Individual Practitioners Research Articles

Healing and Growth after Trauma in a Rural Australian Community-A Case Study

This community case study outlines the development of a small group trauma recovery program (Leading from within), after several suicides created widespread community trauma. My training and almost 30 years experience as a Clinical Social Worker and my personal experience of trauma provided the impetus for this program which developed 20 years ago. The theoretical underpinnings include behavioural, depth, positive and energy psychology, trauma theory and the neuroscience of stress and trauma, attachment theory, family theory, wilderness theory, mind/body medicine, human potential theory, metaphysics (the science of Mind to Matter) [1], psychosynthesis and epigenetics (including the predisposition to transgenerational trauma). Some individual practitioners have also influenced the thinking behind the program development: Viktor Frankl, a Jewish Psychiatrist developed Logotherapy, lost family members, his thesis and all of his possessions during the holocaust and spent considerable time in Auschwitz [2]. He observed people in the camp and saw a demonstration of his theory. His observation was that those who made some meaning for themselves in the situation of utter privation were the ones who seemed to survive the best. He noticed, for example that people who gave their last piece of bread to help someone else seemed to do better than others, even those who seemed physically stronger.

Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition

BackgroundEliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.MethodsA literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa – Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.ResultsHealth practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming ‘competent’ in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.ConclusionsA move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.

Reduced Packed Red Blood Cell Utilization Via Implementation of Transfusion Guidelines in a Large Health System Hospital

Background: We have previously discussed how implementation of Patient Blood Management (PBM) principles such as transfusion guidelines helped reduce packed red blood cell (PRBC) usage in cardiovascular surgery patients (Bowers et al, Reduced Blood Product Utilization via Implementation of an Anemia Clinic and Consult Service in a Large Health System Hospital https://tinyurl.com/y3ucr3sz). We now discuss the effect of implementing transfusion guidelines on PRBC transfusion practices at an institutional level at St. Luke's Medical Center, Advocate Aurora Health in Milwaukee, WI. Methods: Beginning in 2015 Aurora Health Care made 7 g/dL the standard threshold below which packed red blood cell (PRBC) transfusion is considered appropriate. Additionally, transfusing PRBCs as single units with a hemoglobin (Hgb) measurement between each unit was made standard. Education was provided to clinicians on the new standard including best practice advice in the transfusion ordering workflow. Data was gathered on institutional PRBC use and individual clinician PRBC ordering practices. Further education was provided based on the extent to which data showed conformity to the new standard. Results: PBM implementation 2015-2018 was associated with a drop in institutional PRBC usage from 11,490 to 9301 units. The percentage of transfusions ordered with Hgb < 7 g/dL rose from 41.6% to 71.8%. The percentage of single unit orders increased from 67.3% to 91.8%. See Graph/Table 1 & 2 for further analysis of individual practitioner PRBC ordering. See Table 3 for reporting period volume data. Conclusions: Implementation of PRBC transfusion guidelines was associated with a greater than 2000-unit annual reduction in PRBC usage. Reduction was associated with individual clinician transfusion practices that increasingly conformed with guidelines over time. Disclosures Thompson: Adaptive: Membership on an entity's Board of Directors or advisory committees; AbbVie: Research Funding; UpToDate: Patents & Royalties: Myeloma reviewer; BMS: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees; Lynx Bio: Research Funding; VIA Oncology: Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees; Doximity: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Changes in Platelet Utilization Via Implementation of Transfusion Guidelines in a Large Health System Hospital

