Open Forum Research Articles

Exploring Perceptions of Communication among Culturally Diverse Nurses in Saudi Arabia.

Cultural diversity among nurses in the Kingdom of Saudi Arabia poses problems in communication management to ensure optimal patient care. This study explored and described the perceptions of communication among nurses in a culturally diverse workforce. A qualitative approach was used; a sample of seventeen (n=17) nurses was purposively selected. Data obtained from semi-structured interviews were analyzed using Braun and Clarke's six steps of thematic qualitative analysis. Key themes were (1) nurses' perceptions of communication in a culturally diverse workforce, (2) barriers to communication in a culturally diverse workforce, and (3) facilitators of effective communication in a culturally diverse workforce. Nurses have recognized the importance of communicating in a culturally diverse environment to provide optimal care. Strategies such as cultural competence training, open communication forums, and mentorship programs are recommended to improve cross-cultural understanding and collaboration in care teams.

Unshackling from Shadows of the Anisminic Orthodoxy: Reconceptualising Approaches to Ouster Clauses in Hong Kong

Abstract Ouster clauses have perennially borne the mantle of a ‘litigation minefield’, where clashes between legislative and judicial powers unfold in open fora. Recent jurisprudential advancements in the United Kingdom and Singapore demonstrate how judicial approaches to ouster clauses can evolve in the face of constitutional developments. Hong Kong has, however, remained muted while these jurisprudential advancements bear fruit in other parts of the common law world, notwithstanding the fact that its constitutional framework, umpired by the Basic Law, has been in existence for over twenty-five years. This article argues for the need to reconceptualise approaches to ouster clauses in Hong Kong, grounded firmly in its post-1997 constitutional framework. Drawing on comparative jurisprudence, it presents a spectrum of approaches, animated by the dynamic interplay between various ‘macrocontextual’ and ‘microcontextual’ factors, ranging from a localised version of Anisminic, remedial interpretation, and invalidation of ouster clauses on the grounds that they impermissibly affront the constitutional right of access to courts, allocation of judicial power, and constitutional supremacy.

12553 Severe Hyperglycemia After Initiation Of Bictegravir Antiretroviral Therapy With Resolution Upon Discontinuation

Abstract Disclosure: S. Hudson: None. J. Aurora: None. K. Grossman: None. L. Kogelman: None. A.G. Pittas: None. Background: Antiretroviral therapy (ART) containing bictegravir (BIC), a second-generation integrase strand transfer inhibitor (INSTI), is a first-line treatment for HIV. There are mixed reports of INSTIs causing adverse metabolic effects, such as weight gain and hyperglycemia. There are cases of BIC causing hyperglycemia and diabetic ketoacidosis (DKA) within weeks to months following initiation; however, this has not been reported in clinical trials (1). It is unclear whether discontinuing BIC resolves hyperglycemia. We report a case of a patient with prediabetes who developed severe hyperglycemia after switching to a BIC-containing ART. The discontinuation of BIC resulted in significant improvement in glycemia, leading to the de-escalation of diabetes pharmacotherapy. Clinical Case: A 36-year-old woman with obesity was diagnosed with HIV during pregnancy, which was complicated by gestational diabetes mellitus. After pregnancy, she had prediabetes. Her initial ART was darunavir/cobicistat/emtricitabine/tenofovir alafenamide. Due to intolerable GI side effects, six years later, she was switched to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Laboratory tests four months before starting BIC/FTC/TAF were consistent with prediabetes (HbA1c 6.4%, non-fasting blood glucose of 118 mg/dL). After one month, she was started on metformin when her HbA1c increased to 9.1% with a non-fasting blood glucose of 332 mg/dL. Another month later, HbA1c increased to 12.8% with a non-fasting blood glucose of 685 mg/dL without DKA. She was hospitalized for diabetes management. There were no significant changes in weight, viral load, or CD4 count. A search for secondary causes of hyperglycemia (diabetogenic medications, hypercortisolism, and autoimmune diabetes) was not revealing. She was discharged on metformin and insulin glargine. Her HIV regimen was switched to FTC/TAF and doravirine due to suspicion of BIC-induced hyperglycemia. After five months, she developed symptoms of hypoglycemia, and her estimated HbA1c by continuous glucose monitoring was 6.3%. Insulin glargine was discontinued. While on metformin, HbA1c three months later was 6.3%. Two years later on metformin and linagliptin: HbA1c was 6.1% and beta-cell function did not reveal insulin deficiency or resistance (non-fasting blood glucose 96 mg/dL, insulin 13.5 uIU/mL [RR 2.6-24.9 mIU/mL], C-peptide 3.7 ng/mL [RR 1.1-4.4 ng/mL]). Conclusion: Patients with HIV and a history of obesity and/or dysglycemia who are switched to a BIC-containing ART regimen should be educated and monitored for acute hyperglycemia. This may be due to impaired beta-cell function and/or insulin resistance; however, further research is needed to understand the mechanism. An alternative ART regimen should be considered if hyperglycemia develops. Reference: 1. Nolan NS, et al. Open Forum Infect Dis. 2021;16;8(5): ofab077. Presentation: 6/3/2024

