Academic literature on the topic 'Understanding your priorities'

84 Background: In the era of value-based cancer care, identifying what is important to cancer survivors, and their perceived control over these experiences, can inform shared decision-making and support quality care. We examined cancer patient priorities and control to guide the development of a new measure of patient value, Valued Outcomes in the Cancer Experience (VOICE). Methods: 459 cancer patients completed an online survey and rated level of importance and control over 54 value items (0 = not at all; 4 = very much). Items of most and least importance, items with most and least control, and rating discrepancies (importance-control) were identified. Bivariate associations with socio-demographics were examined. Results: Participants were 86% non-Hispanic White; mean age = 60 years, SD= 10; 38% breast cancer, 18% blood, 9% lung, 9% prostate; mean time since diagnosis = 6.5 years, SD= 6; 22% metastatic. Items of highest importance (quite a bit to very much) included, “Having your health care team (HCT) talk to you in a way that makes sense to you” (99% of participants); “Making decisions for yourself” (99%); “Talking honestly with your HCT about your illness” (99%). Participants reported the most control over, “Talking honestly with your HCT about your illness” (89%); “Making decisions for yourself” (88%), “Understanding your illness” (84%). Greatest discrepancies were, “Having your illness not get worse or come back” (96% Important; 27% Control); “Having energy to do things that are important to you (98% Important; 41% Control); “Being able to afford medical expenses” (96% Important; 49% Control); “Having a death free from suffering” (91% Important; 40% Control); “Having your medical providers communicate with each other about your care” (94% Important; 44% Control). Greater importance/control discrepancies were associated with lower income, unemployment due to disability, and poorer health ( ps < .05). Conclusions: Cancer patients experience notable discrepancies between personal priorities and their ability to control these experiences, suggesting key areas for intervention and support. Next steps include psychometric assessment to refine the VOICE scale to guide clinical and research efforts to improve patient care outcomes.

ABSTRACT IMPACT: This work has begun to provide the foundation for better ensuring that translational research funded and supported by our IDeA-CTR grant is more directly addressing community- and stakeholder-authored health priorities. OBJECTIVES/GOALS: In order to effectively engage diverse, societal perspectives, we aimed to determine the relevance and feasibility of purposefully aligning translational research with health priorities adopted by the RI Department of Health, health-focused organizations, and community leaders. METHODS/STUDY POPULATION: Individuals from 27 community organizations in RI were asked, ‘What are your health related goals for your community’ and submitted responses online for 2 weeks. Participants generated 71 goals which they sorted into meaningful clusters and rated for importance and feasibility. Clusters were contrasted with RI health priorities to gauge alignment and saturation. In the next phase of this project, researchers and service users funded by Advance-CTR will be asked in routinely administered surveys how their current work may align with RI health goals and whether their future work can feasibly be connected to those priorities. RESULTS/ANTICIPATED RESULTS: Using Group Concept Mapping software, the 71 health goals identified by community organization representatives were fit into an 8-cluster model. Results suggested highest importance placed on Accessible & Healthy Housing (M=4.12, SD=0.29), Community (M=4.08, SD=0.28), Youth (M=4.04, SD=0.49) and Mental Health (M=4.03, SD=0.46). State agency priorities were found to overlap substantially with clusters defined by community leaders. We expect researchers will rate clusters differently, and find some community-endorsed health goals more relevant to their work than others. Perceived feasibility of tailoring future research to state health goals is expected to vary widely by item and researcher. DISCUSSION/SIGNIFICANCE OF FINDINGS: We intend to: 1) facilitate discussions about successes and challenges of translating community-authored priorities into research, and 2) foster better understanding between researchers and the communities they aim to serve on the role of CTR for addressing health challenges in the state.

The American Society for Cell Biology (ASCB) is a community dedicated to helping prepare the next generation of scientists to advance our understanding of the cell to an unprecedented level of sophistication and detail. Its Education Committee fosters this process by creating educational and professional development opportunities around best practices in science pedagogy, while its Minorities Affairs Committee aims to strengthen the scientific workforce by broadening participation of and support for underrepresented minorities in cell biology. To act upon these complementary priorities, the ASCB has developed a Declaration on Effective and Inclusive Biology Education. Its purpose is to outline practical actions for stakeholders in undergraduate education at the levels of faculty, departments, institutions, professional organizations, and funding agencies. Its recommendations are rooted in evidence-based best practices to support the success of diverse and heterogeneous undergraduate demographics and are designed to be highly adaptable to the existing strengths and needs of individual practitioners, student populations, and institutions. We acknowledge the ever-evolving nature of best practices in undergraduate education and hope that the dissemination of this declaration will play a role in this iterative process.

Therapeutic communication in nursing is a patient centered communication focuses on the patient to promote a greater understanding of patients needs, concerns and feeling. The nurse helps the patent explore their own thoughts and feelings, encourages, expression of them and avoid barriers in communication. Therapeutic communication enhances Trust, Genuine interest, empathy, acceptance, positive regard and therapeutic use of self. Nurses improve Therapeutic communication by effective communication and information sharing strategies, understanding patients preferables regarding the environment. Remembering to clear, cohesive, complete, concise and concrete will enhance Therapeutic communication in nursing profession. Nursing professionals should use techniques that priorities the physical, mental and emotional well being of patients when nurses communicate in a therapeutic manner, it helps the patent to feel safe and at ease. The openness and trust inevitably creates a safe space, which gives your patients the best experience possible. Keywords: Therapeutic communication, nursing professionals, emotional and mental wellbeing.

