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Article: Situational Awareness in the Context of Clinical Practice.

Feller, Shani / Feller, Liviu / Bhayat, Ahmed / Feller, Gal / Khammissa, Razia Abdool Gafaar / Vally, Zunaid Ismail

2023 Volume 11, Issue 23

Abstract: In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) ... ...

Abstract	In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) facilitates clinical reasoning, diagnostic accuracy, and appropriate goal-directed performance, and it enables clinicians to immediately adapt treatment strategies in response to changes in clinical situational actualities and to modify the course of goal-directed activities accordingly. It also helps clinicians prepare future operational plans and procedures based on the projection of situational developments. SA, therefore, is an important prerequisite for safe clinical procedures. The purpose of this narrative review is to highlight certain cognitive and external (environmental) situational factors that influence the development of situational awareness. Understanding the dynamic, adaptive, and complex interactions between these factors may assist clinicians and managers of healthcare systems in developing methods aimed at facilitating the acquisition of accurate clinical situational awareness and, in turn, may bring about a reduction in the incidence of SA, diagnostic, and operational errors.
Language	English
Publishing date	2023-12-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare11233098
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Tumour Genetic Heterogeneity in Relation to Oral Squamous Cell Carcinoma and Anti-Cancer Treatment.

Feller, Gal / Khammissa, Razia Abdool Gafaar / Ballyram, Raoul / Beetge, Mia-Michaela / Lemmer, Johan / Feller, Liviu

International journal of environmental research and public health

2023 Volume 20, Issue 3

Abstract: Oral squamous cell carcinoma (SCC) represents more than 90% of all oral cancers and is the most frequent SCC of the head and neck region. It may affect any oral mucosal subsite but most frequently the tongue, followed by the floor of the mouth. The use ... ...

Abstract	Oral squamous cell carcinoma (SCC) represents more than 90% of all oral cancers and is the most frequent SCC of the head and neck region. It may affect any oral mucosal subsite but most frequently the tongue, followed by the floor of the mouth. The use of tobacco and betel nut, either smoked or chewed, and abuse of alcohol are the main risk factors for oral SCC. Oral SCC is characterized by considerable genetic heterogeneity and diversity, which together have a significant impact on the biological behaviour, clinical course, and response to treatment and on the generally poor prognosis of this carcinoma. Characterization of spatial and temporal tumour-specific molecular profiles and of person-specific resource availability and environmental and biological selective pressures could assist in personalizing anti-cancer treatment for individual patients, with the aim of improving treatment outcomes. In this narrative review, we discuss some of the events in cancer evolution and the functional significance of driver-mutations in carcinoma-related genes in general and elaborate on mechanisms mediating resistance to anti-cancer treatment.
MeSH term(s)	Humans ; Mouth Neoplasms/genetics ; Mouth Neoplasms/pathology ; Carcinoma, Squamous Cell/pathology ; Squamous Cell Carcinoma of Head and Neck/genetics ; Squamous Cell Carcinoma of Head and Neck/complications ; Genetic Heterogeneity ; Nicotiana ; Head and Neck Neoplasms
Language	English
Publishing date	2023-01-29
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20032392
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Errors in clinical diagnosis: a narrative review.

Vally, Zunaid Ismail / Khammissa, Razia A G / Feller, Gal / Ballyram, Raoul / Beetge, Michaela / Feller, Liviu

The Journal of international medical research

2023 Volume 51, Issue 8, Page(s) 3000605231162798

Abstract: Diagnostic errors are often caused by cognitive biases and sometimes by other cognitive errors, which are driven by factors specific to clinicians, patients, diseases, and health care systems. An experienced clinician diagnoses routine cases intuitively, ...

Abstract	Diagnostic errors are often caused by cognitive biases and sometimes by other cognitive errors, which are driven by factors specific to clinicians, patients, diseases, and health care systems. An experienced clinician diagnoses routine cases intuitively, effortlessly, and automatically through non-analytic reasoning and uses deliberate, cognitively effortful analytic reasoning to diagnose atypical or complicated clinical cases. However, diagnostic errors can never be completely avoided. To minimize the frequency of diagnostic errors, it is advisable to rely on multiple sources of information including the clinician's personal experience, expert opinion, principals of statistics, evidence-based data, and well-designed algorithms and guidelines, if available. It is also important to frequently engage in thoughtful, reflective, and metacognitive practices that can serve to strengthen the clinician's diagnostic skills, with a consequent reduction in the risk of diagnostic error. The purpose of this narrative review was to highlight certain factors that influence the genesis of diagnostic errors. Understanding the dynamic, adaptive, and complex interactions among these factors may assist clinicians, managers of health care systems, and public health policy makers in formulating strategies and guidelines aimed at reducing the incidence and prevalence of the phenomenon of clinical diagnostic error, which poses a public health hazard.
MeSH term(s)	Humans ; Algorithms ; Diagnostic Errors/prevention & control ; Public Health
Language	English
Publishing date	2023-08-20
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/03000605231162798
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Article: Noma staging: a review.

