Survey Of Specialists Research Articles

Investigating the mobility of the peer specialist workforce in the United States: Findings from a national survey.

The objectives of the current study were to characterize (a) peer specialist interest in enrolling in/returning to higher education and perceived barriers, (b) perceptions of the local availability of higher education/continuing education programming, and (c) perceived barriers to the advancement of the peer workforce. We utilized both close-ended and open-ended items from a large, collaboratively developed national survey of peer specialists. Analytic methods included both descriptive and basic inferential statistics (N = 801) and qualitative coding and analysis (subsample N = 451). High levels of interest in higher education were found, with nearly 80% of participants reporting that they would enroll/return to college were it feasible. Analysis of open-ended responses regarding perceived barriers to career advancement revealed 5 major themes: financing and administrative policies; perceived public discrimination and devaluation of the peer specialist role by coworkers and agency leadership; lack of opportunities and mechanisms for advancement; the simultaneous need for advanced education and the inaccessibility of college or graduate degrees; and individual level barriers, including internalized stigma and derailed work histories due to disability. As the peer workforce continues to grow, it is critical that the field grapple with fundamental questions as to how to best support the development and advancement of the peer workforce. Our findings underscore persistent workplace challenges and perceived barriers to advancement, insights which may help the field develop strategies for improving development supports. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Experience in Implementing a Practice-Oriented Programme for Retraining Mediators for Education and the Social Sphere

The relevance of the present study is confirmed by an order for retraining specialists for education and the social sphere who can act as mediators and form a culture of peaceful conflict resolution in a multicultural environment. The article analyses and highlights employers’ demands for the mediation competence formation among the participants of the educational space of the Krasnoyarsk Krai. In this context, the authors disclose practical aspects of the mediation competence formation in the process of professional training of future mediators and specialists of school mediation services at the federal university. Based on the analysis of specific features of mediators professional activity, the results of a survey of specialists in the social sphere, as well as experience of training students majoring in pedagogy at the federal university, a model of a practice-oriented programme for retraining mediators for education and the social sphere of the Krasnoyarsk Krai has been proposed. The programme is implemented on the basis of the Centre for Mediation in Education of the School of Education, Psychology and Sociology of Siberian Federal University, in the networking between educational organisations and professional communities. The retraining programme considers the needs of the multinational Siberian society and is aimed at solving regional problems in education and the social sphere. The retraining programme is based on the principles of continuity, professional activity supervision, eventfulness of the educational process, professional activity tests, as well as continuity of the results of formal and non-formal education. Future mediators training within the framework of the retraining programme “Mediation. The Psychology of Conflict Management” is carried out according to a modular curriculum, in which the proportion of practical classes is increased, students’ scientific and research activities on the issues of productive communication in a mediation procedure are organised, and professional tests are carried out within the framework of placement practice. To form the applied aspects of the professional competence of future mediators and specialists of school mediation services, representatives of network partners take part in the educational process. The applied aspects of training future mediators and specialists of school mediation services among teachers help to effectively solve professional tasks of organising a conflict-free educational space and contribute to the formation of the culture of productive communication and conflict resolution. The mediation competence formation among the educational process participants was carried out using methods of measuring communicative, information and analytical, organisational and managerial, as well as emotional competences. The study was conducted with the use of Google services in the period of 2019-2020. In total, 333 people took part in the study, including 238 practicing specialists of school mediation services (control group), and 95 master’s students of the School of Education, Psychology and Sociology of Siberian Federal University in Krasnoyarsk and students of the professional retraining programme “Mediation. The Psychology of Conflict Management” (experimental group)

ОСОБЕННОСТИ ЛИЧНОСТНЫХ ИЗМЕНЕНИЙ СПЕЦИАЛИСТОВ УЧРЕЖДЕНИЙ СОЦИАЛЬНОЙ СФЕРЫ В ПРОЦЕССЕ ОСУЩЕСТВЛЕНИЯ ПРОФЕССИОНАЛЬНОЙ ДЕЯТЕЛЬНОСТИ

The article is devoted to the problem of personal changes in social specialists in the process of performing professional activities. The results of a questionnaire survey of specialists from the Regional Center for Social Services for Elderly and Disabled Citizens on the assessment of the characteristics of the manifestation of emotional burnout syndrome are presented. The professional activity of specialists in the social sphere leads to both positive and negative changes in professional activity. On the one hand, social workers are characterized by an increased level of anxiety and anxiety, emotional and psychological stress, stress, low wages, negativism on the part of clients, a lack of understanding of the importance of their professional activities, and a high degree of responsibility. On the other hand, they are distinguished by active life position, social optimism, harmonious development of physical and intellectual abilities. It is concluded that it is necessary to introduce technologies for the prevention of burnout syndrome for employees of a social service institution.