Career shifts are a naturally occurring part of the trauma and acute care surgeon’s profession. These transitions may occur at various timepoints throughout a surgeon’s career and each has their own specific challenges. Finding a good fit for your first job is critical for ensuring success as an early career surgeon. Equally, understanding how to navigate promotions or a change in job location mid-career can be fraught with uncertainty. As one progresses in their career, knowing when to take on a leadership position is oftentimes difficult as it may mean a change in priorities. Finally, navigating your path towards a fulfilling retirement is a complex discussion that is different for each surgeon. The American Association for the Surgery of Trauma (AAST) convened an expert panel of acute care surgeons in a virtual grand rounds session in August 2023 to address the aforementioned career transitions and highlight strategies for successfully navigating each shift. This was a collaboration between the AAST Associate Member Council (consisting of surgical resident, fellow and junior faculty members), the AAST Military Liaison Committee and the AAST Healthcare Economics Committee. Led by two moderators, the panel consisted of early, mid-career and senior surgeons, and recommendations are summarized below and in figure 1.

BackgroundGenerating information that people living with a rheumatic and musculoskeletal disease (RMD) find useful while making decisions about their treatment requires identifying and understanding educational needs and interests directly expressed from people living with RMD.ObjectivesTo identify what types of information US adults with RMD perceive as important to know about their disease and how they express and prioritize such information.MethodsUsing nominal group technique, focus groups of participants (pts) with RMD generated sets of rank-order educational items which were then aggregated across groups into themes. Based on nominal group results, a survey with the final 28 items was administered online, along with a question about desired functions of a smartphone app for RMD, to members of the ArthritisPower registry in January 2022.ResultsSix nominal groups (n=47) yielded 28 unique items for the online survey of educational priorities. To date, a total of 570 pts completed the survey, of whom 85.4% were female, 89.5% white, mean age of 59.6 (SD 11.2) years. Rheumatoid arthritis (52.5%), osteoarthritis (16.0%), psoriatic arthritis (12.5%), and axial spondyloarthritis (7.5%) were the most common RMDs. Knowing how to tell when a medication is not working, how RMD affects other medical conditions, understanding the results of tests used to monitor their RMD, available treatment options and possible side effects, and how life will change as an RMD progresses were each items that > 75% of pts considered extremely important (Table 1). Top functions pts listed as useful for a smartphone app included being able to participate in research, view lab results, record symptoms or flares, share how they are doing with their provider, and get educational information about their disease (Table 2).Table 1.Top Education Topics Adults with Rheumatic and Musculoskeletal Disease Consider Extremely Important (N=570).Itemn (%)Knowing when the medication is not working505 (88.6)Knowing how a rheumatologic condition can affect your other health conditions or medical issues481 (84.4)Understanding the results of tests used to monitor your condition471 (82.6)Knowing the side effects of available drugs, and how the drugs interact with each other461 (80.9)Finding the right rheumatologist453 (79.5)Having realistic expectations of the effectiveness of the medications445 (78.1)Knowing how the disease will progress, even if the news is bad439 (77.0)Knowing the available medications and treatments for your rheumatologic condition437 (76.7)Knowing how long it takes drugs to work436 (76.5)Understanding how your life will change as your disease progresses434 (76.1)Table 2.Desired Smartphone App Functions Rated By Adults with Rheumatic and Musculoskeletal Disease (N=570).App Functionn (%)Participate in patient-centered research299 (52.5)View my lab results283 (49.7)Record my symptoms (e.g. pain, fatigue) or disease flares to track my health over time278 (48.8)Record my symptoms and share how I am doing with my rheumatology provider to know if I am meeting my treatment goals230 (40.4)Get educational information about my disease225 (39.5)Keep track of the medications prescribed by doctor200 (35.1)Schedule and keep track of my medical appointments, rheumatology and other199 (34.9)Track the vaccines I get (i.e. vaccination record)188 (33.0)Help me improve some of my health habits (e.g. sleep, diet, exercise)187 (32.8)Keep track of my use of over-the-counter, complementary or alternative therapies (herbs, tinctures, acupuncture, massage, stretching, etc.)174 (30.5)Get support for my disease from trained patients with my same health condition (i.e. ‘peer coaching’)144 (25.3)ConclusionPeople with RMD prioritized information about medications and prognosis in educational materials, providing guidance for the development of educational tools. A sizeable minority felt educational materials were an important component of a smartphone app, but also identified other important features such as participation in research.Disclosure of InterestsW. Benjamin Nowell Grant/research support from: Research support from AbbVie, Amgen, Eli Lilly and Scipher, Kelly Gavigan: None declared, Kimberly Garza: None declared, Alexis Ogdie: None declared, Michael George: None declared, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer, Maria Danila: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jeffrey Curtis Consultant of: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Gilead, Janssen, Myriad, Novartis, Pfizer, Regeneron, Roche, and UCB, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB

Background Education in stroke is relevant to stroke survivors, clinicians, care providers, and healthcare system administrators and is of special importance in resource-limited settings. The World Stroke Organization Education Committee undertook a program of work, culminating in a focused workshop, to establish the key educational priorities, and work toward maximizing the WSOs impact on the global burden of stroke. Methods A facilitated workshop took place during the World Stroke Congress in Montreal, Canada in October 2018. The workshop was developed using opinions on priority topics for World Stroke Organization educational activities obtained from web-based surveys of World Stroke Organization Members, supplemented by interviews with international stroke support organizations. The workshop included over 50 international participants, selected to represent a balance of age, gender, geographical region, and different levels of health resources. Participants also included members of the World Stroke Organization Education Committee, the World Stroke Academy, stroke support organizations, and the International Journal of Stroke editorial board. The workshop focused on understanding more about educational needs (at all levels), with emphasis on resource-limited settings. Three broad questions were posed: (1) What are the key educational needs: (a) in your region, (b) from your perspective (e.g. stroke support organization)? (2) Do the current educational activities offered by World Stroke Organization and WSA meet your needs? (3) What could World Stroke Organization/World Stroke Academy offer in your region that would meet your needs? The facilitated discussions were recorded, and the results transcribed and summarized by members of the World Stroke Organization Education Committee. Results Five key needs were identified: 1. Collaborative interdisciplinary, training in both stroke care and how to advocate for stroke. 2. Educational materials provided in a wider range of formats that could be adapted to local circumstances and clinical practices. 3. Educational activities for healthcare providers and stroke support organizations organized regionally, with the World Stroke Organization providing organizational support, and a pool of experts, therapists, nurses, etc. to deliver locally relevant materials. 4. Clear and authoritative online resources, where it is easy to find key policy and protocol guidance. 5. A range of online interactive education and training resources to help build knowledge and competence in stroke care. Conclusion The results of the workshop have been presented to the World Stroke Organization Board and will be used to help to guide the educational initiatives of the World Stroke Organization and World Stroke Academy going forward.

Introduction Evidence on patient preferences is increasingly being used to inform regulatory and reimbursement decisions. In acute leukemia, the number of treatment options is expanding but there is limited quantitative evidence on patients' treatment preferences, especially in the event of relapse. The Acute Leukemia Advocates Network (ALAN) in collaboration with The Office of Health Economics are running a quantitative patient preference study using a discrete choice experiment (DCE) to 1/ Elicit adult acute leukemia patients' preferences for treatment outcomes and characteristics in the event of a future relapse 2/ Explore the tradeoffs that patients are willing to make between different hypothetical treatments 3/ Describe preference heterogeneity in the patient population and 4/ Provide useful insights that could demonstrate patient value for a range of upcoming health technology assessments of relapsed/refractory treatments and guide innovation and development throughout the medical product lifecycle. Here we report on two stages of qualitative research: 1/ Online bulletin boards (OBBs) to identify potential attributes for the DCE and 2/ Cognitive ‘think aloud’ pilot interviews to test participant understanding of the draft DCE survey. Methods Two structured OBBs were conducted - one each for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Each day, participants were asked up to four open questions on the following topics: “your diagnosis and expectation of treatment”, “your first experience of treatment”, “treatment following a relapse”, and “your treatment priorities”. Participants could see and respond to each other's answers. Three researchers acted as moderators and engaged in discussions where appropriate. Following the design of the DCE survey, a series of online one-on-one think-aloud interviews with AML and ALL participants was subsequently conducted to pilot the DCE survey. Interviewees were asked to verbally reflect on their responses, with occasional interviewer prompts. The pilots were conducted in two separate weeks, with a week in between to allow for changes to be made. All participants were recruited via ALAN and its members. Results A total of 12 AML and nine ALL patients took part in the OBBs, of which 15 were female. Age (range: 26-71; average: 51.1) and years of living with the disease (range: &lt;3 to &gt; 10 years) were varied. Both the AML and ALL groups agreed that the effectiveness of the treatment in achieving long-term stable remission would be most important. Severe long-term side effects would also be an important concern but many participants said they could put up with potentially severe short-term side effects for a good chance of long-term survival. Additional concerns were the length of hospital stays, availability of psychological/mental/emotional support, catheter-related pain and infections, and mode of administration (MoA). Several participants argued that an individualized approach to treatment is preferred. Thematic analysis of the OBB data led to the identification of five attributes for the DCE: chance of response (20-95%), duration of response (6-18 months), quality of life (QoL) during treatment (0-50%), QoL during response (25-75%), and MoA (tablets taken at home, injections requiring a hospital stay, injections as outpatient appointments). The DCE was designed using an efficient experimental design and coded as part of an online survey, and subsequently piloted (see Figure 1). In week 1 of the pilots (n=5 interviews), ‘duration of response’, was often misinterpreted as ‘duration of treatment’. Interviewees also interpreted treatment and response as potentially overlapping, and therefore struggled to separate the two QoL attributes. Therefore, we made several changes including explicitly structuring the choice tasks to distinguish treatment and response phases. The changes improved understanding in week 2 (n=5 interviews) and raised some additional minor issues for consideration. Conclusion People with acute leukemia have a range of concerns about treatments in the context of a relapse. However, the primary issues identified in the qualitative research relate to the chance and duration of treatment success, QoL during and after treatment, and the MoA. The pilot interviews were valuable in improving the wording and overall quality of the final survey, which has since been fully launched.

