Review Team Research Articles

1271 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA

Abstract Introduction Pressure injury (PI) management is a challenge in dependent patients in acute care wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). Method A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long Term Care (LTC) wards and thus may improve outcomes. The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD. After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (19(60 %) were female). All had stage 2-4 PIs (present in 25(83%) on admission to ACW). On transfer to LTC wards, all patients had severe physical dependency with a mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days. Results PI improvement by >2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (<21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying. Conclusion These results suggest that an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation has been planned.

Clinical management of pediatric patients with cystic fibrosis and autism spectrum disorder.

Cystic Fibrosis (CF) and autism spectrum disorder (ASD) are life-long conditions with intense treatment burdens for patients and families. Patients with a concurrent diagnosis (CF-ASD) experience unique obstacles to CF care. This study describes the experiences of our multidisciplinary CF team in caring for patients with CF-ASD and provides insight into provider and parental perspectives on clinical management. This is a three-part qualitative study involving (1) retrospective chart review of patients with CF-ASD,(2) surveys with multidisciplinary care team members, and (3) semistructured interviews with caregivers of patients with CF-ASD. Challenges in clinical management of this specific cohort were compiled using data from chart review and care team surveys. Strategies to address these concerns were identified and rated by individual families based on relevance and practicality. Within our CF center, 12 patients have an official diagnosis of ASD. Median age of patients with CF-ASD was 8.5 years (range 3-20 years), 67% were male, and 83% were on highly effective modulator therapy. Clinical barriers included sensory processing issues, environmental overstimulation, intolerance to procedures and to disrupted routines. Potentially impactful strategies include patient-specific coping plans, guided behavioral interventions, parental advocacy, and improved communication between the family and multidisciplinary team. Children with CF-ASD face extraordinary challenges beyond the experience of neurotypical children with CF. Increased awareness of this complex dual diagnosis will help providers be sensitive to the unique needs of these patients, help build consistent and trustworthy relationships with their families and deliver effective clinical care despite limitations.

The Use of Mediation as Alternative Tax Dispute Resolution

Legal remedies that can be taken by taxpayers in the event of a tax dispute by filing an objection to the objection institution located in the Directorate General of taxes. This objection is essentially a legal remedy that is outside the Tax Court to seek justice in tax disputes. The problem is that there are several weaknesses related to fairness to objection institutions in processing objections that exist today, namely: the psychological pressure on the objection reviewer, the organizational structure that is not independent, human resource management, especially the objection review team that has not been optimal. To overcome these problems alternative dispute resolution should use mediation mechanism because it can overcome the buildup of cases in court so that an effective instrument is needed because some countries such as Australia, Britain, America, Canada use mediation as an alternative to tax dispute resolution. Keywords: Alternative Dispute Resolution, Tax Dispute, Property

New Name, New Format!

New Name, New Format!

No More Women Killed in Spain! A Collaborative Femicide Prevention Effort of a Police-Led Team of Ministry of Interior and Academia

Abstract With the turn of the new century, the Spanish government developed a series of initiatives to eradicate gender violence and intimate partner femicides. Among these initiatives, the Secretary of State for Security (SSS) of the Ministry of Interior organized a National Project (Team) for the Detailed Review of Intimate Partner Homicides—a police-led team that partnered with 21 Spanish universities and several correctional facilities across 50 provinces—to conduct a concurrent embedded, correlational mixed-methods study of a nationally representative sample of 171 femicide cases and a control group of 210 non-lethal partner abuse cases (2006–2021). The results of this study served to improve current law enforcement femicide risk prediction tools (Valoracion Policial del Riesgo, VPR) and to develop different offender typologies aiming at guiding treatment interventions. New recommendations were also provided to enhance collaboration between law enforcement and other agencies so extant partner violence cases can be appropriately managed.

