Survey Of Practices Research Articles

Assessing disaster mental health preparedness among primary health care physicians of Karnataka, India: Designing and conducting a knowledge, attitude, and practice survey

Background: Disaster mental health is a critical yet neglected aspect in India. Primary care physicians (PCPs) play a crucial role in mitigating mental health challenges following disasters. This study conducted a knowledge, attitude, and practice (KAP) survey among PCPs in Karnataka to assess their disaster mental health preparedness. Methods: A cross-sectional online survey was conducted from February to May 2023 targeting PCPs across 29 districts of Karnataka in a convenient snowball sampling method. The questionnaire review included KAP questions on disaster mental healthcare. A total of 324 PCPs responded. Results: Knowledge scores were moderate (mean: 7.05), attitudes were positive (mean: 9.15), and practices were poor (mean: 0.32). Significant correlations were found between clinical experience and knowledge/attitudes/practices (rho 0.358, P < 0.001; rho 0.147, P = 0.007; rho 0.232, P = 0.003). Conclusion: There is a large gap between theoretical knowledge and practical preparedness in disaster mental health. Training programs and government initiatives are essential to improve preparedness among PCPs.

Awareness Regarding Medical Device Safety among Physicians: A Knowledge, Attitude, and Practice Survey

Abstract Background: With the huge inflow of medical devices into the healthcare market, it is imperative to monitor the device safety throughout its period of usage, with the help of a systematic continual surveillance mechanism. Although the Materiovigilance Program of India has been formally introduced since 2015, there exists a dearth of awareness regarding its existence and functioning among the major stakeholders of patient safety. Addressing this gap, the study probes the awareness regarding materiovigilance among the doctors in eastern India. Methods: A cross-sectional questionnaire-based study was carried out using a 20-item structured survey tool to evaluate the knowledge, attitude, and practice of medical professionals regarding safety surveillance of medical devices. Responses obtained were statistically analyzed and interpreted. Results: Principal elements of medical device adverse event (MDAE) reporting were known to around 40% of respondents. However, the time frame for reporting an event/incident was found to be grossly unclear. Over 30% of respondents were aware of the effect of MDAEs and that its reporting could enhance patient safety. Items related to practice domains revealed that although around 50% of respondents of either category encountered MDAEs in their practice setup, only 10.95% of faculty and 6.41% of residents have reported it. Less than 5% of the respondents were ever trained on how to report MDAEs. The mean domain score for knowledge was on higher mark for the faculty, while that for attitude and practice domains were higher for the residents. Conclusion: There was a gross dearth of awareness regarding materiovigilance among the doctors. Enhanced sensitization regarding medical device safety surveillance in all healthcare levels can definitely help the situation ensuring patient safety.

Assessing capacity for hereditary cancer risk assessment in metro Chicago.

