Years Of Practical Experience Research Articles

Evaluation of factors affecting pharmacists and pharmacy technicians' satisfaction towards practicing CE activities in Saudi Arabia

BackgroundContinuing education (CE) is an essential requirement for pharmacy professionals to stay abreast with the evolving knowledge and skills of the practice and meet the regulatory mandate. The purpose of this research is to assess factors affecting the satisfaction of pharmacists and pharmacy technicians towards CE practices in Saudi Arabia. Material and methodsA self-administered survey instrument was developed following an extensive literature search. The questionnaire consisted of three sections: participants’ demographics, data on CE activities over the past year and overall satisfaction, and statements of barriers (14 items) and facilitators (12 items) for participation in CE activities (scored on a 5-point Likert scale (5 = always, 1 = never)). The survey was piloted and then distributed as a link through the Saudi Commission for Health Specialties and Saudi Pharmaceutical Society (SPS) between Jan 2018 and Feb 2019. ResultsData was available on 398 pharmacists and 40 pharmacy technicians (completion rate was 55 %). The majority were practitioners, male, working in a hospital setting and had more than five years of practice experience. Half of the participants were from the Central Region and about one-third were non-Saudi. Only a quarter of the participants were satisfied/very satisfied with the current CE practices in Saudi Arabia. Job constraints (62.7 %), cost (55.9 %), schedule of CE activities (55.4 %), lack of information on CE opportunities (53 %) and professional burnout (49.7 %) were the top barriers. There was a significant level of dissatisfaction among pharmacy technicians when compared to pharmacists (p = 0.003), as well as among Saudi pharmacists when compared to non-Saudi pharmacists (p = 0.002). Lack of relevant CE activities (p = 0.05), lack of quality activities (p = 0.002), lack of recognition (p = 0.013) and lack of internet access (p = 0.006) were significantly more barriers for pharmacy technicians compared to pharmacists. The most identified facilitators to engage in CE activities were a personal desire to learn (78.4 %), the requirement to maintain a professional license (73.8 %) and relaxation provided by learning (58.5 %) and networking opportunities (53.4 %). The majority of the participants preferred conferences or interactive workshops, short CE over half a day or less, and the topic of disease management/drug therapy. ConclusionThe findings of the study highlight the need for a partnership strategy that includes various stakeholders to improve CE program quality and accessibility that supports and promotes the professional development of pharmacists and pharmacy technicians in Saudi Arabia. It also underscores the importance of meeting the preferences of pharmacy practitioners when designing CE programs and aligning such activities with their practices.

Knowledge, attitude, and practice of endodontists for use of apex locators in clinical practice in India: A survey-based study

ABSTRACT Aim: The present study aimed to evaluate the knowledge, attitude, and practice (KAP) of endodontists in India for working length measurements using Apex locators. Materials and Methods: This study is an online questionnaire-based survey consisting of 24 questions in total, divided into five parts. The first part consisted of questions related to demographic details, the second part inquires about the tools and technology used for working length determination, and the remaining questions evaluate the KAP regarding the use of apex locators to determine working length (five questions each). Participants in the study were either pursuing or completed postgraduation in endodontics. A total of 257 responses were recorded; however, six participants were excluded due to incomplete submission. Thus, 251 responses were analyzed as descriptive analyses. Correlation analysis and Chi-square tests were performed to find any association between demographic variables and years of experience in practice with KAP of using apex locators by endodontists. Results: In this study, it was observed that the knowledge of the majority of endodontic practitioners was fair, with a positive attitude and practice of using apex locators. Knowledge of the study participants was significantly (P ≤ 0.05) associated with the good attitude and practice of the study participants. Furthermore, years of experience in practice have a positive association with the KAP of endodontists. Conclusion: It can be concluded that endodontists have better clinical acceptance, as they show positive attitudes and practices for using apex locators for working length determination.

