Seek Expert Opinion Research Articles

Key Opinion Leaders' Interviews to Inform the Future of Benefit-Risk Planning in the Medical Total Product Life Cycle of Global Pharmaceutical and Medical Device Organizations.

Key opinion leader (KOL) interviews were conducted by the Benefit-Risk Assessment Planning(BRAP) Taskforce to seek expert opinion mainly from industry and regulatory bodies, about the current status and future direction of benefit-risk assessment (BRA) planning in the lifecycle of medical product development. The findings from these interviews are intended to help communication concerning planning for BRA between industry and regulators and shape future guidance. Key opinion leader interviews consisted of 5 questions related to BRA planning, which were administered to volunteers (mainly clinicians and statisticians) within a pool of experienced pharmaceutical and medical device professionals representing academia, industry, regulatory agenciesand a patient group. The interviewees' responses to the 5 questions were summarized. To analyze the qualitative data, a Coding System was developed to label themes arising from the interviews. The key findings from the interviews were summarized into a Master Template. A quantitative analysis based on descriptive statistics was also conducted. Of the 27 interviewees, there were 11 professionals from regulatory agencies, 11 from industry, 4 from academia and 1 from a patient advocacy group. Key findings based on the comments provided by 48% of the interviewees indicated the need of incorporating BRA into other (e.g., existing) processes with the importance of alignment between processes being stressed in the comments provided by 59% of the interviewees. Commencing BRA early in the product lifecycle was emphasized in comments provided by 44% of the interviewees. Among other needs identified were an appropriate contextualization of benefits and risks (based on comments provided by 41% of interviewees) through adoption of an integrated approach with structured support by regulatory agencies and a need for understanding the audience with better communication of benefit-risk (BR) among all stakeholders (based on comments provided by 44% of the interviewees). Almost all comments provided by interviewees (96%) highlighted the importance of utilizing patient experience/preference to guide new product development and BRA. Comments provided by 74% of the interviewees expressed the need to understand patient tolerance for risk and trade-offs, with a majority (78%) of interviewees highlighting how to gather information, and 59% stressing the need for the selection and development of appropriate methodologies as important considerations for enhancing the quality and relevance of the data collected from patients. Interviewees indicated that BRA should commence early in the medical product development and inform decision-making throughout the product lifecycle. Better planning and integration of BRA into existing processes within industry would be valuable. The importance of incorporating the patient voice into BRA and medical product development was emphasized. Other key findings from the KOL interviews included a need for improved communication of BR information, and establishment of methodologies for performing BRA and soliciting patient input.

Hard-to-reach schools? Discrimination experienced by parents with a migrant background. A participatory research approach

ABSTRACT This study investigated the discrimination experienced by parents with a migrant background in German schools. For this, we shifted the perspective from speaking about to speaking with parents using the critical incident technique as a participatory research approach. The sample included 40 parents from 20 countries of origin, with different languages of origin who had lived in Germany for between two and ten years. The most frequently reported experiences were of low expectations of competence, stereotypical attributions and the deliberate withholding of information. Parents described the pathologising of behaviours due to their family backgrounds that was equated with problem behaviour and the need for treatment. Additionally, school staff alleged that parents were unable or unwilling to support their children in academic matters, giving their ‘migrant status’ as justification. Schools did not offer opportunities for clarification or made it a requirement to seek expert opinion on a child’s mental health before providing opportunities for clarification. Further discriminatory effects, such as the outcomes of self-fulfilling prophecies; feelings of humiliation, helplessness and exclusion; and the fear of being disadvantaged, became evident, which exhausted families mentally and physically. The discussed implications aim at establishing concepts that raise awareness of discrimination and the consequences.

Development and Content Validation of Iliotibial Band Friction Syndrome Index (IBFS-I)

