Community engagement and power dynamics in conservation philanthropy grant making.

Funding decisions influence where, how, and by whom conservation is pursued globally. In the context of growing calls for more participatory, Indigenous-led, and socially just conservation, we undertook the first empirical investigation of how philanthropic foundations working in marine conservation globally engage communities in grant-making decisions. We paid particular attention to whether and how community engagement practices reinforce or disrupt existing power dynamics. We conducted semistructured remote interviews with 46 individuals from 32 marine conservation foundations to identify how conservation foundations engage communities in setting their priorities and deciding which organizations and projects to fund. We found that community engagement in foundation decision-making was limited in practice. Eleven of the 32 foundations reported some form of community engagement in funding decisions. Two of these foundations empowered communities to shape funding priorities and projects through strong forms of engagement. Many engagement practices were one way, one time, or indirect and confined to certain points in decision-making processes. These weaker practices limited community input and reinforced unequal power relations, which may undermine the legitimacy, equity, and effectiveness of conservation efforts. We suggest that foundations aim for stronger forms of community engagement and reflect on how their grant-making practices affect power relations between foundations and communities.

Participación comunitaria y dinámicas de poder en la concesión de subsidios para la filantropía de la conservación Resumen Realizamos la primera investigación empírica sobre la forma en que las fundaciones filantrópicas que trabajan con la conservación marina a nivel mundial involucran a las comunidades en las decisiones para la concesión de subsidios. Prestamos especial atención a cómo y si las prácticas de participación ciudadana refuerzan o interrumpen las dinámicas de poder existentes. Entrevistamos de forma remota a 46 individuos de 32 fundaciones de conservación marina para identificar cómo las fundaciones de conservación involucran a las comunidades para establecer sus prioridades y decidir cuáles organizaciones y proyectos financiar. Encontramos que la participación comunitaria en las decisiones de financiamiento estaba limitada en la práctica. Once de las 32 fundaciones reportaron algún tipo de participación ciudadana en sus decisiones de financiamiento. Dos de estas fundaciones empoderaron a las comunidades para que formaran las prioridades de financiamiento y a los proyectos por medio de una participación sólida. Muchas de las prácticas de participación eran de una manera, de una vez o indirectas y confinadas a ciertos puntos en el proceso de decisión. Estas prácticas más débiles limitaron la aportación comunitaria y reforzaron las relaciones desiguales de poder, lo que puede debilitar la legitimidad, equidad y eficiencia de los esfuerzos de conservación. Sugerimos que las fundaciones busquen maneras más sólidas de involucrar a la comunidad y reflexionen sobre el efecto de sus prácticas de concesión de subsidios sobre las relaciones de poder entre las fundaciones y las comunidades.

Design and management considerations for the Kenya-Tanzania marine transboundary conservation area.

Although transboundary conservation areas (TCAs) are critical tools for protecting ecosystems and ecological processes that transcend national jurisdictions, they are challenging to create due to the differences in governance contexts and capacity and power dynamics among countries. Marine TCAs are also more difficult to enforce relative to terrestrial TCAs because most nations still treat oceans as open access. Current guidelines for TCA development and implementation also focus mostly on terrestrial TCAs, which are not practical for marine TCAs. Hence, we reviewed the challenges associated with the design and management of marine TCAs and devised analytical and practical approaches to support the application of spatial planning frameworks and adaptive governance mechanisms. We used the lessons from the review to examine the decisions made for the proposed marine TCA in the Kenya-Tanzania border region and created options and considerations to promote effective design and management processes. We found the obstacles to marine TCAs in general are related to issues of fit, particularly differences in environmental research capacity, socioeconomic contexts, and internal institutional arrangements. These included differences in knowledge and capacity for marine ecological research and conservation; ability to adjust and update data; differences in values, interests, and resource uses; conservation costs; jurisdictional differences; engagement of multiple levels of organization; and differences in legal bases and policy development processes. Understanding and reconciling these challenges during the TCA development process can help enhance meaningful discussions in the design of the TCA and cultivate the enabling conditions for collaborative governance across countries and within different levels of organization from national to local actors.

