Multidisciplinary Organization Research Articles

A Model for Understanding Lived Expertise to Support Effective Recruitment of Peer Roles.

Peer roles have increased within mental health and alcohol and other drug services. However, there is a lack of understanding about the 'lived experience' necessary for success in these roles and how to recruit effectively. This study explores participants' views on the essential knowledge and skills derived from lived experience to inform the design of peer roles and support effective recruitment. This qualitative study involved 132 participants employed across five multi-disciplinary organizations in the United States. Participants represent three cohorts: designated peer workers, management, and colleagues in other roles. Fourteen focus groups and eight individual interviews were conducted, with separate focus groups for peers, colleagues in non-designated roles, and management. Findings indicate essential aspects of lived experience comprise three domains: life-changing or life-shaping individual experiences (including intersectionality); common impacts of adverse experiences, identification as a peer, and understanding and application of the collective peer thinking and values; and ultimately, Lived Expertise, a unique, experientially developed knowledge base and set of skills that can benefit others. The study identifies Lived Expertise as a unique combination of individual and collectively derived experiential knowledge. Understanding what comprises Lived Expertise can guide the design of roles and improve recruitment strategies, thereby enhancing the effectiveness of roles and support for the peer workforce. This study offers a model for understanding Lived Expertise that can be readily applied in developing recruitment materials, including position descriptions.

Textured insoles may improve some gross motor balance measures but not endurance measures in children with motor coordination issues. A randomised controlled feasibility trial.

Motor coordination concerns are estimated to affect 5%-6% of school-aged children. Motor coordination concerns have variable impact on children's lives, with gait and balance often affected. Textured insoles have demonstrated positive impact on balance and gait in adults with motor coordination disorders related to disease or the ageing process. The efficacy of textured insoles in children is unknown. Our primary aim was to identify the feasibility of conducting a randomised controlled trial involving children with motor control issues. The secondary aim was to identify the limited efficacy of textured insoles on gross motor assessment balance domains and endurance in children with movement difficulties. An assessor-blinded, randomised feasibility study. We advertised for children between the ages of 5-12years, with an existing diagnosis or developmental coordination disorder or gross motor skill levels assessed as 15th percentile or below on a norm-referenced, reliable and validated scale across two cities within Australia. We randomly allocated children to shoes only or shoes and textured insoles. We collected data across six feasibility domains; demand (recruitment), acceptability (via interview) implementation (adherence), practicality (via interview and adverse events), adaptation (via interview) and limited efficacy testing (6-min walk test and balance domain of Movement ABC-2 at baseline and 4weeks). There were 15 children randomised into two groups (eight received shoes alone, seven received shoes and textured insoles). We experienced moderate demand, with 46 potential participants. The insoles were acceptable, however, some parents reported footwear fixture issues requiring modification. The 6-min walk test was described as problematic for children, despite all but one child completing. Social factors impacted adherence and footwear wear time in both groups. Families reported appointment locations and parking impacting practicality. Underpowered, non-significant small to moderate effect sizes were observed for different outcome measures. Improvement in balance measures favoured the shoe and insole group, while gait velocity increase favoured the shoe only group. Our research indicates that this trial design is feasible with modifications such as recruiting with a larger multi-disciplinary organisation, providing velcro shoe fixtures and using a shorter timed walk test. Furthermore, progressing to a larger well-powered randomised control trial is justified considering our preliminary, albeit underpowered, efficacy findings. This trial was retrospectively registered with the Australian and New Zealand Clinical Trial Registration: ACTRN12624000160538.

Analyzing the dynamics of activities of medical organizations repurposed to provide medical care for patients with COVID-19

Objective: to analyze the dynamics of the activities of medical organizations repurposed to provide medical care to patients with COVID-19. Material and methods. In two repurposed multidisciplinary medical organizations in Saratov, a multi-criteria assessment (according to 31 indicators) of the dynamics of their activities was carried out (retrospectively by doctors — 26 and 22 people who participated in providing medical care to patients with COVID-19). Three stages were evaluated: 1) the beginning of admission of patients in April — May 2020; 2) December of 2020; 3) December of 2021. Results. The activities of both repurposed medical organizations throughout the study received an average integral rating of "good". At the same time, its positive statistically significant dynamics between the first and second stages (from 3.9±0.1 to 4.5±0.1 points) was revealed, accompanied by a significant increase in the number of excellent grades given by respondents and indications of a high level of gradation of informative criteria. Informative criteria have been identified, the low and medium levels of which need to be corrected. Conclusion. The expediency of repurposing multidisciplinary medical organizations to provide medical care to patients with COVID-19 has been confirmed.

