Multidisciplinary Practice Research Articles

Interprofessional approach in pharmacogenomics: A systematic review

Background: The expansion of pharmacogenomics for individualised therapy is slow. A multidisciplinary approach is critical for pharmacogenomics to achieve its full potential for optimising patient care. This systematic review aimed to determine the barriers, procedures, and benefits of using an interprofessional approach in the education and clinical practice of pharmacogenomics. Methods This systematic review was conducted using PubMed, Scopus, and ScienceDirect databases. A PRISMA flowchart was used to conduct the systematic review. Results: Seventeen of 236 manuscripts were included. The data were categorised into four major themes: interprofessional approaches, procedures, barriers, and benefits. Eight studies were on interprofessional education (IPE), and the rest were on interprofessional collaboration (IPC). The essential procedure addressed education, resources, and multidisciplinary clinical practice in patient selection/counselling, pharmacogenomic testing, and decision-making and implementation. Eleven barriers and four benefits were identified for IPE and IPC. Conclusions: Barriers were identified in IPE (knowledge/skills, confidence, time, finance, and geographical problem), IPC (resources, communication, and ambiguity about pharmacogenomic services), and IPE/IPC (stereotypes of other professions). Essential collaborative procedures include educational strategies with interprofessional approaches, support systems, and implementation of clinical practices. The benefits of IPE and IPC include improved communication/interaction, knowledge/skills, and therapeutic outcomes. IPE also increased students’ confidence.

Management of Hereditary Transthyretin Amyloidosis (ATTRv) Patients and Asymptomatic Carriers in Spain: The EMPATIa Study.

Background: Hereditary transthyretin amyloidosis (ATTRv) is an autosomal-dominant systemic disease, where amyloid fibrils accumulate especially in the peripheral and autonomic nervous systems and in the heart. The aim of the present work was to outline the follow-up and type of management received by asymptomatic carriers (ACs) and Coutinho stage 1 ATTRv patients in Spain. Methods: A cross-sectional, non-interventional study was conducted throughout seven experienced hospitals in Spain. A total of 86 ACs without neurological symptoms and 19 Coutinho stage 1 ATTRv patients diagnosed 12 months before their enrollment were included. Clinical and demographic data, red flags, and neurological and cardiological evaluations were gathered. In addition, site variables were collected from four centers to describe the clinical management of ATTRv. Results: ATTRv clinical management varied depending on the center setting but was primarily overseen by neurology and internal medicine, which were responsible for the holistic follow-up of ACs and patients. Routinely, neurologists, neurophysiologists, cardiologists, and internal medicine conducted the follow-up. Specialties involved in initial AC assessment were neurophysiologists and cardiologists in 100% of cases, neurologists (75%), internists and geneticists (50%), and ophthalmologists (25%). A review of the medical tests performed proved an exhaustive management of the study population. Stable patients were followed up every 6 months, while those under evolution were monitored every 3-6 months. The frequency of monitoring of ACs was annual, and carriers classified with doubtful disease onset were visited every 3-6 months. Conclusions: The EMPATIa study provides valuable insights into the management of ATTRv in a real-world clinical setting in highly experienced hospitals in Spain. It demonstrates that multidisciplinary practice and enhanced disease awareness may lead to a reduction in diagnostic delay.

Social Justice Pedagogies: Multidisciplinary Practices and Approaches, edited by Katrina Sark

Social Justice Pedagogies: Multidisciplinary Practices and Approaches, edited by Katrina Sark

Multidisciplinary Approaches in General Medical Practice: Enhancing Collaboration for Better Patient Care