Consideraciones en el diseño y gestión del área marina de conservación transfronteriza en Kenia y Tanzania Resumen Aunque las áreas de conservación transfronterizas (ACT) son herramientas importantes para proteger los ecosistemas y los procesos ecológicos que trascienden la jurisdicción nacional, crearlas es un reto debido a la diferencia en los contextos de gobierno y la capacidad y las dinámicas de poder entre los países. Las ACT marinas también son más difíciles de ejecutar en relación a las terrestres porque la mayoría de los países todavía tratan al océano como de libre acceso. Los lineamientos actuales para el desarrollo e implementación de las ACT también se enfocan principalmente en las ACT terrestres, lo cual no es práctico para las ACT marinas. Por lo tanto, revisamos los retos asociados con el diseño y gestión de las ACT marinas y concebimos estrategias analíticas y prácticas para apoyar con la aplicación de los marcos de planeación espacial y los mecanismos de gobierno adaptativo. Usamos lo aprendido con la revisión para analizar las decisiones tomadas para la ACT marina propuesta en la región fronteriza de Kenia y Tanzania y creamos opciones y consideraciones para promover el diseño y procesos de manejo efectivos. Encontramos que los obstáculos para las ACT marinas en general se relacionan con temas de ajuste, en particular las diferencias en la capacidad de investigación ambiental, los contextos socioeconómicos y los acuerdos institucionales internos. Estos obstáculos incluyeron diferencias en el conocimiento y capacidad para la investigación ecológica marina; la habilidad para ajustar y actualizar datos; las diferencias en los valores, intereses y usos de los recursos; los costos de conservación; las diferencias jurídicas; la participación de varios niveles de organización; y las diferencias en las bases legales y los procesos de desarrollo de políticas. El entendimiento y reconciliación de estos retos durante el proceso de desarrollo de una ACT puede ayudar a mejorar las discusiones significativas en el diseño de la ACT y a cultivar las condiciones que permitan la gestión colaborativa entre los países y entre los diferentes niveles de organización, desde el nacional hasta los actores locales.

Stimulating the capacity to govern the commons.

The ability to strengthen governance institutions and fisheries restrictions and laws is needed to improve conservation and management of common-pool resources. We evaluated the potential for stimulating change with modest interventions by studying fishing village households before and after a 27-month intervention period in a high-priority coral reef conservation area. Interventions included training in catch monitoring, stock assessment, mapping fishing grounds, microcredit, gender inclusion, theatrical skills, fuel efficient stoves, and participation in the planning of a conservation proposal. There was a background increase in reported formal education, household size, group membership, and household wealth but a decrease in fish consumption and public services. Of conservation importance, the perceived strength of 13 governance institutions and benefits of 6 fisheries restrictions increased over the intervention period. Finally, correspondence between knowledge of and agreement with recent national fisheries laws was moderate to high and positively correlated. The intervention period was stronger than demographic factors that often influence perceptions, such as village, government services, gender, household size, membership in community groups, and age responses. In general, perceptions of strengths of governance and benefits of restrictions increased more among women and youth than adult men respondents. The largest changes in perceptions of increased benefits were among strict restrictions initially ranked low, specifically fisheries closures, parks, and species restrictions. Consequently, capacity building overrode demographic factors common to poor people with limited employment capacity that can have negative perceptions of strict conservation.