I am writing to draw your attention to a serious concern that requires our attention around global health commitments: the frequently disregarded and undervalued dental reforms. In the realm of global health commitments, dental reforms are often ignored and underestimated. (1) Despite significant advancements in many other facets of health owing to these commitments, dental health remains marginalized within its sphere creating a glaring disparity, especially in lower middle-income countries where it’s a crucial concern.(2) Dental health has a significant impact on a person's quality of life in addition to preventing oral diseases. It has a significant impact on a person's quality of life, having an impact on their mental and physical well-being. Neglected oral health can affect speech, self-esteem, and psychosocial wellbeing as well as cause pain, infections, malnutrition, and systemic health problems.(3) The disruptive relationship between oral diseases and significant medical conditions like diabetes, cardiovascular disease, and adverse pregnancy outcomes emphasizes the complex relationship between dental health and overall health. Despite efforts to promote understanding, such as Universal Health Coverage (UHC) and the International Health Regulations (IHR), oral health is often disregarded in global discussion. Particularly in lower middle-income countries, oral health is neglected due to a lack of tailored interventions, which decreases its significance. A significant leap forward has been made with the recent World Health Organization (WHO) resolution that declares oral health a global priority and calls for its inclusion in national strategies. The WHO has acknowledged the need to address this problem immediately.(4) The challenge, however, is recognition into concrete, commitment-backed activities and specific interventions. The resolution has potential, but its effectiveness will be judged by the concrete measures taken to bridge the gaps. The Sustainable Development Goals (SDGs) offer a potential reference point for rectifying this gap. By integrating oral health in SDGs like Goal 3 on excellent health and well-being, a holistic approach may be taken. This integration could help bridge the gap between international commitments, raise the public's awareness of oral health, and foster tailored initiatives for dental reforms. ---Continue

Kentucky experiences some of the nation’s worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the Commonwealth is home to 13 hazardous waste sites included in the United States Environmental Protection Agency Superfund National Priorities List (NPL). The NPL highlights priority sites for long-term remedial action to reduce environmental contaminants. To enhance the understanding of environmental health and protective actions, the University of Kentucky Superfund Research Center Community Engagement Core developed a 9-lesson extension curriculum “Body Balance: Protect Your Body from Pollution with a Healthy Lifestyle” (Body Balance) and partnered with Kentucky’s Family and Consumer Sciences (FCS) Cooperative Extension Service to pilot the curriculum in Kentucky communities. FCS agents in 4 Kentucky counties delivered the Body Balance pilot study (18-31 participants per lesson). Pre- and post-lesson questionnaires revealed increased knowledge and awareness of the effects of environmental pollution on health and the protective role of dietary strategies. Focus group participants (n = 18) self-reported positive behavior changes because of increases in knowledge and leadership from their FCS agent. The Body Balance curriculum appeared to be a promising mechanism for raising environmental health and diet knowledge, as well as for promoting positive behavior changes among white, middle/older-aged women in rural Kentucky communities.

The objectives and principles of neurological history and examination in children are the same as those in adults. This chapter therefore, will not provide an all-encompassing description of the neurological assessment of children, but highlights where the approach must differ substantially from that used in adults. Further it aims to provide a practical and useful approach to the examination of children, who may be preverbal and certainly will show less stamina for cooperation than adults. Of course as children get older, the examination can become more conventional and systematized. By adolescence the examination can be the same as the adult examination.The first and overriding factor for success is to be flexible and to make observations when the opportunity arises rather than to wait for abnormalities to arise during the course of a more systematic approach. Nonetheless a systematic approach to recording these results is essential, so as to bring together related observations made disparately in time. The history is of paramount importance in guiding the examination. Since it is unlikely that you will be able to complete a full examination, it is important to prioritize the observations needed in light of a differential diagnosis before you begin examining. Rather than rushing straight into the examination it is rewarding to gain a young child’s confidence by playing briefly with them. Also, instead of insisting on examining the child on a couch, it helps to become adept at examining young children on their parent’s or caretaker’s knee. Finally, no matter how cooperative a child is, potentially disturbing investigations should be left until last, including tendon reflexes or examination of the tongue, fundi, and ears. Otherwise all subsequent cooperation from the child may be lost after these examinations.The examination room environment is the key to a successful neurological examination and requires careful thought. There should be sufficient space to accommodate families and for the children to play. The room needs to be friendly and conducive to encouraging play. It needs to be equipped with carefully selected toys, pictures, pencils and paper, and books of interest to children over a wide age range. Observation of the child’s play whilst you are taking a history from the parents or caregivers will allow assessment of the child’s motor skills and developmental stage. Their use of play material can yield important clues to the nature of a deficit, by revealing ataxia, weakness, involuntary movements, tics, or spasticity. Play also provides an opportunity to assess the child’s behaviour, for instance their impulsivity, distractibility, and attention span. Interaction of the child with parents or caregivers can be observed also. If the child participates actively in the history taking, their understanding and contribution to the session allows you to make assessments of their language and intellectual skills.