Multidisciplinary approaches in general medical practice have become integral to providing comprehensive, patient-centered care, as the complexity of modern health issues often requires a diverse range of expertise. This review explores the role and benefits of multidisciplinary teams in enhancing patient outcomes, improving resource efficiency, and increasing patient satisfaction in general medical settings. By examining the contributions of various healthcare professionals—including primary care physicians, specialists, allied health professionals, and behavioral health specialists—this review emphasizes how collaborative efforts address complex health needs more effectively than traditional, siloed approaches. Key case studies illustrate successful multidisciplinary practices in managing chronic diseases and complex conditions, highlighting the advantages of coordinated care models. The review also addresses challenges, such as communication barriers, hierarchical dynamics, and logistical constraints, that can hinder effective collaboration. Furthermore, it discusses technological supports, such as electronic health records (EHR) and telemedicine, which facilitate real-time communication and care coordination. The article concludes with recommendations for expanding multidisciplinary teams in primary care, promoting educational initiatives for team-based care skills, and advocating for policy support to institutionalize multidisciplinary approaches in general medicine. These findings suggest that well-coordinated multidisciplinary teams can transform patient care, making it more holistic, efficient, and responsive to individual needs.

THE BENEFITS OF THE PARTICIPATION OF STUDENTS IN THE LETTERS COURSE IN INTERDISCIPLINARY PROGRAMS RELATED TO TECHNOLOGY IN THE CONTEXT OF HIGHER EDUCATION

This article presents the benefits of the participation of undergraduate students in Letters in interdisciplinary programs related to the insertion and instrumentalization of technology in the context of the Federal University of the Southern Border. The work presents definitions of interdisciplinarity and reflections on multidisciplinary practices and technology in the context of higher education based on the work of Literature students in an interdisciplinary program of technology in education. It also presents reflections on the postulates in official documents such as the National Curricular Parameters (PCNs), the National Common Curricular Base (BNCC), the National Common Base for the initial training of basic education teachers (BNC-Formação) and the National Curricular Guidelines for the Literature course in order to understand what these guiding documents bring to the thematic cores of this work. The initial training of teachers in the area of ​​Literature was related to the technological transformation experienced by society in the 21st century, specifically in the school context, and reflected on ways to prepare future teachers for professional practice in the face of this reality.

Adverse childhood experiences and diet quality in the national sample of Poles: The mediating role of emotion regulation

Adverse childhood experiences (ACEs) increase the risk of adverse psychological and physical outcomes and chronic disease in adulthood. The mechanism of this relationship is still unclear. ACEs might exert their negative influence on adult health via both dietary and psychological axes. Our study aimed to examine the relationship between ACEs and diet quality in the national sample of Poles. We also aimed to determine whether difficulty in regulating emotions act as a mediator of this relationship. The national Polish sample of adults (n = 3557) took part in this study. ACEs were assessed via the Adverse Childhood Experiences Questionnaire. Data on food consumption frequency over the past year, body weight and height were collected using the self-administered version of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN®). Two diet quality scores were evaluated: Pro-Healthy-Diet-Index-10 (pHDI) and Non-Healthy-Diet-Index-14 (nHDI). Emotion regulation (ER) was evaluated via the Difficulties in Emotion Regulation Scale (DERS). Path analysis was used to examine the associations between the variables, firstly formulated by theoretical assumptions expressed by directed acyclic graphs (DAGs). A higher number of ACEs was related to higher difficulties in ER in adults (p < 0.001), which in turn was related to lower pHDI (p < 0.001) and higher nHDI (p = 0.027). Our findings strengthen the rationale for ACEs screening as a potential risk factor for diet-related chronic disease in adulthood. They provide a framework for public health prevention strategies via interventions targeting diet quality and emotional regulation in the setting of multidisciplinary practice.