Personal Relationships Improve Clinicians’ Experiences of Care Coordination Even with Access to Shared Electronic Health Records

Research ObjectiveCoordination of care between specialists and primary care clinicians (PCCs) is a critical component of providing patients with high‐quality specialty care. Previous research has demonstrated care coordination may benefit from use of a shared electronic health record (EHR). Yet reliance on a shared EHR may undercut opportunities to build and maintain personal and professional relationships among clinicians, a factor also positively associated with care coordination. We examine how use of a shared EHR and personal relationships between clinicians interact to influence medical specialists’ experiences of coordination with PCCs.Study DesignWe surveyed a national sample of clinicians from 10 medical specialties concerning their experiences of care coordination with referring PCCs. Participants completed the Coordination of Specialty Care (CSC)‐Specialist Survey 2.0 which comprehensively assesses coordination with referring PCCs as experienced by the specialist across four domains: mutually respectful relationships (Relationships), clarity and agreement on roles and responsibilities (Roles and Responsibilities), timely and helpful communication (Communication), and timely access to well‐organized patient data (Data Transfer). The survey also included single‐item measures assessing Overall Coordination, proportion of referring PCCs the specialist knew personally, and proportion of referring PCCs with whom they shared an EHR. Multiple regression analyses assessed the independent and interactive influence of shared EHR and personal relationships on specialists’ experiences of coordination after controlling for age, gender, and percentage of work in outpatient care.Population StudiedParticipants (analysis N = 514) were medical specialist members of the American College of Physicians (ACP) or a participating society in the ACP Subspecialty Societies (ACP CSS). All received an emailed link to complete the survey online.Principal FindingsSpecialists experienced better coordination if they reported knowing more referring physicians personally, in terms of both Overall Coordination (B = 0.30, P < .0001) and each of the four separately assessed coordination domains: Relationships (B = 0.14, P < .0001); Roles and Responsibilities (B = 0.19, P < .0001); Communication (B = 0.18, P < .0001); and Data Transfer (B = 0.12, P = .001). Having a shared EHR with more referring physicians was positively associated with better Overall Coordination (B = 0.21, P < .0001) and Data Transfer (B = 0.28, P < .0001). The extent of shared EHR also moderated the effect of knowing referring PCCs personally on some aspects of care coordination. For both Overall Coordination and Relationships, the influence of knowing PCCs personally was significantly stronger in the absence of a shared EHR (interactions: B = ‐0.09, P = .03, and B = ‐0.04, P = .04, respectively). However, these interactions accounted for <1% of the variance in reported experiences of coordination.ConclusionsBoth having a shared EHR and having personal relationships with PCCs independently contributed to specialists’ experiences of coordination. Although having greater access to a shared EHR reduced the influence of personal relationships on some aspects of care coordination, personal relationships with PCCs remained a significant independent predictor of coordination as experienced by specialists across all measures.Implications for Policy or PracticeA shared EHR is considered a cornerstone of care coordination. However, our findings suggest that a shared EHR cannot replace the important contribution of personal relationships to clinicians’ experiences of coordination. Health care systems may benefit by augmenting use of a shared EHR with opportunities for personal connection and communication among clinicians.Primary Funding SourceDepartment of Veterans Affairs.

On a collision course? The large diversity of birds killed by wind turbines in South Africa