307 Background: Since 2005, the United States Preventive Services Task Force (USPSTF) recommends that primary care (PC) clinicians identify and refer adults with a high-risk cancer family history to cancer genetic services (CGS), yet hereditary cancer risk assessment (HCRA) continues to be underutilized in PC. A population-based approach to HCRA in PC settings can expand access to cancer prevention and early detection to vulnerable populations and reduce disparities in cancer outcomes. The Chicago Cancer Screening and Testing Access Coalition (CCSTAC) is developing strategies to integrate HCRA in PC settings. We conducted an environmental scan to assess current capacity to deliver 1) HRCA in Federally Qualified Health Centers (FQHCs) and 2) follow-up CGS for high risk patients. Methods: In 2023, we administered two surveys to assess HCRA practices in Metro Chicago. We invited 22 FQHCs to complete a 21-item survey of current practices, readiness to implement, and barriers to HCRA. We also invited 21 CGS sites to complete a 25-item survey to understand staffing, utilization, referral patterns, and barriers to access. Surveys were administered electronically via Qualtrics. We conducted a descriptive analysis of survey data. Results: Twenty FQHCs (91%) completed the survey on HCRA in PC; 85% reported familiarity with USPSTF guidelines for HCRA. The majority (75%) reported no plans to implement HCRA. Clinic workflow, paucity of follow-up resources, cost, lack of provider knowledge, and absence of HCRA as a mandatory performance measure were cited as the most significant barriers to implementation. Genetic counselors (GCs) from 19 CGS hospital-based sites (90%) completed the survey on availability of genetic services. CGS were most often located in a cancer center (47%); no CGS were located in PC. Most referrals originated from oncology, surgery, or gastroenterology, with the lowest rate of referrals from community-based PC. Nearly half of CGS clinics (47%) reported capacity for at least a small increase in patient volume. Wait-time at the majority of CGS clinics was less than a month. GCs cited patient logistics (e.g. transportation, time off work), lack of referral information from providers, and systemic racism as significant barriers in patient access to CGS. Conclusions: After almost 20 years of evidence-based guidelines, use of HCRA is still very limited in the community-based PC setting. Our findings point to a need to bridge the gap between hospital-based CGS and FQHCs to ensure patients in vulnerable communities have access to guideline-concordant cancer prevention and screening strategies. Based on these findings, CCSTAC is designing strategies to integrate HCRA in primary care at FQHCs focused on provider education, well-designed clinic workflows, connections with existing CGS, and advocacy to align UDS and HEDIS measures with USPSTF guidelines.

A survey of obstetrical anesthesia health equity practices at academic centers in the United States (US)

BackgroundLimited research has explored obstetrical anesthesiologists' perceptions of healthcare disparities associated with labor and delivery. The objective of this study was to evaluate the perception of obstetrical anesthesia related healthcare disparities, drivers of disparities, and potential solutions. MethodsAn online survey was emailed to division leads at Accreditation Council for Graduate Medical Education (ACGME) accredited obstetrical anesthesiology programs in the United States. The survey included a mixture of yes/no, select all that apply, and free-text questions. Descriptive statistics were used to characterize variable distribution. Free text responses were categorized into themes by selective coding. Results149 surveys were delivered, 74 surveys were conducted (50 %), and 57 were completed entirely (38 %). Fifty-seven percent of participants reported perceived presence of obstetrical/obstetrical anesthesia related healthcare disparities. Most participants reported that they consider a patient's cultural preferences during clinical management, collect race/ethnicity data, implement specific practices to address disparities, and analyze outcome data by social determinants of health. The majority of participants reported using additional relevant practice features, including translator services, quality improvement practices, provider rounds, standardized protocols, and cultural competency or diversity training. Thematic analysis of free text responses into drivers of disparities mapped to 6 themes: language barriers, racism or bias, socioeconomics or social determinants of health, access or quality of care, patient-provider interactions or cultural sensitivity, and individual patient factors. ConclusionMost academic obstetrical anesthesia center division leads reported perceived presence of obstetric anesthesia related health care disparities. Efforts should be made to devise targeted solutions to this multifaceted, pervasive problem.

Managing the Costs of Kidney Paired Donation: A Survey of Contemporary US Practice and Challenges

Managing the Costs of Kidney Paired Donation: A Survey of Contemporary US Practice and Challenges

A Survey of Obstetric Anaesthesia Services and Practices in the United Kingdom.

