Specialist Officers Research Articles

Palliative care in dermatooncology - Current practice in German dermatooncological centers and specialist offices.

Dermato-oncology patients are often treated in certified skin cancer centers or dermato-oncological specialist offices. Especially in higher tumor stages, patients develop symptoms, either disease-related or due to therapy-related side effects, requiring treatment. Despite a markedly improved prognosis since the introduction of targeted therapies and immunotherapies, advance care planning is required in progressive disease. It is unclear how palliative care of skin cancer patients is currently organized in dermato-oncology. In a nationwide survey, all certified skin cancer centers and dermato-oncological specialist offices in Germany were contacted and asked to participate in this anonymized survey. Overall, 45 responses (42%) were received. The majority (98%) of the respondents screen the patients on a regular basis for distressing symptoms, and all centers are connected to palliative medical care providers. Only 5% of the medical staff members have the additional qualification "palliative medicine". In 68% of the participating institutions, the opportunity for care planning is offered to patients. For 89%, palliative care is relevant for everyday work, and 82% desire more research opportunities on this topic. This survey has shown that palliative care plays a major role in dermato-oncological work. Given that only a small proportion of the staff have received specialized training in palliative care, however, an increase of this proportion would be desirable for comprehensive care.

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

BackgroundIsolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens.Methods and resultsWe performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18–64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle.ResultsAnkle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months.ConclusionUltrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.

Conditioning for Strength, Power, and Aerobic Fitness for Specialist Police Tactical Groups

ABSTRACT Police officers serving in specialist Police Tactical Groups (PTG), including Special Weapons and Tactics teams, are called on to perform tasks in highly volatile and unpredictable situations beyond those of general duties police officers. In addition to carrying loads of 20–25 kg, these officers have, and require, levels of fitness above that of the civilian population, general duties police, and even elite athletes. Through the PTGs' occupational lifespan, from initial selection to operational duties, candidates and serving officers require strength (both absolute and relative), power, and metabolic fitness (aerobic and anaerobic) to pass selection, mitigate injury, and perform occupational tasks. Given the complexities of conditioning these officers, including shift work and unpredictable job demands, a conjugate block periodization approach may be of value. Evidence suggests that a block periodization approach of 3 to 4 mesocycles, including an accumulation phase, a transmutation phase, a realization phase, and potentially a deloading or recovery phase may ensure an adequate training stimulus for these specialist officers. This is especially the case when supported by a dedicated and experienced strength and conditioning coach.

Who Serves Where: A Geospatial Analysis of Access to Endocrine Surgeons in the United States and Puerto Rico

BackgroundThe association between surgical volume and patient outcome is well established, with higher case volume associated with a lower risk of complications. We hypothesized that the geographic distribution of endocrine/head and neck surgeons with an endocrine focus in the United States and Puerto Rico may limit access to many potential patients, particularly in rural areas. MethodsWe used web-based directories from the American Association of Endocrine Surgeons, American Head and Neck Society, and the American Academy of Otolaryngology–Head and Neck Surgery to identify endocrine surgery specialists in the United States and Puerto Rico. Using geographic coordinates and OpenStreetMap and Valhalla software, we calculated the areas within a 60-, 90-, or 120-minute driving distance from specialist offices. We used 2020 U.S. Census Data to calculate census tract populations inside or outside the accessible areas. ResultsExcluding duplicate providers across organizations, we geocoded 603 specialist addresses in the United States and Puerto. We found that 23.76% (78.3 million) of Americans do not have access to a society-affiliated endocrine/head and neck surgeon with an endocrine focus within a 60-minute drive, 14.37% (47.4 million) within a 90-minute drive, and 8.38% (27.6 million) within a 120-minute drive. We observed that the areas of coverage are primarily focused on metropolitan areas. ConclusionNearly one-third of Americans do not have access to a society-affiliated endocrine/head and neck surgeon with an endocrine focus within a 1-hour drive, highlighting a concerning geographic barrier to care. Further work is needed to facilitate patient access and mitigate disparities in quality care.