Abstract The previous chapters discussed ways to establish a strong working relationship with parents using engagement, listening, collaboration, and boundary-setting skills. When you first meet parents, the most important thing you can do is to listen actively to their story. Once you have offered a supportive ear, you can ask specific questions to clarify your understanding of the parents’ concerns. Then you can begin to try to set priorities about actions that need to be taken on behalf of parents’ children.

The aim of this chapter is to provide you with the knowledge to be able to recognize, assess, manage, and care for people with depression in an evidence-based and person-centred way. Depression is disabling and causes significant impact upon many areas of the person’s day-to-day functioning; it is therefore important that nurses have the knowledge and skills to recognize whether someone might be depressed and know how to take the appropriate course of action. This chapter will provide a comprehensive overview of the causes and impact of depression, before exploring best practice to deliver care, as well as to prevent or to minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with depression can be found in Chapter 14….I lost my balance. I fell flat on my face and I couldn’t get up again. And if that implies a certain grace, a slow and easy free-fall, then you have me wrong. It was violent and painful and, above all humiliating . . . I came to understand that we are not simply fighting an illness, but the attitudes that surround it. Imagine saying to someone that you have a life-threatening illness such as cancer, and being told to pull yourself together or get over it. Imagine being terribly ill and too afraid to tell anyone lest it destroy your career. Imagine being admitted into hospital because you are too ill to function and being too ashamed to tell anyone, because it is a psychiatric hospital. Imagine telling someone that you have recently been discharged and watching them turn away, in embarrassment or disgust or fear. Bad enough to be ill, but to feel compelled to deny the very thing that, in its worst and most active state, defines you is agony indeed. (Sally Brampton (2008) in Shoot The Damn Dog.)…Sally’s experience of her depressive episode from her memoir sets the scene of just what people with depression can experience and how big an impact it can have upon their lives. We may all feel low and ‘fed up’ at times, and often we use the term ‘depressed’ as an adjective to describe how we are feeling in general conversation.

Abstract Ever since its 1995 inception at a Puerto Rico colloquium on Critical Race Theory and Latina/o communities, Latina and Latino Critical Legal Theory (LatCrit) agendas have prioritized students and sustainability. This chapter highlights those priorities in the context of the times and ambitions that have helped to activate and shape LatCrit theory, community, and praxis as a form of organized academic activism. The authors describe LatCrit’s origins and history since 1995, its collective present, and their hopes for the future. Understanding the emergence, circumstances, and purposes of LatCrit’s development as a still thriving school of critical outsider jurisprudence and its programmatic expression of anti-subordination interventions during these past few decades brings into focus how and why LatCrit remains an “advocacy project” that might inspire other individuals or collectives, whether in academia or other parts of society, and whether focused on students or other populations. Specifically for students, we suggest a variety of ways to connect with LatCrit scholarship, events, and networks to build your own critical knowledge, professional capacity, and bottom-up advocacy projects.

As the patient in clinic describes the cramp-like pain that he gets in his calf when he walks, a pain that disappears on resting but which is exac­erbated by walking up hills and necessitates him stopping to look in shop windows when out and about, you will be thinking about questioning him for risk factors for vascular disease. Atherosclerosis is a systemic disease. Identification and early treatment of diabetes, hypercholesterolaemia, hypertension, and provision of antiplatelet agents and smoking cessation therapy will confer important cardio- and cerebroprotective benefits. Acute vascular emergencies requiring an urgent response include the patient with sudden onset, limb-threatening ischaemia; the collapsed patient with a ruptured aortic aneurysm; and the patient in whom haemorrhage or ischaemia comprises part of the picture of complex trauma. Rapid, but thorough examination, appropriate resuscitation, and judicious use of diagnostic imaging will help to underpin urgent manage­ment and interventions necessary to obtain the best outcomes for these patients. Despite increasing reliance on minimally invasive diagnostic modali­ties including duplex Doppler ultrasound, magnetic resonance angiog­raphy, and computed tomography angiography, principles of history taking and good clinical examination remain of paramount importance. Observation to detect nuances of ischaemic trophic changes and skin colour, as well as more overt signs of necrosis, gangrene, and ulceration, complements palpation of pulses, detection of subtle changes in skin temperature, delayed capillary refill, and presence of sensory neuropa­thy. A positive Buerger’s test, with pallor of the foot and venous gutter­ing on leg elevation, and rubor (redness), due to reactive hyperaemia on dependency, may help clinch the diagnosis of critical limb ischaemia when other diagnostic features are equivocal. Careful distinction between features of arterial insufficiency, venous hypertension, and diabetic neuropathy may help to determine aetiol­ogy of a recalcitrant lower limb ulcer and the consequent course of management. In the UK, vascular surgery has recently become an independent surgi­cal specialty. This chapter will test your understanding of signs and symp­toms of vascular disease and will hopefully stimulate your understanding of priorities for investigation and management of the range of conditions comprising this exciting sphere of surgery.

Chapter 2 (Session 2) focuses on understanding and managing physical responses to stress. Youth and their families will learn about how the body responds to stress to keep us safe, and how sometimes our bodies and minds may react strongly in situations that are not actually unsafe. Youth learn a variety of skills to manage the body’s response to stress, including ways to Relax Your Self (i.e., relax your body using deep breathing and progressive muscle relaxation, and relax your mind using guided imagery) and Relax Your World (i.e., pleasant activity scheduling). This chapter provides the therapist with guidance on how to prioritize which techniques to emphasize based on each youth’s symptom presentation. At the end of the session, the therapist will work with the youth and their parent to develop a relaxation plan for the week and to continue mood monitoring.

