National Recommendations Research Articles

Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022.

BackgroundIn 2022, a global monkeypox virus (MPXV) clade II epidemic occurred mainly among men who have sex with men. Until early 1980s, European smallpox vaccination programmes were part of worldwide smallpox eradication efforts. Having received smallpox vaccine > 20 years ago may provide some cross-protection against MPXV.AimTo assess the effectiveness of historical smallpox vaccination against laboratory-confirmed mpox in 2022 in Europe.MethodsEuropean countries with sufficient data on case vaccination status and historical smallpox vaccination coverage were included. We selected mpox cases born in these countries during the height of the national smallpox vaccination campaigns (latest 1971), male, with date of onset before 1 August 2022. We estimated vaccine effectiveness (VE) and corresponding 95% CI for each country using logistic regression as per the Farrington screening method. We calculated a pooled estimate using a random effects model.ResultsIn Denmark, France, the Netherlands and Spain, historical smallpox vaccination coverage was high (80-90%) until the end of the 1960s. VE estimates varied widely (40-80%, I2 = 82%), possibly reflecting different booster strategies. The pooled VE estimate was 70% (95% CI: 23-89%).ConclusionOur findings suggest residual cross-protection by historical smallpox vaccination against mpox caused by MPXV clade II in men with high uncertainty and heterogeneity. Individuals at high-risk of exposure should be offered mpox vaccination, following national recommendations, regardless of prior smallpox vaccine history, until further evidence becomes available. There is an urgent need to conduct similar studies in sub-Saharan countries currently affected by the MPXV clade I outbreak.

Blood far forward: A cross-sectional analysis of prehospital transfusion practices in the Canadian Armed Forces

BackgroundCanadian Armed Forces (CAF) operate in environments that challenge patient care, especially trauma. Military personnel often find themselves in remote settings without conventional healthcare facilities. Treating traumatic injuries, particularly hemorrhagic shock, often necessitates prehospital blood transfusion. This study aims to present an overview of the current CAF prehospital transfusion practices. Furthermore, the study compared current and developing protocols against expert-recommended guidelines. MethodsA cross-sectional survey design was employed to describe and compare CAF prehospital blood transfusion practices and protocols against expert recommendations. Topics included protocols, equipment, and procedures. An online survey targeted medical leadership and providers within CAF, with data collected from August 15 to December 15, 2023. Results were summarized descriptively. This study received approval from the Unity Health Toronto Research Ethics Board (REB 23–087). ResultsUnits and teams with prehospital blood transfusion capabilities were contacted, achieving a 100 % response rate. Within CAF, Canadian Special Operations Forces Command (CANSOFCOM), Mobile Surgical Resuscitation Team (MSRT), and Canadian Medical Emergency Response Team (CMERT) possess these capabilities, established between 2013 and 2018. These programs are crucial for military operations. CAF has access to standard blood components, cold Leuko-Reduced Whole Blood (LrWB), and factor concentrates from Canadian Blood Services (CBS), available for both domestic and international missions given adequate planning and favorable conditions. Key findings indicate high adherence to recommended practices, some variability in the transfusion process, and potential benefits of standardizing prehospital transfusion practices. ConclusionsThis study provided insights into CAF's implementation of prehospital transfusion practices, highlighting high adherence to national expert recommendations and the importance of structured protocols in military prehospital trauma management. Implications of key findingsCAF's approach and adoption of prehospital transfusion protocols lay a strong foundation for managing trauma patients in remote settings and for expanding prehospital transfusion capabilities across CFHS deployed assets. Further research is needed to advance military trauma care by adapting prehospital blood transfusion to dynamic tactical landscapes and evolving technologies.

Conversations about death and dying: A co-created workshop for healthcare students

The topic of the physiology of death and dying and how to communicate with people at the end of life is largely absent from healthcare curricula within the U.K. This is despite research indicating that healthcare students find death to be an upsetting experience, and national recommendations advocating that such education be mandatory. This case study outlines the design, delivery, and evaluation of a workshop exploring death and dying in terms of physiology and communication. This intervention was co-created with students using an action research approach. Students appeared to increase in knowledge and skills relating to talking with dying patients and their families, through engagement in the workshop, as evidenced by the evaluation. This study has wider implications for other healthcare courses nationally as higher education institutions seek to address the gap in knowledge and skills relating to death and dying in pre-registration healthcare students. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0/ .

