Level Of Specialization Research Articles

Nutritional aspects of prehabilitation in adults with cirrhosis awaiting liver transplant.

Malnutrition, sarcopenia (low muscle mass), and physical frailty have gained increasing recognition in candidates for liver transplant (LT) as these conditions can impact postoperative functional capacity. Multidimensional prehabilitation programs have been proposed as a safe intervention in adults awaiting LT but the nutritional pillar of prehabilitation has been understudied. This review summarizes the nutritional recommendations for prehabilitation for individuals with cirrhosis awaiting LT. Three major aspects of nutritional prehabilitation are discussed: (1) Assess: Evaluate nutritional status and assess for malnutrition, sarcopenia, and frailty to guide the nutritional prehabilitation intervention intensity, increasing across universal, targeted, and specialist levels; (2) Intervene: Prescribe a nutritional prehabilitation intervention to meet established nutrition guidelines in cirrhosis with a targeted focus on improving nutritional status and muscle health; (3) Reassess: Follow-up based on the required intensity of nutritional care with as needed intervention adjustment. Topics covered in the review include nutritional care levels for prehabilitation, energy prescriptions across body mass index strata, detailed considerations around protein intake (amount, distribution, and quality), carbohydrate and fat intake, other nutritional considerations, and the potential role of dietary supplements and nutraceuticals. Future research is warranted to more accurately evaluate energy needs, evaluate emerging dietary supplementation strategies, and establish the role of nutraceuticals alongside food-based interventions. While the general principles of nutritional prehabilitation are ready for immediate application, future large-scale randomized controlled trials in this space will help to quantify the benefit that can be gained by transitioning the LT approach from passive "transplant waitlist time" to active "transplant preparation time."

Prescribing Justice: A Close Examination of Physicians Acting As Expert Witnesses in Saudi Arabia.

An expert witness is a person who provides testimony on issues that the court finds to be outside the scope of their expertise and experience. Any physician who has performed an independent medical evaluation or written medical records can and should expect to be requested as an expert witness. Medical malpractice, workers' compensation, and personal injury are the most prominent areas where medical expert witnesses participate and provide opinions and testimony. To our knowledge, this is the first study to be conducted in Saudi Arabia on physicians acting as expert witnesses. This observational descriptive cross-sectional study conducted in Saudi Arabia from November 2022 to July 2023 aimed to assess physicians' experiences, education, training, willingness, self-competency, attitude, and perception as expert witnesses. The study population consisted of physicians working in Saudi Arabia, with at least a specialist level of professional expertise. Participants completed a self-administered online survey, utilizing a researcher-designed questionnaire. In total, 417 participants, with males comprising 51.3% of the sample, responded to the survey. More than half of the physicians (58.3%) had never produced a medical report for the court. Among those who had, the majority had done so one to twice. Similarly, the majority had never testified in court (77.5%), with only a small percentage having done so once or twice. Approximately 80% of participants had no prior education or training as expert witnesses, but among those who did, courses and workshops were the most common forms of education or training. Most participants expressed interest in learning or training for this role (69.1%) and were willing to provide medical reports or court testimony (73.9%). However, half of the participants did not feel competent in writing a medical report for the court, and more than half lacked confidence in giving testimony. The findings highlight the need for increased engagement, education, and training among physicians, particularly early and mid-career professionals, to enhance their confidence and competence as expert witnesses and ensure ethical practices in the medicolegal domain in Saudi Arabia.

REFINING METHODOLOGICAL APPROACHES TO ENHANCE TEACHING QUALITY AT THE DEPARTMENT OF INFECTIOUS DISEASES WITH EPIDEMIOLOGY

