Part Of Practice Research Articles

Changes in patient-reported outcomes during admission to a South African psychiatric facility.

Patient-reported outcome measures (PROMs) are used as part of clinical practice to determine the impact of the condition and treatment interventions on a patient's health and quality of life. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered diagnostic tool that has been widely adopted for the detection and monitoring of depression. This analysis reports the change in PHQ-9 scores from admission to discharge in patients admitted for depression to a South African acute psychiatric facility and aims to quantify the treatment effect of the admission using the PHQ-9 as the measurement tool. South African acute psychiatric facility. This was a retrospective observational study of all patients admitted to Netcare Akeso acute psychiatric facilities from 01 January 2018 to 31 October 2022. Patients were included if they were ≥ 18 years of age, admitted with a primary International Classification of Disease (ICD)-10 code for depression (i.e. F32-F33) and fully completed both an admission and discharge PHQ-9 questionnaire. We excluded facilities focusing only on the treatment of patients with specialised conditions such as addiction or eating disorders. This analysis included 13 308 patients admitted for depression at 10 different facilities. The median PHQ-9 score on admission was 19 (interquartile range [IQR] 14-23) and 5 (IQR 2-11) on discharge, with a median change of -12 (IQR -5 to -18). A minimal clinically important difference was seen in 87.6% patients (n = 10 091/11 515); a treatment effect was seen in 74.5% of patients and a clinically significant improvement was seen in 72.1% of patients. With the average patient reporting a four-fold reduction in the severity of their depression scores, PROMs provide a critical patient-centred window into the benefit that an inpatient admission has on those suffering with depression. These changes are consistent with those seen internationally and provide a baseline for understanding the treatment efficacy of an inpatient admission for the treatment of depression.

An Evaluative Study to Determine the Extent of Shat Al-Arab Corniche Design Conformity with Active Urban Design Principles

The trend of active urban design appeared in the year 2005, and as a result of the increasing factors encouraging inactivity and lack of physical activity, cities began to move towards active urban design to make physical activity part of daily practices in the urban environment, which supports the health of its residents. The research dealt with the concept of active urban design, its principles, and the most important influences on human behaviour that encourage active practice in the urban environment. Then the history of physical activity in the city of Basra and inherited popular sports was reviewed, then the extent to which the urban development processes that took place in Corniche Shatt Al-Arab Street and the surrounding area were achieved was measured. Due to its historical, social and economic importance and the conclusions that accompanied the measurement process related to the most important obstacles facing the city in its path towards a sustainable urban design that preserves the health of its residents.

Qualifications of the Ideal Tourism School Administrator: A RepGrid Review

The school administrator has one of the most important roles in the success of an institution and in the execution of processes, especially in some fields like tourism including practical parts. For this success and effective management, there are certain qualities that the school administrator should have. The aim of this study is to examine the cognitive constructs of teachers and to reveal the qualities that the administrator working in tourism should have. Repertory Grid Technique was used in the study, which was prepared according to qualitative research patterns. The study group consisted of 40 teachers working in tourism schools, who worked with at least 6 different administrators. As a result of the study, honesty (η=8, 20.0%), (2) fairness (η=6, 15.0%), (3) personal feature; emotional intelligence; sensitivity (η=5, 12.5%) are the most important qualifications. When these results are taken into consideration, it becomes clear that ideal school administrators should pay attention to these qualifications. It is an important suggestion to pay attention to these qualities in the selection of tourism school administrators.

Workplace learning: the bidirectional relationship between stress and self-regulated learning in undergraduates

