bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards Active Integrated Waiting Lists: The Patient Lived Experience
Authors: Hayes Daniel , Lipscombe Paul , Betts Pete , Cledwyn Victoria , De Jesus Merlisa , Robbins Tim , Chapman Rachel , Randeva Harpal , Patel Kiran
Published: January 2024

Background: Specialist healthcare providers internationally face challenges managing elective care waiting lists. There is an increase focus on how we can provide integrated care solutions to achieve active rather than passive waiting. This requires potentially complex interactions across care boundaries and care providers alongside novel digital solutions. Crucially however we must also understand the lived patient experience of people on those waiting lists. Little research has considered the lived experience of people on waiting lists for specialist care.

Methods: 46,000 individual patients on waiting lists at a major tertiary referral centre in the West Midlands, United Kingdom were sent a survey to understand their experiences of waiting for specialist care whilst remaining in the community context. Patients were contacted via SMS initially with a link to a web-portal with follow up contact via letter for those who did not complete the initial survey. This work is linked to/informed by extensive, commissioned, independent deliberative patient and public involvement work looking at waiting list management previously completed for this organization. This was approved locally as a service evaluation.

Results: 20,741 responses were received, representing a 45% response rate. 62% of response were received via the website, with 38% via letter. 1,633 patients (7.9%) wished to be removed form the waiting list. 18.5% felt that being on the waiting list was severely stopping them from carrying out normal tasks, 17.7% reported that being on the waiting list was severely impacting their ability to work and 14.0% reported that being on the waiting list severely impacted their ability to care for others. 20.7% felt their condition had got severely worse whilst on the list. Impact of being on the waiting list was most notable for those in the most deprived population groups, with 25% of patients in the most deprived areas having been severely impacted by the wait time, compared with 14% in the least deprived areas. There was additional variation on the impact of waiting based on ethnicity, age and work status.

Discussion: High healthcare demands result in an inevitability of patients waiting for specialist services. This work demonstrates the diversity of lived experiences for patients on elective care waiting lists, stressing differences between key population groups including those with protected characteristics. Patient cohorts within specialist waiting lists must be seen as diverse and dynamic. Much promised prioritisation and active waiting initiatives must be individualised to meet the diverse needs of the people on the waiting lists and recognise further work is needed to better understand how to engage with these groups.

Funding received from: West Midlands Academic Health Science Network: Safety Innovation and Improvement Fund
Putting proportionate universalism into practice: challenges and tools
Authors: Van Brussel Leen
Published: January 2024

Proportionate universalism is a well-know strategy in the effort of reducing social health inequalities. It refers to the resourcing and delivering of universal services and interventions at a scale and intensity proportionate to the degree of the need of the target group. However, putting the principle of proportionate universalism into practice, is highly challenging. Applying proportionate universalism demands for a systematic thinking exercise about similarities, unique characteristics and differences of and between different subgroups, especially those most at risk, that are part of the broader target group (e.g. inhabitants of Flanders).

Developing a well thought out strategy of proportionate universalism requires an answer to the following questions:

-What are the high-risk subgroups that require special attention? 

-Can the needs, interests, concerns, barriers, … of the high-risk groups be integrated in a universal approach that serves the entire target group?

-What ‘proportionalities’ need to be added to the universal approach so that high-risk groups are definitely served?

-Are there particular needs, barriers, concerns, … of high-risk groups that are very specific and different from those of other subgroups, which requires the development of a ‘categorical’ service, intervention,… targeting one specific subgroup?

We developed a user guideline, ‘Determining your proportionate universalism strategy’, which supports professionals in the field of prevention and health promotion to reflect upon these questions and formulate answers to them.

In addition to this guideline, we developed an inspirational guide including 10 methods that help professionals putting proportionate universalism into practice: ‘Health promotion for and with socially vulnerable populations: 10 methods for an inclusive approach’. These methods are well known for their potential in health promotion for and with underserved and socially vulnerable groups. The methods are visually presented and clustered in a ‘cake’ and divided into four categories: 1/ ‘getting to know’, 2/ reach, 3/work together and 4/empower and advocate. Each method is furnished with good practices from the field. During the months to come, focus will go to the implementation of both tools (the user guideline and the inspiration guide) in the sector of prevention and health promotion in Flanders.

 

In this presentation, we will present both tools and focus on how they can be used to support the development and implementation of inclusive health promoting interventions that follow the principle of proportionate universalism. We will refer to multiple good practices to illustrate the tool’s added value for professionals and policy makers.
Implementation of an asynchronous general practitioner‑to‑specialist  eConsult service (eConsultant) in Australia
Authors: Job Jenny , Jackson Claire , Liddy Clare , Nicholson Caroline , Donald Maria
Published: January 2024

Background: With the rise in demand for specialist care across Australia, patients are experiencing excessive delays for specialist input, linked with subsequent deterioration in health. eConsultant is an outpatient substitution model which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving GPs remote access to specialist support for patient care within 3-business days. This study, the first to track implementation of an eConsultant service in Australia, identifies barriers and enablers to adoption prior to broader implementation.