Wind energy is a clean, renewable alternative to fossil fuel-derived energy sources, but many birds are at risk from collisions with wind turbines. We summarise the diversity of birds killed by turbine collisions at 20 wind energy facilities (WEFs) across southwest South Africa. Monitoring from 2014 to 2018 recovered 848 bird carcasses across all WEFs, at a crude rate of 1.0 ± 0.6 birds turbine−1 y−1 at 16 WEFs with at least 12 months of postconstruction monitoring. However, mortality estimates adjusted for detection and scavenger bias were appreciably higher: 4.6 ± 2.9 birds turbine−1 y−1 or 2.0 ± 1.3 birds MW−1 y−1 (n = 14 WEFs with site-specific bias correction factors), which is slightly lower than mean rates reported in the northern hemisphere, but still well within range. A striking result was the high diversity of birds killed: 130 species from 46 families, totalling 30% of bird species recorded at and around WEFs, including some species not recorded by specialist surveys at WEF sites (e.g. flufftails Sarothruridae). Species accumulation models suggest that 184 (±22) species will be killed at these facilities, some 42% of species found in the vicinity of WEFs. This is despite the smaller number of migrants in the study region, compared with the north temperate zone. Diurnal raptors were killed most often (36% of carcasses, 23 species) followed by passerines (30%, 49 species), waterbirds (11%, 24 species), swifts (9%, six species), large terrestrial birds (5%, 10 species), pigeons (4%, six species) and other near passerines (1%, seven species). Species of conservation concern killed include endangered Cape Vultures Gyps coprotheres and Black Harriers Circus maurus, both of which are endemic to southern Africa. Every effort must be made to site wind energy facilities away from important areas for birds, particularly raptors.

Incorporating Tacit Knowledge of Experts in the Assessment of Shelters Under Disaster.

During disasters, prompt assessment of evacuation centres and appropriate measures taken based on the assessment are important for protecting local residents' lives and health. To clarify experts' tacit knowledge for improving the management of shelters under disaster, we conducted a questionnaire survey of specialists in disaster management to examine the assessment items to which they accorded top priority. Our results suggest that specialists give highest priority to the number of evacuees, followed by infrastructure and need for medical intervention. Identifying their common views on priorities can be the first step towards taking standard appropriate measures in evacuation centres.

Posterior Cortical Atrophy: Characteristics From a Clinical Data Registry.

Background: Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that presents with higher-order visual dysfunction with relative sparing of memory and other cognitive domains, and it is most commonly associated with Alzheimer's disease pathology. There is a lack of data regarding the presentation of PCA to non-cognitive specialists. Therefore, we collected clinical data from neuro-ophthalmologists regarding the presentation of PCA to their practices and compared data to published cohorts and a published survey of cognitive specialists.Methods: Members of the North American Neuro-Ophthalmology Society Listserv (NANOSnet) were invited to complete an online, retrospective, chart-review data-entry survey regarding their patients with PCA, and REDCap was used for data collection.Results: Data for 38 patients were entered by 12 neuro-ophthalmologists. Patient mean age at presentation was 67.8 years, and 74% of patients were women. Difficulty reading was reported at presentation by 91% of patients, and poor performance on color vision, stereopsis, and visual field testing (performed reliably by 36/38 patients) were common findings. Most patients who were treated were treated with donepezil and/or memantine.Conclusions: Compared to published data from cognitive specialists, patients presenting to neuro-ophthalmology with PCA were more likely to be older and female and have a reading complaint. Reliable visual field testing was the norm with homonymous defects in the majority of patients. The neuro-ophthalmologist plays an important role in diagnosing PCA in older adults with unexplained visual signs and symptoms, and future studies of PCA should involve multiple specialists in order to advance our understanding of PCA and develop effective treatments.

1188-P: Approaches to and Inertia in Cardiovascular and Renal Risk Management of Type 2 Diabetes Patients in Primary Care: Results from a Global Quantitative Survey