Case Study in Girl-led Placemaking

The Mya Malar community park in Yangon, Myanmar, is an innovative, girl-led placemaking project that stands as a noteworthy case study demonstrating the impact of youth engagement and participatory design on their health and well-being. Completed in 2018 as part of the SPRING Accelerator Program, the project was spearheaded by 15 local girls aged 13 to 18 in collaboration with the community under the guidance of Doh Eain, a local multidisciplinary participatory design practice. Like many societies, girls in Myanmar face significant challenges in accessing and utilising public spaces, often grappling with concerns for their safety and a sense of exclusion from the communal environments. Rather than resorting to the default solution of restricting them to their homes, the Mya Malar project deliberately positioned the girls at the helm of the initiative enabling them to be a key part of the entire process from brainstorming to implementation. The project’s significance is further underscored by its contribution to altering the prevailing dynamics of community representation in Yangon. Traditionally dominated by affluent Bamar Buddhist males, the Mya Malar park represented a crucial departure, offering a unique platform for young girls to shape their surroundings by actively navigating the complexities of city systems and participating in urban governance in a city characterised by limited opportunities for youth involvement. The positive outcomes of the project encompassed improvements in the health and well-being of the local youth. By creating a gender-equitable environment, the space promoted an active lifestyle and nurtured social cohesion within the community for a wider demographic, while fostering the soft skills and interpersonal competencies of the participating girls. Its successful amalgamation of social inclusivity, youth civic engagement, and participatory design serves as a testament to the transformative potential of collaborating with youths to shape sustainable and empowering urban environments.

Barriers and enablers to effective weight management for people living with overweight and obesity: A rapid scoping review.

A scoping review was conducted to identify barriers and enablers to effective weight management in healthcare settings for people living with overweight and obesity in English-speaking high-income countries. Peer-reviewed and gray literature were systematically searched in June 2024. Data were analyzed using inductive thematic analysis. Of the 15,684 unique articles identified and screened for relevance, 216 studies were included. Healthcare-related barriers and enablers to weight management were organized under three themes: a) healthcare provider-related factors, b) provision of care, and c) policy/funding. Prominent barriers included healthcare provider knowledge deficits and low prioritization of obesity management, mainly in the primary care setting. Weight management beyond the primary care setting was found to be especially challenging, with poor referral pathways, service fragmentation, lack of multidisciplinary practice, and restricted eligibility criteria, hindering the accessibility of services. Developing consistent policies and guidelines, improving the education of healthcare providers, and increasing funding to provide low-cost comprehensive care, were identified as enablers to access and uptake of weight management services. Considerable overlap in the identified barriers existed across healthcare providers and settings. A whole health system approach to minimize barriers and strengthen enablers to weight management services is needed, to address rising obesity rates.

Visual Outcomes of Children With Craniosynostosis.

Craniosynostosis can impact the visual development of a child. Historically, children with craniosynostosis, particularly when associated with a syndrome, had a significant risk of vision loss. The authors aimed to study the incidence of ophthalmic pathology in a modern, multidisciplinary craniosynostosis practice. Children aged 7 to 13 years attending face-to-face ophthalmic craniofacial clinics between February 2020 and June 2021 were included in a retrospective case note review. Visual acuity, ocular alignment, optic nerve function, and retinal nerve fiber layer (RNFL) condition using optical coherence tomography (OCT) were recorded. Forty-three children (30 girls) were assessed at a median age of 10.3 years (7.8-13.1). Eleven children had unicoronal synostosis, 15 had single-suture synostosis not involving the coronal, 14 had multisuture synostosis involving the coronal, and 3 had multisuture synostosis not involving the coronal. Thirty-two out of 43 had craniofacial surgery. Sixty-seven percent required glasses. Forty-nine percent had strabismus, 11/43 (26%) had squint surgery, and 2/43 (5%) had tarsorrhaphy for corneal protection. Four out of 43 (9%) had papilloedema detected; however, at the final review, 15/68 (22%) eyes showed RNFL changes on OCT imaging, none of whom had optic atrophy. Two children did not meet UK driving standards due to refractive amblyopia; no children were registered as sight impaired. In this cohort, optic atrophy and visual loss due to exposure keratopathy were not seen. A high incidence of strabismus, glasses wear, and amblyopia is persistent. Binocular visual impairment was rare in this cohort: 95% met UK driving standards. Visual outcomes appear to be improving coinciding with improved craniofacial care alongside multidisciplinary team working.