Introduction: Activity-related lateral knee discomfort is a common symptom of Iliotibial Band Friction Syndrome (ITBFS), a condition characterised by excessive friction between the iliotibial band and the lateral femoral condyle. Literature indicates that ITBFS is highly prevalent in road cyclists, military recruits, and habitual runners respectively. But there is scarcity of readily usable tool to identify the extent of ITBS. This study was designed to develop and validate the content of a scale for ITBFS diagnosis. Aim: To develop and content validate of the developed tool which will help the physiotherapist to asses easier and earlier. Materials and Methods: This study involves expert opinions from seven different physiotherapy experts in an offline mode. Study was done in 3 phases: Phase 1: The extensive literature exploration Phase 2: Development of questionnaire Phase 3: Content validation of the developed questionnaire. The Delphi method was used to validate the content, which involves expert review panel, examining the domain and its items, assigning a score to each item, and computing the scale level content validity index (S-CVI) and item content validity index (I-CVI). It was performed using Delphi method which includes seeking expert opinion from 7 different expert from the field of physiotherapy on an offline mode, selecting expert review panel, reviewing domain and items, providing score to each item and calculating I-CVI (item content validity index) and scale level content validity index (S-CVI). Results: I-CVI was calculated using (I-CVI= agreed item/number of expert) and found to be 0.98 and S-CVI using (S-CVI=sum of I-CVI scores/Number of items) and found to be 0.9. This developed questionnaire is having excellent I-CVI and S-CVI. The physiotherapists may use the IBFS-I scale for the early identification of ITBFS. Conclusion: The IBFS-I scale may help physiotherapists diagnose ITBFS early. This scale may prove to be an effective tool in assisting the therapist in determining the degree of ITBFS in individuals

Legal Vacuum Governing the Use of Kirpan for Sikhs Based on Religious Rights and National Constitution

This research raises issues related to the protection of the right to state freedom for Indonesian citizens according to Indonesian national law. Specifically, this research discusses the history of the arrival of the Sikhs and the use of Kirpan in the public space as one of the teachings of the Sikh Religion which is mandatory for Sikhs to follow wherever and whenever. The regulation on the use of Kirpan is still unclear and ambiguous, so there is no legal certainty that protects Sikhs. Sikhs who wish to own and use a Kirpan are required to obtain a permit with the competent authority according to predetermined administrative requirements. However, this only applies to Sikhs who are over 17 years old, while Sikhs who are not yet 17 years old cannot obtain this permit. This has resulted in Sikhs who are under 17 years of age not receiving legal protection in exercising their religious rights. With this legal vacuum, the implementation of human rights in Indonesia is imperfect and not in accordance with Pancasila and the 1945 Constitution of the Republic of Indonesia. This research was conducted using normative juridical methods through literature studies and seeking expert opinion. This study uses a historical approach and a conceptual approach regarding the entry of the Sikh Religion and its teachings. This research is based on primary legal materials in the form of laws and regulations, international regulations, and judge's decisions, as well as secondary legal materials in the form of books, journals, and theses which contain previous research. The legal materials were obtained through library research. The type of analysis used is qualitative, namely by interpreting or interpreting the legal material obtained. The method of interpretation used is the method of grammatical interpretation and the method of historical interpretation. The results of this study state that the Indonesian government must make a law and regulation on the regulation of the use of weapons as a symbol of a religion such as Kirpan without any magical or heritage elements. This is for the sake of implementing religious freedom for Indonesian citizens in Indonesia

Proceedings from the Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA).

Mucosal melanoma remains a rare cancer with high mortality and a paucity of therapeutic options. This is due in significant part to its low incidence leading to limited patient access to expert care and downstream clinical/basic science data for research interrogation. Clinical challenges such as delayed and at times inaccurate diagnoses, and lack of consensus tumor staging have added to the suboptimal outcomes for these patients. Clinical trials, while promising, have been difficult to activate and accrue. While individual institutions and investigators have attempted to seek solutions to such problems, international, national, and local partnership may provide the keys to more efficient and innovative paths forward. Furthermore, a mucosal melanoma coalition would provide a potential network for patients and caregivers to seek expert opinion and advice. The Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA) highlighted the current clinical challenges faced by patients, providers, and scientists, identified current and future clinical trial investigations in this rare disease space, and aimed to increase national and international collaboration among the mucosal melanoma community in an effort to improve patient outcomes. The included proceedings highlight the clinical challenges of mucosal melanoma, global clinical trial experience, basic science advances in mucosal melanoma, and future directions, including the creation of shared rare tumor registries and enhanced collaborations.

The Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale): Construction and Pilot Testing of a Tool to Measure Factors Associated with Childhood Obesity.

