Involvement Of Professionals Research Articles

Operationalizing Digitainability: Encouraging Mindfulness to Harness the Power of Digitalization for Sustainable Development

Digitalization is globally transforming the world with profound implications. It has enormous potential to foster progress toward sustainability. However, in its current form, digitalization also continues to enable and encourage practices with numerous unsustainable impacts affecting our environment, ingraining inequality, and degrading quality of life. There is an urgent need to identify such multifaceted impacts holistically. Impact assessment of digital interventions (DIs) leading to digitalization is essential specifically for Sustainable Development Goals (SDGs). Action is required to understand the pursuit of short-term gains toward achieving long-term value-driven sustainable development. We need to understand the impact of DIs on various actors and in diverse contexts. A holistic understanding of the impact will help us align the visions of sustainable development and identify potential measures to mitigate negative short and long-term impacts. The recently developed digitainability assessment framework (DAF) unveils the impact of DIs with an in-depth context-aware assessment and offers an evidence-based impact profile of SDGs at the indicator level. This paper demonstrates how DAF can be instrumental in guiding participatory action for the implementation of digitainability practices. This paper summarizes the insights developed during the Digitainable Spring School 2022 (DSS) on “Sustainability with Digitalization and Artificial Intelligence,” one of whose goals was to operationalize the DAF as a tool in the participatory action process with collaboration and active involvement of diverse professionals in the field of digitalization and sustainability. The DAF guides a holistic context-aware process formulation for a given DI. An evidence-based evaluation within the DAF protocol benchmarks a specific DI’s impact against the SDG indicators framework. The participating experts worked together to identify a DI and gather and analyze evidence by operationalizing the DAF. The four DIs identified in the process are as follows: smart home technology (SHT) for energy efficiency, the blockchain for food security, artificial intelligence (AI) for land use and cover change (LUCC), and Big Data for international law. Each of the four expert groups addresses different DIs for digitainability assessment using different techniques to gather and analyze data related to the criteria and indicators. The knowledge presented here could increase understanding of the challenges and opportunities related to digitainability and provide a structure for developing and implementing robust digitainability practices with data-driven insights.

A Contemporary Review of Smart Phone Applications in Bariatric and Metabolic Surgery: an Underdeveloped Support Service.

This study aims to be a contemporary review of mHealth apps in bariatric and metabolic surgery (BMS) to assess their quality using the Silberg scale as well as features, themes, usability, and medical/allied health professional involvement (MAPI). Apps were identified using search terms in the Android and Apple app stores. 52 apps were included. 42 (80.7%) apps main target users were patients. More than half, 27 (52%), targeted US based users. 29 (56%) had payment-restricted content. 42 (81%) had MAPI and the mean Silberg score was 5.2. Compared to previous studies the quality of BMS apps is improving with more MAPI and useful functionality. Wider use of mHealth apps for patient centred follow-up, management and care are yet to be widely implemented and explored.

497 Patient perspectives of safe and routine deprescribing for older people living with polypharmacy: an interview study

Abstract Introduction Stopping medicines where harms outweigh benefits (deprescribing) (1) can reduce adverse events from inappropriate polypharmacy. Deprescribing should be undertaken in a patient-centred way with shared decision-making. However, there is a lack of evidence about the patient perspective on how deprescribing should be safely and routinely implemented in UK primary care. Such evidence is needed to enhance the implementation of deprescribing in primary care. Aim • To identify optimal methods of introducing and actioning deprescribing from the patient’s perspective • To understand the nature of support patients require during deprescribing • To identify patient views on the involvement of different healthcare professionals in deprescribing. Methods UK patients aged ≥65 years taking ≥5 medicines and living in their own homes were recruited through social media, service user groups and NIHR People in Research. An interview guide was developed using deprescribing literature, patient and public involvement input, and informed by the theoretical implementation framework Normalisation Process Theory (2). Interviews were conducted online (Microsoft Teams®) or via telephone, audio recorded and transcribed verbatim. Data were analysed using the Framework method. Results Twenty patients, diverse in age and gender, were recruited and three main themes developed: 1. ‘Why deprescribe now?’ focused on the importance of communicating the deprescribing rationale; 2. ‘Monitoring and follow-up’ in which safety netting around deprescribing and patients’ motivations to self-monitor after deprescribing interventions were highlighted; 3. ‘Roles and relationships’ focused on patient views of different healthcare professionals involved in deprescribing and the interpersonal skills needed to develop therapeutic relationships. Conclusion Optimal methods of introducing deprescribing from the patient’s perspective included communication of a convincing and well-communicated rationale for stopping medicines. Patients required support from a range of healthcare professionals with whom they had an existing therapeutic relationship. Whilst patients were motivated to self-monitor any unwanted/unexpected effects post-deprescribing, this was under the condition that timely support would be available when needed. These findings provide a deeper understanding of patients’ needs for the implementation of safe and routine deprescribing in primary care, and these should be considered when designing medication review and deprescribing services. A strength of this study was the overall diversity in age and gender of the patients interviewed. However, although multiple recruitment pathways were utilised, due to the COVID-19 pandemic, recruitment was mainly online which will have excluded patients who did not have access to the internet.

