Training Of Medical Staff Research Articles

Examining healthcare access with physical vs. telehealth options: Promise and peril for socially vulnerable older adults

IntroductionThis paper seeks to understand barriers to healthcare access faced by socially vulnerable older adults in Chicago using qualitative analysis. As the U.S. population ages, ease of healthcare access by older adults grows in importance. Yet, current literature lacks an examination of pain points and coping strategies in accessing healthcare, specifically by socially vulnerable older adults. This is especially relevant as virtual telehealth access and transportation options that shape healthcare access evolve rapidly. MethodsIn this work, we conduct three listening sessions with 40 total participants to understand the lived experiences of Black and Latino older adults living in low-income areas of Chicago. Transcript data was analyzed using qualitative concept and emotion coding to identify vulnerabilities that older patients face in accessing care. ResultsThis work highlights five key takeaways from the qualitative analysis: 1) technology struggles and prospects in accessing healthcare, 2) social resources for coping give rise to tension between dependence and autonomy, 3) system disconnects (medical-pharmacy-transportation) represent key pain points, 4) different means of accessing healthcare (traditional transportation vs. telehealth) are value and emotion ladened, 5) different means of observing lead to new methodological insights. ConclusionOvercoming healthcare access barriers for older adults ultimately requires analysis of specific interfaces between infrastructure, healthcare, and communications systems. Solutions should prioritize the autonomy of older adults by offering physical accessibility and customized technology. The three intervention policies recommended in this paper include: health kiosks implementation, digital access classes, and specialized training for transit drivers and medical staff.

Sociological research methods with a differentiated approachin regional nursing

Background.In the professional audit of the quality of nursing care, sociological research methods are of particular importance in the context of the formation of skills and abilities, with the help of which a set of expert criteria is formed from the general set of practical activities. Taking into account that the selection of qualified elements requires information about the scientific approach, in proportion to the originality of the expert function, it is relevant to identify them more clearly in the examination, which allows correcting the process of training and retraining of personnel. Objective.Toevaluate the sociological research methods of regional nursing on the example of the Orenburg region. Materials and methods.The main criteria for evaluating the activities of medical workers using the Delphi method are presented. The examination performed by the method of sociological and expert survey of average medical workers (n=535), doctors (n=80), heads of medical institutions (n=10) and patients (n=500) allowed us to formulate formalized indicators for evaluating measures to create innovative training and retraining programs for nursing staff. Mathematical "sketches" of the programs are based on factorial/cluster/discriminant analyses. Results. Sociological research methods in regional nursing have sanctioned a set of parameters of the qualities of a specialist in his professional activity in the context of training and retraining of nursing staff. Conclusion. Mathematical prototypes of programmatic training of medical staff created on the basis of sociological research methods in regional nursing contribute to the algorithmization of improvements in the format of the content and quality of training in order to provide competent and competitive specialists for the industry.

Exploring the barriers to the development of organizational health literacy in health institutions to meet the needs of older patients from multiple perspectives: a mixed-methods study

BackgroundThe latest evidence on health literacy in China revealed that only 8% of individuals aged 65–69 years, a segment of the geriatric population, possess adequate health literacy levels, indicating a low level in China. Studies have demonstrated that improving the organizational health literacy of healthcare institutions is a crucial approach to addressing low health literacy among older patients.ObjectiveTo explore the obstacles hindering the advancement of organizational health literacy in healthcare institutions in meeting the needs of older patients.DesignA mixed-methods approach was employed to investigate both the status and barriers to the establishment of organizational health literacy within two healthcare institutions.ParticipantsParticipants included older individuals aged over 60, clinical staff, and managerial personnel from these two health institutions.MethodsThis research utilized the social-ecological model as its theoretical foundation and utilized a mixed-methods approach to examine the current status and challenges in developing organizational health literacy within healthcare institutions. Initially, a survey using a questionnaire (n = 178) was conducted among older patients to evaluate the establishment of organizational health literacy from their perspective. Following this, interviews (n = 22) were carried out with administrators, clinical personnel, and elderly patients to identify the barriers hindering the development of organizational health literacy within healthcare institutions.ResultsQuantitative research indicates that health institutions have been less accommodating to the requirements of older patients, with health information dissemination and communication emerging as the weakest areas. Qualitative investigations revealed three key influencing factors: patient-related factors, including physiological and cognitive decline, as well as low educational attainment among older patients; organizational factors, including inadequate clinical staff numbers, deficient long-term systematic training, and a digital divide resulting from health institutions’ digital advancements; and policy-related factors indicating a lack of regulations governing the establishment of organizational health literacy within healthcare institutions.ConclusionThe two most vulnerable aspects of OHL in medical institutions regarding the needs of older patients are health information and communication. The factors influencing the construction of OHL in medical institutions are multifaceted, encompassing micro, meso, and macro levels. At the macro level, it is essential for medical institutions to enhance leadership awareness of OHL and to incorporate its development into institutional strategic plans. At the meso-level, medical institutions should be made to optimize the medical environment for elderly patients and to prioritize health literacy training for medical staff. At the micro level, attention must be given to the characteristics and needs of elderly patients. Ultimately, by implementing a comprehensive construction of intervention strategies, the response ability of medical institutions to the needs of elderly patients can be enhanced.