Background: Despite recent recommendations for the use of glucose-lowering therapies with additional cardiovascular (CV) and renal benefits, as demonstrated through CV outcomes trials (CVOTs), many patients (pts) with type 2 diabetes mellitus (T2D) managed in primary care remain on therapeutic regimens now considered suboptimal. This global survey of primary care physicians (PCPs) investigated current approaches to early CV and renal risk management of pts with T2D. Methods: This web-based, global, quantitative panel survey of PCPs and primary care diabetes specialists (PCDSs) constituted 20 demographic, Likert scale, and multiple-choice questions covering the current management of pts with T2D, particularly the use of second/third line therapies (sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors). Results: Globally, 1558 PCPs and 119 PCDSs from 18 countries completed the survey. Respondents saw a mean 132 pts with T2D per month and had treated pts with T2D for 17 years. Overall, 73% of PCPs and 72% of PCDSs were responsible for second/third line treatment initiation. The biggest barrier to second/third line treatment initiation identified by respondents was local healthcare systems/insurance companies restricting access to these therapies. Concerns over safety, pt disinterest, and difficulties in maintaining regular appointments were also identified as significant contributors to treatment inertia. Only 68% of PCPs and 52% of PCDSs were aware of data published from recent CVOTs, while 68% and 58%, respectively, stated they had changed their treatment decisions based on these trials. Conclusions: Significant barriers still prevent optimization of T2D pt care in the primary setting, including limited familiarity of PCPs and PCDSs with new CVOT data, treatment inertia, and access restrictions for second/third line treatments. Disclosure S. Brunton: Advisory Panel; Self; Abbott, Bayer U.S., Merck & Co., Inc., Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Lilly Diabetes. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. F. Cos: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk A/S, Sanofi. G.F. Deed: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk Inc., Sanofi-Aventis. N. Kanumilli: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Novartis AG, Novo Nordisk A/S. Consultant; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis. Speaker’s Bureau; Self; Napp Pharmaceuticals. P.R. Kushner: Advisory Panel; Self; Abbott, AstraZeneca, Bayer U.S., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Speaker’s Bureau; Self; AstraZeneca, Janssen Pharmaceuticals, Inc. P.J. Lin: Speaker’s Bureau; Self; Abbott, AstraZeneca, Bausch + Lomb, Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Mead Johnson Nutrition, Merck & Co., Inc., Novo Nordisk Inc., Sun Pharmaceutical Industries Ltd. Other Relationship; Self; Elsevier. J. Nolte: Advisory Panel; Self; AstraZeneca. Funding AstraZeneca

Clinical practice preferences for glaucoma surgery in Japan: a survey of Japan Glaucoma Society specialists

This study evaluated the surgical practice patterns of glaucoma management followed by glaucoma specialists in Japan. A survey was administered to 50 glaucoma specialists who were councilors in the Japan Glaucoma Society about surgical preferences and postoperative glaucoma care. All 50 glaucoma specialists participated in the survey. Results show that, in 2019, compared to conventional trabeculotomy (4.6%), the frequency of minimally invasive glaucoma surgery (MIGS), combined with phacoemulsification, remarkably increased (79.0%) for non-operated eyes with mild open-angle glaucoma associated with cataract. Tube-shunt surgery was performed more often for open-angle glaucoma with previously twice failed trabeculectomy (65.8%) and neovascular glaucoma with previously once failed trabeculectomy (63.4%). In addition, during one year post-operatively, MIGS required less frequent follow-up visits compared to filtering surgery. Although glaucoma specialists in the Japan Glaucoma Society usually prefer trabeculectomy, in the past decade they have selected tube-shunt surgery more often to treat refractory glaucoma. MIGS is increasing remarkably as the choice primary glaucoma surgery.

TYPES OF FAMILIES OF JOINT FORCES OPERATION PARTICIPANTS IN THE EAST OF UKRAINE AND PECULIARITIES OF SOCIAL WORK WITH THEM

Carrying out military actions in the East of Ukraine, Joint Forces Operations, lead to physical and psychological traumatization of military personnel, complications in their socialization into a peaceful society, deterioration of interaction between family members of participants of the Joint Forces Operation and family dysfunction. The purpose of this article is to classify types of families involved in the Joint Forces Operation and determine their specific problems and needs. Based on the survey of families and specialists of state and private organizations, providing social support for this category of recipients of services, classification of types of families participating the Joint Forces Operation (family members, where one of its members is now in a combat zone; families, where one of its members returned from the combat zone; families, who are divorced: before departure to the combat zone, during a stay in a combat zone, after returning from the combat zone; families where one member is war-disabled; the families of the deceased ones) was made. The characteristic of each of the certain types of families allowed choosing the most effective forms of work with the families of the Joint Forces Operation participants.

Effects of the publication of Clinical Guidelines for the Management of Chemotherapy-Induced Peripheral Neuropathy on the Administration Preferences of Oncology Specialists: Japanese Association of Supportive Care in Cancer.