National Recommendations for Pharmacoeconomic Evaluations Reporting for Reimbursement and Procurement of New Pharmaceutical Applications in Egypt

ABSTRACT Introduction To improve resource allocation within our healthcare system, the Egyptian Authority for Unified Procurement, Medical Supply and the Management of Medical Technology (UPA) and Universal Health Insurance Authority (UHIA) established a joint economic evaluation process to support UHIA reimbursement decisions and UPA procurement decisions. The main objective of this study is to describe the developed national pharmacoeconomic guidelines in Egypt, especially for reimbursement and procurement for new pharmaceuticals. Methods A focus group was formed as a national initiative activity by governmental authorities in Egypt. The aim of this focus group was to develop national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products. This group consisted of various stakeholders with experience in health economics, outcomes research, public health, and pharmacy practice. To develop our national pharmacoeconomic guidelines, three steps were taken. First, the focus group reviewed the European Network for Health Technology Assessment (EUnetHTA) methods for health economic evaluations for new pharmaceuticals as well as the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines and the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions. Second, the focus group used the EUnetHTA guideline as a reference and adapted it to our local context. The focus group added the value assessment component, using the CADTH and AMCP guidelines. Third, the focus group collected input and feedback from key stakeholders through a focus group by using the quasi-Delphi panel approach. Results The results of the focus group are a main structure of national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products, consisting of seven main topics. Conclusion Economic evaluation is a core element of Health Technology Assessment, (HTA); therefore, the UHIA and UPA were encouraged to produce unified joint pharmacoeconomic guidelines for innovative products as an initial step in their commitment to implement the use of HTA in decision-making. This standardization of guidelines not only ensures transparency but also guarantees an accurate and transparent process to support evidence-based decision-making. These guidelines are expected to help decision-makers improve their process and attain better health outcomes for Egyptian patients.

Prehospital care for traumatic brain injuries: A review of U.S. state emergency medical services protocols

Traumatic brain injury (TBIs) necessitates a rapid and comprehensive medical response to minimize secondary brain injury and reduce mortality. Emergency medical services (EMS) clinicians serve a critical role in the management of prehospital TBI, responding during an initial phase of care with significant impact on patient outcomes. We used versions two and three of the Brain Trauma Foundation (BTF) Prehospital Guidelines for the Management of Traumatic Brain Injury and the NASEMSO National Model Clinical Guidelines to determine key elements for a TBI prehospital protocol and included common factors across sources such as recommendations concerning patient monitoring, hypoxia, hypotension, hyperventilation, cerebral herniation, airway management, hyperosmolar therapy, and transport destination. We then conducted a cross-sectional evaluation of publicly available statewide EMS clinical protocols in the US to determine the degree of alignment with national guidelines. We calculated descriptive statistics for each factor in the state protocols. Despite adoption of some evidence-based recommendations for a standard approach to the prehospital management of patients with TBI, we found significant variability in statewide EMS treatment protocols for management of severe TBI, especially in the recommended frequency of patient reassessment and for the management of suspected herniation. Most statewide protocols provided guidance regarding oxygenation, ventilation, and blood pressure management that aligned with evidence-based guidelines. While most protocols did address management of oxygenation and ventilation, one in four protocols had no specific guidance for managing hypoxia and only 31% of protocols recommended avoiding hyperventilation. For the management of suspected cerebral herniation, over half of statewide protocols recommended hyperventilation, whereas only 31% explicitly advised against hyperventilation regardless of TBI severity. Interestingly, 94% of protocols do not mention the use of hyperosmolar therapy for TBI patients, neither recommending use or avoidance of hyperosmolar therapy. In conclusion, we found inconsistent adoption of national recommendations in available statewide protocols for prehospital TBI management. We identified significant gaps and variation in statewide protocols regarding patient monitoring and reassessment, as well as in several key areas of severe TBI management.

Chlamydia and Gonorrhea Testing in Pregnancy: Time to Improve Adherence and Update Recommendations.

