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Since its inception, the specialty of acute care surgery has evolved and now represents a field with a broad clinical scope and large variations in implementation and practice. These variations produce unique challenges and there is no consistent definition of the scope, intensity or value of the work performed by acute care surgeons. This lack of clarity regarding expectations extends to surgeons and non-surgeons outside of our specialty, compounding difficulties in advocacy at the local, regional and national levels. Coupled with a lack of clarity surrounding the definition of full-time employment, these challenges have prompted surgeons to develop initiatives within acute care surgery in collaboration with the American Association for the Surgery of Trauma (AAST). A panel session at the AAST 2023 annual meeting was held to discuss the need to define a full-time equivalent for an acute care surgeon and how to consider and incorporate non-clinical responsibilities. Experiences, perspectives and propositions for change were discussed and are presented here.

The study aimed to determine the role of training programs in achieving administrative performance excellence within Orphan Development Foundation. The study population consisted of all employees at the Orphan Development Foundation, with a total number of 55 employees. A questionnaire was designed to collect field data on the study variables. The study adopted the descriptive-analytical approach, as it is one of the most commonly used approaches in studying social and human phenomena. The motive behind such a decision is to reach results that can be generalized to other similar cases, whether it was local, regional or international. The most prominent findings of the study show that there is a statistically significant correlation between training (with its dimensions of needs assessment, program design, implementation, and evaluation) and superior administrative performance (with its dimensions of institutional culture, leadership, building sustainable value, stakeholders' engagement, strategic and operational performance). In addition, the application of training programs, including needs assessment, design, implementation and evaluation within the Foundation is still at a moderate level. Similarly, the level of superior administrative performance at the Orphan's Development Foundation was at a moderate level. The study concluded with a number of recommendations, the most prominent of which include enhancing the role of training in its various dimensions to improve the administrative performance of the Orphan's Development Foundation. It also recommended paying more attention to the training and the process of needs assessment, design, implementation and evaluation within the Orphan's Development Foundation to achieve a higher level of administrative excellence. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Centers for Disease Control and Prevention's Sickle Cell Data Collection (SCDC) program comprises multidisciplinary teams, which include community-based organizations. Partnering with community-based organizations (CBOs) is a novel approach to ensure that SCDC data are actionable. Objective: To better understand areas for mutual capacity building, we explored the relationships and dynamics between CBO and data teams within the SCDC program in 10 states. Methods: We conducted semi-structured interviews with CBO (n = 13) and SCDC (n = 10) participants and then categorized and compared text from each interview and across states. Six themes emerged. Lessons Learned: Transparency and trust are essential. Early CBO engagement and leadership are needed for trust and agreed upon priorities. Conclusions: Participants contextualized trust, the most prominent theme, within discussions of racism and health inequities. Relationships between the CBO and data teams bring hard data and human experience together for advocacy, education, improved care, and a platform for the SCD voice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coverage for cardiac rehabilitation (CR) for patients with heart failure with reduced ejection fraction was expanded in 2014, but contemporary referral and participation rates remain unknown. METHODS: Patients hospitalized for heart failure with reduced ejection fraction (≤35%) in the American Heart Association Get With The Guidelines-Heart Failure registry from 2010 to 2020 were included, and CR referral status was described as yes, no, or not captured. Temporal trends in CR referral were assessed in the overall cohort. Patient and hospital-level predictors of CR referral were assessed using multivariable-adjusted logistic regression models. Additionally, CR referral and proportional utilization of CR within 1-year of referral were evaluated among patients aged >65 years with available Medicare administrative claims data who were clinically stable for 6-weeks postdischarge. Finally, the association of CR referral with the risk of 1-year death and readmission was evaluated using multivariable-adjusted Cox models. RESULTS: Of 69,441 patients with heart failure with reduced ejection fraction who were eligible for CR (median age 67 years; 33% women; 30% Black), 17,076 (24.6%) were referred to CR, and referral rates increased from 8.1% in 2010 to 24.1% in 2020 (Ptrend