Variabilidad demográfica y escalas de aceptación y rechazo sobre las restricciones en el manejo de recursos Resumen Se necesita de la capacidad para fortalecer a las instituciones de gobierno y las leyes y restricciones a la pesca para mejorar la conservación y manejo de los recursos comunes. Evaluamos el potencial para estimular el cambio con intervenciones modestas con un estudio en los hogares de una aldea pesquera antes y después de un periodo de intervención de 27 meses en un área de conservación de gran prioridad para un arrecife de coral. Las intervenciones incluyeron formación en el monitoreo de las capturas, análisis de stock, mapeo de las zonas de pesca, microcréditos, inclusión de género, habilidades teatrales, estufas ecológicas y participación en la planeación de una propuesta de conservación. Hubo un incremento en el trasfondo de la educación formal reportada, el tamaño del hogar, los miembros del grupo y la riqueza del hogar, pero una disminución en el consumo de pescado y en el servicio público. Fue de importancia para la conservación que la fuerza percibida de 13 de las instituciones de gobierno y los beneficios de seis restricciones a la pesquería incrementaron durante el periodo de intervención. Por último, la correspondencia entre el conocimiento sobre y la aceptación de las leyes recientes de pesca fue de moderada a alta y con una correlación positiva. El periodo de intervención fue más fuerte que los factores demográficos que con frecuencia influyen sobre las percepciones, como las respuestas de los servicios de gobierno, aldea, género, tamaño del hogar, membresía en un grupo comunitario y edad. En general, la percepción de la fuerza de la gobernanza y los beneficios de las restricciones incrementó más entre las mujeres y la juventud que entre los hombres respondientes. Los cambios más grandes en la percepción del aumento en beneficios fueron entre las restricciones estrictas marcadas como bajas al inicio, específicamente el cierre de pesquerías, parques y restricción de especies. Como consecuencia, la formación de capacidad sobrepasó los factores demográficos, que con frecuencia son personas con una capacidad limitada de empleo que pueden tener una percepción negativa de la conservación estricta.

Simulating the efficacy of wolf-dog hybridization management with individual-based modeling.

Introgressive hybridization between wolves and dogs is a conservation concern due to its potentially deleterious long-term evolutionary consequences. European legislation requires that wolf-dog hybridization be mitigated through effective management. We developed an individual-based model (IBM) to simulate the life cycle of gray wolves that incorporates aspects of wolf sociality that affect hybridization rates (e.g., the dissolution of packs after the death of one/both breeders) with the goal of informing decision-making on management of wolf-dog hybridization. We applied our model by projecting hybridization dynamics in a local wolf population under different mate choice and immigration scenarios and contrasted results of removal of admixed individuals with their sterilization and release. In several scenarios, lack of management led to complete admixture, whereas reactive management interventions effectively reduced admixture in wolf populations. Management effectiveness, however, strongly depended on mate choice and number and admixture level of individuals immigrating into the wolf population. The inclusion of anthropogenic mortality affecting parental and admixed individuals (e.g., poaching) increased the probability of pack dissolution and thus increased the probability of interbreeding with dogs or admixed individuals and boosted hybridization and introgression rates in all simulation scenarios. Recognizing the necessity of additional model refinements (appropriate parameterization, thorough sensitivity analyses, and robust model validation) to generate management recommendations applicable in real-world scenarios, we maintain confidence in our model's potential as a valuable conservation tool that can be applied to diverse situations and species facing similar threats.

Simulación de la eficiencia de la gestión de híbridos de perro y lobo con modelos basados en individuos Resumen La hibridación introgresiva entre perros y lobos es un tema de conservación por las posibles consecuencias evolutivas deletéreas a largo plazo. Las leyes europeas requieren que estos híbridos se mitiguen mediante una gestión efectiva. Desarrollamos un modelo basado en individuos (MBI) para simular el ciclo de vida del lobo gris que además incorpora los aspectos sociales de los lobos que afectan las tasas de hibridación (p. ej.: la disolución de las manadas después de la muerte de uno o ambos reproductores) con el objetivo de guiar las decisiones de gestión de estos híbridos. Aplicamos nuestro modelo con la proyección de las dinámicas de hibridación en una población local de lobos bajo diferentes selecciones de pareja y escenarios de inmigración y contrastamos los resultados de la extirpación de individuos mezclados con su esterilización y liberación. En varios escenarios, la falta de gestión llevó a una mezcla completa, mientras que las intervenciones de gestión reactiva redujeron de forma efectiva la mezcla en las poblaciones de lobos. Sin embargo, la eficiencia de la gestión dependió en su mayoría de la selección de pareja y el número y nivel de mezcla de los individuos inmigrantes a la población de lobos. La inclusión de la mortalidad antropogénica que afecta a los individuos parentales y mezclados (p. ej.: la cacería) incrementó la probabilidad de que se disolviera la manada y por lo tanto incrementara la probabilidad del entrecruzamiento con perros o individuos mezclados, además de que aumentó la hibridación y las tasas de introgresión en todos los escenarios de simulación. Reconocemos la necesidad de refinar el modelo (parametrización adecuada, análisis detallados de sensibilidad y validación del modelo robusto) para generar recomendaciones de gestión aplicables en escenarios reales y mantenemos la confianza en el potencial de nuestro modelo como una herramienta valiosa de conservación que podría aplicarse a diferentes situaciones y especies que enfrentan amenazas similares.