Method: Our prospective mixed-methods observational study included semi-structured interviews with GPs and stakeholders to understand determinants of implementation. GPs send a Request-for-Advice (RFA) to the specialist and advise patients to schedule a timely follow-up appointment to discuss the eConsultant advice. Adoption (program enrolment/usage by GPs & GP practices) was assessed.

Results: The study is underway in 12 rural/remote and 10 urban general practices. To date, RFAs have been generated for 178 patients (mean age 59.5yrs, 63% rural, 37% urban). The GPs mean time to response by the eConsultant was 1.7 (SD 2.3) days and patients mean time to specialist input (initial GP to GP follow-up appointment) was 13.0 (SD 2.7) days (well below average waiting times for OPD appointments). Qualitative interviews conducted with 11 GPs and 4 stakeholders highlight the benefits of eConsultant to providing efficient/timely access to specialist support for GPs and their patients.

Conclusion: eConsultant is feasible in Australia with benefits to the health system of timely specialist support for patients without the cost of subsidised patient travel, face-to-face visits, and potentially preventable hospital admissions. eConsultant provides GPs with a reliable, auditable record of advice given by specialists, an opportunity for GP practice capacity building and more direct partnership with specialist colleagues. eConsultant offers a streamlined evidence-based option, implementable state-wide, to support patients and primary care providers.
Partnership “Integrated Broad Intake” (IBI)
Authors: Devos Inne
Published: January 2024

Three primary health care organizations are working together to ensure that the barrier is lowered for vulnerable groups to make effective use of all kinds of rights, both financial and social. This partnership “Integrated Social Care” wants to combat non take up and wants to increase the accessibility of social services by working proactively and by outreach.

To set up such partnership depends on the local context. A careful analysis and knowledge of the field, involvement of all relevant actors and the target group itself, are essential to make it work. Client participation is a crucial aspect.

Every citizen can turn to a partner of this partnership for all questions related to health, work, care, finances and social problems. Nevertheless, this partnership focuses on the most vulnerable citizens who do not (yet) receive the social rights they are entitled to.

Colleagues from different ranks of the public social welfare center (OCMW), the social work center (CAW) and the social work department of the health insurance funds (DMW) work together on solutions, along with other local partners and service users.

The partnership ""Integrated Social Care"" is not an organizational model,  but it is a way of offering solutions to vulnerable citizens with complex welfare questions that you cannot find within your own organization alone. This partnership provides neutral information on local social help and service options. They investigate and realize social rights, clarify questions and refer to appropriate local social help and services in a neutral way. A client no longer has to go to different services. Social workers from this different organizations find each other so that the necessary expertise is shared. They work by client centered focus and in a proactive and outreaching way to detect people who were previously under the radar.

This network is strengthened with local partners, such as poverty associations, community work and family doctors. The local government has the final responsibility.

The process guidance provided by the Flemish government to realize this partnership in practice is through the principles of Service Design. In fact, Service Design is both an attitude (customer orientation), a methodology (co-creation with users and employees) and a set of tools (a collection of techniques to develop aid and social services). So, it is not only talking about it, but it's about working in practice with and for the target group.

 

 

Several scientific studies have given us insights to improve the local implementation of this partnership. And we are still learning. The 59 different partnerships ""Integrated Social Care"" are also inspired by each other by using an online platform and by participating guided moments where they exchange good practices.

The objective is a rollout across Flanders in 2022-2023 and a structural embedding of the working principles of “Integrated Social Care” in 2025.
Measuring and Improving Adherence in Primary Health Care – best practices from Medical and Diagnostic Center in Siedlce, Poland
Authors: Owczarczyk Anna , Bogdan Magdalena , Zuk Pawel , Kalisz Małgorzata
Published: January 2024

Adherence is defined as patient compliance with agreed treatment recommendation in order to achieve a therapeutic result. It could be described as combination of three behaviors: compliance, persistence and concordance. “Compliance” is the extent to which a person’s behavior is consistent with the medical advice. In practice, this means following the doctor’s recommendations. “Persistence” means systematic and persistent application of therapy. Finally, “Concordance” is the collaboration between the patient and the doctor in the choice of therapy. Adherence is therefore based on: acceptance of the agreed therapy, adherence to its principles and systematic adherence to the recommendations.

In order to reproduce all three of those components, Medical and Diagnostic Center (MDC) in Siedlce, Poland has developed four dimensions to measure adherence in:

-intake of medication,

-registration for and appearance on compulsory medical visits,

-degree to which patient evaluates the importance of taking medication for their health,

-patient’s active participation in caring for their health.

