Reaching consensus on the definition of person-centred handover practices in emergency departments: A modified online Delphi

AIM

To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments.

BACKGROUND

Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments.

DESIGN

A three-round online Delphi survey.

METHODS

Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted.

RESULTS

Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated.

CONCLUSION

Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments.

REPORTING METHOD

The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist.

IMPACT (ADDRESSING)

Improve handover practices and patient care. Improve person-centred care in emergency departments.

PATIENT OR PUBLIC CONTRIBUTION

Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.

The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review

BACKGROUND

The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research.

OBJECTIVE

The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC.

METHODS

The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature.

RESULTS

The results of this study are expected at the end of 2024.

CONCLUSIONS

The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/55860.

[Developing cultural competence in nursing schools]

Cultural competence is not mentioned as such in the training standards for future nurses, but it is essential for appropriate, personalized and effective care. Learning about and reflecting on one's own history and culture enable an open relationship with patients from other cultures.

Are you thinking what I'm thinking? Defining what we mean by "polysubstance use."

The rise in drug overdoses and harms associated with the use of more than one substance has led to increased use of the term "polysubstance use" among researchers, clinicians, and public health officials. However, the term retains no consistent definition across contexts. The current authors convened from disciplines including sociology, epidemiology, neuroscience, and addiction psychiatry to propose a recommended definition of polysubstance use. An iterative process considered authors' formal and informal conversations, insights from relevant symposia, talks, and conferences, as well as their own research and clinical experiences to propose the current definition. Three key concepts were identified as necessary to define polysubstance use: (1) substances involved, (2) timing, and (3) intent. Substances involved include clarifying either (1) the number and type of substances used, (2) presence of more than one substance use disorder, or (3) primary and secondary substance use. The concept of timing is recommended to use clear terms such as simultaneous, sequential, and same-day polysubstance use to describe short-term behaviors (e.g., 30-day windows). Finally, the concept of intent refers to clarifying unintentional use or exposure when possible, and greater attention to motivations of polysubstance use. These three components should be clearly defined in research on polysubstance use to improve consistency across disciplines. Consistent definitions of polysubstance use can aid in the synthesis of evidence to better address an overdose crisis that increasingly involves multiple substances.

Defining Life Skills in health promotion at school: a scoping review

Background

Life Skills have been central to Health Promotion interventions and programmes with children and adolescents for over 40 years. School is a strategic setting for Life Skills education. Recently, policy-and decision-makers have focused on Life Skills development for youth. Research on Life Skills has gained momentum. Different terms are used to discuss and define Life Skills. Research identifies a lack of conceptual definition. The purpose of this study is to identify the definitions in the literature in English and French, and to reach a conceptual and consensual definition.

Method

The Scoping Review methodology was used. Three research questions aim to identify how Life Skills are defined in the field of health promotion at school, to see whether a conceptual and consensual definition exists, and, if relevant, to propose a conceptual definition. The search was conducted in 5 databases by 3 reviewers. This study focused on full-text publications in English or French, human studies, health promotion in school, school pupils, teacher training, and with a definition of Life Skills. Publications on after-school activities, higher education outside teacher training, adult education, other than peer-reviewed scientific papers were excluded.

Results

48 publications were included in English and 7 in French. NVIVO was used to determine and compare the French and English terms used for Life Skills and their definitions. According to the three research questions, (i) the terms used to define Life Skills are diverse and numerous, with different purposes at school in relation to health promotion, and different taxonomies, and relate to different areas of research; (ii) no consensual, conceptual definition of Life Skills was found; (iii) further semantic, epistemological and ontological clarifications are required.

Conclusion

Some conceptual definitions of Life Skills exist without consensus. Life Skills being at the crossroads between different fields could explain this and is illustrated by the multiplicity and diversity of the terms employed, and the various taxonomies and purposes used at school in health promotion. This may also explain why they are difficult to evaluate. Defining Life Skills consensually cannot be achieved due to the diversity of research perspectives from different fields.

A new paradigm for addictions

AIM

To suggest a new paradigm for addictions.

METHODS

Consideration of relevant research findings and thought experiments.

RESULTS

Common mental motors leading to addictions are pleasure-seeking and hyperbolic discounting. The important point of the latter is that given two choices of future rewards, commonly one initially prefers the larger one available after a longer waiting time but despite this the smaller and sooner reward will be chosen when it becomes available. These are general biological properties, found at least in human beings, the rat, and the pigeon. If this continues it may create an unconscious habit, difficult to change. Several other risk factors for addictions are known, notably both externalizing and internalizing mental problems. Predisposing factors are likely to interact.

CONCLUSIONS

The above suggests a new paradigm for addictions. Pleasure provides temptations, hyperbolic discounting weakens the will. Habits emerge. Addictions seem to be a group of problems of its own kind, not diseases, because diseases do not bring about pleasure, and are not sought for pleasure.

Critical Appraisal of the Concept Frailty: Rating of Frailty in Elderly People has Weak Scientific Basis and should not be Used for Managing Individual Patients

The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scale- scores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care.

Reflecting on challenges and opportunities for the practice of person-centred rehabilitation

OBJECTIVES

To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation.

CHALLENGES

Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation.

OPPORTUNITIES

Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation.

CONCLUSION

Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.

Defining sports moral character and clarifying its related concepts

This study examines the concept of sports moral character and clarifies the differences between it and related moral concepts in sports. The research is conceptual and uses the methods of a literature review and logical analysis. Sports moral character is shown to have the characteristics of practicality, growth, and integration. It is a stable moral quality that is gradually formed and displayed in sports practice under the influence of family, school, and social environments. Sports moral character differs in some ways from other related concepts. Sports morality is the objective existence of "reason," to which sports character and sportsmanship are both more applicable than is sports moral character.