Stakeholders’ Perspectives on Rehabilitation Services in KwaZulu-Natal Province, South Africa: A Mixed-method Study

Background and Objectives: South Africa is committed to enhancing rehabilitation services by 2030 through the National Rehabilitation Policy and the United Nations Convention on the rights of persons with disabilities. However, limited research focuses on rehabilitation services in KwaZulu-Natal (KZN) Province, South Africa. This study aims to provide insights from stakeholders on rehabilitation services in KZN Province focused on infrastructure, referrals, human resources, and multidisciplinary practices. Methods: Using mixed methods, we conducted focus group discussions, interviews, and surveys involving 99 stakeholders, including rehabilitation practitioners, district and provincial managers, and social development representatives from eThekwini, AmaJuba, and King Cetshwayo in South Africa. Descriptive statistics and thematic analysis were used for quantitative and qualitative data. Results: Public institutions reported inadequate referral pathways (2.9 out of 5) compared to private institutions (3.4 out of 5). Acute rehabilitation referrals primarily targeted secondary or tertiary facilities. Disjointed pathways, a lack of protocols, delayed referrals due to various factors and insufficient staff were identified. Physiotherapists were disproportionally more prominent, while social workers, psychologists and bio-kineticists were scarce. Both public (93%) and private (73%) care exhibited high doctor-to-patient ratios. Rehabilitation service disciplines were limited and fragmented, especially in rural areas. Thirty-four respondents (81%) stated no designated rehabilitation services units in their respective institutions. Conclusion: Rehabilitation services, though present at all care levels in KZN, mostly begin at tertiary levels. Local-level rehabilitation is non-existent, with the public healthcare system relying on community rehabilitation workers. Referral pathways require standardization, especially at the local level. Enhancing primary healthcare’s rehabilitation focus by bolstering workforce recruitment can significantly improve multidisciplinary practices. Expanding intermediate care facility licenses can alleviate system strain on KZN’s public health sector.

A Real-Life Study in Patients Newly Diagnosed with Autoimmune Hashimoto's Thyroiditis: Analysis of Asthenia as Admission Complaint.

Background: Amid the large panel of autoimmune thyroid diseases, Hashimoto's thyroiditis (HT) represents a major point across multidisciplinary daily practice. When it comes to the clinical picture, particularly in regard to asthenia (also described as "fatigue" or "decreased energy"), the differential diagnosis is challenging, and a meticulous anamnesis should be backed up by focused lab investigations. Our objective was to analyze the thyroid panel in newly diagnosed patients with HT in relationship with the presence of asthenia as an admission complaint. Methods: This was a retrospective, multi-centric, real-life study conducted in secondary endocrine units (university hospitals) from July 2022 to July 2023. The exclusion criteria were COVID-19 infection; an active malignancy, etc. Results: The cohort (N = 120) included an asthenia group (AS, 49.2%) and a non-AS group of a similar age (49.3 ± 14.7 vs. 47.1 ± 14.8 y, p = 0.426). Headache was more frequent in the AS group (35.6% vs. 18%, p = 0.03). Thyroid function and HT-related antibodies assays were similar between the groups and show no correlation with serum total cholesterol and triglycerides, respectively. TSH levels did not vary among the age sub-groups (p = 0.701). One third of the studied population was affected by hypothyroidism (TSH > 4.5 μIU/mL), being seen at a higher rate in the AS (39%) vs. non-AS group (23%). Total cholesterol positively correlated with the patients' age (r = 0.180, p = 0.049) and triglycerides (N = 120; r = 0.324, p < 0.001), as found only in the non-AS group (r = 0.246, p = 0.006, respectively, r = 0.319, p < 0.001). Conclusions: The analysis of the AS vs. non-AS group pinpointed the fact that, in regard to daily practice, asthenia as an admission complaint seems less of an indicator of an underlying thyroid dysfunction or a higher level of serum antibodies against thyroid in patients without a full clinical picture of thyrotoxicosis or myxoedema.