We conducted a questionnaire survey of oncology specialists to investigate the frequency of administration of different drugs for the management of chemotherapy-induced peripheral neuropathy in Japan in 2015. Our group published Clinical Guidelines for the Management of Chemotherapy-Induced Peripheral Neuropathy in 2017 (CIPN-GL2017). In these guidelines, we recommended duloxetine only. To verify the effect of the publication of the CIPN-GL2017, we conducted a questionnaire survey in 2019. In 2015 and again in 2019, we investigated the use of vitamin B12, antiepileptic agents, duloxetine, antidepressants other than duloxetine, non-steroidal anti-inflammatory drugs, opioids and the Kampo compound (goshajinkigan) in a questionnaire employing a three-point scale wherein A implies routine or prophylactic administration, B implies occasional administration and C implies infrequent administration. We sent the questionnaires via email to 971 diplomates of the Subspecialty Board of Japanese Society of Medical Oncology in 2015 and 1239 diplomates in 2019. The administration ratio (A+B) of duloxetine for numbness and pain was 46.8 and 31.7%, respectively, in 2015 and 68.9% (P<0.01) and 73.1% (P<0.01) in 2019. In response to the question regarding awareness of the CIPN-GL2017, 53.2% of respondents to the 2019 questionnaire were aware of the CIPN-GL2017. Among the respondents with an awareness of the CIPN-GL2017, the prescription rate of duloxetine (78.3%) for pain was significantly higher than that among respondents without any awareness (67.4%). It is possible that the publication of CIPN-GL2017 influenced administration preferences of oncology specialists.

FORMATION OF A SYSTEM OF INDICATORS FOR EVALUATING THE EFFICIENCY OF THE ORGANIZATIONAL STRUCTURE OF A PRODUCTION AND TRADE ENTERPRISE

The study proposed a system of indicators to assess the effectiveness of building the organizational structure of production and trading enterprises, which consists of three groups that reflect: the effectiveness of the enterprise’s management structure through the end results of its activities and management costs, which reflect the content and process of organizing the enterprise’s management structure and management costs that characterize the rationality of the organizational structure of the enterprise and its technical, organizational level. Based on the proposed groups of indicators, it is recommended to conduct an expert survey of trade specialists in order to obtain a real integral conclusion about the appropriateness of assessing the effectiveness of restructuring the organizational structure of the enterprise.Evaluation of the management effectiveness of a manufacturing and trading enterprise serves as an important element in the development of preplanned decisions, which makes it possible to determine the level of adaptability and progressiveness of an existing or projected structure, measures taken in the process of modernizing an enterprise, choosing the most rational version of a structure, and a way to improve it. Moreover, the effectiveness of the organizational structure is evaluated by designers in the process of consulting work to improve management.A comprehensive set of performance indicators for the management system of a manufacturing and trading enterprise is formed taking into account the following directions of evaluating its effectiveness: the degree to which the results correspond to the goals of market activity, the degree to which the process of functioning of the management system meets the requirements for its content and production results.The weak point of most organizational design projects is the lack of attention to the specifics of production and trading enterprises as objects of performance evaluation. As a result, the effect of grouping units is distorted; there is a shift of guidelines when substantiating the integrated activities that are laid down in the project, or the comparability of the options for these activities.The situation in the Ukrainian economy is such that for most trading enterprises, organizational changes are a prerequisite for their survival, to avoid stopping production and trade. In such cases, the characteristics of the systemic effect can be considered in the form of ordinary indicators of the effectiveness of production and trading activities.

MON-138 Coordination of Care: National Survey of Endocrinologists’ Experience with PCPs

Introduction:Coordination of care between primary care physicians (PCPs) and specialists is crucial in providing safe, efficient specialty care for referred patients, but shortcomings in coordination are common.Objective:Examine endocrinologists’ experience of coordination with PCPs and examine the relationship of a shared EHR to coordination.Methods:We surveyed a national sample of US endocrinologist members of the Endocrine Society (ES) or American Association of Clinical Endocrinologists (AACE), using a previously-developed online survey for specialists about care coordination1. ES and AACE included a link in a web-based newsletter and dedicated email. Four multi-item scales included 18 items measuring aspects of coordination with PCPs in the past 3 months: Communication (timeliness and helpfulness), Data Transfer (timeliness and usability), Relationships (mutually respectful), and Roles and Responsibilities (referral clarity, sufficiency, and appropriateness). Item responses and scale scores were on a 7-point frequency scale. A single-item measure of overall coordination with PCPs was measured on a 10-point scale (0 worst possible to 10 best possible). We asked “With about how many referring PCPs do you share an EHR?”. We examined frequencies of individual item responses (≤30%, about 50%, or ≥ 70% of the time) and extent of shared EHR with PCPs (None, Some, All), calculated mean scale scores (range 1-7) and used ANOVA to examine the relationship of a shared EHR to coordination scales and overall coordination.Results:Of 236 respondents: 35% age ≥ 60, 44% female, 80% ≥ 75% clinical effort. The highest frequency of good coordination (≥70% of the time) was reported for: aligned expectations of roles (84%), feeling valued by PCPs (80%) and clear division of responsibilities (70%). The lowest frequency of good coordination was for: kept informed by PCP about relevant issues (14%), and PCPs adequately evaluated prior to referring (18%). Mean (SD) for scale scores were: Communication 4.2 (1.0), Data Transfer 4.2 (1.1), Relationships 4.9 (0.8), Roles and Responsibilities 4.2 (0.9). The score for overall coordination with PCPs was 6.0 (1.9). Sharing an EHR with more PCPs was associated with higher Data Transfer scores (None, N=59, 3.9 (1.0), Some, N=126, 4.1 (0.9), All, N=26, 5.4 (0.8), P for trend <0.001). The effect size (Cohen’s d) for the difference between None and All EHR sharing was 1.6, well over the threshold for “large” effect size (d = 0.8).Conclusions:There are opportunities for improvement across all aspects of inter-clinician coordination for endocrinology referrals. Use of a shared EHR improves data transfer, but not other aspects of coordination.1. Vimalananda VG, Fincke BG, Qian S, et al. Development and psychometric assessment of a novel survey to measure care coordination from the specialist’s perspective. Health Serv Res. 2019;54(3):689-699.

