Time Of Administration Research Articles

C1 esterase inhibitor (C1-INH) for the off-label treatment of angiotensin-converting enzyme inhibitor induced angioedema

Introduction: Currently, C1 esterase inhibitor (C1-INH) is indicated for hereditary angioedema (HAE) but is utilized off-label for angiotensin- converting enzyme inhibitors (ACEi) induced angioedema (AAE). There is no standard of care for the treatment of AAE, however patients may receive a combination of epinephrine, corticosteroids, fresh frozen plasma (FFP), tranexamic acid (TXA), and histamine 1 and 2 receptor antagonists (H1RA, H2RA). C1-INH place is therapy is not well defined. Materials & Methods: A retrospective chart review was conducted from patients at a large academic medical center who received C1-INH for AAE between January 2012 and May 2022. Variables and outcomes of interest were receipt of alternative angioedema treatment prior to C1-INH, time of C1-INH administration, dose of C1-INH, need for intubation or surgical airway placement, duration of intubation, and hospital length of stay. Results: All patients received additional medications for angioedema prior to C1-INH administration. Steroids and H1RAs were most common. The dose of C1-INH ranged from 11.7 IU/kg to 23.2 IU/kg with an average dose of 19.3 IU/kg. Five patients required airway support with four requiring intubation (30.8%) and one requiring a surgical airway. Conclusions: This retrospective review of 13 patients showed mixed results for C1-INH to prevent intubation in AAE. Providers should consider limiting the use of C1-INH to patients who remain symptomatic after administering a combination of other therapies when there is an ongoing risk for airway compromise and adequate time for preparation, administration, and effect.

Некоторые особенности токсикологических свойств специфического иммунобиостимулятора «Трансфер-фактор» в доклинических испытаниях

Abstract. The purpose of the study is to evaluate some aspects of toxicological safety of a specific immunobiostimulant “Transfer factor” in laboratory animal models. Methods. The experiments were performed on mice, rats and guinea pigs. The toxicological safety assessment of the “Transfer factor” preparation included the determination of the following characteristics: chronic toxicity, assessment of specific activity, assessment of embryotoxic and teratogenic properties, assessment of allergenic properties Results. It was established that the introduction of the “Transfer factor” preparation in a chronic toxicological experiment is accompanied by the development of muscle tremor in the rodents’ body, the duration of which depends on the administered dose, route of administration and exposure time, but their body weight increases by 6.29–10.63 %. Autopsy of experimental group animals revealed no visible changes in the arrangement of internal organs and fluid accumulation in the abdominal and pleural cavities, although some pathological changes in color, consistency and size of the lungs, spleen, liver and heart were noted. The mass coefficients of these organs change with an increase in the dose of the administered drug “Transfer factor”, especially with the intraperitoneal route of administration up to 10.39 %. The tested drug in the reaction of lymphocyte blast transformation increases the number of blasts from 0.20 to 1.40 %. The totality of data allows us to state that the drug “Transfer factor” in accordance with GOST 12.1.007-76 belongs to the IV hazard class “low-hazard substances” and it can be recommended for further clinical trials, in which a dosage exceeding 6 ml/kg of live weight will not be used, when administered to laboratory animals, a complex of changes in the internal organs develops. Scientific novelty. The introduction of “Transfer factor” does not affect the condition and functions of the reproductive organs (uterus, ovaries) of pregnant rats, and the drug does not exhibit a negative embryotoxic and teratogenic effect in their body. When studying the allergenic properties of the drug, it was found that it does not cause a general anaphylaxis reaction in the body of guinea pigs, does not irritate the skin in the reaction of immune complexes and the conjunctiva of the eye in the conjunctival test.

Current state content analysis of patient-reported outcome measures and clinical needs assessment tools utilized throughout the cancer care continuum at an academic medical center.

238 Background: The Cancer Survivorship Care Quality Framework (CSCQ-F) is an evidence-based framework that outlines domains and indicators pertinent to the provision of quality cancer survivorship care. Many indicators from the CSCQ-F can be assessed by clinical interview or patient-reported outcome measures (PROMs) to gauge whether patients are receiving quality survivorship care. We conducted a current-state analysis of the PROMs and needs assessment tools (NATs) utilized throughout our academic medical center and assessed the extent to which constructs covered on our assessments align with relevant domains and indicators from the CSCQ-F. Methods: Healthcare leaders identified assessments currently available for use throughout oncology clinics at our institution. We included assessments directly completed by patients (i.e., PROMs) and assessments completed by clinicians based on patient feedback gathered through clinical interview or oncology nurse navigation (i.e., NATs). We excluded assessments not currently in use. We coded each assessment item by construct (e.g., depression, neuropathy, substance use, referral) and time of administration (e.g., new patient visits, treatment change, unknown). Then, we mapped items/constructs to the CSCQ-F domains. Afterward, we compared items/constructs mapped to the CSCQ-F domains with CSCQ-F indicators to identify gaps in assessment. Results: We identified two PROMs (Lucet and The Edmonton Symptom Assessment Scale (ESAS)) and two NATs (Epic Wheel and an internally developed cancer navigation assessment). Constructs covered by these assessments aligned with all domains of the CSCQ-F, except for “Patient/Caregiver Experience.” Gaps in assessment based on the CSCQ-F depend on which assessments patients receive. All new patients are administered Lucet (an electronic distress screening tool) and referred for cancer navigation assessment. However, ESAS is administered through Palliative Care, and it is unclear whether and when all providers administer Epic Wheel (a social determinants of health NAT). The CSCQ-F indicates reassessment of symptoms and/or conditions should occur at defined intervals throughout the cancer continuum, but there is no clear reassessment protocol at our institution. Conclusions: To our knowledge, this is the first content-analysis of PROMs and NATs mapped to the CSCQ-F. Our results signify a need to (1) address gaps in assessment, (2) determine a protocol for symptom reassessment, and (3) standardize enterprise-wide administration procedures for PROMs and NATs throughout the cancer continuum. Future work should also identify who is responsible for following up on patients’ identified concerns and determine whether adequate resources are available to address patients’ symptoms and needs.