Reforming Ukrainian higher medical education is imperative, not only to address issues related to the recognition of Ukrainian diplomas abroad and to enhance the competitiveness of Ukrainian medical institutions and their graduates on the European and global job markets, but also to elevate the efficiency and quality of education. Furthermore, the recent full-scale invasion has resulted in the loss of a significant potential in medical universities across the southeastern region of Ukraine.
 Amidst the ongoing reform of the Ukrainian higher education system, all institutions are transitioning towards a competency-based approach. This approach aims to cultivate and foster specific types and subtypes of competencies in students by ensuring comprehensive assimilation of essential knowledge and practical methodologies.
 The training of highly skilled medical professionals encompasses multidisciplinary education, extending beyond therapy to encompass knowledge spanning over two dozen specialties. Of utmost importance is the ability to diagnose and treat patients with acute and chronic therapeutic and surgical conditions, as well as to provide urgent medical assistance.
 The epidemiological landscape concerning numerous infectious diseases in various countries remains volatile. Incidences of viral hepatitis, tuberculosis, influenza, SARS, AIDS, Lyme borreliosis, among others, continue to rise in Ukraine and neighboring regions. A completely new challenge for the world community is the outbreak of Ebola fever in West Africa, monkeypox and its spread around the world. The appearance of pathogens of infectious diseases resistant to previously developed effective drugs is a cause for concern. Nowadays, the global crisis precipitated by the novel coronavirus, SARS-CoV-2, underscores the urgency for education on emerging and re-emerging infections.
 Given these challenges, the qualification level of future specialists in infectious diseases and epidemiology assumes paramount importance. These professionals must be equipped to organize and deliver medical care under adverse conditions such as war, pandemics, shortages of medical personnel and medications, and a dearth of theoretical and practical knowledge, especially in the face of new infections. To facilitate optimal learning amidst such crises, a phased approach is proposed that includes centralized distance education, methodological support, and practical skill acquisition. By implementing these measures, the assimilation of material and the quality of education can be enhanced for those seeking education during times of crisis.

АКТУАЛЬНІ ТЕНДЕНЦІЇ У ФРІЛАНСІ ЯК ВАЖІЛЬ ЕФЕКТИВНОГО КАДРОВОГО МЕНЕДЖМЕНТУ В УМОВАХ ЦИФРОВІЗАЦІЇ

The article determines that a new form of labor relations "freelance" is intensively and quite effectively implemented in the modern labor market; the spectrum of professions, when this or that work is performed not on a permanent basis, but on an order basis, is quite wide: IT specialists, accountants, lawyers, programmers and consultants on various issues, SMMs, graphic designers, etc.; this form of cooperation helps employers more effectively manage both labor resources in particular and financial resources in general. It is outlined that the impetus for this was the implementation of digital technologies in all sectors of the economy and, as a result, the digitalization of markets and businesses and their attributes. It is well-founded that personnel management remains a key lever for ensuring the efficiency of any organization and in any organization, at the same time, personnel management is a dynamic process that requires constant updating, introduction of new trends and practices, therefore it is important to follow and monitor, adapt and implement constant updates to improve the work of the company's personnel management. The specialization, dynamics of the number and cost of freelance work in 2023 in Ukraine were analyzed and it was determined that the demand for freelance services is quite extensive and diverse from the point of view of specialization, it is both work in the field of IT and software, and work in the creation of entertainment content; the increase in the number of freelancers in 2023 versus 2022 ranges from a maximum of 36.07 (blockchain) to a minimum of 15.02 (social media advertising) percent; the cost of an hour of work for mid-level specialists ranges from (maximum) 1,500 (blockchain) to (minimum) 400 (designing pages in social networks) hryvnias per hour; the cost of an hour of work for high-level specialists ranges from (maximum) 4,000 (announcer services) / 3,967 (blockchain) to (minimum) 700 (designing pages in social networks) hryvnias per hour. It was noted that the criterion of the level of a freelance specialist is the portfolio: the more cases he has, the higher the price he can set for his services; reviews are also one of the most important parameters that indicate the level of a specialist. The coefficients of the cost of an hour of freelance work of high-level specialists relative to medium-level specialists were calculated and their rating was given; a significant gap from other specializations and the maximum ratio of the hourly cost of highlevel specialists relative to middle-level specialists was recorded in two areas: "announcer services" and "script writing" – 5.71 and 4.42, respectively; for other freelance specializations studied in this publication, the value of the coefficient ranges from a maximum of 2.73 (Go (compiled programming language) to 1.51 (DevOps). It has been established that: freelancing is extremely relevant in the labor market, the demand for specialists in this field is stable and tends to increase; the range of specialties is quite wide and continues to expand: and software, and the creation of entertainment content, and work with social networks, etc.; the cost of such services increases both in absolute terms and by specialist level; at the same time, quite a lot of specialties are available for gradual mastering and continuous deepening in the mode of so-called "soft skills", the stages of mastering of which with competent personnel management can take place with maximum tangentiality and integration into the specifics of the organization's activities. The direction of further scientific research on freelancing as a current trend in the labor market should be industry-wide in-depth study of the structure, format and content of professional inquiries to freelancers.

