Low Priority Research Articles

Prioritized health outcomes of acutely hospitalized older patients.

Background: The population is ageing, leading to an increase in older patients visiting the Emergency Department (ED) and acute hospitalizations. Ageing is often accompanied by the presence of multiple chronic diseases, known as multimorbidity. This presence of multimorbidity challenges the application of treatment guidelines, that are generally focused on treating a single disease. Consequently, choosing the most fitting treatment option for the patient with multimorbidity often entails making a trade-off. A trade-off is a situational decision in which prioritization leads to a decrease of benefits for an outcome in return for gains in another. Insight in the health priorities of patients can aid in making this trade-off. Little is known about older patients’ health priorities while being hospitalized, especially for acute hospitalizations. Therefore, we aimed to explore the health priorities of acutely hospitalized older patients.
 Method: In this study we performed a post-hoc analysis of prospectively collected data by the Acutelines Bio- and Databank. Older hospitalized patients (aged ≥ 70 years) were included between September 2020 and October 2022 at the University Medical Centre Groningen, the Netherlands. Demographic, medical and survey data were collected. The primary outcome was the prioritized health outcome of the patient, assessed using the Outcome Prioritization Tool (OPT). Health outcomes of the OPT were life extension, maintain independence, reducing pain and reducing other complaints. Data were analyzed descriptively, whereafter two separate multivariate logistic regression analyses were performed to assess which factors are associated with prioritized health outcomes. For analysis, reducing pain and reducing other complaints were taken together and life extension was used as reference category.
 Preliminary Results: Three-hundred-ninety-nine older patients (mean age 76.7 ± 5.3) were included, with a median Charlson comorbidity score of five. Patients mainly experienced problems with their mobility (75%), somatic complaints (73%) and problems with activities in daily living (69%). Their self-rated health (0-100), based on two weeks before hospitalization, was scored with a mean of 55.5 ± 21.9. The main prioritized health outcome by patients was maintaining independence (42%), whereafter reducing pain (22%), life extension (20%) and reducing other complaints (16%) were ranked. When patients prioritized maintaining independence highest, life extension was most often the lowest priority. If patients did not prioritize maintaining independence highest, it was often prioritized as the second most important health outcome. The education level of the patient and the presence of cognitive impairment were associated more with maintaining independence compared to life extension. Experiencing fear and a lower self-rated health were associated more with reducing complaints compared to life extension. 
 
 Conclusion: Our study showed that, despite being hospitalized for an acute problem, most patients prioritized maintaining independence. This is an interesting finding, as treatment guidelines focus on life extension and treating complaints. Our findings in acutely hospitalized older patients, emphasizes the importance of goal elicitation by healthcare professionals and alignment of a treatment plan to the patients’ goal. An increased awareness of this importance amongst healthcare professionals can lead to providing more optimally integrated care.

Coastal vulnerability assessment with a hierarchical coastal segments approach

Coastal vulnerability assessment is crucial for the effective planning and management of coastal zones, particularly in the face of climate change and increasing coastal hazards. Currently, there is no universal method to accurately assess coastal vulnerability. Therefore, many coastal vulnerability assessments are based on the combined use of physical and social data, simple models, and expert judgment. In this study, the coastal vulnerability index was evaluated using 13 variables related to the physical and social aspects of Campeche state coastline. In addition to an intervention index was identified based on the physical characteristics of the study area. Finally, using the information from the vulnerability index and the action index, areas were defined as hierarchical coastal segments and classified as low, medium, or high priority depending on the economic activities, population, and natural environments present in the area. The results show the distribution of vulnerability along the coast of Campeche: 24% have low vulnerability, 41% have moderate vulnerability, and 35% have high vulnerability. These highly vulnerable areas are in the south, near Laguna de Terminos, the most important coastal lagoon in Mexico, because of its socioeconomic and environmental relevance. The hierarchical coastal segments allow decisions to be made regarding actions that integrate natural and anthropic elements in a more regional and not only local way. The results are useful for medium and long-term planning and management of coastal zones since they allow the identification of vulnerable areas that require a comprehensive solution to the coastal risks to which they are subject. The applied method has the advantages of being replicable and generating a solid base of applicable knowledge owing to the participation of local and foreign experts.

Morphometric parameters based prioritization of watersheds for soil erosion risk in Upper Jhelum Sub-catchment, India.

