Medical Specialties Research Articles

What Factors Contribute to Ethical Problems in Patient Care? A Scoping Review and Case Series of Clinical Ethics Consultations.

A scoping review of ethical risk factors in patient care and a CEC case series were conducted, analyzing the documentation (consultation reports, feedback forms, electronic medical records) of 204 CECs from 2012 to 2020 at a somatic and a psychiatric university hospital in Basel, Switzerland. Ninety-nine ethical risk factors were identified in nine articles, related to four risk areas: patient (41), family (12), healthcare team (29), and system (17). Eighty-seven of these risk factors were documented at least once in the CEC case series. The most prevalent risk factors in the consultations studied were patient vulnerability (100%), missing or unclear hospital ethics policy (97.1%), shift work (83.3%), lack of understanding between patient and HCP (73.5%), poor communication (66.2%), disagreement between patient and HCP about care (58.8%), and multiple care teams (53.4%). The prevalence differed significantly by medical specialty. There are highly prevalent ethical risk factors at all levels of clinical care that may be used to prevent ethical problems. Further empirical research is needed to analyze risk ratios and to develop specific risk profiles for different medical specialties.

Primary contact physiotherapy for patients with suggested vestibulopathy for an Australian ENT clinic: a retrospective cohort study.

To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development. A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff. There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time. The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists' time.

The impact of COVID-19 on resident doctors as the frontline in health services

As the number of confirmed cases of COVID-19 increases, the workload due to the pandemic can affect health workers and increase the risk of psychological stress. Psychological factors such as anxiety can cause various physiological responses, including gastroesophageal reflux disease (GERD) symptoms. The persistent symptoms of GERD can reduce the patient's quality of life. A cross-sectional survey was conducted in October 2021 at the Dr. Zainoel Abidin Regional General Hospital, Banda Aceh. A total of 91 Specialist Medical Education Program responded to the study. Data from respondents were collected through the generalized anxiety disorder-7 (GAD-7), GERD-Q, and WHOQOL-BREF questionnaires. The statistical analysis used was the contingency coefficient test. The results showed that 9.9% of respondents experienced suggestive GERD, minimal anxiety (92%), and good quality of life (51.6%). There was a significant relationship between anxiety levels and quality of life and the GERD prevalence of Specialist Doctor Education Program Participants during the COVID-19 pandemic (p<0.05). Most Specialist Medical Education Program participants did not suffer from GERD with minimal anxiety, followed by mild and moderate anxiety. The majority had a good and moderate quality of life during the COVID-19 pandemic.

TimetoCare

Abstract: The goal of the Healthcare Application's extension, the Health Care Website, is to offer convenient online medical support in a seamless manner. This website, which is made to meet the demands of physicians, patients, and healthcare ecosystem providers, guarantees prompt, precise responses in this digitally sophisticated age. A number of tools are available on the Health Care Website, such as a symptom analyzer that matches users with appropriate medical specialists or makes prescription recommendations depending on symptoms entered. Given the growing number of people using smartphones, the website guarantees that these facilities are always accessible.

Unmet healthcare needs, access to services and experiences with health providers among persons with spinal cord injury in Australia.

Cross-sectional survey. Appropriate and timely lifelong access to healthcare following a spinal cord injury (SCI) is critical, yet unmet healthcare needs in this population are common. Poor experiences with healthcare providers can be a barrier to health-seeking behaviour, and we hypothesised that there would be an association between unmet healthcare needs and care experiences. This study aimed to: (1) describe healthcare provider utilisation in the past year, unmet care needs and satisfaction with healthcare services; (2) explore the association between experiences with healthcare providers and unmet healthcare needs; and (3) explore the association between healthcare provider utilisation and participant characteristics, including unmet healthcare needs. Community. Analysis of data for 1579 Australians aged ≥ 18, who were ≥ 1-year post-SCI and living in the community. Bayesian penalised regression was used to model six binary outcomes: unmet healthcare needs; the use of general practitioners (GPs), allied health practitioners, rehabilitation specialists;medical specialists; and hospitalisations in the past 12-months. Unmet needs were reported by 17% of participants, with service cost the common deterrent. There was evidence of an effect for provider experiences on unmet healthcare needs, but no evidence that unmet healthcare needs was associated with the use of GPs, allied health practitioners, and rehabilitation or medical specialists. Unmet healthcare needs were reported in the context of high healthcare use and large proportions of secondary conditions in a cohort with long-term SCI. Improved health access for people with SCI include better primary-secondary care collaboration is needed.