Karaism: An Introduction to the Oldest Surviving Alternative Judaism by Daniel J. Lasker

Reviewed by: Karaism: An Introduction to the Oldest Surviving Alternative Judaism by Daniel J. Lasker Marzena Zawanowska Daniel J. Lasker. Karaism: An Introduction to the Oldest Surviving Alternative Judaism. London: The Littman Library of Jewish Civilization, 2022. x + 253 pp. For centuries, Karaism has presented a major intellectual challenge to Rabbanite traditionalists, who have regarded the adherents of this alternative form of Judaism as heretics—Jewish Others—and their movement as an alien sect. This bias has affected the scholarly study of Judaism as a whole, which has tended to relegate Karaism to the margins. True, there have always been important exceptions to this rule, and, at least since the early twentieth century, a steadily growing interest in the history and intellectual achievements of the Karaites. Yet many Karaite works still remain unpublished and/or unexplored. Moreover, because scholarly studies tend to focus selectively on narrow topics, on the one hand, and because of the lack of reliable source texts written for a general audience, on the other, there is still much disinformation on the subject. The new publication by Daniel J. Lasker promises to rectify this situation, offering the first comprehensive overview of Karaite history, literature, culture, religious beliefs, and practices, contextualized against the backdrop of rabbinic Judaism, and geared to a nonspecialist audience yet grounded in the latest research. As befits its purpose, the book is written in an engaging style that dispenses with footnotes (and thus—unfortunately for academic readers—also with precise references to cited works), while Hebrew and Arabic words are transliterated in a simplified (though sometimes inconsistent) way into Latin characters. The book is clearly structured. Each chapter, including the introduction, is a self-contained unit—a format that occasionally necessitates some repetition. Each opens with a relatively long source text offering an intriguing introduction to the subject of the following pages. And each, except for the introduction and the concluding chapter, ends with a short summary and suggestions for further reading. The chapters are divided thematically. The first five are devoted to history and intellectual achievements; six, seven, and eight focus on religious practices and beliefs; nine, ten, and eleven examine various genres of Karaite literature. The twelfth and final chapter, which serves as a conclusion to the book as a whole, ponders the future of Karaism. In the preface, Lasker describes his interest and professional involvement in researching Karaism, his reasons for writing this book, and the readers he envisions for it. In the introduction, he presents Karaism as “the oldest surviving alternative Judaism” in relation to other varieties of Judaism and surveys the challenges involved in its research. Chapter 1 focuses on the origins of Karaism and the role played by ʿAnan ben David, as described both by scholars of Karaism and by the Karaites themselves. It also considers the relevance of ancient Jewish sources, like the Dead Sea Scrolls, and contemporary Islamic movements, like Shiʿism, for understanding the emergence of Karaism. Chapter 2 is devoted to the [End Page 191] “Golden Age” of Karaism in the Land of Israel, beginning at the end of the ninth century with the earliest settlement of Karaites in that region and the appearance of the Mourners of Zion movement, through the flourishing of the Karaite center in Jerusalem in the tenth and eleventh centuries, to the aftermath of the First Crusade (1099), when the center of Karaite intellectual activity moved to Byzantium. It also surveys Karaite communities in the rest of the Middle East and Rabbanite-Karaite relations of the time. Chapter 3 scrutinizes the history and literature of the Karaite community in Byzantium, from its inception in the tenth century, through the period of its intellectual prosperity in the eleventh and twelfth centuries to its gradual rapprochement with Rabbanite Judaism between the twelfth and fifteenth centuries, and its decline over the course of the sixteenth century, when it was eclipsed by a new center in eastern Europe. It also briefly surveys other contemporaneous Karaite communities. Chapter 4 is devoted to eastern European Karaites from the period of the first Karaite settlements in the Crimean Peninsula (around the twelfth century) and in the Polish Commonwealth (Poland-Lithuania) (likely in the fifteenth), through their...