Background: As part of system wide implementation of Patient Blood Management (PBM), transfusion guidelines were implemented at St. Luke's Medical Center, Advocate Aurora Health in Milwaukee, WI. Methods: Beginning in 2015 Aurora Health Care made a platelet (PLT) count of ≤10K the standard threshold below which PLT transfusion is considered appropriate. Additionally, transfusing PLTs as single donor units with a PLT count between each unit was made standard. Education was provided to clinicians on the new standard including best practice advice in the transfusion ordering workflow. Data was gathered on institutional PLT use and individual clinician PLT ordering practices. Further education was provided based on the extent to which data showed conformity to the new standard. Results: During PBM implementation 2015-2018 despite an initial decline there was a modest overall increase in institutional PLT usage from 2515 to 2933 units. The percentage of transfusions ordered with PLT ≤10K rose from 21.6% to 31.9%. The percentage of transfusions ordered as single donor units increased from 82.5% to 91.5%. See Graph/Table 1 & 2 for further analysis of individual practitioner PLT ordering. See Table 3 for reporting period volume data. Conclusions: Implementation of PLT transfusion guidelines was associated with an initial annual reduction in PLT usage, but annual PLT utilization did go up overall during the reporting period. Individual clinician transfusion practices overall conformed more with guidelines at the end of the reporting period than at the beginning. Changes in treatment guidelines for acute promyelocytic leukemia, i.e. target PLT >50K, during the reporting period may account for a rebound in PLT usage and a decrease in the percentage of transfusions ordered with PLT ≤10K in the later vs. the earlier years of the reporting period. By contrast transfusions continued a positive trend toward being given as single donor units even in the later years of the reporting period. Disclosures Thompson: Doximity: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Lynx Bio: Research Funding; BMS: Research Funding; VIA Oncology: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; GSK: Membership on an entity's Board of Directors or advisory committees; Adaptive: Membership on an entity's Board of Directors or advisory committees; UpToDate: Patents & Royalties: Myeloma reviewer; AbbVie: Research Funding.

Laboratory Stewardship for Clinical Genetic Testing

Genetic test stewardship programs are increasingly common within hospital and reference laboratories, as are genetic test optimization efforts by individual practitioners. Genetic counselors play a critical role in guiding providers to medically appropriate genetic tests. This short review aims to summarize the impact of genetic counselors and targeted stewardship interventions that improve genetic test utilization. A variety of stewardship interventions exist that collectively help to eliminate unnecessary tests, support coordination of necessary tests, reduce order errors, and integrate processes that ensure results retrieval and accurate interpretation. Ensuring appropriate utilization of genetic tests and reducing errors improves patient care, reduces costs, and lays an important foundation of trust between patients, providers, institutions, and insurers. Rapid evolution of assays, expansion of genetic tests into multiple medical specialties, direct consumer access, and focus on precision-medicine initiatives foretell a future where genetic test stewardship programs are essential to supporting quality patient care.

Gender-diverse practitioners in early years education and care (EYEC): a cross-cultural study of Scotland, Hong Kong, and Mainland China

ABSTRACT This paper discusses whether practitioners’ gender subjectivities influence pedagogies and practices in early years education and care (EYEC) settings and whether an increase of men’s participation can improve gender diversity in EYEC. It draws on poststructuralist theories, understanding gender as the product/outcome of the social formation of subjects and the process of subjectification. This is illustrated through accounts for how individual practitioners from Scotland, Hong Kong, and Mainland China discursively construct their gender subjectivities, in accordance with the respective cultural discourses that shape work with young children in EYEC in the three contexts. Thirty-four practitioners from 17 EYEC settings (1 male and 1 female practitioner from each setting) in the cities of Edinburgh, Hong Kong, and Tianjin were interviewed. The study finds that participant practitioners’ constructions of gender subjectivities vary within and across contexts, and gender-binary discourses are to different extents prevalent in all three contexts. This paper argues for a cross-cultural approach to gender-sensitive teacher training, to interrogate popular discourses that advocate for men to fulfil complementary roles in EYEC to women and to challenge gender binary thinking that persists in EYEC and beyond.

Association of Practitioner Interfacility Triage Performance With Outcomes for Severely Injured Patients With Fee-for-Service Medicare Insurance