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with skin conditions in an evidence-based and person-centred way. The chapter will provide a comprehensive overview of the commonest skin diseases and their causes before exploring best practice to assess and help patients to manage skin conditions. Nursing priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with skin conditions can be found in Chapters 19, 20, 21, 24, 27, and 28 on skin care and the maintenance of skin hygiene, skin barrier integrity, the prevention of skin breakdown, and wound management, respectively. Skin care is a fundamental area of nursing responsibility. The skin, or integumentary system, is the largest organ of the body and has significant protective and thermoregulatory functions. Skin disease is common, accounting for approximately 24% of GP visits (Schofield et al., 2009). It may have a major psychosocial impact on a person’s quality of life through its influence on appearance, body image, and self-esteem. This chapter introduces you to the common skin diseases that you are likely to encounter when caring for adult patients and outlines the nursing problems that you will need to manage. The cause or aetiology of common skin conditions lies with the interaction between genetic and environmental factors. For example, a child’s eczema is influenced by his or her genotype and his or her exposure to environmental allergens. Within the UK population, 23–25% have a skin problem at some time in their lives that can benefit from medical care (Schofield et al., 2009). Skin problems are the commonest reason for consulting a GP, with 6% referred for specialist advice. As such, all registered nurses should have the knowledge and skills to manage the common conditions. The commonest skin conditions in the Western hemisphere are chronic inflammatory skin diseases (CISDs), such as eczema. In developing countries, the common conditions are infections and infestations. The quality-of-life impact of CISDs can exceed that for life-threatening conditions such as cancer (Rapp et al., 1999; Kingman, 2005).

This chapter presents a comprehensive understanding of dementia as a commonly encountered condition/syndrome in the nursing care of older adults and offers insights into the health challenges faced by people living with dementia. It will provide nurses with the knowledge to be able to assess, manage, and care for people with dementia in an evidence-based and person-centred way. After a comprehensive overview of the causes, risk factors, and impact of dementia, it will outline best practice to deliver care, as well as to prevent or minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with dementia can be found in Chapters 14 and 17, respectively. In the past, dementia was most often described in terms of mental disability. However, it is now more often described in terms of neurological disability (i.e. changes in the brain). For example, the Mental Health Foundation describes dementia as:…A decline in mental ability which affects memory, thinking, problem-solving, concentration and perception….The NHS Choices website states:…Dementia describes the effects of certain conditions and diseases on a person’s mental ability, personality and behaviour….Dementia is generally classified according to two international classification systems: the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV); and the International Classification of Diseases tenth edition (ICD-10). Dementia can be defined as a syndrome whereby there is gradual death of brain cells, resulting in a loss of brain ability that is severe enough to interfere with normal activities of living for more than 6 months. Problems with brain function should not have been present at birth and it is not associated with a loss or alteration of consciousness. This latter point distinguishes dementia from delirium, which is a state of mental disorientation that can happen if you become medically unwell, also known as an ‘acute confusional state’ (Royal College of Psychiatrists, 2009). (See Chapter 11). It is vital that nurses hold central what dementia means for people living with it. For example, people will commonly experience changes to their perception, senses, memory, and the range of skills they need to carry out everyday activities.

Unpacking the nature and influence of Hillary Rodham Clinton’s faith is crucial to understanding her priorities, motives, and actions in various stages of her life. Methodism helped shape Clinton’s political philosophy and inspire her extensive social activism. For a variety of reasons, Clinton’s faith, although strongly held and sometimes explicitly expressed, has been underappreciated. The secularity and disinterest of the media, dislike of George W. Bush’s outspokenness about his faith, the belief that many politicians use religious rhetoric for ulterior purposes, her reluctance to discuss her personal life, and the animosity of the religious right have all contributed to Clinton’s faith being either neglected or misconstrued.

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with coronary heart disease (CHD) in an evidence-based and person-centred way. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CHD. In guiding you through patient assessment, the differences between acute coronary syndromes (ACS) and angina are established before exploring best practice to deliver care, as well as to prevent or to minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with coronary heart disease can be found in Chapters 15, 22, 24, and 25, respectively. CHD is defined as the failure of the coronary arteries to deliver adequate oxygen for myocardial work. It is almost always caused by atherosclerosis—a gradual build-up of fatty plaques within the artery wall that reduces blood flow. This failure to meet metabolic demands results in a range of clinical conditions sharing common pathological process (Baxendale, 1992), including ACS and angina. Chest pain is the symptom that informs clinical decision-making. It is classified based on history-taking and investigations such as the electrocardiogram (ECG). Angina was first described by Heberden in 1772 as a ‘painful and disagreeable sensation in the breast, which seems as if it would take their life away if it were to increase or continue.’ (cited by Fox et al., 2006). Stable angina is described as a clinical syndrome that is characterized by discomfort in the chest, jaw, shoulder, back, and arms, typically elicited by exertional emotional stress and relieved by rest or nitroglycerine (Fox et al., 2006). ACS is an umbrella term for several clinical presentations, including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The European Society of Cardiology defines ACS as ‘. . . a life threatening manifestation of atherosclerosis . . . caused by a ruptured atherosclerotic plaque . . . causing sudden complete or critical reduction in blood flow’ (Bassand et al., 2007).