Soil erosion is the inherent and destructive threat affecting agricultural production and livelihood of million mouths. The increased frequency of floods and land use/land cover changes has made Upper Jhelum Sub-catchment susceptible to soil erosion risk. Morphometric based watershed prioritization for soil erosion risk may help in sustainable management of natural resources. Thus, this paper endeavors to prioritize watersheds of Upper Jhelum Sub-catchment in India based on morphometric parameters for soil erosion risk using geospatial techniques. Weights to the morphometric parameters were assigned through a multi-criteria decision method. The watersheds in the Sub-catchment have been categorized into low, medium, high and very high priority classes based on prioritization ranks that were determined by computing the compound value for the soil erosion risk, based on prioritization ranks obtained through compound value for the soil erosion risk. The results revealed 1E1D3 and 1E1D8 watersheds accorded very high priority. The watersheds namely IE1D2 and IEID4 were found under high priority. Medium priority for soil erosion risk was determined in IEID5 and IED7 watersheds while 1E1D1 and IE1D6 watersheds were identified for low priority. The study calls for implementing soil conservation practices in the Sub-catchment. The Sub-catchment can be made less hazardous for the soil erosion risk by implementing contour farming, building check dams, terrace farming, afforestation and limiting large scale overgrazing. The findings of this study may offer valuable insights for stakeholders for conservation of soil resource. The approach utilized in the study may be linked with soil loss estimation for effective conservation of natural resources in further future studies.

Translated article] Design of a panel of indicators for antibiotic stewardship programs in the Emergency Department

ObjectiveTo develop a panel of indicators to monitor antimicrobial stewardship programs activity in the emergency department. MethodsA multidisciplinary group consisting of experts in the management of infection in emergency departments and the implementation of antimicrobial stewardship programs (ASP) evaluated a proposal of indicators using a modified Delphi methodology. In the first round, each expert classified the relevance of each proposed indicators in two dimensions (healthcare impact and ease of implementation) and two attributes (prioritisation level and frequency). The second round was conducted based on the modified questionnaire according to the suggestions raised and new indicators suggested. Experts modified the prioritisation order and rated the new indicators in the same manner as in the first round. Results61 potential indicators divided into four groups were proposed: consumption indicators, microbiological indicators, process indicators, and outcome indicators. After analysing the scores and comments from the first round, 31 indicators were classified as high priority, 25 as intermediate priority, and 5 as low priority. Moreover, 18 new indicators were generated. Following the second round, all 61 initially proposed indicators were retained, and 18 new indicators were incorporated: 11 classified as high priority, 3 as intermediate priority, and 4 as low priority. ConclusionsThe experts agreed on a panel of ASP Indicators adapted to the emergency services prioritised by level of relevance. This is as a helpful tool for the development of these programs and will contribute to monitoring the appropriateness of the use of antimicrobials in these units.

Feasibility Study of Telemedicine Implementation in Tourist Cities of Kerman Province

Introduction: The present study was conducted to evaluate the feasibility of telemedicine implementation in two cities in Kerman province with tourist attractions. Method: This descriptive cross -sectional study was conducted in 2021. Research data were collected using the standard questionnaire "Telemedicine Assessment Tool," designed by the Institute for Medicare (United States). Using the G -power software, the sample size of 68 people was determined. The researchers collected the required data in person at the hospitals under study. The collected data were analyzed using descriptive and analytical statistical methods through SPSS version 26. Results: According to demographic characteristics, the majority of people were women (78.7%), aged less than 30 years old (37.3%), with less than five years of work experience (40.0%), bachelor’s degree (88.0%), and clinical (57.3%). Regarding P -value, there is a significant difference between telemedicine services in terms of importance. Therefore, telemedicine services, consultation with specialists outside the hospital, patient referrals, and remote drug prescribing had respectively the highest priority. In contrast, changing the processes and structure of the hospital had the lowest priority. The lack of technical staff and the problems of initial costs were the main obstacles to the use of telemedicine, and the attitude of employees and competition were the least essential obstacles . Conclusion: Due to the tourism situation of the studied cities, hospitals must try to establish telemedicine. In this regard, investment to solve the problems of initial costs and technical staff has priority.