(1) Background: Childhood obesity poses a global health challenge. In the period from two to six years, the fundamental risk factors are associated with modifiable habits, related to parental attitudes. In this study, we will analyze the construction and pilot test of the PRELSA Scale, designed to be a comprehensive tool that covers the whole problem of childhood obesity, from which we can later develop a brief instrument. (2) Methods: First, we described the scale construction process. After that, we conducted a pilot test on parents to check the instrument's comprehensibility, acceptability, and feasibility. We detected items to be modified or eliminated through two criteria: the frequencies of the categories of each item and responses in the Not Understood/Confused category. Finally, we sought expert opinion through a questionnaire to ensure the content validity of the scale. (3) Results: The pilot test on parents detected 20 possible items for modification and other changes in the instrument. The experts' questionnaire showed good values on the scale's content, highlighting some feasibility problems. The final version of the scale went from 69 items to 60. (4) Conclusions: Developing scales that detect parental attitudes associated with the onset of childhood obesity may be the basis for future interventions to address this health challenge.

Delayed hypersensitivity reaction to cosmetic filler following two COVID-19 vaccinations and infection

BackgroundWith ongoing COVID-19 vaccination schedules and the popularity of cosmetic fillers, it is important to examine and record associated adverse reactions to a more general audience of health care professionals. Case reports exist in subspecialty journals outlining reactions after SARS-CoV-2 infection and vaccination. This is one of the first cases published in Canada, and it highlights priorities and challenges faced by physicians in assessing and managing patients presenting with adverse reactions post vaccination.Case PresentationWe present a case of a 43 -year-old women with delayed type 4 hypersensitivity reaction to hyaluronic acid cosmetic filler triggered by COVID-19 mRNA vaccination. We outline the clinical presentation, diagnosis, complications, and treatment of a late inflammatory reaction to hyaluronic acid filler and highlight the treatment priorities for clinicians faced with similar presentations.ConclusionThe differential diagnosis of delayed onset nodules formation post filler injection is broad and includes redistribution of fillers, inflammatory reaction to biofilm, and delayed hypersensitivity reaction. As result, in order to make the right diagnosis, administer the appropriate treatment and achieve great cosmetic results, we highly recommend seeking expert opinion from dermatologist, plastic surgeon and allergist immunologist in a timely manner.

P45 Lyme-associated uveitis: Panuveitis and positive Lyme results – is it a masquerade or the real deal?

P45 Lyme-associated uveitis: Panuveitis and positive Lyme results – is it a masquerade or the real deal?

Systematic Review and Meta-analysis of TP53, HER2/ERBB2, KRAS, APC, and PIK3CA Genes Expression Pattern in Gastric Cancer.

Background: With a global prevalence of about 10%, gastric cancer is among the most prevalent cancers. Currently, there has been an ongoing trend toward investigating genetic disruptions in different cancers because they can be used as a target-specific therapy. We aimed to systemically review some gene expression patterns in gastric cancer. Methods: The current systematic review was designed and executed in 2020. Scopus, PubMed, Cochrane Library, Google Scholar, web of knowledge, and Science Direct were searched for relevant studies. A manual search of articles (hand searching), reference exploring, checking for grey literature, and seeking expert opinion were also done. Results: In this review, 65 studies were included, and the expression pattern of HER2/ ERBB2, ER1/Erb1/EGFR, PIK3CA, APC, KRAS, ARID1A, TP53, FGFR2 and MET was investigated. TP53, APC, KRAS, and PIK3CA mutation cumulative frequency were 24.8 (I2=95.05, Q value=525.53, df=26, P<0.001), 7.2 (I2=89.79, Q value=48.99, df=5, P<0.001), 7.8 (I2=93.60, Q value=140.71, df=9, P=0.001) and 8.6 (I2=80.78, Q value=525.53, df=9, P<0.001) percent, respectively. Overexpression was investigated for HER1/ Erb1/EGFR, PIK3CA, APC, KRAS, ARID1A, TP53, CCND1, FGFR2, MET and MYC. The frequency of TP53 and HER2/ERBB2 were 43.1 (I2=84.06, Q value=58.09, df=9, P<0.001) and 20.8 (I2=93.61, Q value=234.89, df=15, P<0.001) percent, respectively. Conclusion: More research is encouraged to investigate the genes for which we could not perform a meta-analysis.