First two dimensions measure patient’s compliance and persistence. The issues therefore concern both the fact that certain measures are taken and their regularity. Two other domains consider patient’s concordance. Importantly, fourth dimension focuses on patient role in their health. It assumes that the patient, who is responsible for his or her health, should not only follow the rules of adherence by participating passively in the treatment process, but should also play an active role: they should maintain adequate nutrition, exercise regularly, restrict the use of stimulants or quit smoking. Patients should also be transparent with their doctors about the medicines they are taking.

Adherence of patients in MDC is evaluated by means of patient interview with open-ended questions, but also by verifying data on patient’s weight, filling out prescriptions and registration for compulsory medical visits, including carrying out of preventive check-ups. This is thanks to connected IT system between primary care facilities and pharmacies.

Studies in European countries show that about half of chronically ill patients have problems adhering to prescribed treatment. Encouraging patients to monitor their behaviors, empowering them in making informed decisions around their heath and holding them accountable are key strategies to minimize non-adherence and ensure effectiveness of therapy.
The contribution of the charge nurse in integrated healthcare
Authors: Jubinville Maripier
Published: January 2024

Background:  A charge nurse (CN) is defined as a nurse who holds a clinical-administrative management position. The role requires five essential skills: leadership; interpersonal communication; clinical-administrative caring; problem solving; and knowledge and understanding of the work environment. According to Plourde (2012), these skills can be divided into sub-skills that are needed in practice by CNs when upholding appropriate standards of quality of care in healthcare delivery. These skills are also essential for CNs when facilitating the process of integrated care within healthcare facilities. However, the scientific literature describes less-than-ideal work performance by CNs that relates to a lack of specialized and adapted training. Necessary skills are poorly addressed in the education of CNs, and they receive little formal support upon entry to practice. CNs play an essential role in coordinating processes surrounding integrated care in healthcare facilities, however the literature is scarce on this role of the CN. Objective: To demonstrate the extent to which the CN, by fulfilling their role, contributes to integrated care within healthcare facilities. Methods: A scoping review using the Joanna Briggs Institute (2020) framework was performed. Using a prepared search strategy, CINAHL, MEDLINE, Cairn, and grey literature databases were queried for articles written in French or English and published between 2000 and 2022. Articles mentioning at least one of the five CN skills named by Plourde (2012) were selected. Articles were analyzed according to “Leviers et obstacles au développement de l’ISS” by Longpré (2017) (Facilitators and barriers to the development of the integrated care model) which describes essential elements to consider in order to foster integrated healthcare. Results: 150 articles were retained and analyzed. These articles describe CN skills and how they are operationalized in practice. It was found that the skills and sub-skills of the CN are often addressed in articles describing integrated care, including for example the coordination of a patient's care during their hospitalisation. In addition, CNs allow for accessibility, continuity and integration of care. As such, CNs are key player in the implementation and development of better integrated care. Conclusion: This study illuminates the relevance of providing essential CN training that reinforces the CN skill set which in turn improves the quality and safety of integrated care in healthcare facilities.
Quality Care Program: Raise awareness, motivate and coach community-pharmacists to provide high-quality pharmaceutical care.
Authors: Saevels Jan , De Wulf Isabelle , Duquet Nathalie , De Rocker Hendrik
Published: January 2024

Apart from providing pharmaceutical care when dispensing prescribed medicines, responding to the demand for an OTC drug or advice, is another core task of the community pharmacist. By asking the correct questions, the pharmacist collects all the necessary information to accurately estimate a patient's specific health problem. Pharmacists have a social responsibility and guarantee the responsible delivery of health products and medicines at all times, especially when it concerns non-prescription medicines or in the context of self-care. By providing this person centered care, pharmacists can distinguish themselves from other dispensing channels and can justify why the dispensing of medicines, including OTC medicines, is reserved for the pharmacy.

This brought the Association of Pharmacists Belgium (APB), together with the training institutes for pharmacists, the local pharmacists' associations, and the Belgian universities, to set up the Quality Care Program. The aim of this program is to raise awareness, to motivate and to coach community-pharmacists to provide high-quality care. The program consists of 4 main components:

1. Scientific education: knowledge is the foundation when it comes to quality of care. In addition to cooperation with the training institutes, the existing educational material is collected at a central location.

2. A knowledge test that assesses the knowledge, skills and attitude of pharmacists. The test is intended to be constructive, to confirm that people are doing well or to indicate which points deserve more attention in the pharmacist's approach.

3. Pharmacy Simulator, a serious game (educational video game), is a virtual learning program in which pharmacists learn in a playful way to ask their patients the right questions.

4. A patient perception study aims to provide feedback to pharmacists about how they approach patients with their demand for an over-the-counter medicine in their pharmacy.