The Eurasian Economic Union and Multipolar Globalization

The article discusses ways to resolve the contradiction between globalization and national sovereignty in the context of the transition to a multipolar world order. The main features of the emerging multipolar model of globalization are shown. Through the prism of Eurasian integration, the differences between Russia’s partnership with the countries of the West and its partnership with the countries of the Global East and the Global South are analyzed. The special role of the Eurasian Economic Union and Russia in the formation of a just multipolar world is revealed.Aim. To substantiate Russia’s integration policy in the context of its global confrontation with the West. Tasks. To study the role of mega-regulators and regionalization in resolving the contradictions between the global nature of the economy and national sovereignty in the context of the transition to a multipolar world order. Analysis of the development of the EAEU, its bodies and institutions as a factor in resolving the contradiction between the old and new leaders of globalization.Methods. A systematic approach to the study of Eurasian integration in the process of formation and development of multipolar globalization. Many years of practical experience in participating in specific processes of Eurasian integration.Results. The ways of strengthening the economic sovereignty of the EAEU countries based on the institutional development of Eurasian integration and the formation of new mega-regulators within the framework of the SCO and BRICS are shown.Conclusions. Multipolar globalization is irreversible. At the same time, the EAEU, SCO and BRICS are gaining a leading role in this process. The Russian Federation needs to critically review its partnership with Western countries and organizations, taking into account their threefold role in relation to our country: opponents, rivals, partn.

Speed-power training of highly qualified hammer throwers

Long-term training of highly qualified track and field athletes is impossible without paying attention to one of its constituent parts - training and training methods. The level of training of throwers in track and field is becoming very high, it is becoming more and more difficult to achieve victory. This caused certain efforts of trainers, scientists, and methodologists in preparing the educational and training process of track and field athletes-throwers. The study of the robots of specialists, as well as the analysis of existing programs for improving the speed and strength training of throwers in track and field, indicates that the training method lags behind modern requirements. We consider the reason for this to be the low level of methodical development. Unfortunately, most track and field coaches are not interested in the new guidelines, and the result is the training of inferior reserves.
 The purpose of the work is the development of speed and strength training of highly qualified hammer throwers.
 Research results. We recommend hammer throwers to perform exercises with a barbell during training (jerking, taking the barbell to the chest, pull-ups). Exercises with a barbell (jerk, chest pull-ups, pull-ups and push-ups) are recommended to be performed from the position "from above". The position of the barbell "from above" means that the barbell is raised from the platform with straight lowered arms, the athlete's torso and legs are straightened, and then basic exercises are performed from this position. Moreover, the exercises should be performed in the overcoming and advancing mode, which corresponds to the main technical movement - hammer throwing.
 Conclusions. The results of our research and thirty years of practical experience working with athletes of the highest level of sportsmanship show that in speed-power sports, the connection between the external form and the content of movements is most clearly manifested when interacting with the support and the projectile. This is a causal relationship. Only that athlete who has a sufficient level of development of speed and strength qualities across the entire range of their manifestations, from the fastest and most coordinated rotational movements to the instant manifestation of maximum muscle tension in projectile throwing, can count on serious success in the main exercise.

Lymphatic drainage of sinonasal malignancies and the role of sentinel node biopsies

BackgroundLocoregional recurrence is a critical factor in the prognosis of sinonasal malignancies. Due to the rarity of these tumours, as well as the heterogeneity of histologies and anatomical subsites, there is little evidence regarding the rate and location of regional metastases in sinonasal malignancies. Elective regional lymph node dissection in the therapy of sinonasal malignancies has become controversial. On the one hand, elective regional lymph node dissection is considered to be an overtreatment in the cN0 cases. On the other hand, undetected occult lymphatic metastases are associated with a poor prognosis. In this study, we discuss the role of sentinel lymph node biopsy as a minimally invasive procedure in the treatment of sinonasal malignancies based on our two years of practical experience and the currently available data.ResultsThis is a descriptive, monocentric, retrospective study, including 20 cases of cN0 malignant sinonasal neoplasm, that underwent a surgical therapy between 2020 and 2022. The following aspects were investigated: tumour entity, localisation of the primary tumour, tumoral stage, localisation of the sentinel lymph nodes, and postoperative complications. Squamous cell carcinoma was the most frequently diagnosed tumour entity (50%), followed by adenocarcinoma (20%) and malignant melanoma (15%), adenoid cystic carcinoma and mucoepidermoid carcinoma. Sentinel lymph nodes were most frequently found in the ipsilateral neck region I (45%), followed by the ipsilateral neck region II (40%). In all cases, the removed lymph nodes were free of malignancy. There were no postoperative complications due to lymph node biopsy. There were no recurrences during the study period.ConclusionSentinel node biopsy could add more safety to the management of cN0 sinonasal malignancies due to its low morbidity. Whether SNB could provide an alternative to elective neck dissection in the management of SNM should be investigated in further studies.