Adaptive spatiotemporal management to reduce shark bycatch in tuna fisheries.

Purse-seine tropical tuna fishing in the eastern tropical Pacific Ocean (EPO) results in the bycatch of several sensitive species groups, including elasmobranchs. Effective ecosystem management balances conservation and resource use and requires considering trade-offs and synergies. Seasonal and adaptive spatial measures can reduce fisheries impacts on nontarget species while maintaining or increasing target catches. Identifying persistently high-risk areas in the open ocean, where dynamic environmental conditions drive changes in species' distributions, is essential for exploring the impact of fisheries closures. We used fisheries observer data collected from 1995 to 2021 to explore the spatiotemporal persistence of areas of high bycatch risk for 2 species of oceanic sharks, silky shark (Carcharhinus falciformis) and oceanic whitetip shark (Carcharhinus longimanus), and of low tuna catch rates. We analyzed data collected by fisheries scientific observers onboard approximately 200 large purse-seine vessels operating in the EPO under 10 different flags. Fishing effort, catch, and bycatch data were aggregated spatially and temporally at 1° × 1° cells and monthly, respectively. When areas of high fishing inefficiency were closed the entire study period and effort was reallocated proportionally to reflect historical effort patterns, yearly tuna catch appeared to increase by 1-11%, whereas bycatch of silky and oceanic whitetip sharks decreased by 10-19% and 9%, respectively. Prior to fishing effort redistribution, bycatch reductions accrued to 21-41% and 14% for silky and oceanic whitetip sharks, respectively. Our results are consistent with previous findings and demonstrate the high potential for reducing elasmobranch bycatch in the EPO without compromising catch rates of target tuna species. They also highlight the need to consider new dynamic and adaptive management measures to more efficiently fulfill conservation and sustainability objectives for exploited resources in the EPO.

Gestión espaciotemporal adaptativa para reducir la captura incidental de tiburones en la pesca del atún Resumen La pesca con cerco del atún tropical en el Pacífico Tropical Oriental (PTO) resulta en la captura incidental de varios grupos de especies sensibles, incluidos los elasmobranquios. La gestión eficiente del ecosistema equilibra la conservación y el uso de recursos y requiere que se consideren las compensaciones y las sinergias. Las medidas espaciales adaptativas y estacionales pueden reducir el impacto de las pesquerías sobre las especies accesorias mientras mantienen o incrementan la captura intencional. La identificación de las áreas con alto riesgo persistente en mar abierto, en donde las condiciones ambientales dinámicas causan cambios en la distribución de las especies, es esencial para explorar el impacto del cierre de las pesquerías. Usamos datos de observadores de las pesquerías recolectados entre 1995 y 2021 para explorar la persistencia espaciotemporal de las áreas con alto riesgo de captura incidental para dos especies de tiburón (Carcharhinus falciformi y C. longimanus) y con tasas bajas de captura de atún. Analizamos los datos recolectados por los observadores científicos de las pesquerías a bordo de aproximadamente 200 embarcaciones grandes de pesca con cerco que operaban en el PTO bajo diez banderas diferentes. Agregamos los datos sobre el esfuerzo de pesca, captura y la captura incidental de forma espacial y temporal en celdas de 1° x 1° y mensual, respectivamente. Cuando las áreas con gran ineficiencia pesquera se encontraban cerradas durante toda la investigación y el esfuerzo se reasignaba proporcionalmente para reflejar los patrones históricos de esfuerzo, el esfuerzo anual de captura de atún parecía incrementar en un 1­11%, mientras que la captura incidental de las dos especies de tiburones disminuía en un 10­19% (C. falciformi) y 9% (C. longimanus). Antes de que de redistribuyera el esfuerzo de pesca, la reducción de la captura incidental se acumuló hasta el 21­41% (C. falciformi) y 14% (C. longimanus). Nuestros resultados son congruentes con resultados previos y demuestran el gran potencial de reducción de la captura incidental de elasmobranquios en el PTO sin poner en peligro las tasas de captura de las especies de atún. Los resultados también enfatizan la necesidad de considerar medidas adaptativas nuevas y dinámicas para cumplir de forma más eficiente los objetivos de conservación y sustentabilidad para la explotación de recursos en el PTO.