The Journey from Basic to Clinical Pharmacology

Background The subjects of basic pharmacology and clinical pharmacology originate from same concepts but have a clear demarcation yet are so inter-linked and netted together that it is very critical and technical to identify and differentiate one from the other. This write-up is basically aimed to discuss and analyze the demarcations and similarities between basic and clinical pharmacology. Methodology Total 10 pharmacologists, pharmacists and medical specialists were recruited to conduct the survey from 1st December 2022 to 15th April 2023 in Northwest School of Medicine. Information was collected via literature search online, consulting Pharmacology books, libraries and discussions with subject experts. Results The basic pharmacology focuses on the study of the effects of substances on the body following experimental data that is collected via animal studies which defines the basic parameters and helps in derivation of the main foundational principles of the subject. Clinical pharmacology although follows the same basic principles and concepts but is the study of these principles in the human subjects rather than the animal studies. These studies are subjects however the two are inter-connected in many ways and the concepts go to and fro from one t the other. Conclusion The basic pharmacology is limited to the animal studies while the clinical pharmacology shelters human clinical trials and the policies, which come with the human studies and therapeutics.

A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme.

Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM). We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.

Optimizing Advanced Trauma Life Support (ATLS®) to Maximize Readiness.

The Army utilizes Individual Critical Task Lists (ICTLs) to track and ensure competency and deployment readiness of its medical service members. ICTLs are the various skills and procedures that the Army has deemed foundational for each area of concentration (AOC)/military occupational specialty (MOS). While many ICTLs involve the patient care that military medical providers regularly provide, some procedures are not as commonly performed. This, when coupled with lower patient volume at military treatment facilities (MTF), poses a challenge for maintaining skill competency and deployment readiness. Fort Campbell's Blanchfield Army Community Hospital (BACH) has created a holistic and unique solution to meet many of these standardized requirements and support a ready medical force. By optimizing the Advanced Trauma Life Support (ATLS®) course curriculum to facilitate ICTL completion, BACH has increased its ICTL completion rates, ATLS® course exposure, and streamlined training requirements. The purpose of this article is to describe this best practice and suggest its applicability to other MTFs. By cross-referencing the ATLS® course curriculum and appendices with ICTLs, BACH has augmented ATLS® course certification with the additional completion of 12 ICTLs. This new approach not only increases ICTL completion, but also increases ATLS® curriculum exposure to medical providers, such as Registered Nurses or Nurse Practitioners, who would not typically take ATLS®. Since starting this new approach in April 2021, 73 military medical personnel have completed the ATLS® course at BACH, with 24 different medical specialties represented. A total of 361 ICTLs have been completed with specific ICTL completion counts ranging from 13 to 48. Each ICTL tested was completed 100% of its annual requirement. ATLS® is a mandatory joint interoperability standard for military physicians and it is also an Army ICTL for many AOCs/MOSs. Only counting completion of this course as one ICTL is a missed opportunity for the time spent by Army medical providers and limits the exposure of ATLS® to select AOCs/MOSs. This optimized and novel approach has been successful at BACH, suggesting its applicability at other MTFs that serve as ATLS® testing sites.

Hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand.

To describe the types of hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand, and to explore head of department (HOD) views on issues in current and future service provision. An electronic survey was sent to HODs of public geriatric medicine departments. Seventy-six (89%) of 85 identified HODs completed the survey. Seventy-one (93%) departments admit inpatients and 51 (67%) admit acute inpatients, with variable admission criteria. Sixty-four (84%) have hospitals with an inpatient general medicine service, and 58 (91%) of these admit older patients with acute geriatric issues. Sixty (79%) departments provide inpatient rehabilitation. Forty (53%) have beds for behavioural symptoms of dementia and/or delirium. Seventy (92%) provide a proactive orthogeriatric service. In terms of out-of-hospital services, 74 (97%) departments have outpatient clinics, 59 (78%) have telehealth and 68 (89%) perform home visits. Forty-five (59%) provide an inreach/outreach service to nursing homes. The most frequent gaps in service provision identified by HODs were acute geriatrics, surgical liaison, a designated dementia/delirium behavioural management unit, geriatricians in Emergency, outreach/inreach to residential care and shared care with some medical specialities. Increasing staff numbers and government policy change were the most frequently identified ways to address these gaps. Geriatric medicine service provision is variable across Australia and New Zealand, with key gaps identified. These findings will inform future directions in implementation of geriatric medicine models of care and discussions with various levels of government about the ongoing development of geriatric medicine services.

