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The integration of Electronic Medical Records (EMRs) revolutionized healthcare but often retained limitations from paper-based structures. This study proposes a framework for developing dynamic medical content specifically adapted to the clinical context including medical specialty and diseases. Tailoring content to this dynamic context offers several benefits, including improved access to relevant information, streamlined workflows, and potentially better patient outcomes. We applied our framework to develop neurosurgical content, focusing on brain tumors. The method involves defining the medical specialty, outlining user journeys, and iteratively developing artifacts like assessment forms, dashboards, and order sets. Standardized terminologies ensure consistency and interoperability. Our results demonstrate a successful development of content meeting user needs and clinical relevance. While initial implementation focused on neurosurgery, exploring scalability and AI integration offers promising avenues for further advancement. Future studies could quantitatively evaluate the impact of this method on user satisfaction and patient outcomes.

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Introduction: Special situations that jeopardize the internal and external security for communities are increasing in their frequency and complexity. This creates complicated challenges for individuals, governments and humanity. National and international strategies are being developed that focus on the resilience and coping of all first responders during these extreme stress states. Aim: The aim of the article is to present the framework of strategic resilience, its multidimensional measurement and the possibilities for training robust resilience to increase operational effectiveness in special operational situations. Methodological approach: Research in the area of special operation situations often focuses on the human performance cluster. The Unit of Applied Research 18_RECESS (18_ Research and Education Center for Extraordinary Tactical Situations and Strategically Resilience) at the Department of Disaster Prevention and Crisis Management at Fresenius University of Applied Sciences in Idstein fits into this field. It pursues the adaptation of existing resilience models to special operation situations in line with the definition of strategic resilience. In addition, the focus is on the possibility of training strategic resilience to increase operational effectiveness. There are currently several research projects being conducted in the civilian and civilian-military sectors, as well as with ground and special operations forces. Major findings: Strategic Resilience with its 3 axes Psychological, Physiological and Cognitive Resilience covers the core domains of various existing models of resilience. This provides an adequate concept to describe different factors leading to personnel perseverance in special operation situations. There exists the possibility to train several domains of strategic resilience via problem-oriented intervention (POH).

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Introduction: Cardiovascular diseases are a multifaceted and complex problem in the health system that can change the priorities of the economic, social, and even political systems of countries. Therefore, as a grand challenge (GC), its management requires adopting a systematic, interdisciplinary, and innovative approach. In Iran, the most common causes of death, have changed from infectious and diarrheal diseases to cardiovascular diseases since 1960. Methods: In this study, the novel framework of the problem-oriented innovation system (PIS) has been used, and cardiovascular diseases in Iran have been selected as a case study. To this end, first, the main challenges related to cardiovascular diseases in Iran were identified in two layers of "governance-centered" (including legal and policy gaps, insufficient education, financing, lack and unbalanced distribution of medical personnel) and "society driven" (including unhealthy diet and lifestyle, uncontrolled and hard-to-regulate factors, and high costs) through a library research. Then, the functional-structural framework of the problem-oriented innovation system was used to analyze cardiovascular diseases and provide policy recommendations. Results: The findings indicate that based on the eight functions of the problem-oriented innovation system, an important part of cardiovascular diseases can be managed and controlled in three short-term, medium-term, and long-term periods. Conclusion: Increasing public awareness in the form of university courses, participation of the government with the private sector in building and equipping specialized cardiovascular centers, creating an electronic health record from birth, implementing a family health plan focusing on less developed areas, supporting agriculture and guaranteeing the purchase of agricultural products and healthy food, increasing the capacity of accepting students in medical and paramedical fields, and allocating pharmaceutical currency in the form of pharmaceutical subsidies directly to cardiovascular patients, are among the most important policy recommendations for this grand challenge.

