Consultant Staff Research Articles

Containing spaces for learning through experience: A psychosocial approach to co-operation.

This paper investigates one of the fundamental differences between a co-operative undertaking and a capitalist business: democratic participatory governance as opposed to hierarchical leadership. The latter often comes across as a ‘norm’ to be taken for granted. As such, co-operation is translated into the language of ‘team work’ and ‘staff consultation’, the domains of a successful capitalist company. Participation in co-operative governance, however, is more profound than this and requires an enhanced understanding of the somatic and affective qualities behind democratic decision-making. The paper suggests that a new language might be used to describe this difference, perhaps collective governance should be regarded as a virtue that can be recognised as working beyond values, even co-operative values. A further question arises: if indeed co-operative participatory governance is about relationships among equals, how can this be taught and/or learnt beyond the hard lessons of life experience? What can educational establishments do to teach people how to participate and govern by participating? The paper suggests that possible avenues of exploration in search of an answer to these questions might lie in a psycho-social approach that is able to encourage group learning from experience.

The development of an intradisciplinary staff training intervention on the optimal management of behavioural and psychological symptoms of dementia: A qualitative study

Introduction: Behavioural and psychological symptoms of dementia (BPSDs) are a group of highly prevalent symptoms in residents with a neurocognitive disorder (NCD), including agitation and depressive symptoms. Caregiving staff often mention knowledge and skills deficits regarding optimal BPSD management. While several staff trainings on BPSDs management exist internationally, their transferability to other clinical contexts is limited, owing to methodological challenges. Therefore, to address this implementation gap, there is a strong need for trainings based on high-quality research to strengthen existing evidence, ensure feasibility and reproducibility. Methods: This qualitative study, part of a larger research project, occurred in 2022 on a long-term care (LTC) center unit and an alternate level of care (ALT) hospital unit located in the Province of Quebec, Canada. This study aimed to: 1) evaluate the needs and perceptions of staff caregivers regarding BPSD management, 2) identify the training content and modalities to prioritize according to experts, 3) develop an intradisciplinary training on BPSD management, and 4) pretest the preliminarily version of the training. Objectives one and two were evaluated using focus groups and objective four using individual cognitive interviews. Qualitative interview data was audio-recorded with participants’ consent, transcribed verbatim, and thematically content analyzed using an established method. Results: Overall, thirteen caregivers participated in objective one (8 from the LTC unit, and 6 from the ALT unit). The main staff training need identified on each site was the management of resident’s aggressive behaviours. Staff verbalized a preference for a virtual training. Objective 2 involved a panel of eight experts. Experts recommended the use of an online training platform, and certain training models and indicators. Based on caregivers and experts’ input, five interactive online staff training capsules lasting from 20-25 minutes each and an algorithm guiding the evaluation and management of BPSDs were created. The training capsules and the algorithm were iteratively improved following cognitive interviews with 4 caregivers from the participating sites. Conclusion: An interactive virtual staff training on BPSD management was created based on staff and expert consultation. The next step in investigation will be to evaluate the feasibility and acceptability of the training.

Письма судей и органов судейского сообщества как объект проверки в порядке гражданского и административного судопроизводства

The procedures for citizens to challenge the decisions, action (inaction) of state bodies and officials are widespread in Russian procedural law. Notwithstanding the clear, at first glance, regulation of objects of verification and list of persons, whose decisions, action (inaction) can be appealed in court, in practice there're still controversial cases when citizens and organizations try to protest the letters from judges containing answers on procedural and non-procedural issues arising during the resolution of the case on the merits. Particularly it's about determining the legal nature of letters from judges on the return of statements of claim, on the termination of correspondence with the party; letters sent by court staff (consultants, etc.); letters from bodies of the judicial community. In order to qualify the letters from judges that are not issued as a court ruling the author offers to determine signs of judicial rulings in them. As for letters sent by court staff and bodies of the judicial community the author, based the object and subject criteria, concludes that it is unacceptable to appeal such documents in civil or administrative proceedings.

Indications and success rate of endotracheal emergency intubation in clinical acute and emergency medicine

Securing the airway in the emergency department (ED) is ahigh-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was aretrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications. Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent asix-week training program including atwo-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with aplaced laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate. During the study period 499 patients were intubated by the core ED team and 28patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527(2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08). In clinical acute and emergency medicine, astandardized approach utilizing video laryngoscopy and a bougie following astructured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting.