Treating corneal perforation related to neurotrophic keratitis

Aim of this presentation: To present various scenarios of impending and actual perforation in the background of neurotrophic keratitis and its understanding of its aetiology and management.Presentation: This will be aimed an intermediate and specialist level. The audience will gain insight into the aetiology of impending and actual perforation, history and diagnostics related to it. The audience will also learn about acute and long term management of this condition.

Adaptation of Cloud Computing in Polish Energy Companies

Nowadays, Cloud computing is a major trend in the IT market, changing the way businesses acquire, use and pay for IT solutions to support their operations. Today, companies across the energy sector are increasingly adopting cloud computing solutions (which mainly include IT infrastructure, software platforms and specialized types of software with related services). The article, based on literature studies and analysis of available research results, presents the state of cloud computing adaptation in Polish energy companies against the background of the EU. Previous studies have indicated that energy companies were not leaders in the use of cloud computing. Based on the analysis of statistical data, it can be concluded that the current level of cloud computing adoption in energy companies in Poland is higher than in the EU. In addition, energy companies in Poland have overtaken long-term leaders, i.e. IT and telecommunications companies, in terms of cloud adoption. The article also identifies the levels of cloud computing adoption in enterprises from the energy sector. In energy companies, cloud computing solutions are most often located at the basic, standard or specialist level. In the final part of the article, examples of the implementation of cloud computing solutions in energy companies are presented based on the distinguished levels of adaptation.

Шляхи формування резилієнтності майбутніх фахівців соціальної сфери в умовах війни

The article summarizes and presents the socio-pedagogical challenges related to forming resilience in future social work specialists in wartime conditions. The concept of personal resilience is disclosed; the main negative factors reducing the stress resistance levels of future social work specialists during their professional training in wartime conditions are analyzed; the directions and ways of activities of higher education institutions aimed at forming resilience in future social work specialists in wartime conditions are identified. The scientific research on the ways of forming resilience in future social work specialists in wartime conditions will help to determine effective strategies and approaches for preparing future social work specialists to work in crisis conditions. This includes the development of their personal qualities, psychological resilience, and professional skills necessary for effectively performing their duties. The work considers a comprehensive approach to developing resilience, which includes specialized training courses, practical trainings, psychological support, personal development, a mentoring system, social activity, as well as a healthy lifestyle. Significant emphasis is placed on the role of volunteering and partnerships with various organizations, which contribute to the practical acquisition of necessary skills and the maintenance of emotional health. The study highlights the importance of information awareness and the use of innovative technologies in preparing future social workers. The article's conclusions are aimed at developing recommendations for educational programs and practical measures that will facilitate the formation of highly qualified and stress-resistant social work specialists capable of effectively working in wartime conditions.

Модель формирования базы знаний при подготовке специалистов пожарно-технического профиля

Purpose. The article discusses and analyzes the algorithm and methodology for assessing quality of forming functions (competencies) of students in higher educational institutions of the EMERCOM of Russia (hereinafter referred to as EOHE – Educational Organization of Higher Education) on the basis of previously developed systems. Methods. The analysis of forming functions (competencies) of a future specialist is aimed at one of the highest priority tasks in the implementation of higher education programs in EOHE. Professional competencies of a specialist in real life work (service) conditions are manifested in the ability and readiness to solve assigned tasks within the framework of professional activities. Quality indications of forming functions (competencies) are the ongoing theoretical and practical development of knowledge, skills and habits, as well as their full use in work activities. It should be noted that the quality professional level of a future specialist which is the target objective of any socioeconomic system depends on the competent formation of functions (competencies), determined by the direction of training. Findings. At the moment, in order to train highly qualified specialists in the educational system of the EMERCOM of Russia, it is recommended to use a dynamic model when implementing a network form of the educational program in EOHE, which will allow optimizing system of managing educational process in higher educational institutions of the EMERCOM of Russia. Research application field. The results of the study can be used in educational institutions of EOHE, which are largely provided by the potential of the teaching staff and the logistics of organizations, which will allow achieving high levels of professionalism of future workers (employees). Conclusions. The authors propose to use the results in the organizational design of EOHE management system. The network form of implementing educational program makes it possible to train a highly qualified specialist with a wide range of knowledge in the field of fire safety, as well as in-depth knowledge within the framework of furher service.