Enhancing medical training in conflict zones and remote areas through innovation: introducing the Canadian Virtual Medical University Initiative

The WHO projects a global shortage of 4.3 million physicians by 2030, with the largest deficits in developing and conflict-affected regions. Our aim is to train competent physicians rapidly and affordably through remote education programs. We developed an online medical training curriculum with four levels, focusing on different aspects of human body systems using a competency-based, student-centered approach. This study evaluates the first three levels; level four (internship) is outside this scope. The 105 medical students from eight Afghan universities were randomly assigned to nine groups. The curriculum includes Entrustable Professional Activities (EPA) for the cardiovascular system: level 1 covers basic medical sciences, level 2 pathology and basic clinical skills, and level 3 full clinical competencies. EPAs were delivered asynchronously online via Lecturio, CyberPatient, and Zoom. The 30-day intervention included 4h of weekly online classes for formative assessment, collaborative learning, and evaluation, supervised by medical faculty members. Virtual pre- and post-intervention evaluations used multiple-choice questions and objective structured clinical examination (OSCE). We also conducted a satisfaction survey and open interview forum. Data triangulation from observations, surveys, and interviews validated curriculum effectiveness. The benchmarking method assessed cost-effectiveness. Pre- and post-intervention analysis showed a significant increase in clinical competencies and knowledge acquisition (P<0.0001). The CyberPatient intervention improved clinical competency quality (P<0.0001) and shortened decision-making time (P<0.001). Cost analysis revealed that a virtual medical university would be 95% more cost-effective than traditional medical education. Integrating virtual technology with modern curriculum concepts in pre-internship years can effectively address healthcare training gaps and enhance education quality for healthcare workers at a low cost. Provided by CanHealth International. A UBC spin-off not-for-profit organization.

Health Policy Reforms and Their Effect on Healthcare Delivery: Utilizing Natural Language Processing (NLP) to Analyze Public Sentiment and Policy Feedback

For health policy reforms, they've a profound impact on the healthcare transport structures, shaping how services are given and obtained. For lawmakers to make knowledgeable decisions that cope with the concerns and wishes of the society, they need to be able to apprehend what the public senses and says about the ones changes. The effectiveness and acceptability of health policy reforms can be better understood by the use of Natural Language Processing (NLP), which has advanced strategies for analyzing huge quantities of public discourse. Decoding diverse and unstructured records resources along with open forums, social media posts as well as news tales is one out of several troubles this assignment tackles. Natural Language Processing-Based Integrated Sentiment Analysis (NLP-ISA) is a new approach to evaluating how healthcare delivery has been converted by using changes in health policy. To process big data sets consisting of public speeches, NLP-ISA combines sentiment evaluation with present day herbal language processing algorithms. This technique analyzes public temper to show worries approximately the change in guidelines, gratification, and potential challenges that want interest when it comes to it. This paper helps policymakers to improve carrier conveyance by demonstrating real-time outcomes that their regulations create. It could screen public response in the direction of new hints while ascertaining trends in opinion among contributors of the public. The efficiency will confirm if NLP-ISA is effective or now not through simulation analysis.This process includes comparing previous polls on health care deliveries with the results from previous polls concerning past improvements made on health policies. By simulating the effect of public opinion on policy outcomes, this simulation will show how well NLP-ISA can formulate evidence-based suggestions for policy changes.

From Rhetoric to Action: Justice, Equity, Diversity, and Inclusion in Coordinated Specialty Care for Early Psychosis.

Attention to inclusivity and equity in health research and clinical practice has grown in recent years; however, coordinated specialty care (CSC) for early psychosis lags in efforts to improve equity despite evidence of ongoing disparities and inequities in CSC care. This Open Forum argues that marginalization and disparities in early psychosis research and clinical care are interrelated, and the authors provide suggestions for paths forward. Commitment to equity and justice demands recentering the perspectives of those most affected by early psychosis services and investing in the integration of historically excluded perspectives across all aspects of practice, policy, and research.