Umbrella review of hospital passports: Their use and improvements

AbstractBackgroundThe hospital or health passport is widely acknowledged as a central element in making reasonable adjustments for patients with intellectual disabilities. Historically, the health passport has been used exclusively for patients with intellectual disabilities; however, it has wider applications for any patient requiring additional support. Commonly, it documents past medical history, communication needs and a person's means of expressing pain. There are, however, significant barriers to their use, meaning patients are unable to access adjustments to improve their experiences in a healthcare system that already marginalises and discriminates against people with intellectual disabilities. This umbrella review aims to establish whether the passport is an effective reasonable adjustment, identify barriers to its use and make recommendations to alleviate these barriers.MethodsDatabase and citation searches informed a synthesis of international evidence to address these aims. Following the removal of duplicates and screening, nine review papers originating from the United Kingdom, Australia and Ireland were identified for inclusion. Seven focus on the use of passports for patients with intellectual disabilities, one on the use of passports for autistic people, and one exploring the use of passports for patients with dementia.FindingsThe results demonstrated that the passports are effective in improving care for patients with intellectual disabilities. However, there are barriers to its routine use. We identified three main issues with the current use of the hospital passport. First, there is a need for greater managerial support to implement reasonable adjustments. Second, standardisation of the passports at a national level will make them more accessible to healthcare professionals and will ensure that information is not ‘buried’; the development of a standardised passport must involve consultation of patients, carers and staff to meet the needs of all stakeholders. Finally, education for all healthcare staff to raise awareness of the passport and ensure it is utilised appropriately will ultimately pave the way for positive, long‐lasting change.ConclusionsPassports can be an effective means of communicating reasonable adjustments. Addressing a lack of awareness of its utility, ensuring managerial commitment to implementing reasonable adjustments and making the passport accessible through a standardised format will empower patients to engage with their own care.

Investigation of occupational stress among radiologic technologists in Saudi Arabia using HSE stress indicator tool

BackgroundThe increasing concern about occupational stress and its effects on radiologic technologists (RTs) has been noted, as it can lead to decreased productivity and compromised healthcare quality. This study aimed to evaluate occupational stress and pinpoint the primary indicators of organizational psychosocial hazard exposures among RTs working in hospitals under the Saudi Ministry of Health. The Health and Safety Executive Indicator Tools (HSE-IT) for occupational stress were utilized for this assessment. MethodsThe study employed a cross-sectional online survey that utilized both quantitative and qualitative methods. The quantitative method was based on the HSE-IT, which focuses on six HSE Management Standards that represent potential stress hazards, namely: demands, control, support, relationships, roles, and change. The qualitative method, on the other hand, was based on narrative comments that shed light on the most common sources of occupational pressure and suggestions on how to alleviate this pressure in the radiology department. ResultsA total of 864 responses were collected from RTs in Saudi Arabia. This study revealed that urgent action was needed for demand, managers’ support, workplace relationship, and organizational roles, while assessment of control and organizational change standards were indicated as a “clear need for improvement” and “good, but in need of improvement”, respectively. This study identified particular areas of concern such as workload, shortage of staff, lack of control, feedback, social support, personal harassment, job description, and consultation of staff with changes in their work environment. The relationship between the sociodemographic data and the overall stress results revealed statistically significant differences related to gender (P = 0.020), living place, and working night shifts (P = 0.003). ConclusionThe study found that the risks of occupational stress for RTs are substantial and are not being appropriately addressed. The need for awareness to manage occupational stress is warranted, and therefore, this study presented recommendations for reducing the risks associated with occupational stress.

Utilisation of palliative/ end-of-life care practice recommendations in the burn intensive care unit of a Ghanaian tertiary healthcare facility: An observational study

