bluuebunny/crossref_metadata_2025 huggingface dataset:
76 Defining Social Prescribing Within a Physical Activity Context
Authors: Nielsen Rasmus , Sandell Jacobsen Julie , Andelius Dea Kejlberg , Jessen Nanna Holt , Rasmussen Lene Gissel , Skjerning Halfdan Thorsø , Simonsen Nina Sjørup , Skejø Sebastian , Bueno Solvej Videbæk , Ryom Knud , Kallestrup Per , Christensen Jeanette
Published: September 2024

Purpose

Social prescribing involves linking citizens with non-medical services and support within their community to enhance their health and well-being. In social prescribing, referring citizens to physical activities are often emphasized, probably due to their already existing availability within most communities. Various definitions of social prescribing exist in the scientific literature. Since then, a call for constructive criticism and incorporation of unique perspectives from different contexts was made as it was acknowledged that the definition of social prescribing will evolve over time, including within the domain of physical activity. On this basis, the purpose of the present study was to develop a definition of social prescribing within a physical activity context.

Methods

Based on previous consensus-based and non-consensus-based definitions of social prescribing published in scientific journals (n = 3), the authors (n = 12) of the present abstract co-produced a new definition of social prescribing within the context of physical activity based on face-to-face meetings and correspondence.

Results

The new definition of social prescribing reads: “Social prescribing in a physical activity context has the overall goal of contributing to health and well-being through a process of trusted entities (e.g. GPs) referring individuals directly or through a link worker to groups that are physically active and that support social belongingness”. In this definition, the individual has medial or non-medical needs and is therefore in need of help from trusted entities. Trusted entities can be, but are not limited to: family, friends, health professionals, authorities, job-center personel and patient associations. Link workers are knowledgeable about the possibilities of physical activity in the local area and they support the individual in a co-creating manner to find the best fitting activity. Social belongingness is essential, meaning that the physical activity is not carried out on one’s own, but together with others, thereby supporting physical, mental and social well-being, including the need to belong.

Conclusion

Given the rapid scaling and rollout of social prescribing globally, we hope this definition serves as a complementary contribution to the field of social prescribing by helping to build a common understanding of social prescribing within the field of physical activity.
235 Diagnostic Qualities of the Short Form of the Bruininks-Oseretsky Test of Motor Proficiency for Low Motor Competence
Authors: Šeflová Iva , Chudoba Josef
Published: September 2024

Purpose

The Bruninks Oseretsky Test of Motor Proficiency, 2nd Edition (BOT 2) diagnostic tool with 53 test tasks is used for objective assessment of motor proficiency with regard to the diagnosis of motor deficits in motor control. The normative criteria are initially validated on the US population ages 4 - 21. An adaptation for the European setting exists for German-speaking countries ages 4 - 14. There are short versions of the BOT 2 with self-selected items for screening purposes.

The aim of our study was to evaluate the diagnostic quality of a German short version of BOT 2 for low motor competence and for the risk of developmental coordination disorder.

Methods

The motor competence level in n = 637 Czech children aged 6.0-11.0 years (46.6% girls) was evaluated using Total motor composite and subcategories of fine and gross motor skills: Fine manual control, Manual coordination, Body coordination and Strength and agility.

We used the following variables to describe the diagnostic validity: Sensitivity, Specificity, Accuracy, Positive and Negative Predictive Values, the Receiver Operating Characteristic, and the Area Under the Curve.

Results

The short version of the BOT 2 shows a sensitivity for low motor competence of 77%, specificity of 86% and validity of 83%. For the risk of developmental coordination disorder, sensitivity is 77%, specificity is 94%, and validity is 93%. However, there is a lower positive predictive value of 49%.

Conclusions

The German short version of BOT 2 is an alternative test to the BOT 2 complete form, which is a suitable diagnostic tool for assessing low motor competence, including the diagnosis of risk for DCD. Overall, the BOT 2 short form provides a lower Total motor composite score than the BOT 2 complete form and places significantly more children in the well-below-average category. This is reflected in the low predictive value of a positive test.

Funding Source

This work was supported by the Technology Agency of the Czech Republic under Grant TA ČR Éta 3 TL03000221.
168 Real-world walking of people with the chronic lung disease COPD
Authors: Delgado Ortiz L , Buekers J , Chynkiamis N , Demeyer H , Frei Anja , Gimeno-Santos E , Hansen C , Hausdorff J , Hoopkinson N , Jansen C P , Koch S , Maetzler W , Megaritis D , Puhan M , Singleton D , Thoemmes G , Vogiatzis I , Watz H , Del Din S , Cauffield B , Becker C , Rochester L , Troosters T , Garcia-Aymerich J
Published: September 2024

Purpose

Walking is crucial for active and healthy ageing, but it changes with age and in the presence of diverse health conditions, such as non-communicable diseases. In the field of the chronic lung disease COPD (chronic obstructive pulmonary disease), extensive research has been done on physical activity limitation, but little is known about the patterns of walking during daily life (i.e., real-world). We aimed to assess the levels and distribution of real-world walking (walking activity and gait parameters) in people with COPD compared with healthy adults, and across disease severity; and to identify domains of walking in COPD, using a single wearable device.