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BACKGROUND: Considering the epidemic status of the COVID-19 virus, the discussion of the psychological effects of this disease on the mental health of people at different levels of society is of great importance. Therefore, this study was conducted to investigate the relationship between coping (problem-oriented, emotion-oriented, and avoidance-oriented) with psychological well-being in people with coronavirus disease. MATERIALS AND METHODS: In this correlational study, the statistical population consisted of all individuals with experience of coronavirus in 2021 in Kermanshah city. In total, 220 people were selected as the sample using an available sampling method. The instruments used in this study were Reef Psycho-Welfare Questionnaire (PWBQ) and Andler and Parker Coping Styles (CISS-SF). Data were analyzed using Pearson's correlation coefficient and simultaneous regression. RESULTS: Multiple correlations of coping variables (problem-oriented, emotion-oriented, and avoidance-oriented) with psychological well-being (R = 0.671; P = 0.01) are significant. Problem-oriented coping style (beta = 0.329; P = 0.05), emotional coping style (beta = 0.329; P = 0.05); avoidant coping style (beta = 0.144; P = 0.05) had a significant relationship with psychological well-being. CONCLUSION: According to the obtained results, the importance of paying attention to coping styles in psychological well-being is felt more than before. Psychological well-being seems to be influenced by other factors and their interactive effects as well.

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Traditionally, Electronic Medical Records (EMR) have been designed to mimic paper records. Organizing and presenting medical information along the lines that evolved for non-digital records over the decades, reduced change management for medical users, but failed to make use of the potential of organizing digital data. We proposed a method to create clinical dashboards to increase the usability of information in the medical records. Official clinical guidelines were studied by a working group, including dashboard target users. Necessary clinical concepts contained in the medical records were identified according to the clinical context and finally, dedicated technical tools with standard terminologies were used to represent categories of information. We used this method to generate and implement a dashboard for sepsis. The dashboard was found to be appropriate and easy to use by the target users.

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Our study examined the association between problem-focused coping and resilience among fibromyalgia (FM) patients who live under constant security threats. Resilience is a coping resource and detrimentally affects FM female patients (FMPs) to get up and cope with life. A cohort of 96 FMPs ages 19-75 was subjected to a Fibrotherapy intervention program in the Rehabilitation Help Center in Sderot (Ezra Le'Marpeh), Israel. We examined levels of problem-oriented coping and levels of resilience among the sample. In addition, we assessed whether there is a correlation between their resilience level and their medical metrics. The research included medical metrics and physical metrics. A cohort of 16 FMPs who participated in the quantitative phase composed the qualitative sample. Data from the t-test showed improved mental resilience among all the sample, with a significantly higher level among problem-oriented FMPs. We conclude that resilience is acquired through problem-oriented coping strategies. Furthermore, the association between resilience and problem-oriented coping helped to improve health indicators since coping with the disease included entering a regime of physicals activity and maintaining a healthy lifestyle.

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Objective: To determine the impact of documentation workflow on the accuracy of coded diagnoses in electronic health records (EHRs). Design: Cross-sectional study. Participants: All patients who completed visits at the Casey Eye Institute Retina Division faculty clinic between April 7, 2022 and April 13, 2022. Main Outcome Measures: Agreement between coded diagnoses and clinical notes. Methods: We assessed the rate of agreement between the diagnoses in the clinical notes and the coded diagnosis in the EHR using manual review and examined the impact of the documentation workflow on the rate of agreement in an academic retina practice. Results: In 202 visits by 8 physicians, 78% (range, 22%-100%) had an agreement between the coded diagnoses and the clinical notes. When physicians integrated the diagnosis code entry and note composition, the rate of agreement was 87.9% (range, 62%-100%). For those who entered the diagnosis codes separately from writing notes, the agreement was 44.4% (22%-50%, P < 0.0001). Conclusion: The visit-specific agreement between the coded diagnosis and the progress note can vary widely by workflow. The workflow and EHR design may be an important part of understanding and improving the quality of EHR data. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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BACKGROUND: Correctly structured problem lists in electronic health records (EHRs) offer major benefits to patient care. Without structured lists, diagnosis information is often scatteredly documented in free text, which may contribute to errors and inefficient information retrieval. This study aims to assess whether EHRs with correctly structured problem lists result in better and faster clinical decision-making compared to non-curated problem lists. METHODS: Two versions of two patient records (A and B) were created in an EHR training environment: one version included diagnosis information structured and coded on the problem list ("correctly structured problem list"), the other version had missing problem list diagnoses and diagnosis information partly documented in free text ("non-curated problem list"). In this single-blinded crossover randomized controlled trial, healthcare providers, who can prescribe medications, from two Dutch university medical center locations first evaluated a randomized version of patient A, then B. Participants were asked to motivate their answer to two medication prescription questions. One (test) question required information similarly presented in both record versions. The second (comparison) question required information documented on problem lists and/or in notes. The primary outcome measure was the correctness of the motivated answer to the comparison question. Secondary outcome measure was the time to answer and motivate both questions correctly. RESULTS: As planned, 160 participants enrolled. Two were excluded for not meeting inclusion criteria. Correctly structured problem lists increased providers' ability to answer the comparison question correctly (56.3 % versus 33.5 %, McNemar odds ratio 2.80 (1.65-4.93) 95 %-CI). Median time to answer both questions correctly was significantly lower for EHRs with correctly structured problem lists (Wilcoxon-signed-rank test p = 0.00002, with incorrect answers coded equally at slowest time). CONCLUSIONS: Correctly structured problem lists lead to better and faster clinical decision-making. Increased structured problem lists usage may be warranted for which implementation policies should be developed.