Assessment of the dynamics of inpatient health care delivery in Poland before and throughout the COVID-19 pandemic

A situation of emergency involving the whole population introduces changes in the dynamics of the health services that are provided. The magnitude of these shifts should be also linked to the medical speciality within which the health benefits are delivered. The aim of the paper was to identify changes in tendencies in inpatient medical service delivery during the COVID-19 pandemic by medical specialties. On the basis of a database extracted for in-patient treatment received from the public payer, a retrospective analysis was carried out. Comparing the values of the dynamics of the services provided in each medical speciality, the period before the COVID-19 pandemic was collated to the years of the pandemic (2020–2021). In the period before COVID-19, positive patient dynamics were observed in more than half of the specialities. Between 2020 and 2021, virtually all specialties reversed the trend and negative dynamics were recorded. The dynamics in 2021 indicate a process of return to the values from 2015 to 2019. Emergency situation has affected the dynamics of healthcare provision in different specialities to various extent. The most resistant to the negative impulses of the state of emergency were the areas that are strictly organisationally and financially defined (e.g. the group of “therapeutic and drug programmes”).

Exploration of the Challenges of COVID-19 from the Perspective of Emergency Medicine Specialists

Background. Emergency physicians are at the forefront of the medical system in the face of the COVID-19 crisis. Identifying the challenges, along with the strategies and effective measures implemented by them in the face of the COVID-19 crisis, can be a roadmap for future crisis management planning. This study aims to explain the challenges faced by emergency physicians regarding COVID-19. Methods. This study is a qualitative content analysis. Data were collected using individual and semistructured interviews. Twenty-seven emergency medical specialists in Fars University of Medical Sciences, Iran, participated in the study by purposive sampling method and were interviewed using semistructured interviews. Results. Participants’ experience of COVID-19 led to the extraction of four main themes, including structural factors, threats to the health of the medical team, fluctuations of extremism and wastage in the face of COVID-19, and the country’s policymaking hierarchy. Conclusions. Emergency physicians face challenges such as structural factors, health threats, extreme fluctuations, and national policymaking. To avoid surprises and threats, they must predict acute scenarios, provide necessary equipment, address skilled manpower shortages, and adopt appropriate management policies. This includes culture-building, cross-sector coordination, planning, and efficient management to prevent virus spread.