Despite evidence that treatment of severely injured patients at trauma centers is associated with reduced mortality, nearly half of all such patients are treated at nontrauma centers (undertriaged). Little is known about whether interfacility undertriage occurs because of practitioner decision-making or institutional and regional factors. To assess the associations between variation in triage practitioners at nontrauma centers and between practitioner-level variation and patient outcomes after injury. This retrospective cohort study used Medicare claims data from severely injured patients presenting to nontrauma centers and the practitioners who evaluated them in the emergency department from January 1, 2010, to October 15, 2015. Data analysis was performed from January 15, 2018, to March 21, 2019. Proportion of variation in undertriage associated with practitioners, practitioner rates of undertriage, practitioner characteristics associated with undertriage, and 30-day case-fatality rate. A total of 124 008 severely injured patients (mean [SD] age, 81 [8.4] years; 67 253 [54.2%] female) and the 25 376 practitioners (5564 [21.9%] female) who evaluated the patients in the emergency department of nontrauma centers were included in the study. Undertriage occurred among 85 403 patients (68.9%), with 40.6% of total variation associated with practitioners, 37.8% with hospitals, and 6.7% with regions. Compared with physicians with National Provider Identification (NPI) enumeration before 2007, those with an NPI enumerated between 2007 and 2010 had an undertriage risk ratio (RR) of 0.98 (95% CI, 0.97-0.99), and those with an NPI enumerated after 2010 had an undertriage RR of 0.96 (95% CI, 0.94-0.99). Hospitals with neurosurgeons had an undertriage RR of 1.51 (95% CI, 1.45-1.57) compared with those that did not; hospitals with spine surgeons had an undertriage RR of 1.10 (95% CI, 1.06-1.13); hospitals with general surgeons had an undertriage RR of 1.13 (95% CI, 1.09-1.17). Compared with practitioners who undertriaged 25% or less of patients, a statistically significant increase was found in the odds of death for patients treated by practitioners with a triage rate of less than 25% to 50% (odds ratio [OR], 1.08; 95% CI, 1.05-1.20) and less than 50% to 75% undertriage (OR, 1.12; 95% CI, 1.09-1.26) but not undertriage at greater than 75% (OR, 1.03, 95% CI, 1.00-1.18). In sensitivity analyses to adjust for unmeasured confounding, the association between triage practices and the case fatality rate became monotonic; compared with patients treated by practitioners with an undertriage rate of 25% or less, the odds of case fatality were 1.13 (95% CI, 1.05-1.21; P = .001) among patients treated by practitioners with undertriage rates less than 25% to 50%, 1.22 (95% CI, 1.13-1.32; P < .001) for patients treated by practitioners with undertriage rates less than 50% to 75%, and 1.20 (95% CI, 1.10-1.30; P < .001) for patients treated by practitioners with undertriage rates greater than 75%. The findings suggest that individual practitioner practices are an important source of variation in triage and represent a potential locus of intervention to reduce preventable deaths after injury.

PRIMARY SPONTANEOUS PNEUMOTHORAX: TO OPERATE OR NOT TO OPERATE?

SESSION TITLE: Monday Electronic Posters 1 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Management of primary spontaneous pneumothorax (PSP) differs widely among medical centers and between specialties and disagreement regarding optimal initial management of PSP continues to exist. To improve management of PSP patients, this study assessed which initial management method leads to less recurrences and evaluated the significance of each recurrence. METHODS: Medical records at a tertiary-care, community hospital, were analyzed for all patients with PSP from years 2009-2015. Recurrence rate with type of intervention necessitated for each recurrence and demographic/clinical characteristics were assessed. Management types were medical observation (MO), chest tube placement (CTP), or surgical intervention (SI). Fisher’s exact test was utilized to compare group characteristics. A multivariate logistic regression model was fitted for the primary outcome of recurrence. RESULTS: 213 patients treated for PSP were identified with an average follow-up period of 6.6 years. Of these patients, 15.3%, 43.3%, and 41.3% underwent MO, CTP, and SI, respectively. PSP that were treated medically were smaller in size, but blebs were more prevalent in the SI group. Recurrence rate was significantly lower in the SI group, 11.7%, compared to the MO and CTP groups, 43.5%, 44.4%, respectively (p<0.001). Of those recurrences that initially underwent MO or CTP, 70% and 96.4%, respectively, required a CTP or SI at time of recurrence. The most common management at time or recurrence was SI. CONCLUSIONS: Disagreement and paucity in the literature exists regarding the best initial management of PSP. This is the largest study with the longest follow-up period that addresses this issue. Results from this study demonstrate a nearly 4x higher rate of recurrence with MO and CTP management compared to SI. Additionally, the majority of recurrences managed with MO or CTP initially required invasive management. These findings support early surgical consultation and SI for PSP. CLINICAL IMPLICATIONS: There is great variability in PSP management between individual practitioners and between institutions. Some have elected for non-operative management of most PSPs, while others elect for surgical management at initial presentation. There is a current dearth of studies addressing this issue. This study is the largest patient population with the longest follow-up period of its kind. Results demonstrate a nearly four times lower recurrence rate when a patient was managed surgically. Some have suggested that higher recurrence rates in the MO and CTP groups are not significant, as these recurrences often do not require SI. This study found in fact the majority of recurrences underwent SI and 70-96.4% of recurrences required invasive management. These findings support early surgical consultation and SI. These findings can provide clinicians with data that can be utilized in the creation of treatment algorithms for the management of PSP. DISCLOSURES: No relevant relationships by Devon Collins, source=Web Response No relevant relationships by Sameer Javed, source=Web Response Consultant relationship with Medtronic Please note: $20001 - $100000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Consultant relationship with Auris Robotics Please note: $5001 - $20000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Boston Scientific Please note: $1001 - $5000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Bard Please note: $1001 - $5000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Stock Holder relationship with Transenterix Please note: $5001 - $20000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Stock Consultant relationship with Medtronic Please note: $1001 - $5000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Travel Board Member relationship with bh Please note: $1-$1000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Removed 03/14/2019 by Sandeep Khandhar, source=Web Response No relevant relationships by Chang Liu, source=Admin input Consultant relationship with Medtronic Corporation Please note: $20001 - $100000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee Consultant relationship with Auris Robotics Please note: $5001 - $20000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Biodesix Please note: $5001 - $20000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee No relevant relationships by Jay Patel, source=Web Response No relevant relationships by Josh Stodghill, source=Web Response