The present study focused on the relationships between various aspects of self-regulated learning (SRL) and stress among undergraduate health science students in workplace settings. Although both constructs are associated with academic achievement (Ahmady Set al., in J Educ Health Promotion 10:32, 2021, Cho KK et al., in BMC Med Educ 17:112, 2017), it is still unclear how they influence each other. Employing a longitudinal diary design, the aim of the present study was to examine whether perceived stress in the previous week impacts SRL-aspects in the current week and, conversely, whether SRL-aspects in the previous week impacts stress in the current week. Subjects were 192 undergraduate health sciences students in their workplace placements. SRL-aspects and stress were assessed using scales and previously tested single-item measures. The 21 SRL-aspects used in this study included cognition (learning strategies), motivation, emotion, perception of the learning environment, and regulation of these areas on a metalevel (monitoring and control). Data collected over 15 weeks were analyzed using multilevel vector autoregressive models, with the data nested within weeks and one model dedicated to each SRL-aspect and its relationship with stress. Among the 21 path estimates assessing the impact of prior stress on individual SRL-aspects, 10 were statistically significant. For individual SRL-aspects impacting stress, 7 out of 21 paths were statistically significant (p < .05). Notably, no model showed statistical significance of effects in both directions. Except for two results, cross-lagged relationships were negative, indicating that better SRL-aspects from the previous week resulted in reduced stress in the current week and vice versa. The effects for the cross-lagged paths from SRL-aspects to stress were predominantly of medium size, whereas the influence of stress on individual SRL-aspects was predominantly small. The present study highlights a potentially causal and mostly negative relationship between stress and various aspects of SRL, but also that the individual relationships require differentiated consideration. The results can be used to develop targeted interventions in the practical part of the training of health science students to reduce stress and improve specific aspects of SRL. Furthermore, these findings underscore assumptions regarding connections between anxiety and increased stress, negative relationships between stress and motivation, and the importance of effective time management strategies for stress reduction.

No evidence of mutations associated with anticoagulant resistance in gene Vkorc1 in brown and black rats from Barcelona

Synanthropic rodents such as the brown rat (Rattus norvegicus) and black rat (Rattus rattus) are a source of disturbance in urban areas and the focus of control programs. Control measures often rely on anticoagulant rodenticides, but their broad use is compromised by the emergence of resistance. Here we studied the prevalence of anticoagulant resistance genotypes in the Vkorc1 gene in rats in the metropolitan area of Barcelona. In this area, part of the management practices to control brown rats include anticoagulant rodenticide use, but rodenticides with different active ingredients are used in rotation. Brown rats were sampled from the sewage system during two periods: from December 2016 to November 2017 when difenacoum and brodifacoum were used, and from August 2021 to July 2022 when bromadiolone was used. Because black rats have just recently been detected in Barcelona, we only studied them during the latter sampling period, with samples obtained from a control action carried out in a green urban area. Exon 3 of the Vkorc1 gene was characterized in both species, while exon 1 was additionally analyzed in black rats. Synonymous mutations, not resulting in amino-acid changes, were found in both exons, indicating no evidence of anticoagulant resistance in the rats of Barcelona. This finding indicates that the current rodent management plan in Barcelona, which involves anticoagulant rotation for brown rats and the use of life capture traps in specific situations for black rats, has helped to prevent the emergence of resistance to anticoagulant rodenticides in rats in Barcelona. Future actions should aim to diversify the control measures included in the rodent management plan.

STUDY OF THE INFLUENCE OF ARTIFICIAL INTELLIGENCE TECHNOLOGIES ON THE INDEPENDENT FORMATION OF INFORMATION CULTURE IN TEENAGERS WITH VISUAL IMPAIRMENTS

In this regard, this study aims to investigate the peculiarities of the influence of artificial intelligence technologies on the process of independent formation of information culture in adolescents with visual impairment. To achieve the goal, the methods of analysis, deduction, classification, and systematization were used, and an experiment was conducted regarding the influence of artificial intelligence on the education of teenagers with visual impairments in schools in Kazakhstan. This paper reveals the technologies of artificial intelligence and describes the social necessity of providing equal access to education and information for persons with disabilities. The practical part reveals the importance of developing methods and ways to meet the needs related to social interaction and information culture. The study included a questionnaire aimed at understanding the individual experience of visually impaired teenagers in the use of artificial intelligence technologies. The total sample was 30 students aged between 13 and 17 years old. The paper showed an analysis of the impact of technology on visually impaired adolescents and presented statistics on the use of these technologies in children's learning. In addition, the experience of using artificial intelligence technologies was identified and the impact of artificial intelligence technologies on the development of analytical and critical skills of adolescents was investigated. The work revealed possible problems and ways to improve social adaptation and proposed practical recommendations for educational institutions and specialists working with adolescents with visual impairments. The research materials are of practical and theoretical value for pedagogy, typhlo pedagogy, psychology, and sociology, as they help to reveal the prospects of teaching blind or visually impaired children.