Making a Statement: Positions of Professional Medical Organizations Towards Gender-Affirming Care.

Despite politically charged media coverage and legislation surrounding gender affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC. A list of U.S. medical professional organizations with likely involvement in GAC based on medical or surgical specialties was compiled. For included organizations, we evaluated the availability, content, and publication year of positions on GAC through October 2023. When available, formal positions were categorized as supportive or unsupportive. A total of 314 professional medical organizations were screened for our study based on specialty, relevance to GAC, and issuance of patient guidelines or position statements. Inclusion criteria were met by 55 organizations. Most organizations (35, 63.6%) had formal position statements on GAC. Support for GAC was described in 97.1% (n=34). Further, 94.2% (n=33) of available statements explicitly addressed GAC in individuals less than 18 years old and were largely supportive (96.9%, n=32). This cross-sectional analysis demonstrates that a majority of multidisciplinary professional medical organizations with relevance to GAC have issued formal position statements on the topic. Available positions were overwhelmingly supportive of individualized access to gender-affirming therapies in adult and adolescent populations. However, silence from some organizations continues to represent a modifiable disparity in the provision of GAC.

АНАЛИЗ ОБЪЕМОВ СТОМАТОЛОГИЧЕСКОЙ ОРТОПЕДИЧЕСКОЙ ПОМОЩИ ПАЦИЕНТАМ В СИСТЕМЕ ПЛАТНЫХ МЕДИЦИНСКИХ УСЛУГ

The article is devoted to the analysis of the volume of dental orthopedic care for patients in the system of paid medical services in a multidisciplinary medical organization. Various epidemiological surveys conducted abroad and in our country have revealed an unsatisfactory condition of the organs and tissues of the mouth in the majority of the Russian population. Among dental pathology, tooth loss with subsequent functional disorders occupies a significant place [2–4]. One of the important indicators of dental health of the adult population, characterizing the level of dental care, is to ensure the need for prosthetics. According to WHO, the main causes of missing teeth are periodontitis and caries. Periodontitis is noted in 75–80% of the population, of which 90% are elderly and senile people. According to A. K. Kuryanov and L. N. Babenko (1988), 75% of 1,000 examined at the age of 60 needed dental prosthetics, and complete loss of teeth in the jaw was detected in 225 cases [1]. An analysis of the volume of dental orthopedic care for patients in the provision of paid medical services in orthopedic dentistry showed that for 5 years, among all manufactured orthopedic structures, removable plate prostheses with partial absence of teeth accounted for the largest volume, single crowns in second place, removable plate prostheses in the third place with complete absence of teeth. For each type of orthopedic structures manufactured, there is a growth trend from 2018 to 2022. There was a slight decrease in the volume of orthopedic dental care in 2020, due to the unfavorable epidemiological situation in the country at that time.

Experience in voluntary certification of quality and safety of medical activities of a multidisciplinary medical organization

The article presents the experience of obtaining a certificate of quality and safety of medical activities. The stages of implementation of this project and the basic requirements for documentation are presented. The author also provides recommendations on the implementation of the project for the heads of medical organizations.

Optimizing the management of heart failure: structuring the care pathway

The incidence of chronic heart failure continues to rise in Western countries, justifying the implementation of an optimized multidisciplinary organization based on medical and nursing convergence. Around the main heart failure, assistance and transplantation unit at Toulouse University Hospital, several structures have been put in place to better manage heart failure patients and improve their care pathway.