Developing new aviation management postgraduate program in responding to Industry 4.0: Key findings from multistages-multilevels market study

Most aviation related academic programs in Malaysia were designed centred around the aerospace engineering and aircraft engineering technologies. However, the emergence of Industry 4.0 demands aviation talents especially the non-management aviation practitioners such as aircraft engineers and other technical personnel to equip themselves with certain management-related skills. Hence, there is a pressing need for an advanced industry-driven and practitioners-based academic program in aviation management suits for various categories of aviation practitioners. The aims of this study are to explore the employability prospective of aviation managers (first stage); to examine the Industry 4.0-related management skills needed by aviation companies (second stage); and to analyse the personal development intention of individual practitioners (third stage). This study employed multistage-multilevel analysis on a single-case market study in a Malaysian aviation technical training university. Findings from this study are segregated into three levels. At the industry level, it is concluded that there is a brighter employability prospect of aviation managers at least until 2030. At the organizational level, there is an urgent need for the aviation professionals to upgrade themselves with managerial skills relevant to the Industry 4.0 such as data driven scenario planning, big data analysis, and collaborative decision making. At the individual practitioner’s level, finding indicates that there is an increasing awareness among the individual aviation professional in particular the technical and engineering professional to engage in personal development in aviation management at postgraduate level. The key contribution of this case study is that, through multistages and multilevels analysis, it not only expands the robustness of the market study on new postgraduate program development but also able to incorporate the perspectives of different aviation stakeholders group i.e. the aviation industry, aviation organizations, and individual aviation talents. This multistage-multilevel model can facilitate university’s policy makers to design future industry-based and practitioners-driven development program meant for industry practitioners.

International practices in forensic speaker comparisons

A survey relating to current practices in forensic speaker comparison testing was recently undertaken of 39 laboratories and individual practitioners across 23 countries. Questions were organised around a number of themes, including the preliminary assessment and preparation of case materials, the checking of analysts' work, frameworks used for the expression of conclusions, the use of automatic speaker recognition systems, the use of reference populations, and awareness of cognitive bias. Developmental trends in this area of forensic speech science are established by comparing responses to the present survey with those to the authors' earlier survey published in 2011.

The Experiences of Relatives of People with Acquired Brain Injury (ABI) of the Condition and Associated Social and Health Care Services