["Allgemeinmedizin Kompakt" - branding the concept of success for education in family medicine]

During the preparation period for the examination to become a specialist in general medicine, physicians in advanced training are often left alone. Since 2016, "Allgemeinmedizin Kompakt" has taken on the task of imparting exam-relevant knowledge to young family doctors. The course concept is characterized by independent pharma-free knowledge transfer and is tailored both to doctors in advanced training for exam preparation and to experienced doctors as a repetitorium. In order to increase the level of awareness and to give the course an identity-forming feature, a word/image brand was developed. This is intended to integrate the goals and features as well as create a recognition value. Overall, according to current evaluation, the course concept is appreciated by physicians in advanced training for exam preparation, as the degree of recommendation is 97%. But also experienced physicians are to be addressed by the DMP certifications, so that the course concept is in constant development.

Denying a Unified Concept of Disability

This paper argues that there are reasons to believe that there is no single concept or category which demarcates all individuals who have a disability from those individuals who do not. The paper begins by describing that I call 'a Unified Concept View of Disability' and the role that such a view plays in debates about the nature of disability. After considering reasons to think that our concept of disability is not unified in the way that the Unified Concept View assumes, I outline what a non-unified approach to disability might look like. The paper concludes by considering implications of rejecting the Unified Concept View of disability.

Conceptual tensions and practical trade-offs in tailoring implementation interventions

Tailored interventions have been shown to be effective and tailoring is a popular process with intuitive appeal for researchers and practitioners. However, the concept and process are ill-defined in implementation science. Descriptions of how tailoring has been applied in practice are often absent or insufficient in detail. This lack of transparency makes it difficult to synthesize and replicate efforts. It also hides the trade-offs for researchers and practitioners that are inherent in the process. In this article we juxtapose the growing prominence of tailoring with four key questions surrounding the process. Specifically, we ask: (1) what constitutes tailoring and when does it begin and end?; (2) how is it expected to work?; (3) who and what does the tailoring process involve?; and (4) how should tailoring be evaluated? We discuss these questions as a call to action for better reporting and further research to bring clarity, consistency, and coherence to tailoring, a key process in implementation science.

Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities: Conceptual Framework

Background

The COVID-19 pandemic caused widespread societal disruption, with governmental stay-at-home orders resulting in people connecting more via technology rather than in person. This shift had major impacts on older adult residents staying in retirement homes and residential care facilities, where they may lack the technology literacy needed to stay connected. The enTECH Computer Club from the University of Waterloo in Ontario, Canada created a knowledge translation toolkit to support organizations interested in starting technology literacy programs (TLPs) by providing guidance and practical tips.

Objective

This paper aimed to present a framework for implementing TLPs in retirement homes and residential care facilities through expanding on the knowledge translation toolkit and the framework for person-centered care.

Methods

Major concepts relating to the creation of a TLP in retirement homes and residential care facilities were extracted from the enTECH knowledge translation toolkit. The domains from the framework for person-centered care were modified to fit a TLP context. The concepts identified from the toolkit were sorted into the three framework categories: “structure,” “process,” and “outcome.” Information from the knowledge translation toolkit were extracted into the three categories and synthesized to form foundational principles and potential actions.

Results

All 13 domains from the framework for person-centered care were redefined to shift the focus on TLP implementation, with 7 domains under “structure,” 4 domains under “process,” and 2 domains under “outcome.” Domains in the “structure” category focus on developing an organizational infrastructure to deliver a successful TLP; 10 foundational principles and 25 potential actions were identified for this category. Domains in the “process” category focus on outlining procedures taken by stakeholders involved to ensure a smooth transition from conceptualization into action; 12 foundational principles and 9 potential actions were identified for this category. Domains in the “outcome” category focus on evaluating the TLP to consider making any improvements to better serve the needs of older adults and staff; 6 foundational principles and 6 potential actions were identified for this category.

Conclusions

Several domains and their foundational principles and potential actions from the TLP framework were found to be consistent with existing literatures that encourage taking active steps to increase technology literacy in older adults. Although there may be some limitations to the components of the framework with the current state of the pandemic, starting TLPs in the community can yield positive outcomes that will be beneficial to both older adult participants and the organization in the long term.

Earthworms as catalysts in the formation and stabilization of soil microbial necromass

Microbial necromass is a central component of soil organic matter (SOM), whose management may be essential in mitigating atmospheric CO₂ concentrations and climate change. Current consensus regards the magnitude of microbial necromass production to be heavily dependent on the carbon use efficiency of microorganisms, which is strongly influenced by the quality of the organic matter inputs these organisms feed on. However, recent concepts neglect agents relevant in many soils: earthworms. We argue that the activity of earthworms accelerates the formation of microbial necromass stabilized in aggregates and organo-mineral associations and reduces the relevance of the quality of pre-existing organic matter in this process. Earthworms achieve this through the creation of transient hotspots (casts) characterized by elevated contents of bioavailable substrate and the efficient build-up and quick turnover of microbial biomass, thus converting SOM not mineralized in this process into a state more resistant against external disturbances, such as climate change. Promoting the abundance of earthworms may, therefore, be considered a central component of management strategies that aim to accelerate the formation of stabilized microbial necromass in wide locations of the soil commonly not considered hotspots of microbial SOM formation.

Paper wasps form abstract concept of 'same and different'

Concept formation requires animals to learn and use abstract rules that transcend the characteristics of specific stimuli. Abstract concepts are often associated with high levels of cognitive sophistication, so there has been much interest in which species can form and use concepts. A key abstract concept is that of sameness and difference, where stimuli are classified as either the same as or different than an original stimulus. Here, we used a simultaneous two-item same-different task to test whether paper wasps (Polistes fuscatus) can learn and apply a same-different concept. We trained wasps by simultaneously presenting pairs of same or different stimuli (e.g. colours). Then, we tested whether wasps could apply the concept to new stimuli of the same type (e.g. new colours) and to new stimulus types (e.g. odours). We show that wasps learned a general concept of sameness or difference and applied it to new samples and types of stimuli. Notably, wasps were able to transfer the learned rules to new stimuli in a different sensory modality. Therefore, P. fuscatus can classify stimuli based on their relationships and apply abstract concepts to novel stimulus types. These results indicate that abstract concept learning may be more widespread than previously thought.

A concept analysis of Watson's nursing Caritas process

AIM

The main objective of this analysis is to give an understanding of Watson's nursing Caritas as a concept.