The aim of the study is to evaluate adherence to national recommendations for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) testing during pregnancy including tests for cure/clearance and for persistence/potential reinfection at time of delivery. We evaluated results of chlamydia and gonorrhea nucleic acid amplification tests (NAAT) performed by major national reference laboratory from January 2010 through July 2022. Of 3,519,781 uniquely identified pregnant individuals, we identified 4,077,212 pregnancies. Among pregnancies that had chlamydia or gonorrhea testing, 3.7% (149,422/4,055,016) and 0.4% (15,858/ 4,063,948) were initially positive, respectively. Initial tests occurred in the first trimester for approximately 88%. Of those initially chlamydia test positive, 71% were retested; 15.8% in <4 weeks and 37.3% >8 weeks (similarly for gonorrhea). Among patients initially test positive in early/mid pregnancy, more than one-third had no evidence of late pregnancy retesting. Individuals who were initially test negative and subsequently retested positive were approximately 50% likely to have the last available result be positive. Among all whom initially tested positive and were retested, 6.8% and 4.0%, were positive for chlamydia and gonorrhea, respectively on their last test before estimated delivery. There was no subsequent negative test before estimated delivery for 35.1% and 36.9% chlamydia or gonorrhea infected patients, respectively. Adherence to current recommendations is suboptimal and may not be adequate to reduce disease burden. Professional societies and practice plans should work to encourage better adherence to existing guidelines to protect the health of women and their newborns. We propose recommendations that may be helpful in reducing disease burden.

A Survey of Current Gonioscopy Practise in the United Kingdom.

This survey highlights a deficiency in gonioscopy practices across the UK, particularly in the utilization of indentation gonioscopy and training of junior ophthalmologists. Recommendations include standardizing practice and enhancing training opportunities to improve patient care. Gonioscopy is an important general skill learnt and practised by all grades of ophthalmologists. The aim of this study is to discover the general attitude, perception and practice of gonioscopy among ophthalmologists in the UK. A National gonioscopy survey was carried out by utilising an anonymous electronic questionnaire of 18 questions. The questionnaire was electronically distributed online, using the survey tool, Microsoft 2016 'MS Forms' to all grades of ophthalmologists in the UK. A total of 146 responses were analysed. Overall, 89% of the participants felt 'comfortable in performing slit lamp gonioscopy' but only 38% of junior trainees (ophthalmic specialist trainees years 1-3) felt comfortable in gonioscopy. Only 13% of the junior trainees felt they had adequate training in performing gonioscopy compared with 68% of the total respondents. Surprisingly, the majority of consultants (58%) did not 'strongly agree' to being confident in assessing the angle and its configuration on gonioscopy. The most commonly used gonioscopic lens in this survey was the Zeiss four-mirror gonio lens, but only 38% of participants performed indentation gonioscopy routinely. The majority of the participants utilised the modified Shaffer's classification for gonioscopy. Fewer than expected numbers performed gonioscopy routinely for new glaucoma patients. This survey suggests that gonioscopy is not being performed according to the UK national recommendations and few ophthalmologists perform indentation gonioscopy. Additional gonioscopy training in the curriculum may be helpful.

Feasibility of an implementation strategy for preventing falls in homecare services

BackgroundFalls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial.MethodsThis study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory.ResultsQualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was.ConclusionsOverall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge.Trial registrationThe trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/2JFHV Registered: January 11, 2023.

KV reference dosimetry in Australia and New Zealand: Survey results and trends.

To assess the number of radiotherapy kilovoltage (kV) units in service, their clinical utilization, and methodology and equipment used for absorbed dose determination across Australia and New Zealand. A survey was sent to 61 Australian and New Zealand radiotherapy providers in the second half of 2023. Fifty-seven responses were received, with 43 departments having kV units and providing beam quality data for 185 therapeutic kV beams 20-300kVp. Percentage depth dose curves were compared between five clinical beams with 100 kVp and 2.13-6.28mm Aluminum half value layers (HVLs), demonstrating large differences that can occur between beams with the same kVp. Eighteen departments provided clinical utilization data for their kV units, with a total of 4458 treatment courses and their corresponding kVp reported. All departments complied with national and international recommendations with respect to the equipment used for reference dosimetry of kV beams; 77% of ionization chambers used for absorbed dose determination were of Farmer-type, with the remaining 23% being plane parallel soft x-ray chambers. Methods of derivation of air-kerma calibration factors varied, with 73% of respondents using a draft document disseminated by the Australian Primary Standards laboratory, 23% using HVL alone, and 6% using other methods. The results of this survey provide a snapshot of kilovoltage radiation therapy use and the number of kV units across Australia and New Zealand. This data can be used as a point of reference for future investigations into clinical utilization and reference dosimetry methods across Australia and New Zealand or for comparisons with other countries, facilitating standardization of reference dosimetry practice for kilovoltage units.