Organizational aspects of nutritional support for patients in a multidisciplinary emergency hospital

Nutritional support, which is a process of substrate provision with all the nutrients necessary for life for various categories of patients who do not have the opportunity for proper natural nutrition, is a mandatory basic component of their intensive treatment. The practical implementation of nutritional support has two aspects: clinical and organizational. Currently, all components of the clinical aspect are well developed and tested and there are no reasons not to use them in everyday clinical practice. The least resolved and worked out in the majority of our medical institutions remains the organizational aspect, which often does not allow for the proper realization of this type of medical treatment. The article contains the main organizational options for decision the existing problem and many years of practical experience in implementing nutritional support in a multidisciplinary emergency hospital.

A constant learning curve in working towards integrated health policy: twelve years of practical experience at a Dutch municipality

Background By establishing and implementing an integrated four-year health policy, Dutch municipalities contribute significantly to the protection and promotion of public health. Scientific literature has many insights into integrated health policy, determinants of health and interventions. How is this knowledge used when determining and shaping an integrated health policy? The authors share their experiences concerning the role of knowledge in: 1) determining policy; 2) integrated collaboration; 3) working towards a healthy living environment; and 4) creating a citywide health movement. Key points Based on working on an integrated health policy and the setbacks we have encountered, we have experienced that scientific knowledge and models provide a framework for policy implementation, but other types of knowledge about context, processes and practice are just as important. Furthermore, we learned that other factors are often more decisive in policy and implementation, including the interests of individual parties, correct timing, continuity of persons, and courageous administrators. Working on integrated health policy is a continuous process of staying on course and adapting at the same time, in which searching for the suitable knowledge to work in an evidence-informed way must be part of it. Conclusion The greatest challenge when using knowledge in practice lies in expanding the collaboration between researchers, policymakers, professionals and inhabitants, for example by using boundary spanners. The collaboration should aim to organise a long-lasting adaptive collaboration aimed at mutual learning. This should focus on shared discussion of relevant knowledge, with less emphasis on pure acquisition and use of scientific knowledge.

Prevention of Induced Abortion - Effect on Pain. Systematic Review of a Database

Review of the current literature on pain prevention in induced abortion.An in - depth analysis of the guidelines of leading international and national organizations for prophylaxis of induced abortion-surgical and medicated abortion during the I-st and II-nd trimester in terms of pain response has been carried out. Shared with the author's many years of practical experience in order to assess the risks and benefits of the application of modern means of prophylaxis in artificial abortion and thus to improve the individual obstetric-gynecological practice. Methods: review of available literature from the last 10 years. Results and discussion:Paracetamol, oral lorazepam and nitric oxide do not improve pain control. Currently, the use of sedation is not recommended for Surgical abortion. Inhalation anaesthesia should not be used for sedation. Intravenous sedation with fentanyl and midazolam is recommended and safe - below 1.0% complications. In Medical abortion, 75.0% of women experience pain severe enough to require analgesia. The pain begins 2.5 to 4 hours after the use of perplex and lasts about an hour. During the extravehicular trimester, taking a higher number of doses intravenously is associated with more severe and frequent pain. In medicated abortion < 14 gw. non-steroidal anti-inflammatory drugs are recommended 30-45 minutes before the procedure. Non-steroidal medicines do not reduce the efficacy of urgencies. Routine administration of paracervical block before 13 gw. when using modern means for medicated abortion is unnecessary. Narcotic analgesics (Tramadol) do not affect pain in early Medical abortion and their routine use is not recommended. Conclusion:In Surgical abortion, analgesia is always offered. Most commonly, analgesics, such as non-steroidal anti-inflammatory drugs local anesthesia (paracervical block with Lidocaine 20.1%; or 10.2%),) and/ or sedation, supplemented with verbal sedation, are sufficient to relieve pain before mechanical cervical dilation and during uterine evacuation. The technique of deep paracervical injection of Lidocacaine at two points is recommended.

Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection to radiologist levels

BackgroundTools to increase the turnaround speed and accuracy of imaging reports could positively influence ED logistics. The Caire ICH is an artificial intelligence (AI) software developed for ED physicians to...

Legal Interpreters’ View on the Feedback from Users: A Case Study in Bali

The high volume of legal cases involving foreigners in Indonesia underscores the necessity for proficient legal interpreters, as not all foreigners possess a fluent command of the Indonesian language. As a result, the presence of legal interpreters is essential to aid foreigners navigating the legal system. The initial phase of research, which assessed the effectiveness and user experiences of legal interpreters in assisting foreigners throughout the legal proceedings, revealed that police officers engaged two categories of interpreters: ad hoc and professional interpreters. Ad hoc interpreters are temporary interpreters enlisted for specific purposes such as reporting or particular activities. These interpreters may include individuals like tour guides, drivers, spouses of foreigners, family members, and even household staff. On occasion, police officers also utilized colleagues, fellow officers, prosecutors, or lawyers proficient in English to act as legal interpreters. In contrast, professional interpreters often possess certification from reputable institutions, such as universities, translators' associations, or English language colleges, ensuring a strong command of English. According to perspectives from police officers, prosecutors, and lawyers, ad hoc interpreters tend to lack linguistic expertise and interpreting skills, leading to subpar interpretation quality. Conversely, professional interpreters exhibit superior linguistic knowledge and are largely proficient in interpreting, resulting in significantly improved interpretation services compared to ad hoc options. Legal practitioners who employ professional interpreters find their assistance invaluable. However, from the viewpoint of detainees, in-house interpreters or interpreters associated with law offices have a tendency to cast suspicion on the foreigners they assist and may steer them toward confessing to what the lawyers desire. Based on the results and discussion, it has been determined that non-professional interpreters correspond to the ad hoc interpreters as described in the initial year of research. The interpreters of this category engage in interpretation tasks only occasionally, typically ranging from 1 to 4 instances over a span of 1 to 2 years. Professional interpreters, on the contrary, are skilled language mediators proficient in English, possessing expertise in various interpreting methods, especially in legal contexts. They are affiliated with professional associations and boast over three years of practical experience. Out of a group of 10 proficient interpreters who responded to the questionnaires, three are employed full-time, while the remaining seven operate as independent freelancers. Among the three full-time interpreters, one is stationed in-house. However, these interpreters did not completely concur with the feedback provided by users. Out of the fifteen feedback points submitted by users, a majority believed that the feedback was somewhat inaccurate. Nonetheless, some points were acknowledged for valid reasons: Firstly, considering the high volume of cases presented at the police office, the interpreters might not be well-versed in all the requisite legal terminology. Additionally, not all legal interpreters have been involved in police office proceedings, which results in an unfamiliarity with interrogation methods and procedures. Secondly, instances of interpreters displaying partiality and assisting foreign clients could stem from a lack of comprehension regarding the ethical guidelines governing legal interpreters. Misunderstandings might arise from payment arrangements, briefings, and directives received from supervisors (in the case of in-house interpreters) or from the police (for freelancers). The involvement of lawyers, foreigners, or the police in their compensation might lead to interpreters providing advice, suggestions, and direction for foreigners to admit certain actions. However, only a small subset of interpreters is inclined to do so, while the majority refrains from such actions.

COVID-19 vaccine hesitancy among healthcare workers in Arab Countries: A systematic review and meta-analysis.