Chapter 5 examines the production of intelligence assessments and their impact on policy decision-making in the UK. It’s main focus is on the Joint Intelligence Committee and Defence Intelligence as the leading source of analysis in the UK intelligence community on the Arab uprisings, ISIS and Crimea. The chapter argues that only in the Crimea case did the intelligence community fail to warn. A core reason was that the policy community in the UK was concerned with improving relations with Russia and focused more on issues like counterterrorism, Syria, and Afghanistan. It finds that surprises happen more often in low-priority areas for intelligence collection and assessment. It also highlights the unavoidability of surprise in foreign policy. It concludes with a review of lessons learned and offers three recommendations. First, warning can only happen effectively through a long-term and deep understanding of a region or issue. Second, early warning deserves to be treated as a discipline in its own right, with intelligence products that are marked as such for the customer. Third, one should not underestimate the importance of open-source intelligence as a means to complete the overall picture, and intelligence analysis should not rely on secret sources alone.

Abstract Mentors, sponsors, and networks increase your chances of having a successful career. Mentors provide valuable guidance and advice on career alternatives, while sponsors support candidates selected for highly desirable roles by serving as a reference that they can perform well in positions of increasing responsibility and importance. Networking increases the number of people who are familiar with your abilities and is a powerful way to sustain and enhance your reputation and circle of influence. Networking is about making the right connections and building beneficial relationships. In this article, we showcase how the combination of mentoring, sponsoring, and networking produces advisors who can enable us to have a rewarding and successful professional career. We share our three-component system for optimizing your chances of career success. – Mentoring and the "Critical Listening" model: Intelligent questioning, ranking of options or preferences, and attentive listening are used during mentoring sessions. The balance between these modes as you progress through your career from fresh graduate to mid-career to experienced professional. This model includes practical examples to guide you in your approach mentoring loops whether for either the first or for the nth time with the aim of maximizing the value you can gain from mentoring. – Sponsoring and the "BET" model: BET is our acronym for Building a Network, Equal Priorities, and Tactics (BET). We explain how individuals can acquire and tactically leverage sponsors throughout their careers. The approaches of sponsors and protégées evolves with career stage, that changes priorities and focus. – Networking Development and Optimization: Networking for mentoring and sponsoring is essential to career success. A diverse network enhances innovation and problem solving. We benefit from both deep and shallow connections. Networking built on a foundation of reciprocity includes an exchange of mutually beneficial information that establishes long-lasting professional relationships. Methods to diagnose and address network gaps help professionals to achieve career objectives. Strong networking skills build collaborative relationships that add value for both one's career and employer. Understanding how to maximize the value of mentoring, sponsoring, and networking is essential to career success. We encourage self-analyses throughout your career and provide guidelines on how to leverage mentors and sponsors and utilize best practices to expand your professional network. In an era where COVID has drastically changed how most of us work, understanding how to thrive with these three key instruments for career success is challenging, given the additional hurdle of having to do it in a virtual ecosystem with fewer or no opportunities to meet face to face. This article raises awareness and provides practical guidance for individuals on building beneficial relationships from mentoring, sponsoring, and networking. Keeping networks alive and strong in a reduced mobility world requires new strategies.

Abstract A decision-centric approach to projects creates confidence, improves value, and shortens time to revenue. A straight-forward objective based approach to managing project decisions is presented in the form of four primary questions. Those questions are:Does the issue/threat/opportunity make a material difference to the project? (Materiality)Can anything be done to affect the outcome? (Influence)Can you afford to do anything about it? (Value)What if you are wrong? (Confidence) Materiality – An issue/threat/opportunity must make a material difference to a project decision to be worth receiving attention. The concept of materiality will vary in size and consequence from project to project, so it is important to maintain a decision focus. Understanding the variability in the project with respect to decision thresholds can provide an indication of materiality. We must also ask how different our current assessment of the project, or its environment could get before we would like to change our decision. Affective ability – Accepted risk-management options of avoidance, mitigation, transfer, and acceptance present the decision options within this category. In considering the consequences the options, decision tools such as Indifference Assessment and Pain and Regret Assessment. Avoidance, Mitigation, or Transfer – while most projects can benefit through risk reduction, such effort must make economic sense. Risk reduction paths must add value to the project through added upside or elimination of at least a portion of downside threat. The value of these efforts is aided by use of tools such as Value-of-Information, Value-of-Control, and Value-of-learning. Being wrong – Making a regretful decision is always a possibility but the source of the "wrongness" and its likely impact is often overlooked by teams. In project planning and execution, decision-makers are often presented with a plethora of issues, threats, and opportunities. From development planning through implementation significant time and resource waste can be cut by prioritizing effort to the issues that matter. Understanding the issues in the context of materiality and then what to do, if anything, about an issue, becomes key to maximizing success. This approach cuts waste and focuses the attention on what matters. Decision Intelligence not only increases the probability of making the best decisions, but it also prioritizes work to those items that matter either for value or decision path. While most of the decision tools referenced are well documented in the literature, placing them into the context of the Four Question Approach allows teams and management to focus more closely on efficiently mitigating issues, shortening workflow, and creating significantly higher decision confidence. This novel approach works well in all phases of project planning through project management implementation.