French lay Persons’ judgments of the possibility of a heart attack when experiencing various physical manifestations

BackgroundThe aim of the study was to characterize the different ways in which, based on certain physical manifestations that an individual suddenly experiences, people judge the possibility that these manifestations indicate the onset of a heart attack. MethodsOne hundred ninety-four French adults--plus six physicians--were presented with a set of realistic vignettes composed by orthogonally crossing the levels of four factors: the type of pain felt, and the presence or absence of nausea, excess sweating, and of difficulty breathing. ResultsFour qualitatively different reactions were found among the lay people. The majority reaction (54%) was close to the physicians’ reaction. It consisted of suspecting a heart attack as soon as intense pain occurs in the chest or back. The second reaction (25%) retained from the first one only the idea that a heart attack should be suspected if the pain is localized to the chest. The third reaction (14%) reflected some people’s uncertainty in the face of disturbing manifestations that they find difficult to interpret. The fourth reaction (7%) was that no set of symptoms could mean, for them, the onset of a heart attack. ConclusionOnly about half of the participants appeared to be able to consider unpleasant physical manifestations as a whole and integrate that information into an overall warning judgment that can lead into prompt life-saving actions. We recommend that judgment training on warning symptoms and signs be performed, especially for high-risk patients, in the offices of primary care providers and specialists.

Satisfaction with the quality of outpatient care of medical students as an element of the assessment of the current system of medical care

Introduction. This article discusses the problems of the quality of outpatient care for medical students. Most of the students prefer not to seek medical help from specialists even in difficult situations, and in most cases they self-medicate. This is caused by an insufficient degree of quality service by the outpatient polyclinic service of the attached contingent. The existing state system of medical care is imperfect: there is no unified approach to the organization of student polyclinics; medical organizations do not take into account the age and social specifics of students; low continuity in the rehabilitation and treatment of patients; there is insufficient preventive work among students.Aim: To determine the level of satisfaction with the quality of medical services provided to medical students.Material and Methods. The sociological method included a survey of medical students (1026 respondents) according to a specially designed questionnaire that contained questions about the scope, nature, quality of work and satisfaction with the conditions of the polyclinic institution. The logistic method consisted in the analysis of personnel, resource provision, as well as the activities of the medical institution.Results. Most of the medical students encounter organizational obstacles (appointment, waiting lists at the registry, waiting lists at the day hospital, waiting lists at the reception, etc.). 38.0% of respondents noted that when health problems appear, it is easier for them to go to the medical office of the college than to the district doctor. Moreover, 64.3% of respondents do not have information about the district doctor. Satisfaction depends on a number of factors such as: waiting time for a doctor’s appointment at the office (p < 0.001), availability when making an appointment with a doctor at a polyclinic (p < 0.001), preference when contacting a doctor when health problems appear (p < 0.001), the presence of organizational difficulties to get an appointment or treatment in a polyclinic (p < 0.001), the location of the registry and specialist offices, the terminal for making an appointment (p < 0.001), as well as the conditions of stay in a medical facility (p < 0.001).Conclusion. The necessity of introducing feedback into the practice of working with a contingent of medical students, using available screening technologies to actively identify the most significant factors and risk groups of the most common pathology, taking measures to reduce the impact of controlled factors, as well as annual preventive examinations and medical examinations has been identified.