Opening Remarks by the Chairman of the Editorial Board and Editor-In-Chief

The authors of the article announce a new Russian scientific electronic journal “Timiryazev Biological Journal” founded in 2023, but having more than 150-year history. The most important mission of the journal, according to the authors, is to provide highly qualified information support to topical biological research, for which a solid team of editors and reviewers, who are experts in different branches of biological sciences, is created. The authors invite scientists as well as their young colleagues, post-graduates and PhD students to publish in the journal “Timiryazev Biological Journal”, and express the hope that in the near future the journal will become an important platform for biologists to exchange relevant scientific information, and continue to develop the traditions of academic and applied science, established in the walls of the oldest agrarian university In Rusia Russian State Agrarian University – Moscow Timiryazev Agricultural Academy.

EDITOR'S NOTES—COUNTERFACTUAL THINKING: A NECESSITY FOR PRACTITIONERS AND RESEARCHERS

EDITOR'S NOTES—COUNTERFACTUAL THINKING: A NECESSITY FOR PRACTITIONERS AND RESEARCHERS

A Mealy Machine for Mechanic Dynamic Aesthetic (MDA) Gamification Model of Educator Career System in Indonesian Higher Education Institutions

The purpose of this study is to develop a mechanic dynamic aesthetic (MDA) gamification model for higher education institutions (HEIs’) educator career system (ECS). A mealy machine or finite state machine (FSM) is used to model the ECS gamification mechanic because the academic degrees targeted by the educators are finite and assumed to be the states that they must accomplish during their journey as professional educators. A program is created to simulate the Mealy machine and the results are checked by an ECS reviewer team. MDA-ECS is the result of a new ECS gamification model implemented in Indonesian HEIs. The proposed gamification model’s mechanic is a five-tuple Mealy machine, which consists of four elements: (career) states, start states, inputs, outputs, and transitions. The four functional degrees (FDs): Associate Lecturer, Lecturer, Associate Professor, and Professor: represent the states of the machine. Credit points from the four aspects of 3D-HEI collected by the educator are the machine’s inputs, while the grade of FDs, reward, and punishment are the outputs, and thus the gamification. The simulation showed that the mealy machine met the informational and affective aspects of the ECS regulation in Indonesian HEIs.

Geriatrics studies in Nigeria: systematic review and quality assessment protocol

Introduction: Geriatrics, a specialized medical branch focusing on the health and well-being of older individuals, has gained increasing attention due to the global demographic shift towards an aging population. Despite the significant growth of the older adult population in Nigeria, limited empirical studies hinder the translation of research findings into health and well-being improvements for older adults in the region. Objective: This systematic review will synthesize geriatrics research conducted in Nigeria over the past 6 decades, identifying temporal patterns and research priorities. Methods: Four electronic databases will be searched to identify studies from published and grey literature on geriatrics in Nigeria between 1960 and 2023 and will be reviewed from inception to 2023: PubMed, MEDLINE, Google Scholar, and African Journal Online. The population of interest is older adults aged ≥60 years. The review team comprises primary investigators, content experts, and a subject librarian. Data extraction and analysis will be conducted independently by review authors, and statistical analysis will be performed by experts. Expected results: Depending on the results, we anticipate that this systematic review will help clarify the state of geriatrics studies and services in Nigeria. Relevance: The review will fill research gaps to inform policy directives and interventions in geriatric care by developing evidence-based clinical and policy documents to improve the health and well-being of older adults in Nigeria.

Review of antibiotic prescriptions as part of antimicrobial stewardship programmes: results from a pilot implementation at two provincial-level hospitals in Viet Nam.

To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam. This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01-0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52-40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17-322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13-10.62). This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.

Interventions to treat and prevent postpartum depression: a protocol for systematic review of the literature and parallel network meta-analyses