Vaccine hesitancy is a major obstacle to the large efforts made by governments and health organizations toward achieving successful COVID-19 vaccination programs. Healthcare worker's (HCWs) acceptance or refusal of the vaccine is an influencing factor to the attitudes of their patients and general population. This study aimed to report the acceptance rates for COVID-19 vaccines among HCWs in Arab countries and identify key factors driving the attitudes of HCWs in the Arab world toward vaccines. This systematic review and meta-analysis followed the PRISMA guidelines. PubMed and Scopus databases were searched using pre-specified keywords. All cross-sectional studies that assessed COVID-19 vaccine hesitancy and/or acceptance among HCWs in Arab countries until July 2022, were included. The quality of the included studies and the risk of bias was assessed using the JBI critical appraisal tool. The pooled acceptance rate of the COVID-19 vaccine was assessed using a random-effects model with a 95% confidence interval. A total of 861 articles were identified, of which, 43 were included in the study. All the studies were cross-sectional and survey-based. The total sample size was 57,250 HCWs and the acceptance rate of the COVID-19 vaccine was 60.4% (95% CI, 53.8% to 66.6%; I2, 41.9%). In addition, the COVID-19 vaccine acceptance rate among males was 65.4% (95% CI, 55.9% to 73.9%; I2, 0%) while among females was 48.2% (95% CI, 37.8% to 58.6%; I2, 0%). The most frequently reported factors associated with COVID-19 vaccine acceptance were being male, higher risk perception of contracting COVID-19, positive attitude toward the influenza vaccine, and higher educational level. Predictors of vaccine hesitancy most frequently included concerns about COVID-19 vaccine safety, living in rural areas, low monthly income, and fewer years of practice experience. A moderate acceptance rate of COVID-19 vaccines was reported among HCWs in the Arab World. Considering potential future pandemics, regulatory bodies should raise awareness regarding vaccine safety and efficacy and tailor their efforts to target HCWs who would consequently influence the public with their attitude towards vaccines.

Investigating the Knowledge, Attitude, and Practice of Iraqi Intensive Care Nursing Staff Regarding Hand Hygiene

Background: Hospital-acquired infections are recognized as a major risk factor in healthcare settings. Hand hygiene as the first stage of infection control plays an important role in reducing these infections. This study assesses the knowledge, attitudes, and practice regarding hand hygiene among nurses in intensive care units (ICUs) of Basrah City and Dhi Qar City, Iraq. Methods: This descriptive cross-sectional study targeted 231 ICU nursing staff working in hospitals of Al-Basra and Dhi-Qar in Iraq in 2022. The subjects were recruited through the census. To assess the nurses’ hand hygiene knowledge, attitude, and practice, electronic questionnaires were administered via WhatsApp. The collected data were analyzed using descriptive statistics (absolute and relative frequency, Mean±SD) and inferential statistics (independent t-test, chi-square test, and Fisher test). The data analysis was performed using the SPSS software, version 22. Meanwhile, a significance level of <0.05 was considered for all statistical tests. Results: The mean scores (ranges) of nurses’ hand hygiene knowledge, attitude, and practice were 4.74±1.82 (1-10), 77.25±7.89 (55-95), and 49.80±12.23 (21-70), respectively. There was a significant relationship between hand hygiene knowledge and gender, with female nurses’ knowledge being higher compared to male nurses (P=0.03). Furthermore, nurses with less than 5 years of practical experience in the ICU had a higher mean score of attitudes toward hand hygiene compared to nurses with 5-10 years of practical experience (P=0.015). Additionally, nurses with less than 5 years of experience in the ICU showed a higher mean score of hand hygiene practice compared to nurses with more than 10 years of practical experience (P=0.028). Conclusion: According to the findings, the knowledge, attitude, and practice of ICU nurses about hand hygiene were inappropriate. It is necessary to implement educational programs to improve the knowledge, attitude, and practice of Iraqi ICU nurses in this area.

Ecophilosophy of Semen Antonets, regarding organic farming as a method of non-traditional land use