Context: ABI can arise from many causes and is a significant issue for long-term care. Developments in health care have meant that many more people with ABI are living longer, some with complex needs arising from their brain injury. The consequences of injury are generally long-term, even lifelong. Family members of people with ABI are significant to their rehabilitation, support and care, and research has identified many of the challenges they face. Objective: This paper reports work to survey the views of family members of people with ABI to ascertain their experience of the condition and their views and experience of related health and social care services. Method: An online survey was distributed via ABI networks to family members of individuals affected by ABI. One hundred ten respondents ranked the difficulties met by their relative living with an ABI and rated the services they had encountered. A series of open questions enabled respondents to provide greater detail regarding their experience and knowledge. Findings: The key findings are that relationships between the injured and non-injured parties change, alterations to roles and responsibilities are difficult and mediated via unending and complex grief. Relatives reported poor levels of involvement in decisions regarding the provision of social and health care services, a failure to be given good, accurate information in a timely fashion and the need to ‘fight’ for virtually any service provided. Service provision, particularly post-hospital discharge, was very regularly criticized for being either entirely absent, unaware of the impact of brain injury, failing to take account of actual functioning and/or structured in ways that are not concomitant with the needs of the injured person or the relative. Lack of knowledge of the impact of ABI by non-specialist staff and services is particularly highlighted as a barrier to progress and an added burden for relatives to contend with. Social work in particular was commented upon most negatively, most often for a failure to understand the condition and needs. Valued services and professionals are noted to be humane, knowledgeable about ABI, aware of the impact ABI has on the non-injured relative and able to act as a single ‘one-stop’ focal point for service provision. Limitations: As a self-selecting cohort of respondents to an online survey the work is not necessarily generalisable to the population as a whole. The findings, however, provide important considerations for improving social and health care services for people with ABI and the key relatives involved in supporting them. Implications: Commissioners and providers of social and health care services ought to work more closely with family members of people living with ABI. Services and individual practitioners need to be more knowledgeable about the likely functional outcomes of ABI, in particular the impact of invisible impairments to cognition and executive functioning. Relatives identify the benefit of good quality, accurate information and of a knowledgeable single point of contact across time and setting. Knowledge of ABI, of neurorehabilitation and of the impact of ABI upon family members by social workers is noted to be poor and attention to this may help with people’s rehabilitation and to prevent unnecessary additional carer burden.

Nature-Inspired Drone Swarming for Real-Time Aerial Data-Collection Under Dynamic Operational Constraints

Unmanned Aerial Vehicles (UAVs) with acceptable performance are becoming commercially available at an affordable cost. Due to this, the use of drones for real-time data collection is becoming common practice by individual practitioners in the areas of e.g., precision agriculture and civil defense such as fire fighting. At the same time, as UAVs become a house-hold item, a plethora of issues—which can no longer be ignored and considered niche problems—are coming of age. These range from legal and ethical questions to technical matters such as how to implement and operate a communication infrastructure to maintain control over deployed devices. With these issues being addressed, approaches that focus on enabling collectives of devices to operate semi-autonomously are also increasing in relevance. In this article we present a nature-inspired algorithm that enables a UAV-swarm to operate as a collective which provides real-time data such as video footage. The collective is able to autonomously adapt to changing resolution requirements for specific locations within the area under surveillance. Our distributed approach significantly reduces the requirements on the communication infrastructure and mitigates the computational cost otherwise incurred. In addition, if the UAVs themselves were to be equipped with even rudimentary data-analysis capabilities, the swarm could react in real-time to the data it generates and self-regulate which locations within its operational area it focuses on. The approach was tested in a swarm of 25 UAVs; we present out preliminary performance evaluation.

Safe workloads in midwifery - standard (SWiM)

In recent years there has been growing interest in the relationship between the workload of an individual practitioner and its short- and long-term consequences on birth outcomes. In this respect, data is limited with regard to midwives’ workload. We aimed to evaluate the association between midwives’ annual birth workload and the short-term, adverse maternal and neonatal outcomes occurring at birth.This retrospective cohort study was performed in a single tertiary academic center between 2006 and 2018. All single, live vertex term vaginal births were included and categorized into two groups based on the midwife's median annual volume of births during the study duration. The "high-volume" and "low-volume" groups included births above and below the median annual volume, respectively as a dichotomous variable. Further analyses were performed for the annual volume by deciles. Short term maternal and neonatal outcomes were compared between groups and between deciles.During the study period 140,856 births met the study criteria. The median annual volume of births of a single midwife was 152 [114-195]. Maternal and labor characteristics were comparable between the groups. Maternal outcomes were not significantly associated with the midwifes’ annual workload. However, neonates delivered by midwives with "low" annual volume had higher rate of neonatal jaundice (aOR 1.07, 95 % CI [1.00-1.14]) and mechanical ventilation (aOR 1.32, 95 % CI [1.05-1.66).Adverse perinatal outcomes are only mildly affected by midwives’ annual volume after controlling for the midwife, parturient and neonate's characteristics.

From Burnout to Well-Being: A Focus on Resilience.