Measuring the performance of Antarctic Treaty decision-making.

Agreements reached at the Antarctic Treaty Consultative Meetings (ATCMs) are among the primary means for addressing Antarctic conservation and environmental protection issues. However, according to contemporary scholars, Antarctic Treaty decision-making is becoming increasingly unresponsive to the rising environmental challenges in the region. We assessed the performance of Antarctic Treaty decision-making by measuring the rate and diversity of decision-making over the last 6 decades. To measure the rate, we counted the number of inputs and outputs of ATCMs and calculated the time taken for legally binding outputs to enter into force. To measure diversity, we calculated the range of topics addressed by the inputs and outputs of ATCMs. The average number of agreements reached per ATCM increased from 1961 to 2022. Although the diversity of Antarctic topics discussed at ATCMs remained consistently high, the diversity of topics on which legally binding agreements were adopted declined significantly. Antarctic issues-including those of highest priority-are now almost entirely dealt with through nonbinding, soft-law agreements. It is plausible that this move away from binding decisions reflects a dynamic governance institution evolving to respond to new pressures. However, we suggest that the change reveals a concerning shift in decision-making behavior and performance, unique to the treaty's history. Soft law is beneficial in some cases, but its overuse diminishes accountability and transparency, significantly reducing the parties' abilities to understand and measure their performance, including the outcomes and impacts of decisions. Although the rate and diversity of ATCM inputs and outputs provide only a partial view of decision-making performance, the exploration of these metrics provides a foundation for asking essential questions about the impacts of Antarctic Treaty governance on the region's environmental protection and conservation.

Medida del desempeño de las decisiones del Tratado Antártico Resumen Los acuerdos logrados en las Reuniones Consultivas del Tratado Antártico (RCTA) son uno de los principales medios para abordar las cuestiones de conservación y protección ambiental de la Antártida. Sin embargo, según los académicos contemporáneos, la toma de decisiones del Tratado Antártico es cada vez menos receptiva a los crecientes retos ambientales de la región. Evaluamos el rendimiento de las decisiones del Tratado Antártico con la medida del ritmo y la diversidad de la toma de decisiones en las últimas seis décadas. Para medir el ritmo, contamos el número de entradas y salidas de las RCTA y calculamos el tiempo que tardan en entrar en vigor los resultados con vinculación jurídica. Para medir la diversidad, calculamos la gama de temas abordados por las entradas y salidas de las RCTA. El número medio de acuerdos alcanzados por cada RCTA aumentó de 1961 a 2022. Sin embargo, mientras que la diversidad de temas antárticos debatidos en las RCTA se mantuvo constantemente alta, la diversidad de temas sobre los que se adoptaron acuerdos con vinculación jurídica disminuyó significativamente. Las cuestiones antárticas ­incluidas las de máxima prioridad­ se abordan ahora casi en su totalidad mediante acuerdos no vinculantes y de derecho indicativo. Es plausible que este alejamiento de las decisiones vinculantes refleje una institución de gestión dinámica que evoluciona para responder a nuevas presiones. Sin embargo, sugerimos que el cambio revela una modificación preocupante en el comportamiento y los resultados de la toma de decisiones, único en la historia del tratado. El derecho indicativo es benéfico en algunos casos, pero su uso excesivo disminuye la responsabilidad y la transparencia, lo que reduce significativamente la capacidad de las partes para comprender y medir su rendimiento, incluidos los resultados y los impactos de las decisiones. Aunque la tasa y la diversidad de las entradas y salidas de las RCTA sólo proporcionan una visión parcial del rendimiento de la toma de decisiones, la exploración de estas métricas proporciona una base para plantear preguntas esenciales sobre los impactos de la gestión del Tratado Antártico para la protección y conservación ambiental de la región.

