Medicine Professionals Research Articles

Cannabis and pathologies in dogs and cats: first survey of phytocannabinoid use in veterinary medicine in Argentina

BackgroundIn animals, the endocannabinoid system regulates multiple physiological functions. Like humans, animals respond to preparations containing phytocannabinoids for treating several conditions. In Argentina, laws 27350 and 27669 have expanded the possibility of studying beneficial and adverse effects.Materials and methodsWe conducted a web-based survey of Argentinian Cannabis Veterinarians to make a situational diagnosis on the number of veterinary medicine professionals currently developing treatments with cannabinoids focusing on dogs and cats. ResultsAmong the species treated, 77% corresponded to dogs, while 21% were cats. Pain, seizures, and behavior disorders are the most prevalent conditions in dogs. Seven conditions and combinations were treated in cats. Full-spectrum cannabis extract derived from three different chemotypes was administered alone or with standard medication. Response to cannabis treatment was characterized based on improvement categorized according to clinical assessment. Both dogs and cats showed different improvement grades in clinical signs.ConclusionThis analysis provides promising results regarding the medicinal use of cannabis in dogs and cats. Based on this analysis, we propose to expand the training of professionals, obtain quality preparations, and initiate controlled trials to reinforce knowledge of the use of cannabinoids in veterinary medicine.

New initiatives in science teaching a welcome step

​​The Government has just announced two initiatives to improve science, technology, engineering and maths (STEM) teaching in New Zealand schools. The New Zealand Association of Scientists applauds this move and echoes Minister Joyce’s statement that ‘Boosting the skills and achievement of our young people in maths and science are essential for their future careers and for New Zealand’s economic growth and prosperity’. Dr Nicola Gaston, President of NZAS, said, ‘More broadly, there is a need to boost understanding of science among teachers, students, and across the whole adult population as well, as it is the nature of scientific knowledge to develop beyond what any of us once learnt at school’.There is an obvious and urgent need to advance science and technological literacy in New Zealand. Only recently, the head of Orion Healthcare described the huge shortage of technologically able workers in this country. ‘High-tech industry requires highly trained people, and the production of this capability should be recognised as a key goal of our science system’, said Dr Gaston.Recent reports detailing a fall-off in year-8 student abilities in science and writing underlines the urgent need for improvement. Dr Gaston also commented, ‘Fragmentation and uncertainty have become endemic in New Zealand science. Our government needs to recognise that their policy decisions play a role in shaping the attractiveness of a career in science. We would hope that these new education initiatives are a step towards telling our brightest young students that there are careers besides the professions of medicine and engineering, and that a science degree is the best training for the jobs of the future’.The New Zealand Association of Scientists (www.scientists.org.nz) is a nationwide association of practising research scientists spanning the universities, technical institutes, Crown research institutes, government departments, industry, museums, other science institutions, and independent researchers.

Transcending return-to-sport for injured handball players in Masvingo tertiary institutes, Zimbabwe

The smooth transition of injured players from rehabilitation back to active participation has become a worrisome phenomenological service gap for sports medicine professionals. Pre-mature ending of players’ sports routes and aspirations have been reported. This study sought to examine confounding intransigencies that often entrap players’ smooth transition from rehabilitation to return-to-sport contexts in Zimbabwean Tertiary Handball between 2018 and 2021. High pandemic injury rates among handball players prompted the researcher to conduct this post-injury study. Furthermore, it sought to ascertain the extent to which the ‘sport net’ of health service providers impacted on players’ rehabilitation and return-to-sport phases. The study was a descriptive, prospective cohort design anchored on quantitative approach. The population was 453 from which 228 were drawn. Study participants were coaches, fitness trainers, team physiotherapists, team psychologists and players from 10 selected male and female ZITCOSA handball teams. Stratified random sampling was adopted in selecting respondents for the study. Questionnaires were used as data collection tools. Stratified random sampling was used to select study participants. A convenient size for the study was determined through Taro Yamani’s (1970) formula. Bowley’s proportional allocation formula was then used to statistically allocate participants into their particular strata. Data analysis was performed using IBM SPSS Statistical Version 23 and presented on multi-part graphs. Emerging findings from the study revealed significant service-gaps between rehabilitation and return-to-sport transitional episodes among health service professionals. Subsequently, players’ pre-defined rehabilitation routes pre-maturely ended. Sports clinicians therefore, require further sports medicine clinical development workshops to boost their skill resource bases to effectively trim down problems associated with players’ rehabilitation-return-to-sport transitional phases.