BackgroundThe need to integrate palliative/end-of-life care across healthcare systems is critical considering the increasing prevalence of health-related suffering. In burn care, however, a general lack of practice recommendations persists. Our burn unit developed practice recommendations to be implemented and this study aimed to examine the components of the practice recommendations that were utilised and aspects that were not to guide further training and collaborative efforts. MethodsWe employed a prospective clinical observation approach and chart review to ascertain the utilisation of the recommendations over a 3-year period for all burn patients. We formulated a set of trigger parametres based on existing literature and burn care staff consultation in our unit. Additionally, a checklist based on the practice recommendations was created to record the observations and chart review findings. All records were entered into a secure form on Google Forms following which we employed descriptive statistics in the form of counts and percentages to analyse the data. ResultsOf the 170 burn patients admitted, 66 (39%) persons died. Although several aspects of each practice recommendation were observed, post-bereavement support and collaboration across teams are still limited. Additionally, though the practice recommendations were comprehensive to support holistic care, a preponderance of delivering physical care was noted. The components of the practice recommendations that were not utilised include undertaking comprehensive assessment to identify and resolve patient needs (such as spiritual and psychosocial needs), supporting family members across the injury trajectory, involvement of a palliative care team member, and post-bereavement support for family members, and burn care staff. The components that were not utilised could have undoubtedly helped to achieve a comprehensive approach to care with greater family and palliative care input. ConclusionWe find a great need to equip burn care staff with general palliative care skills. Also, ongoing collaboration/ partnership between the burn care and palliative care teams need to be strengthened. Active family engagement, identifying, and resolving other patient needs beyond the physical aspect also needs further attention to ensure a comprehensive approach to end of life care in the burn unit.

Frequency Of Burnout Among Healthcare Professionals In A Tertiary Care Hospital, After The COVID-19 Pandemic

Objective: In this study, we plan to estimate the frequency of burnout among healthcare providers in a specialized teaching Hospital. Methods: A questionnaire based on the Copenhagen Burnout Inventory (CBI) including personal, work and client subscale was administered to various healthcare workers including staff nurses, residents and consultants. Results: When the demographic data of 100 participants was analyzed it showed that there were 39 (39 %) males and 61(61 %) females. The mean age of participants was 32.2 years. Professional categories enrolled were 40 nurses, 32 consultants and 28 postgraduate trainees. The mean level of personal burnout was 47.15±15.73, 38.53 ± 17.64 and 41.06 ± 15.78 among nurses, postgraduate trainees and consultants respectively. The level of work-related burnout was 45.95 ± 19.01, 36.60 ± 14.93 and 36.75 ± 14.99 among nurses, postgraduate trainees and consultants respectively. Whereas client-related burnout was found to be 42.62 ± 16.63, 27.67 ± 12.22 and 30.71 ± 18.04 among nurses, postgraduate trainees and consultants respectively. Burnout severity was higher among nurses, and also more commonly seen among females as compared to males. Lastly, younger respondents were more burned out compared to older respondents. Conclusion: In conclusion, addressing burnout among healthcare professionals, particularly nurses, is crucial for the well-being of the healthcare force and the safety and quality of patient care. The study’s recommendation for personal and institutional interventions is an essential step in mitigating this issue and ensuring a healthier, more effective healthcare system. Keywords: Burnout severity, moderate burnout, Copenhagen Burnout Inventory.

E-Health, m-Health, personalised medicine – challenges faced by healthcare systems in Central and Eastern Europe

Background and purpose: The purpose of this study aims to explore measures intended to remove barriers to the implementation of innovative interventions and identify best practices applicable in European countries that support the implementation of cutting-edge e-health, m-health and personalised medicine (PM) interventions at the micro-, meso- and macro-regional levels. Thanks to PM, people are closer to more accurate, predictable and powerful healthcare tailored to individual patients [1]. PM indicates treatment adapted to the patient's characteristics, needs and preferences. PM categorises patients according to the risk of developing a particular disease or degree of response to a given treatment using appropriate diagnostic markers. PM also aims to increase control over the optimisation of medical treatment outcomes and increase the precision of medical treatment, as well as improve disease prediction [2]. The study concept constitutes one of the indicators of the Regions4PerMed project entitled "Interregional coordination for a fast and deep uptake of personalised health" (Horizon 2020).
 Group of respondents: The group of respondents included stakeholders of the Regions4PerMed project - members of the Regions4PerMed Advisory Board, organisations associated with the Patients’ Organisations Council, small and medium enterprises involved in e-health innovation, presenters at conferences and workshops associated with research institutions, private funders, policymakers, policy advisors, project managers, researchers, patient representatives, physicians, academic staff and healthcare consultants.
 Techniques and tools: The qualitative research took the form of online questionnaires and focus group interviews (semi-structured) to identify key barriers and facilitators to the implementation of innovative e-health interventions at the micro-, meso- and macro-regional levels within health and social care systems conducted according to the following five thematic priorities of the Regions4PerMed project which are:
 1.Medical Big Data, Electronic Health Records and Health Governance
 2.Connected health: Better system integration and patient management
 3.Health industry: Driving healthcare innovations
 4.Facilitation of the flow of innovation in healthcare
 5.Socio-Economic Aspects – basic principles.
 