Adolescents with Rett syndrome at critical care pathway junctures: Examining clinicians’ decision to initiate invasive long-term ventilation

BackgroundThe initiation of invasive long-term ventilation (I-LTV) for an adolescent with Rett Syndrome (RTT) involves many serious bioethical considerations. In moving towards a more inclusive model of patient participation, transparency surrounding the main influencing factors around this decision is important. ObjectiveWe aimed to identify the main drivers influencing a clinician's decision to support initiation of I-LTV for an adolescent with RTT. MethodWe used an anonymous online vignette-based factorial survey. The survey was distributed internationally through eight professional multi-disciplinary organisations to reach clinicians working in paediatrics. ResultsWe analysed 504 RTT vignettes completed by 246 clinicians using mixed effect regression modelling. The main three significant influencing factors identified were: parental agreement with the decision to support initiation, the family's support network, and proximity to a tertiary care centre. Additional comments from participants focused on family support, and the importance of on-going communication with the family. ConclusionAs the rights of those with disabilities improve and participation of adolescents in decision-making becomes more established, effective communications with the family around goals of care and particular sensitivity and reflective practice around methods of consensus building will likely contribute to a positive decision-making process at this difficult time.

Equity, diversity, and inclusion in the Multinational Association for Supportive Care in Cancer: a global membership survey.

Equity, diversity, and inclusion (EDI) are essential for healthcare organizations since they allow for the development of programs and initiatives that bring together diverse perspectives and knowledge. Global multidisciplinary organizations, such as the Multinational Association for Supportive Care in Cancer (MASCC), need to understand the perspective of their members regarding EDI to identify opportunities to enhance diversity and inclusiveness and to better meet the needs of members from different backgrounds and resources. The MASCC Health Disparities Committee designed a survey to identify issues related to disparities faced by MASCC members when providing supportive care to patients with cancer and to examine the EDI landscape within the organization. Here, we report results related to EDI initiatives within the organization. Two-hundred and eighteen MASCC members responded to the survey (response rate 10.2%). The results indicated that respondents were generally satisfied with how MASCC manages leadership, membership, and organization-related EDI issues. Opportunities for improvement noted by respondents included developing strategies to foster a more diverse membership, improving communication regarding diversity in the organization, and increasing EDI content in educational sessions and publications. The results of this survey represent the first attempt at understanding how to improve EDI within MASCC and will be utilized to guide further initiatives and programs.

Microbiological monitoring of a multidisciplinary medical organization: the basis of strategic planning in the framework of the implementation of epidemiological safety

Relevance. Monitoring of antibiotic resistance and the frequency of isolation of microorganisms at the regional level in each medical organization is of paramount importance for the implementation of epidemiological safety. Objective. To identify the main microbiological trends based on the analysis of the microflora of patients in a single — profile hospital in order to implement weaknesses in strategic planning activities. Materials and methods. A comprehensive analysis of the pharmacoepidemiological results of the consumption of antimicrobial drugs with calculated drug resistance indices and microbiological monitoring data demonstrated the presence of weaknesses and strengths for the strategic development of a multidisciplinary hospital at the regional level in terms of epidemiological safety. Results . Statistically significant differences in the microbiological structure of pathogens are predetermined by the profile of medical care. The main trends in the change in the microflora of a multidisciplinary hospital as a whole are the prevalence of fungal and gram-negative pathogens over gram-positive ones. The presence of a relatively high index of consumpion of cephalosporins of 3–4 generations, fluoroquinolones, carbapenems, protected penicillins determines the high drug resistance index of Klebsiella pneumoniae (0.86) and characterizes the main microbiological trends of a multidisciplinary clinic. Conclusion. Risk stratification by the level of multidrug-resistant pathogens, the use of deterrent strategies for prescribing antimicrobials, the implementation of educational modules, the evaluation of the effectiveness and monitoring of the risk stratification program with in the framework of antimicrobial technologies, the analysis of microbial landscape data using decision support programs are the main tasks of the functioning of a multidisciplinary team of specialists in a multidisciplinary clinic to control antibiotic resistance.