Construction of Theoretical Model for Sustainable Development in Future Mathematical Teachers of Higher Education

In this paper, the authors have identified the main features of constructing a theoretical model of the content part of the future mathematics teachers' training system in a pedagogical institution of higher education in Ukraine in the context of the implementation of the education model for sustainable development. In order to build such a model, the authors have organized a study in the form of an expert survey of specialists in the field of education, specialists in fundamental mathematical disciplines and in the methodic of teaching mathematics, master students, as well as mathematics teachers - participants in retraining courses. The authors have determined the discipline (methodic of teaching mathematics) which became the basis for the model of the content of the future mathematics teachers' training system in the context of the implementation of the education model for sustainable development. The above course in the content such choice has been confirmed by the integration properties and capabilities of the discipline, the potential of its substantive and methodological components for the generalization and systematization of mathematical, pedagogical, natural-scientific and humanitarian knowledge and skills, as well as for the formation of systemic thinking. When studying the issue including a special course in the content part of teacher staff training program, aimed directly at creating an understanding of a human's role and one's dependence on nature, at creating a peaceful and open society, where everyone would have equal rights and opportunities, the authors have distinguished disagreements in experts' opinions.

Off-label prescription of SGLT‑2 inhibitors to patients with type 1 diabetes: an online survey of diabetes specialists and safety recommendations

AIM OF THE STUDY Sodium-glucose cotransport inhibitors (SGLT-i) improve glycemic control in patients with type 1 diabetes (T1DM). However, their use is associated with an increased risk of diabetic ketoacidosis (DKA). Aim of this study was to evaluate the off-label prescription of these drugs to patients with T1DM. MATERIALS AND METHODS From 2018/08/21 to 2019/04/03 AMD invited members to complete a survey on the off-label prescription of SGLT2 inhibitors (SGLT2i) to patients with T1DM. RESULTS N = 161 specialists completed the survey; 72 (44.7%) had prescribed SGLT2i for T1DM patients. Prescribing and non-prescribing specialists were similar for years in practice and type of outpatient facility. Specialists from Northern Italy or caring for ≥50 T1DM patients were more likely to prescribe SGLT2i to their patients. Specialists prescribed SGLT2i mainly to T1DM patients on multiple daily insulin injection. The most frequent reasons for SGLT2i prescription were to improve suboptimal glycemic control, facilitate weight loss and reduce insulin requirement. Only 48% of specialists required patients to sign an informed consent for the off-label prescription.Twenty-five percent of specialists omitted to prescribe strips for ketonuria/ketonemia and only 26% recommended to measure ketones when glucose levels exceeded 200 mg/dl. All specialists recommended avoiding dehydration and prolonged fasting when using SGLT2i, but only 23% reviewed the symptoms of ketosis and only 9.7% offered patients the six expert recommendations for mitigating the risk of DKA. Nearly 20% of specialists who prescribed SGLT2i to T1DM women of childbearing age omitted to inform them of the risks for conception, and only 12.5% provided patients with the four recommendations that should be given when prescribing drugs not authorized in pregnancy. CONCLUSIONS The results of this survey document the need to improve the awareness of professionals and patients about the risks of DKA and risk mitigation when SGLT2i are prescribed to T1DM patients. KEY WORDS SGLT inhibitors; type 1 diabetes; diabetic ketosis/ketoacidosis; off-label prescription.

Management of acute otitis externa in India: a questionnaire based survey of ENT specialists across the country

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A questionnaire-based survey was conducted across ENT specialists in India to know current perception and practice of acute otitis externa (AOE) management.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The survey was conducted between January-June 2019 using a 23-item questionnaire. Questions were pertaining to epidemiology, clinical as well as microbiological features, diagnostic and management approaches. An ENT specialist who has postgraduate diploma or masters in ENT with an active practice from at least 5 years was considered eligible. 100 ENT specialists were randomly approached across India to take this survey. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 68 doctors filled survey-questionnaires completely. 60 (88.23%) specialists were males, with mean age of 48.46±9.98 years. Majority agreed that AOE is polymicrobial (62,91.17%), with bacteria being either a primary pathogen or superimposed on fungal infections (otomycosis) (64,94.11%). Almost 90% respondents (61, 89.7%) agreed that empirical cover for both bacterial and fungal pathogens should be provided in AOE cases. 75% respondents (51/68) agreed that topical ear drop containing antimicrobial agents with steroid is the desirable option to manage AOE. Majority respondents (54, 79.41%) agreed that pain-relieving local anaesthetic eardrops should not be recommended in AOE as their usage can mask the symptoms. 63 respondents (92.64%) agreed that neomycin and clotrimazole have broad spectrum action and are safe in AOE. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Majority ENT specialists opined that AOE cases have mixed bacterial and fungal etiology, and topical eardrop containing both antibacterial and antifungal agent with steroid is the desirable empirical option to manage AOE. Local anaesthetic eardrop should not be used as it may mask the symptoms and affect patient compliance. This publication has collated viewpoints of ENT specialists in India pertaining to AOE. It can aid practitioners in getting information about the current practice in the country related to AOE. &lt;/p&gt;

Research on the motivation of pharmaceutical workers in pharmacies

The purpose of work was to study the motivating and demotivating factors of the activity of pharmaceutical staff and the conditions of increasing their work activity.Materials and methods. The material for our research was statistically processed information that was obtained during the survey of pharmaceutical specialists of pharmacies that differ in the degree of market coverage (national-pharmaceutical organization 1 (PhO # 1), local-pharmaceutical organization 2, 3 (PhO # 2, # 3)) and types (ready pharmacy drugs - PhO №1, pharmacy with manufacturing of drugs – PhO # 2, # 3). In the course of the study, methods of analysis, synthesis, grouping, questioning and the method of F. Herzberg were used. Results. The factors of motivation, of activity, of pharmaceutical personnel were investigated as material stimulation, moral stimulation, measures of administrative influence, labor mood of the collective, desire to achieve respect in the collective, fear of losing work. As a result of comparing the estimates of motivation factors in pharmacies of both types, it was found that PhO # 1 the leading factor of motivation was the working mood of the team (Wij = 1), and in PhO # 2, # 3 were the material stimulation (Wij = 1). It was studied the factors of employee demotivation using the F. Herzberg method as direct management and control, working conditions, interpersonal relationships, wages and stability of work, internal organization policy towards the staff. The results' calculations were showed that the most significant demotivating factors for the employees of the PhO # 1 were the system of interpersonal relationships (Wij = 1) and direct control (Wij = 0.97). It has been studied the opinions of pharmaceutical workers on the creation of certain conditions in order to enhance their work. It was determined that the most significant conditions for increasing motivation in the PhO # 1, in terms of its employees, was to get high wages (Wij = 0.98), stability (Wij = 0.95), rational management requirements (Wij = 0.94), harmonious relationships in the team (Wij = 0.93), bonuses for quality of work (Wij = 0.93), career growth (Wij = 0.92) and comfortable working conditions (Wij = 0.92).Conclusion. Comparative analysis of motivation factors in pharmacies showed that in pharmacies of the first type the leading factor of motivation was the working mood of the team, and of the second type pharmacies – material stimulation. Also important for employees of pharmacies of general type. The study of demotivating factors showed that in pharmacies of both types, unstable interpersonal relationships had a negative effect on motivation. The analysis of conditions of increase of motivation showed that in PhO # 1 it was important to receive high wages and its stability, and for PhO # 2, # 3 – harmonious relationships in the team, bonus system.