Virtual Scribes and Physician Time Spent on Electronic Health Records

Time on the electronic health record (EHR) is associated with burnout among physicians. Newer virtual scribe models, which enable support from either a real-time or asynchronous scribe, have the potential to reduce the burden of the EHR and EHR-related documentation. To characterize the association of use of virtual scribes with changes in physicians' EHR time and note and order composition and to identify the physician, scribe, and scribe response factors associated with changes in EHR time upon virtual scribe use. Retrospective, pre-post quality improvement study of 144 physicians across specialties who had used a scribe for at least 3 months from January 2020 to September 2022, were affiliated with Brigham and Women's Hospital and Massachusetts General Hospital, and cared for patients in the outpatient setting. Data were analyzed from November 2022 to January 2024. Use of either a real-time or asynchronous virtual scribe. Total EHR time, time on notes, and pajama time (5:30 pm to 7:00 am on weekdays and nonscheduled weekends and holidays), all per appointment; proportion of the note written by the physician and team contribution to orders. The main study sample included 144 unique physicians who had used a virtual scribe for at least 3 months in 152 unique scribe participation episodes (134 [88.2%] had used an asynchronous scribe service). Nearly two-thirds of the physicians (91 physicians [63.2%]) were female and more than half (86 physicians [59.7%]) were in primary care specialties. Use of a virtual scribe was associated with significant decreases in total EHR time per appointment (mean [SD] of 5.6 [16.4] minutes; P < .001) in the 3 months after vs the 3 months prior to scribe use. Scribe use was also associated with significant decreases in note time per appointment and pajama time per appointment (mean [SD] of 1.3 [3.3] minutes; P < .001 and 1.1 [4.0] minutes; P = .004). In a multivariable linear regression model, the following factors were associated with significant decreases in total EHR time per appointment with a scribe use at 3 months: practicing in a medical specialty (-7.8; 95% CI, -13.4 to -2.2 minutes), greater baseline EHR time per appointment (-0.3; 95% CI, -0.4 to -0.2 minutes per additional minute of baseline EHR time), and decrease in the percentage of the note contributed by the physician (-9.1; 95% CI, -17.3 to -0.8 minutes for every percentage point decrease). In 2 academic medical centers, use of virtual scribes was associated with significant decreases in total EHR time, time spent on notes, and pajama time, all per appointment. Virtual scribes may be particularly effective among medical specialists and those physicians with greater baseline EHR time.

Pembrolizumab autoimmune related diabetes: Moving forward, keep learning

Immune checkpoint inhibitors (and more specifically programmed cell death 1/programmed cell death ligand 1 inhibitors as Pembrolizumab) initiated a revolution in the field of melanoma and have now expanded to several tumor subtypes and in increasingly broader clinical contexts, including the adjuvant and neoadjuvant setting, with potentially curable patients and prolonged survival. The side effects related to these drugs include a wide spectrum of manifestations, with endocrinological adverse events being some of the most frequent. Pembrolizumab-induced type 1 diabetes mellitus is an infrequent but potentially serious and not clearly reversible side effect that possesses characteristic clinical features and has high morbidity and mortality, with a chronic impact on quality of life. The etiopathogenesis of this phenomenom needs to be further investigated and a collaborative effort through the involvement of oncologists and other medical specialists is necessary for the correct identification and management of patients at risk.

Adiposity trajectories and cardiovascular disease risk in women: a population-based cohort study with a focus on menopausal status

ObjectivesA single measurement of adiposity indices could predict the incidence of cardiovascular disease (CVD); nonetheless their long-term pattern and its association with incident CVD are rarely studied. This study aimed to determine distinct trajectories of adiposity indices among participants of Tehran Lipid and Glucose Study (TLGS) and their association with incident CVD. Furthermore, this study aimed to investigate whether this association differed among individuals according to their menopausal status.MethodA total of 6840 women participated in TLGS, aged 20 years and older were included in this study; they were followed for a median of 16 years. Body mass index (BMI), waist circumference (WC), conicity index (CI) and body roundness index (BRI) were included in the analysis as adiposity indices. The cohort outcome panel of medical specialists identified the CVD outcomes. Trajectory analyses were used to identify homogeneous distinct clusters of adiposity indices trajectories. The association between the trajectory group membership and incident CVD were explored by Cox proportional hazard models, with unadjusted and adjusted model for baseline age, physical activity, smoking status, menopause and family history of CVD.ResultsThree BMI trajectory groups of low, medium, and high and two trajectories for WC, BRI and CI were identified. Adjusted cox proportional hazard models revealed significant associations between the hazard of CVD experience and the high trajectory group of the BMI (HR: 2.06, 95% CI: 1.38-3.07), WC (HR: 2.71, 95% CI: 1.98-3.70), CI (HR: 1.87, 95% CI: 1.26-2.77) and BRI (HR: 1.55-95% CI: 1.12-2.15), compared to the low trajectory group. Subgroup analysis based on the menopausal status of participants showed that the HR of CVD incidences for all of trajectories adiposity indices, except BMI, was statistically significant. Adjusted cox proportional hazard models, in those women not reached menopause during study, revealed that the HR (95% CI) of CVD incidences for high trajectory of BMI, WC, CI and BRI were 2.80 (1.86-7.05); 2.09 (1.40-6.16); 1.72 (1.42-5.61), and 3.09 (1.06-9.01), respectively. These values for those were menopause at the initiation of the study were 1.40 (1.11, 2.53); 1.65 (1.04-2.75); 1.69 (1.01-2.87), and 1.61 (0.98-2.65), respectively.ConclusionOur findings suggest that adiposity trajectories, particularly central adiposity index of CI, could precisely predict the CVD risk. Consequently, preventive strategies should be tailored accordingly.