Cardiomyopathies matter: a multistakeholder european initiative to improve patient outcomes through effective health policies

Abstract Background/Introduction Cardiomyopathies are common and affect up to 1:250 of the population. Despite conferring a risk for sudden cardiac death and substantial disease burdens that could be reduced through better awareness, detection and care, cardiomyopathy care is rarely incorporated in European and national health policies. New European Society of Cardiology cardiomyopathy guidelines (1) could substantially benefit care but need to be supported by effective policies. Cardiomyopathies Matter is a Europe-wide, multistakeholder initiative aiming to raise awareness about cardiomyopathies and to ensure they receive the policy attention they warrant from EU and national decision-makers. Methods Cardiomyopathies Matters participants include experts from the fields of cardiology, cardiac nursing, economics, and patient advocacy, coordinated by a Secretariat, representing 36 countries and 6 patient advocacy groups (PAGs). A Policy Roadmap and other publications were co-created based on i) reviews of published and grey literature, and ii) input from topic experts and PAGs through 2 group workshops, individual consultation meetings, and a modified nominal group technique reviewing successive drafts toward consensus approval. Results The Roadmap (2) identifies unmet needs and challenges throughout the patient care pathway and offers holistic EU and national policy recommendations to address these and improve patient outcomes (Figure 1). These include policy measures to support early and accurate diagnosis, access to expert multidisciplinary care, guidelines-informed disease investigation and management, holistic support and empowerment of patients and carers, and research and innovation. Key aspects for nurses and allied health professionals include the need for 1)improved knowledge and awareness to promote early diagnosis; 2)rapid referral systems to multidisciplinary care and access to specialist cardiomyopathy or heart failure nurses care coordination, 3)genetic counselling (index cases and cascade/family screening), and 4)support of patients and families. Building on existing examples of good practice at national expert centre networks (e.g. France, Spain, UK),Cardiomyopathies Matter published updated policy recommendations for the European Union mandate (3), which are now being adopted more widely. National initiatives are underway or in development in Belgium, Hungary, Italy, Netherlands, Poland, and Spain. Local actions include multistakeholder roundtables and events, national Roadmap publications, events, educational activities, and media outreach. Conclusions EU and national Cardiovascular Health Action Plans are needed, with specific attention to cardiomyopathies and other inherited CVDs. Cardiomyopathies Matter fosters collaboration between healthcare professionals, PAGs and policymakers to promote policies that ensure all patients and families have access to guidelines-informed care.Figure 1Cardiomyopathy Priorities

An Exploration of Contraceptive Choice Pathways in Adolescents and Young Adults

To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method. A retrospective cross-sectional study was conducted of AYA DFAB (N = 2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams. Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at P-value < .001, validating the patterns identified with the Sankey diagrams. We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.

Earth Observation based multi-scale analysis of crop diversity in the European Union: First insights for agro-environmental policies