The co-production process of an assessment programme: Between clarifying identity and developing the quality of French-speaking Belgian community health centres

BackgroundThe assessment of primary care organizations is considered to be essential for improving care. However, the assessments’ acceptability to professionals poses a challenge. Developing assessment programmes in collaboration with the end-users is a strategy that is widely encouraged to make interventions better targeted. By doing so, it can help to prevent resistance and encourage adherence to the assessment. This process, however, is rarely reported. This paper aims to fill this gap by describing the process of the co-production of an assessment programme for community health centres (CHCs) affiliated to the Federation of Community Health Centres (FCHC) in French-speaking Belgium.MethodsWe conducted a documentary study on the co-production of the assessment programme before carrying out semi-structured interviews with the stakeholders involved in its development.ResultsCHCs in French-speaking Belgium are increasing in number and are becoming more diverse. For the FCHC, this growth and diversification pose challenges for the meaning of CHC (an identity challenge) and what beneficiaries can expect in terms of the quality of organizations declaring themselves CHC (a quality challenge). Faced with this double challenge, the FCHC decided to develop an assessment programme, initially called Label, using participatory action research. During the co-production process, this initial programme version was abandoned in favour of a new name “DEQuaP”. This new name embodies new objectives and new design regarding the assessment programme. When studying the co-production process, we attributed these changes to two controversies. The first concerns how much and which type of variety is desired among CHCs part of the FCHC. The second concerns the organization of the FCHC in its capacity as a federation. It shed light on tensions between two professional segments that, in this paper, we called “political professionalism” and “pragmatic professionalism”.ConclusionsThese controversies show the importance of underlying challenges behind the development of an assessment programme for CHCs. This provided information about the evolution of the identity of multidisciplinary organizations in primary care. Issues raised in the development of this assessment programme also show the importance of considering assessment methods that reflect and embody the current realities of these organizations and the way of developing these assessment methods.

The International Working Group on the Diabetic Foot: Stories and Numbers Behind Three Decades of Evidence-Based Guidelines for the Management of Diabetes-Related Foot Disease.

Foot disease is a devastating complication of diabetes. For almost 3 decades, the mission of the International Working Group on the Diabetic Foot (IWGDF) is to produce evidence-based guidelines to inform health care providers worldwide on strategies for the prevention and management of diabetes-related foot disease. In this publication, we aim to better inform the reader about 'the story behind' the IWGDF Guidelines and thus facilitate improved uptake of the recommendations described in the guidelines. The first IWGDF Guidelines were published in 1999, and these have been successfully updated every 4 years since. With each update, IWGDF has improved the methodological rigour and extended the topics covered. This has been possible thanks to the involvement of > 100 experts from > 60 countries, all voluntarily dedicating their time. We estimate that the 2023 update of the IWGDF Guidelines required a total 10years of full-time work, which would have cost 2 million euros if the voluntary work had been financially compensated. The IWGDF Guidelines are not only published in English but also translated to support local implementation. Currently available translations serve 2.9 billion people globally in their native language. As an independent and multidisciplinary organisation, IWGDF hopes that the 2023 update will continue to stimulate clinicians from all different disciplines to deliver the best care possible for these patients, will motivate researchers to undertake the high-quality trials needed to deliver the new evidence to advance the field further, and collectively will support people with diabetes-related foot disease to minimize their disease burdens.

Retrospective pharmacoeconomic study of antibiotic therapy in community-acquired pneumonia