The paper analyzes the scientific works and elaborates the technological aspects and significance of the unique system of organic agriculture of the outstanding scientist-innovator, Hero of Ukraine Semen Antonets. It is emphasized that the Poltava agrarian and scientist Semen Antonets, back in the 70s of the last century, formed philosophical approaches in the field of nature management based on the principles of harmony with the natural environment, due to the implementation of the organic farming system as a method of non-traditional land use. The eco-philosophical orientation and special ecological ethics of the life path and heritage of the famous agrarian, scientist Semyon Antonets, which correspond to the teachings of V. Vernadskyi, the philosophy of H. Skovoroda, H. Skolimovski, and A. Ness, are determined. It has been proven that Semen Antonets proved the truth of the ecological conclusions he defined with fifty years of practical experience, the real implementation and existence of organic farming in the enterprise "Agroecology" of the Poltava region, which has not used chemical substances and mineral fertilizers since 1978. It is emphasized that the paradigm of organic agriculture of Semyon Antonets develops ecophilosophical teaching, contributing to an ecological worldview and universal ecological humanism and thinking. The need for legal protection of organic farming enterprises, and especially the lands of the Agroecology State Enterprise, and their preservation for future generations, has been elaborated.

Leyi Mental Training: Bridging Ancient Wisdom and Modern Science to Reduce Anxiety via Altered Brain Dynamics

Leyi is a set of physical and mental cultivation methods established by Professor Changle Zhou after many years of practice. It combines modern psychological adjustment and Chinese ancient Buddhist practice methods, including relaxation, breathing, meditation, koan, and cognitive regulation. Its purpose is to achieve the state of enlightenment (a high-level ideology in Buddhism). More than ten years of practical experience has proved that Leyi Mental Training can improve people's physical and mental health, especially most participants reported that their anxiety reduced after training. Before and after the training, we recorded the participants' EEG during the task of judging emotional pictures and administered the POMS Scale to them after the task. The results showed that their anxiety subscale scores were significantly reduced after training, and the accompanying brain activity was that the power of frontal gamma was reduced considerably. Studies have found that frontal gamma power is related to DMN activity, and a decrease in frontal gamma power indicates a reduction of internal network activity. We speculate that this may be because Leyi's training changed the way of self-referential processing, which in turn affected the activities of the internal network, which may be one of the brain mechanisms for reducing anxiety

LONELINESS AND SOCIAL ISOLATION: TO SCREEN OR NOT? PROVIDERS’ COMMUNICATIONS AND COMFORTABILITY

Abstract Purpose Research has shown that loneliness and social isolation (SI) can seriously impact older adults’ health and well-being. However, it is unknown whether healthcare providers communicate with their older patients about these issues. This pilot study examines providers’ communication and comfortability on loneliness screening. Methods A convenience sample of providers who see older patients were recruited from healthcare and long-term care settings (n=59). Communication about social isolation was adapted from the revised UCLA 3-item Scale. De Jong Gierveld’s loneliness 6-item scale was used to assess social and emotional loneliness. Comfortable levels with loneliness screening (4 items) were adapted from UCF researchers’ food insecurity screening study. Results Providers’ mean age was 46 years; the majority were females (70%), and 67% were whites, with an average of 17 years of practice experience. About 60% of providers believe loneliness screening should be conducted among older patients during every visit. All the scales showed high internal consistencies with Cronbach’s alphas, ranging from .825 to .897. Data showed that communications about loneliness and social isolation were both low, with item means of 2.34 and 2.15, respectively. Overall, providers showed moderate comfort in conducting such screenings (mean=3.72 on a 5-point Likert scale). Discussion This pilot provides evidence of high reliabilities of these validated measures to assess providers’ communication and comfortability to screen for loneliness and SI. Data showed concerning findings on low communication and only moderate comfort among providers. It calls attention to providing provider training for early intervention, particularly among older patients.

Examining Postpartum Anticoagulation Practices: An International Survey of Healthcare Providers