Characterizing and quantifying crop diversity (“effective number of crops”) across scales is needed to understand a wide range of issues related to resilience of farms and the agricultural sector, the provision of ecosystem services, and ultimately to provide a scientific basis for effective agro-environmental policies. We use a novel European Union (EU) wide satellite-derived product at 10 m spatial resolution to produce datasets of crop diversity across spatial (1–100 km) and administrative scales for the year 2018. We focus on the 27 EU countries and the United Kingdom. We define local crop diversity (α-diversity) at the 1 km scale corresponding to large farms or clusters of small-to-medium sized farms. Across countries, the α crop diversity ranges from 2.3 to 4.4 with the highest levels achieved by systems dominated by a high number of small farms (less than 10 ha on average). Computed at grid level aggregation, γ-diversity (the number and area of crops that are grown independently from the precise location, for landscape region, and country levels) increases rapidly from 2.85 at 1 km to 3.86 at 10 km and levels off 4.27 at 100 km. Such diversity levels are higher than that reported for the U.S.A., likely related to differences in farm structure and practices. β-diversity, the ratio of γ and α diversity, provides a measure of the diversity between agroecosystems and ranges from 1.2 to 2.3 across EU countries. Based on the magnitude and change of γ-diversity across scales, we classify countries’ diversity in four groups with possible consequences for regional to national agro-environmental policy recommendations, in particular the monitoring activities and indicator development of interventions for the implementation of the Common Agricultural Policy (CAP) in the EU. Forthcoming annual high-resolution continental Copernicus crop type maps will facilitate temporal comparisons. Various ecosystem co-variates are to be explored for deeper understanding of the link of crop diversity to agro-ecosystem services.

P-732 Analysis of health and lifestyle behaviour data from 300,065 UK-based women to analyse preconception lifestyle choices in the context of the broader female population

Abstract Study question Do health and lifestyle behaviours from 300,065 UK-based women indicate preconception choices exceeding national recommended limits? Summary answer The majority indulged in lifestyle behaviour(s) that negatively impact fertility despite actively trying to conceive or wanting to start a family in the future. What is known already Existing knowledge underscores the impact of alcohol consumption, drug use, smoking, and vaping on preconception health and fertility. Understanding the associated risks is crucial for optimising reproductive outcomes. Awareness regarding limits of exposure and intake also remains low, hindering informed decision-making. This study, examining data from 300,065 UK-based women, aims to bridge this gap by shedding light on the prevalence of lifestyle choices and their potential implications for fertility. Emphasising the need for heightened awareness, the findings can contribute to informed preconception counselling, promoting healthier lifestyle choices and empowering individuals with the knowledge needed for optimal reproductive well-being. Study design, size, duration A cross-sectional study was conducted on 300,065 women aged 18-58 who used an at-home hormone testing service between September 2020 and January 2024. Users were asked to complete an online health assessment (OHA) assessing demographics, menstrual cycle history, lifestyle and medical history and asked to select one or more categories that best described them - planning for the future (PFF), actively Trying to Conceive (TTC), just curious about their reproductive health, concerned only about symptoms. Participants/materials, setting, methods Among the 300,065 users, 133,682 were PFF, 76,692 were TTC, 81,257 were just curious, and 42,966 were only concerned about symptoms. We analysed the lifestyle habits of users including alcohol consumption, smoking, vaping and recreational drug use. Only users who were PFF, TTC or just curious were included in the analysis. Counts, means and percentages of completed VHAs were calculated using R software. Main results and the role of chance For those TTC, the mean age was 30.7, 39.53% (n = 30,317), consumed 1-14 units of alcohol weekly, 3.95% (n = 3,028) exceeded 14 units, 21.95% (n = 16,834) regularly or occasionally smoked, 22.40% (n = 9,436) regularly or occasionally vaped, and 7.06% (n = 5,415) used recreational drugs regularly or occasionally. Among those PFF, the mean age was 28.3, 57.27% (n = 76,556) consumed 1-14 units of alcohol weekly, 5.31% (n = 7,095) exceeded 14 units, 22.86% (n = 30,566) regularly or occasionally smoked, 27.29% (n = 21,002) regularly or occasionally vaped, and 13.52% (n = 18,071) used recreational drugs regularly or occasionally. For those who were just curious, the mean age was 27.9, 58.10% (n = 30,602) consumed 1-14 units of alcohol weekly, 5.70% (n = 3,010) exceeded 14 units, 21.17% (n = 11,143) regularly or occasionally smoked, 28.53% (n = 15,018) regularly or occasionally vaped, and 14.63% (n = 7,701) used recreational drugs regularly or occasionally. Limitations, reasons for caution As all data was self-reported, there is a risk of recall bias and inaccurate reporting. As the users who completed the OHA were seeking a reproductive healthcare service, there is likely a bias in the selection criteria of study participants. Wider implications of the findings Although those TTC demonstrated fewer adverse lifestyle behaviours our data demonstrates that a significant number were still not following national recommendations. This highlights the need for tailored preconception education to improve fertility awareness and uptake of practices to improve preconception health and pregnancy outcomes. Trial registration number NA