PD32-06 INDUSTRY RELATIONSHIPS WITH UROLOGISTS: CHARACTERIZING THE HIGH-PAYMENT UROLOGISTS

You have accessJournal of UrologyCME1 Apr 2023PD32-06 INDUSTRY RELATIONSHIPS WITH UROLOGISTS: CHARACTERIZING THE HIGH-PAYMENT UROLOGISTS David-Dan Nguyen, Anna-Lisa V. Nguyen, Adree Khondker, Jethro C. Kwong, Anne Xuan-Lan Nguyen, Muhieddine Labban, Rashid K. Sayyid, Naeem Bhojani, Quoc-Dien Trinh, and Christopher J.D. Wallis David-Dan NguyenDavid-Dan Nguyen More articles by this author , Anna-Lisa V. NguyenAnna-Lisa V. Nguyen More articles by this author , Adree KhondkerAdree Khondker More articles by this author , Jethro C. KwongJethro C. Kwong More articles by this author , Anne Xuan-Lan NguyenAnne Xuan-Lan Nguyen More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Rashid K. SayyidRashid K. Sayyid More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Christopher J.D. WallisChristopher J.D. Wallis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous work has shown that relationships between urologists and industry are common. The median industry payment to urologists with industry relationships is modest. However, not much is known about the subset of urologists that receive high payment amounts from industry. Here, we characterize these payments and describe the characteristics of these high-payment urologists. METHODS: We used the Open Payments database to identify all US-based urologists who received >$50,000 USD in general payments in 2021. General payments are separate from research payments. A web-based search was conducted to extract demographics including gender and subspecialty, academic metrics including h-index, and professional involvements including hospital leadership positions and academic appointments. RESULTS: We identified 92 urologists that received over $50,000 USD in general payments. These high-payment urologists received a median payment of $82,408 USD (IQR $ 59,670 USD, $155,329 USD) and a total payment of $18.1 million USD. High-payment urologists represent 1.1% of all US urologists that received a payment in 2021 (n=8729) but received 58.2% of all industry payments made in 2021 ($31.1 million USD). Most high-payment urologists were men (91%) and specialized in urologic oncology (25%). The median h-index was 13. There was an equal distribution of high-payment urologists in academic and community practices. Of all high-payment urologists, 13% were guideline authors, 23% were editorial board members, 42% occupied leadership positions within their institution, and 58% held an academic appointment. CONCLUSIONS: A small number of urologists receive most of the payments from industry. High-payment urologists were predominantly male and specialized in urologic oncology. These individuals hold positions of influence within urology based on their academic and leadership involvements. Additional research is needed to determine the impact of these conflicts of interest on urologic practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e909 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David-Dan Nguyen More articles by this author Anna-Lisa V. Nguyen More articles by this author Adree Khondker More articles by this author Jethro C. Kwong More articles by this author Anne Xuan-Lan Nguyen More articles by this author Muhieddine Labban More articles by this author Rashid K. Sayyid More articles by this author Naeem Bhojani More articles by this author Quoc-Dien Trinh More articles by this author Christopher J.D. Wallis More articles by this author Expand All Advertisement PDF downloadLoading ...