A Cross-Sectional Analysis of Cardiovascular and Bone Health Care Utilization During Treatment With Thyroid Hormone.

Combination therapy with levothyroxine and liothyronine (LT4 + LT3) and desiccated thyroid extract (DTE) make up >10% of new thyroid hormone (TH) prescriptions in the United States. To assess health care utilization related to cardiovascular disease (CVD) and bone health (BH) events (atrial fibrillation [AF], heart failure [HF], myocardial infarction [MI], stroke, and osteoporosis/fractures [FX]) in participants taking LT4+LT3 or DTE surveyed in the Medical Expenditure Panel Survey database. Multi-year cross-sectional analysis examining 5437 participants (≥18 years old) treated with LT4, LT4+LT3, or DTE between 2016 and 2020. Health care utilization was assessed through outpatient, emergency, and hospital visits for AF, HF, MI, stroke, FX, and a composite index. A weighted analysis provided national estimates of health care utilization parameters. Utilization was re-analyzed following propensity score-based matching to balance sociodemographic and clinical covariates between treatment groups. Additionally, provider type and specialty data were obtained from visits associated with TH prescriptions. 5106 participants were treated with LT4 monotherapy, 252 with DTE, and 79 with LT4 + LT3. Prevalence of combined outpatient CVD and BH-related care utilization was lower among DTE/LT4+LT3 vs LT4 users (3.5% vs 7.7%; P = .008). There were no differences in emergency/hospital events. After covariate balancing, CVD and BH-related care utilization was similar between groups in outpatient and emergency/hospital settings. LT3 and DTE made up 7.6% of all TH prescriptions. For visits associated with DTE prescriptions, nurse practitioners and alternative medicine professionals were more likely to be identified as the primary provider type. No significant differences in CVD- and BH-related health care utilization were identified between LT4 and DTE/LT4+LT3 users after covariate balancing. Non-MD providers were more likely to prescribe DTE.

Master program in Lifestyle Medicine: new approach in healthcare in Lithuania

Abstract Background Many studies have proven that lifestyle medicine approach is more effective in preventing, arresting, and reversing chronic diseases than the traditional curative approach. Objectives The first European Union Master degree in Public Health of Lifestyle medicine was established at Lithuanian University of Health Sciences (LUHS) in 2016. The program aims at preparing mediators in unifying classical community-focused public health with person-oriented health services. These health specialists are able to manage risk factors, change individual behaviors related to chronic noncommunicable diseases (NCD's), and work as members in medical teams, especially in primary health care services, public health settings and private sector. Results This program started a new tradition of studies in public health area with advanced competencies in non-pharmaceutical interventions, addressing the roots of NCD's, rather than management of the outcomes. Up to recently, nearly 100 graduates completed the program. It became one of the most popular Master programs at LUHS. The major challenge faced, was introduction of this new approach into Lithuanian healthcare system, demonstrating the need and the effectiveness of the newly trained specialists in the process of health management both for politicians, health care professionals and society. In 2019, lifestyle medicine professionals were officially integrated into primary healthcare sector as team members of physicians. The major success was achieved at the structural level in 2023, when minister of health of Lithuania signed the order that each team of family physicians is obliged to employ lifestyle medicine professional and allocate specific tasks and resources to this new member of the primary health care team. Conclusions Lithuanian healthcare system is now ready to employ lifestyle medicine professionals. It is expected that they will contribute to health improvement of Lithuanian population. Key messages • Lifestyle medicine program trains highly needed professionals for Lithuanian healthcare system. • Healthcare system is now ready to employ lifestyle medicine professionals.

Force plate methodologies applied to injury profiling and rehabilitation in sport: A scoping review protocol.