1087 Factors That Impact Cold Ischaemia Time for Deceased Donor Kidney Transplants: Results of a National Transplant Access to Theatre Audit (NTACT)

Abstract Aim Deceased donor kidney utilisation confronts challenges leading to prolonged cold ischemia time (CIT), affecting graft survival. Despite these challenges, an understanding of the obstacles remains unclear. This audit aims to identify the factors that prolong CIT. Method A multicentre, prospective audit of adult deceased donor kidney-only transplants spanned 14 UK transplant centres from February to September 2022. Data, encompassing time intervals between important checkpoints pre-transplantation and perceived reasons for delays, were collected through RedCap. Descriptive statistics was used for analysis. Results Data from 476 kidney-only transplants were gathered (29 excluded for incomplete/incorrect data). Of these, 230 were donations after brainstem death (DBD) organs, and 202 were donations after circulatory death (DCD) organs. Median CIT was 10:55 (IQR:08:11-15:13) for DBD organs and 11:19 (IQR:08:31-15:10) for DCD organs, with 42% of DCD and 15% of DBD organs surpassing national CIT recommendations. Median time from organ arrival to knife to skin was 04:02 (IQR:02:35-07:35). Full and virtual crossmatches constituted 35% and 65%, respectively, with 16% of results arriving after the organ arrives at centre. Anaesthetic time had a median duration of 00:55 (IQR:00:39-01:10) and Knife to skin to organ perfusion was 01:25 (01:10-01:51). Delays reported in 34% of transplant cases, most common causes were the availability of surgical and anaesthetic teams, porters, and the operating theatre. Conclusions This audit allowed us to uncover the factors that prolong CIT at each stage of the transplantation post-arrival. These findings will guide the establishment of realistic targets for optimizing processes in the future.

Sparing piriformis and internus repairing externus vs. other conventional approaches for hip hemiarthroplasty: A report of early outcomes from a single UK trauma unit

PurposeOver 30,000 hip hemiarthroplasties for neck of femur fractures are performed annually in the United Kingdom (UK). The national recommendation is via the lateral approach, to reduce the risk of dislocation, with the potential expense of reduced function and mobility post-operatively. Muscle-sparing approaches, such as SPAIRE (sparing piriformis and internus repairing externus), have been invented to address the issue of dislocation. MethodsWe performed a retrospective data collection at a single center with a high annual volume of hip hemiarthroplasties over 12 months. All patients who had hip hemiarthroplasty as their primary treatment were included. Patients who passed away and were non-ambulant before their surgery were excluded from the study. Our primary outcome was the dislocation rate and secondary outcomes were the time to mobilization after surgery and the duration of surgery. Statistical analysis was performed using XLSTAT software. ResultsWe identified 194 cases, and these were divided into 3 groups based on the surgical approach: SPAIRE (n = 43), lateral (n = 97), and posterior (n = 54). Groups had similar demographics and a minimum 3-month follow-up after surgery. There were no dislocations in the SPAIRE group, whereas the dislocation rate for the other 2 groups was 2.5% in the lateral and 9.1% in the posterior groups at 6 months post-surgery. There was an earlier return to mobility in the SPAIRE (1.4 day) compared to the 2 other groups ( 2 days and 2.6 days). Average surgical times were very similar among all 3 groups (74 min vs. 79 min vs. 71 min). ConclusionThe SPAIRE approach seems to be safe and provides a low risk of dislocation and good post-operative function for patients undergoing hip hemiarthroplasties.