Communicating with children about ‘everyday’ pain and injury: A Delphi study

Background‘Everyday’ pain experiences are potentially critical in shaping our beliefs and behaviours around injury and pain. Influenced by social, cultural and environmental contexts, they form the foundation of one's understanding of pain and injury that is taken into adulthood. How to best communicate to young children about their everyday pain experiences, in order to foster adaptive beliefs and behaviours, is unknown.MethodsIn this Delphi survey, we sought expert opinion on the key messages and strategies that parents/caregivers can consider when communicating with young children (aged 2–7 years) about ‘everyday’ pain that is most likely to promote recovery, resilience and adaptive pain behaviours. Eighteen experts participated including specialists in paediatric pain, trauma, child development and psychology; educators and parents. The survey included three rounds.ResultsResponse rate was over 88%. Two hundred fifty‐three items were raised; 187 reached ‘consensus’ (≥80% agreement amongst experts). Key messages that the experts agreed to be ‘very important’ were aligned with current evidence‐based understandings of pain and injury. Strategies to communicate messages included parent/caregiver role modelling, responses to child pain and discussion during and/or after a painful experience. Other key themes included promoting emotional development, empowering children to use active coping strategies and resilience building.ConclusionsThis diverse set of childhood, pain and parenting experts reached consensus on 187 items, yielding 12 key themes to consider when using everyday pain experiences to promote adaptive pain beliefs and behaviours in young children.SignificanceParents and caregivers likely play a critical role in the development of children's fundamental beliefs and behaviours surrounding pain and injury that are carried into adulthood. Everyday pain experiences provide key opportunities to promote positive pain‐related beliefs and behaviours. This Delphi survey identified key messages and strategies that caregivers can consider to optimize learning, encourage the development of adaptive pain behaviours and build resilience for future pain experiences.

Testing for syphilis.

Syphilis is no longer a disease headed for the history books but a disease on the resurgence. Its rising prevalence in populations of all sexualities has moved it from an unlikely differential diagnosis to an important one not to miss. With a latency to symptoms of sometimes many years, syphilis is a key disease to consider and does not need the clinician to attempt to risk assess the patient. This article seeks to equip the jobbing neurologist to recognise the manifestations of syphilis, and to understand the tests available, the interpretation of results and the limitations of testing. We provide an overview approach to assessing and managing these cases, what to expect and where to seek expert opinion and advice.

Diagnosing Hip Microinstability: an international consensus study using the Delphi methodology

PurposeHip microinstability is a relatively new diagnosis which is increasingly being discussed in the literature and yet there are no clear guidelines for making a diagnosis. Microinstability has generally been defined as persistent excessive hip motion that has become symptomatic especially with pain. This aim of this Delphi study was to seek expert opinion to formulate a diagnostic criteria for hip microinstability.MethodsA Delphi methodology was used for this consensus study. A literature search was conducted on PubMed up to March 2019 using the keywords ((hip) and (microinstability)) to identify relevant articles on this topic. All relevant criteria used for diagnosing hip microinstability were collated to create a questionnaire and further criterion suggested by the experts were included as well. Four rounds of questionnaires were delivered via an online survey platform. Between each round the authors acted as administrating intermediaries, providing the experts with a summary of results and synthesising the next questionnaire. The expert panel was comprised of 27 members: 24 (89%) orthopaedic surgeons and 3 (11%) physiotherapists from around the world.ResultsExpert panel participation in rounds 1–4 was: 27 (100%), 20 (74%), 21 (78%) and 26 (96%) respectively. A literature review by the authors identified 32 diagnostic criteria to populate the first questionnaire. Experts suggested amending three criteria and creating five new criteria. The panel converged on ranking 3 (8%) of criteria as “Not important”, 20 (54%) as “Minor Factors” and 14 (38%) as “Major Factors”. No criteria was ranked as “Essential”. Criteria were subcategorised into patient history, examination and imaging. Experts voted for a minimum requirement of four criteria in each subcategory, including at least six “Major factors”. The final diagnostic tool was approved by 20 (77%) of the final round panel.ConclusionThis study describes the first known expert consensus on diagnosing hip microinstability. The relative complexity of the final diagnostic tool is illustrative of the difficulty clinicians’ face when making this diagnosis.Level of evidenceV.

Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy.