‫‬‬‬‬‬The Role Of Modern Techniques Of Management Accounting and Cost Accounting in Improving Cost Efficiency and Quality Of Care in Urology: a Theoretical Study

Economic and demographic developments in the past few decades have increased the pressure on efficiency in the healthcare industry. Modern management accounting and cost accounting techniques are a critical component in improving the efficiency and quality of care in urology. With the ever-increasing costs of healthcare, the need for a sophisticated accounting system that can provide accurate data on costs and revenues is more important than ever. The aim of this research was to investigate the role of modern techniques in management accounting and cost accounting as a means of enhancing cost efficiency and quality of care in urology. The research highlights the importance of training medical staff in these techniques, as this can improve overall performance and reduce costs without compromising the quality of care provided to patients. These techniques have been shown to help physicians and administrators make informed decisions, which helps improve the efficiency and quality of care. They also contribute to improving communication between medical teams, enabling better patient care. By focusing on improving resource and cost management, these techniques can play a pivotal role in achieving superior and effective health outcomes.

Development, implementation, and evaluation of a 3D‐printed high‐fidelity pediatric mannequin with expected hard‐to‐intubate airway

AbstractClinical simulation is fundamental for the healthcare staff to learn and enhance their procedural skills without causing harm to the patients. Despite its importance, in literature appears a deficiency of pediatric pathological mannequins, especially those simulating difficult airway management due to the obstruction of the passage of tubes, fiberscopes, or catheters. Given the importance of simulating complex scenarios in the medical staff's training, the authors decided to realize a modular high‐fidelity pathological mannequin with nasal access using reverse engineering and additive manufacturing techniques within T3Ddy, a joint laboratory between Meyer Children's Hospital of Florence and the Department of Industrial Engineering of the University of Florence. The mannequin is developed from diagnostic images of a significant 30‐month‐old polymalformative patient also affected by Pierre‐Robin syndrome modifying the tracheobronchial tree to reproduce an abnormal status. Rigid parts and silicone cast molds are manufactured using 3D‐printed ABS/ASA while platinum‐cure‐silicones are used for the soft ones. Meyer's anesthesiologists collaborated to the realization providing feedback during design and production. The device is evaluated with a 5‐point Likert scale questionnaire and results in a useful tool for the training of procedural skills related to difficult intubation as its realism, anatomical geometry, and tactic feedback are positively evaluated.

Communication barriers to optimal access to emergency rooms according to deaf and hard-of-hearing patients and health care workers: A mixed-methods study.

This study aimed to identify communication barriers between health care workers (HCWs) and deaf and hard-of-hearing (DHH) patients. Both perspectives are offered to provide a comprehensive understanding. Two consecutive studies were conducted from 2018 to 2021. Study 1 comprised mixed methods, employing a cross-sectional survey (n = 288) and in-depth interviews (n = 9) with DHH participants, utilizing accessible tools including sign language. Study 2 involved a cross-sectional survey of health care emergency workers without hearing loss (N = 391). The perceived self-efficacy of DHH patients, and not their hearing loss, was linked with their ability to communicate independently with HCWs. No significant differences in successful communication with these providers were found vis-à-vis mode of communication utilized (sign language, writing, interpreter, etc.). In the qualitative findings, DHH patients noted two urgent care barriers: HCWs' communication unfamiliarity and patients' communication accessibility issues. Quantitative findings indicated a main barrier: difficulties in communicating with HCWs in general (57%) and specifically in the emergency room (ER; 65%). Only 28.8% reported being able to independently communicate with ER staff. Health care providers were not familiar with effective communication strategies when treating these patients. Respondents indicating that communication was not a barrier to care were mainly administrative staff (54.55%), compared to nurses (32.74%) and physicians (22.58%). Communication solutions are needed to improve access to health services, especially in emergencies. Providing medical staff training on effective communication strategies with these patients could simplify interactions and reduce the reliance on hearing family members, potentially improving medical care. Implementing a communication policy for frontline staff, along with the use of visual aids, is crucial. Health care professionals may not realize that small changes can greatly improve communication with DHH patients.