Methods

In a cross-sectional study, 550 people with COPD (37% women, with a mean (SD) age of 68 (8) years, postbronchodilator FEV1 54 (21) %) and 19 age-matched healthy adults were recruited in ten cities across eight countries. Subjects were given a single wearable device to wear at their lower back for one week. Twenty-five walking activity and gait parameters (e.g., number of steps, number of walking bouts (WB)>30s, walking speed in WB > 30s, cadence in WB > 30s, walking speed and cadence variability) were derived from the device outputs.

Results

Most walking activity and gait parameters were reduced in people with COPD compared to healthy adults, and according to COPD severity. Differences remained statistically significant after adjusting for age, sex, height and comorbidities in multivariable analyses. Factor analysis identified six distinct walking domains: Amount of walking, Patterns of walking, Pace, Rhythm, Pace variability and Rhythm variability.

Conclusion

Real-world walking in people with COPD is a multi-dimensional behaviour that is impaired as the disease progresses. These results may be used to set priorities and improve patient centricity in clinical practice, research and public health initiatives.

Support/Funding Source

This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 820820. This JU receives support from the European Union’s Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).
51 She Moves - A comparative study examining the perception of the built environment between men and women
Authors: Duffy Lauren
Published: September 2024

Sustainable urban transport and active travel are part of policy and practice worldwide, with a strong focus on strengthening the relationship between transport and health (US PHA, 2021; NICE, 2012; EU Commission, 2013; ISPAH, 2020). The gap we see in physical activity with males globally being more active than their female counterparts is also evident in transport, with a male bias in planning and design and gender a determinant in modal choice (UN, 2017; ITF, 2018; TII, 2019). This research aims to explore the perceptions of the built environment from a male and female perspective and how this implicates physical activity levels. Walking and cycling for active transport have substantial health benefits, however women are less inclined to use AT than men (Mueller et al, 2015; Garrad et al, 2008; Heesch & Sahlqvist, 2013). This is due to the gendered nature of cites being designed for the use of men and not women (Bassam, 2023).

This study utilised a quantitative approach. A survey was made available nationally (Ireland) on Microsoft Forms, it was available to all genders and both rural and urban individuals. The aim of this survey is gather an in depth understanding of women’s perceptions of the built environment and it’s correlation to activity levels, active travel behaviour and health, and how this differs to men. The Healthy Ireland protocol has been used to gather baseline data, general health and demographic information. The findings have been analysed using SPSS.

The results of this study will be complete before August 2024. The survey is currently available to be completed online. Results are to be published in an academic journal.

The aim of this study is to highlight the difference in perceptions of an individuals built environment dependent on gender. The results from this study will inform policy surrounding the design of cities and towns with infrastructure that is accessible and u​tilized by all. It will inform how we redesign cities for the use of all and have a gender-neutral perspective on city design, active travel and transport.

Support/Funding Source

This research has been funded by Technological University Dublin.
S06-3: We Walk. Developing and pilot testing a dyadic intervention to promote outdoor walking in people after stroke: benefits, challenges and solutions
Authors: Morris Jacqui , Irvine Linda , Tooman Tricia , Dombrowski Stephan , Cormarck Brendan Mc , van Wijk Frederik , Lawrence Maggie
Published: September 2024

Purpose

After stroke, physical activity (PA) levels are low, risking secondary stroke, cardiovascular disease, falls and poor mobility. Regular PA reduces these risks. Walking is a preferred PA option for stroke survivors, and social support influences uptake and maintenance of behaviours. We therefore developed WeWalk, a person-centred, dyadic peer-support behavioural intervention supported by walking buddies, to promote regular walking after stroke. This study evaluated participants’ experiences of WeWalk to refine it ready for effectiveness testing and implementation.

Methods

Intervention: WeWalk involved facilitated face-to-face and telephone sessions with a researcher with behaviour change training, supported by intervention handbooks and diaries. Dyads agreed walking goals and plans, monitored progress, and developed strategies for maintaining walking.

Evaluation

Data were collected through semi-structured interviews and facilitator fieldnotes during intervention delivery, and were analysed using thematic analysis, guided by a theoretical framework of acceptability.