Exploring Research and Service Information System Usability by Heuristic Evaluation as a Compelement of System Usability Scale

The Research and Community Service Information System of LPPM University Lancang Kuning is a web-based application designed to facilitate research and community service activities at the university. This study incorporated two methodologies: a descriptive approach with qualitative analysis for heuristic data collection, and the System Usability Scale (SUS) method, employing quantitative analysis. The research process included stages of problem analysis, literature review, data collection, data analysis, and formulating recommendations based on the findings and discussions. The heuristic evaluation, the first method applied, revealed that aspects H1, H3, and H4 scored 1 when rounded, indicating these were merely cosmetic issues not requiring immediate attention unless spare time was available. Conversely, aspects H2, H5, H6, H7, H8, H9, and H10 scored 2 when rounded, categorizing them as minor usability issues needing resolution, albeit with low priority, to prevent potential user difficulties. Recommendations for these seven heuristic aspects scoring 2 encompassed improvements in system information clarity, feedback processes, image utilization, color selection, grammar quality, and writing consistency. The second method, the SUS, indicated that most users demonstrated adequate skills in terms of learnability, efficiency, memorability, error management, and overall satisfaction with their system usage experience.

Resilience and Ethics in Nursing Education and Practice: Needs and Opportunities.

Nursing faculty and clinicians are leaving the profession due to increased workload and burnout. Evidence-based interventions to build skills in resilience and well-being are encouraged; however, strategies to implement them in nursing curricula and nurse residency programs (NRPs) are not well known. To understand the current state of resilience, well-being, and ethics content in the curriculum in schools of nursing and NRPs in the state of Maryland as part of a statewide initiative for Renewal, Resilience and Retention of Maryland Nurses (R 3 ). A descriptive survey was distributed to leaders of all Maryland nursing schools and NRP directors. Respondents (n = 67) reported minimal resilience, well-being, and ethics content. Teaching modalities included lecture, journaling, mindfulness, and the code of ethics. Barriers included lack of faculty knowledge, low priority, time constraints, and limited resources. Resilience, well-being, and ethics content is limited in nursing curricula. Developing educator skills and best practices to foster resilience and ethical practice are needed.

Determination of the Development Strategy for the Labuan Bajo Waterfront Based on Visitor Satisfaction

The existence of the Labuan Bajo Waterfront is relatively new. However, the Labuan Bajo Waterfront itself has become a tourist attraction in Labuan Bajo. Therefore, a study is needed to determine tourist satisfaction with the Labuan Bajo Waterfront and design a strategy to increase this satisfaction, especially in the attractions, accessibility, and amenities components. The sampling technique used in this study was random sampling with a questionnaire as a data collection technique. This study used the Likert scale to analyze the level of tourist satisfaction and determine the design strategy using the importance-performance analysis (IPA) method. In this study, the data collected came from 194 respondents. The results showed that tourist satisfaction with the Labuan Bajo Waterfront was very satisfied. In addition, the results of the IPA method show that the Concentrate Here Quadrant is related to cleanliness and safety; items in the Keep The Good Work Quadrant are the condition of the pier or walk board, lighthouse, road leading, footpaths in the Water Front area, ease of visiting the Water Front area, seating/rest facilities, and vehicle parking areas; items in the Low Priority Quadrant are road signs leading to the Water Front Area, trash bins, lighting, information boards, and eating and drinking facilities. The Possible Overkill Quadrant is related to tourism/entertainment activities in the Waterfront Area. Thus, even though the satisfaction level of Waterfront visitors is very satisfied, a destination development strategy is needed to improve quality related to cleanliness and safety.

Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the autologous stem cell transplant population: a theory-based interview study.

Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant. Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses), and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium, or low priority. Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g. multidisciplinary teamwork); Beliefs about consequences (e.g. patient benefit); Memory, attention, and decision processes (e.g. refer as early as possible); and Environmental context and resources (e.g. electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention, and decision processes (e.g. conflicting views about who should be referred); Environmental context and resources (e.g. lack of time); Social influences (e.g. families); and Emotions (e.g. patient distress). Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.

