Isolation, Culture, and Quality Assessment of Clinical-Grade Corneal Stromal Stem Cells.

The challenge of treating corneal scarring through keratoplasties lies in the limited availability of donor tissue. Various studies have shown the therapeutic use of cultivated corneal stromal stem cells (CSSCs) to mitigate tissue inflammation and suppress fibrosis and scar tissue formation in preclinical corneal wound models. To develop CSSC therapy for clinical trials on patients with corneal scarring, it is necessary to generate clinical-grade CSSCs in compliant to Good Manufacturing Practice (GMP) regulations. This chapter elucidates human CSSC isolation, culture, and cryopreservation under GMP-compliant conditions. It underscores quality assessment encompassing morphological traits, expression of stemness markers, anti-inflammatory activity, and keratocyte differentiation potency.

A importância dos cuidados paliativos exercidos por médicos de família e comunidade na Atenção Primária à Saúde: uma revisão narrativa / The importance of palliative care performed by family practice doctors in primary health care: a narrative review / La importancia de los cuidados paliativos realizados por médicos de familia y comunitario en la Atención Primaria de Salud: una revisión narrativa

Introdução: A terminalidade é uma situação cada vez mais vivenciada nos serviços de saúde em razão da progressão da expectativa de vida da população e, consequentemente, do incremento de pacientes com doenças crônicas graves. No Brasil, os serviços de cuidados paliativos ainda se encontram centralizados nos serviços de atenção terciária. Entretanto, em diversos países, a Atenção Primária à Saúde tem sido a grande prestadora e coordenadora de cuidados paliativos dos usuários, em prol da descentralização dessa assistência e da promoção do cuidado integral. Objetivo: Realizar uma revisão narrativa da literatura, a fim de identificar a relação dos médicos de família e comunidade na atuação de cuidados paliativos na Atenção Primária à Saúde. Métodos: Revisão bibliográfica por meio do acesso às bases de dados: Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e PubMed. Foram selecionados 16 artigos, os quais foram submetidos a análise temática e posterior discussão das principais características que colaboram para a maior atuação dos médicos de família e comunidade em cuidados paliativos. Resultados: Observou-se a importância da atuação dos médicos de família e comunidade em cuidados paliativos no âmbito da Atenção Primária à Saúde, bem como a interligação entre as duas especialidades, os desafios existentes nesse caminho e os benefícios dessa prática. Conclusões: A oferta de cuidados paliativos pelos médicos de família e comunidade na atenção primária favorece o acesso e acompanhamento dos pacientes. Entretanto, a atuação dos profissionais das Equipes de Saúde da Família nessa linha de cuidado ainda é insuficiente em razão da escassa capacitação na área.

Introduction: Terminality is a situation increasingly experienced in healthcare services due to the progression of the population's life expectancy and, consequently, the increase in patients with serious chronic diseases. In Brazil, Palliative Care services are still centralized in tertiary care services. However, in many countries, Primary Health Care has been the major provider and coordinator of Palliative Care for users, in favor of decentralizing this assistance and promoting comprehensive care. Objective: To carry out a narrative literature review to identify the relationship of Family Practice Doctors in the performance of Palliative Care in Primary Health Care. Methods: Bibliographic review through access to databases: CAPES, LILACS, SciELO, and PUBMED. Sixteen articles were selected, which were submitted to thematic analysis and subsequent discussion of the main characteristics that contribute to the greater performance of Family Practice Doctors in Palliative Care. Results: The importance of Family Practice Doctors in Palliative Care within the scope of Primary Health Care was observed, as well as the interconnection between the two specialties, the challenges along this path, and the benefits of this practice. Conclusions: The offer of Palliative Care by Family Practice Physicians in Primary Care favors the access and monitoring of patients. However, the performance of the professionals in Family Health Teams in this line of care is still insufficient due to the lack of training in the area.

Introducción: La terminalidad es una situación cada vez más experimentada en los servicios de salud debido a la progresión de la esperanza de vida de la población y, en consecuencia, al aumento de pacientes con enfermedades crónicas graves. En Brasil, los servicios de Cuidados Paliativos todavía están centralizados en los servicios de atención terciaria. Sin embargo, en varios países, la Atención Primaria de Salud ha sido la principal proveedora y coordinadora de los Cuidados Paliativos para los usuarios, a favor de descentralizar esta asistencia y promover la atención integral. Objetivo: Realizar una revisión narrativa de la literatura, con el fin de identificar la relación de los Médicos de Familia y Comunitarios en la actuación de los Cuidados Paliativos en la Atención Primaria de Salud. Métodos: Revisión bibliográfica mediante acceso a bases de datos: Portal CAPES, LILACS, SciELO y PubMed. Fueron seleccionados dieciséis artículos, que fueron sometidos al análisis temático y posterior discusión de las principales características que contribuyen para una mayor actuación de los Médicos de Familia y Comunidad en Cuidados Paliativos. Resultados: Se constató la importancia del trabajo de los Médicos de Familia y Comunitarios en Cuidados Paliativos en el ámbito de la Atención Primaria de Salud, así como la interconexión entre las dos especialidades, los desafíos que existen en este camino y los beneficios de esta práctica. Conclusiones: La oferta de Cuidados Paliativos por Médicos de Familia y Comunitario en Atención Primaria favorece el acceso y seguimiento de los pacientes. Sin embargo, la actuación de los profesionales de los Equipos de Salud de la Familia en esta línea de atención aún es insuficiente debido a la falta de formación en el área.