Musculoskeletal injuries are a common health problem among sporting populations. Such injuries come with a high financial burden to the involved organisations and can have a detrimental impact on the career attainment of injured individuals. Force plates are now a common tool available to sport and exercise science and medicine professionals to enable them to profile injury risk predisposition and modulate the rehabilitation process within sporting environments. This is because contemporary force plate technology is portable and affordable and often comes with software that enables the automatic and immediate feedback of test variables to key stakeholders. However, to our knowledge, to date, there has been no comprehensive review of the scientific literature pertaining to clinical applications of force plate technology. Therefore, this article presents a protocol and a methodological framework to perform a scoping review to identify and map the available scientific literature in which force plates have been applied to the injury profiling and rehabilitation of athletes. The specific aims of the scoping review are 1) to identify and describe the force plate tests, methodologies, and metrics used to screen for injury risk and guide the return of injured athletes to full-time training and competition, 2) to identify potential trends and/or differences by participants' age, sex, and/or level of performance in tests, methodologies, and metrics selected, and 3) to identify key gaps in the existing evidence base and new questions that should be addressed in future research. The global aim of the scoping review is to improve practitioner decision-making around force plate test and variable selection when applied to the injury prevention and rehabilitation of sporting populations.

PENGENALAN PROFESI APOTEKER DAN EDUKASI PENGENALAN BENTUK SEDIAAN OBAT SERTA PENGENALAN LOGO OBAT KEPADA SISWA/I DI SMA ST.PETRUS MEDAN

Pharmacists are health workers who deal directly with the community. Drugs have a very important role in health services. Various drug options are currently being developed and available, so careful consideration is needed in choosing a drug to treat a disease.
 Public understanding of the pharmacist and medicine profession is not fully understood. For that outreach activities are needed. Students as a social component of society make a significant contribution to the development of the nation and are expected to be able to participate scientifically in accordance with their scientific disciplines. Therefore it is very important to carry out pharmacist branding from an early age, in this activity high school students will be educated. This training is intended to introduce the duties and functions of pharmacists, recognize drug dosage forms and introduce drug logos.
 This activity is carried out using the Socialization method, starting with reviewing the activity location, making an application letter and carrying out the activity. As for the implementation of the activity, namely first an explanation of the duties and functions of the Pharmacist Profession is carried out. Explanation of drugs, drug dosage forms, drug logos, how to use drugs. Selection of drugs and self-medication using medicines at home or those commonly obtained at the health facility. As for the results of the activity in the form of documentation at SMA St. Petrus Medan obtained. The students were very happy and focused on listening to the explanation of the material presented. The students will also be motivated by this activity because the pharmacist's role is very important in maintaining public health.
 Keyword : Pharmacists, drug dosage form, logo’s drug

Expert consensus for diagnosis and treatment of post-cardiac arrest syndrome in adults by combining traditional Chinese and Western medicine in China (2023)

Reperfusion injury occurs after return of spontaneous circulation (ROSC) in patients with cardiac arrest (CA), which leads to multiple organ dysfunction, called post-cardiac arrest syndrome (PCAS). PCAS is closely related to the prognosis of CA patients, and is an independent risk factor of survival. Integrated traditional Chinese and Western medicine diagnosis and treatment is critical for improving prognosis of PCAS. In order to guide and standardize integrated traditional Chinese and Western medicine diagnosis and treatment in PCAS among clinicians, nurses and research personnel in China, the Emergency Medicine Professional Committee of the Chinese Society of Integrated Chinese and Western Medicine has established an expert group to determine 14 clinical issues related to the diagnosis and treatment of PCAS with integrated traditional Chinese and Western medicine through clinical survey. The working group formulates a search strategy for each clinical issue according to the PICO principle. Chinese and English literature were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, and Cochrane Library. The grade of recommendations assessment, development and evaluation (GRADE) were used to form the level of evidence and recommendation. When the literature evidence was insufficient, the recommendations and level of recommendation were formed after expert discussion. Combined with the aspects of generalizability, suitability, and resource utilization, the expert consensus developed 28 recommendations around the 14 aspects of three stages of PCAS, including early circulation, respiratory support and reversible cause relief, mid-term neuroprotection, improvement of coagulation, prevention and treatment of infection, kidney and gastrointestinal protection and blood sugar control, post rehabilitation treatment, providing references for the integrated traditional Chinese and Western medicine of the diagnosis and treatment for PCAS.

Cost-Effectiveness and Return on Investment Analysis of an In-house HemosIL Heparin-Induced Thrombocytopenia Antibody Assay at a Mid-Sized Institution.