Results

We recruited 21 dyads comprising community-dwelling PWS and their walking buddies. Eighteen dyads completed exit interviews, one dyad was lost to follow-up and two withdrew with ill-health. We identified three themes: acceptability evolves with experience, mutuality, and person-centredness with personally relevant tailoring. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants’ confidence developed as they experienced physical and psychological benefits of walking. WeWalk required careful facilitation. It worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals however in a few dyads agreeing and enacting mutual goals was more challenging. Tailoring intervention components to individual circumstances and values supported dyads in achieving meaningful goals.

Conclusions

WeWalk is feasible and acceptable, illustrating the potential of dyadic interventions after stroke. However, its complexity requires considered implementation strategies. Data highlight the need for careful matching of dyads, facilitation of dyadic working by practitioners who can support development of dyadic relationships; and community structures linked to healthcare pathways that support implementation. We have worked with charities health services organisations to plan and develop these implementation strategies and report the challenges and potential solutions to delivering this complex intervention.
S06-4: How is organised the exercise training of the outpatient phase III cardiac rehabilitation in the Greater Region?
Authors: Lion Alexis , Feiereisen Patrick , Delagardelle Charles
Published: September 2024

Purpose

The phase III cardiac rehabilitation includes lifestyle modifications and exercise training. While the phase III cardiac rehabilitation is recommended, there is no clear recommendation regarding its organisation. To investigate how exercise training in phase III cardiac rehabilitation was organized, we conducted a pilot study in the Greater Region (an international region composed by territories from Belgium, France, Germany, and Luxembourg).

Methods

We emailed and called five organisations offering or coordinating the exercise training of the phase III cardiac rehabilitation in the Greater Region and investigated different parameters: status of the contacted organisations, profile of their participants, recruitment process, organisation of the exercise training classes. We also screened the websites and registration forms of the different contacted organisations.

Results

Non-profit organisations organised exercise training in phase III cardiac rehabilitation in all 4 territories of the Greater Region. The profile of the participants in the exercise training varied across the different territories from participants with cardiac diseases only to everybody. For the 1st registration, participants should provide a medical clearance or/and a referral letter from a medical doctor or a cardiologist. In some territories, a stress test was additionally required for participants with cardiac diseases and participants presenting risk factors for cardiovascular disease. Annual medical clearance was not mandatory in some territories. In two territories, participants may be referred into a starter programme at the beginning of phase III cardiac rehabilitation. After this starter programme, participants were invited to continue into the regular programme. In most cases, exercise training was supervised by physiotherapists or sports therapists. The medical surveillance of the exercise training by a medical doctor and/or a nurse was often recommended but rarely and heterogeneously implemented.

Conclusions

The exercise training of the outpatient phase III cardiac rehabilitation is organised differently in the 4 territories of the Greater Region. Variation exists in implementation of referrals, medical clearance, and medical surveillance. Guidelines based on the evidence and the good practice should be elaborated. It will help non-profit organisations to better organise and administrate exercise training of the phase III cardiac rehabilitation.
S10-4: Facilitating new interdisciplinary collaborations for active mobility: The Academic Observatory for Cycling and Active Mobilities (OUVEMA)
Authors: Gelius Peter , Rérat Patrick , Kayser Bengt
Published: September 2024

Purpose

Although the current social, environmental, and health-related challenges call for a reflection of the place of mobility in tomorrow’s world, modern societies continue to be shaped by decades of motorization. Most European countries, including Switzerland, have not yet overcome this dependence. Exploring these issues requires finding ways to facilitate the collaboration between researchers from different backgrounds, e.g. geography, sport science, psychology, political science, and medicine, and a closer interaction between research and civil society.

Project or policy description

Founded in 2020, the University Observatory for Biking and Active Mobility (OUVEMA) at the University of Lausanne has two missions: First, it aims to provide opportunities for collaboration of researchers from different disciplines to explore four main aspects of biking and active mobility: practices and behaviors; promotional policies; the built environment; and health issues. Specifically, the observatory provides an institutional framework for interdisciplinary research projects and publications related to active mobility, and connects researchers via its scientific and strategic committees. Second, the observatory seeks to connect research and civil society: It interacts with various civil society networks y in French-speaking Switzerland, as well as from European academic institutions pioneering research on the issue. To this end, OUVEMA organizes two annual series of lectures with changing topics, publishes a monthly newsletter sent to 2000 stakeholders, and disseminates information to media outlets.

Conclusions

In the first three years of its existence, OUVEMA has shown that the topics of active mobility and biking open up the possibility for new collaborations between researchers in health, physical activity promotion, and other disciplines interested in human behavior and the built environment. OUVEMA might serve as a blueprint for the establishment of similar institutions across Europe. At the same time, it is crucial to further strengthen the collaboration between such centers of competence in active mobility across Europe to speed up the research and action required to tackle the upcoming global challenges.
S11-4: Reaching people with a disability in a small town–a practice perspective
Authors: Nugent Seamus
Published: September 2024

Purpose

It is well documented that people living with a disability often have restricted opportunities to participate in physical activity and may face significant barriers. This presentation provides a practice perspective on reaching, and providing inclusive, meaningful physical activity opportunities for children and adults living with disability in Ireland.