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ObjectivesGenerating and using real-world evidence (RWE) is a pragmatic solution for evaluating health technologies. RWE is recognized by regulators, health technology assessors, clinicians, and manufacturers as a valid source of information to support their decision-making. Well-designed registries can provide RWE and become more powerful when linked with electronic health records and administrative databases in coordinated registry networks (CRNs). Our objective was to create a framework of maturity of CRNs and registries, so guiding their development and the prioritization of funding.Design setting and participantsWe invited 52 stakeholders from diverse backgrounds including patient advocacy groups, academic, clinical, industry and regulatory experts to participate on a Delphi survey. Of those invited, 42 participated in the survey to provide feedback on the maturity framework for CRNs and registries. An expert panel reviewed the responses to refine the framework until the target consensus of 80% was reached. Two rounds of the Delphi were distributed via Qualtrics online platform from July to August 2020 and from October to November 2020.Main outcome measuresConsensus on the maturity framework for CRNs and registries consisted of seven domains (unique device identification, efficient data collection, data quality, product life cycle approach, governance and sustainability, quality improvement, and patient-reported outcomes), each presented with five levels of maturity.ResultsOf 52 invited experts, 41 (79.9%) responded to round 1; all 41 responded to round 2; and consensus was reached for most domains. The expert panel resolved the disagreements and final consensus estimates ranged from 80.5% to 92.7% for seven domains.ConclusionsWe have developed a robust framework to assess the maturity of any CRN (or registry) to provide reliable RWE. This framework will promote harmonization of approaches to RWE generation across different disciplines and health systems. The domains and their levels may evolve over time as new solutions become available.

This paper presents an innovative approach to improve the accuracy and resolution of defect detection in glass fiber-reinforced plastic (GFRP) composites using pulse compression analysis for thermal wave imaging. GFRP materials, widely utilized in various industries owing to lightweight and durable properties, often present challenges in identifying subsurface defects. Traditional thermal wave imaging techniques face limitations in achieving high-resolution results. The study outlines the theoretical foundation of pulse compression and its application in thermal wave inspection. A comprehensive experimental setup was designed to validate the effectiveness of the proposed methodology. Results indicate a significant improvement in the localization and characterization of defects within GFRP composites. The findings of this research hold implications for nondestructive testing and quality control in industries relying on GFRP materials. The integration of pulse compression analysis into thermal wave imaging establishes a promising avenue for precise defect detection, contributing to the reliability and integrity of GFRP composite structures. Also, two key metrics, absolute thermal contrast and signal-to-background contrast, are used for quantitative analysis. [ABSTRACT FROM AUTHOR]

Background Advancing health equity requires more contextualised evidence. Objectives To synthesise published evidence using an existing framework on the origins of health disparities and determine care-related outcome disparities for residents of long-term care, comparing minoritised populations to the context-specific dominant population. Design Systematic review. Subjects Residents of 24-hour long-term care homes. Methods The protocol was registered a priori with PROSPERO (CRD42021269489). Literature published between 1 January 2000 and 26 September 2021, was searched, including studies comparing baseline characteristics and outcomes in minoritised versus dominant populations. Dual screening, two-reviewer verification for extraction, and risk of bias assessments were conducted to ensure rigour. Studies were synthesized using a conceptual framework to contextualise evidence according to multi-level factors contributing to the development of care disparities. Results Twenty-one of 34 included studies demonstrated disparities in care outcomes for minoritised groups compared to majority groups. Thirty-one studies observed differences in individual-level characteristics (e.g. age, education, underlying conditions) upon entry to homes, with several outcome disparities (e.g. restraint use, number of medications) present at baseline and remaining or worsening over time. Significant gaps in evidence were identified, particularly an absence of literature on provider information and evidence on the experience of intersecting minority identities that contribute to care-related outcome disparities in long-term care. Conclusion This review found differences in minoritised populations' care-related outcomes. The findings provide guidance for future health equity policy and research—supporting diverse and intersectional capacity building in long-term care. [ABSTRACT FROM AUTHOR]