Background Prophylactic anticoagulation is usually recommended for six weeks postpartum (PPM) for individuals at high risk of developing venous thromboembolism (VTE). However, there are no randomized controlled trials (RCTs) assessing optimal duration of prophylactic anticoagulation post-partum. Moreover, the risk is not equivalent throughout the six weeks as evidenced by a sharp decline in VTE risk following the third week PPM. These observations call into question the optimal duration of PPM thromboprophylaxis and whether a full six weeks is needed. Objective This study sought to determine postpartum anticoagulation practices and to explore practitioners' willingness to consider reduction of the duration of PPM prophylactic anticoagulation. Methods We conducted a cross-sectional study between December 2022 and April 2023 using a self-administered electronic questionnaire on the ‘SurveyMonkey’ platform to gauge international preferences for the use, dose and duration of postpartum anticoagulation . The survey was validated for face and content validity and explored expert preferences across complex PPM scenarios. Physician characteristics, years in practice, specialty and continent of practice were also collected. We employed various methods of dissemination including email, scientific conferences, expert groups, and social media. Results Of the 113 participants that responded to the initial invitation, 78 completed the survey with the following regional distribution: 53.9% from Europe, 23.1% from North America, and 19.0% from Australia and New Zealand. Among the respondents, 60% were haematologists, 20% were general obstetric physicians, and 13% were maternal-fetal medicine (MFM) experts. For prior unprovoked or hormone-associated deep venous thrombosis (DVT) or pulmonary embolism (PE), non-hormone associated provoked DVT/PE, cerebral venous sinus thrombosis (CVST) and splanchnic vein thrombosis, 97.4%, 93.5%, 91.0% and 88.5% of experts selected six weeks of prophylactic anticoagulation with LMWH postpartum compared to 3 weeks or prophylaxis with unfractionated heparin. This practice was also supported by 70.5%, 78.2% and 87.2% of experts in individuals with sickle cell disease (SCD), obstetric antiphospholipid syndrome (APS) and high-risk thrombophilia, respectively. For individuals with a history of unprovoked PE/DVT or history of thrombosis at atypical sites (splanchnic thrombosis or CVST) approximately half of the experts (48.7% and 47.4 %) were willing to offer thromboprophylaxis with 3 weeks of LMWH followed by 3 weeks of aspirin, while approximately one-third (34.6% and 32.1%) would consider 3 weeks of LMWH only (Table 1). Respondents managing more than 10 patients per year (p=0.0001), with over 5 years of practice experience (p=0.0004) and specialization in Haematology or MFM demonstrated a greater willingness to explore shorter durations. For scenarios of individuals with SCD, obstetric APS and myeloproliferative neoplasms (MPNs), with no history of VTE, a higher percentage of respondents (69.2%, 60.3%, 67.9%) would support 3 weeks of LMWH followed by 3 weeks of aspirin or no anticoagulation PPM (Table 1). For SCD, Haematologists were slightly less supportive (68.1%) than MFM (80%) and obstetric medicine physicians (75%) of shorter durations, although the difference was not statistically significant (p=0.45). For MPNs, Haematologists were more supportive of shorter durations (76.6%) than MFMs (60%) and obstetric medicine physicians (50%) (p=0.047). For obstetric APS, there was no significant difference amongst the specialties with respect to explore shorter anticoagulation durations. Conclusion The majority of experts (90%) prescribe a 6 week LMWH regimen for patients with a background of DVT/PE, thrombosis in atypical sites, or high-risk thrombophilias, while fewer adopt this approach for SCD, obstetric APS. Half of the specialists would consider shorter durations of prophylactic anticoagulation PPM for individuals with prior DVT/PE, thrombosis in atypical sites and even more (60-70%) for SCD, obstetric APS and MPNs. Experience and caseload influence acceptance of shorter durations. There is an urgent need for prospective studies addressing peripartum management of anticoagulation such as appropriate type, dosage, initiation timing and duration in different diseases, to provide evidence regarding optimal strategies.

An iterative approach for model-based requirements engineering in large collaborative projects: A detailed experience report

In this paper, we report on our 7 years of practical experience designing, developing, deploying, using, and evolving an iterative Model-based Requirements Engineering (MBRE) approach and language in the context of five large European collaborative projects providing complex software-intensive solutions. Based on significant data sets collected both during project execution and via surveys realized afterward, we demonstrate that such a model-based approach can bring interesting benefits in terms of scalability (e.g., a large number of handled requirements), heterogeneity (e.g., partners with different types of RE background), adaptability and extensibility (e.g., to various project's needs), traceability (e.g., from the requirements to the software components), automation (e.g., documentation generation), consistency and quality (e.g., central model), and usefulness or usability (e.g., actual deployment and practical use). Along the way, we illustrate the application of our MBRE approach and language with concrete elements from these several European collaborative projects. More broadly, we discuss the general benefits and current limitations of using such a model-based approach and corresponding language, as well as the related lessons we learned during these past years.