The Role of Faith in Medical Decision-Making

Abstract Background Ultra-Orthodox Israeli Jews face complex decisions when their doctors’ instructions contradict their rabbis’ advice. This study examines how their belief system affects their trust and decision-making in such situations, using socio-economic club theory and Gilligan’s listening guide. Methods Excerpts from 16 focus groups with 128 ultra-Orthodox Jews were analyzed to understand their perspectives on the relationship between doctors and rabbis. The socio-economic approach of Berman’s club theory was applied to explain their behavior, and Gilligan’s listening guide was used to analyze the focus group results. Results The strict behaviors in the relationships between doctors, rabbis, and patients function as social capital, raising the status of ultra-Orthodox Jews as members of an exclusive club. They balance critical health decisions with the social demand to obey religious leaders. However, listening to different voices (‘I,’ ‘we,’ and ‘they’) provides nuanced insights into their decisions, revealing dynamic changes in the community’s perceptions of the doctor-rabbi relationship and varying perspectives within the heterogeneous ultra-Orthodox community. Conclusions Combining Berman’s theory with Gilligan’s listening guide is an effective method for conducting in-depth qualitative research on sensitive issues with religiously strict groups. Understanding the belief systems underlying healthcare decisions is essential for providing culturally sensitive medical care to religious communities and training medical staff serving these communities. Key messages • Ultra-Orthodox Jews balance complex health decisions with social demands, revealing nuanced perspectives through strict doctor-rabbi relationships. • Combining theories and qualitative methods effectively studies sensitive issues in religious groups, informing culturally sensitive healthcare.

The use of psychophysical acting practices for training medical staff

New trends in the industry group of education for actual business models require careful attention and in-depth study of the modular generation of eff ectively working medical staff in order to improve the quality of services provided in the sector. One of the newest solutions is the use of a method of training personnel based on psychophysical theatrical practices to increase their stress tolerance and increase the volume of information consumption with its subsequent processing. The ultimate goal is always to achieve the result of the dialogue, both within the professional environment and in the external contour of the company's events. The fi gure of a human personality is of great importance in the methodology of training specialists. In order to increase the eff ectiveness of patient counseling, an author's approach based on psychophysical acting techniques is used to train doctors, which allows, taking into account a personalized approach, to implement the principle of patient involvement.

FP6.7 - Assessing knowledge and effective utilisation of incentive spirometer across surgical floor

Abstract Aim to assess the level of knowledge of healthcare workers providing incentive spirometer and instruction provided to patient. Methods Snapshot audit between 25&28/05/23 assessing the knowledge and practice using two for patient and staff questionnaires. Inclusions criteria were all adult patients in surgical wards, all healthcare staff. Exclusion criteria were patients who did not receive a spirometer and patients or staff who were not willing to participate in the study. Results 75% of staff provided incentive spirometers, 84% of them never received formal education or training in the use of incentive spirometer. Only one staff member (1.85%) answered all the questions correctly. 83% of patients were not given the correct instructions and approximately 16% were instructed to exhale. Implemented Changes A video created with e-link; explaining the use of incentive spirometer. Training of medical and nursing staff by presenting the project in our local departmental meeting, the results and poster emailed to health professionals. A new patient leaflet was created containing clear instructions, the video link, and a table to record their usage. Random sampling showed significant improvement. The Second cycle will be conducted at beginning of the new year and the results will be presented at the conference Conclusion The lack of training led to incorrect instructions being given to patients. This could lead to false reassurance to the senior medical staff, by assuming that patients are using spirometers correctly which could delay recovery and discharge. Simple training has resulted in significant increase in knowledge and correct use of a spirometer. Checking the staff knowledge is recommended, especially in common daily practice