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It is recognized worldwide that evidence on what effectively prevents abuse of at-risk adults (including older people) is lacking. The purpose of this paper is to make an explicit, contemporary proposal as to why front-line workers and policy-makers interested in preventing the abuse of at-risk adults should adopt an opportunity-focused, problem-oriented policing framework from criminology. This paper will first position the proposal within the current context of responses to the abuse of at-risk adults. Following this, the paper will outline how the problem-oriented policing framework can develop targeted, collaborative, sustainable, and measurable prevention strategies intended to remove the opportunity for specific examples of abuse of at-risk adults.

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Background: Problem-oriented documentation is an accepted method of note construction which facilitates clinical thought processes. However, problem-oriented documentation is challenging to put into practice using commercially available electronic health record (EHR) systems. Objective: Our goal was to create, iterate, and distribute a problem-oriented documentation toolkit within a commercial EHR that maximally supported clinicians' thinking, was intuitive to use, and produced clear documentation. Materials and Methods: We used an iterative design process that stressed visual simplicity, data integration, a predictable interface, data reuse, and clinician efficiency. Creation of the problem-oriented documentation toolkit required the use of EHR-provided tools and custom programming. Results: We developed a problem-oriented documentation interface with a 3-column view showing (1) a list of visit diagnoses, (2) the current overview and assessment and plan for a selected diagnosis, and (3) a list of medications, labs, data, and orders relevant to that diagnosis. We also created a series of macros to bring information collected through the interface into clinicians' notes. This toolkit was put into a live environment in February 2019. Over the first 9 months, the custom problem-oriented documentation toolkit was used in a total of 8385 discrete visits by 28 clinicians in 13 ambulatory departments. After 9 months, the go-live education and EHR optimization teams in our health system began promoting the toolkit to new and existing users of our EHR resulting in a significantly increased uptake by outpatient clinicians. In April 2022 alone, the toolkit was used in more than 92 000 ambulatory visits by 894 users in 271 departments across our health system. Conclusions: As a health-system client of a commercial EHR, we developed and deployed a revised problem-oriented documentation toolkit that is used by clinicians more than 92 000 times a month. Key success elements include an emphasis on usability and an effective training effort.

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Illegal wildlife trade (IWT) is one of the leading causes of the decline in high-value species. Crime-reduction strategies to counter IWT can have unintended effects, with crime displacement occurring when offenders react to such interventions. Despite the value of understanding how and why displacement occurs for informing conservation strategies, few examples are published. We explored a case of perpetrator replacement following an intervention and drew lessons for conservation strategies for high-value species. Poaching and subsequent trade threaten the Sundarbans tiger (Panthera tigris). Pirate gangs were the dominant poachers from 1980 to 2017, but following an extensive campaign, the Sundarbans was declared pirate free in 2018. We interviewed 280 individuals, including 100 tiger poachers, from 26 administrative unions bordering the Sundarbans and used interviewee responses to compare the poaching situation during and after the pirate era. We analyzed the spatial distribution of tiger poachers among the unions and used crime script analysis of the dominant poacher type to identify intervention. Because pirates opportunistically poached tigers, the government's successful counter-pirate campaign inadvertently removed the dominant tiger poaching type. However, a temporary reduction in poaching was rapidly cancelled out by the emergence of at least 32 specialist tiger-poaching teams. With the risk of extortion and robbery from pirates gone, other groups increased the frequency of opportunistic and targeted tiger poaching. Based on expert interviews, we estimated that 341 tiger poachers of all types are active throughout the unions, with 79% of specialists concentrated in 27% of unions. The highly focused counter-pirate campaign reduced motivations and opportunities for piracy but left intact the opportunity structure and trade connections for tiger poaching, and with insufficient enforcement officers trading has flourished. Interventions targeting opportunities for poaching by specialist tiger poachers include heightened surveillance and reporting mechanisms and alternative livelihood provision to disincentivize poaching.