The Quality Care Program was launched in 2021. Each year, the emphasis is on two therapeutic drug groups. Meanwhile, 4 cycles have already been organized on analgesics, laxatives, emergency contraception and reflux for which the global results have been published after each cycle. In the coming months we will investigate how the pharmacy simulator can be better applied and how pharmacists can learn from each other.
Integration of real-world data into clinical data for better personalised treatment of breast-cancer patients
Authors: Ruszanov Anett
Published: January 2024

REBECCA is 4-year project funded under the European Union’s Horizon 2020 research and innovation programme. The project aims to tap into the potential of Real World Data to provide personalised treatment and care to breast cancer patients or cancer survivors. The ultimate goals of REBECCA are to advance clinical research by moving beyond randomised controlled trials and to improve post-treatment in breast cancer to increase patients’ quality of life. 

REBECCA stands for REsearch on BrEast Cancer induced chronic conditions supported by Causal Analysis of multi-source data. The project is built around two axes: 1) clinical research by analysing data to better understand how treatment affects quality of life, and 2) patient management to improve interventions and care choices at the individual level. 

Currently, randomised controlled trials (RCT) are the gold standard in clinical research. However, there are several limitations of using RCTs for complex chronic conditions such as breast cancer as patients may suffer from different conditions that are influenced by various variables. Moreover, RCTs usually only include a small population sample and researchers do not have control over the independent variables. REBECCA aims to move beyond RCTs by using real-world, observational data. 

Real-World Data in REBECCA is collected through sensor and log data retrieved via electronic health records and innovative technical tools developed by the project consortium such as mobile apps and wearable devices (e.g. smartwatches or fitness bands). Patients’ real-life behaviour can thus be monitored, including their physical activity, eating habits, sleep, local environment and information related to their online interaction. Once collected, the real-world data is then processed to extract indicators, which are consequently used to infer causal relationships with PROMS and complex chronic conditions. The causal modelling then indicates causalities and sheds light on confounders.

Causal modelling will enable health managers and practitioners to measure the safety and effectiveness of breast cancer treatments and measure their impact on the quality of life after breast cancer treatment, to improve clinical outcomes and PROMs, and to help develop personalised recommendations and treatments based on the data collected by each patient, thus increasing the value for patients. 

The proposed oral poster session aims to demonstrate through evidence how innovative digital tools collecting patients’ data from informal life settings in a non-invasive manner can be integrated to clinical data gathered in formal care settings and how these different sets of data together can support the provision of personalised treatment and care for breast cancer patients.  This integrated care method also highlights the benefits of detailed patient monitoring and individualised patient lifestyle consultations in patient care workflows.  "
Measuring goal progress using the goal-based outcome (GBO) measure in Youth Wellness Hubs Ontario – an integrated youth mental health service
Authors: Chiodo Debbie , Darnay Karleigh , Henderson Jo
Published: January 2024

Problem and Context. There is a growing body of evidence indicating that the prevalence of mental health difficulties, in particular anxiety and depression, is increasing among youth, and many young people in this age group (12-25 years) do not get adequate mental health support. Recently, a global movement to transform youth mental health services is underway with the establishment of integrated youth services (IYS) that offer youth-specific care and emphasize early intervention and prevention, developmentally and culturally- informed services, community engagement, evidence-based and evidence-informed interventions, and youth and family engagement. While outcome data has an important role in enhancing the effectiveness of care for youth mental health, having young people define for themselves the area they feel should be the focus of in an intervention are also common measures used in IYS settings.  Goal-setting has been used in therapy for several decades, and agreement on goals between young person and their clinician is thought to be central to successfully building a good therapeutic relationship and improving outcomes.

Who is it for? Service providers, researchers, clinicians, youth and families.

Who did you involve and engage with? Participants were young people (>5000) who engaged with a Youth Wellness Hub service between April 2020 and October 2022.  The data for this study comprised over 15,000 goals. Youth can set up to one, two or three goals at each visit using the Goal-Based Outcome (GBO) tool. Inductive thematic analysis was employed on the types of goals set by young people.

 What did you do?  The aim of this study was to explore the type of service goals set by young people who are engaging with integrated mental health services.  The study also looked at whether services facilitated progress in goals as set by young people.

What results did you get? What impact did you have? The analysis identified a number of goal-related themes related to improving mental health, reducing substance use and other addictions, improving physical health, service navigation, and self-improvement. Data from presentation to last assessment will be reviewed to examine change in progress on goals over time.

What is the learning for the international audience? Understanding the clinical utility of an idiographic measure like the GBO with young people accessing community-based services is critical because the tool allows for capturing aspects of young people’s lives that are of importance to them that may not be as easily captured on standardized outcome tools. 

What are the next steps? Future directions include continuous learning and evaluation of the GBO in integrated care settings and examining the association between goal progress and standardize outcomes.
Empowerment and intervention strategies to strengthen the use of sexual and reproductive health services by ensuring continuity of care for adolescent girls and internally displaced women in Burkina Faso
Authors: Sawadogo Pengdewende Maurice , Tchouaket Ngeumeleu Eric , Onadja Yentéma , Sia Drissa
Published: January 2024

Background: In Burkina Faso, a security crisis has displaced families within the country, fleeing high-risk areas. One of the major consequences of this displacement is the low use of sexual and reproductive health care and services, and the reduced empowerment of adolescent girls and internally displaced women (IDP). This research aims to analyze the situation and co-develop intervention strategies to strengthen the empowerment of these adolescent girls and IDP women for the use of these services by ensuring the continuity of this care.