DESIGN

Watson's nursing Caritas is an abstract concept, and difficult to define and operationalize because of its philosophical nature. Watson's nursing Caritas develops a clear relationship between care, caring factors, and the processes of human life.

METHODS

We used Walker and Avant's method. PubMed, Scopus, Ovid, EBSCO, Science Direct, Web of Science, Google Scholar, and ProQuest were searched. "Caritas process" and "Watson's caring theory" were searched. In the primary search, 883 articles were found, but eventually, 25 articles were included in the study.

RESULTS

We define Watson's nursing Caritas as the process based on caring consciousness, engaging in reliable human caring relationships for healing support, integrity, and development of humanity that alters the concept of caring into a higher ethical commitment inspired by responsibility for others, and different meanings, including kindness, compassion, joyfulness, and peacefulness and leads to the establishment of caring behavior in clinical Watson's nursing Caritas, thus leading to improving performance.

CONCLUSION

Clinical nursing Caritas enables nurses to develop an effective human being relationship between nurse-client-family, and ultimately achieve a common experience and perception of caring.

[Development of the concept of positive spirituality in health]

Positive spirituality has three central attributes: connectedness, meaning of life, and identity. Six factors are likely to contribute to its emergence and it can allow the development of ten positive consequences.

The differentiated roles of health in the transition from work to retirement - conceptual and methodological challenges and avenues for future research

OBJECTIVES

The aim of this discussion paper is to (i) identify the differentiated roles of health in the work-retirement transition, and, with respect to these, (ii) highlight topics related to conceptual and methodological problems and challenges in research, and (iii) present avenues for future research.

METHODS

This discussion paper summarizes an OMEGA-NET working group discussion ongoing from November 2018 to September 2021 with face-to-face and online meetings as well as a written online discourse.

RESULTS

'Health' and 'retirement' are ambiguous concepts. With respect to both, in retirement research, the choice of concept and indicator influences the findings. In addition, the impact of health on retirement is not necessarily a direct one, but can be influenced by further factors such as the ability, motivation and opportunity to work. The strong overall association of poor health with retiring early (path 1) bears the risk of masking distinct and deviating mechanisms in subgroups. In fact, there is evidence that also good health may lead to early retirement (path 2), while both poor health (path 3) and good health (path 4) may also make people retire later.

CONCLUSIONS

An increased awareness of the differentiated roles that health may have in the work-retirement transition as outlined in this discussion paper may support research to address questions relevant for policy and practice and increase the impact of research. Recommendations for occupational health and social research are given.

A concept analysis of family caregivers' uncertainty of patient's illness

AIM

To analyze and examine the concept of uncertainty of the patient's illness among family caregivers.

BACKGROUND

Promoting family caregivers' health is significant in nursing. Family caregivers may experience uncertainty related to their loved ones' illness. A lack of clarity exists regarding the uncertainty concept among family caregivers and its implications in nursing.

DATA SOURCE

A review of the literature that focused on family caregivers of adult patients using PubMed, CINAHL, and Scopus databases was completed.

METHODS

The Walker and Avant framework was applied to identify the attributes, antecedents, and consequences of family caregivers' uncertainty.

RESULTS

Eight articles were analyzed. Attributes of family caregivers' uncertainty included the patient's illness probability and family caregivers' perception of the illness. Antecedents included the characteristics of the patient's illness, factors associated with the family caregivers' perception of the illness, and family responsibilities of caregiving. The consequences included family caregivers' emotional, psychological, and financial outcomes. Family caregivers' uncertainty is defined as the perception of the inability to process information regarding the patient's illness trajectory when caring for significant others' illness.

CONCLUSIONS

Individuals can perceive uncertainty differently as a patient-facing uncertainty in illness versus a family caregiver facing uncertainty of their loved ones' illness.

Curiosity in Online Video Concept Learning and Short-Term Outcomes in Blended Medical Education

Background: A student's level of curiosity in a subject after learning about it through online videos has not been addressed well in the medical education field. The purpose of this study, therefore, was to investigate online learning's effect on the stimulation of curiosity and short-term learning outcomes in a blended framework of precision medical education.

Methods: A mixed-methods research design was used. During the 2020 academic year, all fifth-year medical students who, prior to class, viewed 6 video clips that presented 6 core concepts were invited to complete a survey and self-reflection on their learning process to assess their level of curiosity in each concept. For each group of medical students, teaching assistants helped collect anonymous survey data and summative assessment scores representing the students' learning outcomes. Video-viewing patterns, attained through an action log transformation, were also coded for analysis. Mann–Whitney U and Kruskal–Wallis tests were employed to compare differences between groups, and multiple linear regression was used to select the factors affecting learning outcomes. Qualitative data were content-coded through a descriptive approach using thematic analysis.

Results: Of 142 medical students, 136 watched the online videos, 124 responded to the questionnaires, and 92 provided comments. Students' curiosity levels after learning about each concept through online videos significantly correlated with the degree to which a concept was learned. Medical students spent a median of 1.6 h online, and pause frequency correlated with curiosity in certain concepts. Aroused curiosity was associated with short-term learning outcomes in inconsistent effect sizes and directions. Students' feedback revealed various dimensions of curiosity, including novelty acknowledgment, recognition of an information gap, and information-seeking requests.

Conclusions: Curiosity can be induced through online video learning platforms and has a role in short-term learning outcomes in medical education.

[FORMATION OF THE NOTION OF «QUALITY OF LIFE», CONCEPTUALISATION AND METHODOLOGICAL ASPECTS (LITERATURE REVIEW)]

Quality of life (QoL) is an important health outcome and represents the primary aim of all medical interventions. The term QoL has been is frequently used in medical and philosophical literature in recent decades and has become an important concept and goal of public health research. Traditionally, biomedical results rather than QoL were the basic endpoints in clinical and public health research. However, recent research is increasingly focusing on the study of QoL in patients and the making use of QoL assessment has increased considerably. The concept of QoL has led to extensive research and has been used by the professional medical community in the treatment of a broad array of diseases. Literature search methods included database searches Scopus, Web of Science, MedLine, the Cochrane Library. Historical trends in the concept of QoL are discussed in this article and issues related to the conceptual and methodological aspects of constructing QoL in the context of health care.