Inter-rater agreement of CAUTI (catheter-associated urinary tract infections) diagnosis among Infectious disease physicians

Background: CAUTIs constitute forty percent of nosocomial infections, yet their direct link with mortality remains debated. In 2009, NHSN estimated the economic burden of CAUTIs in the U.S. to be over $340 million. Limited data exist on inter-physician concordance in diagnosing CAUTIs, especially in patients with abnormal genitourinary (GU) anatomy. Our study assessed inter-provider variability in diagnosing CAUTI in 50 such patients, including those meeting NHSN(National healthcare safety network) criteria. Methods: We included a random set of 50 adults (18+) with abnormal GU anatomy admitted to the University of Miami hospitals from January 2018 to November 2021 who had a urinary foley catheter and at least one positive urine culture during their hospitalization. Three Infectious disease fellows and three board-certified Infectious disease physicians independently reviewed each patient’s chart, classifying them as having or not having a CAUTI. Inter-physician reliability was assessed using kappa statistics. Results: Our findings highlight substantial variation in clinician-determined CAUTI incidence among the 50 patients with abnormal GU anatomy, ranging from 8% to 32% (Figures 2,3). Inter-rater agreement on CAUTI diagnosis was generally poor (Kappa Hollenbeak CS, et al. The attributable cost of catheter-associated urinary tract infections in the United States: A systematic review. Am J Infect Control. 2018 Jul;46(7):751-757. Trautner BW, et al. Development and validation of an algorithm to recalibrate mental models and reduce diagnostic errors associated with catheter-associated bacteriuria. BMC Med Inform Decis Mak. 2013 Apr 15;13:48. Gafary M, et al. Catheter Associated Urinary Tract Infections (CAUTI) in Bladder Cancer Patients Post Cystectomy With a Neobladder, Open Forum Infectious Diseases, Volume 2, Issue suppl_1, December 2015, 293.

Parent–Teacher Meetings and Student Outcomes: curriculum and PTA meet

ABSTRACT— This study examines the vital functions that efficient Parent-Teacher Association (PTA) meetings and a well-organized curriculum have in the educational ecology. The syllabus acts as a thorough manual that describes the goals of the course, the required readings, the timetable, the grading guidelines, and classroom behaviour. This helps parents and students understand what is expected of them. This paper provides a visible roadmap of the course and shows how a thorough syllabus improves academic performance, accountability, and student participation through systematic review and analysis. This article also explores the dynamics of PTA meetings, which serve as an essential forum for parents, educators, and school administration to communicate and work together. PTA meetings that are successful have well-planned agendas, open forums that promote engaged participation, and productive discussion. Through an analysis of case studies and best practices, the study shows how frequent and well-run PTA meetings help with problem-solving, school initiative support, and creating a sense of community within the school. The synergistic effect produced by integrating PTA meetings with the curriculum improves educational outcomes. The report ends with recommendations for improving PTA meeting formats and syllabus design in order to promote a more welcoming and encouraging learning environment. The research hopes to give educators and school administrators useful insights to enhance parent-teacher interaction and student success through these recommendations. INDEX TEARMS – Frontend development HTML, CSS, JavaScript, Backend development React, Database management PHP / MySQL, ChatGPT.

MT-Keyboard: A Bayesian Model-Assisted Interval Design to Account for Toxicity Grades and Types for Phase I Trials

Conventionally, dose finding trials are based on dose-limiting toxicity (DLT) that only captures the most severe toxicities, for example, treatment related grade 3 or higher toxicity according to the NCI Common Terminology Criteria for Adverse Events. However, this approach is often problematic for certain novel targeted therapies and immunotherapies, which may not induce DLT within a clinically active dose range and are often characterized by low grade toxicities. This important issue has been highlighted and discussed in the American Statistical Association (ASA) Biopharmaceutical (BIOP) Section Open Forums, and is also an important consideration of the Project Optimus initiated by FDA to “reform the dose optimization and dose selection paradigm in oncology drug development.” In this article, we propose an easy-to-implement model-assisted Bayesian design, known as multiple toxicity keyboard (MT-Keyboard) design, to incorporate toxicity grades and types into dose finding. The MT-Keyboard design is able to accommodate binary, quasi-binary and continuous toxicity endpoints that are constructed to account for toxicity grades and types. We further extend the MT-Keyboard design, referred to as TITE-MT-Keyboard, to accommodate late-onset toxicity using the approximated likelihood approach. Simulation shows that the MT-Keyboard and TITE-MT-Keyboard designs have desirable operating characteristics, comparable to or better than some existing designs. A web-based software to implement the design will be freely available at www.trialdesign.org. Supplementary materials for this article are available online.