 Outcomes and contexts: The ongoing research will provide data for the development of recommendations that identify the limitations to and benefits of the implementation of innovative e-health interventions for health and social care, with regard to chronic diseases, at the micro-, meso-, and macro-regional levels. In Poland (as well as throughout Eastern Europe), there are still tangible barriers to the development of e-health and m-health in terms of chronic diseases.
 

Denigration or Decline: Reflections on Offering Staff Consultation Focussing on End‐of‐Life Care In a Homeless Hostel

People experiencing homelessness are subject to entrenched health inequalities and obstacles to accessing care. Numerous studies have highlighted that structural and organisational obstacles result in people experiencing homelessness living with unmet healthcare needs. Over time, this is associated with a reduced life expectancy compared with the national average in the UK. Although combating health inequalities has become a mandate for many healthcare providers, attempts to improve parity and access for people experiencing homelessness has stalled. This article utilises a case study method to highlight instances of psycho‐social exclusion that homeless patients can be subject to and examples where healthcare staff can collude in this exclusion. The article concludes with highlighting the benefits of psychologically informed staff consultation, which creates reflective spaces to gain a better understanding of people experiencing multiple disadvantage and exclusion. In addition, staff consultation allows space to process feelings that are stoked in professionals who struggle to comprehend why it is difficult for some people to accept offers of care.

Assessment of some cytokines levels in a pauci-immune crescentic glomerulonephritis patients

Background: Glomerulonephritis is the common cause of end-stage of renal failure. Rapidly progressive glomerulonephritis (RPGN) is characterized by glomerular injuries and formation of crescents. Moreover, anti-neutrophil cytoplasmic antibodies (ANCA), and pro-inflammatory cytokines play a damaging role in a crescent glomerulonephritis. Objectives: The main goal of the current study was aimed to determine the ANCA autoantibodies, and the serum levels of pro-inflammatory cytokines (IL-6, IL-17, IL-18, INF-γ), as well as the relationship between these cytokines and ANCA test in a pauci-immune crescentic glomerulonephritis patients. Methodology: The study was carried out in AL-Yarmouk teaching hospital and AL-Sader teaching hospital during the period from April 2022 to April 2023. This study was involved 90 patients with a crescentic glomerulonephritis disease, the diagnosis was made by the consultant medical staff. In addition to a 60 samples of healthy individuals as control group was involved to comparison the results. ANCA test was made by Indirect immunofluorescence method for the detection of ANCA autoantibodies in serum, in addition to measure the serum level of cytokines including IL6, IL-17, IL-18, and IFN-γ by using Enzyme Linked Immune Sorbent Assay methods. Results: This study has shown that the majority of patients were male (66.7%). Moreover, the most effected age groups within the age ≥ 61 years in percentage (65.5%) followed by the age group 51-60 years old (28.8%). There were 59 (65.5%) positive cases for ANCA from total patients and all of these cases were MPO-ANCA. The total RPGN patients were showed a highly significant increased mean serum levels of IL-18, IL-17, IL-6, and INF-γ as compared to healthy controls, as well as, the same cytokines were showed significant increased levels in myeloperoxidase (MPO)-ANCA positive serum in crescent glomerulonephritis patients as compared to ANCA –negative serum of patients. These results indicate a functional role of IL-6, IL-17, IL-18, and INF-γ in ANCA-mediated neutrophil activation by the interdependence of IL-6, IL-17, IL-18, and INF-γ priming for ANCA responses. Conclusion: It can be drawn from the present study that, the pro-inflammatory cytokines play an integral role in determining the course of disease and it can be used as major drug targets for therapy, as well as these cytokines have the ability to priming neutrophils thus contribute in the progression of a pauci-immune crescentic glomerulonephritis disease.

The truth project- paper two- using staff training and consultation to inculcate a testimonial sensibility in non-specialist staff teams working with survivors of child sexual abuse.