Meeting Quality Metrics in Oral Squamous Cell Carcinoma Surgery: A Single-Center Experience

Patient-centered quality metrics have been proposed to evaluate and optimize hospital processes, aiming to improve patient outcomes. Furthermore, they can be used to objectively rate and compare the ability of health care providers to meet the needs of their patients. In patients with advanced resectable oral squamous cell carcinoma, optimal surgical treatment of the neck and timely initiation of both surgical and adjuvant therapy, when indicated, are crucial for recurrence-free and overall survival.
 This retrospective analysis included 160 patients who received primary resection of oral squamous cell carcinoma and concurrent neck dissection.It aimed to investigate how well quality metrics were met during a 6-year period in the department of oral and maxillofacial surgery at a university hospital. 93.1% of patients were seen in the specialist's office within 21 days after referral. Resection was classified as R0 in 94.4%. A lymph node yield >= 18 was achieved in 82.5%. The lymph node ratio was <= 6% in 43.3% of nodal-positive necks. Readmission and unplanned revision surgery were rare (6.9%). Adjuvant radiotherapy was started <= 6 weeks after surgery in 45.3%, and the indication was in accordance with international guidelines in all cases. Quality metrics are an effective tool for planning process optimization in a hospital. Moreover, nodal quality metrics such as lymph node yield and lymph node ratio could, after validation, complement existing and well-established prognostic parameters for patient-specific adaptation of adjuvant treatment plans.
 Accepted for publication: November 29, 2022
 Published online: December 15, 2022

Meeting Quality Metrics in Oral Squamous Cell Carcinoma Surgery: A Single-Center Experience.

Patient-centered quality metrics have been proposed to evaluate and optimize hospital processes, aiming to improve patient outcomes. Furthermore, they can be used to objectively rate and compare the ability of health care providers to meet the needs of their patients. In patients with advanced resectable oral squamous cell carcinoma, optimal surgical treatment of the neck and timely initiation of both surgical and adjuvant therapy, when indicated, are crucial for recurrence-free and overall survival. This retrospective analysis included 160 patients who received primary resection of oral squamous cell carcinoma and concurrent neck dissection. It aimed to investigate how well quality metrics were met during a 6-year period in the department of oral and maxillofacial surgery at a university hospital. 93.1% of patients were seen in the specialist's office within 21 days after referral. Resection was classified as R0 in 94.4%. A lymph node yield ≥ 18 was achieved in 82.5%. The lymph node ratio was ≤6% in 43.3% of nodal-positive necks. Readmission and unplanned revision surgery were rare (6.9%). Adjuvant radiotherapy was started ≤ 6 weeks after surgery in 45.3%, and the indication was in accordance with international guidelines in all cases. Quality metrics are an effective tool for planning process optimization in a hospital. Moreover, nodal quality metrics such as lymph node yield and lymph node ratio could, after validation, complement existing and well-established prognostic parameters for patient-specific adaptation of adjuvant treatment plans.

THERAPEUTIC BICHECTOMY WITH AESTHETIC RESULTS NARRATIVE LITERATURE REVIEW

Introduction The surgical removal, known as Bichectomy, of Bichat’s ball, an adipose structure surrounded by a fibrous capsule evident in the middle third of the face, bilaterally, and with an auxiliary function in chewing and sucking, has been constantly and increasingly performed in the offices of specialists in orofacial harmonization (HOF), since its indications refer to aesthetics and therapy to avoid benign lesions in the cheek mucosa. Objective The objective of this research is to guide dental surgeons, specifically HOF specialists on surgical techniques and aesthetic and therapeutic indications. Methodology A bibliographic survey was carried out in the Scielo, PubMed and LILACS databases with the following terms: “bichectomy” and “orofacial harmonization”, and by crossing the Boolean descriptors <and> and <or>, the relationship between between expressions. Results The findings in the literature accurately indicate the bichectomy surgery, but, above all, report the need for regional anatomical knowledge in order to avoid iatrogenic events and improve the patient’s quality of life.