Domestic fish for more versatile and safer consumption EU‐fish IV

Abstract Fish is an important part of nutrition and well‐being. The challenge of Finnish wild fish is contaminants which accumulate in some species in higher concentrations, partially limit the usability of the fish in the food/feed market and weaken the assessment of the state of the marine environment. The aim of this study was to obtain data on the amounts of nutrients and contaminants in domestic fish species that are commercially important or should be increased in use according to national plans. The aim was also to produce information for updating the national fish use recommendations. The concentrations of contaminants in Finnish fish were mostly below the maximum levels set by the EU. The trend of dioxin and PCB compound concentrations in the Baltic Sea has been declining since the 1980s, and the concentrations in Baltic herring appear to have settled around or below the maximum levels in all sea areas and size classes. The PFAS concentrations in the studied fish samples were within the maximum limits, except for Baltic herring in the Archipelago Sea and the Bothnian Sea. Additionally, the PFAS concentrations in Baltic herring rose quite sharply between 2009 and 2023. During the current study, PFAS concentrations in Baltic herring from the same sea area and size classes increased significantly from autumn 2022 to spring 2023. The seasonal trend was suspected to be related to the fish's diet, but factors affecting PFAS concentrations in fish, such as the impact of seasons and fitness (function of weight and size of the fish), need further investigation, and PFAS concentrations in Baltic herring should be monitored. PBDE concentrations in Finnish fish were found to be very low, although they exceeded the environmental quality standard. Mercury concentrations in fish, except for two samples, were lower than the maximum levels set by Commission Regulation (EU) 2023/915. The proportion of methylmercury in total mercury was 56–94% in different fish species. Inorganic arsenic concentrations in all fish samples were below the detection limit of 0.01 mg/kg. The highest concentrations of omega‐3 fatty acids were measured in Baltic herring and vendace. Fish caught from marine areas had higher vitamin D concentrations than those from inland waters, and there was significant variation in concentrations within fish species. With current food consumption and concentration data, the health benefits of fish consumption outweigh the health risks associated with contaminants in fish for all age groups. The greatest health benefits are seen in those over 45 years old, where fish consumption reduces the burden of diseases such as cardiovascular diseases and breast cancer, as well as overall mortality. On a national scale, the current use of domestic and imported fish is estimated to reduce the disease burden annually by nearly 70,000 disability‐adjusted life years (DALYs). As a conclusion, the health benefits of fish consumption outweigh the harms of contaminants in all age groups. Increasing the consumption of fish in accordance with nutritional recommendations would benefit the health of the population. For children and expectant or breastfeeding mothers, a diverse fish consumption is useful. The safe use recommendations of the Finnish Food Authority help this risk group to direct their fish consumption to fishing areas and fish species with the lowest amounts of contaminants.

Physicians' Perceptions and Experiences Regarding Leadership: A Link Between Beliefs and Identity Formation.

Despite the development of national recommendations and training programs for effective leadership, junior and senior medical leaders often find themselves ill-prepared to take on these new responsibilities. This study aimed to explore physicians' perceptions, feelings, and beliefs regarding leadership and to provide recommendations regarding appropriate training and institutional post-training support. We conducted a qualitative study at the Geneva University Hospitals. A purposeful sample of residents (R), fellows (F), attending physicians (A), and chairpersons (CP) were invited to participate in focus groups (or semi-structured interviews) between April and June 2021. We investigated their understanding of leadership, self-perception as leaders, difficulties, and paths to improvement in their leadership skills. Focus groups were transcribed verbatim and analyzed both inductively and deductively using Fishbein's model of behavior prediction and Irby's professional identity formation framework. We conducted ten focus groups (R=3; F=4, A=2, and CP=1) and one interview (CP). Physicians expressed poor self-efficacy at all hierarchical levels: feelings of insecurity and confusion (R and F), frustration (A), and feeling stuck between divisional and institutional governance (CP). Such negative feelings were nurtured by personal beliefs with an intuitive and idealized representation of leadership. Beliefs focused more on personal characteristics rather than on skills, processes, or perceived institutional norms. Unclear expectations regarding physicians' role as leaders, overemphasis on academic achievement, and silo professional organizations fueled their feelings. Participants reported developing their leadership through trial and error, observing role models, and turning to personal resources rather than formal training. Our results show that physicians' leadership skills are still mainly acquired intuitively and that institutional norms do not encourage clarification of leadership roles and processes. Physician training in leadership skills, together with more explicit and clear institutional processes, may help to improve physicians' self-efficacy and develop their identity as leaders.