Real-World Implications of the SOUND Trial.

The SOUND trial demonstrated that omission of sentinel lymph node biopsy (SLNB) is noninferior to axillary staging in patients with early-stage breast cancer (BC) and negative axillary ultrasound (AxUS). We examined the generalizability of these findings in patients with hormone receptor (HR)+HER2- disease. Patients with cT1N0M0, HR+HER2- BC and negative AxUS undergoing breast conservation with SLNB from 2016 to 2023 were identified from a prospectively maintained database. Clinicopathologic characteristics, disease burden, adjuvant treatment, and oncologic outcomes were examined and compared with the SLNB arm of the SOUND trial. In postmenopausal patients, the impact of nodal status and 21-gene recurrence score on chemotherapy recommendations were also examined. Of 3972 patients with cT1N0M0 HR+HER2- breast cancer, 544 underwent AxUS; 312 met SOUND eligibility criteria. Median age was 57 (interquartile range [IQR] 48-64) years, and 199 (63.8%) were postmenopausal. Median (IQR) tumor size was 1.3 (0.9-1.7) cm, and 260 (83.3%) tumors were grade 1 or 2. Sentinel lymph node biopsy was positive in 38 (12.2%) patients. Only three (0.4%) had ≥ 4 positive lymph nodes. At a median follow-up of 26.2 (IQR 10.8-38.2) months, there were no axillary recurrences and one (0.3%) distant recurrence. Among postmenopausal women with recurrence score ≤ 25, chemotherapy recommendations were not associated with nodal status. Examination of our real-world HR+ HER2- "SOUND-eligible" population suggests that nodal disease burden and oncologic outcomes are similar to the SOUND trial population, supporting careful implementation of trial results into multidisciplinary practice. In postmenopausal patients, omission of SLNB does not appear to impact adjuvant chemotherapy recommendations.

Multi-fidelity data mining-based design optimization framework for scramjet-based aircraft

Aircraft design faces complex multidisciplinary problems and often involves numerous design variables, making direct optimization a time-consuming task. With the development of big data and machine learning technologies, using data mining methods to assist optimization has become key to addressing the inefficiency in multidisciplinary design optimization (MDO). To address the high cost of data acquisition in current data mining, this paper proposes an aircraft design optimization framework based on multi-fidelity data mining, using a large amount of inexpensive cursory estimation data to execute the MDO process and form a multidisciplinary optimization database. Then, data mining methods are used to decouple disciplinary relationships, transforming multidisciplinary coupling problems into simpler multi-objective problems. Subsequently, under viscous CFD computation conditions, the EDGE-p-BFFD deformation method is used to fine-tune the obtained configurations, further enhancing multidisciplinary performance. Before both optimizations, data mining methods were used to analyze the impact of design variables on objective functions, forming design knowledge and completing variable selection. In the multidisciplinary optimization practice of airbreathing aircraft, it can be found that the proposed framework effectively achieves disciplinary decoupling and explores the relationship between shape and performance. In the multidisciplinary optimization of the waverider based on cursory estimations, particle swarm optimization increased the aircraft's cruising range by 8.74 %. In the multi-objective optimization of the lifting body based on viscous CFD calculations, data mining was used to transform the problem into several key objectives. The MOEA/D algorithm increased the range by 2.9 %, validating the effectiveness of the data mining-based MDO framework proposed in this paper.