Burnout is a widespread problem in health care. Factors that contribute to enhancing engagement and building resiliency are widely discussed, but the data supporting these practices are not well understood. Interventions aimed at increasing engagement and promoting resiliency are targeted toward individual practitioners, health care institutions, and national organizations. Knowledge of the data supporting various kinds of interventions is vital to implementing change meaningfully. Prevention of burnout should start early in training with appropriate modeling and input from mentors and should incorporate stress management strategies. The most compelling data for building resilience requires institutions, physicians, and their support staff to align their values to create a mutual culture of wellness and engagement. It is imperative that institutional and national reform allows us as physicians to preserve our relationships with patients and colleagues, while also prioritizing time to reflect and pursue outside interests that recharge and restore.

The Law and Ethics of Fetal Burial Requirements for Reproductive Health Care

In Box v. Planned Parenthood (May 28, 2019), the U.S. Supreme Court upheld an Indiana provision which mandates any clinician or facility providing abortion to bury or cremate fetal remains, no different than the requirements for cadavers. Indiana is one of eight states that requires fetal remains be interred or cremated, rather than disposed of as medical material under the rules set forth by the state’s environment and health departments. Individual practitioners or medical facilities must absorb the substantial financial costs required to dispose of fetal remains like deceased persons, or pass them along to their patients, who are in turn forced into making unwanted funerary arrangements for their aborted fetuses – without any countervailing medical benefit. The Supreme Court upheld the Indiana law for serving the state's legitimate interest in expressing respect for unborn life. What the Court missed is how it restricts the right to abortion in ways that demand more rigorous constitutional scrutiny in order to avoid violating a fundamental right. Beyond the burdens that fetal disposition laws place on women, they bear broader cultural consequences by implying that aborted fetuses should be treated no different than born persons who are buried or created after they die.

Barriers and Openings for Transforming Swedish Planning Practice – Examples of Landscape and Health Policy Integration

ABSTRACTThis paper examines how key actors think and act in everyday planning practice when new policies are introduced. Drawing on frame theory, an analytical lens is developed for explaining mechanisms that restrain and promote policy-driven transformation in practice. The analysis focuses on current practice and Swedish planning practitioners’ experience of the integration of recently introduced policies on landscape and health. A key finding is that well-established perceptions of responsibility can hamper policy integration – even in cases where practitioners see benefits to planning outcomes of acting differently. Another key finding is that policies reframing landscape and health as holistic and relational can make individual practitioners question current practice, thereby opening the way for transformation.

Student and Graduate Perceptions Regarding Canadian-based Accreditation of a Pharmacy Program in Qatar

Objective. To determine student and alumni perceptions of a Canadian-based pharmacy degree accreditation in a Middle Eastern setting and to explore the impact on patient care practices. Methods. Current and former Doctor of Pharmacy students from Qatar University were recruited to participate in the study. Three focus groups were conducted with a total of 14 participants (39% of total population). Focus group discussions were recorded and transcribed verbatim. Transcripts were coded using a bottom-up, grounded theory approach to identify overarching themes related to the study objectives. Results. Data analysis of participants' comments revealed three key themes regarding university accreditation by an international organization: influence on education, influence on patient care, and influence on the individual. Overall, participants responded positively toward international accreditation, as it was perceived to ensure the quality of education by meeting international standards, improve patient care through clinical training, and provide greater individual career opportunities through reputability. Participants responded negatively toward some aspects of accreditation: it was perceived to increase student workload, lacked recognition and did not result in differentiation in job-related duties, and was perceived to be the reason for training gaps related to culture and language within the accredited curriculum. Conclusion. Participants perceived international accreditation positively for its influence on education and patient care; however, some misconceptions and negative perceptions existed regarding its influence on the individual practitioner.

From wild harvest towards precision agriculture: Use of Ecological Niche Modelling to direct potential cultivation of wild medicinal plants in Crete