Background. The global recommendations for the treatment strategy of community-acquired pneumonia (CAP) include the empirical prescription of antibiotic therapy (ABT) – beta-lactams, fluoroquinolones, macrolides until the results of laboratory tests are obtained to identify the etiological agent responsible for CAP to determine etiotropic therapy. According to the national Russian clinical guidelines, macrolides, fluoroquinolones, cephalosporins and aminopenicillins are recommended for empirical prescription. Meta-analyses found better outcomes in patients treated with a combination of macrolides with beta-lactam compared to beta-lactam alone. At the same time, the clinical benefit of adding macrolides to beta-lactams for the empirical treatment of moderate CAP remains controversial, since the difference in the results of therapy may depend on the age and comorbid conditions of patients.Objective: to analyze the costs of treating CAP with various ABT strategies in order to optimize the cost structure of a medical organization and plan the budget of local healthcare systems.Material and methods. A retrospective epidemiological analysis of extracts from 157 medical records of middle-aged patients in accordance with the World Health Organization classification treated in multidisciplinary medical organizations was carried out. The methods included frequency analysis, cost of illness analysis, cost minimization analysis, and cost-effectiveness analysis. Depth of research was 2 years.Results. Frequency analysis revealed that the initial strategy of ceftriaxone and azithromycin combination (n=74; 47%) prevailed in prescriptions. In terms of the rate of prescriptions, ceftriaxone monotherapy (n=37; 24%) was in the second place. The analysis of the effectiveness of the selected ABT strategies showed that, in general, 113 (72%) of prescriptions were effective. Standard therapy strategies were equivalent in absolute costs and had a similar cost structure.Conclusion. Doctors’ adherence to national clinical guidelines for CAP treatment was found when prescribing the initial empirical ABT, the dominant strategies were identified. Cost of illness analysis demonstrated that the applied strategies were optimal in terms of cost minimization, and cost-effectiveness ratio. The costs structure in therapy with various ABT strategies did not have significant differences. In medical organizations, they adhere to the most rational and cost-effective strategy for CAP treatment and prescribe ABT regimens in each individual case based on risk factors, as well as the results of studies of CAP pathogens sensitivity.

첨단바이오의약품 신속처리제도 분석

In order to address unmet medical needs, regulatory agencies in each country have an expedited processing system that rapidly develops and commercializes Advanced Therapy Medicinal Products. This study analyzed the expedited processing systems of the United States, European Union, Japan, and South Korea by referring to the websites of regulatory agencies and related regulations and documents. The expedited processing system is divided into approval pathway and designation, where approval pathway is the mechanism for marketing approval, while designation is given to drugs that meet specific criteria. Among several systems, South Korea has customized examination and conditional approval within expedited processing clauses, the United States has Regenerative Medicine Advanced Therapy, the European Union has PRIME, and Japan has Sakigake. Although there are differences in the conditions for being designated as subject to expedited processing in each country, most of the other conditions stipulate similar contents. In order for the expedited processing system of the Advanced Regenerative Bio Act to achieve international harmony, domestic regulatory agencies must actively intervene to achieve interaction in the development process of Advanced Therapy Medicinal Products, and multidisciplinary and multi-institutional organizations must participate together.

Drug provision model of patients based on an architectural approach in the context of digital transformation of military healthcare

According to architectural modeling (the architectural structure of an open group), typed blocks of elements forming the basic components or layers of the architecture of a military medical organization are considered, combined into six domains with a schematic representation as typical architecture. The rational allocation of layers, their contents, interrelations, and directions of development provide an opportunity to effectively manage the complex multidisciplinary military medical organization during digital transformation. For the introduction and implementation of digital solutions, the analysis of the creation of an integrated module of a single digital contour for managing medical property resources indicates the feasibility of substantiating and developing reference functional models according to a single standard for describing business processes and the need to choose the most optimal methodology and notation for modeling reference functional architectures of a military medical organization. In a comparative analysis of the selected notations according to reasonable criteria, the business process model and designations were determined as the optimal and universal description language that most fully meets the needs of functional modeling of the architecture of information systems for the subsequent automation and digitalization of the management of medical property resources in a military medical organization. The reference functional model of the information system for the management of medical property resources is presented by the description of the processes of drug provision of admitted patients, which is one of the main target areas of the military medical organization considering its state task. Moreover, a well-founded and developed standard functional architecture in the notation of the business process model and notation 2.0 is presented as interacting pools displaying the subjects (participants) of the process with the tasks assigned to them. The methods and methodological approaches presented in the article, as well as models of functional architectures for providing medicines to patients admitted to a military medical organization, can be used as a reference in the digital transformation of the management of medical property resources at various levels of military healthcare.