IntroductionPostpartum depression has costly consequences for the mother, baby, and society. Numerous pharmacological and non-pharmacological interventions are available for the prevention and treatment of postpartum depression. To date, no attempt has been made to synthesize the evidence from comparisons of interventions both within and across these categories.MethodsWe will perform a systematic review of the literature and perform network meta-analysis of interventions to (a) prevent and (b) treat postpartum depression. This review will include studies of primiparous or multiparous women during pregnancy or within 12 months of delivery of their baby that assess either interventions initiated during pregnancy or within 1 year of childbirth. Comparators will be other eligible interventions or control conditions. The outcome of interests will be related to the antidepressant efficacy of the interventions as well as their acceptability. The published literature will be searched in Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. The search will use a combination of standardized terms and keywords for postpartum depression, a sensitive search filter to limit for randomized controlled trials, and a librarian-created “humans” filter. The search results will be uploaded to the Covidence online systematic review platform (Veritas Health Information Ltd., Victoria, Australia) where two review team members will independently screen articles. We will extract data to include year of publication, language, country, participants (number, demographic data, eligibility criteria, psychiatric symptoms, and co-morbidities), characteristics of the intervention and control conditions, and reported outcomes. Risk of bias for each study will be assessed independently by two review authors using the RoB 2: A revised Cochrane risk of bias tool for randomized trials. Network meta-analysis will be performed using a Bayesian hierarchical model supplemented with a Markov chain Monte Carlo approach.DiscussionPostpartum depression is a devastating disease with long-lasting consequences. Given the numerous available interventions to both prevent and treat postpartum depression and the great number of studies comparing them, it is imperative that clinicians and patients are provided with an assessment of their comparative efficacy and acceptability.Systematic review registrationProspero registration (CRD42022303247).

Project Management for Cloud Compute and Storage Deployment: B2B Model

This paper explains the project’s objectives, identifies the key stakeholders, defines the project manager’s authority and provides a preliminary breakdown of roles and responsibilities. For the project’s future, it acts as a source of authority. This paper’s objective is to record the justifications for starting the project, its goals, limitations, solution instructions and the names of the principal stakeholders. This manuscript is meant to be used as a “Project Management Plan Light” for small and medium-sized projects when it would be uneconomical to prepare an entire collection of documents that make up a project management plan. A global media cloud will be provided and managed by the ABC cloud company inside of a consumer’s current premises. In this paper, the authors explain the end-to-end delivery of cloud and compute services. The article mainly focuses on the delivery of virtual machines (VMs), graphics processing unit (GPUs), cloud storage, transcoding, packaging, 24/7 customer support and billing modules for the services used by end customers. The process starts with customer requirements gathering to initiate the feasibility check for the services desired or required by the clients. Pre-sale solution engineers capture all the customer requirements in the solution design document to review with the engineering and delivery team for the implementation. Based on the solution design document, the solution engineer needs to raise the system’s feasibility for the local loops, cross connects, VMs, GPUs, storage, transcoders and packagers required to meet the end customer expectations on the service delivery. The solution engineer must sign-off on the solution design document agreed with end customer from the engineering and technical team. The program manager and technical team review the solution design document and confirm the order ID requirement in the system for the sales team to share with the order entry team to log the orders for a signed customer order form (COF). The program manager will initiate the service delivery for these order IDs logged in to the system for these services. Once services are ready for customer delivery, a technical team will share the customer portal with the end customer and provide training to the teams at the customer end use the required resources for cloud, compute and storage uses. Along with the services mentioned above, customers can access the usage and billing information in the customer portal. Moreover, the program manager is to share the project closure document, including the information about the services, reference IDs to log the trouble ticket with the supplier’s 24/7 support team and billing start date for customer acceptance.

Expert searchers identified time, team, technology and tension as challenges when carrying out supplementary searches for systematic reviews: A thematic network analysis.

Systematic reviews require detailed planning of complex processes which can present logistical challenges. Understanding these logistical challenges can help with planning and execution of tasks OBJECTIVES: To describe the perspectives of expert searchers on the main logistical challenges when carrying out supplementary searches for systematic reviews, in particular, forward citation searching and web searching. Qualitative interviews were undertaken with 15 experts on searching for studies for systematic reviews (e.g. information specialists) working in health and social care research settings. Interviews were undertaken by video-call between September 2020 and June 2021. Data analysis used thematic network analysis. We identified three logistical challenges of using forward citation searching and web searching which were organised under the global theme of 'tension': time, team and technology. Several subthemes were identified which supported the organising themes, including allocating time, justifying time and keeping to time; reviewer expectations and contact with review teams; and access to resources and reference management. Forward citation searching and web searching are logistically challenging search methods for a systematic review. An understanding of these challenges should encourage expert searchers and review teams to maintain open channels of communication, which should also facilitate improved working relationships.