Understanding the distribution of wild medicinal plants and areas that are suitable for cultivation of these plants is important for both conservation and agriculture. Here, we study ten taxa with known ethnopharmacological uses, which have been used extensively in traditional medicine and as culinary supplements. We aim to (1) predict and map the potential habitat suitability for these taxa across the study area, (2) investigate spatial patterns that could have management implications, such as niche similarities among the taxa and suitability “hotspots” with the use of novel indices, and (3) develop a platform where parts of this information can be accessed and utilized by all interested groups, from the policy-maker level to the individual practitioner level. Ecological Niche Models developed for each study taxon, based on topographic, bioclimatic, soil, and land use variables had high predictive power and were used as the basis for suitability visualization. A series of informative indices were also calculated and mapped, revealing spatial patterns not readily observable from the single-taxon predictions, and providing valuable information to managers. Finally, a web-based, easy-to-use application was also created, where the predicted suitability scores for the study area can be made accessible to anyone interested. The application can provide information both in a visual form (i.e. maps of predicted suitability) and in a numerical form (i.e. estimated suitability scores for all taxa in a given geographical location). This study provides the scientific tools to make a step towards cultivating a group of economically important wild medicinal plants in Crete, as well as the tools to disseminate this information to decision makers and practitioners, and eventually integrate the research findings in local agricultural practices.

Observational Study of the Multisciplinaryteam role (MDT) on Healthcare Management of Cancer Patients: Benefits and Barriers, AbuDhabi 2017

Background: Multidisciplinary team meetings (MDTs) are designed to optimize patient outcomes. It appears intuitive that MDTs are essential to clinical decision - making and patient management; however, it is unclear whether that belief is supported by evidence. With regard to cancer patients, studies demonstrated that treatment plans made by interacting health care professionals are more effective than those made by&#x0D; individual practitioners.&#x0D; Objectives: To assess the impact of multidisciplinary teams (MDTs) on clinical decision - making and patient outcomes.&#x0D; Methods: We follow a descriptive questionnaire survey study design and created a (10) sections surveymonkey that was distributed via email to (150) experts in surgical oncology, general surgery, oncology, radiation oncology, pathologists, and administrative staff. Fourty (40) completed responses were collected to ensure a statistical basis on which to draw sound conclusions. The remaining 110 staff have submitted incomplete answers. Answers were discussed in a separate MDT meeting with most of the participants.The survey was followed by an interpretation of the respondents’ results and comparison with literatures. Results: 75% of the participants chose” Agree and strongly agree”, supporting the hypothesis that MDT meetings ensure an effective and up-to- date management guidelines. This means that the risk of not discussing a cancer patient cannot be neglected any longer. So the hypothesis statement (H0) is rejected&#x0D; and the alternative statement (Ha) is accepted.&#x0D; Conclusions: The majority of participants saw the value in the MDT process and expressed support for its&#x0D; implementation locally and nationally; however, feedback about the most appropriate format is yet to be&#x0D; established. The clinicians identified the need for agreed standards in MDT performance

Influenza vaccine uptake in the elderly population: Individual and general practitioner’s determinants in Central Italy, Lazio region, 2016–2017 season

BackgroundElderly people are a priority target group for influenza vaccination and their decision to be vaccinated might partly depend on advice received from general practitioners (GP). This study aims to investigate the association between influenza vaccine uptake in the elderly residents in the Lazio region of Italy and the demographic and professional characteristics of their GPs, taking simultaneously into account the elderly’s individual characteristics. MethodsWe used data retrieved from different administrative sources to retrospectively analyse the cohort of 1,255,657 elderly residents aged ≥65 years who were alive and registered in the regional healthcare service at the beginning of the 2016–2017 influenza vaccination campaign (1 Oct. 2016–31 Jan. 2017). We assessed influenza vaccine uptake at the end of the vaccination campaign and evaluated its association with both individual and GP-related characteristics through a multilevel Poisson regression models accounting for clustering at physician level. ResultsOverall, vaccination coverage at the end of vaccination campaign was 50.6%. Elderly residents who were male, older, vaccinated in the previous seasons, living in smaller provinces, and spending more money for specialist medical care showed a significantly increased probability to be vaccinated. Vaccine uptake was also significantly higher in the elderly residents assisted by GPs who got master’s degree more recently, assisted a relatively high proportion of elderly patients, received influenza vaccination, had a computer assistant, and were associated with other physicians. ConclusionsOur results indicate that influenza vaccination coverage in the elderly residents of the Lazio region is still unsatisfactorily low. We identified several determinants of influenza vaccine uptake, related to both individual and GP characteristics. Understanding how GP characteristics affected influenza vaccine uptake in the elderly population might provide insight on GPs’ attitudes and concerns regarding influenza vaccination, allowing the implementation of targeted evidence-based interventions to sensitise GPs and increase vaccination coverage.