Умови застосування примусових заходів медичного характеру

The conditions for applying compulsory medical measures are an important topic that requires careful study and understanding, especially in the context of human rights and medical ethics. Decisionmaking on the application of such measures should be based on specific circumstances and strike a balance between the needs of the individual and the interests of public health. The practice of applying compulsory medical measures is determined by the legislation of each country and international standards. As a rule, they are allowed only in cases of an urgent threat to the life or health of a person or other persons, when an individual cannot make an informed and conscious decision about treatment due to mental illness or other circumstances. At the same time, the use of compulsory medical measures should be limited in time and as effective as possible to achieve the goal of ensuring the safety and well-being of the individual. In addition, it should be accompanied by appropriate human rights guarantees, such as the right to information, consultation and legal protection. This article analyzes the conditions under which coercive medical measures may be applied. In particular, it examines the ethical, legal and practical aspects of this issue, taking into account the rights and interests of patients, as well as the possible consequences for their health and well-being. The article includes a review of relevant international and national legislation, case law and recommendations of professional medical organizations on the use of compulsory medical measures. The author also examines modern approaches to this issue and possible ways to resolve it within the framework of ethical and legal norms. The author of the article provides substantiated recommendations for improving the legislation and practice of applying compulsory medical measures in order to ensure maximum protection of rights and decent treatment of patients in medical institutions.

Dyspnea and Palliative Care in Advanced Chronic Obstructive Pulmonary Disease: A Rapid Review.

Dyspnea is the most common and activity-limiting symptom for those with chronic obstructive pulmonary disease (COPD). Treatment is complex, palliative care (PC) dyspnea relief interventions are poorly understood, and PC remains underutilized in COPD despite national guidelines and recommendations. The purpose of this rapid review was to explore the concept of dyspnea and role of PC through the lens of providers, caregivers, and patients with COPD. A systematic approach for synthesis was used to identify 13 articles published between January 2018 and October 2023. Team members compared data via visualization and theme clustering to identify key conclusions describing operationalization of dyspnea, management, and PC implications. Dyspnea operationalization was challenging, with inconsistent measurement and terminology. Dyspnea was a significant burden in COPD and contributed to complexity of treatment. Opioids were used most often to treat dyspnea, but provider perspectives and biases can influence treatment decisions and perceptions of opioid therapy by the patient and caregiver. Evidence-based clinical practice guidelines and policies are needed to clarify the use of opioid therapy for dyspnea management to reduce stigmatization and barriers to treatment. Provider education should emphasize a multipronged approach to treatment of dyspnea in COPD with integration of PC early in the care continuum.

Understanding factors for adhering to health recommendations during COVID-19 among older adults - a qualitative interview study using health belief model as analytical framework

IntroductionThe COVID-19 pandemic has presented a unique possibility to broaden the understanding of people’s reactions to a global crisis. Early on, it became evident that older adults were particularly vulnerable to the virus and that the actions of this age group would be crucial to the outcome. This qualitative interview study uses the Health Belief Model (HBM) framework as an analytical tool to examine older people’s experiences of adherence to recommendations during the initial phase of the COVID-19 pandemic. It is important to view this study in the context of Sweden’s voluntary restrictions, which further highlight the unique nature of this research.MethodIn April-May 2020, 41 adults aged 70–85 participated in unstructured phone interviews. The objective was to investigate older adults’ perceptions of the COVID-19 pandemic, particularly their understanding of the disease and the conditions that influenced their adherence to health recommendations. HBM was used as an analytical framework to guide the analysis of the interviews.ResultsDespite perceiving COVID-19 as a severe threat to health and society, participants did not let fear dominate their responses. Instead, they demonstrated remarkable resilience and a proactive approach. For some, the perceived susceptibility to the disease was the primary motivator for adherence to the Swedish national recommendations. Notably, trust in the authorities and family members’ requests significantly bolstered adherence. Moreover, adherence was found to contribute to feelings of safety. Conversely, potential barriers to adhering to recommendations included missing loved ones and frustration with sometimes ambiguous information from authorities.ConclusionsThe results from this study indicate that older adults are willing to adhere to voluntary restrictions during a global pandemic. Relatives of older people are a resource for communicating information regarding safety and health messages, a message that is preferably thorough and consistent. Further, much can be gained if loneliness during isolation can be mitigated since missing loved ones appears to be a potential barrier to adherence.