Experto crede

Abstract The article explains the processes involved in knowledge sharing and support giving in an open FB forum dedicated to endometriosis. It builds on the existing understanding of experiential knowledge, as well as adopts Jovchelovitch’s (2007) perspective on knowledge diversity and representation which views knowledge construction as an intersubjective process. The analysis looks at the what, the who, and the how of the community in question, focusing in particular on three areas: identity work (self- and other-categorisation); perspective sharing and recognition by “significant others”; and epistemic self-other positioning. The analysis determines the most common strategies of categorisation, identifies ways of constructing shared understanding, as well as reveals that the participants’ personal truths are based primarily on their embodied experience and hearsay.

Please explain what this diagnosis means because I don’t quite understand

Abstract Hospital discharge documents (HDDs) containing treatment information and recovery recommendations often cause concern or even stress for patients. Studies have shown that the language used in the document is often incomprehensible to the patient and seems intended mostly for (other) medical professionals. The aim of this article is to examine the discursive process of deconstructing medical knowledge encoded in HDDs through online dialogue between users of an open health-related forum in Polish. The analysis has revealed the discursive ways of sharing information and offering support by translating from Latin into Polish, converting from specialist to lay diction or explaining the way institutional conventions are applied in the document. Providing expertise and implicit reassurance in the course of dialogic interaction facilitates successful recovery. The conclusions from this exploratory analysis are hoped to increase the awareness of the parties involved of the function and significance of the medical documentation genre in question.

The Filipino comfort women on YouTube: Emotions, advocacy, and war memories in a transnational digital space

In this article, we examine the representation and contestation of Filipino comfort women’s memories on YouTube and assess the platform’s role in public discourse and transnational activism. Our content analysis of visual and narrative elements, alongside user commentary on selected videos, reveals that YouTube acts as a crucial transnational medium, linking advocacy networks and contextualizing historical narratives. However, the videos often sensationalize the victims’ experiences, undermining the seriousness of sexual violence, which could potentially weaken advocacy efforts. Moreover, user commentary on the videos can promote counter-narratives, rumors, and hostile comments. Despite these challenges, we underscore YouTube’s significance in fostering public discourse on war memories and justice in the Philippines in light of the government’s efforts to suppress the history of Filipino comfort women. The platform encourages the sharing of corroborative postmemory, enhancing war memorialization and audience engagement, and supporting the women’s claims of abuse. Ultimately, YouTube’s role as an open forum for discussion is vital in fostering dialogues for peace and justice and countering propaganda and hate.

Improving Spontaneous Breathing Trials With a Respiratory Therapist-Driven Protocol

RationaleRespiratory therapist (RT) driven spontaneous breathing trial (SBT) protocols have been shown to improve patient outcomes. ObjectiveThis quality improvement (QI) project aimed to standardize and re-establish a RT-driven protocol for screening patients for SBT readiness and placing appropriate patients on SBT. MethodsEndotracheally intubated, mechanically ventilated, adult patients admitted to an academic medical center intensive care unit were screened daily by RTs for SBT readiness. Eligible patients received a SBT with extubation decisions made by the physician team. Patient demographics, indications for intubation, SBT eligibility and exclusionary indications, SBT ventilator settings, start times, duration, and outcomes were collected from the electronic health record. QI interventions included staff re-education, documentation tips, creation of process maps, and interdisciplinary open forum discussions. Results128 patients representing 759 safety screen weaning assessment opportunities were included over a baseline sample and three Plan-Do-Study-Act (PDSA) cycles. Documentation of SBT eligibility increased from 25% at baseline to 86% in PDSA cycle 3 (P=<0.001). Patients assessed to be eligible and received a SBT was 42% in baseline, 35% in PDSA cycle 1, 36% in PDSA cycle 2, and 51% in PDSA cycle 3 (P=0.092). Use of the protocolized SBT ventilator settings improved significantly from 18% to 83% (P=<0.001). Patients who started a SBT before 9 am increased from 41% to 67% (P=0.097) and the median duration of SBT decreased from 211 to 64 minutes. (P=0.008). ConclusionsStandardization of a RT-driven SBT protocol is feasible despite multiple obstacles including staffing and communication challenges and poor shared understanding of terminology.