Copyright of Modern Educational Technology is the property of Editorial Board of Modern Educational Technology, Tsinghua University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería Investiga: Investigaciin, Vinculación, Docencia y Gestiin is the property of Revista Enfermeria Investiga and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This scoping review aimed to document tools designed to identify persons requiring special care dentistry (SCD) and to provide a better understanding of the factors that justify adaptation in the provision of care. Methods: A scoping review methodology was applied. An electronic search was performed in April 2021 using Pubmed and Embase. Additional tools were sought using hand searches and informal professional networking. Results: Ten tools were identified that either predict the complexity of dental management or that retrospectively judge the complexity of care, of which two are as yet unpublished. Some had been developed for a specific population (e.g., patients with Alzheimer's disease, with learning disability, elderly persons) whilst others were applicable for any population (case mix tools). Factors considered included the patient's medical history, ability to cooperate, physical and cognitive autonomy, communication skills, anxiety, need for sedation, oral risk factors, ability to consent and the administrative burden for the dentist. Conclusion: Identifying persons requiring SCD is possible by looking at various factors that influence the provision of dental care. There may be need for adaptation of tools to local circumstances and to the intended usage of the tool at a health services, systems or policy level. [ABSTRACT FROM AUTHOR]

Basically, this study aims to empirically determine the level at which the labour market of semi-peripheral EU countries have been or is being controlled by the outcomes of formal education together with technical/vocational training programmes, using the Greek labour market survey data as a case study. The data employed in this study were comprehensively collated, phased and analyzed at three levels: 1. The micro-level which relayed the econometric analysis of the Greek Labour Force. 2. The meso-level with all analytical activities wrapped around the Greek formal and informal educational system. 3. The macro-level where all data were scrutinized for outcomes relative to the Greek political economy. To the end the results of this study could systematically challenge the provision of training programmes by measuring the minimal impact and ultimately, the usefulness of these policies. However, this is not to say that Greece does not require training; it only means that they can only be used to their full potential in the context of an appropriate institutional framework, which still does not exist.

RATIONALE: Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care hospitals have implemented systems aimed at detecting and responding to such patients. OBJECTIVES: To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients. PANEL DESIGN: The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinicianmethodologists with expertise in developing evidence-based Clinical Practice Guidelines. METHODS: We generated actionable questions using the Population, Intervention, Control, and Outcomes (PICO) format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation Approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs). RESULTS: The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among unselected patients. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system. CONCLUSIONS: The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU. [ABSTRACT FROM AUTHOR]

RATIONALE: Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients. OBJECTIVES: To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients. PANEL DESIGN: The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinicianmethodologists with expertise in developing evidence-based clinical practice guidelines. METHODS: We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs). RESULTS: The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS). CONCLUSIONS: The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU. [ABSTRACT FROM AUTHOR]

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Riwayat: Educational Journal of History & Humanities is the property of Riwayat: Educational Journal of History & Humanities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inter-organizational mentoring (IOM) occurs whenever the mentor and mentee belong to different organisations. IOM has grown recently in the light of professional associations. This work proposes a model for implementing IOM programs based on a literature review on mentoring best practices and experts’ experience. The model, completed with a focus group with 20 experts in IOMPs, highlights differences to be considered in implementing IOMPs, compared to traditional mentoring programs. This paper fills the gap in implementing IOMPs and provides keys to mentors and program coordinators for their efficient implementation.

Developments in the field of education have significantly affected test development processes, and computer-based test applications have been started in many institutions. In our country, research on the application of measurement and evaluation tools in the computer environment for use with distance education is gaining momentum. A large pool of items is required for computer-based testing applications that provide significant advantages to practitioners and test takers. Preparing a large pool of items also requires more effort in terms of time, effort, and cost. To overcome this problem, automatic item generation has been widely used by bringing together item development subject matter experts and computer technology. In the present research, the steps for implementing automatic item generation are explained through an example. In the research, which was based on the fundamental research method, first a total of 2560 items were generated using computer technology and SMEs in field of Turkish literature. In the second stage, 60 randomly selected items were examined. As a result of the research, it was determined that a large item pool could be created to be used in online measurement and evaluation applications using automatic item generation.

BACKGROUND: Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilots success, a formal dental care advocate (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS: Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS: With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS: Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.