Perfil epidemiológico dos acidentes por material biológico em médicos da atenção primária em Minas Gerais, de 2012 a 2021 / Epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, from 2012 to 2021 / Perfil epidemiológico de accidentes por material biológico en médicos de atención primaria en Minas Gerais, de 2012 a 2021

Introdução: Os acidentes ocupacionais com material biológico representam um problema de saúde pública. A exposição ocupacional dos profissionais da saúde configura-se como um risco de transmissão de diversos patógenos. Na literatura, há carência de estudos que analisem o perfil dos acidentes com material biológico nos médicos da atenção primária. Objetivo: Buscou-se compreender o perfil epidemiológico dos acidentes com material biológico em médicos da atenção primária em Minas Gerais. Métodos: Estudo epidemiológico descritivo com análise do perfil dos acidentes com material biológico em médicos da atenção primária em Minas Gerais, utilizando dados secundários. Resultados: No período analisado, foram registrados 111 acidentes com material biológico, dos quais 54% ocorreram somente em 2020 e 2021. A maioria dos casos deu-se em mulheres (59%), e os tipos mais frequentes de exposição foram mucosa (38%) e percutânea (33%). Dos médicos, 23% não possuíam esquema vacinal contra a hepatite B completo. Em média, em 36% dos acidentes os testes sorológicos foram negativos e em 61% não foram realizados ou o campo foi ignorado/deixado em branco. Em apenas 7,2% dos casos a quimioprofilaxia foi indicada, mas ressaltam-se os registros ignorados ou em branco. Mais da metade dos acidentados não emitiu a Comunicação de Acidente de Trabalho (CAT). Conclusões: Os acidentes com material biológico predominam em médicas e nas formas de exposição mucosa e percutânea. Investimentos em medidas de biossegurança e educação permanente são necessários para prevenir casos e estimular sua notificação.

Introduction: Occupational accidents with biological material represent a public health problem. The occupational exposure of health professionals represents a risk of transmission of various pathogens. In the literature, there is a lack of studies that analyze the profile of accidents with biological material among primary health care physicians. Objective: We aimed to understand the epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, Brazil. Methods: Descriptive epidemiological study that analyzed the profile of accidents with biological material among primary health care doctors in Minas Gerais, using secondary data. Results: In the period analyzed, 111 accidents with biological material were recorded, of which 54% occurred only in 2020 and 2021. Most cases occurred in women (59%) and the most frequent types of exposure were mucosal (38%) and percutaneous (33%). About a quarter (23%) of physicians did not have a complete immunization record for hepatitis B. On average, in 36% of accidents serological tests were negative and in 61% they were not performed or the field was ignored/left blank. In only 7.2% of cases, chemoprophylaxis was indicated, but ignored or blank records stood out. More than half of the victims did not fill out a work accident report. Conclusions: Accidents with biological material predominate in female doctors and in forms of mucosal and percutaneous exposure. Investments in biosafety measures and permanent education are necessary to prevent cases and encourage their notification.

Introducción: Los accidentes de trabajo con material biológico representan un problema de salud pública. La exposición ocupacional de los profesionales de la salud representa un riesgo de transmisión de varios patógenos. En la literatura faltan estudios que analicen el perfil de accidentes con material biológico en médicos de atención primaria. Objetivo: Buscamos comprender el perfil epidemiológico de los accidentes con material biológico en médicos de atención primaria en Minas Gerais. Métodos: Estudio epidemiológico descriptivo con análisis del perfil de accidentes con material biológico en médicos de atención primaria en Minas Gerais, utilizando datos secundarios. Resultados: En el período analizado se registraron 111 accidentes con material biológico, de los cuales el 54% ocurrió solo en 2020 y 2021. La mayoría de los casos ocurrieron en mujeres (59%) y los tipos de exposición más frecuentes fueron mucosa (38%) y percutánea (33%). El 23% de los médicos no disponía de un calendario completo de vacunación frente a la hepatitis B. En promedio, en el 36% de los accidentes, las pruebas serológicas fueron negativas y en el 61% no se realizó o se ignoró/dejó el campo en blanco. Solo en el 7,2% de los casos se indicó quimioprofilaxis, pero destacan los registros ignorados o en blanco. Más de la mitad de las víctimas no emitieron el CAT. Conclusiones: Predominan los accidentes con material biológico en médicas y en formas de exposición mucosa y percutánea. Son necesarias inversiones en medidas de bioseguridad y educación permanente para prevenir casos e incentivar su notificación.

Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Empatia (parte I): contribuições para a abordagem centrada na pessoa / Empathy (part I): contributions to a person-centered approach / Empatía (parte I): contribuciones a un enfoque centrado en la persona

Introdução: Este artigo explora o tema da empatia na relação médico-paciente. Objetivo: Contribuir para o aperfeiçoamento das habilidades de comunicação clínica ao revisar o entendimento e a aplicação da empatia na prática clínica. Métodos: Trata-se de uma revisão não sistemática dos principais livros utilizados na comunicação clínica sobre o tema da empatia. O recorte metodológico compreendeu as seguintes etapas: (1) amostra intencional da literatura; (2) coleta e leitura de dados ­ i.e., extração de fragmentos dos textos; (3) análise do conteúdo, com o foco na definição, importância e instrumentalização para a aplicação prática; (4) seleção e síntese, para facilitar a compreensão e a contextualização sobre o tema; e (5) comparação e ponderação do conteúdo selecionado. Resultados: A abrangência com que a empatia foi trabalhada na literatura selecionada resultou em três níveis de densidade empática: baixa, moderada e alta. Assim, a baixa densidade empática limitou-se mais à definição e importância do tema; a densidade moderada incorporou algum exemplo de como aplicar a empatia, porém de forma fragmentada; e a alta densidade empática abordou o tema de modo mais completo, facilitando a instrumentalização na prática clínica. Há concordância na literatura analisada de que a prática da empatia reflete-se na melhoria do cuidado médico, entretanto seu exercício permanece no campo racional. Ao exemplificar a aplicação prática da empatia, os autores sugerem que o médico adote uma postura isenta de julgamentos, ao mesmo tempo que propõem um exercício imaginativo, de adivinhação dos sentimentos/emoções do paciente. Apesar de os autores de alta densidade empática compreenderem a importância das emoções e nomeá-las no processo, percebe-se a necessidade de um desdobramento e aprofundamento a partir desse ponto. Conclusões: Por se tratar de um assunto complexo, com vários matizes, a empatia é abordada de diferentes formas na literatura selecionada. Isso evidencia sua riqueza e originalidade, ao mesmo tempo que apresenta lacunas para sua aplicação na prática clínica.

Introduction: This article explores the theme of empathy in the doctor-patient relationship. Objective: To contribute to the improvement of clinical communication skills by reviewing the understanding and application of empathy in clinical practice. Methods: A non-systematic review of the main books used in clinical communication on the topic of empathy. The methodological approach consisted in the following steps: (1) An intentional sample of the literature; (2) Data collection and reading, i.e., extracting fragments from texts; (3) Content analysis, focusing on definition, importance and instrumentalization for practical application; (4) Selection and synthesis to facilitate understanding and contextualization on the topic; and (5) Comparison and ponderance of the selected content. Results: The scope within which empathy was worked on in the selected literature resulted in three levels of empathic density: low, moderate, and high. Thus, low empathic density was limited to definition and importance; moderate density incorporated some examples of how to apply empathy in a fragmented way; high empathic density addressed the topic more fully, facilitating instrumentation in clinical practice. There is agreement in the literature analyzed that the practice of empathy reflects on the improvement of medical care. However, its exercise remains in the rational field. By exemplifying the practical application of empathy, the authors suggest that the physician adopt a non-judgmental posture, while proposing an imaginative exercise of guessing the patient's feelings/emotions. Although high-density empathy authors understand the importance of emotions and name them in the process, there is a need for an unfolding and deepening from this point on. Conclusions: Empathy is a complex subject with several nuances and is approached in different ways in the selected literature. This evidences its richness and originality, at the same time that it presents gaps for the application of empathy in clinical practice.

Introducción: Este artículo explora el tema de la empatía en la relación médico-paciente. Objetivo: contribuir a la mejora de las habilidades de comunicación clínica mediante la revisión de la comprensión y aplicación de la empatía en la práctica clínica. Método: se trata de una revisión no sistemática de los principales libros utilizados en comunicación clínica sobre el tema de la empatía. El enfoque metodológico comprendió los siguientes pasos: (1) Una muestra intencional de la literatura; (2) Recopilación y lectura de datos, es decir, extracción de fragmentos de textos; (3) Análisis de contenido, centrándose en definición, importancia e instrumentalización para la aplicación práctica; (4) Selección y síntesis para facilitar la comprensión y contextualización sobre el tema; y (5) Comparación y ponderación del contenido seleccionado. Resultados: el alcance con el que se trabajó la empatía en la literatura seleccionada tuvo como resultado tres niveles de densidad empática: baja, moderada y alta. Así, la baja densidad empática se limitaba más a la definición y la importancia; densidad moderada, incorporó algún ejemplo de cómo aplicar la empatía, pero de manera fragmentada; alta densidad empática se acercó del tema de manera más completa, facilitando la instrumentación en la práctica clínica. Existe acuerdo en la literatura analizada en que la práctica de la empatía se refleja en la mejora de la atención médica. Sin embargo, su ejercicio queda en el campo racional. Al ejemplificar la aplicación práctica de la empatía, los autores sugieren que el médico adopte una postura no crítica, al tiempo que propone un ejercicio imaginativo de adivinar los sentimientos/emociones del paciente. Si bien los autores de alta densidad empática entienden la importancia de las emociones y las nombran en el proceso, existe la necesidad de un desdoblamiento y profundización a partir de este punto. Conclusiones: Por tratarse de un tema complejo y con varios matices, la empatía es abordada de diferentes maneras en la literatura seleccionada. Esto evidencia su riqueza y originalidad, al mismo tiempo que presenta vacíos para la aplicación de la empatía en la práctica clínica.