Preface: 2nd International Conference on Portfolios, Economy and Enterprise Reform (PEER 2024)

This book collects papers selected from the 2024 2nd International Conference on Portfolios, Economy and Enterprise Reform (PEER 2024), which was successfully held in Kobe, Japan from March 16-17, 2024. PEER 2024 welcomes researchers, experts, economist, and industry professionals to an open forum where advances in the fields of portfolios, risk management, financial security, regional economic, marketing, business management, and enterprise reform can be shared and examined. The conference is an ideal platform for keeping up with advances and changes to a consistently morphing field. Leading researchers and industry experts from around the globe will be presenting the latest studies through papers and oral presentations. PEER 2024 invites scholars and researchers all over the world to discuss the state-of-the-art and the development of the financial technology. The conference set up a variety of activities such as general report, session report, poster exchanging, technical exhibition and technological innovation contest. This conference provided delegates with a good opportunity to exchange new ideas, establish research and/or business contacts, and establish potential partnerships for global partnerships. With best regards, Organizing Committees of PEER Kobe, Japan

The Impact of Mindfulness-based Cognitive Therapy in enhancing Psychological Resilience among basic education teachers in Oman: Longitudinal Study

The current study aimed to investigate the impact of Mindfulness-based cognitive therapy counseling program in enhancing the psychological resilience of basic education teachers in the Dhofar Region, south of the Sultanate of Oman. The experimental study sample consisted of (60) male teachers in cycle two of basic education in Dhofar Governorate with low psychological resilience scores. This sample was randomly divided into two equivalence groups: one experimental group and the other control group. Each group consisted of (30) male teachers. The counseling program was applied for the male teachers in the experimental group rather than the control group to develop psychological resilience with them. The researchers have used the psychological resilience scale (prepared by the researchers) and a counseling program based on mindfulness-based cognitive therapy (prepared by the researchers). The results of the study indicated that there were statistically significant differences at level (0.01) between the mean scores of the experimental and the control group in the post-test on the psychological resilience scale in favor of the experimental group. There are also statistically significant differences at the level of (0.01) between the mean scores of the experimental group in both the pre-test and post-test on the psychological resilience scale in favor of the post-test. This revealed the effectiveness of mindfulness-based cognitive therapy in increasing the level of psychological resilience among male teachers as the scores of teachers rose significantly on the pre-test. In addition, the study has also concluded with finding non-statistically significant differences at the level of (0.05) between the mean scores of the experimental group in both pre-test and follow-up tests on the psychological resilience scale. The results emphasise continuing mindfulness-based cognitive therapy's effectiveness in increasing psychological resilience among male teachers. In the light of the results, it can be recommended by: Organizing workshops and open discussion forums between teachers, as this approach will significantly motivate social relations, reinforce confidence among teachers, and enhance occupational performance.

Synergy and collaboration with young educators and students: Insights from an open forum on generative artificial intelligence in medical education.

Synergy and collaboration with young educators and students: Insights from an open forum on generative artificial intelligence in medical education.

The case for global governance of AI: arguments, counter-arguments, and challenges ahead

AbstractIt is increasingly recognized that as artificial intelligence becomes more powerful and pervasive in society and creates risks and ethical issues that cross borders, a global approach is needed for the governance of these risks. But why, exactly, do we need this and what does that mean? In this Open Forum paper, author argues for global governance of AI for moral reasons but also outlines the governance challenges that this project raises.

Open Forum in the Dedicated Issue of East European Holocaust Studies on Oral History and the Holocaust

Abstract The text contains answers to 5 questions concerning the use of Oral History in Holocaust research in Eastern Europe and the author’s opinions and experiences with the use of this method.

Centering diversity, equity, and inclusion in a regional professional nursing organization

BackgroundProfessional nursing organizations can respond to threats to social justice by strengthening structures to support diversity, equity, and inclusion (DEI). PurposeDescribe implementation strategies and outcomes to advance DEI from the Western Institute of Nursing (WIN). MethodsIn 2019, WIN committed to prioritizing DEI by updating its vision and mission. A taskforce was assembled to conduct member surveys, focus groups, and open forums to generate recommendations on developing and implementing organizational change. DiscussionThese initiatives culminated in centralized efforts that include the formation of a standing committee, ongoing member surveys, selection of diverse conference topics and speakers, adoption of inclusive practices, and ongoing assessments to make recommendations to the Board to advance DEI. ConclusionThe work of the Committee ensures the organization remains committed to DEI. These strategies inform other nursing organizations as they advance DEI to impact research, education, policy, and practice.

Behavioral Health Workforce Development in Washington State: Addition of a Behavioral Health Support Specialist.

The mental and behavioral health workforce shortage has hindered access to care in the United States, resulting in long waitlists for persons who need behavioral health care. Global models for task sharing, combined with U.S.-led studies of nonspecialists delivering interventions for depression and anxiety, support the development of this workforce in a stepped care system. This Open Forum highlights an innovative effort in Washington State to initiate a bachelor's-level behavioral health support specialist curriculum leading to credentialing to expand the mental health workforce and improve access to care for people with depression and anxiety.