Background Variability in obstetric anaesthetia practice and care delivered within the UK is under-explored. The ObsQoR study explored structures, processes, and outcomes of obstetric anaesthesia in 107 hospitals within the UK's National Health Service, and the results of the hospital-level survey are reported here. Methods Hospitals were surveyed to assess obstetric anaesthesia provision, practice, and care delivery. Questions explored staffing, service provision and training, facilities present, clinical practices, outcome measurement, and key indicators of quality in obstetric anaesthesia. Results We received responses from 106 participating hospitals, representing 69% of all UK obstetric units. One hundred (94%) hospitals had a dedicated consultant obstetric anaesthetist within working hours, with 27 (25%) of hospitals' duty anaesthetists having additional clinical responsibilities outside the care of obstetric patients outside of working hours. Around 102 hospitals (98%) offer multidisciplinary team training, of which 95 (93%) use a simulation-based method. Dedicated high-risk antenatal clinics were present in 50 (47%) hospitals. The majority of hospitals provide written patient information in multiple languages for discussing obstetric anaesthesia options (77, 82%). Seventy-three hospitals (69%) use point-of-care testing to estimate haemoglobin concentration. Labour epidural analgesia is most commonly delivered via patient-controlled epidural analgesia in 80 (76%) hospitals, and the incidence of post-dural puncture headaches was recorded by 80 (76%) hospitals. Conclusions These results demonstrate variation in the provision of staffing, facilities, clinical practices, and outcome measurements across the UK. To deliver safe and equitable care across the UK, there needs to be standardisation of anaesthetic peripartum care based on national recommendations and the benchmarking and measurement of appropriate markers of quality.

A survey of enteral feeding tube practice between nurses and pharmacists

A survey of enteral feeding tube practice between nurses and pharmacists

An international physician survey of current ablation practices in atrial fibrillation: An AIM-AF substudy

BackgroundPractice guidelines recommend ablation (ABL) in atrial fibrillation (AF) for rhythm control. Guidance for antiarrhythmic drugs (AADs) post-ABL is limited. ObjectiveThe purpose of this study was to determine AAD and ABL practices in the United States and Europe. MethodsAn online survey of experienced cardiologists (CDs) (n = 360) and interventional electrophysiologists (EPs) (n = 269) was conducted. AAD- and ABL-related survey questions and responses were analyzed. ResultsABL was preferred more often as first-line AF therapy (Rx) by US CDs/EPs (P ≤.001). ABL was selected to avoid AAD Rx by 46% (50% CDs, 40% EPs); to prevent AF progression by 41% (36% CDs, 47% EPs); and for superior efficacy by 28% (27% CDs, 30% EPs). ABL was used by 9% in asymptomatic AF (9% CDs, 10% EPs), by 14% in subclinical AF (13% CDs, 14% EPs), and by 17% for first AF event (15% CDs, 18% EPs). Primary ABL was preferred in heart failure by 38%. Comorbidities, age, and left atrial size were limitations for ABL by 48%, 40%, and 38%, respectively. AADs were used after ABL for AF/atrial tachycardia (AT) prophylaxis by 34% for 3–6 months and 29% for 1–2 months. AADs were given for a single AF recurrence by 34%, bridging to re-ABL by 32%, and long-term Rx by 34%. AF/AT post-ABL was most often managed with amiodarone (42%–48%). ConclusionABL was frequently preferred over AADs in symptomatic AF but notably also was used for asymptomatic and subclinical AF. Post-ABL AAD Rx for AF prophylaxis or recurrence was frequent, with empiric amiodarone being the most often selected AAD.

Lymph Node Sampling in Pediatric Renal Tumors: Survey of Current Practices and Impact of Education

ObjectiveTo characterize how often and to what extent surgeons are willing to perform retroperitoneal node sampling (RPLNS) for a unilateral renal tumor, and whether they would be encouraged to change goal number of LNs after “targeted education” (TE) MethodsA survey with selected demographic and LN sampling practice questions was distributed to practicing members of the Society of Pediatric Urology (SPU). After answering a seven-question questionnaire, participants were provided with an abstract on the adequacy of LN yield for staging. This served as the TE and then participants were asked to answer a final question on LN sampling goals. ResultsA total of 76 (19.2%) of participants, out of 395 invitations, returned complete surveys. Cross tabulation between sampling goals before and after TE showed that among surgeons sampling 1-4 nodes, 13/24 (54.16%) would be willing to change their practice and sample ≥10 nodes. A higher proportion of participants who were already systematically surveilling 5-9 LNs would be willing to change their current practice: 30/39 (77%) would now aim for ≥10 LNs. On multivariate analysis, only willingness to sample ≥5 LNs in current practice was predictive of changing to sample ≥10 LNs after TE. ConclusionRetroperitoneal LNs are currently still under sampled by pediatric urologists operating on children and adolescents with unilateral renal tumors. Targeted education appears to encourage change in LN sampling practices.