Circulations – Mobility, Fluidity, Impediments and Implications

This article deals with the author’s multidisciplinary contemporary art practice, which persistently returns to the shared history of Africa and the West, and in which the idea of circulations constitutes an underlying current. It presents an individual approach to this theme, showing the role of autobiography on conceptual artistic proposals that are mostly spread between Mozambique, South Africa and Portugal. The search for resonant visual material coming from both colonial and post-colonial history reveals how the effects of colonialism and neo-colonialism may still be traceable in how most African countries experience difficulties in developing economically sustainable democracies. Special attention is given to the moments of political transition. The article describes a practice that engages closely with buildings and their history, including the works Maison Tropicale (2007), For Mozambique (2008), A Tendency to Forget (2015) and Pan African Unity Mural (2018). It is framed and inspired by writings on African mobility by Achille Mbembe and Clapperton Chakanetsa Mavhunga. It looks at intersections and transient workspaces as conveyors of meaning and includes brief considerations on the circulation of decolonial artistic practices between Portugal and Portuguese-speaking African countries.

Multidisciplinary team-based primary care: questions for general practice training

Multidisciplinary teams delivering person-centred care are a central feature of primary care reforms in Australia and North America. General Practice is a primary care service that prioritises clinical person-centred care. The recent Strengthening Medicare Taskforce Report recognised that a person-centred team care approach needs strengthened education and training programs to support multidisciplinary teams in general practice. While the premise of multidisciplinary care is well established, strengthening education and training programs in general practice offers opportunities at the vocational training level and for intra-practice education. This Education in Practice paper discusses the relevance to contemporary general practice of findings from Tasmanian research projects conducted over the past decade, addressing three questions for general practice training: How can approaches to team-based education be tailored to different general practice settings? What strategies are best for delivering interprofessional training in general practice? How can patients be involved in the process of training and education of collaborative healthcare teams? The challenges presented by these questions are addressed by drawing from a consensus project on best practice in interprofessional training for collaborative primary healthcare, and from projects using in-person and online education and training. We propose a model that uses the clinical training space as a way of promoting multidisciplinary general practice. The model incorporates online and face-to-face spaces, where primary health professionals, patients, practices/teaching organisations, educators and technology are aligned through facilitation and feedback channels in ways that promote collaborative practice. Tasmania, as an island state with close connections between its university, state public health service and GP training, is well placed to have the strategic conversations about coordinating general practice education and training to meet the need for an integrated primary care workforce.

Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross-sectional multidisciplinary global web survey.

Published best-practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines. To provide an up-to-date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech-language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs). ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis. Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory-perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory-perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs). Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis. What is already known on the subject Best-practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni-disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced-based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best-practice guidelines.

Multidimensional program for insomnia in a cohort of people with HIV.

Sleep disorders (SD) are prevalent in people with HIV (PWH), but poorly addressed in HIV care. We evaluated the effectiveness of a multidimensional program for SD in an outpatient HIV clinic. Interventional study in 175 PWH on ART suffering from insomnia. Insomnia severity index (ISI), sleep quality, mood disorders, and well being were assessed at baseline and at month 6 after counseling for sleep hygiene and referral to tailored pharmacological and/or neuropsychological interventions. Participants were classified as fully, partial, and nonadherent (FA-PA-NA) to the interventions. Mixed-effects models and longitudinal paired tests evaluated the impact of adherence to interventions on SD overtime. Participants (male 65.7%, median age 51 years, 95.4% with viral suppression) were referred to psychologist (94.8%), psychiatrist (9.1%), and neurologist (2.8%), and 30.3% and 20.5% had indication to hypo-inducing drugs and psychotherapy/cognitive-behavioral therapy. Seventy-seven participants (44.0%) were NA, 9.1% PA, and 46.8% FA. ISI improved in all, but the strongest effect size was seen in FA (D = 0.89, P < 0.001). Perceived wellness improved only in FA, and hours slept per night increased in all but more relevantly in FA and PA (both P < 0.001). In adjusted models, adherence to the interventions ISI decreased (improve) overtime only in FA (aβ = -1.24, P = 0.005 vs. NA; aβ = -0.71, P = 0.349 for PA vs. NA). The introduction of multidimensional programs for SD can reduce the prevalence and severity of insomnia and improve sleep quality and wellness in PWH. Such approach should be integrated into daily multidisciplinary clinical practice for HIV care.