High-energy Proton Beam Therapy (PBT) commenced in England in 2018 and NHS England commissions PBT for 1.5% of patients receiving radical radiotherapy. We sought expert opinion on the level of provision. Invitations were sent to 41 colleagues working in PBT, most at one UK centre, to contribute by completing a spreadsheet. 39 responded: 23 (59%) completed the spreadsheet; 16 (41%) declined, arguing that clinical outcome data are lacking, but joined six additional site-specialist oncologists for two consensus meetings. The spreadsheet was pre-populated with incidence data from Cancer Research UK and radiotherapy use data from the National Cancer Registration and Analysis Service. 'Mechanisms of Benefit' of reduced growth impairment, reduced toxicity, dose escalation and reduced second cancer risk were examined. The most reliable figure for percentage of radical radiotherapy patients likely to benefit from PBT was that agreed by 95% of the 23 respondents at 4.3%, slightly larger than current provision. The median was 15% (range 4-92%) and consensus median 13%. The biggest estimated potential benefit was from reducing toxicity, median benefit to 15% (range 4-92%), followed by dose escalation median 3% (range 0 to 47%); consensus values were 12 and 3%. Reduced growth impairment and reduced second cancer risk were calculated to benefit 0.5% and 0.1%. The most secure estimate of percentage benefit was 4.3% but insufficient clinical outcome data exist for confident estimates. The study supports the NHS approach of using the evidence base and developing it through randomised trials, non-randomised studies and outcomes tracking. Less is known about the percentage of patients who may benefit from PBT than is generally acknowledged. Expert opinion varies widely. Insufficient clinical outcome data exist to provide robust estimates. Considerable further work is needed to address this, including international collaboration; much is already underway but will take time to provide mature data.

“Pathological” fractures in spinal cord injuries and disorders: Insight into International classification of diseases, ninth revision coding

Objective: Analyses of osteoporosis-related fractures in persons with Spinal Cord Injury or Disorder (SCID) using administrative data often exclude pathological fractures (International Classification of Diseases, Ninth Revision (ICD-9) codes 733.1x). We examined how often lower extremity “pathological” fractures were secondary to osteoporosis. Design: Retrospective case–control study, fiscal years 2005-2015. Setting: Veterans Health Administration. Participants: Veterans with SCID and an ICD-9 code for lower extremity fracture. Outcome Measures: Clinical and SCID-related characteristics were compared in pathological and non-pathological fractures. A subset of Veterans with lower extremity fracture had data on fracture etiology from prior electronic health record (eHR) review. Of these, all with eHR-confirmed pathological fractures were considered cases. For each case, four unmatched controls with non-pathological fractures from this subset were randomly selected. Fracture etiology was compared between subsample cases and controls. We sought expert opinion from specialists who care for these fractures to understand their perspectives on what constitutes a pathological fracture and narrate our findings. Results: 6,397 Veterans sustained 16,279 lower extremity fractures, including 314 (1.93%) pathological fractures in 264 Veterans. Ten of 13 (76.9%) cases of pathological fracture (76.9%) and 82.4% of non-pathological fractures were secondary to osteoporosis. Of the 19 experts surveyed, only two coded osteoporotic fractures as pathological. Conclusion: Most pathological lower extremity fractures by ICD-9 codes in SCID are secondary to osteoporosis. Pathological fractures can be considered for inclusion in epidemiologic studies of osteoporosis in SCID when the risk-benefit profile for the study favors capturing all osteoporotic fractures at the expense of some misclassification.

An e-Delphi study to obtain expert consensus on the level of risk associated with preventable e-prescribing events.

AimsWe aim to seek expert opinion and gain consensus on the risks associated with a range of prescribing scenarios, preventable using e‐prescribing systems, to inform the development of a simulation tool to evaluate the risk and safety of e‐prescribing systems (ePRaSE).MethodsWe conducted a two‐round e‐Delphi survey where expert participants were asked to score pre‐designed prescribing scenarios using a five‐point Likert scale to ascertain the likelihood of occurrence of the prescribing event, likelihood of occurrence of harm and the severity of the harm.ResultsTwenty‐four experts consented to participate with 15 pand 13 participants completing rounds 1 and 2, respectively. Experts agreed on the level of risk associated with 136 out of 178 clinical scenarios with 131 scenarios categorised as high or extreme risk.ConclusionWe identified 131 extreme or high‐risk prescribing scenarios that may be prevented using e‐prescribing clinical decision support. The prescribing scenarios represent a variety of categories, with drug–disease contraindications being the most frequent, representing 37 (27%) scenarios, and antimicrobial agents being the most common drug class, representing 28 (21%) of the scenarios. Our e‐Delphi study has achieved expert consensus on the risk associated with a range of clinical scenarios with most of the scenarios categorised as extreme or high risk. These prescribing scenarios represent the breadth of preventable prescribing error categories involving both basic and advanced clinical decision support. We will use the findings of this study to inform the development of the e‐prescribing risk and safety evaluation tool.