NEW CONTENT OF EDUCATION FOR FUTURE OCCUPATIONAL SAFETY SPECIALISTS IN MODERN CONDITIONS

Purpose. To develop proposals and recommendations for the modern digital technology tools usage in the educational process in the training of bachelors and masters in the educational and professional program «Occupational Safety and Health», specialty 263 «Civil Security» to improve the quality of education, taking into account the requirements of the labor market. Methodology. General scientific (comparison, classification, generalization, systematization) and empirical (observation, search, description, analysis, SWOT analysis) research methods were used. Results. As a result of the literature review, new learning technologies were analyzed: virtual and augmented reality (VR/AR) technologies containing educational games and behavioral simulation, artificial intelligence, cloud technologies, video instructions, which allow to eliminate the discrepancy between the required and existing competencies of future occupational safety and health specialists. A SWOT analysis was conducted to assess the main problems and risks of introducing modern digitalization tools into the educational process when teaching under the educational and professional program «Occupational Safety and Health». During the analysis of cases of digital technologies use, data that allowed us to identify the weaknesses and strengths of technologies have been obtained, the possibilities of their application and the threats that all participants in the educational process may face in modern conditions have been determined. With the proper use of the potential of technology, all participants will be able to achieve the desired results by increasing labor productivity, improving work processes, effectively building a labor management system, and deepening the professional competencies of their employees and future specialists. Scientific novelty. The article shows the use of modern digital technologies: virtual and augmented reality (VR/AR), artificial intelligence, cloud technologies to solve problems in the training of future occupational safety and health specialists under martial law, taking into account modern labor market requirements. Practical significance. Increasing the level of modern digital technologies application by all participants in the educational process under the educational and professional program «Occupational Safety and Health» will help to improve the quality of education under martial law and increase the professional level of future specialists. Keywords: digitalization, digital learning technologies, educational process, occupational safety and health, SWOT analysis.

Интернационализация основных программ высшего образования в современных условиях

The subject of the study is the tools to increase the competitiveness of Russian higher education programs, taking into account the geopolitical situation and the development of competition from foreign countries. in the market of educational services. The objectives of the work are to determine, based on statistical indicators of the Ministry of Education and Science of the Russian Federation for 2019-2022, the potential for international competitiveness of higher education programs at the bachelor's, specialist and master's levels and to assess its resistance to external shocks. It has been established that the topic of internationalization of education is of great research interest among Russian and foreign scientists. The internationalization of Russian education is based on strategies to increase competitiveness provided for by the 5-100 Project and the Priority 2030 program. Scaling up the export of Russian education is one of the priorities of Russia's scientific and technical development. The article pays special attention to the study of indicators of leading countries in terms of the number of students accepted for training and the share of those accepted under contracts for the provision of paid educational services in their number in the Russian Federation for the period 2019-2022 in the context of education levels (bachelor's degree, specialty, master's degree). The competitive advantages and disadvantages of Russian education for foreign applicants are highlighted. Conclusions are drawn about the prospects for exporting educational services to the largest states of Eurasia and the Middle East, as well as about the significant potential for promoting master's degree programs in India due to the competitive advantages of Russian education.

Гармонізація ринку освітніх послуг закладів позашкільної музичної освіти країн ЄС та України