This paper explores how trauma informed training and consultation for non-specialist staff at the Independent Inquiry into Child Sexual Abuse in England and Wales enabled them to work with survivors of non-recent child sexual abuse in the Truth Project and other areas of the Inquiry. The paper draws on data gathered from 32 semi-structured interviews with a range of Inquiry staff, including civil servants, legal professionals, senior operational managers, and researchers. The interview questions mapped on to the trauma informed principles embedded in the Inquiry and considered the efficacy and implementation of this training for engaging with survivors' voices, working with challenging testimonies and materials, and contributing to epistemic change. Findings included all staff having an awareness of what it meant to be trauma informed in an Inquiry context, talking about the principles in terms of value-based positions. Staff described an awareness of needing to attend to the idiosyncratic experiences of the individual survivor, and there was recognition that previous damage to survivor trust, through institutional failure, meant that demonstrating trustworthiness was a central task. Staff talked about the impacts of participation on some survivors, and the impacts it had on them to be exposed to trauma-related materials. There was acknowledgment of the limitations of the trauma informed approach but also recognition of the wider applications of this learning for other areas of their personal and professional lives. There is some support for the therapeutic culture developed at the Inquiry leading to what Fricker refers to as a testimonial sensibility, a quality of listening necessary for the establishment of epistemic justice. The discussion focuses on how this way of working can be applied to other public service settings and how epistemic justice concepts can be included in more traditional trauma informed care models to encourage an ethic of listening that has political and social, in addition to therapeutic, outcomes.

Self reported benefits of participating in group prayer in a hospital outpatient setting: A cross-sectional observational study

BackgroundPrayer had long been used as a tool to bring hope among patients suffering with intractable diseases. Most clinical researches conducted so far on prayer were done upon indoor patients. Effects of prayer involving patients and health care providers in a hospital outpatient setting have never been explored. ObjectivesThis cross sectional study aimed to observe the self-perceived changes post prayer among patients and hospital staff involved in the health care delivery and who actually have participated in the prayer sessions. Material and methodSurvey was conducted with the help of a structured questionnaire on routine OP days at Ayurveda –Arthritis Treatment and Advanced Research Center, Lucknow. Patients visiting the center for OP based consultation and hospital staff who has participated in any prayer session were eligible to participate in the survey. Results49 hospital staff and 85 patients have participated in the survey. Among most important self-reported attributes following the prayer sessions in patients were Positive Attitude (84.70%), Optimism about cure (92.90%), Feeling of well-being (95.30%), Optimism about future (95.30%) and Changes in energy level (89.40%). Among hospital staff the important attributes were related to change in energy level (93.90%), increased empathy (93.90%), feeling of universal good (96.00%), less fatigue post prayer (69.40%), sustained effects (81.60%) and healthier feeling (81.60%). ConclusionThis observational study suggests that a simple prayer session in outpatient department may be helpful in inculcating hope and building self-esteem among patients and can bring a better self-image, efficiency and connectedness in the hospital staff. Eventually, this may help in improving the outcomes and quality of care being provided at outpatient setting at any hospital.

Shared Decision-Making to Improve Health-Related Outcomes for Adults with Stroke Disease.

Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based on artificial intelligence in the rehabilitation of stroke patients by empowering patients to make decisions about the use of devices and applications developed in the European project ALAMEDA. To develop a predictive tool for improving disability in stroke patients, key aspects of stroke patient data collection journeys, monitored health parameters, and specific variables covering motor, physical, emotional, cognitive, and sleep status are presented. The proposed SDM model involved the training and consultation of patients, medical staff, carers, and representatives under the name of the Local Community Group. Consultation with LCG members, consists of 11 representative people, physicians, nurses, patients and caregivers, which led to the definition of a methodological framework to investigate the key aspects of monitoring the patient data collection journey for the stroke pilot, and a specific questionnaire to collect stroke patient requirements and preferences. A set of general and specific guidelines specifying the principles by which patients decide to use wearable sensing devices and specific applications resulted from the analysis of the data collected using the questionnaire. The preferences and recommendations collected from LCG members have already been implemented in this stage of ALAMEDA system design and development.