Khammissa, Razia Abdool Gafaar / Lemmer, Johan / Feller, Liviu

Tropical medicine and health

2022 Volume 50, Issue 1, Page(s) 40

Abstract: Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken ... ...

Abstract	Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.
Language	English
Publishing date	2022-06-13
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	2209835-5
ISSN	1349-4147 ; 1348-8945
ISSN (online)	1349-4147
ISSN	1348-8945
DOI	10.1186/s41182-022-00431-6
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Article ; Online: Noma: a neglected oro-facial childhood disease.

Khammissa, Razia A G / Lemmer, Johan / Feller, Liviu

The Lancet. Child & adolescent health

2021 Volume 5, Issue 10, Page(s) 685–686

MeSH term(s)	Africa South of the Sahara ; Child ; Disease Progression ; Humans ; Noma/physiopathology ; Noma/therapy ; Oral Health/standards ; Poverty ; Quality of Life
Language	English
Publishing date	2021-09-18
Publishing country	England
Document type	Journal Article
ISSN	2352-4650
ISSN (online)	2352-4650
DOI	10.1016/S2352-4642(21)00264-9
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Article ; Online: Is noma a neglected/overlooked tropical disease?

Feller, Liviu / Lemmer, Johan / Khammissa, Razia Abdool Gafaar

Transactions of the Royal Society of Tropical Medicine and Hygiene

2022 Volume 116, Issue 10, Page(s) 884–888

Abstract: Noma is a debilitating orofacial necrotizing bacterial disease that disproportionately affects impoverished malnourished persons, particularly young children, the vast majority of whom live in tropical and subtropical areas in sub-Saharan Africa. It has ... ...

Abstract	Noma is a debilitating orofacial necrotizing bacterial disease that disproportionately affects impoverished malnourished persons, particularly young children, the vast majority of whom live in tropical and subtropical areas in sub-Saharan Africa. It has a very high mortality rate; causes significant physical and psychological morbidity, stigmatization and social discrimination; could be prevented, controlled and indeed eliminated by common public health interventions; and is overlooked with regard to public health awareness, in-depth scientific research activities and allocation of funding for prevention, treatment and research. According to the WHO, noma comprises five sequential 'stages': (1) necrotizing gingivitis, (2) edema, (3) gangrene, (4) scarring and (5) sequelae. This WHO staging of noma is contentious, leading to diagnostic confusion with misestimation of the number of noma cases reported in epidemiological studies. We therefore suggest a simpler, more practical and scientifically valid two-stage classification comprising only (1) acute noma and (2) arrested noma. Noma meets all the WHO criteria for classification as a neglected tropical disease (NTD). Most survivors of noma live with gross physical disfigurement and disability, and with impaired psychosocial functioning, so they are very often stigmatized and unjustifiably discriminated against. Owing to the paucity of evidence-based epidemiological data on noma, the relatively low number of people affected worldwide, and its apparently limited geographic distribution, noma does not yet feature on the WHO's list of NTDs, or on any global health agenda, and thus has not become a health priority for global action. We strongly support the inclusion of noma within the WHO list of NTDs. Without doubt this will increase the awareness of noma among healthcare providers and promote the systematic international accumulation and recording of data about noma.
MeSH term(s)	Africa South of the Sahara ; Child ; Child, Preschool ; Global Health ; Humans ; Malnutrition/complications ; Malnutrition/epidemiology ; Neglected Diseases/complications ; Neglected Diseases/diagnosis ; Neglected Diseases/epidemiology ; Noma/diagnosis ; Noma/epidemiology ; Noma/etiology
Language	English
Publishing date	2022-06-01
Publishing country	England
Document type	Journal Article
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1093/trstmh/trac043
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Article ; Online: Noma staging

Razia Abdool Gafaar Khammissa / Johan Lemmer / Liviu Feller

Tropical Medicine and Health, Vol 50, Iss 1, Pp 1-

a review

2022 Volume 6

Abstract: Abstract Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken ... ...