Grupo de mulheres: o desenvolvimento de habilidades de facilitação e a geração de uma dinâmica de grupo promotora de saúde / Women's support group: the development of facilitation skills and the generation of a health-promoting group dynamic / Grupo de mujeres: el desarrollo de habilidades de facilitación y la generación de una dinámica grupal promotora de salud

Introdução: A realização de grupos é uma das possibilidades de atuação das equipes da Atenção Primária à Saúde. Esse tipo de intervenção possibilita o desenvolvimento de ações de cuidado que extrapolam as consultas individuais, propiciando educação em saúde, integração, troca de experiências e ampliação da rede de apoio. Ainda que não tenham necessariamente o propósito de serem terapêuticos em termos de saúde mental, apresentam-se como espaços de promoção de saúde e prevenção de agravos. O trabalho com grupos é capaz de gerar aprimoramento para todas as pessoas envolvidas ­ usuários e profissionais ­ na medida em que possibilita colocar em evidência os saberes da comunidade, abrindo a possibilidade de que as intervenções em saúde sejam criadas em coletivo. Objetivo: Analisar o processo de desenvolvimento da habilidade de facilitação de grupos e os impactos das habilidades adquiridas na sua dinâmica, bem como na sua efetividade como ferramenta de produção de saúde, considerando as habilidades e competências da Medicina de Família e Comunidade. Métodos: Trata-se de pesquisa qualitativa desenvolvida na UBS Santa Cecília. Os encontros aconteceram semanalmente pelo período de uma hora durante seis meses. A ferramenta utilizada para acompanhamento do desenvolvimento da habilidade de facilitação se deu pela observação estruturada, baseada em cinco competências básicas para facilitação de grupos. A dinâmica estabelecida consistiu na determinação de uma profissional facilitadora e outra observadora, que registrou as intervenções realizadas, sendo esses papéis invertidos a cada encontro. Quinzenalmente os dados eram analisados, gerando reflexões e sugestões para melhoria das intervenções. Resultados: Cada competência descrita na ferramenta utilizada teve como resultado o desenvolvimento de habilidades primordiais para o funcionamento do grupo. Um dos maiores indicadores do êxito em alcançar as habilidades desejadas ocorreu pela observação de intervenções cada vez menos necessárias, tomando as participantes os papéis de protagonistas e responsáveis pelo desenvolvimento do grupo, questionando, produzindo e obtendo saúde. Conclusões: A utilização de um instrumento de observação e reflexão das competências do agente atuante como facilitador de um grupo permitiu que a dinâmica se estabelecesse de forma fluida com rápido entendimento das participantes sobre seus papéis no contexto geral do grupo. Observou-se também que a relação estabelecida entre elas resultou na formação de rede de apoio, melhoria do autocuidado e conhecimento, informação em saúde e apoio social às envolvidas.

Introduction: Running support groups is one of the actions of Primary Health Care teams. This type of intervention enables the development of actions that go beyond individual consultations as the only space of care, providing health education, integration, exchange of experiences, and an enlargement in the support network. Although these groups do not necessarily have the purpose of being therapeutic in terms of mental health, they are presented as spaces for building health promotion and disease prevention. The alternative of groups as care practice generates improvement for all involved individuals ­ users and professionals ­ as it makes it possible to highlight the community's knowledge, opening the possibility that health interventions are created collectively. Objective: To analyze the process of ability development in regards to the facilitation of support groups and the impacts of the acquired skills on its dynamics, as well as on its effectiveness as a health production tool, considering the skills and competencies in Family and Community Medicine. Methods: Qualitative study developed at Santa Cecilia BHU. The meetings took place for one hour weekly over a six months period and the tool used to monitor the development of the facilitation skill was the instrument "Structured Observation", based on five basic skills for facilitating groups. The dynamics consisted of the determination of a professional facilitator and an observer, who recorded the interventions that were carried out, with these roles being reversed at each meeting. The data were analyzed bi-weekly, with reflections and suggestions for improving interventions. Results: Each competence described in the tool resulted in the development of essential skills for the functioning of the group. One of the major indicators of the achievement of the desired skills occurred by observing interventions that were less and less necessary, with participants taking on the roles of protagonists and becoming responsible for the development of the group, questioning, producing, and acquiring health. Conclusions: The use of an instrument for observing and reflecting on the skills of the agent acting as a group facilitator allows the dynamics to be fluidly established, with a quick understanding of the participants about their roles in the general context of the group. It was also observed that the relationship established between them resulted in the formation of a support network, improvement of self-care and knowledge, health information and social support for those involved.

Introducción: La realización de grupos es una de las acciones de los equipos de la Atención Primaria a la Salud. Este tipo de intervención hace posible el desarrollo de acciones que extrapolan las consultas individuales como único espacio de cuidado, ofreciendo educación en salud, integración, intercambio de experiencias y ampliación de la red de apoyo. Aunque estos grupos no tengan necesariamente el propósito de ser terapéutico en términos de salud mental, se presentan como sitios de construcción de promoción de salud y prevención de agravios. La alternativa de los grupos como una práctica asistencial crea una mejora para todas las personas involucradas ­ usuarios y profesionales ­ ya que habilita colocar en evidencia los saberes de la comunidad, abriendo la posibilidad de que las intervenciones en salud sean creadas en colectivo. Objetivo: Analizar el proceso de desarrollo de la habilidad de facilitación de grupos y los impactos de las habilidades adquiridas en la dinámica de este, así como en la efectividad como herramienta de producción de salud, considerando las habilidades y competencias de la Medicina de Familia y Comunidad. Métodos: Se trata de estudio cualitativo llevado a cabo en la UBS Santa Cecília. Los encuentros ocurrieron semanalmente durante una hora por seis meses y la herramienta utilizada para seguimiento del desarrollo de la habilidad de facilitación fue el instrumento Observación Estructurada, basado en cinco competencias básicas para facilitación de grupos. La dinámica establecida consistió en la determinación de una profesional facilitadora y otra observadora, que registró las intervenciones realizadas, siendo esos papeles cambiados a cada encuentro. A cada quince días los datos eran analizados, haciendo reflexiones y sugestiones para mejorar las intervenciones. Resultados: Cada competencia descrita en la herramienta utilizada tuvo como resultado el desarrollo de habilidades primordiales para el funcionamiento del grupo. Uno de los grandes indicadores del éxito en alcanzar las habilidades deseadas ocurrió por la observación de intervenciones cada vez menos necesarias, tomando las participantes los papeles de protagonistas y responsables por el desarrollo del grupo, cuestionando, produciendo y obteniendo salud. Conclusiones: La utilización de un instrumento de observación y reflexión de las competencias del agente actuante como facilitador de un grupo permiten que la dinámica se establezca de forma fluida con rápido entendimiento de las participantes sobre sus papeles en el contexto general del grupo. Se pudo observar también que la relación establecida entre ellas resultó en la formación de red de apoyo, mejora del autocuidado y conocimiento, información en salud y apoyo social a las involucradas.