Laboratories face the challenge of providing quality patient care while managing costs and turnaround times (TATs). To this end, we brought the heparin-induced thrombocytopenia (HIT) antibody test in-house with the goal of reducing costs and the time to diagnosis. To determine the cost-effectiveness and return on investment of our in-house HIT antibody test by comparing it to send-out assays with TATs of 2, 3, or 4 days. We performed a retrospective chart review of all patients with a HIT antibody assay and analysis of laboratory financial records. Analysis included the percentage of patients receiving alternative treatment, cost of treatment, startup costs of bringing the test in-house, and average TAT of the in-house test. We found significant reductions in the cost of treatment for patients and the overall cost to the health care system. The in-house assay became cost-effective at between 8 and 20 tests, with a return on investment of up to 298%. Bringing the HIT antibody assay in-house becomes cost-effective at a very low test volume with excellent return on investment. This novel analysis can provide a framework for other laboratory medicine professionals to analyze the benefits of bringing this and other assays in-house.

Comfort Levels of Outpatient Health Care Professionals When Asking About Substance Use-Related Sexual Activity: A Pilot Survey.

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based intervention for substance use. Health care professionals may not receive SBIRT training or know of substance use's intersection with sexual activity. This pilot survey inquired about SBIRT training history, attitudes, and comfort among outpatient health care professionals, including assessing sexual activity-related use. We conducted a snowball cross-sectional survey of outpatient health care professionals at a large southeastern academic medical center in June 2021 with 4-point Likert questions covering demographics, substance use attitudes, SBIRT training history, and comfort implementing SBIRT. Analysis used descriptive statistics and stratification by demographic and practice characteristics. Seventy-three professionals responded, of whom 82% were White and 66% were female. Forty-seven percent were 30 to 39 years old, 33% were internal medicine professionals, and 59% reported previous SBIRT training. All participants reported believing substance use is a significant health issue. Most reported that they were comfortable or somewhat comfortable assessing patients for substance use (85%), dropping to 60% discussing sexual activity. Advanced practice providers and physicians identified more comfort with rapport building around substance use than other health care respondents. Professionals in infectious diseases and psychiatry reported the greatest comfort assessing substance use with concurrent sexual activity. There are gaps in SBIRT training and beliefs among health care professionals. Although health care workers report that assessing substance use is important, some professionals endorsed more comfort discussing substance use with patients than others, especially when inquiring about sexual activity. Future work could replicate the pilot to inform increasing comfort through training in the intersection of substance use and sexuality.

238 An age related acute medical unit: creating an age-attuned model of acute care

Abstract Background Multi-morbidity increases with age and older adults are more likely to present to acute hospital services with complex health states/Geriatric syndromes. For people with underlying physical or cognitive illnesses, these issues can be compounded by the built environment of acute hospitals. Meeting the needs of a frail older population is a key challenge for acute hospital services. The main aims of this development quality improvement project were to create a dedicated Age-related acute medical unit using the concept of universal design, with dedicated, Gerontological staffing including a Registered Advanced Nurse Practitioner (RANP) in Gerontology. Methods A project team was convened with representation from Geriatric nursing, Geriatric Medicine, Health and Social Care Professionals (HSCP), Estates, Technical services and the executive management team. An appropriate area was identified on the acute floor which was co-located with a newly developed Acute Medical Unit. Using a universal design approach, a 4-cubicle Age Related Assessment Unit (ARAU) including a dedicated multidisciplinary assessment room was created. The role of the RANP in ARAU was developed to provide comprehensive geriatric assessment to older medical patients presenting to unscheduled care. Results Following the implementation of the ARAU there has been a 40% increase in the number of unscheduled older patients (>65’s) assessed in the Acute Medical Unit (Q1 2019 to Q1 2023). Conclusion Operating within a defined scope of practice, the RANP in ARAU/AMU provides advanced specialist geriatric nursing skills and knowledge allowing for the identification of medical, psychosocial and functional needs of older adults for older adults who present to unscheduled care with common geriatric syndromes.