Report on the first All-Russian Student Olympiad on Endoscopy

Purpose: To demonstrate the results of the first All-Russian Student Olympiad on Endoscopy. Materials and methods: The team of authors prepared and conducted the first All-Russian Student Olympiad on Endoscopy within the framework of the conference «Topical Issues of Endoscopy». The Olympiad was held in two stages, which allowed evaluating the theoretical knowledge and practical skills of the participants. The topic of the first All-Russian Student Olympiad was upper GI tract endoscopy. The first stage consisted of testing and a quiz. The test was devoted to general issues of endoscopy, and the quiz was devoted to bleeding from the upper GI tract and methods of endoscopic hemostasis. The second stage consisted of a practical part and answers to the judges’ questions. The practical part involved performance of video endoscopy on a biopreparation (porcine esophagus and stomach), identification of a conditional ulcer complicated by bleeding and performance of endoscopic hemostasis by clipping. When performing the task, the team spoke through all their actions. After the manipulation, each team answered 2 questions from the judges. Results: The results of the All-Russian Student Olympiad revealed three winners. 1st place: the team of the N. I. Pirogov Russian National Research Medical University (A. A. Klimenko, 3rd year student; K. A. Kuznetsova, 5th year student; A. I. Khizhnyak, 5th year student); 2nd place: the team of the St. Petersburg State Pediatric Medical University (D. K. Skalinsky, 3rd year student; A. D. Komarova, 3rd year student; I. A. Cherepakhina, 5th year student); 3rd place: the team of the V. A. Almazov National Medical Research Center FSBI of the Ministry of Health of Russia (A. D. Shelimanova, 4th year student; Yu. M. Bogdanov, 5th year student; M. V. Chukin, 4th year student). Conclusion: The event enabled the students to show curiosity, determine the attitude to the future profession, demonstrate their knowledge and manual skills in the field of endoscopy, as well as gain experience in teamwork. Evaluating the work of the novice endoscopists, the leading specialists in the field of surgery and endoscopy identify promising students, which has a positive impact on attracting young promising specialists to the profession.

Experiences of integrating social prescribing link workers into primary care in England: Bolting on, fitting in or belonging.

Following the 2019 NHS Long-Term Plan, link workers (LWs) have been employed across primary care in England to deliver social prescribing (SP). To understand and explain how the LW role is being implemented in primary care in England. Realist evaluation undertaken in England. Focused ethnographies around seven LWs from different parts of England. As part of this, we interviewed 61 patients and 93 professionals from healthcare and the voluntary, community and social enterprise (VCSE) sector. We reinterviewed 41 patients, seven LWs and a LW manager 9-12 months after their first interview. We developed four concepts around how LWs are integrated (or not) within primary care: Centralising or diffusing power; Forging an identity in general practice; Demonstrating effect; Building a facilitative infrastructure. These concepts informed the development of a programme theory around a continuum of integration of LWs into primary care - from being 'bolted on' to existing provision, without much consideration, to 'fitting in', shaping what is delivered to be accommodating, through to 'belonging', whereby they are accepted as a legitimate source of support, making a valued contribution to patients' broader well-being. SP was introduced into primary care to promote greater attention to the full range of factors affecting patients' health and well-being, beyond biomedicine. For that to happen, our analysis highlights the need for a whole system approach to defining, delivering and maintaining this new part of practice.

PIONEER REAL UK: A Multi-Centre, Prospective, Real-World Study of Once-Daily Oral Semaglutide Use in Adults with Type 2 Diabetes.