Aprendizaje a partir de la sustitución del infractor para eliminar las oportunidades de crimen y prevenir la caza furtiva del tigre de Sundarbans Resumen El mercado ilegal de fauna (MIF) es una de las principales causas de la declinación de especies importantes. Las estrategias de reducción de crímenes para contrarrestar el MIF pueden tener efectos no deseados, como el desplazamiento del crimen que ocurre cuando los infractores reaccionan a dichas intervenciones. A pesar de lo valioso que es para las estrategias de conservación entender cómo y por qué ocurre este desplazamiento, se publican pocos ejemplos. Exploramos un caso de sustitución del infractor después de una intervención sacamos lecciones para las estrategias de conservación de especies importantes. La caza furtiva y el mercado subsecuente son una amenaza para el tigre de Sundarbans (Panthera tigris). Los piratas fueron los cazadores dominantes entre 1980 y 2017, pero después de una campaña exhaustiva, el Sundarbans fue declarado libre de piratas en 2018. Entrevistamos a 280 individuos, incluidos 100 cazadores furtivos, de 26 uniones administrativas que rodean al Sundarbans y usamos sus respuestas para comparar la situación de la caza furtiva durante y después de los piratas. Analizamos la distribución espacial de los cazadores furtivos entre las uniones y usamos el análisis de escritura criminal del tipo dominante de cazador para identificar las intervenciones. Ya que los piratas eran cazadores furtivos oportunistas, la campaña exitosa del gobierno para contrarrestarlos eliminó sin saberlo el tipo dominante de caza furtiva. Sin embargo, una reducción temporal de la caza se canceló rápidamente con la emergencia de al menos 32 equipos especialistas en la cacería furtiva de los tigres. Sin el riesgo de la extorsión o robo por parte de los piratas, otros grupos incrementaron la frecuencia de la cacería oportunista y focalizada. Con base en las entrevistas a expertos, estimamos que 341 cazadores de tigres de todos los tipos están activos en las uniones, con 79% de los especialistas concentrados en 27% de las uniones. La campaña focalizada anti-piratas redujo las motivaciones y oportunidades de piratería, pero no afectó la estructura de oportunidades y conexiones mercantiles de la cacería furtiva de tigres, lo cual, sumado a la falta de suficientes agentes policiales, ha aumentado el mercado. Las intervenciones enfocadas en las oportunidades de cacería de los cazadores especialistas incluyen una mayor vigilancia y mecanismos de reporte y el suministro de sustentos alternativos para desalentar la cacería furtiva.

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Objective:To explore the application of problem-oriented group teaching in the teaching of Nursing Education.Methods:The convenience sampling method was used to select 76 undergraduate nursing students as research subjects. These students participated in the teaching of Nursing Education. Students who received traditional teaching were included in control group ( n=38), while students who received problem-oriented group teaching were included in the observation group ( n=38). The two groups were evaluated for learning effectiveness, information awareness, and satisfaction with teaching. SPSS 20.0 was used for the t-test and chi-square test. Results:The observation group had significantly higher usual examination score, final examination score, and total score than the control group ( P<0.05); there was no significant difference between the two groups in the pre-learning information behavior tendency score, information cognition score, and total score. After the learning, the above scores increased in both groups, with significantly higher scores in the observation group than in the control group ( P<0.05); the observation group had a significantly higher teaching efficiency, a significantly stronger learning initiative, and a significantly higher degree of satisfaction with the teaching methods and the attitude of the teacher than the control group ( P<0.05). Conclusion:The application of problem-oriented group teaching in the teaching of Nursing Education can improve students' learning effectiveness, information awareness, and satisfaction with teaching, making it suitable to be widely used in teaching practice.