Incorporation of human-wildlife interactions in ecosystem-based management to enhance conservation of endangered guitarfish.

Growing human use of the marine environment increases the proximity of humans to marine wildlife and thus likely increases human-wildlife interactions. Such interactions influence perceptions of nature and promote or undermine conservation. Despite their importance, human-wildlife interactions are rarely considered in ecosystem-based marine spatial planning (MSP). Ideally, these interactions should be identified and considered in ecosystem-based management (EBM), which is often purported to be the basis for MSP. We used Marxan software and data from a citizen science project documenting location, species, age, sex, and activity type to identify regions along Israel's coast with a high probability of encounters between people and 2 species of guitarfish. We considered the geographic distribution of these encounters and the various activities undertaken by the reporting observers. We ran 4 scenarios in Marxan. Two had conservation goals of 30% and 50% guitarfish habitat protection. In the third and fourth scenarios, we added a 50% conservation goal of human leisure activities to each guitarfish conservation goal. We also conducted a gap analysis between our guitarfish conservation goals and the Israel Nature and Parks Authority's master plan for marine protected areas. We found the park authority was close to meeting the 30% goal but was far from meeting the conservation goal of 50% of guitarfish habitat conservation. Different human uses were more likely to interact with different life stages of guitarfish, and different recreational activities occurred in different areas. Identifying areas of specific human use showed which activities should be addressed in conservation management decisions. Our addition of certain recreational uses to the model of habitat conservation showed how enhancing human dimensions in conservation planning can lead to more holistic ecosystem-based conservation necessary for effective marine planning.

Incorporación de las interacciones humano­fauna dentro de la gestión basada en el ecosistema para mejorar la conservación del pez guitarra en peligro Resumen El uso creciente que el humano le da al mar incrementa la cercanía de las personas con la fauna marina, lo que probablemente incrementa las interacciones humano­fauna. Dichas interacciones influyen sobre las percepciones que se tienen de la naturaleza y promueven debilitan la conservación. A pesar de su importancia, pocas veces se consideran las relaciones humano­fauna dentro de la planeación espacial basada en ecosistemas marinos (PEM). Lo ideal debería ser la identificación y consideración de estas interacciones dentro de la gestión basada en el ecosistema (GBE), la cual con frecuencia se considera como la base de la PEM. Usamos software Marxan y datos de un proyecto de ciencia ciudadana que documenta la ubicación, especie, edad, sexo y tipo de actividad para identificar las regiones de la costa de Israel con una alta probabilidad de encuentros entre las personas y dos especies de pez guitarra. Consideramos la distribución geográfica de estos encuentros y las diferentes actividades que realizan los observadores. En Marxan corrimos cuatro escenarios. Dos de los escenarios contaban objetivos de conservación del 30% y 50% de la protección del hábitat del pez guitarra. En los otros dos escenarios, añadimos un objetivo de conservación de 50% de las actividades humanas de recreación a los objetivos uno y dos. También realizamos un análisis de brecha entre los objetivos de conservación del pez guitarra y el plan maestro para las áreas marinas protegidas de la Autoridad de Parques y Naturaleza de Israel. Descubrimos que esta autoridad estaba cerca de lograr el objetivo del 30% pero lejos del de 50% de la conservación del hábitat del pez guitarra. Fue más probable que los diferentes usos humanos interactuaran con diferentes estadios de vida del pez guitarra y las diversas actividades recreativas ocurrieron en áreas distintas. La identificación de las áreas con un uso humano específico mostró cuáles actividades deberían abordarse en las decisiones de gestión de la conservación. La suma de ciertos usos recreativos al modelo de conservación del hábitat mostró cómo aumentar las dimensiones humanas en la planeación de la conservación puede derivar en una conservación basada en el ecosistema más holística, necesaria para la planeación marina eficiente.