Oral semaglutide provides an alternative to injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) for treatment of type 2 diabetes (T2D). The PIONEER REAL studies evaluate clinical outcomes of oral semaglutide treatment of T2D in a real-world setting. PIONEER REAL UK focused on adults living with T2D in the UK. The multi-centre, prospective and non-interventional single-arm study enrolled 333 participants and followed them for 34-44 weeks. Participants were treated as part of routine clinical practice and had not been previously treated with injectable glucose-lowering medication. The primary endpoint was change in glycated haemoglobin (HbA1C) from baseline to end of study (EOS). Secondary endpoints included change in body weight, proportion of participants with HbA1C < 7% (53 mmol/mol) at EOS and proportion of participants with ≥ 1%-point HbA1C reduction and body weight reduction of ≥ 3% or ≥ 5% at EOS. Treatment satisfaction was assessed by Diabetes Treatment Satisfaction Questionnaire (DTSQ) status and change. Of 333 participants, 299 completed the study and 227 were on treatment at EOS. People treated with oral semaglutide experienced significantly reduced HbA1C by an estimated change of - 1.1%-points (95% CI - 1.27 to - 0.96; P < 0.0001) or - 12.2 mmol/mol (CI - 13.87 to - 10.47; P < 0.0001). Estimated change in body weight was - 4.8 kg (CI - 5.47 to - 4.12; P < 0.0001). At EOS, an HbA1C level < 7% (53 mmol/mol) was recorded in 46.3% of participants. A ≥ 1%-point reduction in HbA1C combined with a ≥ 3% reduction in body weight was observed in 36.4% of participants, and 27.1% had a ≥ 1%-point reduction in HbA1C and a ≥ 5% body weight reduction. Treatment satisfaction improved significantly during the study. No new safety concerns or cases of severe hypoglycaemia were reported. People living with T2D in the UK experienced a meaningful decrease in HbA1C and body weight after initiation of oral semaglutide treatment. No new safety issues were observed. ClinicalTrials.gov: NCT04862923. Graphical plain language summary available for this article.

Biodiversidade faunistica coletada em 3 locais diferentes com pelo menos 10 espécies de insetos

Taxonomy, Systematics, and Phylogeny are important fields of study in the context of Biological Sciences. Studying biodiversity as well as understanding the evolutionary relationships between taxa is of fundamental importance. The objective of the present work is to demonstrate the presence of several species of insects, particularly mosquitoes, collected in the 2024.1 semester, by students of the mandatory discipline of General Systematics and Phylogênia (TA 464) as a practical part of the discipline's activities mediated by Academic Monitoring. The students of the discipline of General Systematics and Phylogeny (TA 464), due to the practical work carried out throughout the 2024.1 semester, postulate that it is a matter of time for the arrival of oropouche fever in the city of Tauá due to the faunal biodiversity of mosquitoes in the city and the fact that BR 020 serves as a "corridor" for the entry and exit of humans and mosquitoes transported by motor vehicles circulating 24 hours a day. day on BR 020. Stressing that interdisciplinary and transdisciplinary measures must be taken to minimize the impact on the population. As well as new research should be carried out with partnerships between CECITEC and LACEN/Tauá.

Conservation of Food, Medicinal and Dyes Crops Based on Local Community Wisdom in Mareje Village, West Lombok

Mareje Village, located in Sheet District, West Lombok Regency, NTB, Indonesia, is one of five villages and sub-districts in the Sheet District area. Nature protection is carried out to care for and protect natural resources, including flora, fauna, ecosystems and the environment. It involves a series of actions to ensure the sustainability and balance of ecosystems and natural habitats. This research aims to identify various food, medicinal and dye plants that have long been part of the conservation practices of the Mareje Village community. The research method used is descriptive qualitative, with data collected through trusted online sources, as well as interviews and questionnaires with local residents. The research results show that the people of Mareje Village still rely on various plants as a source of food, dyes and medicine. This includes rice, corn, cassava, taro, long beans, peanuts, green beans, and sweet potatoes for food; turmeric, pandan, katuk leaves, butterfly pea flowers, and dragon fruit for coloring; as well as white binahong, cat's whiskers, castor leaves, Chinese betel leaves, katuk leaves, black turmeric, bridal flowers, and horsewhip for medicine.