Inappropriate Involvement? Presenting Empirical Insight into the Preparation Phase of Advance Directives of Persons Living with Dementia Under German Legislation

ABSTRACT The scholarly debate on advance directives (ADs) in the context of dementia is mainly built around ethical arguments. Empirical studies that shed light into the realities of ADs of persons living with dementia are few and far between and too little is known about the effect of national AD legislation on such realities. This paper offers insight into the preparation phase of ADs according to German legislation in the context of dementia. It presents results from a document analysis of 100 ADs and from 25 episodic interviews with family members. Findings show that drafting an AD involves family members and different professionals in addition to the signatory, whose cognitive impairment differed considerably at the time of preparing the AD. The involvement of family members and professionals is at times problematic, which prompts the question of how much and what kind of involvement of others turns an AD of a person living with dementia into an AD about a person living with dementia. The results invite policy makers to critically review legislation on ADs from the perspective of cognitively impaired persons, who might find it difficult to protect themselves from inappropriate involvement when completing an AD.

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review.

Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.

Symptoms of work-related burnout revealed in the process of remote working and resilience

The term remote working is one of the forms of doing some kind of work, which allows both the employee and the employer to work from a convenient location using internet technologies. The mentioned method of work has become quite demanding and relevant in the conditions of the COVID 19 pandemic, especially in the educational field. Which is accompanied by its positive and negative characteristics. The goal of our study was: to reveal the symptoms of work-related burnout of teachers in the process of remote learning and to determine the relationship between these symptoms and the resilience. The following research methods have been selected in accordance with the goal, : to detect emotional burnout, we used C. Maslach and M. Leiter instrument. According to these authors, burnout is the result of irrelevance between person and work. As this irrelevance increases, the likelihood of burnout syndrome formation increases. The instrument mentioned above consists of three scales: emotional exhaustion, depersonalization, reduction of personal achievements.In order to study the resilience, we selected the instrument developed by S.R.MADDI, which contains three components: involvement, control and risk-taking. Based on the empirical research, it was found that among the emotional burnout scales for teachers, the highest score was found on the reduction scale. Which reflects the level of satisfaction with oneself as a professional. A relatively low score was found on the emotional exhaustion scale, and the lowest score was found on the scale of depersonalization. That is, emotional indifference is the least characteristic of teachers; The results obtained on the resilience scale were distributed as follows: the highest score was obtained on the scale of control, the average score was on the scale of involvement, and the lowest score was on the scale of risk-taking. Correlation analysis between resilience and professional burnout variables gave us a very interesting picture. In particular, all three scales of resilience are in positive correlation with a scale of work-related burnout, such as depersonalization, which means that the more arrogant behavior, professional slang, and use of labels are expressed with the teacher, the higher is: 1. Professional involvement, i.e. enjoying one's work , 2. Control, that is, the belief that the struggle allows us to make influence on what happens, even if this influence is not absolute and success guaranteed, 3. Risk-taking, that is, the belief that everything that happens to him/her based on positive or negative experiences contributes to his/her development. A negative correlation was confirmed with all three scales of resilience and with such a scale of work-related burnout as exhaustion, which means that in the case of increased psychological exhaustion, when the teacher loses the interest and positive feelings of   surrounding people, at this time the belief that the struggle allows us to make an influence on what happens (control) is low. The level of involvement is also low, which creates a feeling of being rejected. And finally - in the case of a high rate of burnout, the willingness to take risks is low, that is, the teacher is less likely to believe that everything that happens to him/her contributes to his/her development. Based on the research, it was determined that the components of resilience: involvement, control and risk-taking significantly hinder the development of teachers' work-related burnout.

Factors associated with higher quality of clinical practice guidelines and their recommendations for the pharmacological treatment of depression: a systematic review

ObjectiveThe objective of this study was to assess the quality of clinical practice guidelines (CPGs) for the pharmacological treatment of depression along with their recommendations and factors associated with higher...