We conducted interviews with clinicians and staff involved in Veterans' decisions about where to receive their health care to assess experiences with community care coordination and identify areas for improvement. Insufficient time and knowledge were cited as barriers to assisting Veterans in making decisions about whether to use community care resources. Concerns regarding quality of community care and lack of patient understanding on the implications of accessing community care also arose. Clinicians need to be able to help Veterans make informed choices about where to receive their health care and may require decision support that integrates their informational needs with their values and preferences, clarity on the referral process, and improved ways to measure and describe quality of care to Veterans. VA has recognized issues with community care and established new initiatives but the rollout is complex and ongoing. [ABSTRACT FROM AUTHOR]

ContextEarly tailored transplant education could help patients make informed transplant choices.ObjectiveWe interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken.DesignA grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations.ResultsBarriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant.ConclusionIncreasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.

Purpose Results of the first ASHP national survey of clinical services provided by health-system specialty pharmacies (HSSPs) are presented. Methods A survey questionnaire was developed by 26 HSSP contacts after reviewing available literature on the role and services of HSSPs. After pilot and cognitive testing resulting in a final questionnaire of 119 questions, a convenience sample of 441 leaders in HSSPs was contacted using email and invited to participate in the survey. Results The survey response rate was 29%. Almost half of respondents (48%) had offered pharmacy services for 7 years or more, and most (60%) dispensed more than 15,000 prescriptions annually. Respondents most commonly (42%) reported a specialist model wherein staff are dedicated to specific specialty disease states. Over half of respondents reported providing several medication access, pretreatment assessment, and initial counseling services to patients referred to them, regardless of whether the HSSP was used for medication fulfillment. All HSSP activities were noted to be documented in the electronic health record and visible to providers frequently or always. Almost all respondents noted that HSSP pharmacists have a role in specialty medication selection. Disease-specific outcomes were tracked in 95% of responding HSSPs, with 67% reporting that outcomes were used to drive patient monitoring. HSSPs were often involved in continuity of care services such as transitions of care (reported by 89% of respondents), referral to other health-system services (53%), and addressing social determinants of health (60%). Most respondents (80%) reported providing clinical education to specialty clinic staff, including medicine learners (62%). Though only 12% of respondents had dedicated outcomes research staff, many reported annually publishing (47%) or presenting (61%) outcomes research. Conclusion HSSPs are a clinical and educational resource for specialty clinics and have developed robust patient care services that encompass the patient journey from before specialty medication selection through treatment monitoring and optimization. [ABSTRACT FROM AUTHOR]

BACKGROUND: Persistent and severe low back pain is challenging to treat. Multidisciplinary care with systematic follow-up may be more effective than usual care. However, such a model has yet to be developed and tested. OBJECTIVE: Our objectives were to develop and test the feasibility of a three-month multidisciplinary intervention with systematic follow-up in a specialized hospital spine center for patients with severe and persistent low back pain. METHODS: Using the Medical Research Council and National Institute for Health and Care Research framework for the development and testing of complex interventions, we developed a multidisciplinary intervention with systematic follow-up and tested its feasibility, using a-priori-determined outcomes during three months for 24 patients seen at a regional diagnostic spine center unit. As part of the evaluation, we conducted semi-structured interviews with participants and a focus-group interview with clinicians. RESULTS: Of the 24 patients included, only 17 completed the course of care and provided complete data for feasibility assessment. We failed to reach our a-priori feasibility outcomes, had difficulty with inclusion, and participants did not find the intervention effective or satisfactory. CONCLUSIONS: The intervention was not feasible as barriers existed on multiple levels (e.g., clinical, administrative, and patient). Excessive study moderations must be made before the intervention is feasible in a randomized trial. [ABSTRACT FROM AUTHOR]

Background. In 2018, Egypt underwent a health system reform programme, in which a universal health insurance system rolled out across the country beginning, with the Port-Said Governorate in July 2019. Objectives. This study was conducted to assess patient satisfaction and health system responsiveness among attendants to family health centres and units affiliated with universal health insurance in the Port Said Governorate, Egypt. Material and methods. A descriptive cross-sectional study was conducted that included 156 patients who were seeking health care in family health centres and units affiliated with universal health insurance in the Port Said Governorate. A multi-clustering sampling technique was used. Data was collected using an interviewer-administered questionnaire. Results. Among the 156 patients who were enrolled in the current study, 54 were male (34.6%) and 102 were female (65.4%), with a mean age of 37.10 ± 15.22 years. Regarding domains of health system responsiveness, about 73% of the attendants perceived the overall health system responsiveness as good regarding the domains of basic amenities, communication and confidentiality. On the other hand, three domains were perceived as poor, including autonomy, prompt attention and dignity (37.8%, 34% and 30.8%, respectively). Conclusions. It was found that more than two third of the attendants perceived the overall health system responsiveness as good. [ABSTRACT FROM AUTHOR]