Are Segmental Parties Bad for Women? Rethinking the Challenges of Representation in Consociational Power-Sharing

ABSTRACT Consociational power-sharing mandates representation of politically salient groups in government and encourages their participation in decision making. This leaves identities and issues not centrally related to the primary political division technically negligible for political stability. That cross-segmental policy issues in general and those specifically of concerns to women in divided societies enjoy low priority in dominant political parties is well documented. There is no agreement on why it is so. This paper analyses the system-level incentives that segmental parties in Northern Ireland follow when crowding out concerns and interests that might be relevant for individual voters identifying primarily outside the established politically salient cleavages. We conclude that in Northern Ireland, the systematic marginalisation of ‘women-specific issues’ is not systemic but rather highlights system-given opportunities for major political parties to avoid engagement with socially salient issues at no electoral cost.

Wild relatives of potato (Solanum L. sec. Petota) poorly sampled and unprotected in Colombia

AbstractWild potato relatives (Solanum L. sec. Petota) play a vital role in crop improvement, understanding crop evolution, and conserving potato diversity. However, these invaluable resources are often neglected and underutilized and are susceptible to threats such as climate change, urbanization, and agricultural expansion. Little is known about the diversity, conservation status, and distribution of wild potato species in Colombia. To address this gap, we assessed the conservation status of five wild potato relatives conserved in the ex situ Colombian Central Collection. Five species were analyzed for their spatial patterns of biodiversity, conservation status, and conservation gaps. Colombia was found to have six centers of species richness, four areas of endemism, and six biogeographical regions. Of the five native species, only one was classified as adequately conserved for ex situ conservation, while the other four were considered low priority. In contrast, for in situ conservation, three species showed high priority, one was classified as medium priority, and one as low priority. In light of these findings, we propose three conservation strategies: (1) conducting collection missions to increase accessions in the national germplasm bank, prioritizing high‐priority species; (2) identifying and protecting unprotected natural habitats and engaging stakeholders to enhance in situ conservation efforts; and (3) establishing regional community genebanks to ensure localized conservation efforts.

Nutritional-environmental trade-offs in potato storage and processing for a sustainable healthy diet

Over the last decade, poor diets and limited access to nutritious foods have been critical drivers of micronutrient deficiency in human health. However, food fortification at an industrialized scale in developed countries has helped eliminate deficiency-related diseases. In developing countries, fortified foods and biofortified materials have been delivered to nutrient-deficient communities. While these strategies have produced significant and acclaimed results, reports from the Food and Agricultural Organization suggest that over a quarter of the world’s population suffers from micronutrient deficiency. This implies that there are still declines in micronutrients in food products at different nodes along the food value chain (FVC). Hence, this study sets out to track micronutrient leakages at specific nodes of the FVC using potato household storage, processing, and consumption in the United States as a case study. The experiment was laid out in a full factorial design with three storage conditions (cupboard at (17.5–22.4 °C, 32.7–48% RH), refrigerator at (–1.8 – 0.89 °C, 37.5–66.1% RH) and ideal condition at (7.2–11.1 °C, 85.0–92.4% RH)), two storage times (2 weeks (±3 days) and 5 weeks (±3 days)) and three household processing pathways (boiling in water, baking at 204 °C, and frying in vegetable oil at 149–204 °C). Additionally, we explored the dynamics of optimal household storage and processing pathways by placing a high, low, or equal priority on environmental sustainability or nutrient retention. The results show that storing potatoes for 5 weeks (±3 days) and processing through boiling (in water at 100 °C), baking (at 204 °C), and frying (in vegetable oil at 149–204 °C) are associated with 33.5%, 40.3% and 15.0% greater nutrient loss than a similar processing scenario after 2 weeks (±3 days) of storage. Additionally, storing and processing potatoes after 5 weeks (±3 days) results in approximately 2.2 ± 0.7 times more damage to human health, ecosystem safety, and resource availability than storing and processing potatoes after 2 weeks (±3 days), averaged between the different storage conditions. Storing and processing after 5 weeks (±3 days) results in approximately 53.6 ± 10.3 times more damage to human health, species disappearing per year, and USD loss than freshly purchased and processed potatoes. Perhaps the most significant finding from the study is that storing potatoes in cupboards and boiling (BL-CP pathway) is optimal for achieving a sustainable healthy diet, as it yields the optimal combination of nutrient retention and low environmental damage. Insights from the study could be translated to support consumer decision-making as they weigh the value of environmental sustainability against nutrition in the context of household potato storage and processing.

Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review

BackgroundAn estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review.MethodsThe scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question.ResultsA total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms.ConclusionImportant barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.

ANALISIS RISIKO K3 PADA MAINTENANCE MESIN FINAL PRESS MENGGUNAKAN METODE SWIFT

This study aims to determine the hazards that arise as a result of the final press machine maintenance process and to provide a solution to the existing hazards in the form of safeguards or recommendations for improvement. The method used in this study is the SWIFT (Structural What If Analysis) method, which is a technique for identifying the dangers of a questioning approach using the what if keyword. System design is carried out to evaluate the company's occupational safety and health system by examining the causes and implementing corrective solutions. In this paper, the results of this study were carried out using a qualitative method by conducting an analysis on maintenance activities for the final press machine which resulted in risks with different levels, namely 13 medium priorities, 3 low priorities and 4 lowest priorities with the conclusion that the medium priority would be recommended for system improvement because it has the highest priority value which aims to prevent and reduce the risk level of work accidents in the final press machine maintenance process. Suggestions for companies to pay more attention to the safety and health of workers in order to achieve a comfortable and safe work system for workers by providing PPE, and there needs to be an emphasis on implementing efforts to control work accidents for workers to minimize the risk of work accidents.

An evaluation framework for urban ecological compensation priority in China based on meta-analysis and fuzzy comprehensive evaluation

This initiative seeks to attain a harmonious equilibrium of regional environmental pressures and improve resource utilization efficiency within the context of habitat and environmental preservation. The escalating urban population exposure underscores the significance of restoring human settlements, emerging as a critical concern in urban planning and development. However, a notable deficiency exists in both theoretical foundations and methodologies for identifying cities requiring greater support for environmental restoration. The evaluation of ecological compensation priority has thus become pivotal in accomplishing this objective. Consequently, this study endeavors to elucidate the research paradigm surrounding urban ecological compensation priority and proffer a framework for assessing and analyzing the spatial characteristics of such priority in China. Employing the meta-analysis method, the study established an evaluation index system for ecological protection importance (EPI) to delineate ecological compensation priority. Leveraging data sourced from literature findings and publicly available data from Google Earth Engine, an evaluation of EPI subsystems (HSEQ and ecological sensitivity) ensued via the application of a fuzzy comprehensive evaluation model. Ultimately, the EPI value was computed using a coupling coordination degree model, facilitating the determination of ecological compensation priorities for Chinese cities. The results showed that (1) Most cities displayed both low-grade human settlement environmental quality (HSEQ) and ecological sensitivity, especially about 59.8% cities in lowest grade HSEQ. And they showed aggregated distribution from both the aspects of the HSEQ(Moran’I = 0.16) and the eco-sensitivity(Moran’I = 0.297). (2) 53.5%(n = 53) cities in low compensation priority and 38.4%(n = 36) in medium compensation priority, only 8.1%(n = 8) cities in high compensation priority. (3) 83.75% cities accorded with the feature that cities with obvious population growth could upgrade the compensation priority. It indicates that cities and urban agglomerations with potential for population growth should receive more attention. This study presents an analytical framework for urban ecological compensation, aiming to offer valuable insights for urban HSEQ policy decisions related to urban ecological management.

In‐depth evaluation of protein domains improves classification of SORL1 variant pathogenicity in Alzheimer’s Disease patients