Usability of mixed reality in awake craniotomy planning

Purpose This study aimed to describe our institutional use of a commercially available mixed reality viewer within a multi-disciplinary planning workflow for awake craniotomy surgery and to report an assessment of its usability. Materials and methods Three Tesla MRI scans, including 32-direction diffusion tensor sequences, were reconstructed with BrainLab Elements auto-segmentation software. Magic Leap mixed reality viewer headsets were registered to a shared virtual viewing space to display image reconstructions. System Usability Scale was used to assess the usability of the mixed reality system. Results The awake craniotomy planning workflow utilises the mixed reality viewer to facilitate a stepwise discussion through four progressive anatomical layers; the skin, cerebral cortex, subcortical white matter tracts and tumour with surrounding vasculature. At each stage relevant members of the multi-disciplinary team review key operative considerations, including patient positioning, cortical and subcortical speech mapping protocols and surgical approaches to the tumour. The mixed reality system was used for multi-disciplinary awake craniotomy planning in 10 consecutive procedures over a 5-month period. Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5. Feedback highlighted the benefit of being able to rehearse important steps in the procedure, including patient positioning and anaesthetic access and visualising the testing protocol for cortical and subcortical speech mapping. Conclusions This study supports the use of mixed reality for multidisciplinary planning for awake craniotomy surgery, with an acceptable degree of usability of the interface. We highlight the need to consider the requirements of non-technical, non-neurosurgical team members when involving mixed reality activities.

Use of digital technology to give and receive feedback in clinical training: a scoping review protocol

BackgroundFeedback is vital to improving trainee competencies in medical education. The challenges of the global COVID-19 pandemic related to social distancing to curb the spread of the virus ignited a rapid transition to online medical education. These changes highlight the need for digital feedback tools that enhance the efficacy and efficiency of feedback practices. This protocol is for a scoping review that aims to identify the different digital tools and applications in medical education as reported in the literature, as well as highlight gaps in the current literature and provide suggestions for future technological developments and research.Methods and analysisA review of the relevant literature will be guided using the Joanna Briggs Institute methodological framework for scoping studies. Using the search strategy developed by the authors, an electronic search of the following databases will be conducted: PubMed/MEDLINE, EBSCOhost (academic search complete, CINAHL with full text) Scopus, Google Scholar, Union Catalogue of Theses and Dissertations (UCTD) via SABINET Online and World Cat Dissertations and Theses via OCLC. Studies will be identified by searching literature from January 2010 to date of review. Using a validated data extraction form developed for the scoping review, the review team will screen eligible studies and import them onto an electronic library created specifically for this purpose. Data collection for the review will be documented through a PRISMA-P flowchart, and the scoping review will use a basic descriptive content analysis to analyse and categorise the extracted data. All review steps will involve two or more reviewers.DisseminationThe review will provide a comprehensive list of digital tools and applications used to enhance feedback in clinical training and inform future technological developments. The findings will be disseminated through medical education conferences and publications.

Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review.

The growing older population with advanced chronic kidney disease (ACKD stages 4-5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and interventions specific to this population. The aim was to objectively review the evidence relating to older people (≥65years) living with frailty and ACKD. More specifically how frailty is identified, what interventions have been studied and what outcomes have been reported including outcomes important to patients, families and carers. A scoping review was undertaken following the PRISMA-Scr guidelines. Nine databases were searched and a review team of five people followed a process using defined inclusion and exclusion criteria. Data were then analysed to answer the specific questions of the review. The World Health Organization's International Classification of Functioning Disability and Health was used to map outcomes across the domains. A total of 90 studies were included. The most reported frailty measure was the frailty phenotype. The most reported outcomes were mortality, hospitalisation and healthcare utilisation. Health-related quality of life was the most common patient-reported outcome measure. There were few intervention studies and limited evidence of patient and carer perspectives. This scoping review highlights important areas for further research in older people living with frailty and ACKD. This includes a 'gold standard' measure for identifying frailty, interventions and improvements in outcome measures that matter to patients (including studies that focus on carers and carer burden) and priority setting for future research.