Methods: This study is based on a mixed approach (quantitative and qualitative). The quantitative component is based on a survey of 1,474 randomly selected households in temporary IDP reception sites in the cities of Kaya and Kongoussi in Burkina Faso. Empowerment was analyzed in terms of motivational autonomy and exercise of choice in family planning. Descriptive analysis and multivariate logistic regression have allowed us to describe the empowerment of IDP women and adolescent girls and identify the determinants of the use of modern contraception among IDP adolescents and women. The qualitative component has enabled to co-construct intervention strategies to strengthen empowerment and also ensure continuity of care, using a participatory approach supported by a deliberative workshop.

Results: Out of a sample of 1,220, adolescent girls (12-19 years old) and women (20-49 years old) represented respectively 17.5% and 82.5%. The analysis showed that 42.5% of IDP adolescent girls and women were using a modern method of contraception at the time of the survey. The analysis also showed that 89.2% and 79.5% of adolescent girls and IDP women have low levels of motivational autonomy and exercise of choice in family planning, respectively. A poor perception of contraceptives side effects and possible difficulties with the partner or even the fear of having difficulties returning to fertility after contraception ""damage"" women's motivation to use contraception methods. In addition, the ability to discuss with the partner hinders the exercise of choice in contraception. Intervention strategies based on community dialogue and communication with IDPs and community members have emerged as those promoted to facilitate the use and continuity of health services.

Recommendations: Empowerment appears as a determining factor to enhance the contraceptive demand by adolescent girls and internally displaced women. Community dialogue and communication sessions on family planning for IDPs and the population must be well implemented.
Raising awareness for frailty in community dwelling elderly. First experiences of a frailty initiative by physical therapists in collaboration with municipal services.
Authors: De Zitter Ann , Van Nespen Barbara , Mariman Kristen , Willems Dorien , Roels Pascale , De Ridder Raïna , De Cock Kristof , De Hertogh Willem , Herremans Véronique , Bocklandt5 Ellen
Published: January 2024

Background: Falling in the elderly is a global health concern. A subgroup of elderly, i.e. those who are considered as frail, is at increased risk for falling. The prevention of falling is necessary to reduce its physical, psychosocial and socioeconomic impact. Health care providers in primary care are well positioned to reach this population. They can play an important role in informing and advising elderly and to raise awareness at an early or pre-frail stage. Pre-frail elderly, however, do not always visit care providers. Yet, they are the target group. To be able to reach them in a targeted way, the help of municipal services can be called in.

Objective: To analyze how a frailty screening can be organised successfully by physical therapists and municipal services.

Methods: Pre-frail community dwelling elderly (> 70 y old) in the community of Beveren, Antwerp, Belgium were invited for a frailty screening via the municipal information brochure and flyers. It was organised on two mornings between 9.00 h – 13.00 h. The screening consisted of the filling out of questionnaires (Short Falls Efficacy Scale-I, EuroQuality of life-5D, 1Minute-Osteoporosistest, Sarc-F(Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls), Self-reported history of fall incidents and dizziness), supervised by a community nurse or psychologist. Next, five physical tests were performed, supervised by physical therapists: Short Physical Performance Battery, Hand Grip Strength, Functional Reach Test. Lastly, an audiogram was taken by an audiologist. At the end of the screening all test results were discussed in a one-to-one conversation. All participants received tips, tricks and advise based on their personal situation. Additionally, general information on staying healthy and active was available.

To increase the number of participants, the tests were held in a public place and free public transport was provided for those in need of it. Other health care providers such as general practitioners, dietitians, healthcare promotors were informed about this screening initiative.

Results: In the community of Beveren (49.000  inhabitants, spread over an aera of 150 km²) we reached in two screening-moments 20 and 38 community-dwelling elderly. Relatively healthy elderly were present. 4 used the free public transport. We were able to screen and inform 58 persons on 7 hours. All participants were positive about the initiative and were open to the provided information.
Belgian Integrated Health Record (BIHR): from 2025, all well-being and health data will be available for all members of the care team, including the patient himself. 
Authors: De Maeseneer Jan , Broeckx Dirk , Montag Ilke , Briganti1 Giovanni , Van der Hulst Eric , Vandormael Dorien , Demyttenaere Bart
Published: January 2024

•Why are you conducting a workshop? Please explain the problem, the context, or the case study,

It would be an absolute added value for the BIHR-project to also hear the voice and opinion from other countries and experts: what went very smoothly? But also, what obstacles were they confronted with and how did they tackle these challenges.

•Who is it for? Please explain who you would like to engage with.