La aplicación del saber médico. Hipertensión y daño cognitivo

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Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

A perceção de líderes formais de enfermagem sobre a prática baseada na evidência / Formal nurse leaders' perception of evidence-based practice / La percepción de los líderes formales de enfermería sobre la práctica basada en la evidencia

Resumo Enquadramento: A implementação da Prática Baseada na Evidência (PBE) é crucial para a qualidade dos cuidados de enfermagem. As ações desenvolvidas pelos líderes formais são essenciais para implementar a PBE, tornando-se determinante conhecer as suas perceções. Objetivo: Conhecer as perceções de líderes formais de enfermagem sobre a PBE. Metodologia: Estudo descritivo exploratório com abordagem qualitativa. Foram realizadas entrevistas semiestruturadas a 17 líderes de três hospitais portugueses. Os dados foram analisados através de análise de conteúdo e do software MAXQDA Analytics Pro 2022. Salvaguardados os pressupostos éticos. Resultados: Emergiram dois temas com respetivas categorias − Conhecimento sobre PBE (Conceito de PBE, Impacto da PBE nos resultados em saúde e Autoperceção do conhecimento sobre PBE); Papel na implementação da PBE (comportamentos e caraterísticas). Conclusão: Os líderes descreveram a sua perceção sobre o Conceito de PBE e a relação do Impacto da PBE com resultados em saúde, a necessidade de conhecimento e o seu investimento formativo, bem como o seu papel neste processo. Futuros programas formativos deverão ser implementados nesta área.

Abstract Background: The implementation of Evidence-Based Practice (EBP) is critical to the quality of nursing care. Formal leaders play a crucial role in developing interventions to implement EBP, so it is important to understand their perceptions. Objective: To examine formal nurse leaders' perceptions of EBP. Methodology: Descriptive exploratory study with a qualitative approach. Semi-structured interviews were conducted with 17 leaders from three Portuguese hospitals. Data were analyzed using content analysis and MAXQDA Analytics Pro 2022 software. All ethical principles were observed. Results: Two themes and their categories emerged − Knowledge of EBP (Concept of EBP, Impact of EBP on health outcomes, and Self-perception of the knowledge about EBP) and Role in EBP implementation (behaviors and characteristics). Conclusion: The leaders described their perception of the concept of EBP and the association between the impact of EBP and health outcomes, the need for knowledge, and the investment in training, as well as their role in this process. Future training programs should be implemented in this area.

Resumen Marco contextual: La implantación de la Práctica Basada en la Evidencia (PBE) es esencial para la calidad de los cuidados de enfermería. Las acciones emprendidas por los líderes formales son esenciales para implantar la PBE, y es fundamental conocer sus percepciones. Objetivo: Conocer las percepciones de los líderes formales de enfermería sobre la PBE. Metodología: Estudio exploratorio descriptivo con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 17 líderes de tres hospitales portugueses. Los datos se analizaron mediante análisis de contenido y el programa MAXQDA Analytic Pro 2022. Se garantizaron los presupuestos éticos. Resultados: Surgieron dos temas con sus respectivas categorías − Conocimiento sobre la PBE (Concepto de la PBE, Impacto de la PBE en los resultados sanitarios y Autopercepción del conocimiento sobre la PBE); Papel en la aplicación de la PBE (comportamientos y características). Conclusión: Los líderes describieron su percepción del concepto de PBE y la relación del Impacto de la PBE con los resultados sanitarios, la necesidad de conocimientos y su inversión formativa, así como su papel en este proceso. Los futuros programas de formación deberían aplicarse en este ámbito.

Repairing with a warm heart: How medical practitioners cultivate affective relationships with clients.

Healthcare providers are often advised to manage emotions to adhere to professional feeling rules and avoid deep affection for clients, but there are situations where this would not apply. We offer an atypical case of a cleft lip and palate (CLP) treatment program where affectionate medical provider-patient relationships are encouraged. Participant observation in a CLP department, in-depth interviews with the medical team, and public online content from the official WeChat account of the department showed that a meaningful bond was formed through a contextual concordance of moral consideration and professionalism across the organization. Medical practitioners have developed and justified such emotional work at the individual, professional, and organizational levels through three concordant micro-processes: developing the moral deservingness of the patient, instilling moral fulfillment into professionalism, and establishing moral consensus among medical professionals. This study enhances our current understanding of emotional work in healthcare by recognizing the moral consideration of patients and its influence on medical practices and by highlighting the complexities and dynamics of different feeling rules.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: Geriatric neurology in practice.