Domestic violence: alcoholism as a cause and a contributing factor

The article examines the influence of alcoholism as one of the main factors contributing to domestic violence. It was established that alcoholism is a problem that significantly increases the psychological causes of violence, is a significant factor that affects the spread of domestic violence, as it significantly changes a person’s behavior and psycho-emotional state. Under the influence of alcohol, people can lose self-control, become more aggressive and prone to violent actions, which is especially dangerous in the home environment, where interaction takes place against the background of close relationships and emotional dependence. It is motivated that people under the influence of alcohol can exaggerate the importance of minor misunderstandings or react to them with disproportionate aggression, which leads to the escalation of conflicts that could be resolved without violence under normal circumstances. It is indicated that an important aspect is that alcoholism affects the psychological state of all family members. Victims of violence, especially domestic violence, often feel isolated and vulnerable, which can lead to social tension and conflict in communities. Victims of domestic violence may experience constant fear and stress due to the unpredictability of their partner’s behavior, which creates a state of chronic tension that can lead to mental disorders. It is highlighted how the use of alcohol changes a person’s behavior, reducing his ability to self-control and increasing the risk of aggressive actions. Particular attention is paid to how alcoholism creates economic instability and psychological stress for victims, making it difficult to get out of violent relationships. The social aspect of the problem was also investigated, in particular the influence of the cultural legitimization of alcohol on the perception of violence. In some societies, alcohol is part of a cultural practice that can contribute to the normalization of aggressive behavior and reduce the perceived seriousness of violence. To effectively combat domestic violence, it is necessary to change social norms and raise awareness of the negative consequences of alcoholism, while providing adequate support to victims.

Can You Stop Your Mind and Your Daily Activities?

The paper investigates meditation as a state of consciousness that isolates an individual from the attitude of everyday life and the perspective of practical actions. It is an “ethnography of the mind” instead of the place. The paper analyses self-reports from meditators’ self-observations as part of hatha yoga practice and data from semi-structured interviews with hatha yoga teachers. Elements that distract or help people meditate were analysed and interpreted. The features of the meditative state during the practice of sitting meditation are also reconstructed. Attention is paid to three essential aspects that are related to each other when entering the meditative state: emerging thoughts, body sensations, and emotions. The analysis focuses on how practitioners deal with these obstacles; what tactics do they employ to eliminate barriers or redirect attention and include them in the background of the concentration point? What is the role of teaching meditation? What are the effects of meditation from a practitioner’s point of view? Empirical materials obtained from the first-person perspective of the researcher, the author of this article, and his collaborators in the study were also analysed.

A descriptive study of the connections between social risk and healthcare utilization with supportive oncology care

Objective This study utilized social risk data in the electronic heath record collected as part of routine clinical practice and examined relationships with supportive oncology care contacts and healthcare utilization. Methods A total of 2,807 cancer patients were screened for four social determinants of health (SDOH) domains (financial resource strain, housing instability, food insecurity, and transportation need) and categorized to low or high risk SDOH groups. The number of patient contacts with supportive oncology was compared amongst the groups. The data were analyzed for demographic and outcome differences including emergency department visits, inpatient admissions, and appointment adherence. Results Heightened social risk was associated with more total contacts with supportive oncology care. Patients with high SDOH risk had more contacts across all outcomes examined including emergency department visits (M = 13), inpatient admissions (M = 14), and missed appointments (M = 11). Conclusions Patients with both greater social risks and acute care utilization are associated with more psychosocial interventions in supportive oncology follow-up. These findings highlight the need for comprehensive action to respond to social risk factors identified in SDOH screening.

Biostimulation methods based on chemical communication improve semen quality in male breeder rabbits