Position of Beta-blockers in the Treatment of Hypertension Today: An Indian Consensus.

Management of essential hypertension (HTN) remains challenging, with contemporary control being achieved in <1/10 of the cases, especially when aligned with the recently updated guidelines of American College of Cardiology (ACC) or International Society of Hypertension (ISH). The place and positioning of beta-blockers have been evolving, with recent focused updates, such as the European Society of Hypertension (ESH) 2023 guidelines, that may hold relevance for the Indian phenotypic traits of premature cardiovascular disease (CVD), fragile coronary architecture, and/or high resting heart rate. To further develop consensus on the clinical role and relevance of beta-blockers, including nebivolol, an Indian consensus was evolved with graded recommendations on their clinical role in HTN, HTN with additional cardiovascular (CV) risk, or type 2 diabetes mellitus (T2DM). An expert review panel was constituted, comprising interventional and clinical cardiologists as experts, to synthesize the literature for the development of a validated knowledge, attitude, and practice (KAP) survey questionnaire. Research databases, including Cochrane Systematic Reviews, PubMed, and Google Scholar, were accessed for contemporary information and guidelines on beta-blockers updated until Dec 2023. Delphi rounds were conducted to develop graded recommendations based on the strength, quality of evidence, and the agreement among the panelists (n = 9). Consensus was achieved on the graded recommendations, with ≥70% of national panelists in agreement. Ninety-six percent of respondents opined that the new ESH HTN guidelines (2023) help gain confidence in using beta-blockers, which are considered first-line drugs for the treatment of HTN. Beta-blockers, including nebivolol, can be recommended in patients with HTN with high resting heart rates, including young hypertensive patients under 40 years of age. For people under 60 years old with HTN, regardless of whether they have comorbid diseases, beta-blockers are the recommended drug choice. Ninety-five percent of respondents opined that nebivolol is the preferred beta-blocker in hypertensive patients with T2DM, followed by bisoprolol and metoprolol. More than 90% of respondents opined that the three most commonly preferred beta-blockers by experts in patients with angina were nebivolol, metoprolol, and bisoprolol. Beta-blockers, including nebivolol, can be considered initial-line therapy for HTN management in real-life settings in India and nebivolol is preferred because of its two important properties: highest beta-1 selectivity and endothelial-dependent vasodilation.

Anticoagulation Strategies for Continuous Renal Replacement Therapy in France: A Survey of Practices

Introduction: Anticoagulation for continuous renal replacement therapy (CRRT) can be performed using systemic anticoagulation or regional citrate anticoagulation (RCA). The 2012 Kidney Disease Improving Global Outcomes guidelines support the use of RCA as the first-line strategy in patients requiring CRRT, with and without bleeding risk. Implementing RCA in the intensive care unit (ICU) implies involving all medical and nursing staff. The primary objective of this study was to report and describe the various anticoagulation strategies for CRRT in French ICUs. The secondary objectives were to determine the rate of RCA use and to identify the factors limiting its implementation. Methods: An online questionnaire containing 40 questions was sent to attending physicians and fellows practicing in French ICUs between May and September 2021. The questionnaire was sent via several networks: mailing list from the French Society of Anesthesia and Intensive Care Medicine and mailing lists of RRT manufacturers. Results: A total of 597 responses were analyzed. RCA was used by most of the participants for patients with (81%) and without (80%) increased bleeding risk. The preferred CRRT modality of the participants while using RCA was continuous veno-venous hemodialysis (48%). The clinical situations frequently reported as an absolute contraindication to RCA were uncontrolled shock associated with liver failure and drug poisoning impairing citrate metabolism (62% and 52%, respectively). In case of a higher risk of citrate accumulation, most participants claimed to perform closer biological monitoring (57%) or to modify the CRRT protocol (61%). Among the participants who did not prescribe RCA as a first-line strategy, the main factors limiting its implementation were the lack of nurse (50%) or physician (34%) training. Conclusion: RCA is the main anticoagulation strategy prescribed for CRRT in France. Providing medical and nursing staff easy access to training may facilitate the understanding and use of RCA as the first-line anticoagulation strategy for CRRT.