In the current conditions of globalization and integration processes between Ukraine and the European Union (EU), the topic of harmonization of the educational services market, in particular in the field of extracurricular music education, becomes especially relevant. Harmonization of educational standards and approaches between the EU countries and Ukraine allows creating a single educational space that provides a high level of specialists’ training competitive both at the national and international labor markets.The article is devoted to the analysis of har monization key aspects of the educational services’ market in the field of music education, which includes consideration of the legal framework, analysis of methods and tools used for harmonization, as well as assessment of the these processes’ impact on the development of extracurricular music education in Ukraine. Considerable attention is paid to the study of the experience of the EU countries in the uniform standards’ implementation of education, in particular in the field of music education, and its possible application in the Ukrainian context. The article also analyzes the existing problems and challenges that stand in the way of harmonization, among which are the need to adapt national legislation, improve the level of teachers’ professional training, as well as provide financial and institutional support for this process from the state and international organizations. In addition, the prospects for the educational services market development in Ukraine in terms of integration into the European educational space are discussed. As the result of the study, it was found that the harmonization of the educational services’ market in the field of extracurricular music education is a necessary step to ensure the competitiveness of the Ukrainian educational system, its integration into the European space and improving the music education quality. It also creates preconditions for the cultural exchange development and national musical traditions preservation, which contributes to the formation of a unique cultural landscape in Europe. In general, the educational services harmonization in the field of music education should become the basis for the development of a sustainable and high-quality educational system that will meet the needs of modern society and the challenges of the global labor market.

Improving surgical technique for tracheal resection with anastomosis

To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.

LIFE CYCLE MANAGEMENT MODELS OF COMPONENT EDUCATIONAL RESOURCES OF THE COMPANY

Learning management systems are characterized by the fact that the scenarios of their operation are related to various aspects of educational activity, which in turn requires costs for the creation of professional training programs, electronic educational resources and their exploitation. These problems confirm the relevance of research aimed at developing models of life cycles for electronic educational resources, programs and qualification levels of specialists, as well as at creating effective tools for automated management of the learning process. The purpose of this study is to optimize the life cycles of electronic educational resources, training programs, employer requirements and increase efficiency in managing the continuous process of training specialists. Analytical studies of life cycle models of electronic educational content, learning and educational activity management systems, content management systems were carried out in the work in order to select and develop tools for automated design and filling of educational resources, as well as synthesis of the life cycle management system of its main components. Models of the life cycles of the main components of the educational environment have been developed, which allow for their coordination and optimization for the system of automated management of training processes and professional development. Distinctive features of the models are the comprehensive synchronization of the life cycles of all components with the assessment of the effectiveness of this process, as well as adjustment to the changing requirements of the external environment. A model for synchronizing the life cycles of the components of the educational environment, including electronic educational content and a system for managing learning and professional development processes, has been developed. A feature of the model is a comprehensive assessment of the effectiveness of the synchronization process at all its stages for the automated selection and/or synthesis of personalized training programs and electronic resources in accordance with the changing requirements of standards and employers.

THE SPECIFICITY OF THE FORMATION OF PROFESSIONAL IDENTITY IN MILITARY INSTITUTIONS OF HIGHER EDUCATION

The article examines the specifics of the formation of professional identity in military institutions of higher education. The idea that the development of higher military education remains a priority task of Ukrainian state-building is emphasized. The term „professional military education” is explained, referring to specialized military education, which is obtained under educational programs at the appropriate levels of military education in order to improve the professional level of a military specialist. It is proved that the formation of the professional identity of applicants of higher military education is a long process of qualitative modification of their inner world, which correlates with the stages of professionalization by enriching social subjectivity, selfactualization, and self-fulfillment in military professional activities. That is why, identification is proposed to be perceived as the main mechanism of socialization of an individual, translation of military-professional corporate values, and professional adaptation, which contributes to the freedom of individual development, enrichment, and diversity of meanings of activity. The role of the „self-concept” as a cognitive system for regulating behavior in various life conditions, in accordance with which there is a search for the meaning of one’s own existence, and the formation of an internal position, is emphasized. It is determined that the educational and professional environment in military institutions of higher education provides for constant problematization by solving several non-standard professional tasks that are projected onto a multidisciplinary structure of professional training, which has a systematic, progressive, and dynamic nature. It is shown that a developed sense of professional identity allows an individual to build his or her own professional perspective, taking into account the specifics of the acquired military professional experience and integration into the valuable military experience of foreign countries.

