A practical approach to screening for carbapenemase-producing Enterobacterales- views of a group of multidisciplinary experts from English hospitals.

INTRODUCTION: Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges. METHODS: A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE. KEY FINDINGS: Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks. CONCLUSION: Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources- such as upscaled screening- to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs.

Insights into Current Education of Acupuncture as a Non-Conventional Therapy in Portugal.

Acupuncture, as an ancient practice for healthcare in China, is now widely used in the world and regarded as a non-conventional therapy (NCT) in many Western countries. In Portugal, acupuncture has been structured and well regulated for the market of teaching and clinical practice, but little effort has been put in to explore it in depth. This article aims to disclose the current education of acupuncture as a NCT in Portugal through investigation of acupuncture laws, field surveys, teaching work, and interviews with people from the NCT field. We found that according to the academic norms and rules of education in Portugal, there is a gradual difficulty in the progression and maintenance of the degree training dynamics. The reasons are the lack of more tolerant transitional measures and many practical difficulties confronted by the institutions that embark on these complementary programs. Therefore, it will be necessary to promote additional programs and measures to avoid a total emptiness of the teaching of acupuncture and at the same time losses of clinicians, competencies, and quality of information that are difficult to recover. It could be very meaningful and thought provoking to the future development and improvement of acupuncture in Portugal and in other countries that welcome acupuncture and intend to have better legislation and application.

Legislation for disabled people in Brazil: from human dignity to social inclusion: advancing capabilities as an ethical imperative / Legislación para los discapacitados en Brasil: de la dignidad humana a la inclusión social: el avance de las capacidades como imperativo ético / Legislação para os incapacitados no Brasil: da dignidade humana à inclusão social: o avanço das capacidades como imperativo ético

Abstract The study analyzes the ethical and legal basis of Brazilian legislation for people with disabilities and verifies whether the instruments used therein are in line with national and international law. It also investigates the coherence and cohesion of the law and its ethical norms to build an inclusive and just society. Through an exploratory and integrative review, it analyzed the legal provisions in force in Brazil published on the official websites of the Brazilian federal government and available on the Internet. It was evaluated whether the definition used for persons with disabilities follows the United Nations Convention on the Rights of Persons with Disabilities. Also, whether it is necessary to evaluate disabilities and who should perform this task professionally. Thirty-three legal norms were found, among which only three laws and two decrees are in line with the recommendations of the UN Convention. It is necessary to review the existing norms and promote the consolidation of laws, decrees, ordinances and normative instructions regarding the rights of persons with disabilities in a uniform manner, on an adequate technical-scientific basis. This review should be consistent with the provisions of the 1988 Federal Constitution, the International Convention on the Rights of Persons with Disabilities and the Brazilian Inclusion Law.

Resumen El estudio analiza el fundamento ético y jurídico de la legislación brasileña para las personas con discapacidad y comprueba si los instrumentos allí utilizados se ajustan al Derecho nacional e internacional. Además, investiga la coherencia y cohesión de la ley y sus normas éticas para construir una sociedad inclusiva y justa. Mediante revisión exploratoria e integrativa, analizó las disposiciones legales vigentes en Brasil publicadas en los sitios web oficiales del gobierno federal brasileño y disponibles en Internet. Se evaluó si la definición utilizada para las personas con discapacidad sigue la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad. También, si es necesario evaluar las discapacidades y quién debe realizar esa tarea profesionalmente. Se encontraron 33 normas legales, entre las cuales solo tres leyes y dos decretos se ajustan a las recomendaciones de la Convención de las Naciones Unidas. Es necesario revisar las normas existentes y promover la consolidación de las leyes, decretos, ordenanzas e instrucciones normativas relativas a los derechos de las personas discapacitadas de manera uniforme, sobre una base técnico-científica adecuada. Esta revisión debe ser coherente con las disposiciones de la Constitución Federal de 1988, la Convención Internacional sobre los Derechos de las Personas con Discapacidad y la Ley de Inclusión brasileña.