Biostimulation aims to optimize reproductive parameters as part of animal management practices by modulating animal sensory systems. Chemical signals, mostly known as pheromones, have a great potential in this regard. This study was conducted to determine the influence of short-term male rabbit exposure to different biological secretions, potentially pheromone-mediated, on reproductive parameters of males. Four groups of 18 males each were exposed to A) doe urine, B) 2-phenoxyethanol, C) doe vaginal swab, and D) distilled water (control), three times over a 2.5h exposure window, just before semen collection. Semen volume, sperm concentration and motility, as well as subpopulation analysis of the spermatozoa were assessed for each condition. Additionally, testosterone levels in blood samples were monitored at five time points over the 2.5 h exposure window. We found a higher percentage of motile, progressive, fast progressive and mid-progressive spermatozoa in any of the three experimental groups compared to the control group. In contrast, the semen volume and the percentage of immotile and non-progressive spermatozoa was generally higher in the control group. We then identified a higher proportion of a subpopulation of fast and progressive spermatozoa in groups A, B, and C compared to group D. Our data indicates that sperm motility increases when animals are exposed to specific biological fluids potentially containing pheromones, and that an increase in sperm volume does not correlate with an increase in spermatozoa concentration, progressiveness, and speed. Finally, no differences in testosterone levels were found among comparisons, although males of groups A and C (exposed to natural female biological fluids) showed a tendency towards higher testosterone levels. In conclusion, our results indicate that rabbit sperm quality increases upon exposure to the biological secretions proposed, thereby supporting further investigation into their molecular identity. This exploration could eventually pave the way for implementing the use of pheromones in rabbit husbandry to enhance reproductive and productive parameters in farmed rabbits.

Telelactation Within the Landscape of Breastfeeding Support: Experiences of Latina Parents.

Despite increasing breastfeeding initiation rates in the United States, disparities in breastfeeding continuation and exclusivity by race and ethnicity persist. We aimed to understand the perceptions and experiences of Latina parents who received access to telelactation, and assessed the implications of integrating telelactation into pediatric settings. This cross-sectional qualitative study drew from participants enrolled in a randomized controlled trial about breastfeeding support. We recruited 20 participants from among those participating in a randomized controlled trial assessing the effect of telelactation on breastfeeding outcomes. The study design was informed by an Equity-Centered Model and authentic entry. We conducted a thematic content analysis through an iterative approach, where we systematically generated themes to describe code application patterns. We identified three themes: (1) telelactation within the broader landscape of breastfeeding support; (2) perceptions of telelactation support; and (3) recommendations on the use of telelactation in the context of pediatric care. We found that participants had an escalation approach for seeking breastfeeding support and propose a new model: Breastfeeding Support Escalation Protocol, which can be applied to lactation support in pediatric care. Parents' perceptions and recommendations highlighted their desire for care coordination, expanded options for telelactation engagement, and care continuity, which are important reflections for pediatric offices considering integrating telelactation services into their practice. Latina parents found telehealth to be helpful and an acceptable alternative to in-person services. Pediatric offices can take steps toward becoming Breastfeeding-Friendly by partnering with telelactation services. More research is needed on the logistical implications and cost-effectiveness of telelactation services as part of the pediatric practice.

An exploration of UK speech and language therapists' treatment and management of functional communication disorders: A mixed-methods online survey.

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care. What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.

Ocular effects of Rho kinase (ROCK) inhibition: a systematic review.

Topical therapies targeting Rho-associated protein kinase (ROCK) signalling, including netarsudil (Rhopressa®) and ripasudil (Glanatec®), have become widely adopted as part of standard clinical practice to lower intraocular pressure (IOP) in patients with ocular hypertension or glaucoma. Given the pleiotropic roles of ROCK signalling, ROCK inhibition has the potential to cause unintended ocular side effects beyond IOP lowering in other substructures of the eye, both beneficial and deleterious. Additional experience and observation of patients treated with this class of medications have uncovered both new side effects not reported in the initial clinical trials, as well as potential benefits that have inspired off-label uses and that have been the topic of numerous clinical studies, case series, case reports, and translational studies. Here, we performed a comprehensive systematic review and identified 170 studies describing ocular effects of ROCK inhibition. In addition to describing well-established ocular effects associated with inhibition of ROCK signalling, such asconjunctival hyperaemia, corneal verticillata, and reticular corneal epithelial oedema, we also highlight other effects, such as corneal haemorrhages, changes in corneal contour, anterior subcapsular opacities, contact dermatitis, punctal stenosis, and eyelid wound dehiscence, which have been described in case series and case reports. Finally, we evaluated studies describing potential novel applications of ROCK inhibition for treating disorders affecting the cornea, the retina, and the optic nerve, finding strong evidence in support of a beneficial effect of ROCK inhibitors on corneal oedema due to corneal endothelial cell dysfunction. The other potential applications require further research.