Integrating Sex/Gender into Environmental Health Research: Development of a Conceptual Framework

There is a growing awareness about the need to comprehensively integrate sex and gender into health research in order to enhance the validity and significance of research results. An in-depth consideration of differential exposures and vulnerability is lacking, especially within environmental risk assessment. Thus, the interdisciplinary team of the collaborative research project INGER (integrating gender into environmental health research) aimed to develop a multidimensional sex/gender concept as a theoretically grounded starting point for the operationalization of sex and gender in quantitative (environmental) health research. The iterative development process was based on gender theoretical and health science approaches and was inspired by previously published concepts or models of sex- and gender-related dimensions. The INGER sex/gender concept fulfills the four theoretically established prerequisites for comprehensively investigating sex and gender aspects in population health research: multidimensionality, variety, embodiment, and intersectionality. The theoretical foundation of INGER's multidimensional sex/gender concept will be laid out, as well as recent sex/gender conceptualization developments in health sciences. In conclusion, by building upon the latest state of research of several disciplines, the conceptual framework will significantly contribute to integrating gender theoretical concepts into (environmental) health research, improving the validity of research and, thus, supporting the promotion of health equity in the long term.

[The organizational culture of medical organizations as a factor of carrier orientations of medical personnel]

The problems of professional advancement of medical personnel, their professional formation and professional career have enduring importance in connection with development and improvement of medical care system in any society. The purpose of the study is to investigate characteristics of influence of type of organizational culture of medical organizations on career orientations of medical personnel. The study covered sampling of 7 364 employees of medical organizations. The complex of psycho-diagnostic techniques was applied that permitted to examine prevailing type of organizational culture of medical organizations (The R. Harrison questionnaire adapted by S. A. Lipatov), preferences of medical personnel in building up their professional career (E. Schein questionnaire "Carrier Anchors"), and their concepts about competitive medical worker (semantic differential - 16 opposite personality characteristics). The statistical methods included standard procedures of primary mathematical processing of empirical data (frequency and percentage distribution, calculation of mean group indices, standard deviation and dispersions), comparative analysis using Student's test (correctness of criterion application was checked by the Libya test), Spearman correlation analysis. It is established that under developed organizational culture of medical organization, its orientations towards task and personality, with team cohesion and high level of value-orientated unity of their members, medical workers have consistency of concepts concerning career and a unity of career orientations targeted to professional competence and service to other people that determines quality of medical care.

Scoping study of definitions and instruments measuring vulnerability in older adults

BACKGROUND

It is important to foster social participation and health equity, especially for older adults in situations of vulnerability. Despite growing interest in vulnerability, there is no consensus regarding how to define or measure this concept. This paper provides an inventory and synthesis of definitions of and instruments measuring vulnerability in older adults.

METHODS

Using a scoping study framework, eight databases (Abstracts in Social Gerontology, Academic Search Complete, AgeLine, CINAHL, MEDLINE, SocINDEX, PsycInfo, Scopus) were searched with relevant keywords [Vulnerab* AND (Concept*, Defin*, Meaning, Terminology, Measurement, Assessment*, Indicator*, Instrument*, Scale*, Questionnaire* OR Test*) AND (Aging, Aging, Elder*, Gerontolog*, Older OR Senior*)].

RESULTS

Thirty-one original definitions and five measuring instruments were identified, content-analyzed, and compared. Vulnerability definitions mostly focused on people under conditions that increased their risk of harm because of individual physical factors, the environment, and their interaction. Considering these definitions, experts in the field of aging, including two representing older adults, participated in a workshop, and a consensus was reached to define a situation of vulnerability as "a set of circumstances in which one or more individuals experience, at a specific moment in time, one or multiple physiological, psychological, socioeconomic or social difficulties that may interact to increase their risk of being harmed or having coping challenges that have a negative impact on their life." Although none of the measures fully targeted this definition, the Perceived Vulnerability Scale (PVS) is one of the most complete measures, with 22 items considering feelings of vulnerability toward personal and environmental factors, and good psychometric properties.

CONCLUSIONS

The proposed definition and the PVS help to provide a common language and measure in health and social sciences research, policy and practice identifying and reaching older adults in situations of vulnerability and intervening to foster social participation and health equity.

Indeterminate form of Chagas disease: historical, conceptual, clinical, and prognostic aspects

Chagas disease (CD) remains a serious endemic disease in Latin America and a major public health problem. Because of globalization, the disease has spread to non-endemic areas in the northern hemisphere. In the chronic phase of the disease, most patients present with the indeterminate form (IF), characterized by positive serology for Trypanosoma cruzi, absence of clinical findings, and normal findings in electrocardiogram (ECG). IF was not recognized as a clinical entity until decades after the discovery of the disease, and only in the 1940-50s, it was categorized as a form of CD, and its conceptual definition was ratified in the 1980s. Children, adolescents, and young adults with the IF benefit from etiological treatment and tend to have less progression to heart disease in the long term than the untreated ones. IF patients have an essentially benign clinical condition, and their prognosis can be compared to that of healthy individuals with normal ECG findings. Currently, because of aging, patients with the IF have comorbidities that require attention in health services.

Development of a Search Task Using Immersive Virtual Reality: Proof-of-Concept Study

BACKGROUND

Serious games are gaining increasing importance in neurorehabilitation since they increase motivation and adherence to therapy, thereby potentially improving its outcome. The benefits of serious games, such as the possibility to implement adaptive feedback and the calculation of comparable performance measures, can be even further improved by using immersive virtual reality (iVR), allowing a more intuitive interaction with training devices and higher ecological validity.

OBJECTIVE

This study aimed to develop a visual search task embedded in a serious game setting for iVR, including self-adapting difficulty scaling, thus being able to adjust to the needs and ability levels of different groups of individuals.

METHODS

In a two-step process, a serious game in iVR (bird search task) was developed and tested in healthy young (n=21) and elderly (n=23) participants and in a group of patients with impaired visual exploration behavior (ie, patients with hemispatial neglect after right-hemispheric stroke; n=11). Usability, side effects, game experience, immersion, and presence of the iVR serious game were assessed by validated questionnaires. Moreover, in the group of stroke patients, the performance in the iVR serious game was also considered with respect to hemispatial neglect severity, as assessed by established objective hemispatial neglect measures.

RESULTS

In all 3 groups, reported usability of the iVR serious game was above 4.5 (on a Likert scale with scores ranging from 1 to 5) and reported side effects were infrequent and of low intensity (below 1.5 on a Likert scale with scores ranging from 1 to 4). All 3 groups equally judged the iVR serious game as highly motivating and entertaining. Performance in the game (in terms of mean search time) showed a lateralized increase in search time in patients with hemispatial neglect that varied strongly as a function of objective hemispatial neglect severity.

CONCLUSIONS

The developed iVR serious game, "bird search task," was a motivating, entertaining, and immersive task, which can, due to its adaptive difficulty scaling, adjust and be played by different populations with different levels of skills, including individuals with cognitive impairments. As a complementary finding, it seems that performance in the game is able to capture typical patterns of impaired visual exploration behavior in hemispatial neglect, as there is a high correlation between performance and neglect severity as assessed with a cancellation task.

Conceptualizing patient participation in psychiatry: A survey describing the voice of patients in outpatient care

Background

While increasingly discussed in somatic care, the concept of patient participation remains unsettled in psychiatric care, potentially impeding person‐centred experiences.

Objective

To describe outpatient psychiatric care patients’ conceptualization of patient participation.

Design

An exploratory survey.

Setting and participants

Patients in four psychiatric outpatient care units.

Variables

Patients conceptualized patient participation by completing a semi‐structured questionnaire, including optional attributes and free text. Data were analysed using statistics for ordinal data and content analysis for free text.

Results

In total, 137 patients (69% of potential respondents) completed the questionnaire. The discrete items were favoured for conceptualizing patient participation, indicating a primary connotation that participation means being listened to, being in a reciprocal dialogue, learning about one's health care and managing one's symptoms. Additional free‐text responses acknowledged the attributes previously recognized, and provided supplementary notions, including that patient participation is about mutual respect and shared trust.

Discussion

What patient participation is and how it can be facilitated needs to be agreed in order to enable preference‐based patient participation. Patients in outpatient psychiatric care conceptualize participation in terms of both sharing of and sharing in, including taking part in joint and solo activities, such as a reciprocal dialogue and managing symptoms by yourself.

Conclusion

While being a patient in psychiatric care has been associated with a lack of voice, an increased understanding of patient participation enables person‐centred care, with the benefits of collaboration, co‐production and enhanced quality of care.

Patient contribution

Patients provided their conceptualization of patient participation in accordance with their lived experience.

[Conception and framework of land ecological restoration for a new stage in China.]

Based on the theories of geography and landscape ecology, land ecological restoration is an important strategy to promote ecological civilization and build a beautiful China. Land ecological restoration in China has the characteristics of multi-disciplinary theoretical system, diverse work mode, integration of technology and methods, and diversified practice and exploration. The overall effectiveness of the work coexists with arduous tasks. Based on the new challenges in land ecological restoration, we summarized the overall framework and technical path of land ecological restoration, the working mechanism and mode of regional land ecological restoration, the content system and technical standards of land ecological restoration. In the new stage, the top-level design of land ecological restoration in China should focus on the work system, business boundary and institutional system, identify the responsibility boundary of different business processes, and realize the closed management of the whole work chain from the perspective of theory, system, engineering and technology. Rural settlement area, urban built-up area, industrial and mining gathering area, ecological function area and blue ocean area are the five major elements of regional scale land space, which correspond to five different ecological restoration modes, namely, comprehensive land improvement, urban renewal and double repair, mine geological environment restoration, mountain-river-forest-farmland-lake-grassland restoration, and blue bay restoration. It is necessary to comprehensively use the thinking of "Three Integrations" (information, technology, and process) to build a set of regional land ecological restoration work mode covering the integration of investigation, monitoring and evaluation, land space planning, project implementation, project acceptance and ecosystem monitoring and evaluation.

The evolution of the concept of stress and the framework of the stress system

Stress is a central concept in biology and has now been widely used in psychological, physiological, social, and even environmental fields. However, the concept of stress was cross-utilized to refer to different elements of the stress system including stressful stimulus, stressor, stress response, and stress effect. Here, we summarized the evolution of the concept of stress and the framework of the stress system. We find although the concept of stress is developed from Selye's "general adaptation syndrome", it has now expanded and evolved significantly. Stress is now defined as a state of homeostasis being challenged, including both system stress and local stress. A specific stressor may potentially bring about specific local stress, while the intensity of stress beyond a threshold may commonly activate the hypothalamic-pituitary-adrenal axis and result in a systematic stress response. The framework of the stress system indicates that stress includes three types: sustress (inadequate stress), eustress (good stress), and distress (bad stress). Both sustress and distress might impair normal physiological functions and even lead to pathological conditions, while eustress might benefit health through hormesis-induced optimization of homeostasis. Therefore, an optimal stress level is essential for building biological shields to guarantee normal life processes.

Definitions and Operationalization of Mental Health Problems, Wellbeing and Participation Constructs in Children with NDD: Distinctions and Clarifications

Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.

A Chinese Conceptual Semantic Feature Dataset (CCFD)

Memory and language are important high-level cognitive functions of humans, and the study of conceptual representation of the human brain is a key approach to reveal the principles of cognition. However, this research is often constrained by the availability of stimulus materials. The research on concept representation often needs to be based on a standardized and large-scale database of conceptual semantic features. Although Western scholars have established a variety of English conceptual semantic feature datasets, there is still a lack of a comprehensive Chinese version. In the present study, a Chinese Conceptual semantic Feature Dataset (CCFD) was established with 1,410 concepts including their semantic features and the similarity between concepts. The concepts were grouped into 28 subordinate categories and seven superior categories artificially. The results showed that concepts within the same category were closer to each other, while concepts between categories were farther apart. The CCFD proposed in this study can provide stimulation materials and data support for related research fields. All the data and supplementary materials can be found at https://osf.io/ug5dt/ .

Disease Concept-Embedding Based on the Self-Supervised Method for Medical Information Extraction from Electronic Health Records and Disease Retrieval: Algorithm Development and Validation Study

BACKGROUND

The electronic health record (EHR) contains a wealth of medical information. An organized EHR can greatly help doctors treat patients. In some cases, only limited patient information is collected to help doctors make treatment decisions. Because EHRs can serve as a reference for this limited information, doctors' treatment capabilities can be enhanced. Natural language processing and deep learning methods can help organize and translate EHR information into medical knowledge and experience.

OBJECTIVE

In this study, we aimed to create a model to extract concept embeddings from EHRs for disease pattern retrieval and further classification tasks.

METHODS

We collected 1,040,989 emergency department visits from the National Taiwan University Hospital Integrated Medical Database and 305,897 samples from the National Hospital and Ambulatory Medical Care Survey Emergency Department data. After data cleansing and preprocessing, the data sets were divided into training, validation, and test sets. We proposed a Transformer-based model to embed EHRs and used Bidirectional Encoder Representations from Transformers (BERT) to extract features from free text and concatenate features with structural data as input to our proposed model. Then, Deep InfoMax (DIM) and Simple Contrastive Learning of Visual Representations (SimCLR) were used for the unsupervised embedding of the disease concept. The pretrained disease concept-embedding model, named EDisease, was further finetuned to adapt to the critical care outcome prediction task. We evaluated the performance of embedding using t-distributed stochastic neighbor embedding (t-SNE) to perform dimension reduction for visualization. The performance of the finetuned predictive model was evaluated against published models using the area under the receiver operating characteristic (AUROC).

RESULTS

The performance of our model on the outcome prediction had the highest AUROC of 0.876. In the ablation study, the use of a smaller data set or fewer unsupervised methods for pretraining deteriorated the prediction performance. The AUROCs were 0.857, 0.870, and 0.868 for the model without pretraining, the model pretrained by only SimCLR, and the model pretrained by only DIM, respectively. On the smaller finetuning set, the AUROC was 0.815 for the proposed model.

CONCLUSIONS

Through contrastive learning methods, disease concepts can be embedded meaningfully. Moreover, these methods can be used for disease retrieval tasks to enhance clinical practice capabilities. The disease concept model is also suitable as a pretrained model for subsequent prediction tasks.

Considerations on the concept, definition, and diagnosis of amyotrophic lateral sclerosis

The concept, definition, and diagnosis of amyotrophic lateral sclerosis (ALS) currently present some problems. This article systematically reviews the literature on the history, current concepts, definition, and diagnosis of ALS, and discloses the present problems based on the retrieved literature and the authors’ clinical experience. The current concepts and definitions of ALS have not yet been unified or standardized in clinical practice, and are sometimes vague or inaccurate, which can cause difficulties for neurologists in the clinical treatment of ALS. The concept and definition of ALS need to be further ascertained, and the current diagnostic criteria for ALS require further development. The identification of effective and objective biomarkers may be a feasible method for the early and accurate diagnosis of ALS. Therefore, future research should focus on the identification of reliable biomarkers—especially neuroimaging biomarkers—through autopsy. Standardizing the concept and definition of ALS and formulating clear diagnostic criteria will largely avoid many uncertainties in the future clinical research and treatment of ALS, which will greatly benefit patients.

[About experience of developing concept of personnel policy in health care at the level of the subject of the Russian Federation]

The personnel policy is one of priority areas of developing national health care. Its effective implementation requires evidence-based development of relevant program documents, the most important of which is the Concept of health care personnel policy that currently exists only in a number of regions of the Russian Federation. In this regard, the purpose of the study was to develop approaches to scientific justification and development of the Concept of health care personnel policy at the level of region of the Russian Federation, as exemplified in the Irkutsk oblast. The article describes progress of this large-scale and lengthy study, its main results included. The developed approaches resulted in comprehensive organizational technology of development corresponding Concept. The results of this experience can be implemented in other regions of the Russian Federation. Therefore, it is of scientific and practical interest for all potential developers of similar program documents and wide range of specialists in health care organization.

Dealing with dysnomia: Strategies for the cultivation of used concepts in social research

This article follows recent calls to turn social theory away from its fixations on intellectual history and toward the mechanics and craft of creating social theories in the research process. The subject of this article is a dilemma common to theorizing in social science: dysnomia, or the phenomenon in which some object is poorly named. Specifically, this article focuses on how social scientists distinguish original concepts from their equivalents in everyday speech. Three tactics for dealing with dysnomia are named-academic arcana, classification and sociologism-and considered in order to ascertain the strengths and weaknesses of each.

Patients and Health Professional's Perspective of Functional Mobility in Parkinson's Disease

Background: Functional mobility (FM) is the person's ability to move to accomplish daily living tasks and activities. FM limitations are common in Parkinson's disease, increase with disease progression, and can be highly disabling. Although several studies in Parkinson's disease (PD) field use this concept, only recently, a formal definition has been proposed.

Objective: We aimed to explore patient's and health professional's perspectives of FM in PD.

Methods: A focus group methodology has been used. Four focus groups, with a total of 10 patients and 10 health professionals, were performed. Six patients were early stage and four advanced stage. The health professional's group was composed of five neurologists and five physiotherapists. The suitability of the new concept, the impact of FM limitations in PD patient's daily routine, and the potential benefit of walking aids have been discussed.

Results: All participants were able to provide a spontaneous definition of FM, matching with the proposed concept. All agreed that PD affects patient's FM, increasing the limitations with disease progression, and with the existence of a serious prejudice with walking aids that hinders its use. Early-stage patient's perspective seems to be more in line with neurologist's perspective, while the views of advanced-stage patients were closer to physiotherapist's views.

Conclusion: FM concept was considered as intuitive and useful. FM limitations have an important physical and social impact in the advanced stage of the disease. Although patients and health professionals acknowledge walking aid's benefit improving patient's FM, the prejudice associated with this type of tools limits its recommendation and use.

Conceptual principles and patterns of legal regulation of the processes of storage, access and data protection of genome sequencing in foreign countries as the basis for the modernization of Russian legislation

The relevance of the study of the general principles and patterns of legal regulation of access storage processes and data protection of genome sequencing in foreign countries is determined by the need to develop a general concept of legal regulation of this type of activity in Russia. The purpose of this study is to develop the system-forming principles and patterns of access storage and data protection of genome sequencing in Russia. To achieve this goal, tasks were set and solved to identify and study the general principles and patterns of legal regulation of access storage processes and data protection of genome sequencing in foreign countries. The international documents regulating the features of regulation of access storage processes and data protection of genome-wide sequencing, the doctrinal sources of Great Britain, the USA, France, Israel, and Japan are studied. Methods used: general philosophical, general scientific, private scientific, special (structural-legal, comparative-legal, formal-legal). The general principles for the formation of the concept of legal regulation of genome sequencing in Russia are proposed. It was revealed that the creation of a universal regulatory regulator aimed at protecting the subject of personal data in view of the prevalence of public interests over private ones and the constant expansion of the scope of application of genetic data obtained as a result of genome-wide sequencing is the main problem in developing a legal regulation mechanism in the studied area. For the first time, the authors determine the basic principles for developing the concept of genome-wide sequencing in Russia, including: recognition of human rights and human dignity as the highest value, the necessity of researchers' responsibility for the well-being of participants in view of the obtained research results, the mandatory informed consent of which should be voluntary, permanent, their right to get acquainted with the results obtained if it concerns their health, access to such information, ensuring the right to non-knowledge of research results and others.

Paradoxes of person-centred care: A discussion paper

Aim

Previous research has mainly focused on the advantages of PCC and less on its disadvantages. Hence, there is a need to further explore the recent research regarding PCC from both sides. Therefore, the aim of this paper is to elucidate the advantages and disadvantages of PCC.

Design

Discussion paper.

Methods

We searched relevant literature published January 2000-March 2018 in PubMed, Medline, CHINAL, Scopus and Web of Science.

Results

The results showed that PCC can contribute to improved health and well-being, improved mutual interaction in relationships, improved cost-effectiveness and improved work environment, while the disadvantages can involve increased personal and financial costs, exclusion of certain groups, increased personal and financial costs, exclusion of staff's personhood and unfairness due to empathy. An analysis of the existing literature on PCC showed paradoxes, which call for further investigation.

Six decades of lateral flow immunoassay: from determining metabolic markers to diagnosing COVID-19

Technologies based on lateral flow immunoassay (LFIA), known in some countries of the world as immunochromatographic tests, have been successfully used for the last six decades in diagnostics of many diseases and conditions as they allow rapid detection of molecular ligands in biosubstrates. The popularity of these diagnostic platforms is constantly increasing in healthcare facilities, particularly those facing limited budgets and time, as well as in household use for individual health monitoring. The advantages of these low-cost devices over modern laboratory-based analyzers come from their availability, opportunity of rapid detection, and ease of use. The attractiveness of these portable diagnostic tools is associated primarily with their high analytical sensitivity and specificity, as well as with the easy visual readout of results. These qualities explain the growing popularity of LFIA in developing countries, when applied at small hospitals, in emergency situations where screening and monitoring health condition is crucially important, and as well as for self-testing of patients. These tools have passed the test of time, and now LFIA test systems are fully consistent with the world's modern concept of ‘point-of-care testing’, finding a wide range of applications not only in human medicine, but also in ecology, veterinary medicine, and agriculture. The extensive opportunities provided by LFIA contribute to the continuous development and improvement of this technology and to the creation of new-generation formats. This review will highlight the modern principles of design of the most widely used formats of test-systems for clinical laboratory diagnostics, summarize the main advantages and disadvantages of the method, as well as the current achievements and prospects of the LFIA technology. The latest innovations are aimed at improving the analytical performance of LFIA platforms for the diagnosis of bacterial and viral infections, including COVID-19.

[The comparative evaluation of policy documents of the Russian Federation concerning personnel policy in health care]

Nowadays, in Russia number of problems is present in effective personnel policy in health care. The National Concept of personnel policy in health care (2002) expired in 2010 and no new one was developed. However, corresponding program documents were adopted at the level of subjects of the Russian Federation. The purpose of study was to compare evaluation of program documents of subjects of the Russian Federation related to issues of personnel policy in health care. The continuous sampling technique was applied to study these documents, which were valid in the territories of all subjects of the Russian Federation in 2002-2019. The comparative assessment was performed. It is demonstrated that the most informative document in this area is only the corresponding specialized Concept. However, this document was adopted only in 8.2% of the subjects of the Russian Federation, and they were valid only in two subjects. The concepts of health care development in the subjects of the Russian Federation, addressing medical personnel policy were adopted in 44.7% of the subjects of the Russian Federation. However, these legal documents operate only in 15.3% of territories. At the same time, the availability of appropriate specialized program document is a prerequisite of development of coherent and effective medical personnel policy in health care at all its levels.

Vulnerability in birth: A negative capability

AIM

This article explores the literature on women's expectations for birth, the sociocultural context from which these expectations originate and their impact on the interpretation of birth experience.

BACKGROUND

Childbirth is associated with specific expectations from women with the potential for dissatisfaction if these expectations are not met.

DESIGN

This paper presents a systematic analysis of the concept of vulnerability in childbirth.

FINDINGS

A framework was extracted from the literature that linked the themes of a discourse of control, construction of inadequacy and shame of exposure to explain the sociocultural origin of dominant childbirth expectations in the literature. The experience of vulnerability unique to the birthing event is suggested as exposing the woman to this underlying contextual framework and impacting the interpretation of her birth.

CONCLUSION

This synthesis has exposed the transient experience of vulnerability during birth as a significant contributor to the birthing woman's interpretation of the birth and her place within it.

RELEVANCE TO CLINICAL PRACTICE

An explanatory framework is offered to clinicians that could increase their awareness of sociocultural and historical factors impacting a woman's expectations for birth. Appreciation of the woman's vulnerability in birth, exposing her to the influence of this framework, can assist clinicians to facilitate a quality birth experience for women. Furthermore, supporting women and midwives to accept this experience of birth vulnerability as a "negative capability," can facilitate an empowering birth experience.

Key components of shared decision making models: a systematic review

OBJECTIVES

To (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Peer-reviewed articles in English presenting a new or adapted model of SDM.

INFORMATION SOURCES

Academic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019.

RESULTS

Forty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment options was the most prominent component across models. Components present in >50% of models were: Make the decision (75%), Patient preferences (65%), Tailor information (65%), Deliberate (58%), Create choice awareness (55%), and Learn about the patient (53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time, Describe treatment options and Make the decision are the two components which are present in most models in any time period. Create choice awareness stood out for being present in a markedly larger proportion of models over time.

CONCLUSIONS

This review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key.

TRIAL REGISTRATION

PROSPERO registration CRD42015019740.

[Methodological analysis of basic concepts and terms used in forensic medical ballistics and most frequently common mistakes]

The objective of this work was to determine the reasons and to find the ways to prevent common mistakes in using conceptual and terminology framework in forensic medical ballistics. Basic research and dissertation papers, practice guidelines and textbooks, educational learning materials, as well as conceptual and terminology frameworks of the regulatory legal acts of the Russian Federation had been analyzed. The study outcomes make it possible for a forensic medical expert to use basic definitions and terms of forensic medical ballistics in his/her practice methodologically correctly and in a well-argued manner, to reduce dramatically or completely exclude a possibility of expert's mistakes, to formulate reliable and sound conclusions upon the fact and conditions of a firearm use and upon a concrete mechanism of a gunshot wound formation in general.

Child and Youth Health Literacy: A Conceptual Analysis and Proposed Target-Group-Centred Definition

(1) Background: This article adopts an interdisciplinary perspective to analyse, examine, and reflect upon prominent health literacy (HL) understandings in childhood and youth. (2) Method: The conceptual analysis combined Rodgers’ and Jabareen’s approaches to conceptual analysis in eight phases. (3) Results: First, we present exploratory entry points for developing a child-specific HL understanding based on the six dimensions of a ‘health-literacy 6D model’. Second, we describe and reflect upon five meta-level dimensions covering the HL definitions and models for children and youth found in the conceptual analysis. Third, we integrate our findings into a target-group-centred HL definition for children and youth. (4) Discussion/Conclusion: This article raises awareness for the heterogeneity of the current conceptual HL debate. It offers a multidisciplinary approach for advancing the existing understanding of HL. Four recommendations for future actions are deduced from the following four principles, which are inherent to the proposed target-group-centred HL definition: (a) to characterize HL from an asset-based perspective, (b) to consider HL as socially embedded and distributed, (c) to recognize that HL develops both in phases and in flexible ways, and (d) to consider the multimodal nature of health-related information. Further research is necessary to test the feasibility and applicability of the proposed definition and conceptual understanding in both research and practice.

[On the Issue of Evolution of the Concept of "Public Health"]

The article substantiates necessity of including into common concept of "public health" such an additional systemic attribute as psychological (spiritual) health. The essence of psychological health is revealed as a totality of values, attitudes and motives of human behavior in society - kind of all characterizing human personality. It is demonstrated that in the most degree disorders of psychological health occur under effect of negative alterations of social cultural environment (anomia, desocialization, undermining cultural core of society) resulting in development of abnormal types of personality. The increasing of prevalence of these types in population is to be considered as disorder of psychological health and decreasing of vitality of society.

What Do Preschool Children in India Understand About Death?: An Exploratory Study

Most people avoid talking about death with children even when required, as they are unsure at what age children start understanding the concept of death. Although this question has been researched in the west, it has not been answered in the Indian context. Therefore, this study was conducted in India with 25 children (14 females, 11 males; 3-5 years), using play and joint story construction method, along with semistructured interviews. Results indicated that majority of the children understood that everyone has to die, including significant people like their own parents (i.e., universality) and also, many children understood that death is final (i.e., irreversibility). However, only few children understood that all cognitive/behavioral functions cease at death (i.e., nonfunctionality). In conclusion, only a small proportion of preschoolers seems to have had a mature concept of death.

[The Concept of Patient-Oriented Model of Organization of Medical Care]

The efficient and rational support of quality om medical care rendering is an important aspect of the system of organization of health care functioning. The study considers the development of concept of patient-oriented model of medical care rendering and also system analysis of main parameters of the model. The study was based on the analysis of publications and normative legislative documents of Minzdrav of Russia and the Federal Foundation of mandatory medical insurance, control boards of health care and territorial Foundations of mandatory medical insurance, subjects of the Russian Federation. The comprehensive analysis resulted in formulation of main parameters and propositions of the patient-oriented model. The concept of related model of organization of medical care rendering to population was presented too. The implementation of the proposed concept in case of its appropriate implementation will favor amelioration of clinical outcomes, increasing of satisfaction and compliance of patients, that will permit to optimize organization of medical care rendering.

Alzheimer's Disease and Chinese Medicine as a Useful Alternative Intervention Tool: A Mini-Review

BACKGROUND

Alzheimer´s disease (AD) is a serious and complex neurodegenerative disease. Currently, there are about 44 million people suffering from AD all over the world and this number is expected to rapidly grow due to demographic changes. The disease can be treated both pharmacologically and non-pharmacologically. Unfortunately, it cannot be cured yet. Nevertheless, the drugs for the treatment of AD are quite expensive, have different side effects and only delay symptoms of this disease. Therefore researchers suggest the use of various non-pharmacological therapies. Apart from relatively popular in western world such as physical activities, cognitive training or healthy diet, Chinese medicine starts to be practiced in Europe.

OBJECTIVE

The purpose of this mini-review is to discuss the concept of Chinese medicine and explore its most common and effective forms in the treatment of AD.

METHODS

This was done by conducting a literature search in the world´s acknowledged databases such as Web of Science, Scopus, PubMed and Springer.

RESULTS

Five randomized controlled clinical trial studies were analyzed and their findings were discussed.

CONCLUSION

The authors of this mini-review list the key benefits (e.g., positive results of the reviewed randomized clinical trials studies for the improvement of cognitive decline in AD) and limitations (e.g., low awareness of benefits of TCM in Europe) of Chinese medicine therapy for the treatment of AD.