BREAST CONSERVING SURGERY AWARENESS AND ACCEPTANCE AMONG FEMALE NURSES IN IRRUA SPECIALIST TEACHING HOSPITAL

Introduction: Breast Conserving Surgery (BCS) is oncologically safe for eligible patients with breast cancer and has enormous physical and psychological benefits. Despite this, the mastectomy rate in many centres is still very high. Nurses are frontline staff in healthcare settings and have great contact with the patients. The level of their awareness would have a great impact on patients eligible for breast conservation seeking expert opinion. This study explored the awareness, perception and acceptance of BCS among female nurses in a rural Nigeria tertiary hospital.&#x0D; Methodology: A quasi-structured self-questionnaire was distributed to 235 nurses using a convenient sampling method. The responses on 219 adequately filled questionnaires were entered into an IBM SPSS Statistics Data Document (version 21.0) for analysis. Categorical variables were presented in counts and percentages. Association between the acceptance of BCS versus its awareness, equivalence to TM and years of nursing practice were tested using Chi-square probability test and a p-value of &lt;0.05 was considered statistically significant.&#x0D; Result: The 219 participants had a good representation of junior and senior nurses among whom 80.4% were at least 45 years old and 82.2% were married. The nurses were mostly general nursing practitioners (76.7%) and 49.3% of the nurses had practised for a duration not less than 10 years of age. The 126 (57.5%) nurses, who described BCS as the surgical removal of a cancerous breast lump short of mastectomy, were considered to be aware of BCS irrespective of their understanding of complementary treatment modalities, eligibilities, comparative advantages to TM and certainty of its oncologic safety. The lack of ready access to radiotherapy centres (54.3%) and delay/overcrowding of these facilities (42.5%) were recognised respectively as major local challenges to BCS practices. The equivalence of BCS to TM was affirmed in 44.3% of the nurses and 35.6% had participated in managing breast cancer patients using the conservative surgical approach. 57.1% were willing to accept BCS or recommend it for an eligible friend or relative and no statistically significant association was observed among those who accepted BCS when matched with the level of awareness or the duration of nursing practice. A higher and significant level of acceptance of BCS was noted among those aware of its oncologic equivalence to TM (p-value = 0.000)&#x0D; Conclusion: This study demonstrated gaps in knowledge of BCS among nurses who are stakeholders in assisting patients make the right decision. This knowledge gap in the perception of BCS will interfere with the ability of the nurse to adequately counsel patients in need of their expert opinion. The awareness of the oncologic equivalence of BCS to TM increased its acceptance significantly. An increase in public awareness and education of nurses is required to improve the acceptance rate of BCS in our practice. Caregivers should also devise effective means of communication to encourage eligible patients for breast conservation

English

‘ No thi ng Ch an ge s i f No t hi ng Ch an ge s’ Treating a case of full mouth rehabilitation has remained a challenge till date. Dentistry has witnessed many advancements in terms of material science, technology and treatment procedures. What has not evolved is the thought process of application of these newer methods and technology. Any treatment procedure performed on a patient is not a straightforward mathematical calculation which can be implemented in a specified manner. Clinical processes, especially a case of full mouth rehabilitation requires comprehensive knowledge and understanding of the stomatognathic system. The word rehabilitation in itself conveys responsibility. A lot is involved at both the ends - the receiver (patient) and the donor (the rehabilitation specialist). The oxford dictionary defines rehabilitation as ‘The action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.’ 1 It is a great responsibility on restoring dentist to bring the abnormal and compromised oral functions back on track. The multidisciplinary dimension of the treatment cannot be ignored. Although the culmination of an elaborate treatment is by a restoring specialist which happens to be prosthodontist most of the time, other specialists such as endodontist, periodontist, oral surgeon, orthodontist and an oral radiologist play a significant role throughout the planning and execution. It is advisable to seek expert opinion and include specialty procedures whenever deemed necessary.