Pattern of Clinical Presentation and Management of Inflammatory Bowel Disease

Background: Inflammatory bowel disease (IBD) is characterized by non-specific chronic relapsing inflammation of the gastrointestinal tract and extra-intestinal manifestations. It includes Crohn’s disease (CD) ulcerative colitis (UC) and unclassified colitis. Objective: To assess the clinical presentations and management of inflammatory bowel disease in Sudanese patients. Methodology: Prospective, cross-section hospital-based study was conducted at Soba University Hospital (SUH) and Ibn Sina Hospital, in a period from December 2016 to March 2017. Data was entered and analyzed with SPSS, an interview questionnaire containing demographic, clinical, type of IBD, treatment, and complications. Results: A total of 64 IBD patients were included, 50% were diagnosed with UC, 28.1% with CD and 21.9% unclassified type. The most frequent age in UC patients was 41 – 50 years 34.4%, in CD was 31- 40 years 38.9% and for the unclassified type was 51 – 70 years 57.2%. The female was higher in CD while males were higher in Ulcerative colitis disease, symptoms were diarrhea, rectal bleeding, abdominal pain, rectal pain, tenesmus and fatigue. Study participants received 5 amino salicylic acid, and steroids, especially in the oral formulation. Minimal usage of topical forms, azathioprine, and biological agents. Conclusion: The study concluded UC is more common than CD. This should be taken into account as an important update for internal medicine professionals to adjust their expectations and lines of diagnosis, and management. The emergence of the unclassified type in Sudan requires good communication between the pathologists and the physicians and MDT meetings in every patient with suspicion of IBD.

Forging a Synergistic Path: Navigating the Relationship between Healthcare Professionals and Artificial Intelligence in Medicine

Forging a Synergistic Path: Navigating the Relationship between Healthcare Professionals and Artificial Intelligence in Medicine

Call It an "Evolution": Promoting Student-Athlete Well-Being During the Transition From Collegiate Sport.

After highly publicized stories of student-athletes' struggles with mental health, the spotlight on mental health and well-being in this special issue coincides with a broader growing concern for the long-term impact of competitive sport participation on student-athlete health and wellness. The end of a competitive sport career represents a potentially vulnerable life transition. As demonstrated in the literature, the unique aspects of elite sport culture shape student-athletes' perceptions of their identity, health, and health behaviors, which have implications for how student-athletes navigate their health and well-being as they transition away from the embedded health care structure inherent to elite sport. Given evidence indicating that student-athletes may face mental and physical health concerns after retirement from sports, targeted transitional strategies are needed to provide patient-centered care in this population. In this article, we briefly summarize current understanding of sport transition and highlight some key findings from studies conducted by the contributing authors' research groups exploring the impact of sport career transitions on student-athlete well-being. We also reflect on limitations of the existing research and transition models and, in turn, propose potential directions for adopting a nuanced and multidimensional framework to explore interconnected transition domains. We conclude by offering recommendations for sports medicine professionals to consider in future research, programming, and policies to promote student-athletes' holistic well-being through this critical transition.

Establishing Benchmark Percentiles for the Classification of Body Fat Percentage of Professional Male Athletes Competing in Combat Sports through Bioimpedanciometry

Body composition as a meaningful factor can result in physiological responses in both the physical body and general health status. Nevertheless, the schemes for establishing cut-off points for identifying the classifications of the body fat percentage of athletes competing in combat sports still include gaps. The aim of this study was, by using bioimpedanciometry, to calculate the percentiles for the classification of body fat percentages in Lithuanian professional male athletes (n = 52) competing in combat sports with weight classes. A total of 52 Lithuanian professional male athletes competing in combat sports with weight classes were evaluated using a multi-frequency bioelectrical impedance analysis method with frequencies ranging from 1 kHz to 1000 kHz. Percentiles P3, P10, P25, P50, P75, P90, and P97 were used to determine the classification. As a consequence, the following classification categories were assigned: 6.6–7.8% (extremely low); 7.9–10.9% (very low); 11.0–14.7% (below normal); 14.8–18.8% (normal); 18.9–21.5% (above normal); 21.6–29.3% (very excessive); and ≥29.4% (extremely excessive). The assessment of body composition in combat sports athletes identified an inverse association between higher body fat levels and a decrease in the muscle-to-fat ratio (β –1.3, 95% confidence interval (CI): –1.5; –1.0, p < 0.001). The relationship between lower body fat percentage and lighter weight categories in which combat sports athletes from different combat sports were competing has been identified (β 0.3%, 95% CI: 0.2; 0.3, p < 0.0001). The established cut-off points may assist sports medicine professionals and sports dietitians in monitoring the adiposity of combat sports athletes.