Resumo O estudo analisa o fundamento ético e jurídico da legislação brasileira para as pessoas com incapacidade e comprova se os instrumentos ali utilizados se ajustam ao Direito nacional e internacional. Além disso, investiga a coerência e coesão da lei e suas normas éticas para construir uma sociedade inclusiva e justa. Mediante revisão exploratória e integrativa, analisou as disposições legais vigentes no Brasil publicadas nos sites web oficiais do governo federal brasileiro e disponíveis na Internet. Avaliou-se se a definição utilizada para as pessoas com incapacidade segue a Convenção das Nações Unidas sobre os Direitos das Pessoas com Incapacidade. Também, se é necessário avaliar as incapacidades e quem deve realizar essa tarefa profissionalmente. Se encontraram 33 normas legais, entre as quais somente três leis e dois decretos se ajustam às recomendações da Convenção das Nações Unidas. É necessário revisar as normas existentes e promover a consolidação das leis, decretos, regulamentos e instruções normativas relativas aos direitos das pessoas incapacitadas de maneira uniforme, sobre uma base técnico-científica adequada. Esta revisão deve ser coerente com as disposições da Constituição Federal de 1988, a Convenção Internacional sobre os Direitos das Pessoas com Incapacidade e a Lei de Inclusão brasileira.

A Wasted Opportunity During a Pandemic: The Foreign Medical Graduates in the USA.

In this brief note from the field, we address an essential issue of non-inclusion of Foreign Medical Graduates (FMG) practicing in the US into the healthcare disaster response in the current pandemic. Because FMGs represent a significant share of the entire country's physician workforce, it seems not prudent to ignore the need to address the current immigration barriers affecting the crucial healthcare needs during this pandemic. Being subjects of the ongoing complex bureaucracy complicated by recent anti-immigrant steps, FMGs that practice for years on temporary (H1B) visas cannot fully join COVID-19 forces. In addition, these physicians face multiple challenges related to their health protection, protection of their immediate family, job security, and the potential risk of being deported. We believe that physicians' immigration status should no longer be disregarded outside of academic interest. It carries the same importance as other public health issues, especially in severe healthcare crises like this pandemic.

[Organ donor families should be free to meet their recipients under controlled conditions if both sides wish, Italian National Committee for Bioethics says (Italian translation by A. Scarabelli)].

On 27 September 2018 the Italian Committee for Bioethics (ICB) adopted an opinion regarding the possibility of an exception to the anonymity obligation when both parties agree and have signed an appropriate informed consent form. According to the IBC any contact between the donor's family and recipient must be managed by a third-party body pertaining to the National Health Service, established to guarantee strict control over the expression of consent in order to avoid any risk of inappropriate behaviour. The paper traces how Reg and Maggie Green, on holiday from California, donated the organs of their seven-year old son, Nicholas, to seven Italians after he had been shot in a carjacking on the Salerno-Reggio Calabria highway in 1994. Reluctant as a foreigner to propose a change in Italian law that effectively prevents the two sides from contacting each other, Reg Green held back for 22 years until, at age 87, he began a public campaign to voice his concern that the law was hurting transplant families rather than helping them. (This is the Italian translation of an article published in the Annali dell'Istituto Superiore di Sanità 2019; 55(1):6-9. https://doi.org/10.4415/ANN_19_01_03).

Neurosurgical Practice in Transition: A Review.

Neurosurgery is experiencing a period of acute change driven by 2 forces: (1) the perception that the healthcare system in the United States is wasteful and that patients are receiving low "value" care, (2) the belief that quality and long-term outcomes can be measured accurately. We believe 3 important shifts will emerge as a result of these forces. First, payment models will change. They will become anchored to a concept of population health, with capitation payments on a per-patient basis going to provider entities that undertake financial risk. Second, fee-for-service payments will be tied increasingly to administrative and clinical quality measures. Finally, out-of-pocket costs for patients will increase and affect both treatment decisions and willingness to participate in restrictive health care networks. In this review, we describe these changes and discuss possible consequences. We note the changing demographics of neurosurgical practices. Overall, independent private practices, managed by the neurosurgeons, will decline. The proportion of fee-for-service cases will decrease while cases reimbursed through capitation will increase. Physician integration with provider organizations, whether via full employment, a "lease," or some other arrangement, will also increase. We note the increasing importance of quality measures, and how they are likely to affect neurosurgical practices and reimbursement. We describe the advantages and disadvantages of fee-for-service and population health; describe opportunities and risks arising from these transitions; and outline strategies to thrive in a changing environment.