BIHR is a ‘Moonshot’: the expert group defined four major groups that are essential to bring BIHR to a successful project: the citizens, the healthcare providers, the various governments, and partners from the industry.

In the panel debate we would like to have representatives from those different stakeholders around the table.

It would also be an absolute added value to hear success stories from other countries and see if things could be realized in Belgium in the short and/or medium term.

•Ilke Montag, MD, MSc: lead of the Belgian expert panel about BIHR

•Jan De Maeseneer, MD, PhD: Head of WHO Collaborating Centre on Family Medicine and Primary Health Care - Ghent University Belgium

•Bart Van den Bosch, MD, PHD: CIO at University Hospital Leuven Belgium

•A representative of the European Patients Forum (European Patients' Forum - Home (eu-patient.eu))

•A representative of the International Hospital Federation (Home - IHF - International Hospital Federation (ihf-fih.org))

•Someone who can explain the concept and the functioning of EHRs in the Canadian Primary Health Care Services

•Someone who can explain the concept and the functioning of Slovenian Community health centers with multidisciplinary teams 

•What are you going to do? Please explain the structure of the session. Please remember that workshops’ objective is to be interactive and engage with the audience - At least ½ of the time should be based on the interaction with the audience.

•How are you going to engage with the audience?

•How are you going to summarize the take home messages?

We will start with a short 15 min. presentation/introduction of the concept of BIHR. Afterwards, the moderator asks for a short reflection on this concept by the various panel members. The panel members are then asked to name both a success story and the lessons learnt from less successful projects. To involve the public in the debate, statements for debate will be used, each time from a unique perspective (citizens, care providers, governments, industry). The panel members will be confronted with the voting results on the statements.

The take home message will be a compilation of the success keys cited by each of the panel. There will also be a warm appeal to work together not only across the various levels in health care, but also across national borders.
Family involvement in care: essential next step?!
Authors: Steeman Kim
Published: January 2024

First, we outline the current state of family involvement in mental health care. Based on testimonials from families and family organizations, the strengths, needs and deficits regarding family involvement in mental health care are listed. Furthermore, some innovative good practices are explained, demonstrating the ongoing evolution in healthcare.

Research has demonstrated that treatement, involving, supporting and informing family members and children has an important positive impact for family, patient and care provider.

However, too often Familieplaform receive signals from family members and family organizations that family invovement in mental health care is limited. Moreover, great differences exist between organisations, teams and health care provivers: while some organisations/teams/care providers akcnowlegde the importance of family (involvement) and make great efforts to maximale involve the context, many others don’t. By creating frameworks - such as the multidisciplinary guideline for involving relatives in mental health care - we want to invite mental healthcare organizations to systematically make the ‘family reflex’ and to see family as  equal partners in care.

The ‘Family Reflex’ translates the guideline on involving relatives in mental health care by offering online trainings, a Quickscan, coaching programs, etc. During this workshop, we will discuss the recommendations of the guideline, the merrit of the Family Reflex and our experiences in helping organisations and care providers to integrate these recommendations into their own practice. 

We discuss with participants on different topics : professional secrecy, support for family members/ children, participation in care.

Concrete:

explaination 45min

interaction 3x15 min (each topic/ can be less)
Analysis of Exhumations Carried Out in Three Divisions of Sindh
Authors: Saleem Muhammad Wasif , Singh Dolat , Fauzia Taqia , Rashid Azhar , Hashmat Shazia , Alam Shomaila Ameer
Published: January 2024

Aim: To determine the causes of death on exhumation in three divisions of Sindh, Pakistan Study Design: Cross-sectional Place and Duration of Study: Department of Pathology, Chandka Medical College, Larkana Methods: 131 exhumations carried over 1 year were included in the study. In accordance with protocol, the graves were first identified and body was removed from it. Routine autopsy was carried out. Written consent for obtaining data was taken from the relatives present and a standard proforma was used to note findings. Samples for histopathology were also taken and cause of death was evaluated. After taking relevant information, the bodies were buried in accordance with the religious and cultural norms of the relatives. Data was entered and analyzed using SPSS 22.0. Results: Males were more commonly exhumed. 21-40 years age group was most commonly involved. Most exhumations were carried out in Larkana. Most common weapon used was forced blunt trauma. Almost all bodies were at different stages of decomposition. We then observed the type of weapon/medium used. All 131 cases were of unnatural death. We observed that the most common weapon used was a hard blunt object (n=41; 31.29%), water causing drowning (n=34; 25.95%), sharp forced trauma (n=21; 16.03%) and strangulation (n=19:14.50%) were commonly used. Whereas, the least commonly used were firearms (n=16; 12.21%). According to our observation, 57.25% (n=75) were partially decomposed, 40.45% (n=53) had advanced decomposition whereas 2.29% (n=3) had no decomposition at all. Practical Implication: Analysis of exhumations is crucial for uncovering forensic evidence, resolving criminal cases, and providing closure to families. It helps ascertain causes of death, identify potential foul play, and contribute to the justice system's integrity. Additionally, exhumation analysis aids in refining investigative techniques and advancing forensic science. Conclusion: We recommend exhumation when required be carried out in females as well. We also recommend early exhumation in cases of suspected foul-play. Our data may help in future planning of policies regarding exhumation. Keywords: Exhumation; 3 Divisions of Sindh; Decomposition, Causes of Death, Drowning, Firearm Injuries, Weapon
Analysis of Stenting versus Non-Stenting in patients Undergoing Ureteroscopic Lithotripsy for Management of Ureteric Calculi
Authors: Wahab Aziz Ul , Alam Numan , Hussain Adee , Ali Izhar , Khan Ijaz , Mirza Zahoor Iqbal
Published: January 2024