The role of IL-6, and IL-12+p40 in Ischemic heart disease patients

Background: Ischemic heart disease (IHD) is often termed coronary artery disease or coronary heart disease; because it is usually caused by atherosclerosis that occurs when fatty materials and a substance called a plaque are built up on the walls of coronary arteries. Such consequences lead to a narrowing of these arteries and then blood flow can slow down or stop, causing chest pain, shortness of breath, heart attack and other related symptoms.
 Objectives: To investigate the correlation between Ischemic heart disease and patient’s descriptive data such as gender, age, and to evaluate the role of two cytokines IL-6 and IL-12+p40 in the aetiology of IHD, as well as to observe the relationship of IL-6 , IL-12+p40 and two related diseases diabetes mellitus and hypertension in IHD patients.
 Methodology: A total of 70 (55 males and 15 females) patients with ischemic heart disease (IHD; stable angina) were included in the study. They were admitted to the Coronary Care Unit (CCU) at Ibn-Al-Betar Hospital (Baghdad) for a surgical operation during the period July 2022 - April 2023. The diagnosis was made by the consultant medical staff at the hospital. In addition to the patients, a total of 20 apparently healthy individuals (control group), with no history of cardiovascular diseases, were included in the study for the purpose of comparison with patients, they were age- and gender matched with patients. five ml of peripheral blood were obtained by venipuncture from each patient before surgical operation using 5 ml disposable syringe, the blood was drawn in a plain tube (without anti-coagulant). Serum levels of IL-6 and IL-12+p40 were quantitatively determined in patients and control subjects by means of indirect sandwich ELISA test.
 Results: Thirty patients from total IHD patients were observed to have diabetic mellitus, and the frequency in males was more than in females (73.3 vs. 26.7%), twenty two IHD patients were observed to have hypertension in percentage higher in males than in females (77.3 vs. 22.7%). The results obtained from this study about age group distributions of IHD patients with diabetic are higher in 60 and more age group in percentage (63.3%) , as well as in hypertensive patients in percentage (68.2%). Serum levels of IL-6 for total patients are (404.8 pg/ml), diabetic (480.3 pg/ml), non-diabetic (250.8 pg/ml), hypertensive (451.6 pg/ml) and non-hypertensive (322.2 pg/ml), patients showed a significant increased serum level of IL-6 as compared to controls (155.7 pg/ml). The diabetic patients also showed a significantly higher level than non-diabetic patients (480.3 vs. 250.8 pg/ml), as well as, hypertensive patients (451.6 pg/ml) versus non-hypertensive patients (322.2 pg/ml). Serum level of IL-12+p40 for total patients (410.2 pg/ml), diabetic (357.7 pg/ml), non-diabetic (458.1 pg/ml), hypertensive (270 pg/ml) and non-hypertensive (420.5 pg/ml) patients showed a significant decreased level of IL-12+p40 as compared to controls (649.3 pg/ml). In contrast, the non-diabetic patients showed a significantly higher level than diabetic patients (458.1 vs. 357.7 pg/ml), as well as, non-hypertensive patients (420.5 pg/ml) versus hypertensive patients (270.0 pg/ml).
 Conclusion: The prevalence of IHD according to age are increased in older aged patients, the male show high infected percentage than female. Chronic diseases like hypertension and diabetes mellitus were contributed to the pathogenesis of IHD, and proinflammatory cytokine cascades play crucial roles in the onset and progression of IHD.
 Recommendations: Targeting cytokines in an attempt to develop pharmacological activators of some interleukins, and inhibitors of other ones, and this may provide effective means to control atherosclerosis and associated diseases (i.e. diabetes mellitus and hypertension).
 Keywords: IL-6, IL-12+p40, IHD

Innovative Models of Geriatric Mental Health Services

The demographics of residents residing in long term care facilities is changing in many ways. There is a substantial increase of those admitted with serious mental illness, and at a younger age. Greater than 50% of residents have a neurodegenerative illness, such as dementia, and subsequently they all will experience behavioral and psychological symptoms of dementia during their admission. The new ICD-10 codes are integral to quality care and outcomes for this population. Most current approaches to the behavioral health needs of this population fall short of meeting resident and facility needs. This presentation seeks to consider a bold, interprofessional, and integrated approach to the bedside care of geriatric mental health services in long term care. Consideration includes proper ICD-10 code diagnosis and a culture of care that emphasizes the patient as an individual to improve quality of life and quality of care. This falls directly in line with the President's Commission on Aging Quality and Best Practices in Geriatric Psychiatric services and includes: a multidisciplinary team approach, specific geriatric expertise, individualized assessment, collaborative treatment planning between the consultant and facility staff, as well as a strong educational component. Current barriers to success will be explored to improve overall performance of the mental healthcare team.

Smartphone Slit Lamp Imaging-Usability and Quality Assessment.