Experience of treatment of chronic migraine with botulinum toxin type A among aesthetic medicine professionals in Poland.

This study aimed to evaluate the knowledge and standard of treatment of chronic migraine with botulinum toxin by Polish aesthetic medicine professionals. Onabotulinum toxin A injections are used as a preventive treatment for chronic migraine. Besides neurologists, healthcare professionals of multiple specialisms can offer this treatment. Aesthetic medicine professionals commonly use the treatment to extend the scope of their practice. This may bring about a situation wherein physicians with different levels of experience and training are providing botulinum toxin injections for chronic migraine. An online survey asking about patient qualification procedures, the level of adherence to the PREEMPT paradigm, product-, technique-, dosing-, and treatment intervals-related aspects of the treatment, efficacy evaluation practices and concerns about the use of botulinum toxin in chronic migraine was sent to 110 Polish physicians practicing aesthetic medicine. The response rate was 73.6%. The results of the survey revealed multiple deviations from the current paradigm of treatment of chronic migraine with botulinum toxin, from improper patient qualification through treatment procedure to the evaluation of the efficacy. Only around one-third of professionals evaluated the observed effectiveness of therapy as very good. Most respondents wanted to expand their knowledge and skills in chronic migraine treatment. There is a considerable willingness among aesthetic medicine specialists to treat patients with chronic migraine with botulinum toxin. The current levels of knowledge and skills in this treatment are limited, and multiple physicians declared deviations from the diagnostic criteria and the therapeutic protocol. Transferring aesthetic medicine practices to neurology treatment is common and may result in a lack of effectiveness of treatment or even intensification of symptoms. An appropriate educational programme should be implemented for all physicians authorised to administer BoNT-A in Poland.

A Ten-Year Follow-Up Case Report on the Treatment of Severe Obstructive Sleep Apnea Using a Mandibular Advancement Device

This report describes the challenging case of a 45-year-old male Caucasian patient with morbid obesity and severe obstructive sleep apnea who was followed up for over 10 years by a multidisciplinary team that included sleep and dental medicine professionals, physiotherapists, and nutritionists. The patient underwent seven polysomnographic studies during the follow-up period; furthermore, nocturnal digital monitoring (NDM) was performed during the COVID-19 pandemic. The polysomnographic study revealed that the apnea-hypopnea index of the patient reduced from 131.7 ev/h to 9.4 ev/h without symptoms, while his NDM oxygen desaturation index varied because of weight gain during the COVID-19 pandemic. This case report highlights the importance of a multidisciplinary team in ensuring the success of mandibular advancement device therapy with excellent clinical outcomes. Furthermore, this report suggests that NDM was a good tool for follow-up during the COVID-19 pandemic.

ПОДРОСТОК С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК — ГОТОВНОСТЬ К ПЕРЕВОДУ ВО ВЗРОСЛУЮ НЕФРОЛОГИЧЕСКУЮ СЛУЖБУ ЗДРАВООХРАНЕНИЯ И ТРУДНОСТИ ПЕРЕХОДНОГО ПЕРИОДА: ОБЗОР ЛИТЕРАТУРЫ, СОБСТВЕННЫЕ НАБЛЮДЕНИЯ