Complications related to unwitnessed magnet ingestion in paediatrics: Case series.

Foreign body inges tion is one of the mo s t common problems a mo ng chi ldren. There is a great te ndency among children between the age of six months to six years to p lace objects, such as coins, fish bone, pins, button batteri es, magnets and o th er hous ehold ite ms, in their m outh and often swa llow them. Magnet ingestion is not uncommon. Hazardous effects can occur owing to the fact that these are usually unwitnessed leading to disparity in histor y an d delayed presentation. Nowadays these m agnets are made of Neodymium which is a s trong element and can be moulded into various shapes and sizes, making them more attractive to children . Single magnet ingestion may pass with out complication, bu t multip le ingested magnets pose risk of severe complications such as obstruction, inter bowel fistulae, and perforation often requiring urgent intervention. Here, we present three cases who presented to the emergency d epartment with unusu al prese nt ation s an d ultimately under went exp loratory La parotomy with surprising intra- operative findings along with magnetic objects.

[Blockchain in health: Transforming security and clinical data management]. / Blockchain en salud: transformando la seguridad y la gestión de datos clínicos.

INTRODUCTION: Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. DISCUSSION: This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. CONCLUSION: Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative.

Comprehensive medication management (CMM): Application of a new pharmaceutical practice in onco-hematology.

The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP. The aim of this study is to assess the impact of the applying a clinical pharmacist-driven comprehensive medication management (CMM) service to onco-hematology patients. This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1. Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%. The integration of CMM services in onco-hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.

Optimizing pharmaceutical management of clinical trials.

OBJECTIVES: The clinical trials pharmacists have an essential role in managing the pharmaceutical part of interventional studies. The primary objective of this article was to provide a template for improving trials management for the growing number of studies without increasing personnel resources. MATERIAL AND METHODS: A retrospective study was conducted between 2016 and 2020 at the service of pharmacy at Lausanne University Hospital in Switzerland. RESULTS: The number of clinical trials (in progress) managed at the pharmacy increased from 77 to 115 (+49%) between 2016 and 2020. The majority of these studies were in oncology and were sponsored by industry. Therefore, different changes in routine tasks were decided during the 5 years term to meet the above challenge. These modifications allowed to improve pharmaceutical and administrative management of clinical trials, without increasing personnel resources. The management template was accepted by the sponsors, and no issues were mentioned by national and international audit authorities. CONCLUSION: Changes could be made in the routine practice of the clinical trials pharmacists to improve the management of studies, while the number of trials is increasing every year.

[Setting up a training program in a geriatric short-stay department]. / Mise en place d'un programme de formations au sein d'un service de court séjour gériatrique.

As the department's team had been renewed in less than two years, it was necessary to invent a method to improve cohesion and communication, and to enhance the skills of professionals. This led to the creation of a training program using a variety of methods (theoretical training, care approaches and quality coffees).

[Staff hebdomadaire qualité et gestion des risques en gériatrie: un outil d'appropriation de la démarche qualité pour le management des unités]. / Staff hebdomadaire qualité et gestion des risques en gériatrie : un outil d'appropriation de la démarche qualité pour le management des unités.

The quality approach has become essential in geriatric hospital services, but also in the medico-social sector. This process is continuous and shared by all those in charge of the care units, to facilitate unit management and support caregivers in this approach. The weekly structured quality staff meeting is a relevant tool to facilitate the understanding and appropriation of this approach by the medical and nursing managers of the care units.

[At the heart of care management, the relationship]. / Au cœur du management du soin, la relation.

The prevalence of management concerns in hospitals and a highly normative conception of health care are converging today in a standardization of care. The latter is undoubtedly at the root of the current malaise among caregivers. Indeed, the New Public Management approach is encouraging them, despite themselves, to carry out their missions to the detriment of the values of care. A more appropriate form of management would, on the contrary, be based on a continuity to be sought between care values and management values, around the notion of support. This would mean reinstating concern for interpersonal relationships at the heart of care management missions.

Approach to the care process by nurse case managers in a breast unit.

OBJECTIVE: Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS: Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS: The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Functional outcomes of canalicular laceration repair with self-retaining masterka stent in a tertiary eye care center in France: A retrospective study of 30 patients.