Background: Ureteroscopic lithotripsy (URL) for ureteric calculi is commonly followed by ureteric stenting in around 60% of patients. However, its use for ureteric stones is debatable due to the stent-related symptoms and extra risks of stent migration, stent encrustation, and vesicoureteral reflux. Aim: To compare stenting to no-stenting in terms of mean operative time and mean hospital stay in patients receiving ureteroscopic lithotripsy for the treatment of ureteric calculi. Methods: This RCT, conducted at the Armed forces institute of urology Rawalpindi, included 104 patients aged 18 to 65 years with newly diagnosed ureteric calculi of 10-20 mm in size. They were subsequently separated into two equal groups, group A patient underwent ureteric stenting, and group B patients without a ureteric stent after uncomplicated calculus clearance with URL. Operative time was recorded in minutes, and hospital stay was measured in hours. Data were analyzed by SPSS version 22. Results: The mean (SD) operative time was significantly longer in group A as compared to Group B, 48.02 ± 4.33 and 33.67 ± 2.27 min, respectively (p-value <0.0001), similarly mean duration of hospital stay for Group B patients was significantly shorter as compared to Group A patients (21.94 ± 2.29 versus 27.10 ± 4.16 hours) which were significant statistically (p < 0.0001). Practical implication: Every URS procedure does not need stenting. Patients with uncomplicated URS should not under DJ stenting. URS without stenting reduces hospital stay and operative time. Conclusions: Non-stenting has reduced mean hospital stay duration and reduced mean operative time in comparison with stenting after URL; thus, unless desirably needed stenting in URL should be avoided. Keywords: Ureteroscopy (URL), DJ stenting, operative time. hospital stay. Keywords: Ureteroscopy (URL), DJ/JJ stenting, operative time.Hospitalstay.
Risk Factors of Neonatal Sepsis in DHQ Hospital Skardu
Authors: Bashir Muhammad
Published: January 2024

Background: Sepsis is a substantial cause of newborn illness and death. Few aspects of sepsis' clinical impact and risk factors are thoroughly recognized. Late-onset sepsis is linked to healthcare-associated infections and affects newborns older than seven days. Aim: To evaluate the clinical outcome and risk variables related to newborn sepsis at the DHQ hospital Skardu in Pakistan. Methods: A quantitative retrospective institution-based chart review was carried out at DHQ Hospital Skardu with a sample size n=225. Results: 164(72.9%l) of the 225 evaluated newborn charts were for newborns less than 7 days old, and 144(64%) were for males. Meconium aspiration syndrome involved forty newborns, or 17.8%, while abnormal respiratory symptoms affected twenty-nine infants or 12.9%. Among newborns diagnosed with neonatal sepsis, therapy resulted in complete recovery for 189(84%) infants, death for 9(4%) infants, and transfer of care to other hospitals for 13(5.7%) infants. Meconium aspiration syndrome and respiratory distress syndrome contributed to the poor prognosis of newborn sepsis (AOR = 0.1989 [0.059-0.664] and AOR = 0.258 [0.072-0.900], respectively). Conclusion: The clinical prognosis for newborn sepsis at DHQ hospital Skardu was worse than desirable. RDS and meconium aspiration syndrome were the most accurate indicators of a poor prognosis in newborn sepsis. It is hypothesized that improved prenatal care, early diagnosis and treatment of neonatal illnesses or abnormalities, and the provision of essential newborn care to all newborns through the end of the neonatal period will all contribute to improved neonatal outcomes. Keywords: Risk factors, treatment, Sepsis, Neonatal, DHQ hospital, Sakrdu, Pakistan
Prevalence of Musculoskeletal Disorders and Ergonomic Risk Factors among Firefighters
Authors: Farooq Hamza , Chaikumarn Montakarn
Published: January 2024

Background: Injury to the musculoskeletal system or the human body's ability to move is known as a musculoskeletal disorder (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.). Firefighting is a physically hard and dangerous job. Firefighters carry out emergencies and prevent fire and respond to disaster. Workers who deal with fireworks often have musculoskeletal disorders. Aim: To investigated the prevalence of musculoskeletal disorders and ergonomic risk factors among firefighters. Methodology: Nordic musculoskeletal questionnaire was used to report musculoskeletal disorders in 106 firefighters and quick exposure check (QEC) questionnaire was used in 20 firefighters for 3 different tasks to evaluate the ergonomic risk factors. Results: Firefighters experienced low back pain as major pain in last 12 months followed by shoulder and neck pain. Low back pain along with knee pain caused trouble in working in last 12 months. While pain in last 7 days were low back pain followed by knee and upper back pain. Task of lifting ladders on shoulder was the major ergonomic risk factor for developing musculoskeletal disorders as compared to holding up hose and folding the hose task. Conclusion: High prevalence was shown in low back, knees, neck and shoulder. Lifting up ladders on shoulder task leads to ergonomic risk for development of musculoskeletal disorders. Keywords: Firefighters, musculoskeletal disorders, ergonomic risk factors, QEC (quick exposure check), Nordic musculoskeletal questionnaire.
Clinico-pathological Spectrum of Pyogenic Granuloma in Patients Presenting at Ayub Teaching Hospital, Abbottabad
Authors: Naz Shabana , Naeem Shagufta , Rehman Abdur , Jadoon Zainab , Khan Naveed , Saad Ammar Bin
Published: January 2024

Background: Oral Pyogenic Granuloma (OPG) is a type of oral mucosal lesion that is distinguished by its rapid development, friable nature, and vascular proliferation. Aim: To examine the demographic and histopathological features of patients diagnosed with oral pyogenic granuloma. Study design: The cross-sectional study. Methodology: This study was conducted in the Dentistry Department of Ayub Medical College, Abbottabad following the acquisition of a comprehensive medical history through a pre-established form, pertinent clinical information pertaining to the patients, including age and lesion location, was collected. All excisional biopsy specimens were collected. Following preservation in 10% neutral buffered formalin, the gathered specimens underwent preparation for paraffin embedding. The histopathological findings that were assessed and documented included the observation of ulceration, inflammatory cell infiltration, vascular proliferation, fibrosis, and epithelial alterations. Data was analyzed in SPSS. Results: The 51 patients who were a part of the research had a mean age of 31.14+SD and were all female. The bulk of the patients were between the ages of 26 and 35. Lesion diameters varied from 0.5 to 3 cm, with 1.1 to 2 cm being the most common size range. 78% of the cases involved pregnant females. The most common site was the gum mucosa, lips, tongue, and palate were the next most typical locations for OPG. The majority of patients had pseudoepitheliomatous hyperplasia, mild chronic inflammation, and fibrosis, in addition to lobules of capillary sized blood vessels according to histopathological examination. Conclusion: Oral Pyogenic Granuloma is predominantly seen in young females, and is mostly associated with pregnancy and most common site is gum mucosa. The histopathological findings demonstrate characteristic features such as pseudoepitheliomatous hyperplasia, chronic inflammation, and fibrosis. Understanding these features contributes to accurate diagnosis and management of this lesion. Keywords: Oral Pyogenic Granuloma, lobular capillary hemangioma, pseudoepitheliomatous hyperplasia.
Success of Extracorporeal Shockwave Lithotripsy (ESWL) in Relation to Triple D Score
Authors: Hassan Bazgha , Yousuf Shariq Bin , Gul Laraib , Ullah Shuah , Qureshi Harris Hassan , Mahar Naveed Ahmed , Hashmi Altaf
Published: January 2024

Aim: To determine the frequency of success of ESWL in patients with renal stones and to compare the success of ESWL with different Triple D scores in the same group of patients. Methodology: Descriptive study in the Department of Urology, Sindh Institute of Urology and Transplantation Hospital, Karachi from 29thOctober 2020 to 28th April 2020. One hundred and fifteen patients with renal stone seen as radio opaque shadow on X rays KUB were included. CT was performed and stone diameters were measured. Quadruple D-score was defied because stone location is combined with TrD-S ranging from 0 (worst) to 3 (best) points. KUB was used for evaluation of stone free status after 4-weeks of ESWL sessions. Patient can be regarded stone free if complete stone was removed. Results: The mean age was 48.99±10.67 years, the mean size of the stone was 12.99±3.54mm, and the mean triple D score was 1.70±1.00. There were 75(65.22%) males and 40(34.78%) female patients. The success of ESWL was found in 79(68.70%) patients. On comparison of success of ESWL with triple D score, success of ESWL was found in 04(26.7%) having 0 score, in 19(54.3%) having 01 score, in 27(77.1%) having 02 score, and in 29 (96.7%) having 03 score (P<0.001). Conclusion: The triple D score appears to be a useful predictor of ESWL treatment outcomes. Using the Triple D score may improve the cost-effectiveness of ESWL by limiting its use to patients likely to have favourable outcomes. Key Words: Extracorporeal shockwave lithotripsy (ESWL), Triple D score, Renal stone