Clinician awareness of brain computer interfaces: a Canadian national survey

BackgroundIndividuals with severe neurological disabilities but preserved cognition, including children, are often precluded from connecting with their environments. Brain computer interfaces (BCI) are a potential solution where advancing technologies create new clinical opportunities. We evaluated clinician awareness as a modifiable barrier to progress and identified eligible populations.MethodsWe executed a national, population-based, cross-sectional survey of physician specialists caring for persons with severe disability. An evidence- and experience-based survey had three themes: clinician BCI knowledge, eligible populations, and potential impact. A BCI knowledge index was created and scored. Canadian adult and pediatric neurologists, physiatrists and a subset of developmental pediatricians were contacted. Secure, web-based software administered the survey via email with online data collection.ResultsOf 922 valid emails (664 neurologists, 253 physiatrists), 137 (15%) responded. One third estimated that ≥10% of their patients had severe neurological disability with cognitive capacity. BCI knowledge scores were low with > 40% identifying as less than “vaguely aware” and only 15% as “somewhat familiar” or better. Knowledge did not differ across specialties. Only 6 physicians (4%) had patients using BCI. Communication and wheelchair control rated highest for potentially improving quality of life. Most (81%) felt BCI had high potential to improve quality of life. Estimates suggested that > 13,000 Canadians (36 M population) might benefit from BCI technologies.ConclusionsDespite high potential and thousands of patients who might benefit, BCI awareness among clinicians caring for disabled persons is poor. Further, functional priorities for BCI applications may differ between medical professionals and potential BCI users, perhaps reflecting that clinicians possess a less accurate understanding of the desires and needs of potential end-users. Improving knowledge and engaging both clinicians and patients could facilitate BCI program development to improve patient outcomes.

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The article presents the definition of the main indicators for assessing the moral and psychological state of military guards of the convicted from the National Guard of Ukraine units using an expert assessment.Using the method of expert assessment, a ranking of indicators has been compiled that affects the moral and psychological state of servicemen convoying convicts of the National Guard of Ukraine in extreme and stressful conditions. Their importance can be assessed using the method of determination of the leading indicators that are a part of the moral and psychological state of the military guards of the convicts of the National Guard of Ukraine.The expert assessment is based on the receiving and processing of data from the survey of specialists. Scientific and pedagogical staff of the National Academy of the National Guard of Ukraine (fourteen people), officers of the guards of convicts of the National Guard of Ukraine (fourteen people) and cadets of the operational and tactical level were involved in the expert assessment of the indicators of the state of health, moral and psychological state. The selection criteria were professional experience (military service) of convoying of the convicted by the units of the National Guard of Ukraine for at least ten years, for scientific and pedagogical workers a scientific degree or a scientific (military) rank.As a result of the expert assessment, fifty-four main indicators were selected, reflecting the structure of the moral and psychological state of the escort units of the National Guard of Ukraine. These indicators are an expert assessment in extreme and stressful conditions.

New tools for early detection of multiple sclerosis progression: MSProDiscuss questionnaire

Diagnosis of secondary progressive multiple sclerosis (SPMS) is based on a history of gradual worsening of neurological symptoms within 6-12 months without exacerbations following an initial relapsing-remitting (RRMS) disease course. In the absence of reliable MRI, immunological and clinical markers, it is hardly possible to achieve objectivity in determining the transition of MS to a progressive stage. This often leads to a long period of diagnostic uncertainty, which prevents timely therapeutic decisions. Physicians expressed an unmet need for a tool that could be used in routine clinical practice to assess the risks of progression to SPMS quickly and reliably, in an easy-to-interpret output for a joint discussion with the patient. From a wide range of disease symptoms and lifestyle factors reflecting the progression to SPMS and obtained by analysis of large clinical data (3294 cases) and a survey of patients and specialists, significant were identified and ranked by categories according to combined expert opinion. A mathematical model was developed and validated, and an electronic version of the MSProDiscuss questionnaire created. Test sensitivity for SPMS diagnosis is 0.82, specificity 0.84, interrater reliability 0.95. Median time for completion of the questionnaire was 2.16 minutes per patient. Physicians of the Russian Federation who used the questionnaire confirmed its high feasibility. Thus, the methodology of the questionnaire development based on the combined opinion of patients and physicians, along with the large clinical data, made it possible to obtain high sensitivity, specificity and reproducibility of the test and takes little time with a clear output. MSProDiscuss may be useful not only in the differential diagnosis of RRMS and SPMS, but also to determine the risks of progression to SPMS, which is of great clinical importance.