BACKGROUND: Older adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. OBJECTIVE: To design and implement a geriatric multidisciplinary clinic for older adults with MS. METHODS: We describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. RESULTS: The team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 92% felt they benefitted from attending. Additionally, 80% of participants reported that the clinic improved their overall quality of care. CONCLUSION: The Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Selective Outcome Reporting among Randomized Controlled Trials Published in Leading Dental Journals: A Research-on-Research Study.

OBJECTIVES: To study the prevalence and manifestation of selective outcome reporting (SOR) among randomized controlled trials (RCTs) published in leading dental journals, and to explore the association between SOR and potentially related factors. METHODS: We hand-searched RCTs published in the leading dental journals between 2018 and 2023. RCTs with registrations and defined primary outcomes were included, and their relevant characteristics were extracted for analysis. Discrepancies between publication and corresponding registration were compared regarding primary outcome and other study characteristics. The generalized estimating equation model was applied to identify factors associated with SOR. RESULTS: Two hundred and seventy trials were included. SOR was identified in 51.5% (n = 139) of the included RCTs with the discrepancy in the assessment timing of the primary outcome as the most common manifestation (n = 86, 31.9%). Substantial discrepancies were observed regarding sample size (n = 148, 54.8%) and source of funding (n = 105, 38.9%). Sample size [odds ratio (OR) 0.61, 95% confidence interval (CI) 0.40 to 0.92], timing of registration (OR 2.10, 95% CI 1.03 to 4.31), and discrepancy in follow-up length (OR 32.01, 95% CI 11.80 to 86.83) were identified as statistically significant factors associated with SOR. CONCLUSIONS: SOR was prevalent among RCTs in leading dental journals. Researchers and other stakeholders should be aware of this reporting issue and make joint efforts to improve the outcome reporting quality. CLINICAL SIGNIFICANCE: The findings of this research-on-research study indicate a substantial presence of SOR in the field of dentistry. Such bias can potentially mislead readers and distort the pooled effect estimates in evidence synthesis, ultimately influencing clinical decision-making.

Consequences of career progression barriers experienced by doctors in GP training: an interpretative phenomenological study.

BACKGROUND: Despite commitment across national medical education and training bodies to tackle differential attainment (DA), alongside a wealth of research into contributing factors and solutions, progression in narrowing the gap has lagged. This study explores the lived experiences of doctors facing DA, career progression barriers and their wider consequences. METHODS: Interpretative phenomenological analysis was chosen as the methodological framework. The six doctors interviewed were released from General Practice training before enrolling in a 'targeted' intervention scheme designed to support them with training completion. RESULTS: The cohort included four international medical graduates and two graduates from the United Kingdom. Three participants were neurodiverse. Three inter-related themes were identified. 1) 'Career insecurity' is defined as uncertainty about career prospects and attainment of career goals. At varying points along their journey navigating through progression barriers, participants frequently questioned their futures and the decision to persist in the arduous pursuit of training completion. 2) 'Psychological injury' featured prominently in the experiences of the 'targeted trainees'. Feelings of worthlessness, helplessness, low energy and mood, and 'traumatic' experiences were described. 3) 'Social injury' illustrates consequences to doctors' familial and social contexts (including relationships), as well as wider societal consequences (such as attrition). CONCLUSION: Our research evidences the consequences of DA and career progression barriers. We highlight the urgent need for escalated efforts in addressing the challenges faced by different groups of doctors and narrowing the attainment gap. Recommendations for interventions are included in our study.

Postnatal care after gestational diabetes - a systematic review of clinical practice guidelines.

BACKGROUND: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research. METHODS: We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool. RESULTS: Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care. CONCLUSIONS: Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health. PROTOCOL REGISTRATION: This review was registered in PROSEPRO (CRD42023454900).

Knowledge, attitude, and practices towards hepatitis infection and its associated factors among adults in Gondar town, northwest Ethiopia; a community-based study, 2021.

BACKGROUND: Hepatitis virus infection remains a serious public health concern worldwide. Percutaneous, mucosal, or non-intact skin exposure to infectious blood, semen, and other body fluids are the major routes of infection in endemic areas, including Ethiopia, where little is known about the community's knowledge, attitudes, and practice toward hepatitis infection. Thus, this study aimed to determine the knowledge, attitude, and practices towards hepatitis infection among adults in Gondar town. METHODS: A community-based cross-sectional study was conducted from July to August 2021 on a total of 390 participants. Proportional sample allocation was used in 3 randomly selected sub-cities. Then, study participants from randomly selected households were recruited by using a systematic random sampling technique. Socio-demographic data and questions regarding KAP were collected via a self-administered and interviewer-administered questionnaire. Statistical analysis was performed using SPSS version 20. Logistic regression analyses were used to identify the associated factors and a p-value < 0.05 was considered statistically significant. RESULTS: The mean age of the study participants was 30 ± 8.43 years and more than half ½ (53.3%) ranged from 26 to 40 years old. In this study, 335 (85.9%) of study participants had poor knowledge about hepatitis infection. About 344 (88.2%) had a negative attitude toward hepatitis infections, and 344 (88.2%) of the participants had a poor practice to prevent hepatitis infections. Multivariate analysis affirmed that having vaccination for hepatitis infection was significantly associated with a positive attitude (AOR, with 95% CI: 2.135 (1.006-4.532) and good practice levels (AOR, with 95% CI: 22.623 (0.032-0.156). CONCLUSIONS AND RECOMMENDATIONS: In this study majority of the participants have poor knowledge, attitudes, and practices toward hepatitis infection. Therefore, targeted community-based interventions are necessary. However, this study revealed that having vaccination for hepatitis infection was significantly associated with a positive attitude and good practice levels among the study participants.