To assess the usability and image quality of a smartphone adapter for direct slit lamp imaging. A single-center, prospective, clinical study conducted in the Department of Ophthalmology at the University Hospital Zurich, Switzerland. The smartphone group consisted of 26 medical staff (consultants, residents, and students). The control group consisted of one ophthalmic photographer. Both groups took images of the anterior and the posterior eye segment of the same proband. The control group used professional photography equipment. The participant group used an Apple iPhone 11 mounted on a slit lamp via a removable SlitREC smartphone adapter (Custom Surgical GmbH, Munich, Germany). The image quality was graded independently by two blinded ophthalmologists on a scale from 0 (low) to 10 (high quality). Images with a score ≥ 7.0/10 were considered as good as the reference images. The acquisition time was measured. A questionnaire on usability and experience in smartphone and slit lamp use was taken by all of the participants. Each participant had three attempts at the same task. The overall smartphone quality was 7.2/10 for the anterior and 6.4/10 for the posterior segment. The subjectively perceived difficulty decreased significantly over the course of three attempts (Kendall's W). Image quality increased as well but did not improve significantly from take 1 to take 3. However, the image quality of the posterior segment was significantly, positively correlated (Spearman's Rho) with work experience. The mean acquisition time for anterior segment imaging was faster in the smartphone group compared to the control group (156 vs. 206 s). It was vice versa for the posterior segment (180 vs. 151 s). Slit lamp imaging with the presented smartphone adapter provides high-quality imaging of the anterior segment. Posterior segment imaging remains challenging in terms of image quality. The adapter constitutes a cost-effective, portable, easy-to-use solution for recording ophthalmic photos and videos. It can facilitate clinical documentation and communication among colleagues and with the patient especially outside normal consultation hours. Direct slit lamp imaging allows for time to be saved and increases the independence of ophthalmologists in terms of patient mobility and the availability of photographic staff.

How to improve hospital employees’ health and well-being: a staff consultation

ObjectiveExplore perspectives from healthcare workers in a large public hospital (11,000 staff) on employers supporting their health and well-being.MethodsHeads of departments/services were invited to convene focus groups, facilitated by a moderator using a semi-structured discussion guide. ResultsOver 450 members of staff participated in 28 focus groups. Themes identified were: 1)unique nature of working in a large hospital, 2)hospital management agenda and relationship with staff, 3)working environment, and 4)staff health and well-being initiatives.ConclusionsOptimal uptake of health-promoting initiatives was hindered in part due to lack of staff awareness and a range of barriers. Key requirements for improving staff health were perceived to be sufficient staffing, time and space to work safely and comfortably. Engaging with staff to hear their views, build trust and identify their needs is an essential first step.

A survey of organizational structure and operational practices of elite youth football academies and national federations from around the world: A performance and medical perspective.

Medical and performance units are integral components of player development programmes in elite football academies. Nevertheless, the nature of the operational processes implemented by practitioners within clubs and national federations remains unexplored. The aim of the present study, therefore, was to survey elite youth professional football academies from around the world regarding the operational processes adopted by their medical and performance units. Of the 50 organizations invited, 10 national federations and 25 clubs took part in the survey resulting in a response rate of 70% (95% confidence interval, 56%-81%). The respondents represented three groups: senior club and academy management, performance, and medical staff. The majority (60%-90%) of clubs and national federations reported strategic alignment between senior and academy medical and performance units as well as between academy medical and performance units. Survey responses indicated substantial heterogeneity in the composition and number of medical and performance professionals employed in academies. The majority of respondents agreed their medical and performance departments were effective in utilizing staff knowledge and external sources of knowledge to inform their practice (56%-80%). Performance staff (40%-50%) and physiotherapists (30%-32%) were deemed most influential in injury prevention programmes. During the return-to-play process, the influence of specific practitioners in the medical and performance units was dependent upon the phase of return-to-play. Shared decision-making was common practice amongst performance and medical staff in injury prevention and return-to-play processes. Medical and performance data were generally centralized across the first team and academy in majority (50%-72%) of clubs and national federations. Data were integrated within the same data management system to a higher degree in clubs (68%) vs. national federations (40%). Research and development activity were reported for most academies (50%-72%), and generally led by the head of performance (37%) or team doctor (21%). Research activities were largely undertaken via internal staff (~100%), academic collaborations (50%-88%) and/or external consultants and industry partnerships (77%-83%) in the national federation and clubs. Collectively, these findings provide a detailed overview regarding key operational processes delivered by medical and performance practitioners working in elite football academies.

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About The Author