Research of accessibility to inclusive medicine through the prism of marketing analysis

Part of the results of the research conducted by the authors with the aim of identifying the needs of persons with disabilities in relation to medical services are presented. The analysis of scientific works revealed a lack of research on the current state of accessibility of medical services for persons with special needs at the regional level. The purpose of the article was to identify the level of availability of medical services for persons with special needs at the regional level and to develop the recommendations based on the results of the study. The following methods were used: analysis of secondary information; survey using a questionnaire; statistical method; method of comparative analysis; synthesis; generalization; observation (analysis of information posted on the websites and official pages in social networks of the subjects under study); grouping. The analysis of the information obtained during the observation and survey revealed that the highest level of accessibility of buildings for persons with special needs in the studied UTC is characteristic of medical institutions (0.9), the lowest level of accessibility - educational institutions of UTC (0.5). In the course of the observation, it was found that the majority of dispensaries in the investigated territorial communities are equipped with accessible toilets (mostly, urban territorial communities), the ramps and stairs meet the requirements, and there are informational signs. At the same time, the issues of providing parking spaces, sufficient space in the corridors for the unhindered movement of people with limited mobility, sufficient width of the doorways to specialist offices, the presence of a call button and signs in Braille, sound notification for people with hearing and vision problems, the serviceability of elevators in more than single-story medical facilities. Half of the interviewed persons with special needs living in the studied UTC believe that the availability of quality medical care for persons with disabilities is equal in their community and is provided in a timely manner, so there is still potential for improving both medical services and their accessibility. In order to improve the accessibility of services for people with disabilities, the respondents indicated the importance of having accessible transport in the community and expanding the range of medical services for people with disabilities. Further research will be devoted to the analysis of the accessibility of educational institutions of territorial communities for persons with special needs.

Prevention of Migraine

Migraine, a primary headache disorder is a chronic and complex neurological disease that affects millions of people worldwide, impacting their quality of life. It is one of the most common reasons why individuals seek the advice of their physician, and is one of the most common referrals seen in the offices of general neurologists and headache specialists. In the past decade, there has been robust research on not only the pathophysiology of migraine but in the efforts to treat and, importantly, prevent. The introduction of calcitonin gene related peptide antagonists (CGRP-A) have opened new doors for preventive treatment options. OnabotulinumtoxinA (BoNTA) has remained a staple in the treatment of chronic migraine with data emerging with combination therapy. Neurostimulation has offered additional nonpharmacologic approaches to migraine treatment. In addition to lifestyle and behavioral modifications, these have changed the landscape of migraine prevention.

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

BackgroundGastrocnemius tendon lengthening is performed to treat numerous conditions of the foot and ankle. Gastrocnemius shortening has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flat foot deformity, and metatarsalgia. Ultrasound-guided ultraminimally invasive lengthening of the gastrocnemius is a step forward in this type of surgery. It can be performed in both legs simultaneously without ischemia using only local anesthesia plus sedation and without the need for a cast or immobilization. The truly novel advantage of the procedure is that it can be performed in the office, without specific surgical instruments. The aim of our research was to prove the effectiveness and safety of a new closed needle-based ultrasound-guided surgical procedure for lengthening the gastrocnemius tendon.Methods and resultsWe performed ultrasound-guided gastrocnemius tendon lengthening using a needle in eight fresh frozen specimens (3 left and 5 right). None of the specimens had been affected by disease or undergone previous surgery that could have affected the surgical technique. We used a linear transducer with an 8- to 17-MHz linear transducer and the beveled tip of an Abbocath as a surgical blade to perform the lengthening procedure. The gastrocnemius Achilles tendon recession was entirely transected in all eight specimens, with no damage to the sural nerve or vessels. The improvement in dorsal flexion was 15°.ConclusionNeedle-based ultrasound-guided gastrocnemius tendon lengthening is safe, since the surgeon can see all structures clearly, thus minimizing the risk of damage. The absence of a wound obviates the need for stitches, and recovery seems to be faster. The procedure can be performed in a specialist's office, as no specific surgical instruments are required. This technique could be a valid option for gastrocnemius lengthening and may even be less traumatic than using a hook-knife, as in our previous description.

Military Professionalism, Power, and the Division of Labor: The Case of the Reintroduction of NCOs in the Swedish Armed Forces

While noncommissioned officers (NCOs) are hailed as the “backbone” of the world’s armed forces, relatively little scholarly attention has been paid to them compared with the officer corps. NCOs have been at the margins of social scientific literature, largely because of Huntington’s officer-centric concept of the military profession, which was based on a sharp division of roles and which excluded NCOs as well as reservists and soldiers. This article holds that the officer–NCO relationship is not a functional, timeless universal in military organizations and thus merits scholarly attention. The (re)introduction of NCO-style “Specialist Officers” in the Swedish Armed Forces is used to highlight how organizational and technological factors affect the division of labor between officers and NCOs and the text ends with a call for comparative research efforts on the category of NCOs.

Epidemiological and clinical data for allergic contact dermatitis in Kosovo during 2010- 2020

Introduction: Allergic Contact Dermatitis is a form of eczema or dermatitis on the skin which appears as a delayed-type IV hypersensitivity reaction that manifests 48-72 hours after exposure to the allergen (low molecular weight chemical) with social, psychological, occupational, and familial by having an impact on the patient’s quality of life. Objectives: The purpose of the study is to show the epidemiological and clinical situation of Allergic Contact Dermatitis in Kosovo by identifying the most at-risk patients. Patients and Methods: The study is of a retrospective cohort, clinical-analytical type. The study population consists of 1201 pediatric, adult, and elderly patients who presented to the Allergy Clinic, University Hospital Center (UHCK), and the AllergyAsthma Specialist Office in Prishtina, Kosovo with suspicion of Contact Dermatitis and from which 536 were diagnosed with ACD during 2010-2020. Results: Of the 355 cases, 59 patients were male (11.03%) and 477 were female (88.97%). The youngest patient in the study was 1 year old and the oldest was 85 years of age. The most common allergens from our study are Nickel sulphate 5% in 404 cases (57.7%), P-phenyl diamine 1% in 97 cases (13.86%), Cobalt chloride 1% in 46 cases (6.57%), Potassio Bicromato 0.5% in 23 cases (3.29%), Thiuram-mix in 19 cases (2.7%), Paraben mix 16% in 13 cases (1.86%). Conclusion: 12% of patients who come to the Allergy Clinic for skin problems have Allergic Dermatitis Contact and Prevalence to have a positive result in at least one allergen is high 44.6%. The most affected age group is 25-29 years (102 cases or 19.3% of cases with Allergic Contact Dermatitis). For each year of increasing age, the likelihood of Allergic Contact Dermatitis increases by a factor of 1.01; the presence of allergic diseases increases the likelihood by a factor of 0.511, the female gender has a 3,084 times greater risk of contracting Allergic Contact Dermatitis in a lifetime.

Balance Training With Vibrotactile Neurofeedback and Ginkgo Biloba Extract in Age-Related Vertigo.

Background: Balance training with vibrotactile neurofeedback (VNF) can improve balance and subjective impairment in age-related vertigo and dizziness. Ginkgo biloba dry extract EGb 761 has been shown to improve subjective impairment in chronic vertigo and the efficacy of conventional balance training. The combination was expected to work synergistically in this difficult-to-treat population.Objectives: To demonstrate the efficacy of VNF added to EGb 761 for age-related vertigo and dizziness.Design: Multicenter, prospective, controlled, randomized, single-blind, two-arm trial (German Clinical Trials Register https://www.drks.de No. DRKS00007633).Setting: Specialist offices and tertiary care outpatient department.Participants: One hundred and twenty subjects aged 60+ years with chronic dizziness for over 3 months, a Dizziness Handicap Inventory (DHI) Sum Score >25 and fall risk in balance-related situations as measured by the geriatric Standard Balance Deficit Test Composite Score (gSBDT-CS)>40. Patients with other distinct vestibular pathology (e.g., Meniére's disease, stroke, BPPV) were excluded.Intervention: EGb 761 (80 mg twice daily for 12 weeks) plus 10 days of individually adapted balance training with VNF, randomized 1:1 to sensitive (active) or non-sensitive (sham) neurofeedback.Measurements: The change in gSBDT-CS after 6 weeks (primary), other gSBDT outcomes, DHI, cognition, hearing, and safety.Results: One hundred nine of 120 enrolled subjects received both treatments at least once. Over 12 weeks, the gSBDT-CS improved by 6.7 (active) vs. 4.5 (sham). There was a difference in favor of the active treatment of −2.4 (95% CI −5.4; 0.6) after 6 weeks. Under active treatment, more pronounced effects occurred in all secondary analyses and in nearly all secondary endpoints. The DHI sum score decreased from 44.1 to 31.1 in the total sample with a treatment group difference after 6 weeks of −3.1, 95% CI (−7.1; 0.9). No safety issues were reported.Conclusion: Over 12 weeks, the combination of balance training with VNF and Ginkgo biloba dry extract EGb 761 reached a clinically relevant improvement of age-related vertigo and dizziness with a good pharmacological safety profile.

Association between dental extractions and implant installations - a retrospective clinical study/ Associação entre exodontias dentárias e instalações de implantes – estudo clínico retrospectivo

Aim: The retrospective study aimed to draw, the profile of a series of patients who received immediate implants, emphasizing the causes for exodontia. Materials and Methods: This 10-year retrospective study (2006-2016) conducted a data survey on patients subjected to exodontia and immediate implant installation. The study was based on the analysis of the clinical data collected from the records of dental offices of Implantology specialists. The instrument contained questions regarding the patients' systemic condition, dental causes for exodontia, and types of implants installed. Results: Out of 846 teeth extracted from the 407 patients analyzed, 242 were replaced with single implants, 276 with implants for upper protocols, and 328 with implants for lower protocols. The highest rate of implant installations occurred between 2010 and 2014, corresponding to 51.4% of the sample, in which 64.1% of patients were women and 58.3% were aged 41 through 60 years. The highest incidence of extractions presented periodontal (19.2%), prosthetic (17.4%) and endodontic causes (15.2%). Among the prosthetic causes, caries was present in 111 cases. For periodontal causes, generalized chronic periodontitis was present in 200 teeth. In endodontic causes, root fracture was evident in 114 teeth and more prevalent in single-tooth exodontias (p<0.001). In addition, the highest rate of tooth losses (32.4%) occurred from strategic exodontias for single-tooth replacement or upper and lower protocols (p <0.001). Conclusion: Immediate implants proved to be an important alternative for the rehabilitation of compromised teeth, which was shown by the success of the technique and patient satisfaction.

Utilization of palliative care services in patients who died from stage IV non-small cell lung cancer (NSCLC): A retrospective study from a tertiary care center in rural Maine.

95 Background: It is known that palliative care involvement in metastatic NSCLC cancer patients has been shown to improve quality of life in previous studies. The aim of our study was to analyze the utilization of palliative care services among patients who died from NSCLC and the setting in which these patients first received palliative care. Methods: This is a retrospective chart review analysis of patients with stage IV NSCLC who were diagnosed at Eastern Maine Medical center and the affiliated cancer center who died between January 2016 and December 2018. We collected demographic data, date and stage of diagnosis, location of palliative referral, location of first palliative care contact with the patient, time between diagnosis and death, utilization of hospice services and time between the initial palliative care consult and death. Results: 255 patients with stage IV NSCLC died between 2016 and 2018. Mean age was 65.5 years. Women were 49% and men were 51%. Majority (60%) of patients had good performance status with ECOG score between 0-1 at presentation. All 255 patients were referred to palliative care. The location of initial palliative care referral following diagnosis was 40% from the hospital, 32% from the oncology clinic and 28% from the outpatient specialist or PCP office. Overall, 174 patients (68%) were seen by palliative care and 81 (32%) were not seen. Of the patients seen 119 (68%) had their initial palliative evaluation in the hospital, and 55 (32%) in the clinic. Majority (55%) had more than one follow-up visit. Consults initiated in the inpatient setting were more likely to be seen by palliative care than in the outpatient setting (p 0.0009). Time between diagnosis to palliative care consult was less than one month in 39%, 1-2 months in 25%, 2-6 months in 21%, and more than 6 months in 14% patients. Patients seen by palliative care had a more likelihood to end up on hospice (p 0.09). The majority of patients seen by palliative care (53%) died within a month of initial consultation. Conclusions: All patients in our study population were referred to palliative care with 100% provider compliance. Among these, 68% were seen by palliative care. Interestingly, inpatient referrals were more likely to be seen by palliative care than the outpatient referrals. We think this is likely related to ease of access to palliative care team in the hospital as well as some of the patients being at terminal stages of their disease. About 33% of patients died within a month of their initial diagnosis, likely giving palliative care team a shorter window of opportunity to be seen in the outpatient setting. Prioritizing referrals of stage IV NSCLC patients might decrease the wait time after initial referral and increase the availability of palliative care services to these patients.

The Effect of ARMY Professionals` Perceptions of the System on Organizational Commitment: The Mediation Effects of Professional Identity

Purpose: The purpose of this study is to analyze the mediation effect of professional identity in the process of the effect of Army professionals perceptions of the system on organizational commitment, and to draw policy implications for the training and utilization of effective professionals. Methods: The survey was conducted on Army professionals and the hypothesis was verified using structural equations(AMOS18.0). Results: First, system trust did not have a significant effect on professional identity. Second, system internali-zation had a positive(+) effect on professional identity. Third, the indirect effect of professional identity was not significant in the relationship between system trust and organizational commitment. Fourth, the indirect effect of professional identity was significant in the relationship between system internalization and organizational commitment. Conclusion: First, it is necessary to consider the organizational level of professional personnel management system that allows professional personnel officers to have a positive perception and agree with its purpose. Sec-ond, in the process of system change, the situation and opinions of the army specialist officers who are subject to the system change should be reflected as much as possible, and the detailed consideration of the organiza-tional level that makes them well accept the purpose and purpose of system change is necessary. Third, when the Army professional personnel officers are provided with conditions to work with a high professional identity and implement related policies, their organizational commitment can be increased.

Professional Socialization During Restructuring: A Study of Workload and Career Time

This article examines the experiences of newly graduated officers and specialist officers, as they recently entered employment in the Swedish Armed Forces. Building on 35 interviews, this article illustrates the dynamics of excessive workload and an unstructured working environment, and how embedded strategies for mentoring and guidance can reduce negative outcomes associated with the workload. The article introduces the concept of career time, reflecting the participant’s propensity to perform unpaid work to pursue a career in the organization. This study reveals tensions between organizational and employee interests, and experiences of exclusion from the officer profession, contextualized drawing on classical theorists Foucault and Habermas. When restructuring organizations, the quest for efficiency can outweigh professional values, such as esprit de corps and taking pride in work and professional identity.

Perceptions of Officer Training Among Newly Employed Officers and Specialist Officers in the Swedish Armed Forces – A Qualitative Study

Professional officer training in Sweden has gone through some major changes in the last 30 years. The current officer system is a two-category system, where officers complete the three-year academic Officers’ Programme, and specialist officers complete 18 months of vocational training at the Swedish Armed Forces’ training schools. The aim of this study was to investigate newly graduated officers’ and specialist officers’ perceptions of their officer training. Results showed that their perceptions could be covered by three overriding themes: identification, vertical versus horizontal career paths and the perceived relevance of the officer training. Furthermore, the respondents’ officer identification seemed to have developed before officer training, and the individual motivators concerned deliberate choices of becoming either an officer or a specialist officer. Coaching was crucial to both officers and specialist officers. However, the officers stated that coaching came at an early stage of their basic military training, whereas specialist officers were coached at a later stage in their career. The implications for the Swedish Armed Forces is that identification and career path are issues that need to be addressed early in a soldier’s military career, and that officer training needs to be more focussed on defining career paths, especially for specialist officers.