Background: Systematic comparisons of the doses of the Food and Drug Administration (FDA)-approved dual orexin receptor antagonists (DORAs) for people with insomnia are limited. Methods: PubMed, Embase, Cochrane Library, and Clinicaltrials. gov were systematically searched to identify relevant studies published before 31 October 2022. We assessed the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework. Results: We pooled 7257 participants from 9 randomized controlled trials (RCTs). Moderate to high certainty evidence demonstrated suvorexant (20 and 40 mg) and daridorexant (10 and 50 mg) as the most effective in latency to persistent sleep (LPS) reduction. Lemborexant at 5 and 10 mg was the most effective in subjective sleep onset time (sTSO) reduction. For wake time after sleep onset (WASO), all drugs except daridorexant 5mg were more effective than placebo. Lemborexant 5mg was among the best in subjective WASO (sWASO) (moderate to high certainty) and had the highest surface under the curve ranking area (SUCRA) values for sWASO (100%). For total sleep time (TST), suvorexant and daridorexant, except the respective minimum doses, were more effective than placebo, while suvorexant 40 mg and lemborexant 10 mg may have been the most effective for subjective TST (sTST) (low to very low certainty). Suvorexant 40 mg (RR 1.09), suvorexant 80 mg (RR 1.65), and daridorexant 25 mg (RR 1.16) showed a higher safety risk than placebo. Conclusion: Suvorexant 20 mg, lemborexant 5 mg, lemborexant 10 mg, and daridorexant 50 mg represent suitable approaches for insomnia. [ABSTRACT FROM AUTHOR]

Developments in the field of education have significantly affected test development processes, and computer-based test applications have been started in many institutions. In our country, research on the application of measurement and evaluation tools in the computer environment for use with distance education is gaining momentum. A large pool of items is required for computer-based testing applications that provide significant advantages to practitioners and test takers. Preparing a large pool of items also requires more effort in terms of time, effort, and cost. To overcome this problem, automatic item generation has been widely used by bringing together item development subject matter experts and computer technology. In the present research, the steps for implementing automatic item generation are explained through an example. In the research, which was based on the fundamental research method, first a total of 2560 items were generated using computer technology and SMEs in field of Turkish literature. In the second stage, 60 randomly selected items were examined. As a result of the research, it was determined that a large item pool could be created to be used in online measurement and evaluation applications using automatic item generation. [ABSTRACT FROM AUTHOR]

Copyright of Gazi Journal of Educational Sciences (GJES) is the property of Gazi Journal of Educational Sciences (GJES) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While cultural competency has been recognized as an important feature in health care delivery, evaluating intervention effectiveness is often overlooked.This project used an explanatory sequential mixed methods study design within a community-based participatory research structure. A 29-item Organization cultural competency Checklist was created and distributed to a purposive sample of staff at 55 New York State (NYS) Department of Health AIDS Institute-funded health and human service providers. Organizations recruited clients to complete a 27-item Client Checklist. Basic univariate analyses were conducted on quantitative items (Stata v.18). For questions asked to both groups, we conducted chi-square tests to determine statistically significant differences (p-value < 0.10). Qualitative stories about the impact of culturally competent care provision were analyzed using the Most Significant Change process by a Community Advisory Board (CAB) of LGBTQ+ NYS residents.The Organization Checklist had 92 responses from 37 organizations. The Client Checklist yielded 32 responses from five organizations. While high agreement between client and staff was reached on the majority of items, opportunities for improvement included updated intake forms and strengthening relationships with other local LGBTQ+ organizations. Using 62 raw stories, the CAB identified two main themes of affirming and un-affirming care, further organized into personal, perception, provider, and systemic categories.Clients reported higher engagement in health-seeking behavior with culturally competent providers and care-avoidance with culturally incompetent care. Clients decided the safety of expending emotional labor to educate providers. Improving organizational cultural competency is an ongoing process requiring consistent and prompt attention. [ABSTRACT FROM AUTHOR]