Project or policy description

While significant efforts have been made in Ireland and elsewhere to facilitate access, this presentation will provide insights from a Sports Inclusion Development Officer, working in a town in Ireland, on how providing facilitators (funding streams and a varied programme of activities) does not necessarily remove barriers for people with disability to access physical activity and participate.

Conclusions

There are problems in areas with low population density – small numbers of people with specific disabilities leading to no specific activities for specific disabilities. Clubs are providing options, in some instances, but they are often not easy to implement as the volunteer base has declined and many sports clubs focus on performance rather than participation. Sometimes they are difficult for those with disabilities to access and participate. Often, the policy and willingness for change is there at organisational level but at intervention level there are difficulties in implementation.
Daily Limited Future Time Perspective Is Associated With More Health Behavior Within Older Adults
Authors: Hill Kyrsten C , Allemand Mathias , Hill Patrick
Published: September 2024

Objectives

Cross-sectional studies suggest that individuals who perceive a broader future horizon may be more likely to consider the future consequences of their actions and, as a result, engage in healthy lifestyle behaviors. However, research has yet to consider how this association plays out on the daily level.

Methods

The present study used daily diary data from a sample of 198 older adults aged 60 years and older (M = 63.34, SD = 3.29) to investigate the relationship between daily future time perspective (FTP) and daily health behavior. Participants reported on sociodemographic characteristics during baseline surveys and completed daily diary measures of FTP and health behavior (e.g., nutrition, exercise, social/leisure activity) across 14 days. Multilevel modeling was used to examine within- and between-person associations between daily FTP and health behavior.

Results

Daily FTP was significantly associated with daily health behavior at the within- but not at the between-person level. Counter to past cross-sectional work, results revealed that individuals showed increased engagement in health behavior on days when they reported a more limited FTP.

Discussion

Findings highlight the importance of moving beyond the between-person level to consider how FTP fluctuates from day-to-day and relates to health behavior in everyday life. Older adults who view a more limited time horizon may be motivated to increase that future through healthier activities.
Absolute quantification of BACH1 and BACH2 transcription factors in B and plasma cells reveals their dynamic changes and unique roles
Authors: Kurasawa Takeshi , Muto Akihiko , Matsumoto Mitsuyo , Ochiai Kyoko , Murayama Kazutaka , Igarashi Kazuhiko
Published: September 2024

Changes in the absolute protein amounts of transcription factors are important for regulating gene expression during cell differentiation and in responses to changes in the cellular and extracellular environment. However, few studies have focused on the absolute quantification of mammalian transcription factors. In this study, we established an absolute quantification method for the transcription factors BACH1 and BACH2, which are expressed in B cells and regulated by direct heme binding. The method used purified recombinant proteins as controls in western blotting and was applied to mouse naïve B cells in the spleen, as well as activated B cells and plasma cells. BACH1 was present in naïve B cells at approximately half the levels of BACH2. In activated B cells, BACH1 decreased compared to naïve B cells, whilst BACH2 increased. In plasma cells, BACH1 increased back to the same extent as in naïve B cells, whilst BACH2 was not detected. Their target genes, Prdm1 and Hmox1, were highly induced in plasma cells. BACH1 was found to undergo degradation with lower concentrations of heme than BACH2. Therefore, BACH1 and BACH2 are similarly abundant in B cells but differ in heme sensitivity, potentially regulating gene expression differently depending on their heme responsiveness.
3E Approach to Psychopathology
Authors: Aftab Awais , Nielsen Kristopher
Published: September 2024

Kristopher Nielsen, PhD, is a clinical psychologist based in Wellington, New Zealand. He completed his PhD in Psychology at Te Herenga Waka—Victoria University of Wellington in 2020. His thesis concerned the development of a conceptual model of mental disorder grounded in enactivism and explored how we might explain mental disorders from this perspective. He is the author of 3E Psychopathology: Reimagining Mental Disorder in an Embodied, Embedded, and Enactive Mind (Palgrave Macmillan, 2023). Nielsen’s framework of psychopathology emphasizes organizational causality, naturalized normativity, contextuality, complex dynamic networks, and explanatory pluralism. This interview explores how he applies the embodied, embedded, and enactive conceptual framework to psychiatry, and how his approach differs from the enactive framework developed by Sanneke de Haan.
Institutional Corruption and Social Justice in Psychiatry
Authors: Aftab Awais , Cosgrove Lisa
Published: September 2024

Lisa Cosgrove, PhD, is a Clinical Psychologist and Professor of Counseling and School Psychology at University of Massachusetts Boston. She is a former research fellow at the Edmond J. Safra Center for Ethics at Harvard University. Her research addresses ethical and medical-legal issues that arise in organized psychiatry because of academic–industry relationships. She is the co-author of Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform (Palgrave Macmillan, 2015). Cosgrove’s research work has focused on how pharmaceutical industry influence and academic guild interests have shaped the evolution of psychiatry, which she discusses using the framework of institutional corruption. She is a critic of industry influence on psychiatric research and practice and advocates for a social justice and rights-based approach to psychiatry. This interview explores her views on institutional corruption, depression screening recommendations, medicalization, and a social justice approach to medicine.
Critical and Relational Psychiatry
Authors: Aftab Awais , Double Duncan
Published: September 2024

Duncan Double, MB BChir, MRCPsych, is a retired consultant psychiatrist who worked in this role in the UK National Health Service for over 27 years, mostly in Norfolk and Suffolk NHS Foundation Trust. He was also Honorary Senior Lecturer at University of East Anglia. He is a founding member of the Critical Psychiatry Network (www.criticalpsychiatry.co.uk) and editor of the book Critical Psychiatry: The Limits of Madness (Palgrave Macmillan, 2006). This interview discusses how Double understands the critical psychiatry movement and its essential message, the international evolution of the movement, disagreements within the Critical Psychiatry Network, biological explanations of mental illness, the influence of Adolf Meyer and George Engel, and Double’s adoption of the term relational psychiatry.
Psychoanalysis and the Re-enchantment of Psychiatry
Authors: Aftab Awais , Shedler Jonathan
Published: September 2024

Jonathan Shedler, PhD, is Clinical Professor of Psychiatry at University of California San Francisco and is known internationally as an author, researcher, and clinician educator. His 2010 article ‘The efficacy of psychodynamic psychotherapy’ won worldwide acclaim for establishing psychodynamic therapy as an evidence-based treatment. He is co-creator of the Shedler–Westen Assessment Procedure (SWAP), a clinician-completed psychological test for personality assessment and clinical case formulation, and co-author (with Nancy McWilliams) of the Personality Syndromes section of the Psychodynamic Diagnostic Manual (PDM-2) (Guilford Press, 2017). Shedler is an articulate and prominent defender of the psychoanalytic tradition of psychotherapy, and he has been on a mission to remedy the misconceptions around psychodynamic thinking. This interview discusses the relationship between the psychoanalytic worldview and the medical model, and re-examines the role of psychodynamic psychotherapy in contemporary psychiatry and psychology.
Surgical Instruments
Authors: Sagarwala Salman , Kim Brian Y. , Kim David H.
Published: September 2024

Surgical equipment and preparation are vital aspects of success for any operative procedure. They include operating room setup and equipment check, team check, preoperative optimization, and intraoperative equipment and usage. The operating room setup, equipment check, and team check involve checking the classification of the setting that the procedure will take place in, as well as ensuring that key required equipment and elements are present. Examples of key required equipment are basic anesthetic monitors, airway equipment, medications, table (and positioning), and a ventilator device. From the surgical perspective, basic operating equipment and techniques include lighting, cautery, suction, draping, and intraoperative imaging. Operating room team member preoperative check, a formalized procedure time out, and team introduction are necessary. Surgical instruments are myriad, and no single chapter could cover the breadth of available instruments, applications, and uses completely. Briefly, instruments include surgical scalpels, blades, scissors, forceps, clamps, needle holders, suture needles, suture threads, skin closure devices, retractors, suction devices, electrosurgery tools, and orthopedic instruments. Each category encompasses a large variety and subtypes of instruments, each with common tool variants as well as specific basic applications and uses.
Perioperative Considerations
Authors: Kim Brian Y.
Published: September 2024

Chronic pain is a common, debilitating condition globally, with significant socioeconomic impacts on afflicted individuals and the healthcare system. In a 2016 National Health Survey by the Centers for Disease Control and Prevention, 50,009,000 people in the United States had chronic pain, and of that total, 19,611,000 people had high-impact chronic pain, defined as chronic pain limiting life or work activities on most days or every day during a 6-month period. The overall total of direct medical costs, lost productivity, and disability was estimated to be $560 billion each year. With such a high-impact medical condition, emphasis has been placed on development of evidence-based means of chronic pain management. Over the past two decades, large strides have been made in minimally invasive spine surgeries, including neuromodulation, vertebral augmentation therapies, and implanted pain devices, with concomitant increasing interventional invasiveness. The increase in invasiveness incurs the need for increased vigilance about patient safety and care. The perioperative considerations for minimally invasive spine procedures are discussed here.
Minimally Invasive Lumbar Decompression
Authors: Jain Sameer , Jassal Navdeep Singh
Published: September 2024

Lumbar spinal stenosis (LSS) is widespread in the elderly population; its prevalence is estimated to be greater than 20% in individuals 60 to 69 years old. LSS presents clinically as neurogenic claudication, which is usually described as gluteal and/or leg pain, numbness, weakness, or fatigue with walking and standing that is alleviated with sitting and/or lumbar flexion. One of the most common causes of LSS is ligamentum flavum hypertrophy (LFH), which may lead to both central and foraminal stenosis. This chapter describes in detail the minimally invasive lumbar decompression (MILD) procedure designed to treat this condition. The indications, safety/efficacy data, and procedure are reviewed, and both standard and streamlined techniques are described.
Indirect Lumbar Decompression
Authors: Jameson Jessica , Li Sean , Bhutra Steven , Kohan Lynn , Ori Arti
Published: September 2024

Indirect lumbar decompression is a valuable tool for the treatment of lumbar spinal stenosis. It offers many patients a minimally invasive treatment for symptomatic neurogenic claudication. This chapter covers the evidence for the procedure, the periprocedural considerations that should be addressed, postoperative care, and management of the potential complications.
Vertebroplasty
Authors: Goree Johnathan , Malinowski Mark
Published: September 2024

Vertebral compression fractures are a common cause of severe back pain in osteoporotic geriatric patients. Vertebroplasty is a safe, effective, low-cost way to reduce pain and to improve mortality risk in these patients. This chapter discusses the indications, risks, contraindications, and literature behind this procedure. It also discusses the procedural technique in detail and provide pearls for successful treatment.
Legal Issues
Authors: Manoharan Senthil Vel Rajan Rajaram , Walia Jessy , Bozman Mack
Published: September 2024

This chapter discusses legal and ethical issues that healthcare providers often face when caring for older adults. These challenges may involve balancing autonomy and safety concerns in both community and nursing home settings. Healthcare providers who work with elderly patients often encounter clinical challenges related to cognitive deficits, including questions of decision-making capacity, power of attorney/guardianship, and end-of-life care. Healthcare providers treating older adults must navigate a complex array of medical and psychosocial issues that give rise to ethical dilemmas concerning autonomy, patient welfare, and social justice. Potentially disabling effects of neuropsychiatric conditions, which disproportionately affect older adults, may compromise their autonomy. This chapter covers legal issues and challenges in both the criminal justice system and long-term care settings, which require healthcare providers to be familiar with the legal framework to act in the best interest of patients.
Capital Punishment—Executions
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Capital punishment or the death penalty is a government-sanctioned punishment for committing a capital offense and is legal in 24 states, American Samoa, the federal government, and the military. The American Medical Association and the American College of Physicians prohibit practitioner involvement in execution, including determining competence, administering drugs, and monitoring vital signs. The healthcare profession’s principles of beneficence (do good) and nonmaleficence (do no harm) would be violated by participation in an execution, which has no regard for the principle of patient autonomy. A political ideology of retribution should not redefine the healthcare profession’s ideology as a healing art, and practitioners must prioritize patient-centered care to maximize the patient’s best interests regarding healing.
Disagreements
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Healthcare is a collaborative effort that involves legal, institutional, professional, and evidence-based decision-making. Conflicts may arise in the patient–practitioner relationship due to different interpretations of facts, values, and priorities. Still, these disagreements should be resolved through respectful communication between the licensed practitioner and other healthcare providers. The ultimate responsibility for patient care rests with the licensed practitioner. If a disagreement may harm the patient, it may be necessary to bring the issue to higher levels of institutional policy for reporting. However, patients should not be informed about the disagreement, which could damage their trust in the healthcare team. Residents must not practice medicine independently and must comply with the attending practitioner’s decisions.
Do Not Resuscitate Order, Do Not Attempt Resuscitation Order, and Allow Natural Death Order
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: A do not resuscitate (DNR) order is a patient’s or surrogate’s decision not to undergo resuscitative procedures if they experience cardiopulmonary arrest. It is important for practitioners to have discussions with patients about cardiopulmonary resuscitation (CPR) procedures while patients still have decisional capacity. Without such a discussion or a living will, the standard of care is to perform CPR. However, CPR should not be performed if a DNR order is in place. It is a misperception that a DNR order means a patient will receive less care. The patient should receive the same care as a non-DNR patient, excluding CPR.
Healthcare Records
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Patients have the legal right to access and copy the information in their healthcare records because it belongs to them. Because it would be a violation of the Health Insurance Portability and Accountability Act, healthcare facilities cannot release protected health information to outside parties without the patient’s consent or a court order. The autonomy principle is reflected in patients’ informed consent to disclose confidential information. There are some professional exceptions to this confidentiality, such as therapeutic privilege, where withholding information is allowed to avoid harm to the patient. Society has laws to protect the confidentiality and privacy of healthcare records based on the principle of justice (be fair). However, in certain circumstances, such as public safety or court order, the practitioner may be legally mandated to disclose the healthcare record information.
Precision Medicine
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:Precision medicine represents a personalized approach to healthcare, tailoring treatment and prevention strategies to individual genes, environment, and lifestyle variations. This approach often employs whole-genomic sequencing to decipher a patient’s entire DNA sequence, guiding therapeutic intervention. Predictive genomic testing assesses disease risk, diagnostic genomic testing verifies diagnoses, and pharmacogenomic testing determines appropriate medication dosages. Although promising, precision medicine raises several ethical concerns. These include complex patient autonomy issues, such as familial implications, healthcare disparities exacerbation, and privacy and confidentiality issues. Economic pressures further complicate these ethical considerations. The drive to create universal drugs, rather than personalized ones, may lead to excluding individuals at higher risk of adverse reactions. This could make drug development more profitable but result in “orphan patients” without optimal treatment options based on genetic risks. This underscores the need to consider economic and ethical factors carefully.
Racial Concordance
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:Racial concordance in healthcare refers to patients’ preference for choosing a practitioner with the same racial or ethnic identity and cultural background. As society diversifies, it has been argued that the healthcare workforce should reflect this diversity. The patient–practitioner relationship is vital, and racial concordance may enhance this relationship. Patients have autonomy in their choices, whereas practitioners must prioritize patients’ best interests and work to reduce healthcare disparities. Unjust discrimination is illegal, unprofessional, and unethical, and practitioners must be self-aware of implicit biases while following healthcare standards of care. The professional character of practitioners is essential for providing society with stability and consistency in healthcare.
Sexual Boundaries
Authors: Bulger Jeffrey W.
Published: September 2024

The practitioner–patient relationship is unique and requires strict boundaries to protect the patient’s autonomy (informed consent), beneficence (do good), nonmaleficence (do no harm), and justice (be fair). The American College of Physicians and the American Medical Association (AMA) Code of Medical Ethics view sexual relationships between a practitioner and a current patient as unethical and detrimental to the patient’s well-being. The AMA also states that a practitioner should avoid nonsexual contact with a patient that may lead to romantic or sexual contact. The practitioner should avoid sexual or romantic relations with anyone directly involved with the patient’s health. The patient–practitioner relationship is one-sided, with the patient divulging protected health information, making the patient vulnerable to exploitation by the practitioner. It is therefore essential for the practitioner to maintain clear and distinct boundaries to protect the patient’s best interests.
Social Media Boundaries
Authors: Bulger Jeffrey W.
Published: September 2024

Social media integration into the healthcare profession has occurred, along with its associated challenges. The use of social media by the healthcare community has increased dramatically in recent years, but it must be used with care to avoid blurring professional and personal boundaries. Students and practitioners must be aware of institutional social media policies, as well as Health Insurance Portability and Accountability Act privacy laws, and the consequences of violating them. Patients’ autonomy, practitioner’s obligation to “do good” and “do no harm,” and public policy principles of justice must be taken into consideration when using social media. Social media can result in both positive and negative consequences, and clear boundaries must be established to maximize the patient’s best interests and maintain professional and legal standards.
Telemedicine
Authors: Bulger Jeffrey W.
Published: September 2024

There are three main types of telemedicine: synchronous, asynchronous, and monitoring. Synchronous telemedicine involves real-time interactions between patients and practitioners, whereas asynchronous telemedicine involves non-real-time interactions and is used for educational purposes and non-emergency communications. Monitoring involves tracking a patient’s vital signs and other data remotely. To ensure patient autonomy, practitioners must obtain informed consent and ensure privacy and security protocols. Practitioners must also follow the principles of beneficence (do good) and nonmaleficence (do no harm) and establish clear professional boundaries. Telemedicine is primarily regulated by state legislation, with some states having telemedicine parity laws mandating reimbursement for telemedicine visits at the same rate as in-person visits. As telemedicine becomes more widespread, there is a growing need to consider whether healthcare licensure should be national rather than state-based. Issues also arise with state-based healthcare licensure exams and dispersing state Medicaid funds to practitioners in other states.
Terminology of suicide and suicidal behaviour, and the meaning of suicide in different cultural backgrounds
Authors: Schneider Barbara , Milin Sascha , Wolfersdorf Manfred
Published: September 2024

The interpretation and meaning of suicidal behaviour are different across cultures and subcultures. In the Western world, psychiatric disorders or severe psychosocial and existential crises are at the centre of interpretation and the meaning of suicidal behaviour. However, cross-cultural commonalities in characteristics of individuals who die by suicide (such as depression, hopelessness, and relationship problems) are observed. These let us assume universality and invariance in cross-cultural meanings of suicide. Worldwide, there is no unique and universally valid definition of suicidality—most definitions are based on psychiatric and psychological concepts. The meanings of suicidal behaviour in all forms, like death wishes, suicidal thoughts, suicide attempts, death by suicide, and self-destructive behaviours, which have no acute suicidal intent but are self-destructive in the long range—are different, because they are based on cultural traditions. Only by differentiating as precisely as possible the ethnic-, culture-, and subculture-dependent meanings of suicide can valid theories of causation and prediction, and also intervention and prevention programmes, be developed.
Suicidal behaviour and sociocultural factors among South Asians in the United Kingdom
Authors: Poppleton Aaron , Saini Pooja , Panagioti Maria , Husain Nusrat
Published: September 2024

British South Asians form the largest ethnic minority group in the United Kingdom (UK). Variations in British South Asian culture, religion, and demography influence community mental health, including rates and characteristics of self-harm and suicide. Specific factors predisposing and protecting this community from self-harm and suicide have been identified, including mental health stigma, cultural identity, religion, marriage and relationships, domestic violence, and mental and physical health conditions. Further multilevel factors influence British South Asian uptake of and engagement with mental health services, in addition to use of alternative healers. Universal and targeted approaches to cultural adaptation of self-harm and suicide prevention and management strategies are required to improve community trust and service engagement. Possibilities include school- and community-based health education programmes, resource development, clinician and wider health care staff training in cultural competence, and adaptation of psychological interventions and therapies to address interpersonal triggers for self-harm and suicide.
Suicide in Indonesia
Authors: Marthoenis Marthoenis , Safuni Nani , Dahlia  , Fathiariani Liza
Published: September 2024

Suicide is an alarming problem in Indonesia. Even though the estimated rate of suicidal behaviour is increasing, the exact number of suicide cases remains unknown. Several factors have been reported to be associated with suicidal behaviour among Indonesians, including cultural beliefs, financial and familial issues, and the Islamic beliefs in the Indonesian population. This chapter discusses the epidemiology of suicide in Indonesia, suicidal behaviour among adolescents and people with a mental disorder, suicide methods used in Indonesian population, Indonesian mass media reporting of suicidal cases, Islamic culture and suicide in Indonesia, suicide prevention initiatives, and the case of culture-related suicidal behaviour in a province of Indonesia. The chapter concludes by highlighting that more attention should be paid to suicide prevention nationwide.
Pregnancy and childbirth
Authors: Andrew Marion I. , Cyna Allan M.
Published: September 2024

As a core member of a multidisciplinary team caring for mother and baby, the anaesthetist has a unique opportunity to positively influence the environment women and their partners experience in the obstetric setting. This chapter offers the anaesthetist strategies and examples to gradually move away from repeated phrases, and ingrained patterns of speech that emphasize negative perceptions of pregnancy, labour, and delivery. With an understanding of acceptance and subconscious responses, language can be used to engender an atmosphere of calm where women experience being supported, encouraged, and respected for their individual strengths and preferences. The chapter covers both routine contexts as well as ‘urgent’ epidural or emergency caesarean section where ‘LAURS’ and ‘GREAT’ frameworks provide a foundation for building trust and gaining cooperation even in the most challenging of circumstances such as loss and bereavement.
Other challenges
Authors: Hood Gillian M. , Tan Suyin G.M.
Published: September 2024

Patients with complex communication needs are a heterogenous group encompassing people with language impairment and intellectual or behavioural disability requiring additional consideration of communication technique. Firstly, the communication issue should be recognized and defined. Identification of the barriers and mindfulness of our own and the patient’s emotional responses helps formulate appropriate strategies. When working with patients with intellectual disability or rare syndromes, parents and carers are an invaluable resource. Understanding the patient’s particular likes, dislikes, triggers, and needs helps to shape personalized care that builds on the patient’s strengths and avoids causing distress. There are a variety of strategies to avert or defuse a meltdown.

Patients with adverse developmental experience or previous traumatic hospital experiences are commonly encountered in acute care settings. These patients may not be well recognized and frequently have difficulty engaging in care. Creating a ‘psychologically safe’ environment is paramount. ‘LAURS’ principles guide the approach.
Needle phobia
Authors: Cyna Allan M. , Andrew Marion I.
Published: September 2024

Effectively managing patients with needle phobia requires a patient’s trust and confidence. It is important to recognize the specific conscious and subconscious aspects of the problem—consciously the patient has come for safe and optimal care but subconsciously is preventing that care from occurring. Rapport building through a ‘LAURS’ approach promotes autonomy; empowers the patient and increases a sense of control. Metaphor and positive expectancy generated by a confident, calm approach with a clear expectation of success is helpful. It is vital to ask permission at each stage of cannula placement, since control and trust are critical. It is also important to reinforce any success achieved. Such techniques frequently succeed when logic, cajoling or ‘jollying along’ has failed.