This is the final report for research into rangahau priorities for occupational therapy services in the Waikato, by Otago Polytechnic | Te Pūkenga and Te Whatu Ora, funded by the Health Research Council.

Background: Public behaviour and the new hostile threats • Civil contingencies planning and preparedness for hostile threats requires accurate and up to date knowledge about how the public might behave in relation to such incidents. Inaccurate understandings of public behaviour can lead to dangerous and counterproductive practices and policies. • There is consistent evidence across both hostile threats and other kinds of emergencies and disasters that significant numbers of those affected give each other support, cooperate, and otherwise interact socially within the incident itself. • In emergency incidents, competition among those affected occurs in only limited situations, and loss of behavioural control is rare. • Spontaneous cooperation among the public in emergency incidents, based on either social capital or emergent social identity, is a crucial part of civil contingencies planning. • There has been relatively little research on public behaviour in response to the new hostile threats of the past ten years, however. • The programme of work summarized in this briefing document came about in response to a wave of false alarm flight incidents in the 2010s, linked to the new hostile threats (i.e., marauding terrorist attacks). • By using a combination of archive data for incidents in Great Britain 2010-2019, interviews, video data analysis, and controlled experiments using virtual reality technology, we were able to examine experiences, measure behaviour, and test hypotheses about underlying psychological mechanisms in both false alarms and public interventions against a hostile threat. Re-visiting the relationship between false alarms and crowd disasters • The Bethnal Green tube disaster of 1943, in which 173 people died, has historically been used to suggest that (mis)perceived hostile threats can lead to uncontrolled ‘stampedes’. • Re-analysis of witness statements suggests that public fears of Germany bombs were realistic rather than unreasonable, and that flight behaviour was socially structured rather than uncontrolled. • Evidence for a causal link between the flight of the crowd and the fatal crowd collapse is weak at best. • Altogether, the analysis suggests the importance of examining people’s beliefs about context to understand when they might interpret ambiguous signals as a hostile threat, and that. Tthe concepts of norms and relationships offer better ways to explain such incidents than ‘mass panic’. Why false alarms occur • The wider context of terrorist threat provides a framing for the public’s perception of signals as evidence of hostile threats. In particular, the magnitude of recent psychologically relevant terrorist attacks predicts likelihood of false alarm flight incidents. • False alarms in Great Britain are more likely to occur in those towns and cities that have seen genuine terrorist incidents. • False alarms in Great Britain are more likely to occur in the types of location where terrorist attacks happen, such as shopping areass, transport hubs, and other crowded places. • The urgent or flight behaviour of other people (including the emergency services) influences public perceptions that there is a hostile threat, particularly in situations of greater ambiguity, and particularly when these other people are ingroup. • High profile tweets suggesting a hostile threat, including from the police, have been associated with the size and scale of false alarm responses. • In most cases, it is a combination of factors – context, others’ behaviour, communications – that leads people to flee. A false alarm tends not to be sudden or impulsive, and often follows an initial phase of discounting threat – as with many genuine emergencies. 2.4 How the public behave in false alarm flight incidents • Even in those false alarm incidents where there is urgent flight, there are also other behaviours than running, including ignoring the ‘threat’, and walking away. • Injuries occur but recorded injuries are relatively uncommon. • Hiding is a common behaviour. In our evidence, this was facilitated by orders from police and offers from people staff in shops and other premises. • Supportive behaviours are common, including informational and emotional support. • Members of the public often cooperate with the emergency services and comply with their orders but also question instructions when the rationale is unclear. • Pushing, trampling and other competitive behaviour can occur,s but only in restricted situations and briefly. • At the Oxford Street Black Friday 2017 false alarm, rather than an overall sense of unity across the crowd, camaraderie existed only in pockets. This was likely due to the lack of a sense of common fate or reference point across the incident; the fragmented experience would have hindered the development of a shared social identity across the crowd. • Large and high profile false alarm incidents may be associated with significant levels of distress and even humiliation among those members of the public affected, both at the time and in the aftermath, as the rest of society reflects and comments on the incident. Public behaviour in response to visible marauding attackers • Spontaneous, coordinated public responses to marauding bladed attacks have been observed on a number of occasions. • Close examination of marauding bladed attacks suggests that members of the public engage in a wide variety of behaviours, not just flight. • Members of the public responding to marauding bladed attacks adopt a variety of complementary roles. These, that may include defending, communicating, first aid, recruiting others, marshalling, negotiating, risk assessment, and evidence gathering. Recommendations for practitioners and policymakers • Embed the psychology of public behaviour in emergencies in your training and guidance. • Continue to inform the public and promote public awareness where there is an increased threat. • Build long-term relations with the public to achieve trust and influence in emergency preparedness. • Use a unifying language and supportive forms of communication to enhance unity both within the crowd and between the crowd and the authorities. • Authorities and responders should take a reflexive approach to their responses to possible hostile threats, by reflecting upon how their actions might be perceived by the public and impact (positively and negatively) upon public behaviour. • To give emotional support, prioritize informative and actionable risk and crisis communication over emotional reassurances. • Provide first aid kits in transport infrastructures to enable some members of the public more effectively to act as zero responders.