AbstractBackgroundRare pathogenic SORL1 gene variants have been identified as strong risk‐increasing factors in Alzheimer’s disease (AD). Recent analysis indicated that SORL1 loss‐of‐function (LoF) variants associated with a ∼40‐fold increased risk for early‐onset AD, while missense variants that were prioritized using in silico variant pathogenicity‐prediction algorithms associated only with a 2‐fold risk increase. However, current risk‐prediction strategies do not take SORL1‐specific features into account. We aimed to design a variant classification strategy that adds in‐depth knowledge of SORLA structural folding and function to the variant risk prediction.MethodWe identified coding SORL1 variants in a discovery/replication sample of whole exome sequencing data from the ADES/ADSP studies comprising 18,959 cases and 21,893 controls after quality control. We selected only the extremely rare variants (MAF<0.05%) and further divided these into LoF(n = 77) and missense variants(n = 539). With an in‐depth evaluation of protein functional domains (informed by pathogenic variants in homologous genes) combined with their predicted pathogenicity (REVEL algorithm) we prioritized missense variants into ‘high priority’, ‘moderate priority’ and ‘low priority’. We compared the age‐dependent penetrance of missense variants for each priority‐category and LoF variants, in context of APOE genotype.ResultCarriers of prioritized missense variants had a similar age‐dependent penetrance as LoF variants, with median age at AD‐onset of ∼65 years which is significantly lower compared to non‐carriers (∼72 years). In addition, carriers of prioritized SORL1 missense variants have an expedited age at onset by ∼7 years independent of their APOE genotype. If we look at a 80% penetrance level, SORL1 carriers with homozygous ε4 background had AD by age 61 (95%CI 60‐NA, n = 6) compared to age 73 (95%CI 72‐73, n = 1091) for SORL1 WT carriers. Carriers with a heterozygous background had AD by age 71 (95%CI 68‐76, n = 62) compared to 78 (95%CI 78‐78, n = 4816) for WT. For a non‐ε4 background the age at onset for carriers was 83 years (95%CI 78‐90, n = 54) compared to 85 years (95%CI 85‐85, n = 5773) for WT. The moderate and low priority group showed no significant difference compared to WT.ConclusionOur prioritization model can successfully identify likely pathogenic missense SORL1 variants, allowing for better identification of patients with possible SORL1‐associated‐AD.

Constipation in the critically ill

Abstract 
 Aims and objectives: To define constipation in the critically ill patient and to develop an evidence-based protocol for how critical care nurses and physicians can prevent and treat constipation in the critically ill patient admitted in the ICU.
 Background: Constipation is a common complication amongst critically ill patients. The rate of constipation is reported from 15-83%. Basic nursing tasks in a high-tech environment might get low priority and lead to care left undone. Constipation increases both morbidity and mortality and is associated with worse functional outcomes in these patients. Management of constipation is therefore of medical and health economic interest and is an area where significant improvement is possible.
 Design: A systematic review was conducted supported by an expert librarian, and an evidence-based protocol was developed based on research findings and consensus from an interdisciplinary group.
 Methods: 19 studies investigating preventative and management measures of constipation in the critically ill admitted in the ICU were included. Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to provide rigorous methodology in the development of the evidence-based protocol. Critical Appraisal Skills Program (CASP) was applied to assess the quality of the included studies. 
 Conclusion: A systematic interprofessional approach to prevention and treatment of constipation is important to be able to evaluate and improve continuously in an evidence-based manner. More research is needed. Studies investigating non-pharmacological measures are scares.
 Relevance to clinical practice: This evidence-based protocol represents a systematic (and not individual) approach to interprofessional prevention and treatment of constipation in the critically ill. This interprofessional approach may ensure better quality of advanced nursing care in the ICU. The evidence-based protocol must be implemented in education of advanced nursing and physician programs.
 
 

Abstract A070: The influence of cultural factors on health-seeking behaviors regarding prostate cancer among African immigrant men in the United States

Abstract Background: The increasing number of African immigrants in the United States has contributed to the diversity of the country's Black population. However, there is limited research on the impact of immigration, particularly regarding chronic diseases like cancer, within the sub-Saharan African immigrant (SSAI) community. To address this gap, this study aimed to explore cultural factors among SSAIs to better understand the drivers of health disparities in prostate cancer outcomes. Methods: A qualitative approach using grounded theory was employed for this study. Participants were purposefully recruited to reflect the cultural diversity among SSAIs. Recruitment occurred at health fairs, community events and by snowball approach. In-depth interviews were conducted with 16 participants, including prostate cancer survivors. Nine participants have lived in the US for at least 10 years. The average age of participants was 51 years. Country of birth for study participants include, Nigeria, Ghana, Cameroon, Kenya, and Ethiopia. Interviews were transcribed, verified, and de-identified then imported into NVivo 12 software. Four research team members, three of them African immigrants, performed open and axial coding, with consensus on the emerging findings. Results: This study identified several key cultural factors influencing SSAI men’s health behaviors. These factors include the perception of cancer in their country of birth, the low priority given to preventative care in their country of origin, and reluctance to embrace a Westernized diet, the perception of cancer in their country of origin as a death sentence, viewing cancer as a spiritual/religious attack, and associating cancer with affluence. In addition, these cultural factors made participants hesitant to discuss cancer, relying on religion for healing instead of medical care, and seeking healthcare only for cure. Conclusion: This study illuminates key cultural factors among SSAI men that influence their health-seeking behaviors. These findings highlight the need for culturally tailored behavioral interventions to address these factors and improve health outcomes within this understudied population. Citation Format: Ernest Kaninjing, Motolani Ogunsanya, Kaitlin Van Voorhis, Gladys Asiedu, Assata Kokayi, Rae Walker Brennan, Mary Ellen Young, Folake Odedina. The influence of cultural factors on health-seeking behaviors regarding prostate cancer among African immigrant men in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A070.