COOPERATION OF A MULTI-NETWORK SCHOOL EDUCATIONAL ORGANIZATION WITH FAMILIES OF CHILDREN WITH HEARING IMPAIRMENT

This article discusses issues related to the organization of cooperation of multidisciplinary preschool educational organizations with families of children with hearing impairment

Acceptance of diagnosis and management satisfaction of patients with “suspected Lyme borreliosis” after 12 months in a multidisciplinary reference center: a prospective cohort study

IntroductionBecause patients with a “suspicion of Lyme borreliosis (LB)” may experience medical wandering and difficult care paths, often due to misinformation, multidisciplinary care centers were started all over Europe a few years ago. The aim of our study was to prospectively identify the factors associated with the acceptance of diagnosis and management satisfaction of patients, and to assess the concordance of the medical health assessment between physicians and patients 12 months after their management at our multidisciplinary center.MethodsWe included all adults who were admitted to the Tick-Borne Diseases Reference Center of Paris and the Northern Region (TBD-RC) (2017–2020). A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains and 13 items rated between 0 (lowest) and 10 (highest grade): (1)Reception; (2)Care and quality of management; (3)Information/explanations given to the patients; (4)Current medical condition and acceptance of the final diagnosis; (5)Overall appreciation. Factors associated with diagnosis acceptance and management satisfaction at 12 months were identified using logistic regression models. The concordance of the health status as assessed by doctors and patients was calculated using a Cohen’s kappa test.ResultsOf the 569 patients who consulted, 349 (61.3%) answered the questionnaire. Overall appreciation had a median rating of 9 [8;10] and 280/349 (80.2%) accepted their diagnoses. Patients who were “very satisfied” with their care paths at TBD-RC (OR = 4.64;CI95%[1.52–14.16]) had higher odds of diagnosis acceptance. Well-delivered information was strongly associated with better satisfaction with the management (OR = 23.39;CI95%[3.52–155.54]). The concordance between patients and physicians to assess their health status 12 months after their management at TBD-RC was almost perfect in the groups of those with confirmed and possible LB (κ = 0.99), and moderate in the group with other diagnoses (κ = 0.43).ConclusionPatients seemed to approve of this multidisciplinary care organization for suspected LB. It helped them to accept their final diagnoses and enabled a high level of satisfaction with the information given by the doctors, confirming the importance of shared medical decisions, which may help to reduce health misinformation. This type of structure may be useful for any disease with a complex and controversial diagnosis.

Отечественный и международный опыт организации оказания медицинской помощи пострадавшим в техногенных чрезвычайных ситуациях

ummary. The aim of the study is to investigate and to systematize world experience in the organization of measures to prevent technogenic emergencies (ES), as well as the experience of timely measures to eliminate their medical and sanitary consequences, to ensure safety of the population, to provide medical care and reduce the damage caused to national economy. Study materials and methods. Various databases were used, including PubMed; Russian information-analytical portal in the field of science, technology, medicine and education — scientific electronic library eLIBRARY.RU; open access statistical reporting data and also official sites of scientific journals on the specified subjects. Results of the study and their analysis. It is noted that most countries, including the Russian Federation, have accumulated a lot of experience and developed a large number of regulatory documents governing algorithms and a necessary amount of activities in the field of protection of population and territories from man-made emergencies. In the event of such emergencies there are extremely urgent tasks to reduce or to prevent potential sanitary losses among civil population, as well as to ensure the uninterrupted operation of medical facilities. To solve them a whole complex of measures on medical and psychological protection of the population and employees of medical institutions is carried out. A specific peculiarity of professional activity of specialists of rescue services and medical workers, providing liquidation of medical and sanitary consequences of technogenic emergencies, is work in special conditions and under the influence of a considerable quantity of stressogenic factors. Organization of medical support of the victims of man-made emergencies also includes the creation of mobile forces, capable of ensuring the timeliness of medical care to victims. Most European countries have created joint rapid response forces, which are represented by mobile medical brigades and detachments, organized on the basis of large multidisciplinary medical treatment organizations. Their main task is to assess medical situation in the affected area: number of victims, severity of injuries and their preferential localization, need for specialized medical care, dislocation of the available medical forces and facilities and their capabilities. Domestic and international experience of organization of medical aid rendering to victims of technogenic emergencies shows that high levels of stress, anxiety, depression, professional burnout occur among the specialists of rescue services and medical workers, which may have long-term consequences. New methods and approaches to the organization of medical care in man-made emergencies are being developed and implemented all over the world and ways to support specialists of rescue services and medical workers taking part in the liquidation of man-made emergencies are being improved.