Paediatric airway foreign-body removal equipment availability in sub-Saharan Africa

Sub-Saharan Africa (SSA), home to over 1 billion people, has only one paediatric otolaryngology fellowship program and nine fellowship-trained paediatric Otolaryngology Head and Neck Surgery (OHNS) specialists covering seven countries. Seven of these specialists estimated an average of 40+ patients per month are in need of critical surgical airway management in their respective countries and that 2–25 deaths per year (mainly paediatric) occur in their country from lack of access to foreign body removal equipment. Investing in paediatric airway infrastructure and capacity would largely benefit the health system in SSA, where the current lack of equipment alone leads to unmeasured morbidity and mortality. As a region of the world with the largest paediatric populations, sub-Saharan Africa’s need is all the more pressing given the disproportionately low number of medical specialists, institutions and resources. Collaborative approaches in procurement and maintenance of high-quality, cost-effective equipment are crucially desirable factors in both low- and middle-income countries (LMICs) and high-income countries (HICs). We, as the Global OHNS Initiative, urge for multi-stakeholder engagement and collaboration to forge lasting change.

#2582 For an efficient CKD healthcare delivery, knock on a door of the orthopaedist!

Abstract Background and Aims CKD patients are usually free from symptoms. Some of them do not wish to visit a physician until the very moment when they suffer from symptoms. Those CKD patients might be found more often in certain medical specialities than others. In order to improve healthcare system efficacy, it is imperative to find the best field we should dig in. Method A hospital-wide survey was performed including all the patient visits according to specialities over 365 days in a general hospital. All the laboratory data including eGFR and haemoglobin were retrieved during the period. In case of multiple laboratory measurements in a single patient, a median value was used for analysis. Prevalence of cases with at least one measurement of eGFR during the period was 5 559/11 582 (48.0%) in medicine, 1 195/2 405 (49.7%) in surgery, 691/3 301 (20.9%) in orthopaedics, and 2 808/12 450 (22.5%) in “other” specialities. Here, “other” specialities are highly heterogeneous, including gynecology, dermatology, ophthalmology, otorhinolaryngology, anesthesiology and urology. Results A total of 29 738 patients were analyzed. The prevalence of eGFR less than 60 mL/min/1.73 m2 was highest in orthopaedics (353/691, 51.1% among patients with eGFR measurement), much more than those in medicine (2,341/5,559, 42.1%), in surgery (364/1 195, 30.5%) or in others (1 052/2 808, 37.4%). The prevalence of eGFR less than 45 mL/min/1.73 m2 was highest again in orthopaedics (133/691, 19.2%), much more than those in medicine (794/5 559, 14.3%), in surgery (80/1,195, 6.7%) or in others (339/2,808, 12.0%). The prevalence of renal anemia, defined as eGFR &amp;lt;60 mL/min/1.73 m2 and haemoglobin &amp;lt;11 g/dL, was highest in orthopaedics (74/691, 10.7%), compared with those in medicine (302/5 559, 5.4%), in surgery (35/1 195, 2.9%) or in others (123/2 808, 4.5%). Conclusion For an efficient CKD healthcare delivery, the exceedingly high prevalence of CKD among patients visiting orthopaedics should not be missed.

Integrating the social determinants of health into graduate medical education training: a scoping review

BackgroundThe social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs.MethodsA systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded.ResultsThe initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum.ConclusionApplying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.