Objective: To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO. Material and Methods: Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination. Results: The total of 932 CEO’s were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO’s had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases. Conclusion: Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO’s actions was evidenced, mainly related to the work processes. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Antropología Social is the property of Universidad Complutense de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Special Study Week-SSW, as an opportunity for in-depth and critical studies in an important thematic field, is a new practice at the Faculty of Pedagogy at the University of Tetova. It is carried out in collaboration with the Swiss Association ARSIMI6. Participants include fourth-year students of the Faculty of Pedagogy, lecturers from this faculty, and a representative of the ARSIMI association. Based on the hypothesis that "Critical assessment, transparency, and taking results seriously have a positive impact on changing and improving weak elements," the four days of the SSW were evaluated in detail by 60 participating students. The assessments for each previous day were presented the following day. In the paper titled "The Effects of Evaluation of the Special Study Week - A Case Study of the Faculty of Pedagogy at UT," the assessments of each day and the overall evaluation are presented. The overall evaluation indicates that this week has influenced the increase in knowledge and the way of studying - especially as researchers and discoverers. Didactic methods and professional competencies of lecturers received the highest ratings from students. The increase and expansion of students' knowledge are evaluated at 5.71 (out of 6), while the possibility of applying the acquired knowledge in professional work is rated at 5.68. The duration of lecture sequences and the participation and integration of all participants in the activities carried out received a lower average rating. After processing the evaluations, it was found that the overall assessment of SSW is correlated with didactic methods of work and social forms (Pearson's coefficient of 0.498), with study and group work, and with the work atmosphere created (Pearson's coefficient of 0.457). [ABSTRACT FROM AUTHOR]

Background: In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics., Objective: The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP., Design Setting and Patients: This was a retrospective cohort study of children with NS in BC., Measurements and Methods: We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna)., Results: Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m 2 vs 3492, IQR 3397-3644 mg/m 2 , P = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = .575), or development of frequently relapsing courses (50% vs 62%, P = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, P = .655) and dietitian-reviewed food records (67% vs 47%, P = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, P = .01, BCCH vs regional)., Limitations: Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance)., Conclusion: Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses. Materials and Methods: This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects. Conclusions: This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions.

Without any doubt, we are living in a very modern, sophisticated, and computerized world, in which a great part of the activities done in the past by workers, are now carried out by machines or intelligent devices, capable to communicate with the environment and to make decisions according to the information received from there. The ergonomics science adapted during the time, introducing in its area of study the effects of the human-computer interaction, the new forms of stress, and the new factors which are affecting the work at the workstations. However, there are still workplaces where physical work is prevalent and where it is necessary to analyze the work conditions to improve them and to avoid injuries during the work. This study is based on the research which has used ergonomic analysis, namely the LEST method for the optimization of the work of handler workers at a Romanian company with several working points in different regions of the country. The working points are equipped with different endowments depending on the period when they operate. The study reveals that the handlers are facing different problems at their workstations depending on the technical level of the equipment they use and the organization of the work. The same tasks lead to different perceptions and different levels of fatigue for the workers. The ergonomic analysis offers the possibility to identify the stress factors for each workstation and optimize them to provide optimum work conditions in which the worker can perform in the best way.