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Drawing on the literature of problem-oriented governance (POG) and social motivation for voluntary compliance, this study discusses how South Korea's efforts to cultivate distributed cognitions and build core capabilities of POG-reflective improvement, collaborative, and data analytic capabilities-contribute to the citizens' voluntary compliance with the current vaccination policy by improving trust and confidence. A systematic content analysis and documentation review of relevant policies, situation reports, after-action reports, official briefings, and news articles provide significant implications for both theories and practices of policy compliance and governance for effective and efficient management of many wicked problems like the COVID-19 pandemic.

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Background: Identifying, preventing, and resolving medical problems are some of the most central functions of clinical pharmacy (CP) and pharmaceutical care (PC) practitioners. Usually, the practitioners and researchers find a challenging to link the problem and the appropriate intervention to be included in the care plan. A comprehensive, well-structured, validated, simple use and standardized tool, which fulfill these requirements in daily clinical practice, are currently rare. Purpose: To design and validate a comprehensive medical problem-oriented plan (MPOP) classification system in addition to assessment and care plan tools for use in practicing, researching, and teaching CP and PC. Materials and methods: The methodology was composed of five steps: literature searching and classification of the problems; developing the assessment of treatments and care plan templates; implementing the tutorial; validation; completion and evaluation of the final version. Results: The classification system (MPOP tool) is an open hierarchical structure, where higher levels are broadly defined, consisting of 5 main categories, and lower levels become more specific. In the MPOP tool's final version, a total of 24 major subcategories were distributed to the major five categories as 4 (Indication), 5 (Effectiveness), 7 (Safety), 3 (Patient), and 5 (Miscellaneous). Different minor subcategories (subcategory 2, n = 62) and 95 plans (interventions) were determined. Each of the subcategories and plans includes a notes section that represents a specific detail. There was strong agreement on using the MPOP tool between the two authors (κ = 1.000, p < 0.0005) and between three random clinical pharmacists out of 17 (κ = 0.947, 95% CI, 0.840 to 1.055, p < 0.0005). The validity and reliability statistics demonstrate that the Alsayed_v1 tools are extremely appropriate. The majority of users expressed high satisfaction with all the assessment, MPOP, and care plan tools. Conclusion: The Alsayed_v1 tools introduced in this paper were applied to actual patient cases and were validated. These tools include: assessment of treatments, MPOP, and care plan. Including the interventions in the classification system is important especially in PC research where the type of recommendations should be documented to assess the value and impact of the service and saves the time of practitioners in typing the appropriate interventions. By applying the steps within these Alsayed tools, the clinical pharmacists can actively provide the best practice to achieve the optimal patient outcome.

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Objectives: This randomized controlled trial (RCT) assessed the effectiveness of a community-infused problem-oriented policing (CPOP) intervention on reducing property/violent crime. Methods: In two mid-Atlantic cities, a total of 102 crime hot spots were randomly assigned to receive CPOP or standard patrol. Analyses examine changes in crime the year before, during, and one year after the intervention. We used hierarchical Poisson regression models. Results: We found no main effects for the CPOP intervention on property and violent crimes in either site. In site B, the violent crime count in low treatment hot spots was 200% higher than controls post-intervention but this likely reflected officers paying less attention to treatment locations with lower levels of crime. Conclusions: Our results suggest that CPOP was not effective in the unusual context of the COVID-19 pandemic and post-George Floyd killing. Given the challenges of implementing CPOP during this unique time, caution is needed in interpreting these findings.