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Clinical Barriers in Treating Patients with Schizophrenia Who Use Cannabis

Within the past two decades, psychiatric clinics have seen an increase in the number of patients with schizophrenia who use cannabis. Studies have demonstrated the drug’s exacerbating effects on schizophrenia symptoms and treatment, posing a challenge to clinicians who treat this patient population. However, insight into the perspectives and needs of these clinicians remains largely absent within the existing literature. To provide them a voice, this study utilized surveying and interviewing with a mixed quantitative and qualitative design to evaluate and analyze the perspectives, concerns, and needs of clinicians who treat patients with schizophrenia who use cannabis. Participating clinicians (n = 5) were generally confident in understanding how cannabis use affects schizophrenia and their roles as providers. However, these clinicians were less confident in the effectiveness of existing treatments, education, and literature on the subject. Additionally, participants voiced concerns about issues such as the limitations of existing literature on this patient population, the lack of established guidelines and protocols for treating this patient population, and the absence of educational resources and materials for both clinicians and patients. Overall, the number of voiced concerns and the high variation between clinicians strongly imply the necessity of these clinicians’ perspectives within research on this patient population. Increased involvement of medical professionals within the literature on cannabis use in schizophrenia should hopefully serve to implement and improve the resources that these clinicians need to make a lasting positive change in patients with schizophrenia who use cannabis.

An Explorative Study: The Challenges of Cross-Cultural Adaptation among Expatriates in Kuala Lumpur, Malaysia

The current progress of technological modernization has further enhanced the increase in the number of international migration movements around the world. The encouragement of international migration is also driven by the policies enacted by the government at the policy implementation stage, producing a dynamic and highly innovative local workforce as well as high demand from industries, institutions, and statutory bodies to fill the energy gap in professional work. International migration is an advantageous approach and has been found to positively impact a country’s economic and socio-political development. Furthermore, the involvement of professionals, especially expatriates who are technologically literate, highly knowledgeable, and have extensive experience in certain fields, not only helps the country’s economic growth but also contributes to the sustainability and viability of organizational management. Nonetheless, individuals involved in international migration, especially expatriates, tend to experience problems adaptating to the cultural environment of the host country due to the differing cultural practices than their countries of origin. Therefore, the aim of this study is to explore the challenges of cultural adaptation among expatriates in Kuala Lumpur, Malaysia. The findings of this study found that the lack of social interaction and lack of cultural interaction are the challenges faced by expatriates while adapting to the culture in Malaysia. The findings of this study also provide benefits to the organizations and agencies of the government i.e. MIDA or TalentCorp in managing expatriate issues in Malaysia in order to reduce the turnover and repatriation among expatriates.

Diverse Geriatric Workforce Education History, Needs, and Opportunities: Focus on Psychiatric Advanced Practice Nurses

Primary TopicAdvanced Practice Nursing History and Current State of Education Update Secondary TopicExploration of opportunities for filling educational gaps for subspecialty geriatric psychiatry training in Diverse WorkforceThis symposium is sponsored by the AAGP IDEA Committee.Advanced practice nurses are continuing to grow as partners of care for the geriatric psychiatry patient population. With increasing specialty workplace shortages across acute, ambulatory, and long-term care settings and growing numbers of geriatric psychiatrists retiring and less coming into the field, there is need to increase interprofessional collaboration with advanced practice nurses. The variety of advanced practice nurses practicing in the field has led to understandable confusion surrounding educational standards and experience from physician colleagues.Advanced nursing education has evolved over decades adapting to the needs of the ever-changing healthcare system and patient needs. Advanced practice nurses came in existence to assist in providing care to the underserved and often rural populations that struggled to maintain physician employment. The first advanced practice nurse specializing in the field of psychiatry was the certified nurse specialist. This role originally encompassed a larger focus on psychotherapy. Over decades and changes in healthcare, there was a larger call for psychiatric prescribers due to psychiatrist shortage, leading to the development of the psychiatric nurse practitioner role. Psychiatric nurse practitioners are board certified to provide psychiatric healthcare across the lifespan but are considered generalists until provided experience and training in specialty areas. Psychiatric nurse practitioners specializing in geriatric psychiatry do not currently have any additional academic institution driven training, but become specialists through mentorship from geriatric psychiatrists, nurse practitioners, or physician assistants within depth knowledge in geriatric mental healthcare. They also engage with continuing medical education, professional organization involvement, and gain clinical experience at bedside and in advanced practice nursing. Some advanced practice psychiatric nurses come into geriatric psychiatry practice from a calling and passion for this population, while others find their career gravitates towards this population as a response to a call from the community in need of care. There is desire and need for increased standardized educational opportunities for advanced practice nurses who are passionate about caring for the mental health needs of older people, and a hope that geriatric psychiatrists may offer assistance and guidance with the interprofessional united goal to improve access to quality care to our geriatric patients.