Barriers to Pediatric Rheumatology Care: A Survey of Pediatric Clinical Practices at Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates.

Background Access to pediatric rheumatology (PR) is limited in Abu Dhabi, United Arab Emirates, with only three trained pediatric rheumatologists in Abu Dhabi. However, the limited access and current levels of PR care in the Abu Dhabi workforce have not yet been formally assessed. The objective of this study was to evaluate the confidence in the delivery of PR patient care and the need for a structured PR training program among pediatricians. Methods The anonymous web-based Google Forms survey (Google LLC, Mountain View, CA, USA) included 16 items on PR training programs and patient care. The survey was sent to physicians in the pediatric department in Sheikh Khalifa Medical City, Abu Dhabi, through June 2024. Results Among the 54 participants, the majority were general pediatricians (70.4%). Most participants encountered PR patients monthly (51.9%) or weekly (29.6%), yet 87% had less than one year of experience in PR. Confidence levels in examining, investigating, and managing PR patients were generally low to moderate, while physicians primarily reported high confidence in referring patients. A significant need for a structured PR training program at SKMC was identified, with 92.6% of participants advocating for its implementation. Conclusions The majority of pediatricians do not feel confident in examining, investigating, and managing pediatric patients with rheumatic diseases. There is a need for a structured PR program at Sheikh Khalifa Medical City, Abu Dhabi, due to a significant shortage in PR physicians.

Digital Twins in Manufacturing: A Survey of Current Practices and Future Trends

Digital Twin (DT) is the advanced tool of smart manufacturing which provides a proper way to model, analyse, and control the physical systems. A DT is the lifelike rendition of a physical object or phenomenon that uses real-time actual phenomena data to depict its actions, efficiency, and responses within the surrounding context. This technology allows electronic manufacturers to obtain a real-time stream of their systems, in which predictive maintenance, increased operation effectiveness, and improved product quality can be attained. By developing an ever-evolving replica of the physical structures, systems or even operation lines, Digital Twins enable the functionality of exploring various demanding circumstances and schemata, all in order to make effective decisions. When the manufacturing environments are rapidly changing, and there are more interconnections between them, the use of Digital Twins is especially useful. They continue improvement by highlighting problems, forecasting failure, and making choices based on data. The purpose of this article is to examine smart manufacturing via the lens of IoT DT technology. It gives general information about its uses, such as in the processes, time-saving and safety measures. As well, the paper considers the difficulties related to the practical application of DT, including costs, data management, and requirements for the formation of standards. Thus, based on analysing future developments and the role of Digital Twins as an innovation enabler in different industries, this study can benefit scholars, practitioners, and politicians who look forward to unlocking the potential of this innovative solution.

Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.

Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures. A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates. Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months). Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.

Assessment of “Knowledge, attitudes and practice” of the population of the Republic of Tajikistan regarding COVID-19