PURPOSE: To evaluate the long-term functional outcomes of canalicular laceration repair using the Masterka® monocanalicular intubation system. METHODS: this interventional case series included the data from 30 patients who underwent canalicular laceration repair with a 30-mm pushed monocanalicular stent (Masterka®) and suturing of the lacerated canaliculus with 8/0 Vicryl interrupted sutures. Operative details and complications were meticulously noted. Stent removal took place as early as 3 months post-surgery, with functional success defined as the absence of epiphora four years after surgery. RESULTS: The average age of patients was 28.5±26.3 years, with 20 out of 30 patients (66.6%) being male. Lower canaliculus involvement was noted in 23 patients (76.6%), while the upper canaliculus was affected in 7 patients (23.4%). On average, patients presented for medical attention within approximately one day of sustaining with injuries, and all underwent successful repairs. Notably, functional success was observed in all 30 cases, constituting a 100% success rate. Stent-related complications were encountered in two patients (6.6%). One patient reported stent removal after an average follow-up period of one month, while the other developed a punctal granuloma one-month post-surgery, which regressed following one month of topical steroid treatment. CONCLUSION: Repairing canalicular lacerations using the self-retaining Masterka® monocanalicular intubation system demonstrated a notable achievement in long-term functional success while presenting minimal complications. To further substantiate these promising results, an interventional study that includes a comparison analysis with other types of intubation methods is warranted.

Nurse managers coping strategies for crisis management: qualitative systematic review.

Stressor-related disorders are a growing issue for both the individual and the organizations. The aim of the study was to analyze the strategies used by nurse managers to face crises. A systematic review of the literature, including qualitative studies was performed. Data were analyzed using framework-based synthesis and summarized into domains. Quality was evaluated using the JBI QARI Checklist. 10 studies met the inclusion criteria. Data collection was based on interviews, followed by questionnaires and focus groups. Good communication, organizational commitment and emotional support were the principal domains. Institutions should support nurse managers to cope with stress and make suggestions for adaptations.

E-consults between primary care and internal medicine: implementation, accessibility, benefits, and implications.

AIM: This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine. METHODS: This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed. RESULTS: A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15-102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5645 patients (49.4%) were given an in-person appointment. For the remaining 5789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (p < 0.0001), visited the emergency department more times (one month: p = 0.04; three months: p = 0.001), were admitted to the hospital more times (one month: p = 0.0001; three months: p = 0.0001), and had higher mortality at one year (12.7% vs. 9.8% p = 0.0001). In the Cox analysis, only in-person appointments (RR = 1.11; p = 0.04)) and age (RR = 1.09; p < 0.01) were independent factors of mortality. No complaints or claims of any kind were registered. CONCLUSIONS: These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention.

BACKGROUND: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION: NCT05605392.

Deductive Care Methodology: Describing and testing modes of care research.

OBJECTIVE: Define the modes of procedure of the Deductive Care Methodology (DCM) in the generation of knowledge about person's health care. METHODOLOGY: Design and test of the DCM modes based on three phases: mapping of the DCM, generation of models from this methodology and testing of the models through studies in a clinical context. RESULTS: The DCM presents five levels of abstraction with three modes broken down to 16 types. The modes are: Philosophical Mode to conceptualize and obtain generalities about reality, Mathematical Mode to operate with generalities, and Physical Mode to operationally verify, validating the results and the predictive capacity of the model. This MDC allows the creation of three models: Knowledge Model about Person Care, an ontology of care, Vulnerability Model about the person and Taxonomic Triangulation Model for knowledge management. All models generate products for computational knowledge management. In addition, the models are applied in teaching and generate research with more than a hundred participations in conferences and journals, of which five impact publications (from 2008 to 2022) classified in the categories of Nursing and Informatics are analysed. CONCLUSIONS: The DCM collects prior knowledge to work with certainties, evidence and applying inferences that do not depend on the number of cases or inductive designs. This research presents a formal structure of the DCM with an interdisciplinary orientation between Health Sciences and Computer Sciences.