Transition of an adolescent patient with chronic kidney disease (CKD) from pediatric to adult healthcare system is an urgent problem Worldwide. The purpose of this research was to generalize the idea of readiness of adolescents with CKD to transfer into adult nephrology healthcare system, to describe the challenges of such transition period and to determine the roles of participants in the process and their mutual interactions in order to develop and implement the working regional model for organizing the transition of adolescents with CKD within a clustered system of provision of specialized healthcare services. Materials and methods used: a single-center cross-sectional questionnaire surveying of adolescents and young adults with CKD regarding their readiness to transition in two observation groups was carried out on the basis of both adult and pediatric sections of the Samara Oblast Regional Clinical Hospital named after V.D. Seredavin (Samara, Russia) in Jan. 2021-March 2023. Group 1 consisted of young adults aged 18 to 22 y/o with CKD stages 2 to 3; and Group 2 included adolescents aged 13 to 18 y/o with CKD stages 2 to 5. The results were then evaluated with the TRxANSITION Index (formerly TRxANSITION Scale), PedsQL and the SF-36 questionnaire. Adolescents’ parents/caretakers took a survey on the independence of their children as well. Results: the data on the insufficient independence of adolescents were obtained, as follows: 66.7% [34.9-90.1%] (n=8) “never” took medication on their own, 50.0% [21.1-78.9%] (n=6) have never asked their physicians questions (p<0.001), 50.0% [21.1-78.9%] (n=6) “never” and 33.3% [9.9-65.1%] (n=4) “almost never” did they agree to meet with the physician (p=0.005). Adolescents experienced difficulties in both communicating and working together with a physician: 33.3% [9.9-65.1%] (n=4) and 25.0% [5.5-57.2%] (n=3) “difficult,” respectively; 50.0% [21.1-78.9%] (n=6) and 58.3% [27.7-84.8%] (n= 7) “almost difficult,” respectively (p<0.001). On the other hand, “almost everything” and “everything” do they know about their health status 47.1% [23.0-72.2%] (n=8) and 35.4% [14.2-61.7%] (n=6), respectively, of young adults with CKD vs. adolescents (p<0.001). Conclusion: structurization of the participants’ roles in the communication system “patient and his family members - medicine professionals - psychologists - social workers” contributes to the stabilization of an adolescent with CKD during the transition period.

Establishing an expert opinion framework for lung volume reduction in Ireland: a Delphi consensus technique

BackgroundLung volume reduction (LVR) is an effective treatment option offered to patients with emphysema. There is no formalised LVR referral network in Ireland. A rigorous approach to agreeing and implementing a LVR referral framework in an Irish context is required. A Delphi process was used to provide a basis for a framework of multi-disciplinary teams (MDTs) which can provide LVR as a management option. A Delphi process offers a framework for understanding variations and developing a consensus from expert opinion.AimThe aim of this study was to develop consensus on recommendations for LVR referral guidelines in an Irish context and provide a national scope based on current practice and evidence.DesignIn accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building Delphi study was performed. Thirty-three statements informed from review of research literature were identified and presented to participants. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ≥ 70% agreement was defined as consensus and items with a consensus rating of < 70% were revised during the process. In total, Delphi questionnaires were distributed to 18 experts with a response rate of 78% (n = 14) and a follow-up response-rate of 50% (n = 7).Setting/participants.The expert panel in Ireland consisted of representatives from respiratory medicine, cardiothoracic surgery and allied-health professionals with expertise in COPD care.ResultsOf the initial 33 statements in five dimensions, there were consensus regarding 31 statements.ConclusionsThe 31 statements agreed through this Delphi study clarify a coherent direction for development of a LVR framework in Ireland. The Delphi study methodology described is a useful process to reach consensus among multi-disciplinary experts.

The maintenance of classism in medical education: "time" as a form of social capital in first-generation and low-income medical students.

As first generation (FG)/low income (LI) students enter the elite profession of medicine, schools make presumptions about how FGLI students allocate their time. However, their lives are markedly different compared to their peers. This study argues that while all forms of capital are necessary for success, time as a specific form keeps classism in place. Using constructivist grounded theory techniques, we interviewed 48 FGLI students to understand where, why and how they allocated their time, and the perceived impact it had on them. Using open coding and constant comparison, we developed an understanding of FGLI students' relationship to time and then contextualized it within larger conversations on how time is conceptualized in a capitalist system that demands time efficiency, and the activities where time is needed in medical school. When students discussed time, they invoked the concept of 'time famine;' having too much to do and not enough time. In attempting to meet medicine's expectations, they conceptualized time as something that was 'spent' or 'given/taken' as they traversed different marketplaces, using their time as a form of currency to make up for the social capital expected of them. This study shows that because medical education was designed around the social elite, a strata of individuals who have generational resources, time is a critical aspect separating FGLI students from their peers. This study undergirds the idea that time is a hidden organizational framework that helps to maintain classism, thus positioning FGLI students at a disadvantage.