A survey on management practices of hypotension in preterm neonates: an Indian perspective.

Background: Hypotension is a common entity in the neonatal intensive care unit (NICU) and is reported in 24%-50% of preterm infants with birth weight less than 1,500 g. Rapid diagnosis and aggressive management is crucial to reduce its detrimental effects on end-organs especially the brain. Physicians often rely on blood pressure alone as a reliable indicator of tissue perfusion, but variations exist in the definition of this crucial parameter. There are also practice variations in the use of diagnostic tools and management modalities among physicians. Methodology: A physician-based cross-sectional survey of management practices of hypotension in preterm neonates in Indian NICUs was conducted using an online survey tool. The questionnaire addressed diagnostic criteria used, utility of echocardiography for the assessment of hypotension, and management strategies used, such as volume expansion, inotropes and steroids. Results: Three hundred and twenty physicians, working predominantly in Level III NICUs, responded to the survey. The practice of delayed cord clamping was followed in the units of 78% respondents. Only 44% respondents had an institutional written protocol for the management of hypotension. The criteria for the diagnosis of hypotension varied, with 52% using mean blood pressure (BP) less than gestational age as the criteria. Capillary refill time, blood pressure and heart rate were the most common clinical criteria used. 85% respondents used echocardiography in the NICU, but only 73% utilised it for assessment of a hypotensive neonate. Physicians preferred a 'volume-inotrope-echo-steroid' strategy, with 85% respondents using volume expansion. Dopamine was the preferred first line inotrope, followed by norepinephrine and low-dose epinephrine. Conclusion: This survey reflects significant variations in practice amongst neonatal physicians in India. Bedside targeted echocardiography needs to be better utilised as a vital tool to determine the pathophysiology of disease and hemodynamic monitoring in the management of hypotension in neonates. While further research is needed on outcome-oriented objectives, awareness and dissemination of already existing guidelines would be useful to standardize clinical practice.

Actual clinical practice pattern in SWL after COVID-19 era: a critical evaluation from different aspects.

To outline the current status of Shock Wave Lithotripsy (SWL) in stone treatment and the changes in the mode of application after the COVID-19 pandemic along with critical factors affecting the clinical practice of this particular procedure. This study targeted national and international urology experts who could share and contribute their experiences and perspectives on SWL practices after COVID-19 era. Approximately 650 urology specialists were invited to participate in the survey based study via Google Forms. Participation was voluntary and 398 of the invited participants completed the survey, yielding an acceptable response rate of approximately 61.23%. This survey highlights significant findings that shed light on the changes in clinical SWL applications. Nearly half of SWL procedures are performed by technicians or nurses instead of experienced urologists, potentially affecting the proper application and outcomes of the procedure. SWL seemed to be applied on a guideline (GL) indications based manner by the majority of the participants. Fluoroscopy remains still as the most commonly used method for radiological assessment, underscoring the necessity to teach sonography applications to younger urologists. Key reasons for the limited clinical application of SWL include the absence of lithotripters in the departments, high lithotriptor costs and significantly lower reimbursement rates compared to PNL and fURS modalities. Finally, an increase in SWL utilization rates has been observed post-COVID-19, highlighting its certain advantages realized during this period. These findings provide important insights into the role of SWL in stone treatment and the main factors influencing its clinical application practices. Although the popularity of SWL in the management of urinary stones is being stated to decline particularly in the last two decades, data obtained in this survey emphasized well that it is still a viable option especially for stones smaller than 15 mm. Our findings highlight the enduring relevance of SWL in contemporary stone therapy protocols in the context of COVID-19, where outpatient, non-invasive procedures are preferred. In addition to the consideration of certain factors affecting the rate of its application in clinical practice, to achieve high success rates with minimal complications in SWL, strategic patient selection and adherence to procedure guidelines seem to be crucial.

Adult-supervised practice in learner's permit phase has a significant but limited ability to improve safe driving skills.