Association between Oral Active-Matrix Metalloproteinase-8 Levels and Subretinal Fibrosis among Wet Age-Related Macular Degeneration Patients

Purpose Periodontitis causes low-grade systemic inflammation and has been associated with elevated active-matrix metalloproteinase (aMMP-8) levels, blood-ocular barrier breakdown and a risk of wet age-related macular degeneration. To assess the association between aMMP-8 levels and macular status among patients with wet age-related macular degeneration (AMD). Methods Patients on anti-VEGF treatment for wet AMD were enrolled for oral aMMP-8 rinse test in Mehiläinen Private Hospital, Helsinki, Finland. Macular status was examined from spectral-domain optical coherence tomography (SD-OCT) scans by a medical retina specialist and aMMP-8 levels were analyzed with chairside point-of-care oral rinse (PerioSafe®) test and real-time quantitated by a dentist using the ORALyzer®- reader with a 10 ng/ml cut-off for aMMP-8 activity. Results Elevated aMMP-8 levels were found in 10 out of 32 patients. Age, gender, anti-VEGF (bevacizumab or aflibercept) distribution, cumulative number of anti-VEGF injections and treatment interval were comparable between patients with aMMP-8 levels below and above the point-of-care level. Macular status differed in regard to aMMP-8 activity; among patients with aMMP-8 levels below the point-of-care subretinal fibrosis was found in 6 out of 22 eyes, whereas among patients with aMMP-8 levels above the point-of-care subretinal fibrosis was found in 8 out of 10 eyes (p = 0.005). Respectively, the mean thickness of subretinal fibrosis at fovea was 19.5 ± 44.1 and 92.3 ± 78.3 µm (p = 0.018). No differences were found in the presence and in the area of geographic atrophy, or fluid distribution, whereas thicknesses of serous pigment epithelial detachment (65.5 ± 99.5 and 12.9 ± 27.9 µm, p = 0.038) and neuroretina (204.2 ± 57.8 µm and 143.0 ± 43.7 µm, p = 0.006) were greater in the eyes of patients with physiological aMMP-8 levels compared to those with elevated aMMP-8 levels. Conclusion Elevated aMMP-8 levels may account for subretinal fibrosis formation in wet AMD.

Determination of the relationship between the Vocational Qualifications and Academic Programs on a Perceived Competencies Basis Approach: A Case for Geographical Information Systems

GIS education and training activities become widespread as GIS utilization inevitably increases worldwide. Besides, vocational standards and qualifications are developed to form a quality assurance basis for GIS-related jobs and services and the employment of qualified personnel. From this perspective, this study aims to examine to what level the graduates of GIS associate degree, master, and doctorate programs have gained the necessary knowledge and competencies defined in the GIS Specialist (Level 6) National Qualification throughout their academic education. Within this context, an online survey was developed based on 43 performance criteria derived from the vocational qualification units (A1, A2, A3). The respondents were asked to self-evaluate the achievement of the given criteria during their academic education on a 5-point Likert scale. It was detected that 39.1% of the 174 survey participants have associate degrees, 61.7% have master's degrees (with thesis, without thesis, and distance education), and 6.9% have doctorate degrees. In comparison, 3% of them completed the GIS certificate program. The results showed that the competency achievement perceptions in the A3 section increased following the education level of the graduates. No significant difference was determined for A1, while an insignificant difference was detected for the A2 unit between the graduates of doctorate and distance education master's degree programs. The results are expected to be adopted by the relevant parties to align the GIS education programs with the sectoral needs and vocational qualifications.

Оценка родителями инклюзивной образовательной среды школы и своего участия в ее создании

<p style="text-align: justify;">The role of parents as participants in educational relations, and especially in the context of inclusive education, has attracted the attention of researchers for a long time, and this attention does not weaken, confirming the importance of this topic. In this work, we set ourselves the goal, based on monitoring data for 10 regions of Russia, to determine, on the one hand, the opinion of parents about the readiness of schools for inclusive education based on a number of indicators of the inclusive educational environment, and on the other hand, their participation in various forms of work offered by schools. The sample was randomly formed by strata (selection of regions, selection of schools, selection of parents). The total sample size was 121,364 parents from 679 schools, where the proportion of parents of students with disabilities was 6,99% (8 478 respondents). For data processing, a random sample (10% of the total number) was formed and used for frequency and correlation analysis. A frequency analysis of parents’ opinions on various aspects of a school’s readiness for inclusion revealed three groups of characteristics of an inclusive educational environment, differing in levels of readiness: the first concerns the professional level of teachers and support specialists, the second concerns the relationships between teachers and students, as well as between students, the third concerns the general material and technical equipment of schools, materials, textbooks and educational equipment adapted for children with disabilities, as well as the adaptability of the school space and its territory. The frequency analysis is confirmed by the results of correlation analysis: the characteristics included in one group showed a strong correlation with each other, and in different groups showed an average correlation. An important exception was the strong correlation between the level of professional readiness of teachers and the relations between teachers and students. Parents' participation in the forms of work offered by the school turned out to be significantly less than the perceived opportunities for participation, which confirms the hypothesis that there is a significant difference between the perceived opportunities for participation and the actual participation of parents in the forms of work offered by schools. This is consistent with the position that the key to attracting parents to participate in creating an inclusive educational environment is the connection between the conditions created by schools and the requests of parents as subjects of educational relations, their active position in supporting the efforts made by the school.</p>