Introduction. Despite the high level of vaccination, some groups of the population still lack reliable information about vaccines and resources with which to familiarize themselves with it. Social and behavioral changes are a key element of an effective response to COVID-19, such as increasing the level of knowledge of the population through the dissemination of information and educational materials on vaccination of the population against coronavirus infection. The purpose of the study: to assess the level of knowledge about COVID-19, behavioral practices, as well as attitudes towards vaccination and other ongoing anti-epidemic measures among the population of the Republic of Tajikistan. Materials and methods. The study was conducted by the NGO “Subhi Tandurusti” from February to May 2024. To assess the level of respondents in the Knowledge, Attitudes and Practices survey regarding issues related to COVID-19, a questionnaire survey was conducted using a specially designed questionnaire. The study involved 2,500 respondents from 15 different districts and cities of the republic. Results. About 93 % of respondents (n = 2322) correctly answered this question regarding modes of transmission of the virus, indicating a high level of awareness of modes of transmission of COVID-19. Relatively high rates of correct answers were recorded to the question “Is it possible to get sick with COVID-19 several times?” 69.5 % of respondents (n = 1737) answered this question correctly, indicating an understanding that it is possible to get sick with COVID-19 several times. Attitude of respondents regarding the safety and effectiveness of vaccination: 78.3 % of respondents (n = 1957) expressed confidence in its safety, 11.3 % (n = 282) did not know the answer, and 10.4 % (n = 261) did not consider the vaccine safe. 2,430 people (97.20 %) have already received the full course of vaccination against COVID-19, 42 people (1.68 %) have only received the first dose of the vaccine and are planning to receive the second. The most popular source of information about COVID-19 was television programs – 44.0 % of respondents (n = 1101), followed by information materials (25.2 %, n = 631) and the Internet, including websites and social networks (22.8 %, n = 571). At the same time, 75.6 % (n = 1889) of respondents rated information and educational materials about COVID-19 as very useful and reliable. To the question “Have you been tested?”: 639 people (25.6 %) “never” got tested, 588 (23.5 %) “often” and 461 (18.4 %) “always” got tested. Conclusion. The results of the study showed that the interviewees had sufficient knowledge about COVID-19, including the transmission of the virus through various routes and clinical symptoms of the disease, as well as the importance of vaccination. Public health initiatives help better protect public health during emergencies such as infectious disease pandemics.

Policy palette: A spectrum of legal and educational challenges in the political landscape

The creation of points where law, politics and education policies take intersection is a very complex and dynamic environment determined by philosophical shifts, economic problems, and social dynamics. This study dissects various complicated challenges facing the process of the framing of educational policies and their implementation which have become rampant due to the rapid political transformations. The researched evaluation is applied via both qualitative and quantitative methods, including juridical research, case and best practices studies and surveys, with the descriptive nature of the research as the main tool. The heart of the essay is three main themes - the contention between the rigidity of the academic standards and the holistic growth of students, its possible effects when students are too identified with a test-centric approach as their knowledge is sacrificed for their test scores, and the inclusion of rights and protections for underrepresented populations even when faced with a government’s resistance. Similarly, the research examines the perils of creating legislation too quickly, especially, because of unexpected side effects and interpretation conflicts. Findings show profound demographic differentials over districts which implies the designing and implementation of policies need to be modified accordingly. Unless a certain policy brings the best outcomes in the learning process, then nobody should choose it even if it means disrupting student well-being and decreasing their involvement. It is also emblematic of how cross-party cooperation and stakeholders’ understanding are important aspects of fairly dealing with complicated policy environments.

Using scalable vector graphics in medieval Latin palaeography: new approaches, new conversations

Abstract The use of scalable vector graphics (SVG) in the study of pre-modern handwriting (palaeography) to date has been extremely limited, especially amongst scholars of the medieval Latin West and its manuscript culture(s). Informed by the author’s experience of using vector graphics for over a decade in researching and teaching medieval Latin palaeography in UK and EU Higher Education, this short article offers a starting point for further conversation. Following a general introduction and a concise survey of current practice, it discusses some basic SVG editing tools and exemplifies the utility of their application in three key areas of palaeographic study (tracing, analysis, and visualization) before highlighting, by way of conclusion, potential avenues of future development with the aim of enabling and encouraging colleagues to make greater use of SVG in their research and teaching.

Describing Community-Based Nurses' Knowledge, Attitudes, and Practices in the Nutritional Care of Older Adults: Results of a UK Survey.