О необходимости соблюдения индивидуального подхода при маршрутизации пациентов с атеросклерозом брахиоцефальных артерий в рамках проекта «Здоровая Москва».

During the implementation of the program, up-to-date data were obtained on the state of the cardiovascular system, the main risk factors for stroke, especially among middle-aged able-bodied people who had a new coronavirus infection COVID‑19. An assessment was made of the dynamics of populations undergoing preventive examinations in the format of field medical care, the most common diseases, including pathologies of the BCA. A database has been created for long-term monitoring of the incidence of cardiovascular diseases in the population and the prevention of BCA pathologies and stroke. The routing of patients with BCA pathologies was developed based on the analysis of many years of practical experience in providing specialized medical care to patients with pathology of the precerebral arteries in medical organizations of the Moscow public health system. Routing of patients within the framework of this project, based on a specially developed methodology, an integrated approach to treatment with preliminary training of medical personnel in the ultrasound technique for measuring carotid artery stenosis according to the European ECST scale, a clear algorithm and mechanisms for working with patients within the framework of intersectoral activities, allows to reduce the incidence of stroke and mortality. Successful strategies to expand screening of patients with BCA pathology implemented in the «Healthy Moscow» project require further study to evaluate the effectiveness of specific stroke prevention mechanisms.

Assessment of hearing performance of dental technicians due to the professional noise exposure

BackgroundSome of the noise-intensive processes in dental laboratories include the finishing of crowns, bridges, and removable partial dentures; blowing out workpieces with steam and compressed air; and deflating casting rings. High sound pressure levels are also present in dental vibrators, polishing equipment, and sandblasters. The aim of this study was to Evaluation of the effect of noise production in dental technology laboratory on dental technician hearing capacity.MethodsFor this cross-sectional study, a total of 120 dental technicians were chosen. Otoscopic evaluation and the Weber test were used to establish if they had sensorineural or transmission hearing loss at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz, respectively. Then an OAER (objective auditory evoked response) and PTA (clinical aurimeter) test were administered (Neurosoft, Russia). The whole procedure was carried out by an audiologist and an ENT specialist.ResultsThe PTA results showed that the patient had mild hearing impairment overall, with the loss being more severe in the left ear than in the right. The OAE test results revealed that in-ear of the left side, 84.5% of subjects passed and 15.5% of subjects struggled and were referred to an ear specialist, whereas in the right ear, 82.7% of subjects passed and 17.3% struggled and were referred to an ear specialist. According to this study, in a right-handed study participant, the ear on the left side is more vulnerable than the right side. Differences in the mean hearing threshold at 4000 and 6000 Hz in the left ear were statistically significant in the groups of workers with eleven to fifteen years of practical experience and twenty-one to twenty-five years of practical experience, respectively (Minervini, et al. J Clin Med 12:2652, 2023).ConclusionsA statistically meaningful threshold shift from 4000 to 6000 Hz is observed as the working experience grows, and this is suggestive of sensorineural hearing impairment brought on by the noisy dental environment.

Celebrating culture in American dermatology part I: A special tribute to Dr E. A. (Billy) Hankins III, dermatologist with American Indian heritage as a minor part of his ethnic background

This contribution honors the life of Dr E. A. (Billy) Hankins III, a board-certified dermatologist and dermatopathologist with 40 years of practice experience, now retired, having American Indian heritage as a minor part of his ethnic background. Hankins spent many years as a physician volunteer for an indigent clinic serving the urban American Indian community of the city and county of Los Angeles, California (the American Indian Free Clinic). He is a Vietnam era war veteran as well as a master sculpture taxidermist and wildlife recreation artist. He has been active for many years with the Association of American Indian Physicians, of which he is a member. Hankins is the founder and curator of vertebrate zoology and chief preparator for the World Museum of Natural History, an international, nonprofit public museum of natural history located on the campus of La Sierra University in Riverside, California. Dr Hankins’ life story offers insight into American Indian culture as it relates to dermatology, and hopefully it will inspire more American Indian medical students to pursue a career in that specialty.