Exploring demand-side barriers to credit uptake and financial inclusion

PurposeThe purpose of this study is to explore the demand side factors affecting financial inclusion in general and credit uptake in particular.Design/methodology/approachThe present study is descriptive and exploratory in nature and is purely based on primary data. The data collection instrument has been scientifically after thorough review of literature and seeking expert opinion. Primary data have been collected from the respondents of lower socioeconomic class in selected rural areas in the State of Maharashtra, India. Exploratory technique like factor analysis and structural equation modelling have been used to identify the inter-relations between financial inclusion and underlying barriers.FindingsThe study concludes that there are major latent issues that determine the uptake and usage of financial services, major being “operational and implementation challenges”, “financial literacy” and “affordability”. The “usage” aspect further impacts financial inclusion along with “access” variable. These are some of the most important factor for creating demand-driven approach towards financial products and services specially credit. The author concludes that the identified latent barriers with respect to the “usage” dimension of financial inclusion require greater policy attention so that it can complement the supply-side measures.Practical implicationsThe study establishes that merely having “access” through bank account ownership will not fulfil the objective of financial inclusion, and it is the “usage”, which is also important to realize the full potential of financial inclusion at the bottom of the pyramid. So, policy actions should be directed toward enhancing the “usage” aspect of financial services. The “usage” dimension could be enhanced through targeted interventions to mitigate the effect of identified latent barriers.Originality/valueThough researchers have made a mention of demand-side barriers to financial inclusion, detailed study on the topic is missing. The study is one of its kinds in exploring the severity of various demand-side barriers that determine financial inclusion. In the context of emerging economies like India, financial inclusion is often measured in terms of banking outreach and “access”. There are limited studies capturing the “usage” dimension of financial inclusion.

A Practical, Clinical User-Friendly Format for Breast Ultrasound Report.

Breast ultrasound (BUS) is often performed as an adjunct to mammography in breast cancer screening or for evaluating breast lesions. Our aim was to design a practical and user-friendly format for BUS that could include the details of the Breast Imaging Reporting and Data System. As a team of radiologists and surgeons trained in the management of breast diseases, we gathered and carried out the project in four phases-literature search and collection of present report formats, summarizing key points and preparing the first draft, seeking expert opinion and preparing the final format, and pilot testing-followed by a survey was answered by the research team's radiologists and surgeons. It produced a list of items to be stated in the BUS report, the final BUS report format, and the pilot format guide. Then, the radiologists used the format in three active ultrasound units in university-affiliated centers, and reports were referred to the surgeons. At the end of the project, the survey showed a high degree of ease of use, clarity, conciseness, comprehensiveness, and well-classified structure of the report format; but radiologists believed that the new organization took more time. We propose our design as a user-friendly and practical format for BUS reports. It should be used for a longer time and by various ultrasound centers in order to ascertain its benefits.

Knowledge, Attitude, and Perception of Health Care Personnel Working in Intensive Care Units of Mass Gatherings Toward the Application of Telemedicine Robotic Remote-Presence Technology: A Cross-Sectional Multicenter Study

Background: The innovative telemedicine robotic remote-presence technology offers a promising solution to confront the challenges faced by health care personnel during events of mass gatherings by consulting expertise from offsite settings. Objective: To assess knowledge, attitude, and perceptions of health care personnel (physicians and nurses) toward telemedicine robotic remote-presence technology, at the intensive care units (ICUs) of hospitals serving mass gathering. Methods: The primary sampling unit included physicians and nurses using the sophisticated technology of telemedicine with robotic presence at the ICUs of Mina hospitals. An electronic invitation containing the survey tool was sent to all the participants from the four selected hospitals. Mean scores for knowledge and attitude questions were based on Likert scale responses. Result: The study received a final sample of 140 valid and complete responses. The findings showed overall positive attitude, but the knowledge was limited. On a maximum score of 5, the mean knowledge and attitude scores obtained were 2.55 and 3.51. The participants expressed strong agreement in using technology to seek expert opinion, increase communication among providers, and improve clinical decisions, which is an essential factor during mass gatherings. However, concerns about patient privacy and confidentiality were raised. Lack of training and insufficient knowledge regarding telemedicine and robotic systems' applications were identified as significant barriers, followed by issues related to equipment malfunction. Conclusions: Reinforcing continuous training programs to the health care staff to maximize the potential benefits of the innovative technology is suggested.