Hurdles and potentials when implementing internet-delivered Acceptance and commitment therapy for chronic pain: a retrospective appraisal using the Quality implementation framework.

Internet-delivered psychological interventions can be regarded as evidence-based practices and have been implemented in psychiatric and somatic care at primary and specialist levels. However, challenges as low adherence and poor routinization, have arisen during attempts to implement internet-delivered interventions in chronic pain settings. Internet-delivered Acceptance and Commitment Therapy (IACT) has been found to be helpful for chronic pain patients and might aid in developing pain rehabilitation services. However, the integration of IACT into standard health care has not yet been described from an implementation science perspective. The aim of this hybrid 1 effectiveness-implementation study was to evaluate the process of implementing IACT in a pain rehabilitation setting, to guide future implementation initiatives. In this retrospective study we described actions taken during an implementation initiative, in which IACT was delivered as part of an interdisciplinary pain rehabilitation program (IPRP) at a specialist level clinic. All documents relevant to the study were reviewed and coded using the Quality Improvement Framework (QIF), focusing on adoption, appropriateness and sustainability. The QIF-analysis of implementation actions resulted in two categories: facilitators and challenges for implementation. Sustainability may be facilitated by sensitivity to the changing needs of a clinical setting and challenged by unfitting capacity building. Appropriateness might be challenged by an insufficient needs assessment and facilitated by aligning routines for communication with the clinic's existing infrastructure. Adoption may be facilitated by staff key champions and an ability to adapt to occurring hurdles. Possible influential factors, hypotheses and key process challenges are presented in a logic model to guide future initiatives. Sustainable implementation may depend on both the continuity of facilitating implementation actions and flexibility to the changing needs and interests of patients, caregivers and organization. We conclude that the use of theories, models and frameworks (TMF) as well as a logic model may ease design, planning and evaluation of an implementation process. Lastly, we suggest that IACT may be appropriate for IPRP when given before or after IPRP, focusing on psychiatric comorbidities.

Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study

ObjectiveThis study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to...

Israeli pediatricians' confidence level in diagnosing and treating children with skin disorders: a cross-sectional questionnaire pilot study.

Pediatricians daily see large numbers of patients with skin disorders. However, they encounter limited guidance as a result of a marked deficiency in pediatric dermatologists. Hence, reevaluation of training opportunities during pediatric residency has become essential. Our aim was to evaluate the confidence level of pediatric residents and specialists in diagnosing and treating skin disorders in children and to determine career and training-related characteristics that influence it. Conducted as a cross-sectional study, we administered a questionnaire to 171 pediatricians across Israel. We assessed respondents' self-efficacy about their ability to diagnose and treat skin disorders and collected data regarding their previous dermatology training and preferred training methods. 77.8% of respondents reported below or average self-efficacy scores in diagnosing and managing children with skin disorders. Older age (>40 years old; OR = 5.51, p = 0.019), treating a higher number of patients with skin disorders (OR = 2.96, p = 0.032), and having any training in dermatology, either during medical school or residency (OR = 7.16, p = 0.031, OR = 11.14, p = 0.003 respectively), were all significant parameters involved in pediatricians reporting high self-efficacy in skin disorder management. Most pediatric residents and pediatricians have average or below-average confidence in managing pediatric skin disorders. We suggest incorporating dermatology rotations during pediatric residency to improve young pediatricians' self-efficacy in managing skin disorders and ultimately help pediatricians provide better care for patients presenting with dermatological conditions. These findings can ultimately help refine a pilot program in dermatology that might be implemented during pediatric residency.