To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom. A descriptive cross-sectional, anonymized, online survey of nurses' knowledge, attitudes, and practices related to older adults' nutrition was developed. Community-based nurses working with older adults in the United Kingdom were recruited via social media and convenience sampling. Responses were received from 194 community-based nurses. Nutritional care was seen as a multidisciplinary responsibility by 62% of participants. Most undertook nutrition screening (93%), were confident in providing nutritional advice (83%), and ease of identifying those in need (88%) was high. However, some aspects of nutritional knowledge were less complete, including recommended daily intakes of protein (60% unsure) and fiber (52% unsure). High confidence in delivering nutritional advice contrasted with uncertainty around some aspects of nutritional knowledge, suggesting opportunities to improve training on the nutritional needs of older adults. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Complacency in the quantification and reporting of climate impacts as carbon dioxide equivalent emissions

PurposeThe choice of characterization model has the potential to profoundly influence LCA results and conclusions. It is therefore a requirement of ISO 14044:2006 that the selection of characterization model shall be both justified and consistent with goal and scope. The purpose of this article was to examine current practices regarding the characterization of GHG emissions and reporting as CO2 equivalent emissions.MethodsA survey of practice was conducted across articles recently published in the International Journal of Life Cycle Assessment. Each article was examined using seven predetermined questions covering reporting of CO2 equivalent emissions and justification of climate metric used, interpretation of results in relation to climate measures or goals, and the implications of choosing an alternative climate metric.Results and discussionOf the sample of 85 articles, more than half reported GHG emissions as CO2 equivalent emissions. Of these, 81% unambiguously reported the climate metric used. Most often, there was no justification for the choice of a characterization model. Where a justification was given, the most common reason was alignment with the requirements of a program or PCR document. In some cases, the choice of characterization model was determined by the choice of impact assessment method (e.g., CML, ReCiPe). In other cases, the choice of characterization model was based on the desire to compare results to other studies. It is noted that none of the abovementioned reasons is scientific justification related to a stated climate objective. Not surprisingly, most studies made no attempt to interpret results reported as CO2 equivalent emissions in relation to climate measures or goals, and most did not discuss the potential implications of alternative climate metrics. For almost half of the articles, the choice of climate metric was assessed as potentially having major implications for decision-making or comparison to alternative systems.ConclusionsBased on this survey, it is evident that key aspects of ISO 14044:2006 are routinely not being followed. When GHG emissions are aggregated into a single impact category indicator result, there is a loss of transparency about climate impacts over time and the potential to unknowingly trade short-term climate benefits against the exacerbation of the difficulties of achieving long-term climate stabilization. As such, whenever GHG emissions are reported as CO2 equivalent emissions, it is imperative that the choice of characterization model is unambiguously reported and justified, that results are interpreted in relation to environmental outcomes, and that the potential implications of selecting alternative models are discussed.Graphical

A French Preoperative Cholesteatoma Management: Current Preoperative Consultation and Tendencies.

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended questions and 1 open-ended question. Seven questions concerned the participants' characteristics and 2 questions concerned the physiopathology of cholesteatoma. Nine questions focused on surgical information, six questions focused on the procedure modalities and ten questions focused on the risks of complications from the intervention. Results: Eighty-two surgeons answered the survey. In 75% of the cases, an information form written by a professional society was provided. The risk of recurrence or residual post-operative cholesteatoma was systematically stated in 78% of cases (n = 64), while the risk of aesthetic sequelae was only stated in 1% (n = 1). Participants working in a university hospital were more likely to inform patients about the risks of vertigo (p = 0.04), aesthetic risks (p = 0.04), poor functional outcomes (p = 0.04), surgical revision (p = 0.05) and the risk of peripheral facial paralysis (p = 0.05). Surgeons who mainly practiced otology were more likely to inform patients about the risks of recurrence and/or residual cholesteatoma (p = 0.02) and taste disturbances (p = 0.02). Conclusions: Cholesteatoma surgery was well explained to patients during the preoperative consultation, mostly with written support, even if the information given was not the same for all complication risks. It could be useful to create an information form dedicated to cholesteatoma surgery to improve comprehensive information and maintain a trustworthy relationship with patients.