CAM therapy initiative for Alzheimer’s patients : Asian perspectives

AbstractBackgroundIn resource‐poor‐settings, Unlike Western nations monitoring Alzheimer’s‐treatment‐Adherence is low priority due to lack of training modules/funds/expertise. drug‐toxicity, social stigma causes high‐incidence of withdrawal from therapy. Hence our we‐analyzed locally available Complementary‐Alternative Medicines [CAM] in Alzheimer’s‐casesFacilities for diagnosis/treatment located in major‐cities &are unaffordable to >75%. ADR’s & social stigma worsened situation. CAM must be incorporated along with standard DRUG’s to reduce ADR’s & control symptoms to get better treatment‐Adherence. Provide CAM to Traditional‐faith‐hearers. To assess CAM response to pain/fatigue/Myalgia/bed‐sores/wt‐loss, feeling of hopelessness, Dementia. Hence we combined CAM with standard‐drugs.Methodn = 72 cases aged 60‐70 years enrolled. 30% females, 70% males. self report questionnaire distributed in NGO clinic. Mud therapy 60%, Bach‐flower 40%, Accupressure/Accupuncture 80%, Hydrotherapy 10%, Hypnotherapy 70%, ayurvedic therapy 80%, 60% on Unani, 50% Homeopathic, 60% Herbal‐Oil‐TFH massage therapy, 30% Aromatherapy.Resultpatients treated in 7 CAM sessions. responses evaluated by feedback‐Performa periodically to modify treatment. Symptom relief 92%, Psycholocal mood elevation 52%, willingness to shift back to std‐drug thrapy 80%. CAM 80% cheaper compared to std drugsConclusion80% patients used & preferred CAMs. CAM effectively compliments Alzheimer’s treatment‐adherence. Community NGO’s must be part of such efforts to evolve newer concepts in Adherence. Realizing divergent versions of CAM multicentre study needed.

Batu Cermin Cave Labuan Bajo Development Strategy Based on Tourist Satisfaction Level

<p><em>Tourist satisfaction is essential for the sustainability of tourism activities at tourist attractions. Batu Cermin Cave is one of the attractions in Labuan Bajo. Batu Cermin Cave underwent renovations in 2021 and reopened in 2022. Since then, no studies have shown tourist satisfaction with the services and facilities at Batu Cermin Cave. Therefore, this research aims to determine the satisfaction level and develop strategies based on the level of tourist satisfaction. This research uses a mixed-method approach with an explanatory sequential design. Quantitative data collection uses accidental random sampling techniques with survey questionnaires and qualitative data uses observation techniques. The data collected came from 124 respondents. Data was analyzed using importance-performance analysis. In the Keep Good Work Quadrant, there were nine attributes: the appearance of the tour guide, speed of service of the tour guide or staff in serving visitors, the readiness of the tour guide or staff in serving visitors, timeliness of service, reliability in service, politeness and friendliness, patience in serving, area parking, and walking paths in the Batu Cermin Cave Area. In the Low Priority Quadrant, there are four attributes: work equipment for staff and tour guides in serving visitors, trash cans, information boards, and places to eat and drink. The Overkill Quadrant is an attribute of providing exceptional services for tourists and the road to Batu Cermin Cave. In the Top Priority quadrant, namely, security when visiting Batu Cermin, toilets, and road signs to Batu Cermin Cave. The priority development strategy is based on the attributes of the Top Priority quadrant are 1) increasing visitors' sense of security when carrying out tourism activities at Batu Cermin Cave, and 2) Improving the quality of supporting facilities such as toilets and road signs to Batu Cermin Cave..<strong></strong></em></p>