Involvement of community pharmacy professionals in maternal health service provision in Ethiopia: a multi-centre cross-sectional survey

Abstract Objectives In countries with high maternal mortality and a shortage of healthcare professionals, community pharmacy professionals can provide important maternal healthcare services within their scope of practice. Evidence of community pharmacy professionals’ level of involvement in maternal health service provision in Ethiopia is limited. This study aimed to assess the level of involvement of community pharmacy professionals in providing maternal health services in Ethiopia. Methods A multi-centre cross-sectional survey of 238 community pharmacy professionals was conducted from March to July 2020 in 6 cities of Amhara regional state in Ethiopia. Independent samples t-test and one-way analysis of variance (ANOVA) were used to test the mean difference. Key findings Most community pharmacy professionals were either ‘involved’ in advising about vitamins (53.4%), provision of contraceptives (52.9%), advising about lifestyle changes (46.2%), responding to minor symptoms (47.5%), nutritional advice during pregnancy (45.0%) and breastfeeding guidance or ‘very involved’ in advising about screening for chronic disease (41.6%). However, the level of involvement of community pharmacy professionals differed according to study participants’ educational qualification/s, years of experience, licensure level, setting type, responsibility in the facility and previous training exposure about maternal health services. Conclusions Community pharmacy professionals in Ethiopia are involved in providing various maternal health services highlighting the importance that pharmacists can play in improving access and care within this context. However, government attention is needed to enhance their role through policy support and capacity building to improve the quality of service provided which could contribute to the reduction of maternal mortality.

БОЛЕЗНЬ ШЕГРЕНА И ОСТЕОПОРОЗ В ПРАКТИКЕ ВРАЧА-СТОМАТОЛОГА: КЛИНИЧЕСКИЙ СЛУЧАЙ

Subject. The subject of this research is Sjogren's syndrome.
 Objective. The objective of this research is to report a clinical case of Sjogren's syndrome associated with osteoporosis under hospital outpatient care provided by a dental therapist.
 Methodology. The research design includes description of one clinical case. The study is conducted by the Department of Preventive Dentistry and Propedeutics of Dental Disease, and the Department of Intermediate Level Therapy and Geriatrics of Ural State Medical University. This paper presents clinical observations of the patient developing main symptoms of Sjogren's syndrome, as well it explores somatic/dental status and describes the framework for supervision during dynamic observation.
 Conclusion. The case study allows to explore one of the multiple cases leading to development of chronic Sjogren's syndrome. The patient experiences a worsening of symptoms associated with menopausal transition and with new signs brought on by osteoporosis shows specific symptoms. Clinical manifestations of Sjogren's disease are highly variable, complicating the diagnostic process. This creates a risk of delayed treatment and provokes the development of severe complications, especially against the background of osteoporosis. Rational selection of appropriate modern medical treatment (active general drug therapy) and dynamic observation of a reumatologyst are specially important. However, being an interdisciplinary problem Sjogren's syndrome requires involvement of dental professionals, training in professional oral hygiene procedure which is the initial step of comprehensive maintenance treatment (based on clinical recommendations) and dynamic observation of patients; based on systemic manifestations, other specialists such as a reumatologyst, a gastroenterologist, an endocrinologist, an ophthalmologist may be involved.

Local, collaborative, stepped, and personalized care management for older people with chronic diseases – results from the randomized controlled LoChro-trial

BackgroundIn the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness.MethodsA two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants’ evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling.ResultsWe analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity.ConclusionSupporting patients’ self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904

Consenso de recomendaciones para la mejora de la coordinación asistencial inter e intra-centros en el abordaje de la hemofilia

ObjectiveDefine consensus recommendations to improve care coordination between Hospital Pharmacy, Haematology and Nursing, inter- and intra-center, in the care of haemophilia patients. MethodRecommendations for the improvement of care coordination in the management of haemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Haematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analysed through different metrics. ResultsFifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Haematology and Nursing in the management of haemophilia patients were identified, grouped into eight areas of action: i) Haemophilia units, reference centers and multidisciplinary care; ii) Role of Haematology, Hospital Pharmacy and Nursing in the patient journey of haemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. ConclusionsHaemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Haematology and Nursing.

How We Got Here: The Legacy of Anti-Black Discrimination in Radiology

Current disparities in the access to diagnostic imaging for Black patients and the underrepresentation of Black physicians in radiology, relative to their representation in the general U.S. population, reflect contemporary consequences of historical anti-Black discrimination. These disparities have existed within the field of radiology and professional medical organizations since their inception. Explicit and implicit racism against Black patients and physicians was institutional policy in the early 20th century when radiology was being developed as a clinical medical field. Early radiology organizations also embraced this structural discrimination, creating strong barriers to professional Black radiologist involvement. Nevertheless, there were numerous pioneering Black radiologists who advanced scholarship, patient care, and diversity within medicine and radiology during the early 20th century. This work remains important in the present day, as race-based health care disparities persist and continue to decrease the quality of radiology-delivered patient care. There are also structural barriers within radiology affecting workforce diversity that negatively impact marginalized groups. Multiple opportunities exist today for antiracism work to improve quality of care and to apply standards of social justice and health equity to the field of radiology. An initial step is to expand education on the disparities in access to imaging and health care among Black patients. Institutional interventions include implementing community-based outreach and applying antibias methodology in artificial intelligence algorithms, while systemic interventions include identifying national race-based quality measures and ensuring imaging guidelines properly address the unique cancer risks in the Black patient population. These approaches reflect some of the strategies that may mutually serve to address health care disparities in radiology. © RSNA, 2023 See the invited commentary by Scott in this issue. Quiz questions for this article are available in the supplemental material.

Interdisciplinary collaboration to identify challenges and opportunities in urban sound planning

Urban sound planning aims to integrate soundscape approaches within existing planning frameworks to create sound environments which are conducive to health and wellbeing. It recognises that the best soundscape outcomes are achieved when acoustic environments are considered from the outset of the urban planning and design process-and that this must be done with the interdisciplinary involvement of professionals from a range of fields. While the benefits of soundscape approaches in urban design have been demonstrated, positive soundscapes and public health outcomes have been limited by a gap between theoretical understandings of sound as a manageable resource versus implementation in planning and the built environment. This is especially true in jurisdictions that lack quality-based environmental noise policies, as their regulatory actions are confined to the mitigation of "noise" as a waste or pollutant. This paper explores the challenges for implementation of quality urban sound planning within the regulatory system of New South Wales, Australia. Barriers and opportunities for soundscape approaches in planning are discussed, based on experiences from professionals in relevant domains and examples of successful soundscape and health outcomes in other jurisdictions.

Emotional Support Animal Partnerships: Behavior, Welfare, and Clinical Involvement

ABSTRACT The present study gathered information about the characteristics of individuals and dogs in Emotional Support Animal (ESA) partnerships, instances of service-animal misrepresentation, animal welfare and behavior, dimensions of bond quality, and health professional involvement. Seventy-seven adults (53 female, 24 male) with a canine ESA were surveyed via Qualtrics panel services. Data were analyzed for descriptive data, as well as correlational analyses among variables. Participants reported high frequencies of misrepresentation of emotional support animals, access law violations, and problematic instances including ESAs with a history of aggression and times when participants were unable to care for their dog. The majority of participants reported mental illness diagnoses, seeking ESA documentation from mental health providers; however, levels of health professional involvement in the ESA-procuring process were varied. Several dimensions of bond quality between participants and their ESA were reported to be consistently high across participants. Correlational data brought forth questions about the roles that health professionals and animal welfare could play in preventing harm to clients, animals, and communities, discouraging unlawful and problematic behavior, and strengthening the human–animal bond between their clients and ESAs. For example, welfare concerns were correlated with problematic animal behaviors and perceived costs to the participants. Additionally, as professional involvement increased, so too did rates of misrepresentation of ESAs as service animals and access law violations. These data provide a first picture of ESA partnerships and can be a springboard for future research toward protecting individuals with disabilities, their animals, and communities.