#165 Substantial variation in the evaluation of kidney transplant recipient candidates prior to waitlisting: a worldwide scoping review

Abstract Background and Aims Before patients with end stage kidney disease can undergo kidney transplantation, their suitability is assessed through a transplantation work-up. Several international guidelines have outlined the most important factors in determining patient suitability for kidney transplantation, but there is little agreement among them and it is unclear whether their recommendations have been adopted into clinical practice. Variation in the evaluation of kidney transplant recipient candidates could contribute to inefficiency and inequality in accessing the transplant waiting list and kidney transplantation. Therefore, the standardization of pre-waitlisting practice patterns is desirable and in line with recommendations from Europe [1] and the US [2]. An overview of publications on pre-waitlisting practices for kidney transplantation is needed to increase the transparency of kidney transplant recipient candidacy evaluation and is a first step towards the standardization of pre-waitlisting procedures. To date, such an overview has not been performed. Therefore, our aim was to conduct a scoping review on the evaluation of kidney transplant recipient candidates prior to waitlisting, investigating: (a) the content of the transplantation work-up; (b) contraindications to waitlisting; and (c) the organization of the transplantation work-up. Method A systematic search was conducted in Ovid Medline and Ovid EMBASE in collaboration with a medical information specialist. Studies reporting practice patterns on the evaluation of adults receiving their first kidney graft from a deceased donor were included. Studies were excluded if they only reported: on pediatric patients; from the perspective of the patients; practice patterns following waitlisting; COVID-19-related changes to practice patterns; and results from novelty screening methods used to evaluate kidney transplant recipient candidates without evidence that these methods were also used in clinical practice. Results Results from 40 studies were summarized, of which a majority were conducted in Europe (n = 11) and the US (n = 21). The content of the transplantation work-up varied widely between studied centers. Results show that the presence of a written transplantation work-up was common in the US, UK, and Norway, while in other countries, the presence of a written transplantation work-up protocol was not reported. Common domains within the transplantation work-up included screening for infections, heart disease, peripheral artery disease, and malignancy. A wide range of contraindications to waitlisting were reported. The criteria for contraindications related to obesity and age/frailty varied between studied centers and appear to have changed over time. In general, the organization of the transplantation work-up (e.g. the referral process, the transplant care team, and the use of multidisciplinary meetings) was comparable across studied centers, but differences were observed in the way the transplantation work-up was carried out. Conclusion This is the first review summarizing practice patterns related to the evaluation of kidney transplant recipient candidates prior to waitlisting. Results showed substantial variation in the evaluation of kidney transplant recipient candidates and pre-waitlisting practice patterns globally. These findings contribute to increasing the transparency of pre-waitlisting practice patterns, as was endorse by EU and US recommendations. In turn, this may aid in standardizing criteria used to evaluate kidney transplant recipient candidates prior to waitlisting, which could improve kidney transplantation access and outcomes.

Role of a unified preventive environment with the partici pation of pharmacy organizations in the fight against chronic non-communicable diseases

Relevance. Preserving and strengthening the health of the population is the most important task of the healthcare system, including pharmacy organizations. Therefore, it is important to unite the efforts of medical and pharmaceutical specialists to form a unified preventive environment in the region. This will make it possible to rationally distribute the resources of healthcare organizations in the fight against chronic non-communicable diseases and increase citizens’ satisfaction with accessible preventive care.Methodology. To achieve the goal and solve the assigned problems, content analysis, comparative and logical analysis, and observation and graphic methods were used. The objectives of this study were to obtain regulatory documentation data, the main strategies and recommendations of the World Health Organization in the field of protecting public health, the infrastructure of pharmacy organizations, and consumer opinion.Results. The study highlighted the main aspects of preventive activities, which are the actions of pharmaceutical specialists toward preserving public and individual health. The current state of preventive work of pharmacies in the Yaroslavl region has been studied, and the most common preventive services have been identified. The need for the formation of a unified preventive environment in the region with the participation of pharmacies is substantiated as one of the ways to improve the professional activities of pharmaceutical specialists in the prevention of chronic non-infectious diseases. A model of a unified preventive environment for the regional healthcare system was developed, indicating the general and specialized functions of the organizations. An assessment of the effectiveness of the implementation of preventive services in the activities of pharmacy organizations was conducted.Conclusion. An analysis of the current state of preventive activities of pharmacy chains indicates the potential of a pharmacy organization to implement a wider range of preventive services. Combining the efforts of healthcare professionals through the formation of a unified preventive environment with the participation of pharmacy organizations can provide a significant impetus in the fight against chronic non-communicable diseases.

Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers

ObjectivesHealthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative...