Journal articles on the topic 'Degree Discipline: Healthcare'

As complexity challenges healthcare providers across disciplines, calls arise for greater collaboration across settings and disciplines. In this column, the importance of honoring the wisdom of the diverse perspectives of collaborators with varying educational and experiential backgrounds is explored. For authentic collaboration to be possible, collaborators must have a solid theoretical, scientific, and experiential foundation within their particular discipline. The challenge for nurse faculty is to prepare students for collaboration by providing teaching-learning opportunities for building a solid foundation in the discipline, being clear about the distinctions across disciplines as well as the distinctions among the many degree levels within nursing.

Singapore is a modern city state and the smallest nation (land area of 699 km2) in South East Asia. Its population of over 4 million is multiracial, with the Chinese (76.8%) constituting the majority of the population, followed by the Malays (13.9%) and the Indians (7.9%). The present health system is one that stresses individual responsibility, based on a system of compulsory medical saving accounts and on market mechanisms for the allocation of scarce healthcare resources. There are both public and private healthcare sectors. Since 1985, every public sector hospital has been ‘restructured’ — to grant some degree of autonomy in operational matters, with the intention of creating competition and financial discipline, although the government still retains 100% ownership of the hospitals.

Background: In India, long term data regarding professional outcomes and geographical distribution of enrolled medical graduates is lacking. This adversely impacts policy for efficient healthcare delivery. Methods: A cross sectional survey of students enrolled as medical graduates in year 2001 was done at single point follow up after 17 years. Along with demographic data, gender, seat quota, post-graduate qualification, type of practice, discipline of choice and current geographic locations were collected. Logistical regression model with odds ratio was used to analyse association between variables. Results: 192/200 medical graduates were analysed. Male: female ratio was 119: 73. 109 (56%) had post-graduate degree, 35 (18%) had post-graduate diploma, while another 24 (12.8%) completed super-specialty degree.125 (65%) completed post-graduation in clinical disciplines. 103 (54%) are serving government institutes. 54 (28%) practice in metro cities, while 48 (25%) are in non-metro capital urban locations. Only 44 (23%) are serving rural Indian population, while 17 (9%) are at foreign countries. General medicine (12.5%), obstetrics (8%), paediatrics (8%) anaesthesia (7%) and general surgery (6.7%) were the most common broad clinical specialities. Females had high likelihood to pursue obstetrics/ gynaecology {OR-11.4 (95%CI-2.6-48.7)}; while males were more likely to select medical {OR-0.54 (95% CI-0.25-1.0)} and surgical disciplines {OR- 0.42 (95% CI-0.18-0.98)}. Conclusions: Majority of medical graduates complete post-graduation courses, with preference for clinical disciplines. Less than one fourth of doctors serve rural population.

PurposeThe quality of maternal healthcare training is the most optimal degree of health in the delivery of effective, efficient and quality healthcare in midwifery discipline. Student accoucheurs studying at the Free State School of Nursing are faced with resistance, discrimination, rejection and unacceptability by pregnant women during their clinical placement at the Free State maternal healthcare institutions. This results in poor quality of training of student accoucheurs in maternal healthcare. Considerable studies have been conducted on males in midwifery nursing, but no guidelines have been developed to facilitate student accoucheurs' acceptance and improvement of the quality of training in maternal healthcare, hence the purpose of this study.Design/methodology/approachA descriptive, explorative qualitative design was used in this study. Qualitative focused group discussions (n = 32) were conducted through purposeful sampling method. Data was analysed thematically.FindingsThree main categories emerged: student accoucheurs' related factors with social interactions and relations as a theme; maternal healthcare users’ related factors with transcultural diversity and socio-economic status as themes; nurse training institutions and maternal healthcare institutions service providers-related factors with gender inequality in the work place as a theme. Ultimately, the guidelines to facilitate acceptance and improvement of quality training of student accoucheurs in maternal healthcare institutions were developed and recommended for implementation.Originality/valueThe paper developed guidelines to facilitate acceptance and improvement of quality training of student accoucheurs in Free State maternal healthcare institutions.

The conditions of modern pharmaceutical market development require leadership at each level that lets not only respond rapidly and efficiently on the changes of the environment but initiate the necessary changes. Leaders as agents of changes can transform people’s values, to motivate and inspire, to form the vision of development of healthcare system and pharmaceutical sector taking into account the principles of system thinking for the provision of population with available, quality and safe pharmaceutical care and the improvement of their life. The aim of the work is the development of an elective discipline «Leadership in Pharmacy» for training Master of Pharmacy, Industrial Pharmacy. The literature review based on the data of international and foreign educational standards of higher pharmaceutical education, the current national educational standard, the experience of teaching subjects devoting to leadership in pharmacy both abroad and in Ukraine has been carried out. Such a scientific quantitative method as a survey has been used. 221 students from the School of Pharmacy at Bogomolets National Medical University have taken part in the survey. The recommendations of the International Pharmaceutical Federation pay attention to the advisability of forming leadership competencies for pharmaceutical workers. The national standards of higher pharmaceutical education in the USA, Great Britain, Australia, Canada include a specific list of leadership competencies. The domestic standard of higher education for getting a Master’s degree in Pharmacy, Industrial Pharmacy includes certain general competencies based on the leadership. Some leadership skills are listed as special competencies and they are reflected in the discipline «Pharmaceutical Management and Marketing». However, a discipline aimed at the complex and systematic formation of leadership competencies is not presented in the working educational plan for training Masters in the field of knowledge «Healthcare» and specialty «Pharmacy». About 70% of the School of Pharmacy students at Bogomolets National Medical University think that the materials devoted to leadership «worth including» to the educational program and 28% of them notice that «rather worth including». According to the students’ opinions, the most interesting leadership topics are traits of leaders aimed at the success, leadership and team, the formation of leadership strategy – 76%, 72% і 70% respectively. The structure of the elective discipline «Leadership in Pharmacy» with an indication of the aim, list of topics, and the desired educational outcomes (competencies) has been presented. The elective discipline «Leadership in Pharmacy» considering the formation of leadership skills at three successive levels, namely individual, team and organization has been developed. This discipline consists of the following modules: «Foundations of Leadership. Personal Leadership», «Leadership and Collaboration», «Leadership and Organizational Change».

Nearly two-thirds of psychiatric patients are reluctant to seek help from healthcare professionals due to stigma, discrimination, and negligence that evolve around the community, including healthcare providers. Future health professionals should have a positive attitude toward psychiatry and patients with mental health problems. Thus, it is vital to identify medical students’ attitudes toward psychiatry as future healthcare providers. The authors conducted a cross-sectional study by using online questionnaires of “Perceptions of Psychiatry” in Faculty of Medicine Universitas Indonesia, with first- and fourth-year students (before psychiatric rotation), as well as fifth-year students and alumni (after psychiatric rotation). Out of 250 questionnaires distributed, 224 subjects responded, with a response rate 89.6%. Chi-square or fisher analysis was conducted to know the correlation between gender and attitudes towards psychiatry. The frequency distribution method was applied to identify the degree of stigmatization from respondents. A mix of positive and negative perceptions towards psychiatry was identified. The overall response was favorable to both before and after psychiatric rotation groups. Differences in perceptions between male and female psychiatry students as a discipline and career were statistically significant. Correcting misapprehension and removing the stigma on psychiatry during medical education might decrease the stigma in the psychiatric field and patients.

The article shows that to maintain health, diseases prevention and country biosafety requires a deep knowledge of basic preventive health care discipline - epidemiology. Experts-epidemiologists are in demand both in the institutions of Rospotrebnadzor (Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing) and the Ministry of Healthcare. Analysis the educational process in departments and epidemiology courses of 48 medical colleges indicated the importance of the organization in all medical college individual faculties or epidemiology courses where have worked as a lecturer specialists of «medical and prophylactic business», or certificate epidemiologist, or doctors a degree in the specialty «epidemiology». There is necessary «rejuvenation» of the lecturer staff. Also in connection with a significant change in the epidemiology of the application area is necessary to organized regularly training for epidemiology lecturer.

In the article we have analyzed the significance and importance of the “Infection Control” discipline in pursuing a master’s degree in nursing. The article states that the master nurse is the lead organizer and executor of activities related to the creation of a safe hospital environment, while the correctness and completeness of the actions at the workplace depends on the depth of theoretical knowledge and sophistication of practical skills. The paper specifies the general and occupational competencies, forms and methods of conducting lectures and practical sessions, describes the expected results of training, indicates interdisciplinary integration, draws attention to the problems of honesty in the performance of autonomous and individually research work by the seekers of higher education. It is noted that the practical health care needs such a master nurse, who not only possesses thorough professional knowledge, but also is capable to act clearly and quickly in an emergency, perfectly master up-to-date techniques of preventing, in particular, the healthcare-associated infections through the developed clinical judgment. It is the competency based potential capacity of the “Infection Control” academic discipline that makes it possible to realize these tasks. The priority area of improving the educational process is its practical orientation and significance.

Background: Student-run health initiatives in the community setting have been utilized to provide practical experience for undergraduate students to develop professional competencies, gain exposure to diverse populations, and to engage in activities of social accountability. There is much literature on student-run health initiatives; however, there is no consensus on a definition of this concept or a comprehensive synthesis of the literature that describes student-run health initiatives offered by students in pre-licensure healthcare education programs. Purpose: To provide a concept analysis of, and propose a definition for, student-run health initiatives that provide community-based services for students during pre-licensure health discipline education. Methods: A systematic literature search and review process was used to identify and synthesize peer-reviewed articles from 7 academic databases covering a range of pre-licensure health disciplines and education. Walker and Avant’s framework for concept analysis was used to guide exploration of attributes, antecedents and consequences of student-run initiatives, and to inform development of a definition for this concept. Results: The review yielded 222 articles for data extraction and represented 17 distinct pre-licensure health disciplines, 18 health-related disciplines, and a range of other baccalaureate and graduate programs. Our analysis revealed 16 definitions, 5 attributes, 6 antecedents, and consequences identified for student-run health initiatives. Attributes were Provision of Service, Service is Free, Target Clientele, Volunteerism, and Student Governance. Antecedents included Purpose/Rationale, Affiliation with Academic Unit, Location and Partnerships, Funding and Resources, Professional Oversight, and Preparation for Student Role. Consequences were improved access to services and outcomes for clients; competency development, personal gains and interprofessional learning for students; and positive outcomes for broader systems, such as decrease of service utilization and cost/benefit. Conclusions: There was no clear conceptual definition for student-run health initiatives, but many defining characteristics and well-described exemplars in the literature. Given the variations in purpose and scope of these initiatives, particularly to distinguish degree of students’ roles in operations and the involvement of academic institutions, we propose 3 distinct conceptual definitions: student-run, student-led, and student-infused health initiatives.

The Pharmacy Education in Europe (PHARMINE) project studies pharmacy practice and education in the European Union (EU) member states. The work was carried out using an electronic survey sent to chosen pharmacy representatives. The surveys of the individual member states are now being published as reference documents for students and staff interested in research on pharmacy education in the EU, and in mobility. This paper presents the results of the PHARMINE survey on pharmacy practice and education in Finland. Pharmacies have a monopoly on the dispensation of medicines. They can also provide diagnostic services. Proviisori act as pharmacy owners and managers. They follow a five-year (M.Sc. Pharm.) degree course with a six-month traineeship. Farmaseutti, who follow a three-year (B.Sc. Pharm.) degree course (also with a six-month traineeship), can dispense medicines and counsel patients in Finland. The B.Sc. and the first three years of the M.Sc. involve the same course. The current pharmacy curriculum (revised in 2014) is based on five strands: (1) pharmacy as a multidisciplinary science with numerous opportunities in the working life, (2) basics of pharmaceutical sciences, (3) patient and medication, (4) optional studies and selected study paths, and (5) drug development and use. The learning outcomes of the pharmacy graduates include (1) basics of natural sciences: chemistry, physics, technology, biosciences required for all the students (B.Sc. and M.Sc.), (2) medicine and medication: compounding of medicines, holism of medication, pharmacology and biopharmaceutics (side-effects and interactions), patient counseling, efficacy and safety of medicines and medication, (3) comprehensive and supportive interactions of the various disciplines of pharmacy education and research: the role and significance of pharmacy as a discipline in society, the necessary skills and knowledge in scientific thinking and pharmaceutical research, and (4) basics of economics and management, multidisciplinarity, hospital pharmacy, scientific writing skills, management skills. In addition, teaching and learning of “general skills”, such as the pharmacist’s professional identity and the role in society as a part of the healthcare system, critical and creative thinking, problem-solving skills, personal learning skills and life-long learning, attitude and sense of responsibility, and communication skills are developed in direct association with subject-specific courses. Professional specialization studies in industrial pharmacy, and community and hospital pharmacy are given at the post-graduate level at the University of Helsinki.

Background: Responsibility is an important component of the professional values and core competencies for bachelor degree nursing students and has relationships with nursing education and professionalization. It is important for providing safe and high-quality care to the clients for the present and future performance of student. But there is no clear and operational definition of this concept for bachelor degree nursing students; however, there are extensive contents and debates about the definitions, attributes, domains and boundaries of responsibility in nursing and non-nursing literature. Objective: To examine the concept of responsibility among bachelor degree nursing students using the evolutionary approach to concept analysis. Methods: A total of 75 articles published between 1990 and 2016 and related to the concept of responsibility were selected from seven databases and considered for concept analysis based on Rogers’ evolutionary approach. Ethical considerations: Throughout all stages of data collection, analysis and reporting, accuracy and bailment were respected. Findings: Responsibility is a procedural, spectral, dynamic and complex concept. The attributes of the concept are smart thinking, appropriate managerial behaviours, appropriate communicational behaviours, situational self-mandatory and task-orientation behaviours. Personal, educational and professional factors lead to the emergence of the responsible behaviours among bachelor degree nursing students. The emergence of such behaviours facilitates the learning and education process, ensures nursing profession life and promotes clients and community health level. Responsibility has some effects on nursing students. Discussion: This concept had been changed over time since 1990–2016. There are similarities and differences in the elements of this concept in disciplines of nursing and other educational disciplines. Conclusion: The analysis of this concept can help to develop educational or managerial theories, design instruments for better identification and evaluation of responsible behaviours among bachelor degree nursing students, develop strategies for enhancing the responsibility and improve the safety and quality of nursing care in the community and healthcare system.

Pregnant women with substance use disorder (SUD) can face varying degrees of negative interactions with healthcare providers, including judgment of the individual’s value and involvement in their infant’s care. This research explored potential stigma and attitudes among medical providers within a maternal/fetal healthcare setting towards women with maternal SUD. An electronic survey was administered to 117 health care providers, including social workers, who work with pregnant women in an urban, Midwest, healthcare facility. Attitudes and stigma differed significantly based on the health care providers’ discipline. Healthcare providers who viewed SUD as a disease had a more positive perception of mothers with SUD. By building professional awareness, creating policy change, increasing education, and continuing research regarding maternal SUD, social workers have an opportunity to develop responsive support programs for healthcare workers and promote overall change within the healthcare setting.

Purpose The purpose of this paper is to analyse and compare the level of professional identity strength between healthcare and social sciences students. Design/methodology/approach Based on a sample of 339 students, the authors conduct an ANOVA analysis in order to compare students’ professional identity strength across the abovementioned groups. Findings The authors’ results show that there are significant differences in professional identity strength between healthcare and social sciences students. In particular, healthcare sciences students show stronger professional identity than social sciences students. Originality/value This study contributes to the existing literature on professional identity in higher education by being the first study comparing student’s professional identity between bachelor degrees from different professional fields of study and by showing the relevance of discipline as a contextual variable in the study of students’ professional identity.

Purpose – The purpose of this paper is to explore involving doctors in shared leadership. It examines the policies that have led to the focus on shared leadership and the implications for practice. Design/methodology/approach – This is a conceptual paper, examining policy developments and key literature to understand the move towards shared leadership. It focuses on UK NHS, and in particular doctors, although the concepts will be relevant to other disciplines in healthcare, and healthcare systems in other countries. Findings – This paper suggests that the shared-leadership approach for doctors has potential given the nature of clinical practice, the inherently collaborative nature of healthcare and the demands of new healthcare organisations. Health policy reform, generally, will mean that all doctors need to be engaged with leadership, albeit, perhaps, at different levels, and with different degrees of formality. Leadership will remain an important precondition for the success of the reforms. This is likely to be the case for other countries involved in healthcare reform. Practical implications – To highlight the benefits and barriers to shared leadership for doctors. Originality/value – Offers an alternative to traditional approaches to leadership.

Background: Veterans have a variety of unique healthcare needs and receive care from both the US Department of Veterans Affairs (VA) and private healthcare systems. Because healthcare students will likely treat veterans at some time during their career, it is important they gain exposure to working with veterans during their professional degree programs. Case Presentation: This case report presents the development of an annual Veteran-Centered Care Conference (VCCC) at the Massachusetts College of Pharmacy and Health Sciences. The VCCC included a faculty librarian who led a multi-disciplinary team that planned and coordinated each event. Speakers and participants included university students and faculty from multiple healthcare disciplines, as well as representatives from the VA, veterans’ advocacy groups, and community members (including many veterans). The purpose of the VCCC was to raise awareness of the healthcare needs of contemporary veterans. The goal of the VCCC was to improve healthcare provided to veterans by enhancing civilian health professions students’ knowledge of the potential effects of military service on a person’s health. Conclusion: After four successful events covering such topics as PTSD, specific health concerns of women veterans, substance use disorder, and homelessness, the VCCC was canceled, primarily due to low pre-registration. Examples of lessons learned and future possibilities for the VCCC and the patient-centered care conference format are discussed. This report is of particular importance given the many years the United States has been at war in the Middle East and the recent withdrawal of troops from Afghanistan.

Delivering care that meets patients’ preferences, needs and values, and that is safe and effective is key to good-quality healthcare. Disease-related malnutrition (DRM) has profound effects on patients and families, but often what matters to patients is not captured in the research, where the focus is often on measuring the adverse clinical and economic consequences of DRM. Differences in the terminology used to describe care that meets patients’ preferences, needs and values confounds the problem. Individualised nutritional care (INC) is nutritional care that is tailored to a patient’s specific needs, preferences, values and goals. Four key pillars underpin INC: what matters to patients, shared decision making, evidence informed multi-modal nutritional care and effective monitoring of outcomes. Although INC is incorporated in nutrition guidelines and studies of oral nutritional intervention for DRM in adults, the descriptions and the degree to which it is included varies. Studies in specific patient groups show that INC improves health outcomes. The nutrition care process (NCP) offers a practical model to help healthcare professionals individualise nutritional care. The model can be used by all healthcare disciplines across all healthcare settings. Interdisciplinary team approaches provide nutritional care that delivers on what matters to patients, without increased resources and can be adapted to include INC. This review is of relevance to all involved in the design, delivery and evaluation of nutritional care for all patients, regardless of whether they need first-line nutritional care or complex, highly specialised nutritional care.

The Coronavirus Infectious Disease 2019 (COVID-19) was declared a pandemic in March of 2020. Since then, most schools, colleges, and universities across the globe stopped delivering classes face-to-face and transitioned into virtual modalities of instruction. This reformation of academics has had an impact on every field of study, especially those students in the areas of Science, Technology, Engineering, and Mathematics (STEM), and in the realm of healthcare education. Ranging from middle/high school to undergraduate and graduate programs, STEM degrees require intensive curricula integrating extensive lectures on theoretical topics and laboratory exercises to apply those concepts in a practical setting. Likewise, healthcare education involves hands-on, clinical lab components working on patients, guided by supervisors. The guidelines developed by the Centers for Disease Control and Prevention (CDC) in the United States recommended refraining from these physical learning environments since social distancing has been an important preventative measure against the contagion. As in-person classes, labs, and residencies across the world were disrupted, students, faculty, staff, and administrators of STEM and healthcare fields had to face and navigate multifarious challenges to continue the education effectively, while maintaining safety. This review encapsulates such effects of the pandemic on STEM and healthcare education in various countries. The analysis aims to provide an insight into the strategies of distance education and alternative pedagogies for these disciplines adopted by institutions globally in the light of COVID-19, which could potentially serve as a reference model during any future pandemics.

E-learning is seen as a possible solution to the problem of modernization of the university education in response to the changing needs of the society. In undergraduate healthcare training, e-learning is implemented predominantly as blended learning in addition to the traditional classroom teaching. A major factor in the success of e-learning are learners’ attitudes, beliefs and concerns. The aim of the present study was to investigate undergraduate healthcare students’ attitude to e-learning at Medical University – Plovdiv. In this case, e-learning is considered to be electronic educational resources organized as an interactive e-learning unit or course, provided through a learning content management system. The survey was carried out in 2016 through a self-reported questionnaire among 270 first year students from ten healthcare specialties. Participants were asked to express a degree of agreement with nine statements on a five point Likert scale. The influence of gender, age, specialty and previous e-learning experience on the opinion of students was investigated. The results showed that students’ attitudes towards e-learning were positive, but learners were not enthusiastic about it. Genders have different views about e-learning implementation – women are more likely to accept it. The experience first year students had did not allow them to judge if e-learning supports better time-management or life-long learning skills. Students agreed that implementation of e-learning depends on the subjects and there are disciplines that can be provided as distant courses within the learning management system.

Objectives(1) Identify the healthcare settings in which goal attainment scaling (GAS) has been used as an outcome measure in randomised controlled trials. (2) Describe how GAS has been implemented by researchers in those trials.DesignScoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews approach.Data sourcesPubMed, CENTRAL, EMBASE and PsycINFO were searched through 28 February 2022.Eligibility criteriaEnglish-language publications reporting on research where adults in healthcare settings were recruited to a randomised controlled trial where GAS was an outcome measure.Data extraction and synthesisTwo independent reviewers completed data extraction. Data collected underwent descriptive statistics.ResultsOf 1,838 articles screened, 38 studies were included. These studies were most frequently conducted in rehabilitation (58%) and geriatric medicine (24%) disciplines/populations. Sample sizes ranged from 8 to 468, with a median of 51 participants (IQR: 30–96). A number of studies did not report on implementation aspects such as the personnel involved (26%), the training provided (79%) and the calibration and review mechanisms (87%). Not all trials used the same scale, with 24% varying from the traditional five-point scale. Outcome attainment was scored in various manners (self-report: 21%; observed: 26%; both self-report and observed: 8%; and not reported: 45%), and the calculation of GAS scores differed between trials (raw score: 21%; T score: 47%; other: 21%; and not reported: 66%).ConclusionsGAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inadequacies and inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results.PROSPERO registration numberCRD42021237541.

Journey of anatomy as a discipline began from crude ancient civilizations with credit to cadavers at the centre up to this modern computerized creativity with reference to magnanimity of cadavers and donors. The study investigated various limitations in acquiring cadavers amongst healthcare givers in southwestern Nigeria: awareness of bequest program, religious beliefs, socio-cultural heritage and family influences. Questionnaire-based proforma was adopted with three sections: facility, socio-demographics and donation characteristics containing 20-item self-administered Likert-style: ‘yes’, ‘no’ and ‘not sure’. Facilities visited and formal permission sought to engage the middle-aged healthcare workers for one-month’s period. Data subjected to statistical package for social scientists with statistical-significance taking as p<0.05. One-hundred-and-thirty-six middle-aged healthcare workers and above participated. Highest participants recorded in: tertiary institution; age group 50-54years; gender male; Ekiti indigenes; tertiary educational degrees; married workers; Christianity; and doctors by profession. Cronbach’s alpha reliability value of 0.801 established the study to be second to excellence. Issues on bequest program, sources of cadaver and affection independently explained poor awareness and alienation to bequeathment affairs. Influential factors on bequeathment synonymously judged unquestionable religious beliefs, veritable socio-cultural traditions and family dominancy as militating factors. Typically, awareness on bequeathment was still pitiful as the criteria were only known in papers rather than the hearts of healthcare workers who were meant to propagate the crusade of bequeathment. The need to establish a global policy for bequeathment affairs including social, moral, political and financial needs for broadcast was conclusively accented, most especially, in Nigeria and the likes. El camino de la Anatomía como disciplina comenzó en las civilizaciones antiguas con un crédito central en los cadáveres hasta la aparición de la creatividad computarizada moderna en relación a la magnanimidad de cadáveres y donantes. Este estudio investigó varias limitaciones en la adquisición de cadáveres entre donantes del sistema de salud en el sudoeste de Nigeria: conocimiento del programa de legado, creencias religiosas, herencia socio-cultural e influencia familiar. El cuestionario adoptado estaba basado en una proforma con tres secciones: Facilidad, características de la donación y características socio-demográficas, que contienen 20 items autoadministrados al estilo de la escala de Likert: `Sí', `No' y `no estoy seguro'. Las instalaciones visitadas y el permiso formal requeridos para incluir a los trabajadores de mediana edad del Sistema de salud por el período de un mes. Los datos fueron sometidos al paquete estadístico para científicos sociales (SPSS) tomando como significación estadística valores de p<0.05. Participaron ciento treinta y seis trabajadores del Sistema de Salud de mediana edad y mayores. Los participantes mayores registrados en: institución terciaria; grupos de edadde 50-54años; del género masculino; Indìgenas Ekiti; grado educativo terciario; trabajadores casados; Cristianismo; y doctores de profesión. El valor de la confiabilidad alfa de Cronbach de 0.801 estableció al estudio en segundo lugar a la excelencia. Algunas cuestiones en el programa del legado, la procedencia del cadáver y el afecto explican el pobre conocimiento y la enajenación en los asuntos del legado. Los factores influyentes en el legado que se juzgaron como indiscutibles fueron: la creencia religiosa, las verdaderas tradiciones socio-culturales y la dominancia de la familia como factores limitantes. Típicamente, el conocimiento del legado seguía siendo lamentable pues los criterios seran solo conocidos en los papeles más que en los corazones de los trabajadores del Sistema de Salud que fueron elegidos para propagar la cruzada del legado. La necesidad de establecer una política global para los asuntos del legado incluyendo las necesidades sociales, morales, políticas y financieras de la difusión fue concluyentemente acentuada, especialmente, en Nigeria y similares.

OBJECTIVES/SPECIFIC AIMS: Innovation in healthcare is increasingly dependent on technology and teamwork, requiring effective collaboration among diverse disciplines. However, large knowledge barriers exist between these diverse disciplines which hinders effective communication and the innovation processes. We organized an intensive team-based competition event, Sinai MedMaker Challenge, that engaged individuals with a wide range of backgrounds in medicine, biomedical research, computers science, and engineering to collaborate in solving medical problems with technology-based solutions. The learning objectives were to: enable participants to identify healthcare problems which lend themselves to technology-based solutions; delineate key behaviors critical to multidisciplinary team success; identify optimal strategies for communicating in teams; engage and inspire participants to apply knowledge of technology to meaningfully impact clinical care and well-being. METHODS/STUDY POPULATION: The Sinai MedMaker Challenge was a 48-hour team-based competition, modeled after previously held health “hackathons.” Adapting from guidelines provided by MIT Hacking Medicine, the event gathered participants from diverse backgrounds (clinicians, medical students, graduate students in biomedical science and humanities, software developers, engineers, and others), for the purpose of utilizing technology to address pressing problems in the diagnosis, management and/or treatment of pain and/or fatigue. The event flow can be outlined as follows: Phase 1—pre-event brainstorming via Slack and Sparkboard online platforms; Phase 2—problem review with clinical experts; Phase 3—solution pitches, formation of teams, development of prototype solutions; Phase 4—presentations and prizes awarded. The event was sponsored by ISMMS Institutes and Technology Companies. Mentors roamed throughout the event to support the teams in the technical, clinical, and business development aspects of their solutions. RESULTS/ANTICIPATED RESULTS: In total, 78 participants forming 14 teams, worked on the development of software and hardware prototypes (apps/websites, devices, wearables) to address a variety of pain and fatigue problems, culminating in final pitch presentations to a panel of judges comprised of academic experts; innovators and entrepreneurs in the technology start up space. Award recipients were: (1) PT partners, a wearable device for monitoring physical therapy post knee replacement; (2) SickleMeNot, an interactive, multimodal website/app for children designed to assess, monitor and manage pain; and (3) Biolumen, a functional biofeedback system, to treat chronic back pain. Evaluations revealed a high-degree of satisfaction with the event. Several teams continue to develop their prototypes. DISCUSSION/SIGNIFICANCE OF IMPACT: The Sinai MedMaker Challenge (1) was a compelling and productive forum to bring together students, trainees, faculty and other stakeholders to explore tech-based solutions for management, monitoring, and treatment of pain and fatigue; and (2) can be repeated annually, fostering a “Community of Practice,” and expanded to offer pre and post event opportunities to encourage iterative learning and ongoing creative output.

Introduction: the perennial pandemic: There are serious challenges posed by the SARS-CoV-2 virus and COVID-19 as the disease. With the persistence of the pandemic over one and half year, it is being feared that the COVID-19 may have become the new reality associated with human existence world over and the mankind may have to live with it for years or even decades. Further, the grievous nature of the disease is evolving further with genomic changes in the virus in form of mutations and evolution of variants, with enhanced infectivity and probably virulence. Acute and chronic phases of COVID-19: Epidemiologically, it is becoming clear that apart from the advanced age and pre-existing conditions, such as diabetes, cardiovascular, pulmonary, and renal diseases, certain constituent factors render some patients more vulnerable to more severe forms of the disease. These factors influence the COVID-19 manifestations, its course, and later the convalescence period as well as the newly defined ‘Long COVID phase. The substantial continuing morbidity after resolution of the infection indicates persisting multisystem effects of ‘Long Covid’. Lung damage associated with COVID-19: COVID-19 is primarily a respiratory disease presenting with a broad spectrum of respiratory tract involvement ranging from mild upper airway affliction to progressive life-threatening viral pneumonia and respiratory failure. It affects the respiratory system in various ways across the spectrum of disease severity, depending on age, immune status, and comorbidities. The symptoms may be mild, such as cough, shortness of breath and fevers, to severe and critical disease, including respiratory failure, shock, cytokine crisis, and multi-organ failure. Implications for the post-COVID care: Depending on the severity of respiratory inflammation and damage, as well as associated comorbidities, duration of injury and genetics, the progressive fibrosis leads to constriction and compression of lung tissues and damage to pulmonary microvasculature. Consequently, the COVID-19 patients with moderate/severe symptoms are likely to have a significant degree of long-term reduction in lung function. Depending on the severity of the disease, extensive and long-lasting damage to the lungs can occur, which may persist after resolution of the infection. Managing the long COVID’s challenges: Given global scale of the pandemic, the healthcare needs for patients with sequelae of COVID-19, especially in those with lung affliction are bound to increase in the near future. The challenge can be tackled by harnessing the existing healthcare infrastructure, development of scalable healthcare models and integration across various disciplines with a combination of pharmacological and non-pharmacological modalities. Following clinical and investigational assessment, the therapeutic strategy should depend on the disease manifestations, extent of damage in lungs and other organs, and associated complications.

Introduction: Evidence based medicine and practice needs to have a robust and reliable curriculum. This curriculum has been designed keeping in mind the latest technology and teaching strategies. There has been a major shift in context to the patient physician relations, care and utilisation of best available evidence in making informed decisions about the various treatment options and approaches to patient care. Nurses form an integral component of the healthcare delivery system and of the health system itself. There has been substantial research in the nursing principles and indexed nursing journals are publishing articles pertaining to the various disciplines and components of nurse practitioners and related patient care services. Methodology: It is a cross sectional study and total of 50 registered nurses were recruited from a public hospital to engage in the evaluation for statistically meaningful and valid results or interpretations. A self-administered questionnaire was distributed among 62 registered nurses; 12 registered nurses did not fill the questionnaire therefore 50 registered nurses were recruited. Result: Pie chart shows the major differences in frequency of all themes, the junior registered nurses have more knowledge about EBM as compared to their seniors 70% and 10% respectively but when asked about doing post-graduation the seniors showed more interest as compared to junior nurses 67% and 2% respectively. The junior nurses showed more counselling ability and also practiced EBM. Overall there was significant decline in senior nurses’ performance when compared with junior nurses p-value is 0.001 Conclusion: Evidence based medicine is based on three components; utilising prior knowledge based on clinical experience, searching systematically evidence and acknowledging patient’s preferences. Junior registered nurses understand evidence based medicine and are eager to apply EBM in their career whereas senior nurses where more interested in obtaining higher degree and were less interested in patient care

e18267 Background: Patient care quality is a discipline with enormous relevance in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in quality for oncology practices. The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. ECO reached an agreement with QOPI to involve Spanish hospitals in the QOPI program. Methods: 7 rounds of data collection have taken place (Fall 2015 to Round 2 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered them the necessary support. 18 Spanish hospitals have participated in the 7 rounds, and 12 of them have repeated participation. Core, Lung Cancer and Breast Cancer modules were completed. Results: During the 7 rounds, 2341 charts were submitted by the Spanish practices. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, 100% in the three following rounds and 88% in the last round. For the 12 hospitals that repeated participation, 8 reported improvements at different degrees of their global scores. These hospitals specifically show an improvement in the QOPI measures related to the signed patient consent for chemotherapy and the documentation of the patient consent in the practitioner note, the chemotherapy intent documentation, the appropriate completion of the chemotherapy planning, the documentation of the number of chemotherapy cycles and the development and documentation of the pain assessment. On the other hand, regarding QOPI Certification, three Spanish hospitals have received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. The ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, with these performed for the first time in Spain in 2017 and 2018 respectively.

Background and Objectives: Action, not fear, is the path forward in the coronavirus infectious disease 2019 (COVID-19) pandemic. Since early 2020, the world’s nations have faced conundrums over severe acute respiratory syndrome corona virus type 2 (SARS-CoV-2) infections resulting in COVID-19 resulting in national closures, and thus, a clear understandable plan that nations can implement is required to reopen. The healthcare benefits of reopening a nation more likely than not exceed the benefits of continued pandemic-related closure. Pandemic-related closures have resulted in countless delayed or avoided urgent care evaluations. Furthermore, routine care of acute and chronic illnesses, including evaluations, diagnoses, and treatments, has also been delayed. Isolation, loss of income, and fear have resulted in mental health conditions or exacerbated existing conditions. The magnitude of untoward ramifications is unknown and may ultimately represent an inestimable degree of danger and morbidity, and even death. The pandemic of SARS-CoV-2 has created an atmosphere of fear of COVID-19 that has directly and indirectly injured the world’s population. Since this has resulted in increasing morbidity and mortality, creating economic chaos, and near systemic collapse of educational systems with no well described plan forward, it is the purpose of this study to provide guidelines that provide a path forward to safely open a nation. Physicians often equipped by their education, training, and experiences across disciplines are uniquely positioned to comprehend, coordinate, and teach other physicians, business owners, and municipal and government leaders from guidelines. As such, physicians may take the lead in a path forward to reopening a nation, including opening businesses, educational facilities, and religious establishments, while minimizing the risk of SARS-CoV-2 infection. Materials and Methods: Reviews of the literature among the disciplines of environmental air, sanitation, social interaction, medical testing, vaccination, protection, and disease prevention and safety allowed for the conceptualization and eventual genesis of identifiable interventions which either reduce the viral load in the environment or inactivate the virus from replication. Each of the guidelines was selected based on the principle that it involved the elimination or inactivation of the viral particle. With a reduction in viral load or inactivation of replication, the implementation of these guidelines is expected to allow for reopening a nation with an increased level of safety. Results: The guidelines identified, including air exchange (ventilation), air filtration, personal protective filtering devices (masks), hand hygiene, social distancing, screening and testing, vaccines, high-risk patient protection, medical management, and adjunctive therapies, are described and referenced. Conclusions: In that the pandemic is primarily a public health issue, the path forward is best coordinated by local, regional, and national physicians. Many physicians with a breadth of experiences are uniquely positioned to coordinate the implementation of these interdisciplinary guidelines. Using these guidelines as a planned, coordinated action, not fear, is a path forward. Nations have a decision to make: closuring versus opening.

The demands of decision-making in nursing practice require nurses to make sound judgements in a complex and rapidly changing healthcare environment. Critical thinking (CT) is an essential component of the repertoire of skills nurses must develop to meet these changing demands. Findings from studies conducted in developed countries recommend further research to explore educational strategies to teach CT. Nursing education in Kenya is primarily delivered using traditional teacher-centred strategies. Although nursing programmes seek to develop CT skills in nursing graduates, research in Kenya has not yet provided evidence of the learning and application of CT skills in practice. Research that illustrates how CT is learned is essential for curriculum review enabling faculties to develop innovative student-centred teaching strategies. This study illuminates how nurses described CT and their preferred learning strategies for developing CT skills. A qualitative descriptive design was adopted with a purposive sample of seven diploma-bachelor graduates. Using an interview guide, the researchers conducted one-on-one semi-structured interviews. Content analysis was done to identify themes emerging from the data. Two themes emerged from the data: description of CT, and acquiring CT knowledge. The results of this study demonstrate that CT definition is highly discipline-specific and recommends student-centred strategies as more effective in developing CT skills. The findings indicate that nurses’ ability to engage in CT is promoted when nurse educators use learning strategies that actively engage students in the application of knowledge.

Abstract Background Provision of effective Interprofessional learning (IPL) opportunities plays a vital role in preparing healthcare students for future collaborative practice. There is an identified need for universities to better prepare students for interprofessional teamwork, however, few large-scale IPL activities have been reported. Additionally, little has been reported on disciplinary differences in student learning experience. The Health Collaboration Challenge (HCC) is a large-scale IPL activity held annually at the University of Sydney. This study sought to explore students’ experience of early participation in an interprofessional case-based learning activity, and the similarities and differences in the perceived value of interprofessional (social) learning for each discipline. Methods In 2018, 1674 students from 11 disciplines (dentistry, oral health, nursing, pharmacy, medicine, occupational therapy, speech pathology, physiotherapy, dietetics, diagnostic radiography, exercise physiology) participated in the HCC. Students worked in teams to produce a video and patient management plan based on a patient case. Participants completed a questionnaire, including closed and open-ended items. Quantitative data were analysed using descriptive statistics. Thematic analysis was used to code and categorise qualitative data into themes. These themes were then applied and quantified at a disciplinary level to measure prevalence. Results In total, 584/1674 (35%) of participants responded to the questionnaire. Overall, students perceived their experience to be largely beneficial to their learning and interprofessional skill development. Positive aspects included opportunities for peer learning, collaboration, networking, and understanding the different roles and responsibilities of other health professions. Negative aspects included the video form of assessment, inequity in assessment weighting across disciplines, the discipline mix within teams and lack of case relevance. Conclusion The learning activity provided a framework for students to practice and develop their skills in interprofessional teamwork, as they prepare for increased clinical placements. Overall, students perceived their experience as beneficial to their learning and professional development early in their degree. However, they expressed dissatisfaction with the inequity of assessment weighting across the disciplines; lack of relevance of the case across disciplines; and the activity of producing a video. Further research is needed regarding the ideal number of disciplines to include in teamwork specific to a patient case.

AbstractDelivering customer-centric product presentations for biotherapeutics, such as monoclonal antibodies (mAbs), represents a long-standing and paramount area of engagement for pharmaceutical scientists. Activities include improving experience with the dosing procedure, reducing drug administration-related expenditures, and ultimately shifting parenteral treatments outside of a controlled healthcare institutional setting. In times of increasingly cost-constrained markets and reinforced with the coronavirus pandemic, this discipline of “Product Optimization” in healthcare has gained momentum and changed from a nice-to-have into a must.This review summarizes latest trends in the healthcare ecosystem that inform key strategies for developing customer-centric products, including the availability of a wider array of sustainable drug delivery options and treatment management plans that support dosing in a flexible care setting. Three disease area archetypes with varying degree of implementation of customer-centric concepts are introduced to highlight relevant market differences and similarities. Namely, rheumatoid arthritis and inflammatory bowel disease, multiple sclerosis, and oncology have been chosen due to differences in the availability of subcutaneously dosed and ready-to-use self-administration products for mAb medicines and their follow-on biologics.Different launch scenarios are described from a manufacturer’s perspective highlighting the necessity of platform approaches. To unfold the full potential of customer-centric care, value-based healthcare provider reimbursement schemes that incentivize the efficiency of care need to be broadly implemented.

This work presents a description and assessment of the first introductory course in biomedical engineering, the result of a two-year exchange between clinicians and researchers in the Faculties of Medicine and Engineering and Applied Science. The course is an integration of research into teaching, as well as the first step in incorporating engineering into Medicine. Through lectures, clinical shadowing, tours, critical reflection and a final project, students interested in healthcare experienced a unique, multidisciplinary learning environment in a seminar-style setting. The work will present student assignments, student feedback and student application of the key concepts in the course. An assessment of the defined learning outcomes for the course is also addressed. In presenting this work, the authors would also like to promote knowledge sharing of how engineering and medicine are integrated at other universities in the area of Biomedical Engineering, specifically as a major, a sub-discipline, or a multidisciplinary undergraduate degree.

IntroductionEngagement in positive health behaviour and physical activity is important in reducing the risk of lifestyle diseases and disability later in life. The purpose of this research was to evaluate the health and physical activity characteristics of undergraduate paramedic and nursing students. MethodsDescriptive and inter-discipline survey of university students enrolled in healthcare programs. The health status and physical activity patterns of paramedic and nursing undergraduate students were assessed by the health survey questionnaire (SF36) and international physical activity questionnaire (IPAQ), respectively. Comparisons for Health status – Total, health dimensions, and weekly metabolic equivalent (MET) were performed.Results A total of 226 undergraduate students were surveyed with 66.4% enrolled in the Paramedic, 17.7% in Nursing, and 15.9% enrolled in the double degree Nursing/Paramedic Bachelor programs. Results for the SF36 –Total show that there was a significant difference in health status between the undergraduate cohorts (P=0.001). Results for the IPAQ shows a significant difference in physical activity between the programs (P =0.030). Chi-Square analysis shows a significant proportion of students report low levels of physical activity (less than 600 MET-min/week). Comparison between IPAQ and Year of study show a significant difference between groups (P =0.007).ConclusionSubstantially reduced health status and physical activity patterns were shown in nursing students compared to paramedic students and amongst 1st year university undergraduates. This research highlights the need to further investigate the health status and physical activity patterns within university healthcare students.

Abstract Background Current health challenges are highlighting as Global Health (GH) is a discipline of growing importance for future physicians. Although its training is globally recommended, it has not universally entered the curricula of degree courses in Medicine and Surgery. A cycle of 6 seminars in global health has been promoted by researchers and public health residents of the Center for Research and Studies in GH of the Università Cattolica del Sacro Cuore (UCSC) in Rome, and offered for 4 consecutive years to medical students attending the UCSC. Objectives and Methods Main goal was increasing students knowledge and awareness in global health issues exploring their needs and perceptions about the impact of the topic on their future career. Two-hours frontal lessons held by experts and practical sessions (PBL) facilitated by promoters were planned on topics as determinants and inequalities in health, UHC, fragile and vulnerable population as migrants and victims of violence, SDGs, AIDS and emerging infectious diseases,international cooperation, maternal-child health. A pre-course, single event and post-course questionnaire was administered to participants. Results A mean of 48 students (± 15.7SD), 66.7% females, attending mainly the second(40.4%) and the third year (39%), joined each event. The analysis of the pre-course questionnaire has highlighted students' interest in healthcare inequalities, pandemics, migration, health in developing countries, healthcare systems. At the end, 92% of participants has considered the course interesting, 87% stated that the topic should be part of the degree course and 78% that it will influence their career. The methodology was considered adequate in 94% of cases underlining its strong incentive to work in team. Conclusions The strong interest of medical students in acquiring skills in global health seems to firmly encourage its inclusion and strengthening in study plans to prepare them properly to face the future challenges in health. Key messages Medical students consider the global health training relevant for their career encouraging its inclusion in the Medicine and Surgery curriculum. Practical sessions and team work could be useful tools to adequately train the future health workforce.

Abstract Background Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field. Methods By means of a methodological observational study, an analysis of all academic medical dissertations’ abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including “qualitativ*” were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed. Results In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts (n = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene (n = 27) and general practice (n = 26), followed by medical psychology (n = 19). About half of the studies (n = 47) used qualitative research methods exclusively, the other half (n = 56) used mixed methods. For data collection, primarily individual interviews were used (n = 80), followed by group interviews (n = 33) and direct observation (n = 11). Patients (n = 36), physicians (n = 36) and healthcare professionals (n = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common (n = 67). Nearly half of the abstracts (n = 46) lacked information on how data was analysed, most of the remaining (n = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method). Conclusion A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Introduction: With advances in medication and device therapy for heart failure pts, the number of end-of-life situations encountered in cardiology is rising. We aimed to understand perceptions and attitudes of medical and paramedical staff regarding end-of-life situations using a qualitative approach. Methods: Single-centre, qualitative study using semi-directive interviews with physicians, nurses and nurses’ aides in a university hospital cardiology unit. Participants were invited to describe experiences and feelings about end-of-life situations. Interviews were transcribed in full and analyzed using thematic analysis. Results: 13 physicians, 16 nurses and 5 nurses’ aides were interviewed. The main themes that arose in the discourse were the frequency, the type of death (emergency vs chronic disease), the value of the pt’s life, the positive effect of communication, and the rarity of advance directives (AD). The majority felt that end-of-life situations are increasingly frequent, and their management has improved. Cardiology was felt to be a highly technical discipline where death is generally rapid; otherwise, for pts with end-stage heart failure, the course of disease allows time to anticipate end of life issues. Nurses tend to engage in a degree of “coaxing” to persuade physicians to move from a curative to a palliative frame of mind, particularly in the cardiac intensive care unit. The perceived value of the pt’s life plays a role in the level of therapeutic engagement, with younger patients receiving more intensive resuscitation manoeuvers, whereas oldest-old patients are more rapidly labelled as “end of life” cases. Communication was felt to be key to ensuring that pt, family and healthcare workers (HCW) are all in agreement regarding clinical status and likely outcome. Nurses in particular can suffer considerable distress when their opinions regarding the pt’s status or wishes are not taken into account by the physicians, or when they are asked to continue invasive therapies for a pt they consider to be at the end-of-life. Poor communication was felt to engender suffering both among HCW and families; and lack of time was cited as a frequent cause. AD were not unanimously considered useful; some felt that discussing end-of-life may be more harmful than helpful, and overall, AD remain infrequent in our unit. The pt’s wishes are taken into account if possible, but some believe the pt is not qualified to know what can be done, and in such cases, their wishes may be disregarded as inappropriate to the clinical situation. Conclusions: Most participants felt that management of end-of-life has greatly improved in terms of pain relief and communication. Poor communication remains prevalent and can be a source of suffering for patients, families and caregivers, especially nurses.

Abstract Background Integrative medicine has become a new healthcare model due to the growing evidence base for complementary and integrative therapies. However, some question whether complementary and integrative therapies can truly be integrated with biomedicine due to differences in underlying paradigms and theoretical bases. This study aimed to explore differences in scientific worldviews between students studying East Asian medicine and those completing an allopathic medical degree using the validated Thinking about Science Survey Instrument (TSSI). Methods 122 medical students from Albert Einstein College of Medicine (Einstein) and 48 East Asian medicine students from the Pacific College of Health and Science (Pacific College) participated in this study. Participants completed the TSSI, a 60-item Likert-scale instrument that quantitatively measures the sociocultural resistance to, and support for science. Item and category means were compared between each group using an independent sample t-test. Results Distinct differences were seen between the two groups of students with regard to age, gender distribution and prior education. Einstein students were generally supportive of science and Pacific College students were generally supportive of/positively neutral to science. Einstein students more strongly affirmed the relationship of science in relation to the categories of Epistemology, Public Health, Emotion and Aesthetics, the Economy, and Public Policy. Pacific College students more strongly affirmed the relationship between science and the category Race and Gender. There were no differences in the categories of Environment and Resource, Science for All, and Religion and Morality. Conclusion This study suggests that there are differences underlying the scientific worldviews of Einstein and Pacific College students, particularly with regard to Epistemology and Public Health. Such differences may be related to the different theoretical knowledge bases and ways of viewing health within the two disciplines. Despite demographic and educational differences between the two groups their overall scientific worldviews were similar with neither group expressing disparate views. This suggests that both groups may be receptive to the value of other paradigms. Providing courses that focus on different therapeutic approaches and paradigms during medical training may foster interprofessional understanding and collaborative practice between health professionals of different medical disciplines.

The pathogenesis of obesity includes but not limited to genetic makeup, unbalance between intake and expenditure, proinflammatory cytokines and anti-inflammatory cytokines, obese and “anti-obese” hormones, and other causes. To lose weight, the best targets are these points. Fat distribution is determined by genetic makeup especially hormones. Too much obese hormones like steroid, estrogen and too less “anti-obese” hormones like endorphin, serotonin, dopamine, oxytocin, and testosterone is associated with fat deposit on the buttocks and thigh, namely “fat ass”, which appears an indicator for degree of homosexuality. Obesity is impacted by many factors. These factors include unhealthy lifestyle, metabolic factors, and unresolved frustrations etc. One biggest unresolved frustration is closeted sexual orientation especially homosexuality. Any sexual orientation is normal. Sexual orientation is X-linked and Y-linked traits, passing down from generation to generation. Homosexuality presents in different degree, some are stronger and some are lighter. The phenotype varies among different individuals, the manner, the behavior, the gesture, habit, likes, dislikes, and personalities. Gay marriage is granted in many states. Yet tradition is tradition does. Many folks still live in the dark, which causes lots of stress related work/school problems, smoking/alcohol/substance abuse, mental problems/psychiatric disorders, STDs, inequality for minorities, etc. Even progress had been made, LGBT healthcare is still on the way. Stress related issues, abuse, and mental problems can be managed positively, as well as with the recognition and acceptance by selves, family and friends, and “anti-obese” factors. STDs shall be better prevented with barrier protection and more disciplined sexual practice. Related information and education can be merged into smartphone app and into EMRS for regular visits. Team work among different society and community shall be strengthened. Above all, deal the reality with whole hearts, with love, with positive attitude. Smile, the world will smile at you. Start local, go global. Don’t ever shut the door.

Digitally mediated contexts are proliferating across all professional disciplines and also transverse social cultures in higher education worldwide. Malta is no exception. Financial pressures, keeping up with international advances, maintaining standards and changing patterns of lifelong learning are driving the education institutions to adopt online modes of communication, interaction and education. As expected, these changes can also be evidenced in the healthcare education sector. This inevitably brings with it a drive towards innovative modalities of interaction, carrying out research and in the pedagogy of teaching and learning. More importantly it necessitates an institutional shift towards prioritising the development of digital literacy among higher education students and academics alike. This does come with challenges – financial and logistical – but significant in the case of post-certification students is the varying degrees of digital literacy competences, combined with a packed curriculum, to be covered in a restrained timeframe, in combination with work and personal commitments. Additionally, a large percentage of these students have gone through their education in the traditional format, and therefore studying in a technology-centric environment presents unique difficulties. The following report presents recommendations envisaged to overcome the challenges around digital literacy in post-certification healthcare professionals. It is to be highlighted that many of the proposals are applicable to the development of digital literacy within the wider higher education community and are not restricted to post-certification healthcare professions alone.

ObjectivesHealthcare professionals need to take into account their knowledge, skills and attitudes to develop a focused clinical question, perform an effective search of the literature, critically appraise the evidence, and apply to the clinical context and evaluate the effectiveness of the process. To date, there is a lack of consensus on evidence-based medicine (EBM) curriculum for undergraduate healthcare students in Brazil. The aim of this study was to develop a consensus on EBM curriculum contents for healthcare schools in Brazil considering expert opinion.DesignModified three-round Delphi methodology.SettingOnline survey.ParticipantsThe expert panel was composed of 40 healthcare professionals from different specialties. Most of the participants (n=24; 60%) were female with the age between 30 and 44 years. Participants were also experts in the field of epidemiology, biostatistics or public health. The mean experience of experts in teaching EBM was 9.5 years.Main outcome measuresAn online questionnaire consisting of 89 items related to EBM was sent to the experts. The experts ranked each item of EBM curriculum considering the importance of each item as omitted, mentioned, explained or practised. The last section of the questionnaire was composed of ‘additional content’ where the experts evaluated only if an item should be included or not, the form of offering the EBM contents and the total workload (in hours/semester). Open-ended questions were present in each section to give the opportunity to experts to insert suggestions. Items that reached values greater than or equal to 70% of agreement among experts was considered definitive for the curriculum. Items between 51% and 69% of agreement were included for the next round and those items with less than or equal to 50% of agreement were considered unnecessary and were excluded. In the third round, the EBM contents were classified according to the degree of consensus as follow: strong (≥70% of agreement), moderate (51%–69% of agreement) and weak (50% of agreement) based on the maximum consensus reached.ResultsOf the 89 initial contents, 32 (35.9%) reached a strong degree of consensus, 23 (25.8%) moderate degree of consensus, two (2.2%) weak degree of consensus and 35 items were not recommended (≤50% of agreement). The workload suggested by experts should be between 61 and 90 hour/semester and an EBM curriculum should be offered with epidemiology and biostatistics as prerequisites. Regarding the importance of each item, 29 (72.5%) should be explained and 25 (27.5%) should be practised with exercises.ConclusionsThe consensus on an EBM curriculum for Brazilian healthcare schools consists of 54 items. This EBM curriculum also presents the degree of consensus (strong, moderate and weak), the importance of each item (mentioned, explained and practised with exercises). A total workload of between 60 and 90 hours per semester was suggested and the EBM curriculum should be offered with epidemiology and biostatistics as prerequisites, but also EBM contents should be included within other disciplines throughout the entire undergraduate course.

The paper explores new approaches in the area of training graduate students who take double degree international programs in Russia and Kazakhstan. Results of “Theory and Practice of Achieving Excellence in Sport” project are presented. This project was aimed at developing disciplines based on contemporary theoretical approaches and scientific achievements in sports psychology and also practical knowledge, making it possible to quickly involve graduate students in academic activity. The concept of excellence, which was initially manifested in sports and then in other areas (business, education, healthcare), was selected as the project’s methodology basis. The following research methods were used: systemic, comparative and contrastive analysis of philosophical, psychological, pedagogical, method and medical literature, studying psychological and pedagogical design experience; observation methods (direct and indirect observation); archival research (analyzing the results of pilot and experimental activity, content analysis). The developed project is united by a shared idea and includes 4 disciplines. The paper outlines each discipline’s tasks, features of its content and forecasted results in developing students’ competence. Results of practical activity proved students’ interest in new disciplines and enhanced motivation to select subjects for their Master’s Theses relevant for contemporary research areas. The main output of working on this course is building a new generation of students ready for academic exchange, self-development and professional achievements.

Abstract Background Active engagement in research by healthcare organisations and clinicians is associated with improvements in healthcare performance. Barriers to research engagement by clinician allied health (AH) professionals include competing priorities from high clinical workloads, lack of research skills and confidence, and lack of supportive research relationships. Collaboration with universities on joint clinical research projects is well recognised as a means of building health service research capacity. Research projects undertaken by students as part of their qualifying degree represent one such opportunity. However, there are few reports evaluating these collaborations from the health service perspective. Methods A qualitative study using semi-structured interviews and thematic analysis to explore the experiences of AH professionals in the co-supervision of students completing research placements as part of their professional degree course. Results Fourteen health service employees from six allied health disciplines described collaborations on research projects with 24 students from four different universities. Student placements and projects varied widely in length of placement, extent of collaboration, supervision structure and study design. Three overarching themes were identified in the AH professional co-supervision experience: 1) Professional growth; 2) Mismatch with expectations; and 3) Focus on the student. Project outcomes were categorised from the health system perspective. These were 1) Healthcare performance improvements, including local increases in staff clinical practice knowledge and wider contributions to the evidence base; 2) Research capacity gains within the health service, including research knowledge and skill development, collaborative linkages and opportunity for future research; and 3) Staff-centred outcomes including increased job satisfaction. Conclusions This study demonstrates the potential for AH professional supervision of students on research placements to contribute to healthcare performance improvements and research capacity gains within health services, alongside providing personal benefits for the AH professionals involved. Early consultation with a health service-employed research specialist may support health professional and student learning, team collaboration and project coordination for these student projects.

This article focuses on approaches to implementing the principles of P4 medicine, specifically, stimulating prevention-based thinking among students of faculties of general medicine and pediatrics. Below, we describe a pilot approach to teaching hygiene that was implemented at the Department of General Hygiene (Kazan State Medical University). Considering the gnoseological role of empathy, we designed an interactive workbook for students taking a course in Hygiene. The workbook allows the student to engage in empathic interactions and discourse about the studied subject with the teacher and peers. After the course, the students were surveyed; their degree of engagement in the learning process and their expectations were evaluated. The respondents rated their interest in Hygiene before starting the course as 5.6 and 5.7 points on the 10-point scale (for the traditional and innovative courses, respectively). During the course, the score increased to 5.8 and 8.6 points for the traditional and innovative courses, respectively. Our pilot project demonstrates the need for reviewing the strategy of teaching hygiene and prevention-related disciplines at clinical faculties and including the principles of P4 medicine in the medical curriculum, thus allowing the student to effectively perform their professional duties in primary healthcare.

The International Journal of Telerehabilitation (IJT) is a biannual journal dedicated to advancing telerehabilitation by disseminating peer-reviewed information about current research and practices. IJT is indexed by PubMed and Scopus. IJT is published via the open journal system (OJS) and sponsored by the University of Pittsburgh’s Office of Scholarly Communication and Publishing at the University Library System. This institutional support enables IJT to be subscription free and require no author fees. The current issue of the multi-disciplinary IJT features impactful research across rehabilitation disciplines. As context, COVID-19, a global pandemic, even with the availability of vaccines, is still dramatically affecting healthcare worldwide to greater or lesser degrees, as well as the global economy. Submissions to IJT continue to increase, ostensibly to document how telerehabilitation is meeting these challenges. We regret that we are unable to publish the high volume of articles that are being submitted. Instead, we strive to promptly suggest other placements for work that is not central to the mission of the journal (i.e., telerehabilitation) or relevant to the larger IJT audience.

Abstract Background Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. Methods This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. Results Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. Conclusions Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. Trial registration NCT02965794. US National Library of Medicine, ClinicalTrials.gov. Registered 4 August 2014.

<b><i>Introduction:</i></b> Nutrition is a fundamental part of living a healthy lifestyle and is well-recognized in the prevention and treatment of several illnesses. The physicians’ collaboration according to their perception regarding the nutrition services and dietitian roles is important for optimal healthcare management. However, gaps exist in the knowledge and understanding of how the dietitian is perceived by physicians. To the researchers’ knowledge, this is the first study to assess the physicians’ perceptions regarding the role and services of dietitians in Riyadh city. <b><i>Method:</i></b> A cross-sectional study was conducted by using an anonymous self-administered online-based survey to investigate physicians’ perceptions regarding the role and services of dietitians. In addition to demographics, the questionnaire consisted of 20 statements that covered five domains of the dietitians’ scope of practice (Medical Nutrition Therapy, Legislation and Policy, Research and Interventions, Community Programs, and Sports Nutrition). A total of 407 participants were recruited between February and March 2021. Male and female medical physicians with different professional degrees who worked in Riyadh city were eligible to be included in the study. A cross-tabulation test was used to determine the difference among physicians regarding their perceptions of dietitians’ services and roles. <b><i>Results:</i></b> For all of the 20 statements that demonstrated dietitians’ services and roles, the mean score was classified as “strongly agree” with a mean of 4.33 (SD ± 0.541). There was a statistically significant relationship between physicians’ perceptions according to their nutritional background and two statements regarding dietitians’ clinical roles. In addition, there was also a statistically significant relationship between physicians’ perceptions who are not working in academia and three statements regarding dietitians’ clinical and nonclinical roles. <b><i>Conclusions:</i></b> This study’s findings support the importance of dietitians’ services in the healthcare setting as a multidisciplinary approach and recommend expanding dietitians’ employment opportunities outside the healthcare setting. Additionally, this study emphasizes incorporating nutrition education for physicians and demonstrates physicians’ understanding of nutrition as a discipline.

Worldwide Corona virus outbreak has cause panic and enormous health and economic effects due to inadequate or lack of appropriate information about COVID -19. Aims: The aim of the study was to determine the Level of knowledge and Preparedness to Corona Virus (COVID –19) Pandemic among Health Workers in Igembe South, Meru County, Kenya. Study Design: This was cross-sectional study was conducted to determine their Knowledge and Preparedness among HCWs on COVID-19 pandemic. Place and Duration of Study: The study was conducted in Igembe South Health Facilities between March and June 2020. Methodology: A facility based cross-sectional study was conducted in Igembe South Sub County of Meru County from March 2020 to June 2020 among 87 Health Care Workers to determine their Knowledge and Preparedness on COVID-19 pandemic. Data was collected using structured Likert’s Scale questionnaire. Descriptive analysis was performed to obtain frequencies and distribution of the variables. Results: The results shows that eight seven (87) health care workers with mean age of 34± 9 (SD) years with a minimum age of 19 years and maximum age of 60 years were recruited responded to the questions of the study. Among the 87 participants, 51 (58.6%) had at least a bachelor's degree, 30 (34.5%) participants had a diploma and 6 (6.9%) participants had a certificate. About 32 (36.8%) of the participants were nurses. Other professional disciplines included nutritionists, records officers, supporting staff, social workers among others. Majority of the facilities acknowledged receiving Ministry of Health guidelines and protocols on COVID-19 case management. Regarding knowledge of COVID -19 Almost half (48.3%) of the participants somewhat agreed that health care workers had knowledge of Corona Virus Pandemic, however, most of the respondents (50.6%) strongly disagreed that they are equipped with adequate Knowledge to manage severe Corona Case compared to (8%) respondents who strongly agreed that Corona Virus Incubation period is an average of 7 days and maximum of 14 days. Conclusion: The study concludes that knowledge and preparedness level on COVID - 19 was above average, however, there is need for continuous professional development (CPD) training and support supervision for HCWs to ensure maintenance of appropriate practices during the COVID-19 pandemic. The study further concludes that those with knowledge and are conversant with their respective areas of practice are at less risk, considering that inadequate knowledge is not only a risk factor for poor delivery of WHO approved COVID -19 guidelines met to prevent the spread of COVID -19, but also increases the occupational risk to health care workers.

Background: Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via acase-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking.Objectives: The objectives of the study was to describe a decentralised nursing management education programme located in Durban, South Africa and describe the perceptions of nursing faculty facilitators regarding implementation of this teaching method.Method: Data was collected through the use of one-on-one interviews and also focus groups amongst the fifteen facilitators who were using a case-based curriculum to teach the programme content. The average facilitator was female, between 41 and 50 years of age,working part-time, educated with a baccalaureate degree, working as a professional nurse for between 11 and 20 years; slightly more than half had worked as a facilitator for three or more years.Results: The facilitators identified themes related to the student learners, the learning environment, and strengths and challenges of using facilitation to teach the content through cases. Decentralised nursing management educational programmes can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services.Conclusion: Nursing faculty facilitators need knowledgeable and accessible contact with centrally based full-time nursing faculty in order to promote high quality educational programmes.

This proceedings consists of the peer-reviewed papers from the 2nd International Conference on Robotics, Intelligent Automation and Control Technologies (RIACT 2021), which was organized by the School of Mechanical Engineering at Vellore Institute of Technology, Chennai, India on September from 23rd to 25th, 2021. However, due to the COVID 19 pandemic the conference was held Online. The main objective of RIACT 2021 is to provide a platform for researchers and practitioners from both academic institutions and industries to meet and share cutting-edge developments in the areas of Robot Design, Development and Control, Rehabilitation Robots and Devices, Intelligent Automation and Fault Diagnosis, Agricultural Robots, Underwater Robots, Development of Drones, Control and Supervision Systems, Vision Systems, Actuators and Sensors, Mechatronics Systems, System Interface and Control, Sustainable Technologies and associated disciplines. This conference also provided an opportunity to exchange research evidence and innovative ideas and also the issues related to Robotics and Automation. This proceeding will include presentations on the latest research areas such as Agriculture Drones, Bio Mechanisms for rehabilitation applications and Deep learning in robotics. This conference had gathered an excellent group of keynote speakers from around the globe on different topics such as Engineering Challenges of the AI-Enabled Automation and Process Optimisation for Healthcare and Business Domain, Upcoming future of robotics in protected horticulture, Intelligent Systems: From Smart Manufacturing and Network Perspectives, High-performance surgical and wearable robots for translational medicine, Challenges in Rover Mission, Two-Degree-of-Freedom Control of Flexible Manipulator, Manipulator Rule Generation from Table Data Sets and Its Application, Enduruns: Long-endurance sea surveying autonomous unmanned vehicle with gliding capability powered by hydrogen fuel cell, Bio-Inspired Swarm Intelligence with Engineering Applications, K-Learn for Robotics: Kinesthetic and STREMS, Embedded Machine Learning for Decentralized Automation, Real-time decentralized control: Design guidelines and applications, Whole-Body Optimization using Differential Dynamic Programming for Humanoid Robot Applications and How Business Technology Platform Accelerates Your Innovation. List of Advisory Committee, Technical Review Committee, Program Committee Members, Organizing Committee Members, Co-Convenor, Convenor are available in this pdf.

Hepatocellular carcinoma (HCC) will soon become a prominent part of the medical and economic burden on many Western countries’ healthcare systems. This review will discuss some emerging scenarios concerning the different classifications of HCC from the clinical, histological, and molecular perspective and to what extent they are integrated with each other. Beginning with an overview of the current numbers and facts regarding HCC, it touches upon the latest development of the epidemiological scenario. It is noteworthy that besides viral hepatitis infection, the fast growing rate of individuals affected by metabolic syndromes represents an additional influential factor on the rising incidence of HCC. However, despite recognised epidemiological evidence, too little is known about the molecular mechanisms that favour HCC development and progression. For instance, long non-coding RNAs playing a major role in the HCC carcinogenesis process have only recently been recognised. Although high cure rates are achieved for clinically asymptomatic patients when small tumours are detected, HCC is typically silent with few severe symptoms until its advanced stages. Patients with severe clinical signs are seldom good candidates for any type of curative therapy. Microscopically, HCC cells resemble normal liver cells to a variable degree, depending on the tumour differentiation status. Pathologists often use a panel of markers to assist HCC differential diagnosis. From a molecular perspective, HCC presents as a highly heterogeneous tumour entity. Despite considerable research efforts, to date no molecular classification has been introduced in clinical practice. A number of classifications have been suggested to stratify HCC patients by the likelihood of survival, with the aim of identifying those with the best chance of being successfully treated. These different systems do not seem to work well in conjunction and the various involved disciplines have so far failed to achieve their common goal. Co-ordinated initiatives involving clinicians, pathologists, biologists, and bioinformaticians are needed to achieve a comprehensive classification of HCC.

Education and career choices are two major life decisions.1 One who considers a degree in Medicine may ask: “am I up to the challenge,” “am I curious about how medicine improves life,” and “do I care profusely about human life?” Practicing clinical medicine is the most common path; but, not all those with a career in Medicine are physicians. There are researchers in the basic sciences, and there are inventors and innovators of biomedical devices. All those working in Medicine start with valuing and pursuing the improvement of life. The ideal medical school integrates disciplines for a complete understanding of medicine.2 Two of the articles in this edition describe challenges facing Philippine medical schools. The first article re-evaluates the adjustment factor used in the admission process. The second article highlights flexibility and innovation in the sudden shift to online learning. The MD-PhD Program connects scientific research with clinical practice. In the US, this program started in the 1950s and expanded through the Medical Scientist Training Program to more than 90 active MD-PhD programs in 2016.3 The country’s first MD-PhD Program started in 2010 at the University of the Philippines College of Medicine (UPCM). One of our physician-scientist graduates authored an article on the pharmacologic potential of locally harvested edible mushrooms. Many other UPCM graduates do research at the Philippine General Hospital. As an academic medical center, it houses “a large and diverse sample of patients, experienced and interested investigators, with organizational support.”4 In this edition, physician trainees and faculty authored or mentored seven studies. They study various disease and systems processes with the goal of health promotion. Three articles studied hospital processes related to health service delivery. Radiation oncologists explored delays in repeated CT simulation for the radiation of head and neck cancer patients. Ophthalmologists formed a time quality management team to reduce the total consultation time at their outpatient clinic. OB-GYN sonologists looked at methods of manual disinfection of transvaginal probes to keep patients safe while undergoing such procedures. Two articles studied the epidemiology of cerebrovascular diseases and neoplasms (periampullary malignancies), two of the top causes of mortality in the country. Two other studies looked at diseases that affect the quality of life: visual impairment in the young, and the use of a modified approach to hip arthroplasty. Case reports remain valuable sources of unusual information and new ideas.5 This edition also features a case report on a rare childhood malignancy found in an elderly patient who was successfully treated. The road from discovery to healing can take many forms as exemplified by the 11 articles in this edition of Acta Medica Philippina. Publication is a step on the road from discovery to healing. To complete the journey is to implement their findings in clinical practice. Many implementation challenges exist due to differing approaches.6 The road from discovery to healing is not an easy one. We hope to close the gap between evidence and practice; we contribute to an ever-evolving and growing body of knowledge; and we offer the best treatment to our patients, the lives we value the most. Jean Anne B. Toral, MD, MSc Department of Obstetrics and Gynecology College of Medicine and Philippine General Hospital University of the Philippines Manila Coordinator for Research and Chief of the Expanded Hospital Research Office, Philippine General Hospital REFERENCES Camilleri AR. What are life’s biggest decisions? [Internet]. 2021 [cited June 2022]. Available from: https://www.psychologytoday.com/us/ blog/life-s-biggest-decisions/202101/what-are-lifes-biggest-decisions Napier S. Rapid response: the characteristics of an ideal medical school. BMJ. 2019; 323:1437. Harding CV, Kahn JR, Akabas MH, Andersen OS. History and outcomes of fifty years of physician-scientists training in medical scientist training programs. Acad Med. 2017 Oct; 92(10):1390-8. Pinsky WW. The roles of research in an academic medical center. The Ochsner Journal. 2000 Oct; 2(4):201-2. Loubon CO, Culquichicon C, Correa R. The importance of writing and publishing case reports during medical training. Cureus. 2017 Dec;9(12):e1964. Kristensen N, Nymann C, Konradsen H. Implementing research results in clinical practice – the experiences of healthcare professionals. BMC Health Sciences Research. 2016; 16:48.

Data are generated and employed for many ends, including governing societies, managing organisations, leveraging profit, and regulating places. In all these cases, data are key inputs into systems that paradoxically are implemented in the name of making societies more secure, safe, competitive, productive, efficient, transparent and accountable, yet do so through processes that monitor, discipline, repress, coerce, and exploit people. (Kitchin, 165) Introduction Provenance refers to the place of origin or earliest known history of a thing. It refers to the custodial history of objects. It is a term that is commonly used in the art-world but also has come into the language of other disciplines such as computer science. It has also been applied in reference to the transactional nature of objects in supply chains and circular economies. In an interview with Scotland’s Institute for Public Policy Research, Adam Greenfield suggests that provenance has a role to play in the “establishment of reliability” given that a “transaction or artifact has a specified provenance, then that assertion can be tested and verified to the satisfaction of all parities” (Lawrence). Recent debates on the unrecognised effects of digital media have convincingly argued that data is fully embroiled within capitalism, but it is necessary to remember that data is more than just a transactable commodity. One challenge in bringing processes of datafication into critical light is how we understand what happens to data from its point of acquisition to the point where it becomes instrumental in the production of outcomes that are of ethical concern. All data gather their meaning through relationality; whether acting as a representation of an exterior world or representing relations between other data points. Data objectifies relations, and despite any higher-order complexities, at its core, data is involved in factualising a relation into a binary. Assumptions like these about data shape reasoning, decision-making and evidence-based practice in private, personal and economic contexts. If processes of datafication are to be better understood, then we need to seek out conceptual frameworks that are adequate to the way that data is used and understood by its users. Deborah Lupton suggests that often we give data “other vital capacities because they are about human life itself, have implications for human life opportunities and livelihoods, [and] can have recursive effects on human lives (shaping action and concepts of embodiment ... selfhood [and subjectivity]) and generate economic value”. But when data are afforded such capacities, the analysis of its politics also calls for us to “consider context” and “making the labour [of datafication] visible” (D’Ignazio and Klein). For Jenny L. Davis, getting beyond simply thinking about what data affords involves bringing to light how continually and dynamically to requests, demands, encourages, discourages, and refuses certain operations and interpretations. It is in this re-orientation of the question from what to how where “practical analytical tool[s]” (Davis) can be found. Davis writes: requests and demands are bids placed by technological objects, on user-subjects. Encourage, discourage and refuse are the ways technologies respond to bids user-subjects place upon them. Allow pertains equally to bids from technological objects and the object’s response to user-subjects. (Davis) Building on Lupton, Davis, and D’Ignazio and Klein, we see three principles that we consider crucial for work on data, darkness and light: data is not simply a technological object that exists within sociotechnical systems without having undergone any priming or processing, so as a consequence the data collecting entity imposes standards and way of imagining data before it comes into contact with user-subjects; data is not neutral and does not possess qualities that make it equivalent to the things that it comes to represent; data is partial, situated, and contingent on technical processes, but the outcomes of its use afford it properties beyond those that are purely informational. This article builds from these principles and traces a framework for investigating the complications arising when data moves from one context to another. We draw from the “data provenance” as it is applied in the computing and informational sciences where it is used to query the location and accuracy of data in databases. In developing “data provenance”, we adapt provenance from an approach that solely focuses on technical infrastructures and material processes that move data from one place to another and turn to sociotechnical, institutional, and discursive forces that bring about data acquisition, sharing, interpretation, and re-use. As data passes through open, opaque, and darkened spaces within sociotechnical systems, we argue that provenance can shed light on gaps and overlaps in technical, legal, ethical, and ideological forms of data governance. Whether data becomes exclusive by moving from light to dark (as has happened with the removal of many pages and links from Facebook around the Australian news revenue-sharing bill), or is publicised by shifting from dark to light (such as the Australian government releasing investigative journalist Andie Fox’s welfare history to the press), or even recontextualised from one dark space to another (as with genetic data shifting from medical to legal contexts, or the theft of personal financial data), there is still a process of transmission here that we can assess and critique through provenance. These different modalities, which guide data acquisition, sharing, interpretation, and re-use, cascade and influence different elements and apparatuses within data-driven sociotechnical systems to different extents depending on context. Attempts to illuminate and make sense of these complex forces, we argue, exposes data-driven practices as inherently political in terms of whose interests they serve. Provenance in Darkness and in Light When processes of data capture, sharing, interpretation, and re-use are obscured, it impacts on the extent to which we might retrospectively examine cases where malpractice in responsible data custodianship and stewardship has occurred, because it makes it difficult to see how things have been rendered real and knowable, changed over time, had causality ascribed to them, and to what degree of confidence a decision has been made based on a given dataset. To borrow from this issue’s concerns, the paradigm of dark spaces covers a range of different kinds of valences on the idea of private, secret, or exclusive contexts. We can parallel it with the idea of ‘light’ spaces, which equally holds a range of different concepts about what is open, public, or accessible. For instance, in the use of social data garnered from online platforms, the practices of academic researchers and analysts working in the private sector often fall within a grey zone when it comes to consent and transparency. Here the binary notion of public and private is complicated by the passage of data from light to dark (and back to light). Writing in a different context, Michael Warner complicates the notion of publicness. He observes that the idea of something being public is in and of itself always sectioned off, divorced from being fully generalisable, and it is “just whatever people in a given context think it is” (11). Michael Hardt and Antonio Negri argue that publicness is already shadowed by an idea of state ownership, leaving us in a situation where public and private already both sit on the same side of the propertied/commons divide as if the “only alternative to the private is the public, that is, what is managed and regulated by states and other governmental authorities” (vii). The same can be said about the way data is conceived as a public good or common asset. These ideas of light and dark are useful categorisations for deliberately moving past the tensions that arise when trying to qualify different subspecies of privacy and openness. The problem with specific linguistic dyads of private vs. public, or open vs. closed, and so on, is that they are embedded within legal, moral, technical, economic, or rhetorical distinctions that already involve normative judgements on whether such categories are appropriate or valid. Data may be located in a dark space for legal reasons that fall under the legal domain of ‘private’ or it may be dark because it has been stolen. It may simply be inaccessible, encrypted away behind a lost password on a forgotten external drive. Equally, there are distinctions around lightness that can be glossed – the openness of Open Data (see: theodi.org) is of an entirely separate category to the AACS encryption key, which was illegally but enthusiastically shared across the internet in 2007 to the point where it is now accessible on Wikipedia. The language of light and dark spaces allows us to cut across these distinctions and discuss in deliberately loose terms the degree to which something is accessed, with any normative judgments reserved for the cases themselves. Data provenance, in this sense, can be used as a methodology to critique the way that data is recontextualised from light to dark, dark to light, and even within these distinctions. Data provenance critiques the way that data is presented as if it were “there for the taking”. This also suggests that when data is used for some or another secondary purpose – generally for value creation – some form of closure or darkening is to be expected. Data in the public domain is more than simply a specific informational thing: there is always context, and this contextual specificity, we argue, extends far beyond anything that can be captured in a metadata schema or a licensing model. Even the transfer of data from one open, public, or light context to another will evoke new degrees of openness and luminosity that should not be assumed to be straightforward. And with this a new set of relations between data-user-subjects and stewards emerges. The movement of data between public and private contexts by virtue of the growing amount of personal information that is generated through the traces left behind as people make use of increasingly digitised services going about their everyday lives means that data-motile processes are constantly occurring behind the scenes – in darkness – where it comes into the view, or possession, of third parties without obvious mechanisms of consent, disclosure, or justification. Given that there are “many hands” (D’Iganzio and Klein) involved in making data portable between light and dark spaces, equally there can be diversity in the approaches taken to generate critical literacies of these relations. There are two complexities that we argue are important for considering the ethics of data motility from light to dark, and this differs from the concerns that we might have when we think about other illuminating tactics such as open data publishing, freedom-of-information requests, or when data is anonymously leaked in the public interest. The first is that the terms of ethics must be communicable to individuals and groups whose data literacy may be low, effectively non-existent, or not oriented around the objective of upholding or generating data-luminosity as an element of a wider, more general form of responsible data stewardship. Historically, a productive approach to data literacy has been finding appropriate metaphors from adjacent fields that can help add depth – by way of analogy – to understanding data motility. Here we return to our earlier assertion that data is more than simply a transactable commodity. Consider the notion of “giving” and “taking” in the context of darkness and light. The analogy of giving and taking is deeply embedded into the notion of data acquisition and sharing by virtue of the etymology of the word data itself: in Latin, “things having been given”, whereby in French données, a natural gift, perhaps one that is given to those that attempt capture for the purposes of empiricism – representation in quantitative form is a quality that is given to phenomena being brought into the light. However, in the contemporary parlance of “analytics” data is “taken” in the form of recording, measuring, and tracking. Data is considered to be something valuable enough to give or take because of its capacity to stand in for real things. The empiricist’s preferred method is to take rather than to accept what is given (Kitchin, 2); the data-capitalist’s is to incentivise the act of giving or to take what is already given (or yet to be taken). Because data-motile processes are not simply passive forms of reading what is contained within a dataset, the materiality and subjectivity of data extraction and interpretation is something that should not be ignored. These processes represent the recontextualisation of data from one space to another and are expressed in the landmark case of Cambridge Analytica, where a private research company extracted data from Facebook and used it to engage in psychometric analysis of unknowing users. Data Capture Mechanism Characteristics and Approach to Data Stewardship Historical Information created, recorded, or gathered about people of things directly from the source or a delegate but accessed for secondary purposes. Observational Represents patterns and realities of everyday life, collected by subjects by their own choice and with some degree of discretion over the methods. Third parties access this data through reciprocal arrangement with the subject (e.g., in exchange for providing a digital service such as online shopping, banking, healthcare, or social networking). Purposeful Data gathered with a specific purpose in mind and collected with the objective to manipulate its analysis to achieve certain ends. Integrative Places less emphasis on specific data types but rather looks towards social and cultural factors that afford access to and facilitate the integration and linkage of disparate datasets Table 1: Mechanisms of Data Capture There are ethical challenges associated with data that has been sourced from pre-existing sets or that has been extracted from websites and online platforms through scraping data and then enriching it through cleaning, annotation, de-identification, aggregation, or linking to other data sources (tab. 1). As a way to address this challenge, our suggestion of “data provenance” can be defined as where a data point comes from, how it came into being, and how it became valuable for some or another purpose. In developing this idea, we borrow from both the computational and biological sciences (Buneman et al.) where provenance, as a form of qualitative inquiry into data-motile processes, centres around understanding the origin of a data point as part of a broader almost forensic analysis of quality and error-potential in datasets. Provenance is an evaluation of a priori computational inputs and outputs from the results of database queries and audits. Provenance can also be applied to other contexts where data passes through sociotechnical systems, such as behavioural analytics, targeted advertising, machine learning, and algorithmic decision-making. Conventionally, data provenance is based on understanding where data has come from and why it was collected. Both these questions are concerned with the evaluation of the nature of a data point within the wider context of a database that is itself situated within a larger sociotechnical system where the data is made available for use. In its conventional sense, provenance is a means of ensuring that a data point is maintained as a single source of truth (Buneman, 89), and by way of a reproducible mechanism which allows for its path through a set of technical processes, it affords the assessment of a how reliable a system’s output might be by sheer virtue of the ability for one to retrace the steps from point A to B. “Where” and “why” questions are illuminating because they offer an ends-and-means view of the relation between the origins and ultimate uses of a given data point or set. Provenance is interesting when studying data luminosity because means and ends have much to tell us about the origins and uses of data in ways that gesture towards a more accurate and structured research agenda for data ethics that takes the emphasis away from individual moral patients and reorients it towards practices that occur within information management environments. Provenance offers researchers seeking to study data-driven practices a similar heuristic to a journalist’s line of questioning who, what, when, where, why, and how? This last question of how is something that can be incorporated into conventional models of provenance that make it useful in data ethics. The question of how data comes into being extends questions of power, legality, literacy, permission-seeking, and harm in an entangled way and notes how these factors shape the nature of personal data as it moves between contexts. Forms of provenance accumulate from transaction to transaction, cascading along, as a dataset ‘picks up’ the types of provenance that have led to its creation. This may involve multiple forms of overlapping provenance – methodological and epistemological, legal and illegal – which modulate different elements and apparatuses. Provenance, we argue is an important methodological consideration for workers in the humanities and social sciences. Provenance provides a set of shared questions on which models of transparency, accountability, and trust may be established. It points us towards tactics that might help data-subjects understand privacy in a contextual manner (Nissenbaum) and even establish practices of obfuscation and “informational self-defence” against regimes of datafication (Brunton and Nissenbaum). Here provenance is not just a declaration of what means and ends of data capture, sharing, linkage, and analysis are. We sketch the outlines of a provenance model in table 2 below. Type Metaphorical frame Dark Light What? The epistemological structure of a database determines the accuracy of subsequent decisions. Data must be consistent. What data is asked of a person beyond what is strictly needed for service delivery. Data that is collected for a specific stated purpose with informed consent from the data-subject. How does the decision about what to collect disrupt existing polities and communities? What demands for conformity does the database make of its subjects? Where? The contents of a database is important for making informed decisions. Data must be represented. The parameters of inclusion/exclusion that create unjust risks or costs to people because of their inclusion or exclusion in a dataset. The parameters of inclusion or exclusion that afford individuals representation or acknowledgement by being included or excluded from a dataset. How are populations recruited into a dataset? What divides exist that systematically exclude individuals? Who? Who has access to data, and how privacy is framed is important for the security of data-subjects. Data access is political. Access to the data by parties not disclosed to the data-subject. Who has collected the data and who has or will access it? How is the data made available to those beyond the data subjects? How? Data is created with a purpose and is never neutral. Data is instrumental. How the data is used, to what ends, discursively, practically, instrumentally. Is it a private record, a source of value creation, the subject of extortion or blackmail? How the data was intended to be used at the time that it was collected. Why? Data is created by people who are shaped by ideological factors. Data has potential. The political rationality that shapes data governance with regard to technological innovation. The trade-offs that are made known to individuals when they contribute data into sociotechnical systems over which they have limited control. Table 2: Forms of Data Provenance Conclusion As an illuminating methodology, provenance offers a specific line of questioning practices that take information through darkness and light. The emphasis that it places on a narrative for data assets themselves (asking what when, who, how, and why) offers a mechanism for traceability and has potential for application across contexts and cases that allows us to see data malpractice as something that can be productively generalised and understood as a series of ideologically driven technical events with social and political consequences without being marred by perceptions of exceptionality of individual, localised cases of data harm or data violence. References Brunton, Finn, and Helen Nissenbaum. "Political and Ethical Perspectives on Data Obfuscation." Privacy, Due Process and the Computational Turn: The Philosophy of Law Meets the Philosophy of Technology. Eds. Mireille Hildebrandt and Katja de Vries. New York: Routledge, 2013. 171-195. Buneman, Peter, Sanjeev Khanna, and Wang-Chiew Tan. "Data Provenance: Some Basic Issues." International Conference on Foundations of Software Technology and Theoretical Computer Science. Berlin: Springer, 2000. Davis, Jenny L. How Artifacts Afford: The Power and Politics of Everyday Things. Cambridge: MIT Press, 2020. D'Ignazio, Catherine, and Lauren F. Klein. Data Feminism. Cambridge: MIT Press, 2020. Hardt, Michael, and Antonio Negri. Commonwealth. Cambridge: Harvard UP, 2009. Kitchin, Rob. "Big Data, New Epistemologies and Paradigm Shifts." Big Data & Society 1.1 (2014). Lawrence, Matthew. “Emerging Technology: An Interview with Adam Greenfield. ‘God Forbid That Anyone Stopped to Ask What Harm This Might Do to Us’. Institute for Public Policy Research, 13 Oct. 2017. <https://www.ippr.org/juncture-item/emerging-technology-an-interview-with-adam-greenfield-god-forbid-that-anyone-stopped-to-ask-what-harm-this-might-do-us>. Lupton, Deborah. "Vital Materialism and the Thing-Power of Lively Digital Data." Social Theory, Health and Education. Eds. Deana Leahy, Katie Fitzpatrick, and Jan Wright. London: Routledge, 2018. Nissenbaum, Helen F. Privacy in Context: Technology, Policy, and the Integrity of Social Life. Stanford: Stanford Law Books, 2020. Warner, Michael. "Publics and Counterpublics." Public Culture 14.1 (2002): 49-90.

Photo by Diana Polekhina on Unsplash ABSTRACT With the increasing legalization of MAiD across the world, the question of whether psychiatric patients with refractory mental illness should have access to this health service is a topic of ethical debate. Even so, with present-day autonomy encouragement, and the right to die, a psychiatric diagnosis should never automatically preclude a patient from making decisions about their treatment, including the use of MAiD. INTRODUCTION Likely, no matter where we live in the world, we have similar wants: to be healthy, to be happy, to be in a community, to make our own decisions about our lives. The first and last of these wants are the primary concerns of medicine. Diseases are treated, suffering is alleviated, chronic illnesses are managed – to the extent possible. Along the way, patient autonomy is encouraged. Perhaps the greatest manifestation of this autonomy is evidenced in the increasing availability of Physician-Assisted Suicide or Medical Aid-in-Dying (MAiD). With important nuances, the criteria that patients must meet to participate in MAiD are generally similar: a patient must be over the age of 18, able to state a voluntary desire to end their own life, and two independent physicians must verify their decision-making capacity. Yet, clinical criteria for accessing this option differ. In U.S. jurisdictions where MAiD is legal, patients must have a terminal illness with a 6-month prognosis.[1] In Holland and Belgium, the presence of “intractable pain” is sufficient.[2] With the increasing legalization of MAiD across the world, the question of whether psychiatric patients suffering from refractory mental illness should have access to this means of relieving suffering is under continual debate. The ethical implications of denying autonomous decision-making to psychiatric patients at the end of life will be discussed – along with suggestions for clinical practice. l. Medical Aid-in-Dying and the Psychiatric Patient There are three main arguments against allowing a patient with psychiatric suffering to pursue MAiD. The first is that patients with severe mental illness may have impaired decision-making capacity. This impaired capacity generally encompasses the following four criteria: the ability to express a choice, the ability to understand the information presented, the ability to appreciate the “medical consequences of the situation,” and the ability to engage with different choices of treatment.[3] These criteria are impaired to varying degrees across the spectrum of mental illnesses. For instance, about 50 percent of patients with schizophrenia hospitalized for an acute episode displayed at least one element of impaired capacity, compared with 20-25 percent of those admitted with an acute depressive episode. In contrast, depression treated on an outpatient basis may not be associated with any impairment in capacity.[4] The second argument against allowing a patient with psychiatric suffering to pursue MAiD is that suicidality itself can manifest as a common symptom of psychiatric disorders (including major depressive disorder). In this context, a patient with severe mental illness who has requested MAiD, following appropriate treatment, may in fact no longer wish to die. The fear of wrongly fulfilling a MAiD request in this context alienates the notion of liberally applying MAiD to the psychiatric population. A literature review found that between 8 percent and 47 percent of patients in the Netherlands and Oregon who requested MAiD presented with depression, while 2-17 percent of those who pursued MAiD to completion had “depressive symptoms.” In the Netherlands, patients with depression were significantly less likely to be granted euthanasia/MAiD requests.[5] Providers are rightfully afraid of making a mistake that will cost a life. Kious and Battin phrase the dilemma simply: “When is it worse that someone die, whether from suicide or with physician assistance, who could have been helped, and when is it worse that someone whose suffering could only be alleviated by death continue to suffer?”[6] It is doubtful that this question will ever have a sufficient answer. The third argument, that Calkins and Swetz fervently pose, claims that “allowing the psychiatrically ill to participate in [MAiD] will compromise the patient-clinician relationship and the relationship of medicine with the public as a whole… fundamentally alter[ing] the clinician’s role as healer and trusted advisor.”[7] This argument stems from western medicine’s bias of preserving life at whatever cost, the idea being that any deviation from this goal constitutes an abandonment of the patient. Calkins and Swetz’s suggestion that all patients with severe, persistent mental illness who might request MAiD do so inappropriately vastly overestimate the capacity of current psychotropic pharmacology to alleviate pain and suffering. There remain patients who have diligently run the gamut of available treatment options and remain debilitated by their disease. Allowing for participation in MAiD can instead be a testament to the strength of a patient-clinician relationship: that this patient, after presenting the topic of MAiD to their “healer and trusted advisor,” is met with a provider who willingly and carefully listens to their reasons for requesting this option, rather than rejecting the notion out of hand. If deemed appropriate, and after careful fulfillment of the remaining MAiD criteria, the relationship can then shift towards an end-of-life alliance – therapeutic in and of itself, one in which the goal is not further treatment but a peaceful end. However, attitudes about the appropriateness of MAiD for patients with severe mental illness differ, even among psychiatrists. In a survey of 457 psychiatrists in Switzerland – one of the few countries in which MAiD can be granted “on the basis of a primary psychiatric diagnosis,” 29.3 percent of respondents indicated some degree of support for the availability of MAiD to patients with severe and persistent mental illness – an acceptance rate that parallels that of medical providers.[8] Among a profession dedicated to preserving life, there remains much (reasonable) caution about hastening its end. ll. The Psychiatric Advance Directive The ambiguity over whether patients with psychiatric illnesses should be allowed to make their own treatment decisions is not limited to the end of life. For patients with predominantly medical conditions who no longer have the capacity to make decisions about their care (for instance, patients with advanced dementia), clinicians can defer to previously stated wishes as expressed in an advance directive or per the discretion of a healthcare proxy. This deferred decision-making is sometimes referred to as substituted judgment.[9] As a correlate, patients suffering from mental illness can complete a Psychiatric Advance Directive (PAD) to indicate what treatments they would or would not want should they lose decisional capacity. These are often informed by prior, traumatic hospitalizations (for instance, a patient may request not to undergo involuntary electroconvulsive shock therapy, or receive specific antipsychotics, or may decline all psychiatric management). Yet, in contrast to advance directives guiding medical treatment, PADs are frequently (and legally) overridden if they violate “accepted clinical standards.”[10] At their discretion, physicians can override any part or all of a patient’s PAD if it violates what they deem to be acceptable care. Rather than a “let-the-patient-decide” law, the actual influence of PADs on clinical management is often minimal – shrinking its effect to a “let the doctor decide whether the patient gets to decide” law.[11] For example, Pennsylvania’s PAD statute (Act 194) specifies three instances in which physicians can override a patient’s directive. First, a physician maintains the right to involuntarily admit a patient under civil commitment law. Second, a physician may override any part of a patient’s PAD so long as they make “every reasonable effort” to have the patient transferred to a provider willing to adhere to the patient’s request. Third, the act protects any physician who violates a patient’s PAD request from “criminal or civil liability or discipline[e] for unprofessional conduct” who is deemed to have acted in “good faith” based on accepted clinical guidelines.[12] In Pennsylvania’s fairly standard PAD legislation, the physician is virtually untouchable. North Carolina’s “Advance Instruction for Mental Health Treatment” documentation explicitly communicates its limitations to the patient: the opening paragraph states, “Your instructions may be overridden if you are being held in accordance with civil commitment law.”[13] Of course, neither is it sustainable to adhere to all PAD requests. Consider the case of Hargrave v. Vermont. The Second Circuit Court of Appeals upheld the durable power of attorney (DPOA) of Nancy Hargrave (a patient with schizophrenia who was civilly committed) to refuse treatment. As Applebaum notes, “If large numbers of patients were to complete advance directives such as Nancy Hargrave’s, declining all medication, hospitals might well begin to fill with patients whom they could neither treat nor discharge.”[14] Notably, this case is an exception rather than the rule. Broad legislation emulating Hargrave will not act towards the betterment of all patients with severe mental illness. But, in the conversation on the applicability of MAiD for psychiatric patients, it is worth noting how frequently and readily these patients’ wishes are overlooked, even when they have been expressed and properly documented in a state of decisional capacity (as must be the case when completing a Psychiatric Advance Directive). lll. The Way Forward While those with mental illness deserve both fierce protection and robust mental health treatment, they also have a right to define what quality of life is acceptable. When determining the point at which treatment of a psychiatric illness becomes futile – and thus the option of pursuing MAiD more readily permissible – the concept of “qualitative futility” is particularly generative. Focus turns towards a patient’s first-person experience of illness and an understanding of their “subjective view about the quality of an outcome.”[15] This perspective shifts away from the statistical probability that a certain treatment will succeed and instead incorporates the lived reality of a patient’s illness narrative. For example, in the World Health Organization’s published report on the treatment of cancer pain, the phrase “total pain” identifies the physical and non-physical components of suffering, including “the noxious physical stimulus and also psychological, spiritual, social, and financial factors.”[16] For severely ill patients with treatment-refractory mental illness, an understanding of “qualitative futility” and “total pain” could be the most humane way to approach who should and should not qualify for MAiD. In one take on how patients with mental illness have the right to define what consists of an acceptable quality of life, Kious and Battin posit that if a patient’s decision to pursue MAiD is voluntary and if the patient possesses decision-making capacity, their request should be granted “irrespective of whether their underlying medical diagnosis is physical or mental, terminal or nonterminal.”[17] While this option should, of course, be withheld from patients suffering from an acute exacerbation in which the patient may not achieve decisional capacity, it is nevertheless true that psychiatric illness, even in severe cases, is often episodic, undergoing periods of remission when a patient may be symptom-free.[18] During these periods of lucidity, the patient’s perception of quality of life should be examined with great care. Another option offered by Kious and Battin to identify psychiatric patients who may be appropriately pursuing MAiD is to create two “metric[s] for suffering” – one for physical and one for mental illnesses. For psychiatric patients who wish to end their lives, this establishes a threshold above which suffering becomes “unbearable,” opening the door for a legitimate conversation about MAiD between patient and physician (should the patient request it). Suffering below this threshold would remain grounds for involuntary admission to an inpatient facility.[19] The question remains: how do we gauge severe enough suffering to die and suffering that is not? In exploring this question, Zhong et al.’s understanding that a person with mental illness pursuing MAiD must be evaluated differently proves valuable. The authors suggest that rather than focusing on “point capacity” (the ability to make a specific decision), an evaluation of “global capacity” should instead be conducted - a style of evaluation that is interested in “fully contextualiz[ing]” the patient’s choice to pursue MAiD. This requires asking not only about medical and psychiatric history but also family and relationship history, trauma history, education and employment history, and includes a rigorous collection of collateral information from family and friends who can confirm the patient’s wishes.[20] An additional benefit of evaluating for “global capacity” should the choice of MAiD be followed to completion is the illumination, no matter how slight, that might be provided to relatives and friends. This prior justification for, and understanding of, the patient’s decision might dull the sharpness of loss for family and friends – healing insight that may be inaccessible in the case of unassisted suicide. While Kious and Battin express concern that it is “deeply unclear” how to measure the dimensions of suffering given that “we cannot wholly trust first-person reports,” these narratives nonetheless form the substrate of psychiatry and serve as the diagnostic tool of most gravitas available to providers of mental illness.[21] They must be trusted. Or, as the old medical adage goes, they can be trusted and confirmed. It is no accident that in the WHO’s “Cancer Pain Relief” manual, the first step of pain assessment is to “believe the patient’s complaint of pain.”[22] The lived experience of a patient with severe, refractory mental illness can challenge physician hesitation about the appropriateness of MAiD. In the previously cited study in which 29.3 percent of Swiss psychiatrists reported general support for the availability of MAiD in cases of refractory mental illness, the percentage curiously swelled when presented with three clinical vignettes (in each, the patient is stated to have decision-making capacity to “refuse further treatment”). In the case of a 37-year old female with a 26-year history of anorexia nervosa, ten prior hospitalizations, a weight of 52 pounds, general muscle weakness, and low bone density, who no longer wishes to undergo force-feeds, 35.4 percent of respondents indicated that they would support her choice of MAiD.[23] In the case of a 33-year old male with a 16-year history of schizophrenia, who has failed numerous trials of anti-psychotic regiments and electroconvulsive shock therapy, who has “never been free from positive or negative symptoms,” and whose persisting illness has left him severely isolated, 32.1 percent indicated that they would support his choice of MAiD. And in the case of a 40-year-old male with persistent suicidal ideation for 20 years, whose symptoms have been refractory to numerous trials of anti-depressants, anti-psychotics, mood stabilizers, combination therapy, psychotherapy, and electroconvulsive shock therapy, who plans to commit suicide “in the near future,” 31.4 percent of respondents indicated that they would support his choice of MAiD. With generous and nuanced attention to a patient’s “total pain,” following careful evaluation of their “global capacity,” and after a thorough review of all treatment trials and any available therapeutic options yet un-tried (assessing “psychiatric futility”), those who are suffering from severe, refractory mental illness should be granted similar access to MAiD as patients suffering from cancer, ALS, and other organic causes of disease. We cannot adequately police the “badness of suffering.”[24] CONCLUSION In summary, a psychiatric diagnosis should never automatically preclude a patient from making decisions about their treatment, including deciding to end one’s own life with the help of a licensed provider. Medical Aid-in-Dying is associated with a safe, certain, and painless death. In the circumstances where it would be applicable, it serves as a less fraught option than unassisted suicide. We owe anyone who is ceaselessly suffering that much. Or, at the very least, we owe this equally fraught topic an honest conversation. [1] Calkins, Bethany C., and Keith M. Swetz. “Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Imperative Over a Crisis.” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 68–70, doi:10.1080/15265161.2019.1653398. [2] Montanari Vergallo, Gianluca et al. “Euthanasia and physician-assisted suicide for patients with depression: thought-provoking remarks.” Rivista di psichiatria vol. 55,2 (2020): 119-128. doi:10.1708/3333.33027 [3] Appelbaum, Paul S. “Assessment of Patients’ Competence to Consent to Treatment.” New England Journal of Medicine, vol. 357, no. 18, 2007, pp. 1834–40, doi:10.1056/nejmcp074045. [4] Appelbaum, Paul S. “Assessment of Patients’ Competence to Consent to Treatment,” 1834–40. [5] Levene, Ilana, and Michael Parker. “Prevalence of Depression in Granted and Refused Requests for Euthanasia and Assisted Suicide: A Systematic Review.” Journal of Medical Ethics vol. 37,4 (2011): 205-11. doi:10.1136/jme.2010.039057 [6] Levene, Ilana, and Michael Parker. “Prevalence of Depression in Granted and Refused Requests for Euthanasia ...” 205-11. [7] Calkins, Bethany C., and Keith M. Swetz. “Physician Aid-in-Dying and Suicide Prevention in Psychiatry,” 68–70. [8] Hodel, Martina A et al. “Attitudes Toward Assisted Suicide Requests in the Context of Severe and Persistent Mental Illness: A Survey of Psychiatrists in Switzerland.” Palliative & Supportive Care vol. 17,6 (2019): 621-627. doi:10.1017/S1478951519000233 [9] Appel, Jacob M. “Trial by Triad: Substituted Judgment, Mental Illness and the Right to Die.” Journal of Medical Ethics, 2021, pp. 1–4. doi:10.1136/medethics-2020-107154. [10] Swanson, Jeffrey W et al. “Superseding Psychiatric Advance Directives: Ethical and Legal Considerations.” The Journal of the American Academy of Psychiatry and the Law vol. 34,3 (2006): 385-94. [11] Swanson, Jeffrey W et al. “Superseding Psychiatric Advance Directives,” 385-94. [12] Ibid [13] “Advance Directive for Mental Health Treatment." NC Secretary of State. Web. 13 July 2021. <https://www.sosnc.gov/forms/by_title/_advance_healthcare_directives>. [14] Appelbaum, Paul S. “Law & Psychiatry: Psychiatric Advance Directives and the Treatment of Committed Patients.” Psychiatric Services (Washington, D.C.) vol. 55, no. 7, 2004, pp. 751–763. doi:10.1176/appi.ps.55.7.751 [15] Zhong, Rocksheng, et al. “Physician Aid-in-Dying for Individuals with Serious Mental Illness: Clarifying Decision-Making Capacity and Psychiatric Futility.” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 61–63, doi:10.1080/15265161.2019.1654018. [16] World Health Organization. (‎1986)‎. Cancer Pain Relief. World Health Organization. https://apps.who.int/iris/handle/10665/43944 [17] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 29–39, doi:10.1080/15265161.2019.1653397. [18] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying,” 29–39. [19] Ibid [20] Appelbaum, Paul S. “Law & Psychiatry,” 751–763. [21] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying,” 29–39. [22] World Health Organization, Cancer Pain Relief. [23] Hodel, Martina A et al. “Attitudes Toward Assisted Suicide Requests,” 621-627. [24] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying,” 29–39.