SFBC Working Group on sources of errors in laboratory medicine: objectives and key areas of work

Laboratory medicine plays a crucial role in patient care, contributing to approximately 70% of clinical decisions. In collaboration with clinicians, laboratory medicine specialists perform analyses that are useful for diagnosis, screening and prevention. Laboratories are known for their efficiency, which is reached through a rigorous quality system. However, errors can occur, especially given the complexity of the total testing process. These errors may lead to severe consequences, such as incorrect diagnoses or delays in treatment. Errors can occur at every stage of the total testing process, those related to the pre-analytical phase being the most prevalent. To reduce medical errors related to laboratory processes, it is essential to provide training for medical and paramedical staff, optimize production automation, and leverage technological advancements. These considerations have led to the creation of a French Working Group on Sources of Errors in Laboratory Medicine, under the aegis of the French lean society of clinical chemistry and laboratory medicine (Société Française de Biologie Clinique - SFBC). The objectives of this working group are to produce an educational handbook on sources of errors in laboratory medicine, provide training for clinical chemists, and conducting applied research projects to better understand the mechanisms behind specific errors. Ultimately, the aim is to minimize errors and enhance the quality of laboratory tests.

Prehospital treatment of severely burned patients: a retrospective analysis of patients admitted to the Berlin burn centre

BackgroundPrehospital management of severely burned patients is extremely challenging. It should include adequate analgesia, decision-making on the necessity of prehospital endotracheal intubation and the administration of crystalloid fluids. Guidelines recommend immediate transport to specialised burn centres when certain criteria are met. To date, there is still insufficient knowledge on the characteristics of prehospital emergency treatment. We sought to investigate the current practice and its potential effects on patient outcome.MethodsWe conducted a single centre, retrospective cohort analysis of severely burned patients (total burned surface area > 20%), admitted to the Berlin burn centre between 2014 and 2019. The relevant data was extracted from Emergency Medical Service reports and digital patient charts for exploratory data analysis. Primary outcome was 28-day-mortality.ResultsNinety patients (male/female 60/30, with a median age of 52 years [interquartile range, IQR 37–63], median total burned surface area 36% [IQR 25–51] and median body mass index 26.56 kg/m2 [IQR 22.86–30.86] were included. The median time from trauma to ED arrival was 1 h 45 min; within this time, on average 1961 ml of crystalloid fluid (0.48 ml/kg/%TBSA, IQR 0.32–0.86) was administered. Most patients received opioid-based analgesia. Times from trauma to ED arrival were longer for patients who were intubated. Neither excessive fluid treatment (> 1000 ml/h) nor transport times > 2 h was associated with higher mortality. A total of 31 patients (34,4%) died within the hospital stay. Multivariate regression analysis revealed that non-survival was linked to age > 65 years (odds ratio (OR) 3.5, 95% CI: 1.27–9.66), inhalation injury (OR 3.57, 95% CI: 1.36–9.36), burned surface area > 60% (OR 5.14, 95% CI 1.57–16.84) and prehospital intubation (5.38, 95% CI: 1.92–15.92).ConclusionWe showed that severely burned patients frequently received excessive fluid administration prehospitally and that this was not associated with more hemodynamic stability or outcome. In our cohort, patients were frequently intubated prehospitally, which was associated with increased mortality rates. Further research and emergency medical staff training should focus on adequate fluid application and cautious decision-making on the risks and benefits of prehospital intubation.Trial registrationGerman Clinical Trial Registry (ID: DRKS00033516).

Assessment of epidemic risk state and its change trend of public hospital in underdeveloped area in different stages.

Epidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics. Based on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved. The stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are , , and , respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness. This paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.

Pulling Back the Curtain: A Cross-Sectional Analysis of Medical Spas in Missouri.

There is very little legislation defining the degree of supervision and training required to perform cosmetic procedures in Missouri. The medical spa industry, particularly the volume and complexity of cosmetic procedures offered by medical spas, has seen significant growth in recent years. To better understand the medical spa workforce, depth, and breadth of aesthetic procedures offered by medical spas in Missouri. Cross-sectional study based on standardized telephone interviews, supplemented by website data. Survey responses were recorded, streamlined, and analyzed. Although 94.59% of medical spas in Missouri are affiliated with a physician, only 22.52% of medical spas have a physician on-site for administration of cosmetic treatments. Nonphysician staff members who administer cosmetic services generally outnumber physician affiliates at Missouri medical spas, with the average ratio of nonphysician staff who administer cosmetic services to MD/DO affiliates per spa being 2.1:1. There is significant variability in the level of training and supervision of medical spa staff performing cosmetic treatments in Missouri. As the medical spa industry continues to grow and high-risk cosmetic procedures become more commonplace, consistent statewide regulation of medical spas is needed to prevent harmful patient outcomes.