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Emotional intelligence (EI), problem-oriented coping, and resilience have been deeply studied as psychological predictors of wellbeing in stressful daily situations. The aim was to find out whether coping, EI, and resilience are predictors of well-being, using two statistical methodologies (hierarchical regression models and comparative qualitative models). With this objective in mind, we built an online evaluation protocol and administered it to 427 Spanish people, exploring these variables through a selection of validated tests. The extracted data were studied using linear predictive tests (hierarchical regression models), as well as fuzzy set qualitative comparative analysis. We found that EI variables had important associations with coping, positive affect, negative affect, and life satisfaction, and also acted as relevant predictors for all of them, together with resilience and problem-oriented coping. The fuzzy set qualitative comparative analysis showed a series of logical combinations of conditional causes and results of each potential configuration for these variables. The interaction between the presence of EI, resilience, and coping resulted in high levels of well-being. On the other hand, the presence of high emotional attention in interaction with low resilience and low coping abilities resulted in low well-being. These results increase knowledge about protective factors and allow for the creation of intervention programmes to enhance them.

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Background: Mental disorders are one of the leading causes of illness and disability worldwide. According to the World Health Organization (WHO), one in four people in the world will be affected by mental or neurological disorders during their lifetime. Regular evaluation of mental health outcomes plays an important role in making decisions about timely treatment of the patient. Studies show that a medical record does not provide enough information about the diagnosis, current symptoms, psychiatric medications, and side effects of current medications and treatments for ongoing health care. In this study, the completeness of paper-based psychiatric records was investigated. Aim: The current study aimed to explore the completeness rate of paper-based psychiatric medical records (PMRs) and to investigate the factors effective on documentation status. Setting: The study was conducted in Ebnesina and Dr. Hejazi Psychiatric Hospital and Education Center. The case hospital is a psychiatric teaching hospital, which has 900 beds. Materials and Methods: The completeness rate of PMRs was determined using descriptive statistics. Fleiss' Kappa agreement and effective factors on PMRs' documentation status were assessed. Results: In total, 83.65% (n = 312) of the PMRs had at least one documentation defect. A significantly higher level of documentation completeness rate between different psychiatric wards was observed. Conclusion: Based on our results, it is suggested to conduct regular evaluation and provide feedback to the health-care providers, and conduct training courses.

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The health system in the Netherlands is one of the best in the world and it is a challenge to keep this affordable and accessible for everyone. A shift from care to lifelong maintenance of health is highly needed, but the drivers of change are missing. Obviously, the involvement of citizens is essential, but to introduce the change the indispensable incentives must be identified. The believe in integrated network care is growing, but it requires a fresh view on the integration of prevention and care, the involvement of the "old players" to create a new governance model, the supporting IT and adequate funding arrangements. In the Tiel region the implementation of the INCA model for integrated care in the primary care setting might make the difference for this journey.

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Flirting situations are opportunities to behave in extraverted ways. However, it is not clear whether engaging in flirting behavior predicts extraversion. The current study explored whether extraversion increases following a 3-h flirt training and compared two training routes to flirting. A two-arm randomized pre-post design with two active conditions were used. Ninety-six adults between 18 and 49 years (67.7% women) were randomized to either: (1) a problem-oriented training strategy that aims to compensate for problems and deficits related to flirting; or (2) a strengths-oriented training strategy that capitalizes on individuals' strengths and resources. The outcome variables were assessed before and 30 days after the training. Participants in both conditions reported higher scores in flirting behavior as well as in extraversion following the trainings. The results suggest that flirt trainings are potentially interesting indirect intervention approaches to increase the expression of extraversion.

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Our problem-oriented approach to health care, though historically reasonable and undeniably impactful, is no longer well matched to the needs of an increasing number of patients and clinicians. This situation is due, in equal parts, to advances in medical science and technologies, the evolution of the health care system, and the changing health challenges faced by individuals and societies. The signs and symptoms of the failure of problem-oriented care include clinician demoralization and burnout; patient dissatisfaction and non-adherence; overdiagnosis and labeling; polypharmacy and iatrogenesis; unnecessary and unwanted end-of-life interventions; immoral and intolerable disparities in both health and health care; and inexorably rising health care costs. A new paradigm is needed, one that humanizes care while guiding the application of medical science to meet the unique needs and challenges of individual people. Shifting the focus of care from clinician-identified abnormalities to person-relevant goals would elevate the role of patients; individualize care planning; encourage prioritization, prevention, and end-of-life planning; and facilitate teamwork. Paradigm shifts are difficult, but the time has come for a reconceptualization of health and health care that can guide an overdue transformation of the health care system.

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