation of the TDF allowed for the comprehensive understanding of barriers and enablers to the implementation of psychological care recommendations for patients with T2DM, and consequently, has given direction to future interventions strategies aimed at improving the implementation of such recommendations.

SP0214 Differences across Europe in the Delivery of Patient Education – What Should BE Done?

BackgroundPatient education (PE) is “a planned, interactive process between patients and health professionals (HPs), aimed at supporting and enabling patients to manage their life with arthritis and optimising their health...

“Life is not a rehearsal, it's a performance”: An ethnographic enquiry into the subjectivities of children and adolescents living with antiretroviral treatment in northeastern Tanzania

Antiretroviral treatment (ART) enables ever more HIV-positive children in sub-Saharan Africa to grow into adulthood. While policy documents recommend that children be fully informed about their health status and actively participate in treatment related decision-making, the implementation of such recommendations is often confined by organizational shortcomings and counterproductive power dynamics within medical institutions. By briefly outlining children's enrolment in HIV treatment in a highly frequented treatment center in northeastern Tanzania, in this article I demonstrate the complexity of HIV disclosure to children and the limitations of their participation in practice. I then turn to the subjective experiences of 13 children and adolescents (9–19years) living with antiretroviral medicines. The study revealed that especially the younger among them had to maneuver a field of ‘informational inconsistency’ produced by different actors' contradicting strategies of disclosure and concealment. Furthermore, children and youths constantly had to reconcile a gap between maintaining their sense of ‘normalcy’ and contrastingly experienced debilitating drug side-effects, social discrimination, and – as far as the adolescents were concerned – uncertainties in relation to sexual relationships. Based on this ethnographic material, the article concludes with several suggestions how to improve the provision of medical services and socio-moral support for HIV-positive children and adolescents.

BJOG Editor's Choice

Cervical screening within organised screening programmes has dramatically reduced the incidence and mortality from cervical cancer. In England, screening used to start from the age of 20 years but, for the last decade, screening has begun at 25 years of age. The other home countries within the UK have some autonomy on the delivery of NHS screening programmes and as a result there are often differences in practice with other countries adopting a more conservative approach; Northern Ireland introduced this change in 2011, Wales in late 2013 and in Scotland it is envisaged that this will be achieved by 2015. The initial change to the age at which screening starts in England was not readily accepted by many health professionals and many suggested that this change would put young women's lives at risk. However, the evidence base from the NHS screening programmes suggests that cervical cancer is very rare in women under the age of 25 years and, with the majority of these cancers being quick to develop, screening is unlikely to benefit younger women. Furthermore, it is now apparent that infection with high-risk human papillomavirus (HPV) is often transitory—particularly in young women—and as a consequence many early epithelial neoplastic changes are also transitory. Only women with persistent oncogenic HPV infection and disease are likely to benefit from screening (i.e. women aged over 25 years), particularly as treatment might be associated with adverse outcomes. Currently, there is little opposition to screening only women aged 25 years or more in the UK. In this month's BJOG, further evidence from the Canadian screening programme supporting the delayed onset of screening is debated by Professor Dickinson and colleagues on page 255. A proposed change to the starting age of screening to reflect current UK practice (and many other European countries) is not being warmly received by many Canadian health professionals. In a mini-commentary, Professor Massad also illustrates that there is a wide variation in practice in the USA and guidelines are often not adhered to. Hopefully, the commentaries will give our international readers an insight into why there might be variations in practice in the western world. Although there is always scope for improving the evidence base for guidelines, the implementation of such recommendations is often evolutionary as illustrated by the UK experience. There is a growing body of evidence suggesting that a history of pelvic inflammatory disease (PID) may predispose to pelvic malignancy. Reactive free radicals produced by inflammation can cause damage to DNA, pro-inflammatory molecules can promote neoplastic transformation by paracrine modulation, and chronically activated innate immune cells suppress adaptive immune responses. Ovarian cancer has been directly associated with asbestos and talc exposure, and also by epidemiological studies comparing cohorts of women with a history of PID and controls. In an epidemiological study Hsu and Lin in Taiwan demonstrate a potential association between PID and colorectal carcinoma on page 337. These are interesting findings and, if proven by larger studies, are further evidence for the importance of primary prevention of PID (Figure 1). Finally, Jayaprakasan et al., based in the UK, have investigated the effect of ethnicity on live birth rates after in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment in a retrospective single institution study (page 300). Live birth rates following IVF/ICSI treatment were significantly lower in the ethnic minority group compared with white European women, which suggests that ethnicity is a major determinant of live birth following IVF treatment (Figure 2). Ideally, ethnic-minority-specific evidence should be available when counselling couples on fertility outcomes.

Landscape and weather determinants of prey availability: implications for the Lesser Kestrel Falco naumanni

Spatial and temporal variation in prey abundance have been shown to impact the time of breeding and breeding success of birds. Understanding the ecological requirements of preferred prey can help develop management measures to improve food supply for target species. For the colonial Lesser Kestrel Falco naumanni, mole crickets Gryllotalpa spp. are one of the most important prey items during the mate‐feeding period. Lesser Kestrel colonies with higher mole cricket consumption had earlier egg‐laying dates, suggesting that differences between individuals in the time of breeding could be caused by differences in the diet. Moreover, the mean number of mole crickets in pellets was significantly correlated with clutch size (in one of the studied years) and egg volume. Thus, the impact of environmental variables and land use on mole crickets is likely to be relevant to Lesser Kestrel conservation. Weekly consumption of mole crickets was higher following an increase in either precipitation or minimum temperature values. Furthermore, mole cricket consumption was higher in colonies surrounded by higher quality soils and in wetter areas and years. Predicted probability of mole cricket occurrence in surveyed watercourse margins suggested a positive relationship between soil penetrability and mole cricket occurrence. Among variables that might be the target of management, the presence of riparian vegetation positively influenced the occurrence of mole crickets, whilst tillage and sowing of streambeds were revealed as the most important threats. We suggest that the maintenance of native vegetation in the margins of watercourses could improve soil resilience to erosion, increase water retention, soil penetrability and fertility, and provide a food supply and shelter for mole crickets. Overall, the implementation of such recommendations is likely to benefit other farmland species known to consume mole crickets, including several endangered species.

Antiemetic guidelines: are they being used?

Evidence-based guidelines are regarded as therapeutic standards for many medical interventions. However, implementation of such recommendations seems to be rather difficult. An international antiemetic guideline for the treatment of patients undergoing chemotherapy was issued by the Multinational Association of Supportive Care in Cancer in 1997 and has been in use ever since. However, for many reasons, the guideline has not been followed completely, despite the fact that if antiemetics are used in accordance with guidelines, efficacy is similar to that achieved in randomised controlled trials. Structural difficulties, patients characteristics, and other barriers, such as the individual acceptance of guidelines and education of physicians and nurses, could be crucial factors for successful implementation. Thus, better adherence to antiemetic guidelines can only be achieved through a complex and long-term process, consisting of efficient education, training, and monitoring of all individuals involved.