THE RESULTS OF A SOCIOLOGICAL SURVEY AMONG PATIENTS WHO RECEIVED NURSING CARE IN MEDICAL ORGANIZATIONS PROVIDING PALLIATIVE CARE

Nursing care in organizations providing palliative care plays a critical role in ensuring the comfort and quality of life of patients with severe or incurable diseases. This assistance includes physical care, pain control, emotional support and assistance to families. Nurses can also train families in patient care, assist in decision-making, and coordinate medical procedures. It is important that nurses in palliative care organizations are sensitive, empathetic and have appropriate medical training.The authors of the article conducted a sociological survey among nurses and patients receiving palliative care of medical organizations Republic of Kazakhstan. Аt the moment, the results of such a survey help to identify the root of the organization of nursing care in medical organizations in the healthcare sector. Objective: To study the level of accessibility of medical care among nurses and patients in the palliative care department. Materials and methods: This study is a one-stage sociological research by the survey method with the filling out of questionnaires and the method of in-depth interviewing. The questionnaire is taken as a basis as a research tool. The questionnaires are developed separately for each group of respondents and are presented in Kazakh and Russian. The study involved patients aged 60 and older who received palliative care among medical organizations providing care to senile and elderly people. The design of the study is a one-step cross-sectional study. The number of respondents is 120 nurses, 100 patients (81% of them women, 19% male). Statistical Analysis – Stata: Release 15. Categorical variables were calculated as fractions (%) and quantitative continuous variables as averages. The student’s t-test and univariate variance analysis were used. A p value of less than 0.05 was considered important. Research methods: Social, statistical. The choice of statistical criteriawill depend on the type of variables being analyzed. The Student's t-test and univariate variance analysis were used. A p value of less than 0.05 was considered important. The result of the study: The questionnaires were adapted to fill out patients receiving palliative care in medical organizations. The survey questionnaire provided information about the place of work, position, length of service, professional development, working conditions and the quality of palliative care in this aspect, as well as the life plans of respondents. The closed form of questions in the questionnaire contains the principle of alternative answers encoded for subsequent processing. For some questions, it was allowed to give up to three possible answers. The open form of answers to a number of questions allowed us to obtain more detailed information on the aspects of the respondents' professional activities of interest, as well as their working conditions. Conclusion:The study showed that the majority of nurses and patients receiving palliative care highly appreciate the level of accessibility and quality of medical care in medical organisations in the Republic of Kazakhstan. However, despite the high level of satisfaction, some problems were identified, such as obtaining prescriptions for narcotic drugs and insufficient awareness of available medical products and patients' rights. These results emphasise the need for further improvements in the quality of palliative care and training of medical staff to provide better patient care.

Analysis of Community Health Center Performance on Tuberculosis Control Programs

Purpose of the study: To explore and analyze the implementation of the Tuberculosis control program using the DOTS strategy at the Satelit Community Health Center. This research aims to identify factors that support and hinder the implementation of the program, evaluate the effectiveness of approaches that integrate Islamic values ​​in health education. Methodology: This research uses a qualitative method with a case study design. The population in this study were all individuals involved in the TB control program at the Satellite Health Center. The data collection technique in this research uses in-depth interviews with guided questions that have been prepared in advance. Data obtained from interviews were then analyzed using thematic analysis method. Main Findings: This research shows that the implementation of the Tuberculosis control program at the Satelit Community Health Center has gone well even though it still faces various challenges. The success of the program is greatly influenced by political commitment, the performance of the Medication Monitor (PMO), as well as adequate facilities and training support. The integration of Islamic values in health education has proven effective in increasing patient compliance and community participation. Novelty/Originality of this study: The novelty of this research lies in the holistic approach in evaluating the performance of community health centers in managing TB, which includes the use of information technology to improve data recording and reporting, intensive training for medical staff in TB case management, as well as improving the infrastructure of community health centers to support more efficient services.

Expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients (2024 edition)

As one of a major public health issue in China, the number of new cases and deaths of malignant tumors has been climbing year by year. Implantable venous access port (IVAP) is used as a safe infusion route in the treatment of malignant tumor patients such as infusion of antitumor drugs and intravenous nutrition. With the widespread application of ultrasound-guided Sedinger puncture techniques and intracardiac electrocardiogram positioning technology, IVAP in the upper arm has been recognized by the majority of medical personnel and cancer patients due to its advantages of hiding scars and completely avoiding the risk of hemothorax and pneumothorax. In order to standardize the clinical application of IVAP via the upper arm approach in cancer patients, improve the success rate of implantation, reduce complications and improve patient satisfaction, the Breast Cancer Expert Committee of the National Cancer Quality Control Center consulted guidelines and the latest evidence-based evidences and established the expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients through literature research and expert discussions, in order to provide reference for the standard application of IVAP in the upper arm. The consensus mainly introduces the indications, contraindications, preoperative evaluation, implantation site, operation procedure, utilization and maintenance, complications and management, medical staff training and patient education of IVAP in the upper arm, in order to provide reference for clinical staff.

Rescue Missions with Patients with Psychiatric and Psychosocial Symptoms: An Analysis from Eastern Lower Saxony

Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis. Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020. 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies. Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff.

Fitwalking: A New Frontier for Kidney Patients – A Center’s Experience

Introduction: Physical inactivity is common in patients with chronic kidney disease (CKD) and is an important modifiable risk factor for mortality, morbidity, and reduced quality of life. The present single-centre pilot study evaluated the possibility of performing structured physical exercise using a specific walking model, Fitwalking, in a population of patients with CKD and, according to the American College of Rheumatology guidelines, also in a population with immuno-rheumatological disease. Methods: Patients were recruited from nephrology, haemodialysis, peritoneal dialysis, transplantation, and immuno-rheumatology outpatient clinics. After general and functional clinical evaluation and exercise prescription at the Department of Sports Medicine, we performed scientifically proven tests on CKD (6-min walk test and sit-to-stand test), before and after the Fitwalking technique training course, and again after 6 and 12 months, evaluated its effectiveness and identify any critical issues. Results: We enrolled 80 patients (41 males, 51.2%), with a mean age of 53 ± 12 years; the clinical data showed statistically significant improvements in systolic, average, and differential blood pressure, average speed, and physical strength. Participants also adapted to muscle fatigue, experienced a reduction in BMI with stable lean mass and reduced fat mass, and reported improved perceptions of physical and mental health, and quality of life. Conclusion: All enrolled patients successfully completed the process. A specific prescription was used that provided health education and allowed for the implementation of structured physical activity that could be performed safely and independently even after the training period. The activity was sustainable thanks to the training of in-house medical and nursing staff, demonstrating that it is possible to overcome this type of barrier to physical activity in CKD and in immuno-rheumatological patients.

Incorporating a Public Transit Equity Lens in Evacuation Planning

Disasters caused by extreme weather and human-initiated events continue to disproportionately affect vulnerable and underserved communities. Although these communities often rely on public transit to travel, most North American jurisdictions still lack a fundamental understanding of equity-centered needs or evacuation plans that incorporate public transit use. Consequently, this study conducted a community-centered methodology with eight focus groups in February 2023 among historically underrepresented groups in evacuation planning. Comprising 52 participants in Edmonton, Alberta, the groups included carless residents, people with disabilities, older adults, lower-income households, racial and ethnic minorities, recent immigrants, parents/guardians of young children, and women. Thematic analysis of the focus group data was performed using MAXQDA. Participants identified challenges and concerns related to public transit costs, possible overcrowding, and inadequate assistance services for people with disabilities and the medically fragile during evacuations. The focus groups largely looked to emergency management offices and transportation agencies to ensure public transit reliability, affordability, and accessibility. Surprising references were also made to public transit as a potential tool for building community cohesion and reducing sentiments of anxiety during disasters. Finally, we found that each group had specific insights based on their vulnerability. For example, whereas lower-income households prioritized increased frequency of transit services during emergencies, older adults called for trained medical staff and accessibility features. We offer several policy recommendations to enhance both resilient and equitable evacuation planning.

Bioethical challenges in postwar development aid: The Rwandan case study.

This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11-year-old Seraphine treated due to the consequences of right tibia osteomyelitis and 11-year-old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises.