Team Of Specialists Research Articles

Managing medical care for victims with thermal burn injuries caused by emergency accidents in megacity settings

Relevance. In emergency settings, medical care for thermal burn injuries remains a crucial problem of disaster medicine. In industrially advanced countries with ongoing urbanization, burns represent a most frequent and severe type of injuries requiring emergency medical care. The study objective is to analyze the efficiency of emergency medical care provided in Moscow over the 6 year’s timespan (2018 to 2023) to victims of emergency accidents presented with thermal burns.Methodology and methods. The study relies on the data obtained from the Disaster Medicine of Moscow automated analytical information system with a focus on the victims of emergency accidents presented with burns throughout the past 6 years (2018 to 2023). The platform is managed by the Moscow Territorial Scientific and Practical Center for Disaster Medicine (CEMP) and the N.V. Sklifosovsky Research Institute of Emergency Medicine.Results and discussion. Over the past 6 years (2018 to 2023), the emergency accidends affected 1989 victims presented with thermal burns, including 438 (22.0 %) declared dead at the scene prior to the arrival of CEMP medical and specialized emergency response teams. 1,216 patients (61.1 %) were evacuated to referral centers at multidisciplinary hospitals, 315 patients (15.9 %) travelled to medical hospitals by passing-by vehicles to apply for medical help independently, and 20patients (1 %) were referred for outpatient follow-up. Overall, 597 patients were admitted to burn injury department at the N.V.Sklifosovsky Research Institute. Those included 33.1 % in extremely severe and severe condition, with 1.7 % requiring tracheal intubation and respiratory ventilation support.Conclusion. At pre-hospital stage, deployment of the medivac ICU teams is the most promising strategy to ensure high quality medical care. Given the high incidence of multiple injuries (up to 49.6 %) in emergency accidents, sophisticated medical care shall be provided by a multidisciplinary team of reconstructive burn surgeons, ICU staff specializing in inhalation injuries, and medical professionals.

Which is the more effective management strategy for irritability and challenging behaviour in autism, medication or psychosocial interventions?

Purpose The purpose of this study is to critically analyse the current research around the impact of management strategies on challenging behaviour in autism. Design/methodology/approach Mixed method analysis. Findings Seven studies were included for discussion. The author found significant heterogeneity in the outcome measures of all the studies and was unable to provide a meta-analysis. The results showed that psychosocial interventions offer the most promise in terms of safety and efficacy. The author was unable to explain what part of their intervention had the most significant effect. Antipsychotic interventions demonstrated the most robust methodologies and therefore, the results are more reliable. Research limitations/implications These studies provide valuable evidence for UK guidelines and suggest that lower doses of medication do not have a therapeutic effect on patients. Furthermore, these studies do not use psychosocial interventions alongside medication reduction, which may have proven valuable to help the author’s understanding of the different management strategies for treating challenging behaviour in autism. Thus, this literature review recommends further studies in the reduction of medication alongside psychosocial interventions with a larger number of participants recruited from a diverse range of backgrounds. Practical implications Gerrard et al. (2019) hope that positive behavioural support will become standard practice for specialist teams following the results of their findings and conclude that in the absence of effective management strategies, there is a greater likelihood of the re-introduction of medication. Admittedly, they do not understand what components of their intervention had the greatest significance on the results and identify this as a limitation of the study. In the single case study by Lee, Rhodes and Gerrard (2019), they claim that medication reduction and discontinuation can be successful if the rate of titration reduction is slowed down. This may offer some insight into the success of the strategy by Gerrard et al. (2019). Social implications Bishop-Fitzpatrick et al. (2013) state that the researchers in their systematic reviews used “creative techniques” to address the core deficits of autism (p. 7). It can be argued that psychosocial interventions are highly individualized, making them difficult to implement in practice and are ungeneralizable. For this purpose, the reduction of medication cannot be implemented consistently as it is not clear what strategies are effective. Originality/value This is the author’s own work, and to the best of the author’s knowledge, it does not infringe upon anyone’s copyright and that any ideas, techniques or any other material are fully acknowledged in accordance with the Harvard referencing guidelines.

Multidisciplinary Approach in the Treatment of Gastric and Duodenal ulcer Complicated by Bleeding

A multidisciplinary team is a team of specialists from different fields of medicine, united by the solution of one problem on previously agreed principles. A possible example of this approach in the treatment of gastric ulcer and duodenal ulcer complicated by bleeding is the joint interaction of doctors - general surgeons, endoscopists, gastroenterologists, general practitioners, therapists, nutritionists, psychologists. Since these specialists often encounter these dangerous diseases, a joint approach to their treatment is fully justified. When considering many medical problems, cooperation and joint work of several at once is necessary, both narrow specialists and general practitioners who work in the same team and try to achieve a common goal. In modern world medical practice, this approach is used more and more, because it allows you to combine the knowledge of different doctors, for the benefit of the patient and make the treatment closer to this patient. Today, a multidisciplinary approach of a team of doctors of different specialties is increasingly engaged in the treatment of patients in the world's leading clinics. It is believed that this approach has a future, because it allows to easily and quickly determine the sequence and priority of treatment methods. Also, recommendations to the patient are given in agreement and situations where one contradicts the other are excluded. Collegiality is observed.

The interaction of structured data using openEHR and large Language models for clinical decision support in prostate cancer.

Multidisciplinary teams (MDTs) are essential for cancer care but are resource-intensive. Decision-making processes within MDTs, while critical, contribute to increased healthcare costs due to the need for specialist time and coordination. The recent emergence of large language models (LLMs) offers the potential to improve the efficiency and accuracy of clinical decision-making processes, potentially reducing costs associated with traditional MDT models. We conducted a retrospective study of 171 consecutively treated patients with newly diagnosed prostate cancer. Relevant structured clinical data and the European Association of Urology (EAU) pocket guidelines were provided to two LLMs (chatGPT-4, Claude-3-Opus). LLM treatment recommendations were compared to actual treatment recommendations of the MDT meeting (MDM). Both LLMs demonstrated an overall adherence of 93% with the MDT treatment recommendations. Discrepancies between LLM and MDT recommendations were observed in 15 cases (9%), primarily due to lack of clinical information that could be provided to the LLMs. In 5 cases (3%), the LLM recommendations were not in line with EAU guidelines despite having access to all relevant information. Our findings provide evidence that LLMs can provide accurate treatment recommendations for newly diagnosed prostate cancer patients. LLMs have the potential to streamline MDT workflows, enabling specialists to focus on complex cases and patient-centered discussions. In this study, we explored the potential of artificial intelligence models called large language models (LLMs) to assist in treatment decision-making for prostate cancer patients. We found that LLMs, when provided with patient information and clinical guidelines, can recommend treatments that closely match those made by a team of cancer specialists, suggesting that LLMs could help streamline the decision-making process and potentially reduce healthcare costs.

أهمية دراسات الجدوى في نجاح المؤسسات الاقتصادية في مدينة عمّـان - الأردن

This study examined the importance of feasibility studies in driving the success of economic institutions in Amman, Jordan, using a descriptive-analytical approach. The research sample consisted of 385 randomly selected owners of economic institutions in the city. A validated and reliable questionnaire was utilized for data collection, and SPSS was employed for analysis. Findings demonstrated that feasibility studies have a statistically significant impact on the success of economic institutions. Key aspects such as preliminary analysis, market analysis, financial analysis, and technical analysis were highlighted as crucial contributors. The study recommended forming specialized teams to conduct detailed preliminary analyses to establish a clear strategic vision. It also stressed the importance of implementing ongoing market analysis systems to monitor customer trends and adapt to emerging opportunities effectively.

Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation.

Oncological treatments, such as radiotherapy, which requires consistent electricity, the presence of specialized clinical teams, and daily patient access to treatment facilities, are frequently disrupted by extreme weather events, posing several health hazards to patients. This study explores the association between declared wildfire disasters during radiotherapy and overall survival among patients with non-small cell lung cancer (NSCLC). The study population consisted of 202,935 adults with inoperable Stage III NSCLC, who initiated radiotherapy from 2004 through 2019. Exposure was defined as a wildfire disaster declaration in the county of the treatment facility within 12weeks of initiating radiotherapy. Overall survival was defined as the interval (months) between age at diagnosis and age at death, date of last contact, or study end. Cox proportional hazards was used to estimate crude and adjusted hazard ratios and 95% confidence intervals with inverse probability weighting. Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI 1.00-1.06; p = 0.02), compared to unexposed patients in adjusted models. Exposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients with stage III non-operable NSCLC. This finding underscores the critical need for developing adaptation strategies within the healthcare sector, especially in oncology.

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG).

Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires. The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat? To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence. A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted. From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines.

Progress and Challenges in Integrating Nutritional Care into Oncology Practice: Results from a National Survey on Behalf of the NutriOnc Research Group.

Nutritional care is a cornerstone of cancer treatment, with the potential to significantly improve patient outcomes by addressing malnutrition and enhancing recovery. Despite growing awareness, the integration of evidence-based nutritional strategies into oncology remains inconsistent. Following a 2020 survey that highlighted critical gaps, the NutriOnc Research Group launched targeted initiatives to raise awareness and improve practices. This study reassesses progress in integrating nutritional care and identifies persistent challenges. A 29-question survey was conducted in 2024 among 73 early-career oncologists, surgeons, radiation oncologists, and nutrition specialists across Italy. Respondents provided insights into clinical nutrition program availability, multidisciplinary team composition, screening practices, and educational needs. Encouraging advancements were noted, with 80.8% of respondents reporting the presence of clinical nutrition programs, compared to fewer structured efforts in 2020. However, only 26.0% included nutrition specialists in multidisciplinary teams, and barriers such as financial constraints, limited product availability, and the absence of trained professionals persisted. While 82.2% performed nutritional screening, variability in tools and practices highlighted the need for standardization. Strikingly, 98.6% expressed a strong demand for advanced education on clinical nutrition, emphasizing the need for innovative and accessible training programs. This study reveals a landscape of progress tempered by persistent inequities. To close the gap, oncology must embrace standardized protocols, expand access to trained nutrition specialists, and invest in educational initiatives. The findings offer actionable insights for transforming cancer care through nutrition, underscoring its potential to improve survival, quality of life, and overall treatment success.

Surgical treatment of burned hand: differences between adult and pediatric patients

Introduction: the hand is very susceptible to burn injuries, affecting the vast majority of burn patients and impairing their functionality and quality of life. More than 50 % of those affected are pediatric, which makes recovery difficult because their tissues are in full growth. Objective: to determine the best treatment to recover the functionality of the burned hand, and minimize the consequences of contractures. Method: an exhaustive search was carried out where relevant works were selected for this study, for their treatment and reconstruction techniques, and the age of their patients. The variable of greatest consideration is the functionality of the hand. Results: in the case of pediatric hands, which have a greater propensity for poor healing, it is essential to evaluate the procedures and their reconstructive results in the acute phase to reduce surgeries due to complications. Patients are more concerned about their aesthetic appearance, especially children, and about their functionality, despite the pain they may feel. Conclusions: surgical treatment, performed by a team of specialists, is the best option to prevent and resolve scars and contractures that hinder hand functionality, as well as aesthetics and growth sequelae in pediatric patients

Effects of UK hostile environment policies on maternity care for refugees, asylum seekers, and undocumented migrants in Camden: Examining the experiences of healthcare professionals and community organisations.

The London borough of Camden has long been home for many refugees, asylum seekers, and undocumented migrants (RASUs). Over time, it has witnessed an increase in the population of these migrant groups, accompanied by notable changes in the obstacles they encounter when seeking health services, particularly maternity care. We explore how the 'hostile environment' policies affect access to and delivery of quality maternity services for RASUs. This study was conducted over eight months (November 2021-July 2022) both remotely and face-to-face, in various locations in Camden and in the Maternity Department at University College London Hospital, UK. Healthcare professionals (HCPs) and community organisations (COs) were identified as two major stakeholders involved in the care provision for RASUs. 33 semi-structured interviews were conducted (with 22 HCPs and 11 COs) to understand their experiences of delivering care to this population. There was consensus among HCPs and COs that the current immigration policies undermined their duty of care, personal morals, and the principles of the NHS. These policies have created a restrictive environment, making it increasingly difficult for migrants to navigate the healthcare system and creating an atmosphere of distrust, propagating fears of being charged. This has led to HCPs and COs going beyond their remits to ensure that RASUs are accessing and engaging with maternity care, regardless of an individual's status and despite any potential repercussions for themselves. In the face of an intensifying hostile environment under the UK government, supporting RASUs cannot be solely reliant on political measures. We need to advocate for healthcare navigator roles, health justice partnerships, specialist teams, and comprehensive training for service providers. HCPs and COs should be adequately supported in their endeavours to ensure RASUs have access to standardised, high-quality maternity care.

Patient and Public Involvement in Pharmacoepidemiological Research: An Environmental Scan of an Emerging Area.

Patient and public involvement (PPI) in research is required to improve the relevance, feasibility, and interpretability. However, research on PPIs in pharmacoepidemiology (PE) is still limited. This study aimed to provide an overview of PPI implementation in pharmacoepidemiology through an environmental scan. The environmental scan combined systematic reviews and expert interviews. A systematic review was conducted in MEDLINE, EMBASE, and the Cochrane Library from January 1, 2010, to June 30, 2023, to identify PE studies in which PPIs were mentioned. An additional review covered British Medical Journal's (BMJ) original articles from January 1, 2019, to June 30, 2023, via a similar method. In parallel, a cross-sectional study was conducted with a standardized questionnaire for French PE research teams, involving interviews via videoconference. We identified 3615 references for screening, among which 232 were selected for full-text screening. However, no studies have reported the use of PPIs in PE studies. The additional BMJ review identified 1058 references, 74 of which met the full-text selection criteria, and eight were included. Of 13 French PE research teams surveyed, three had prior PPI experience, and 12 affirmed the relevance of PPI in PE. The respondents identified barriers such as PE's complexity (n = 9). They suggested training for patients (n = 9) and collaboration with specialist teams (n = 5) to facilitate PPI. Our environmental scan highlighted the emergence and relevance of PPIs in PE studies, even though they are still uncommon. Tools are needed to acculture and assist PE researchers in engaging in PPIs.

The Importance of Sharing Current Scientific Information with Biology Teachers in Weekly Newsletters

High-school teachers and students do not usually have access to scientific research advances because original research papers contain many highly specialized words that are specific to the discipline. Scientific newsletters (SNs) summarize current scientific research advances and trends. During the 2022–2023 school year, 21 SNs teaching biology content were written by a team of science-education and biology specialists working at the National Center for High-School Biology Teachers in Israel, according to the following criteria: (a) the SNs were based on primary research papers published in international well-known scientific journals such as Nature, Cell or Science; (b) the biological content was related, albeit not necessarily directly, to the Israeli high-school biology curriculum; (c) some of the SNs were related to biological events that occurred during the week in which the SN was distributed, such as World Diabetes Day. The SNs were written in Hebrew, translated to Arabic, and sent weekly via WhatsApp to 901 high-school biology teachers. After sending 10 SNs, an anonymous questionnaire was sent to the teachers to understand their use of the SNs and identify topics to which teachers would like us to relate in the next SNs. Forty-nine teachers answered the questionnaire, revealing that according to their open-ended answers, some of the teachers valued the importance of receiving SNs teaching biology topics as a way to enrich their own biological knowledge, and to engage their students with meaningful scientific research and with the real-world work of scientists. Further research is needed to analyze the impact of the SNs on teachers’ professional development.

The Impact of Bullying on the Social Development of Adolescents at SMA Negeri 1 Sungai Ambawang, Kubu Raya Regency

The aim of this research is to determine the role of schools in minimizing the impact of bullying on the social development of students at SMA Negeri 1 Sungai Ambawang. The location of this research is SMA Negeri 1 Sungai Ambawang, Kubu Raya Regency. The research subjects were members of the Violence Prevention and Handling Team (TPPK) of SMA Negeri 1 Sungai Ambawang. This research uses qualitative research. Data collection techniques in this research were observation, interviews and documentation. The data analysis techniques used are data collection, data reduction, data presentation, verification. The results of this research are the role of SMA Negeri 1 Sungai Ambawang school in creating Anti-bullying Programs and Policies; the school formed a special team, namely the Violence Prevention and Handling Team (TPPK); The monitoring system implemented is in collaboration with all school officials to monitor and pay attention to bullying in the classroom. There is a school community approach at SMA Negeri 1 Sungai Ambawang, namely teachers and the PPK Team play a role in providing guidance, direction, support and protection to students; provide an understanding of the dangers of bullying towards students by providing outreach; ascertain where bullying occurs by seeking information about acts of bullying that students often experience at school; handling of bullying cases is carried out through discussions with parents, teachers and third parties, namely the police as mediation intermediaries, providing guidance and supervision to students; The school will collaborate with the Kubu Raya Regency Women's Empowerment and Child Protection Service.

Corporate Hereditary Succession Risk Management

The relevance of the study lies in the presence of problems related to hereditary transfer of business, especially in conditions of economic turbulence in the Russia, which, together with the loss of enterprises, can lead to the loss of accumulated knowledge and created technologies, which will put the Russian economy at a disadvantage compared to international competitors. In addition, this topic has not been sufficiently studied from the perspective of enterprise risk management. In the study, the factors of successful hereditary succession are divided into internal and external ones. External factors include a perfect regulatory framework and availability of necessary socio-economic infrastructure; internal factors include adherence to the principles of corporate governance G20/OECD, formation of a systematic approach to the transfer of the company to heirs, including development of their competencies, compliance with the legislative norms of the Russian Federation and formation of official succession plans. The purpose of the study is to develop a risk management mechanism for the hereditary succession of a corporation. Materials and methods. In the course of the research, the following methods were used: analysis of Russian and foreign scientific sources and business Internet resources, the case method, the «bow tie» risk management method (GOST R ISO/IEC 31010-2011), the scoring method based on the interpretation of scientific publications. Results. An event of hereditary succession, having a dual nature, like any risk, can affect the financial performance of the company, the image of the company in the eyes of the consumer (risks in brand management) and other aspects of the company's activities, that is why careful preparation and selection of the most favorable moment at the stage of the company's life cycle, for example, during its economic growth are necessary. The practical experience described in the article has shown that the absence of a regulated process for transferring business ownership leads to significant losses: closure of enterprises, financial damage to the company and heirs, complete loss of business, a decrease in market share, etc. An impulse mechanism for preventing the risk of hereditary succession has been identified in studying the experience of Chinese companies, which is implemented through one-time events, such as charitable donations to strengthen reputation. A systemic mechanism for preventing the risk of hereditary succession was identified from the experience of Auchan company, in which both the organizational structure and a set of measures were aimed at increasing the stability of the company in transferring business to heirs. It is proposed to introduce a hereditary succession risk management mechanism at the enterprise based on GOST R ISO/IEC 31010-2011. The use of the risk analysis method («bow tie») made it possible to systematize the causes, consequences and to offer a set of preventive (drawing up a legally formalized inheritance plan, training the heir in management skills, appointing intermediaries in conflict resolution, assessing market changes and adapting to them) and mitigating (creating a reserve fund in case of crisis situations, maintaining stable relationships with partners and clients, support for employees during the transition period, legal support) measures to prevent the risk of hereditary succession. The mechanism represents a cyclical sequence of stages aimed at continuous improvement of the risk management process during business transfer. The interdisciplinary approach at each stage is carried out with the help of a team of specialists, the contribution of each of whom is evaluated on a 10-point scale. Conclusions. The proposed mechanism can be adapted for various industries and types of family business and will help to mitigate the risks of hereditary succession, preserve the stability of enterprises and the Russian economy as a whole.

Analysis of The Readiness of Electronic Medical Record Implementation Using DOQ-IT at Rsud Class D Pratama Sendawar

This study aims to evaluate the readiness of Class D Primary Hospital Sendawar in implementing Electronic Medical Records (EMR) using DOQ-IT, focusing on four aspects: human resources (HR), organizational work culture, governance and leadership, and technology infrastructure. The method used was qualitative through in-depth interviews with health workers and hospital staff, and thematic analysis. The results showed that HR had a positive understanding of the benefits of EMR, but lacked information technology skills and adequate training. Organizational work culture supports the implementation of EMR, but needs strengthening in the formation of special teams and policy development. Management support for EMR is strong, but a clear strategy for internal coordination is needed. Technology infrastructure is currently inadequate, with problems in hardware, software and internet networks. The research conclusions emphasize the need for increased HR training, policy development, and infrastructure improvements. RSUD Kelas D Pratama Sendawar is advised to adopt a comprehensive approach to managing change to facilitate an effective transition to the EMR system.

The evolution of financial regulation and the role of the monetary authority of Singapore: a historical analysis based on organizational knowledge creation theory

ABSTRACT This study explores the historical development of Singapore as an international financial center and the pivotal role played by the Monetary Authority of Singapore (MAS) in promoting financial liberalization and strengthening financial regulation and supervision. It focuses on two significant reforms within MAS, led by different chairpersons. The first reform, initiated by Goh Keng Swee in 1981, emphasized enhancing regulatory frameworks and supervision. The second reform, led by Lee Hsien Loong in 1998, sought to balance regulatory oversight with financial liberalization. This study adopts a dynamic theory of organizational knowledge creation (OKCT) to analyze the mechanism of human capital accumulation within MAS. Specifically, it addresses three research questions about forming specialized reform teams, developing reform ideas, and disseminating new visions to financial supervisors. Utilizing resources such as MAS’s 40-year history book, Annual Reports, and Executive Oral History Materials, this study demonstrates the effectiveness of OKCT in understanding MAS’s adaptive approach to regulatory challenges and its strategic development as a leading international financial center.

Adherence to national trauma triage criteria in Norway: a cross-sectional study

BackgroundNorwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals.MethodsA digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator’s discretion in cases of non-respondents or need to clarify answers.ResultsThirty-eight trauma hospitals were invited to answer the survey, where 35 hospitals responded (92%), making 35 the denominator of the results. Thirty-four (97.1%) hospitals stated that they followed NTrC. Thirty-three (94.3%) of the responding hospitals provided documentation of their criteria in use, of which twenty-eight (80%) of responding hospitals adhered to the NTrC. Three (8.6%) hospitals employed a tiered TTA approach with different sized teams. In addition four hospitals (11.4%) used specialized teams to meet the needs of defined patient groups (e.g. geriatric patients, traumatic brain injury). Twenty-one (60%) of the responding hospitals had written guidelines on who could perform TTA and in 18 hospitals (51.4%) TTA could be performed by pre-hospital personnel. Twenty-three (65.7%) of the hospitals documented which criteria that were used for TTA.ConclusionThere is good adherence to the national criteria for activation of the trauma team among Norwegian trauma hospitals after implementation of national guidelines. Individual hospitals argue the use of certain local criteria and trauma team activation decision-making processes to increase their precision in specific patient populations and demographics. Further steps should be done to reduce the variation in TTA decision-making processes among hospitals and improve documentation quality.

Infrastructure Analysis of Long-term Care for Elderly Adults in Iran: A Qualitative Study

Objectives: To analyze the challenges and dimensions of long-term care (LTC) infrastructure in Iran’s health system. Design: Exploratory qualitative content analysis. Setting(s): Iran’s health system. Participants: Individuals with a minimum of five years of experience in geriatric care, LTC, and health systems, as well as at least a master’s degree in health system management. Outcome Measures: The data on challenges and dimensions related to the LTC infrastructure in Iran’s health system were gathered through 15 semi-structured interviews. Results: The challenges of LTC infrastructure in the health system of Iran were divided into two main themes (physical and human resources) and four sub-themes (lack of skilled and trained human resources, lack of attention to older adults in the training of specialists, the inappropriateness of LTC facilities, and weakness of LTC infrastructure). In addition, the planning and development of human resources, use of human resources, and development of specialized facilities and community-based care were identified as the sub-themes of the components. Conclusions: The training of specialized human resources, the updating of medical science curricula according to demographic changes, and the formation of multidisciplinary specialized teams to assess care needs and provide services are among the most important measures to provide human resource infrastructure. Moreover, designing LTC facilities at different levels and using the capacity of primary healthcare centers are among the most important measures to provide physical infrastructure that should be prioritized.

EATING DISORDERS IN CHILDREN AND ADOLESCENTS AS A COMPLEX PUBLIC HEALTH ISSUE: RISKS, TRENDS, MANAGEMENT

The medical and social significance of eating disorders (EDs) in adolescents is determined by their prevalence, impact on patients' quality of life, consequences, and the burden they place on the public health system. The high level of stress due to the COVID-19 pandemic and the full-scale Russian-Ukrainian war has led to a deterioration in the mental health of citizens in our country, restricted access to medical care for all segments of the population, resulting in late diagnoses of these disorders, low treatment effectiveness, and insufficient preventive measures. The purpose of the article is to study EDs in children and adolescents as a complex public health issue, covering such aspects as prevalence, classification, etiology, early diagnosis, treatment, development of preventive programs and promotion of healthy eating behavior in this age category, as well as analysis actions and policies of national healthcare systems in various countries regarding the management of this pathology. The methods used include the analysis and synthesis of current scientific sources from the databases PubMed, Scopus, and Google Scholar covering the years 2010–2024. The main findings of the study identify key issues related to the understanding, diagnosis, treatment, and prevention of eating disorders in adolescents. The study summarizes the needs of the national public health system to ensure proper management of these disorders. It describes the contemporary understanding of the multifactorial nature of eating disorders. The necessity of involving a multidisciplinary team of specialists in the treatment process is demonstrated, along with the use of trauma-focused, biopsychosocial, and age-dependent approaches to achieve high therapeutic efficacy. The negative impact of the COVID-19 pandemic and the war on the onset and course of eating disorders is also evidenced. The practical value of this work lies in the fact that its results serve as a foundation for developing effective programs for the diagnosis, treatment, and prevention of eating disorders in adolescents, with mandatory involvement of the patients' families and communities. The findings also provide a basis for creating training programs for multidisciplinary team professionals in the management of eating disorders, as well as for developing recommendations on counseling activities and promoting mental health and healthy eating behaviors. The results of this study provide a foundation for implementing alternative treatment options that can be effectively contrasted with traditional inpatient care

Нейрофиброматоз 1 типа и ассоциированные заболевания: педиатрические аспекты диагностики, наблюдения, терапии

Neurofibromatosis type 1 (NF1) is a genetically determined disease characterized by damage to all organs and systems with dominant involvement of the skin and peripheral nervous system. One of the main NF1 features is the age-dependent representation of its clinical symptoms, which is the reason for untimely diagnosis verification and inadequate medical care which in its turn entails the risks for severe disability and reduced life expectancy. Obviously, the key factors in improving the prognosis for life and its quality are the improvement of screening, diagnostics, therapy and rehabilitation programs, both in childhood and in adult patients. The issues of social and psychological adaptation of patients and their families are highly relevant, this therefore requires the availability of information sources and the involvement of a multidisciplinary team of medical specialists at all stages of medical care. The purpose for publication of this bibliographical review was to highlight the features of diagnosis and observation of children with NF1 as well as existing treatment options for associated diseases.