Sexual Violence against Adults Aged 50 Years and Older and Implications for Prevention: A Thematic Analysis of Service Providers' Perceptions.

At-risk older adults and older survivors of sexual violence (SV) remain largely absent from SV prevention and intervention, owing to ageism and sexism, as well as other intersectional forms of prejudice, including among service providers (e.g., social workers, healthcare professionals, practitioners in SV organizations, and practitioners who serve older adults). This study explored perceptions, knowledge and experiences with SV against adults 50 years and older. Service providers who work with older adults and/or survivors were recruited, owing to where SV in later life is reported (e.g., healthcare, long-term care, and social service organizations, and to police in addition to SV service organizations), to contribute to the limited research in this area and to advance prevention and intervention. A survey was conducted on SV in later life, exploring knowledge, perceptions and experiences with SV in later life along with potential solutions for prevention and intervention among 126 service providers who worked with survivors and/or older adults. Their responses were thematically analyzed. Five themes were identified: (a) misconceptions of SV in later life and unique barriers to preventing it; (b) needs for knowledge, awareness, research and education; (c) policy and resource development; (d) victim blame and internalized stigma, and (e) ageism, intersectional prejudice and rape culture. The findings offer an in-depth understanding of barriers to prevention, and intervention, and multi-level recommendations for addressing them, which are provided by a diverse group of service providers who have worked with older adults and/or with survivors, reflecting multidisciplinary practice wisdom and experience.

Paraquat Poisoning: Insights from Autopsy, Histology, and Liquid Chromatography with Tandem Mass Spectrometry in Multidisciplinary Forensic Toxicology Practice.

The herbicide paraquat (PQ) is responsible for a significant number of fatalities resulting from self-poisoning. Nevertheless, only a limited number of comprehensive studies focusing on fatal PQ poisoning, which include examination of autopsy findings, histopathology, and quantitative analysis of post-mortem samples, have been published. This study aimed to evaluate autopsy findings, histopathology, and quantitative analysis of PQ in post-mortem human serum samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS), a simple, sensitive, and specific method. Autopsies were performed on all deaths due to PQ poisoning, and serum samples were sent to the toxicology laboratory for chemical analysis. The method was successfully applied to seven human serum samples, and the results indicate its reliability for detecting PQ. The study reports fatal serum PQ levels ranging from 0.5 to 372.0 µg/mL. The comprehensive data presented in this study can be useful for further research and practical applications.

Transforming healthcare: A pilot study to improve primary healthcare professionals’ self-management support behaviour through blended learning

BackgroundSelf-management of a chronic condition is a complex but increasingly important issue. However, a supportive attitude and behaviour among healthcare professionals is hampered by a lack of awareness, knowledge and motivation. In addition, the role of professionals in supporting self-management seems unclear.MethodsA blended learning program for primary healthcare professionals was developed to strengthen self-management support in primary care. The program was piloted in community health centres and multidisciplinary medical practices in Flanders. Using the Kirkpatrick model, the impact on healthcare professionals’ reaction, learning and behaviour regarding self-management support was evaluated.ResultsA total of 60 healthcare professionals registered for the educational program. Post-learning questionnaires and verbal feedback showed a positive response, with professionals highly appreciating the innovative blended learning approach. In terms of learning, participants showed a good understanding of self-management support, although nuances were observed in the application of acquired knowledge to practice scenarios. Finally, preliminary insights into behavioural change were explored, revealing a positive impact of the intervention on participants’ supportive self-management behaviours in healthcare practice.ConclusionsOur study provides preliminary insights into the outcomes of a blended learning program designed to increase awareness and knowledge of self-management support among professionals. The program needs to be refined for general implementation in primary care.