OBJECTIVES: Most U.S. states require adult-supervised practice for adolescent learner permit holders intending to obtain a driver's license before 18. However, the effectiveness of adult-supervised practice in imparting safe driving skills had been inconclusive prior to the recent development of consistent measures of adolescent learners' driving performance. We examined the relationship between the number of adult-supervised practice hours and driving performance and skill deficits for 441 learner permit holders ages 16 and 17 in Pennsylvania. METHODS: Data came from a virtual driving assessment (VDA) deployed across Children's Hospital of Philadelphia's Primary Care Network and a self-reported survey at the time of the VDA. Based on a previous study, we defined two VDA Driving Classes that describe driving performance: Major Issues or Major Issues with Dangerous Behavior Class, and Minor Issues or No Issues Class. The response options for adult-supervised practice hours were presented to adolescents as categories (none, <15 h, 15-<65 h, 65 h, and >65 h). We grouped those with 65 h with those with >65 h given the low numbers of responses in these categories. The analysis used a Chi-square test and a binomial logit to investigate how adult-supervised practice hours correspond to adolescents' VDA Driving Classes. RESULTS: Chi-square test showed weak associations between VDA Driving Classes and adult-supervised practice hours. The binomial logit found that adolescents who reported zero adult-supervised practice hours were more likely to be classified into the Major Issues or Major Issues with Dangerous Behavior Class than those who reported adult-supervised practice hours. For those who reported adult-supervised practice, the differences in VDA Driving Class were not statistically significant across the three practice categories (i.e., <15 h, 15-<65 h, and ≥65 h). The model found no significant associations between VDA Driving Class and whether adolescent learners reported practicing with a formal instructor. CONCLUSIONS: Our findings suggest that under current adult-supervised practice routines, longer practice hours have limited associations with improvements in adolescents' VDA Driving Class. Some adolescents might not be ready to deal with the more dangerous settings the VDA presents even after completing the required hours of adult-supervised practice.

A cross-sectional study of evidence-based practice and its determinants among healthcare professionals in Northwest Ethiopia.

Background: Evidence-based practice (EBP) is the integration of current best evidence with clinical expertise by considering patient preferences and values. Evidence based practice has not been well studied in Ethiopia. Therefore, this study aimed to assess EBP and its determinants among health professionals working at primary public hospitals in the Central Gondar zone, Northwest Ethiopia. Methods: A facility-based cross-sectional study was conducted on 422 health professionals. A simple random sampling technique was used to select the study participants. The data were entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. The descriptive, bivariable, and multivariable logistic regression analysis were conducted. Adjusted Odds Ratio (AOR) with 95% confidence intervals and p-value <0.05 were used to assess association of explanatory variables with EBP and declare statistical significance, respectively. Result: About 44.1% (95%CI: 39, 50%) of healthcare professionals had good evidence-based practice. Educational status (AOR: 3.05, CI: 1.07-8.66), spare time (AOR: 1.90, CI: 1.09, 3.31), good knowledge (AOR: 7.95, CI: 4.83, 13.08), good skill (AOR: 2.39: CI: 1.27, 4.53), training (AOR: 2.13, CI: 1.26, 3.58), and internet access (AOR = 2.02: 95% CI: 1.25-3.27) were found to be significant predictors of evidence-based practice. Conclusion: This study revealed that EBP was low compared to national standards. Moreover, having good knowledge and skill about evidence-based practice, being trained, having spare time and internet access and upgrading educational status of health care professionals would enhance good evidence-based practice.

Drought and rewatering practices improve adaptability of seedling maize to drought stress by a super-compensate effect.

Periodic drought adversely affects the growth and yield of summer crops in the Huang-Huai-Hai Plain. Drought-rewatering practice as one of the important agronomic measures to improve crop drought resistance. A field experiment was conducted to investigate practice physiological, biochemical, and molecular responses of maize seedling after two rounds of repeated drought and rewatering treatments. The results demonstrated that rewatering following repeated drought events had a compensatory effect on the photosynthetic rate (Pn) and on osmotic and antioxidant regulation. Specifically, the Pn and stomatal conductance (Gs) increased by 10.12 % and 5.61 %, respectively, compared to the control (CK) during the second round of treatment. Additionally, soluble protein (sPro) and proline (Pro) content rose significantly, with increases of 26.12 % and 343.49 % observed on day 5 of the second round, leading to a gradual reduction in leaf water content and osmosis. Following drought exposure, the activities of superoxide dismutase (SOD) and peroxidase (POD) contributed to the decreased levels of malondialdehyde (MDA), with both enzymes recovering during rewatering. In contrast, plant height, leaf area, and biomass were significantly reduced in the CK group. Notably, root length increased by 21.05 % after the drought-rewatering practice, enhancing the maize seedlings' ability to adapt to drought stress. Overall, maize seedlings exhibited enhanced adaptability to drought conditions following two cycles of drought-rewatering treatments.

Digital fist bumps: searching for datafication and digitalisation in everyday CrossFit coaching practice.

The research presented here explores the nuances of data collection and sharing via digital platforms in everyday CrossFit coaching practice. There is a growing body of work on data and digital platforms in CrossFit, though currently there is a lack of understanding of the role of coaches in these processes. Empirically grounding the digital fitness practices of CrossFit coaching is essential for our understanding of the sport, as well as to critically engage with the dominant socio-technical narratives of the digital fitness revolution: narratives that obscure the agency of coaches. This research foregrounds the coaches' agency and lived experiences, focusing on their everyday coaching practices around data and digital platforms. Six semi-structured in-depth interviews with CrossFit coaches in Sweden were undertaken in 2023. These focused on if, when, how and why they collect, or encourage their participants to collect, data on their training and share this via digital platforms. The findings reveal several different, though interrelated, areas where the CrossFit coaches can be seen as mediating between often competing narratives around data and digital platforms. These everyday practices include mediating between group vs. individual training, data collection and sharing vs. "moving well", CrossFit's methodology of quantification of fitness vs. the needs of the participants and navigating the techno-solutionist vs. reductionist narratives around digital fitness tracking.