Abstract	Abstract Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.
Keywords	Noma classification ; Acute noma ; Arrested noma ; Necrotising gingivitis ; Necrotising periodontitis ; Necrotising stomatitis ; Arctic medicine. Tropical medicine ; RC955-962
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Burnout phenomenon: neurophysiological factors, clinical features, and aspects of management.

Khammissa, Razia A G / Nemutandani, Simon / Feller, Gal / Lemmer, Johan / Feller, Liviu

The Journal of international medical research

2022 Volume 50, Issue 9, Page(s) 3000605221106428

Abstract: Burnout syndrome is a distinct "occupational phenomenon" rather than a medical condition, comprising emotional exhaustion, physical fatigue, and cognitive weariness. Both exogenous work-related and endogenous personal factors determine the extent and the ...

Abstract	Burnout syndrome is a distinct "occupational phenomenon" rather than a medical condition, comprising emotional exhaustion, physical fatigue, and cognitive weariness. Both exogenous work-related and endogenous personal factors determine the extent and the severity of symptoms in burnout syndrome. Persistent burnout is a cause of reduced quality of life and is associated with increased risk of sleep impairment and with several medical disorders including mild cognitive impairment, diabetes, and cardiovascular disease.Active coping strategies promoting mental resilience and adaptive behavior, stress-reducing activities, improving work conditions, and reducing exposure to work stressors together may alleviate the distress of burnout and should be introduced early in the clinical course of burnout syndrome. The purpose of this review was to explain this complex and puzzling phenomenon and to describe burnout management.
MeSH term(s)	Adaptation, Psychological ; Burnout, Professional/psychology ; Emotions ; Fatigue ; Humans ; Quality of Life
Language	English
Publishing date	2022-09-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/03000605221106428
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 925: Show issues

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bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Situational Awareness in the Context of Clinical Practice

Shani Feller / Liviu Feller / Ahmed Bhayat / Gal Feller / Razia Abdool Gafaar Khammissa / Zunaid Ismail Vally

Healthcare, Vol 11, Iss 23, p

2023 Volume 3098

Abstract	In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) facilitates clinical reasoning, diagnostic accuracy, and appropriate goal-directed performance, and it enables clinicians to immediately adapt treatment strategies in response to changes in clinical situational actualities and to modify the course of goal-directed activities accordingly. It also helps clinicians prepare future operational plans and procedures based on the projection of situational developments. SA, therefore, is an important prerequisite for safe clinical procedures. The purpose of this narrative review is to highlight certain cognitive and external (environmental) situational factors that influence the development of situational awareness. Understanding the dynamic, adaptive, and complex interactions between these factors may assist clinicians and managers of healthcare systems in developing methods aimed at facilitating the acquisition of accurate clinical situational awareness and, in turn, may bring about a reduction in the incidence of SA, diagnostic, and operational errors.
Keywords	situational awareness ; clinical reasoning ; clinical judgement ; decision making ; mental models ; electronic health records ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: The burnout construct with reference to healthcare providers: A narrative review.

Khammissa, Razia Ag / Nemutandani, Simon / Shangase, Sindisiwe Londiwe / Feller, Gal / Lemmer, Johan / Feller, Liviu

SAGE open medicine

2022 Volume 10, Page(s) 20503121221083080

Abstract: Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most ... ...

Abstract	Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most frequently observed among professionals who work directly with people, particularly in institutional settings. Healthcare professionals who work directly with patients and are frequently exposed to work overload and excessive clinical demands, to ethical dilemmas, to pressing occupational schedules and to managerial challenges; who have to make complex judgements and difficult decisions; and who have relatively little autonomy over their job-related tasks are at risk of developing clinical burnout. In turn, clinical burnout among clinicians has a negative impact on the quality and safety of treatment, and on the overall professional performance of healthcare systems. Healthcare workers with burnout are more likely to make mistakes and to be subjected to medical malpractice claims, than do those who are burnout-naïve. Experiencing the emotional values of autonomy, competence and relatedness are essential work-related psychological needs, which have to be satisfied to promote feelings of self-realization and meaningfulness in relation to work activities, thus reducing burnout risk. Importantly, an autonomy-supportive rather than a controlling style of management decreases burnout risk and promotes self-actualization, self-esteem and a general feeling of well-being in both those in charge and in their subordinates. The purpose of this article is to discuss some of the elements constituting the burnout construct with the view of gaining a better understanding of the complex multifactorial nature of burnout. This may facilitate the development and implementation of both personal, behavioural and organizational interventions to deal with the burnout syndrome and its ramifications.
Language	English
Publishing date	2022-03-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2735399-0
ISSN	2050-3121
ISSN	2050-3121
DOI	10.1177/20503121221083080
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