0340 AASM Insomnia Summit 2022

Abstract Introduction Significant challenges exist in access to high-quality care for insomnia disorder. After the recent publication of clinical practice guidelines on behavioral/psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a virtual one-day summit in September 2022 to discuss improving care for patients with insomnia disorder. Methods Fifty attendees representing a variety of organizations (e.g., medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the Summit. Videos highlighting patient perspectives and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions: (1) barriers to care, (2) facilitators of high-quality care, and (3) future directions and innovations. After 3-4 brief topical presentations by content experts, summit participants divided into seven breakout groups to brainstorm and prioritize issues. Each breakout highlighted 3-5 priorities and reported back to the broader group following each thematic session. Results The top barriers to care for insomnia disorder identified by summit participants included (1) limited access to care, (2) limited awareness of insomnia treatment options, (3) limited treatment formats, (4) low perceived value of insomnia treatment, and (5) insufficient number of trained clinicians to provide care. The top facilitators of care included (1) increased education and awareness, (2) novel models to increase access to care, (3) developing and expanding the insomnia patient care workforce, (4) incorporating research into practice, and (5) increasing reimbursement. Top priorities for future directions included (1) increasing awareness among patients and healthcare providers, (2) increasing the number of skilled behavioral sleep medicine providers, (3) increasing advocacy efforts to address insurance issues (e.g., billing, reimbursement, and performance measures), and (4) working collaboratively with multidisciplinary organizations to achieve common goals for insomnia disorder care. Conclusion The AASM and participants from partnering organizations successfully engaged in a summit and identified prioritized strategies to improve access to high-quality care for insomnia disorder across diverse clinical settings (e.g., private practice, academic institutions, and rural areas). The priorities are to improve access to care for insomnia disorder, which require advocacy efforts to increase awareness of treatment options, improve reimbursement, and grow the skilled workforce for treating insomnia disorder. Support (if any) AASM

Working conditions of medical workers during the COVID-19 pandemic in 2020–2021 in Novosibirsk

Introduction. The high risk of infection of healthcare workers dictates the need to study their working conditions during the COVID-19 pandemic.
 The study aims to research the working conditions of medical workers during the COVID–19 pandemic in multidisciplinary medical and preventive organizations.
 Materials and methods. Analysis of working conditions of medical workers of medical and preventive organizations. The study design is a closed population (four medical institutions were randomly selected), a target group (doctors and nurses). The authors analyzed the staffing table and 16 reports on a special assessment of working conditions at 1,251 workplaces (1,845 medical workers, of which 787 doctors, 1,058 nurses). Statistical analysis included: standard methods of descriptive statistics, determination of relationships by logistic regression (odds ratios (OR) and 95% confidence intervals (OR CI)). p<0.05 was taken as the critical level of significance.
 Results. The largest number of ill medical workers provided assistance to patients without signs of COVID-19 both in hospitals (86.06% of doctors, 85.85% of nurses) and in outpatient polyclinic treatment and prevention organizations (90.31% of doctors, 92.05% of nurses). The probability of getting sick COVID-19 was maximum in an infectious diseases hospital (compared with emergency departments OR 2.049; 95% OR CI 1.194–4.608 and diagnostic and treatment units of medical institutions OR 3,057; 95% OR CI 1,876–4,98). The workplaces of medical workers who have undergone COVID-19 in infectious diseases hospitals and specialized teams are classified as harmful class 1–3 degrees, and workers are classified as high occupational risk groups according to SARS-CoV-2. The probability of getting sick with COVID-19 is significantly higher when in contact with pathogens of infectious diseases (class of working conditions 3.3 compared to 3.1 or 3.2).
 Conclusion. The workplaces of medical workers who have undergone COVID-19 in infectious diseases hospitals and specialized brigades are classified as harmful class of the first to third degree, and workers are classified as high occupational risk groups for COVID–19.
 Ethics. Scientists have conducted the study in compliance with the Ethical principles set out in the Helsinki Declaration of 1975 with amendments of 1983 and obtaining the informed consent of patients.