Impact of Procedures and Human-Animal Interactions during Transport and Slaughter on Animal Welfare of Pigs: A Systematic Literature Review

Animal welfare is a high social and political priority and is enshrined in European and national legislation. This systematic literature review (funded by the German Ministry of Food and Agriculture; grant no. 2817806A18) was conducted to find animal and management-based indicators that could be influenced by changes in pig handling and management procedures on the day of slaughter and, therefore, will directly result in improved animal welfare. For this systematic literature review, following the PRISMA guidelines, we conducted a structured literature search using the databases PubMed®, Web of ScienceTM, and LIVIVO with set search terms and their combinations in German and English. Only peer-reviewed original articles from European countries from 2009 until 2022 that dealt with welfare during transport and/or slaughter of fattening pigs and offered potential measurable indicators on the basis of the animal or management, and either directly or indirectly recommended handling practices were included. We used the literature management system EndNoteTM, and after duplicate removal, a total of 1099 records were found for further analysis. After analysis and discussion in the review team, which consisted of three experts in total, 105 articles underwent full-text screening. Finally, 39 articles were included in the results for this systematic literature review. According to this systematic literature review, the following procedures have a positive impact on the animal welfare of pigs on the day of slaughter. Calm-rather than rough-handling of pigs was the most influential factor. This can be achieved by using animal-friendly driving aids. Loud noise should be avoided in general or reduced as far as possible. Transport time is not always influenceable, but shorter transport duration with stocking density as stated by the European regulations as a maximum will reduce stress in pigs. Our review showed that there are differing scientific results about lairage duration, although this should be set in relation to prior stress and transport time. Knowledge of good stunning parameters, such as gas concentration, exposure time to the gas, recommended amperage, and current flow duration is essential. If electrical stunning is performed, the correct attachment of electrodes is crucial. The control of stunning effectiveness is extremely important to avoid suffering and pain, with the proviso that it is assessed on the basis of multiple parameters. The corneal reflex, regular gasping, and the up-righting reflex could be assessed together. Certificates of competence and continuing educational programmes for the personnel form the basis of animal-friendly handling and a stressless slaughter routine. It can be assumed that the results of this systematic literature review reflect the state of current research of pig welfare during transport and slaughter in the European Union, even though it must be assumed that not all relevant points were covered by the review, which can be seen as a limitation at the same time because important non-European or older publications could not be included.

Understanding State-of-the-Art Literature Reviews.

Understanding State-of-the-Art Literature Reviews.

Editorial: There Are Promises to Keep and Miles to Go Before I Leave…

Editorial: There Are Promises to Keep and Miles to Go Before I Leave…

Colorectal cancer in South Africa study on the effect of delayed diagnosis to treatment intervals on survival

Data on colorectal cancer (CRC) diagnosis to treatment interval (DTI), an index of quality assurance in high-income countries (HICs) is lacking in South Africa. This study aimed to determine DTIs and their impact on CRC survival in a South African cohort. Participants (n = 289) from the Colorectal Cancer in South Africa (CRCSA) cohort were identified for inclusion. The DTI was defined as the duration between the diagnosis and initial definitive treatment and categorised into approximate quartiles (Q1-4). The DTI quartiles were 0-14 days, 15-28 days, 29-70 days, and ≥ 71 days. Overall survival (OS) was illustrated using the Kaplan-Meier method and compared between DTI groups using Cox proportional hazards (PH) regression. There was no significant impact of the DTI (as quartiles) on overall CRC survival. The median length of time between DTI in this cohort was 29 days. Significant associations were identified between the DTI and self-reported ethnicity (p-value = 0.025), the site of the malignancy (colon vs rectum) (p-value < 0.0001), multidisciplinary team (MDT) review (p-value = 0.015) and the initial treatment modality (p-value < 0.0001). Prolonged DTIs did not significantly impact survival for those with CRC in the CRCSA cohort. Symptom to diagnosis time should be investigated as a determinant of survival.