Purpose Specialty medications can have life-altering outcomes for patients with complex diseases. However, their benefit relies on appropriate treatment selection, patients' ability to afford and initiate treatment, and ongoing treatment optimization based on patient response to therapy. Mounting research demonstrates the benefits of the health-system specialty pharmacies (HSSPs) in improving specialty medication access, affordability, and outcomes. The purpose of this rapid review is to describe the currently reported role and function of HSSP pharmacists and outcomes reported with use of the HSSP model, and to identify gaps in the literature where more information is needed to better understand the HSSP model and outcomes. Summary Current literature describes the role of HSSP pharmacists in facilitating patient access, affordability, and initiation and maintenance of specialty medications. Though it is clear HSSP pharmacists are involved in treatment monitoring, often through utilizing the electronic health record, more information is needed to elucidate the frequency, method, and extent of monitoring. Despite several valuable continuity of care services reported to be provided by HSSPs, the breadth and degree of standardization of these services remains unclear. There is minimal literature describing HSSP education and research involvement. HSSPs have reported significant benefits of this patient care model, as demonstrated by higher adherence and persistence; better clinical outcomes; financial benefits to patients, payers, and the health system; better quality of care; higher patient and provider satisfaction with services, and highly efficient specialty pharmacy services. More literature comparing clinical and diagnosis-related outcomes in HSSP versus non-HSSP patients is needed. Conclusion HSSPs provide comprehensive, patient-centered specialty medication management that result in improved care across the continuum of the specialty patient journey and act as a valuable resource for specialty clinics and patients beyond medication management. Future research should build on the current description of HSSP services, how services affect patient outcomes, and the impact HSSP network restrictions. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Management & Agribusiness / Jurnal Manajemen & Agribisnis is the property of IPB University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: : Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses.Materials and Methods: This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: : The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects.Conclusions: : This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions. [ABSTRACT FROM AUTHOR]

Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P <.001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations. [ABSTRACT FROM AUTHOR]

Although Americans seek care for their nail diseases on an outpatient basis, they also seek nail care in the setting of the emergency department (ED). This study aims to characterize the treatment of nail diseases at ED visits in the United States from 2009–2018. Data from 2009–2018 was collected from the National Hospital Ambulatory Medical Care Survey for EDs. There was an estimated 1.54 (95% CI [1.35, 1.74]) million nail visits to the ED from 2009–2018. Whites accounted for the most visits (57%), followed by African Americans (21%). 25–44-year-olds was the age group with the most visits. The South was the region with the most visits (33%). The most common diagnosis was paronychia (42%). Treatments for paronychia included oral antibiotics, incision and drainage, or both. The accuracy of reporting the correct diagnosis remains the biggest limitation. Nail disease visits accounted for over a million visits to the ED from 2009–2018. All ages and sexes were represented in these visits. Paronychia made up the largest portion of visits and was treated with oral antibiotics, incision and drainage, or both. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) inform healthcare decisions and improve patient care. However, an evaluation of guidelines on gastrointestinal diseases (GIDs) is lacking. This study aimed to systematically analyze the level of evidence (LOE) supporting Chinese CPGs for GIDs., Methods: CPGs for GIDs were identified by systematically searching major databases. Data on LOEs and classes of recommendations (CORs) were extracted. According to the Grades of Recommendation, Assessment, Development, and Evaluation system, LOEs were categorized as high, moderate, low, or very low, whereas CORs were classified as strong or weak. Statistical analyses were conducted to determine the distribution of LOEs and CORs across different subtopics and assess changes in evidence quality over time., Findings: Only 27.9% of these recommendations were supported by a high LOE, whereas approximately 70% were strong recommendations. There was a significant disparity among different subtopics in the proportion of strong recommendations supported by a high LOE. The number of guidelines has increased in the past 5 years, but there has been a concomitant decline in the proportion of recommendations supported by a high LOE., Conclusions: There is a general lack of high-quality evidence supporting Chinese CPGs for GIDs, and there are inconsistencies in strong recommendations that have not improved. This study identified areas requiring further research, emphasizing the need to bridge these gaps and promote the conduct of high-quality clinical trials., Funding: This study was supported by the National Key R&D Program of China (2022YFC2503604 and 2022YFC2503605) and Special Topics in Military Health Care (22BJZ25)., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods: A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results: Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion: The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level. [ABSTRACT FROM AUTHOR]

While digital health solutions have shown good outcomes in numerous studies, the adoption of digital health solutions in clinical practice faces numerous challenges. To prepare for widespread adoption of digital health, stakeholders in digital health will need to establish an objective evaluation process, consider uncertainty through critical evaluation, be aware of inequity, and consider patient engagement. By "making friends" with digital health, health care can be improved for patients. [ABSTRACT FROM AUTHOR]