Changing indications for keratoplasty: monocentric analysis of the past two decades

Abstract Purpose Over the past two decades, lamellar keratoplasty procedures, such as Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet's Membrane Endothelial Keratoplasty (DMEK) as well as Deep Anterior Lamellar Keratoplasty (DALK), have become an integral part of clinical practice. With advances in contact lens fitting for keratoconus management and the implementation of UVA-Riboflavin Crosslinking (CXL), the landscape of keratoplasty indications is undergoing changes. Procedures and indications in a single tertiary care center over the past two decades are reviewed in this retrospective analysis. Methods: Retrospective analysis utilized anonymized electronic data from the LIONS cornea bank Baden-Württemberg, Eye Center Freiburg, spanning from beginning of 2004 to end of 2023. The primary focus was on surgical procedures and indications for keratoplasty. Results The study encompassed a comprehensive analysis of 7130 corneal transplants. Penetrating keratoplasty (PK) exhibited a significant decline from 95% (n = 206, 2004) to 11% (n = 46, 2023), while DMEK increased from 48% (n = 157, 2012) to 82% (n = 347, 2023). Fuchs endothelial dystrophy (FED) emerged as the dominant indication, witnessing a significant increase from 24% (2004, n = 39) to 72% (2023, n = 288). Conversely, keratoconus (KC) showed a reciprocal change from 25% (2004, n = 40) to 4% (2023, n = 17). PK demonstrated a noteworthy indication shift in descending order from Bullous Keratopathy (BK), FED, and KC in 2004 to KC, graft failure, corneal scars, and ulcers in 2023. Repeat keratoplasty following DMEK remained rare, but a discernible upward trend was observed for PK. Conclusion This retrospective analysis highlights significant changes in both keratoplasty indications and techniques over the past two decades. DMEK has emerged as a successful intervention for treating endothelial diseases, while PK retains its qualitative indispensability for a wide range of indications. Modern corneal banks are urged to maintain a robust supply of grafts for all surgical techniques in anticipation of potential increased demand in the future, particularly for repeat keratoplasties. Key messages What is known • Over the past two decades, lamellar keratoplasty procedures such as DSAEK and DMEK have increasingly replaced penetrating keratoplasty (PK) in clinical practice due to their improved outcomes and reduced complications for certain indications. New Findings • Our study reveals a significant shift in keratoplasty indications, with Fuchs endothelial dystrophy (FED) emerging as the predominant indication, increasing from 24% in 2004 to 72% in 2023, while keratoconus (KC) declined from 25 to 4% during the same period. • Penetrating keratoplasty (PK) has shown a marked decline in use, dropping from 95% of keratoplasties in 2004 to 11% in 2023, whereas DMEK has grown to represent 82% of procedures in 2023. • Despite the rise of DMEK, PK remains vital for a broad spectrum of indications, highlighting the necessity for corneal banks to maintain a versatile supply of grafts to meet diverse clinical needs, particularly in cases of repeat keratoplasties.

NATO Support and Procurement Agency: a Powerful Instrument of Collaborative Logistics

The paper evaluates the level of cooperation between the Ministry of Defence and the NATO Support and Procurement Agency (NSPA) in the field of procurement of military equipment. In the practical part, the results of the research on the level of participation of Czech-based suppliers in NSPA activities between 2018 and 2022 are presented. Pareto analysis comparing the participation of the Czech and international companies in contracts implemented by NSPA in terms of their subject, quantity and financial value is used. Qualitative case studies from three different areas illustrate in which NSPA projects the Czech Republic has already been involved in and which benefits and risks are associated with this cooperation for the MoD. Positives and drawbacks in the process of acquiring military equipment in-house and opportunities and threats that may arise from the acquisition of military equipment through the NSPA are summarised in the form of the SWOT analysis. Finally, recommendations are presented on how to improve the cooperation between the MoD and the NSPA in the field of acquisition.