Early intervention of 5% albumin shown superior control of vascular integrity and function compared to ringer’s lactatein hospitalized adult with grade I & II Dengue hemorrhagic fever: a multicenter randomized controlled trial in Indonesia

BackgroundDengue virus remains a major public health problem with one of the hallmark pathologies is the vascular leakage caused by endothelial dysfunction which can lead to Dengue Hemorrhagic Fever (DHF) manifestation. In the status quo, no specific therapy has been discovered but rather heavily relies on judicious and frequent monitoring of intravenous fluids administration. The current guideline has discussed the roles of fluid therapy during the Dengue Shock Syndrome (DSS) stage, however, administration of early fluid intervention for DHF grade I and II remains uncharted territory. In addition, the choice and timing of colloid administration remains underexplored. As one of the widely available colloids, 5% albumin has known physiological properties that potentially minimize plasma leakage. Therefore, this study aimed to evaluate the benefit of early intervention of 5% albumin in adults with DHF in the hope of preventing the lethal progression to DSS and further, shorten the length of stay (LOS) for patients.MethodsWe conducted a multicenter, open-labeled, randomized controlled trial in Jakarta and Banten to compare the effect of early intervention with 5% albumin in adult patients with DHF compared to Ringer’s Lactate (RL). Statistical analyses were conducted using unpaired t-test and Mann-Whitney for normally and abnormally distributed data respectively.ResultsAdult patients with a diagnosis of DHF grade I and II that being hospitalized to receive the early intervention of 5% albumin had significantly lower levels of hemoconcentration 4, 12, and 24 h (p = 0.002, 0.001, 0.003, respectively), higher platelet counts 4 h (p = 0.036), higher serum albumin levels 48 h (p = 0.036), lower proteinuria 24 and 48 h post-albumin administration (p < 0.001, < 0.001, respectively), and shorter LOS (p < 0.001) when compared to the RL group.ConclusionEarly intervention of 5% albumin showed better control on vascular integrity and function compared to ringer lactate in hospitalized adults with grade I & II DHF, thus halting the progression of DHF into DSS and other related complications which leads to faster recovery and shorter length of stay.Trial registrationThe study was registered to www.clinicaltrial.gov with trial registration number NCT04076254, and registration date October 31st 2016.

The impact of delayed versus early administration of granulocyte colony-stimulating factor following autologous hematopoietic stem cell transplantation on transplantation outcome.

Granulocyte colony-stimulating factor (G-CSF) is routinely administered after autologous hematopoietic stem cell transplantation (auto-HSCT) to decrease the duration of neutropenia and diminish the incidence of febrile neutropenia. Nevertheless, the most advantageous timeframe for administering G-CSF in the transplantation setting remains elusive. We conducted a cross-sectional study of 200 patients diagnosed with hematological malignancies who underwent auto-HSCT between July 2017 and January 2022. Patients were divided into two groups of 100 individuals based on the timing of G-CSF administration after auto-HSCT. In the first group, G-CSF was administered on post-transplantation day +1, while in the second group, G-CSF was administered on post-transplantation day +5. Patient demographics and clinical outcomes, including time to neutrophil engraftment, time to platelet engraftment, length of hospital stay, duration of fever, and incidence of bacterial and fungal bloodstream infections, were compared between the two groups. We identified a significantly shorter platelet engraftment time in the day +5 group than in the day +1 group (P<0.001), though the groups were similar regarding neutrophil engraftment time. The total number of G-CSF injections differed significantly according to the administration schedule. The number of red blood cells and length of hospital stay was greater in the day +1 group (all P<0.001). The incidence of bacterial and fungal bloodstream infections and duration of fever did not differ between the groups. Delayed administration of G-CSF on day +5 is as effective as early administration and can positively influence platelet engraftment, transfusion support, and hospitalization time.

Steroids in severe community-acquired pneumonia.

There is conflicting evidence regarding the use of steroids in severe community-acquired pneumonia (CAP), with previous randomised controlled trials limited by small sample sizes. ESCAPe and CAPE COD are two recently published large trials on steroids in severe CAP. ESCAPe assessed the initiation of methylprednisolone within 72-96 h of hospital admission, while CAPE COD studied the use of hydrocortisone within 24 h of the development of severe CAP. ESCAPe did not show any differences in all-cause 60-day mortality or any of its secondary outcomes. CAPE COD showed that hydrocortisone improved all-cause 28-day mortality and reduced the risk of intubation or vasopressor-dependent shock. Important differences between the trials included the steroid regimens used, timing of steroid administration and baseline characteristics, with more diabetic patients included in ESCAPe. The results of CAPE COD support the initiation of hydrocortisone within 24 h of developing severe CAP, but more research is needed to evaluate long-term outcomes and optimum dosing regimens for steroids in severe CAP.

S1361 Evening Timing of Inpatient Intravenous Infliximab Administration Is Associated With Worse Disease Outcomes

S1361 Evening Timing of Inpatient Intravenous Infliximab Administration Is Associated With Worse Disease Outcomes

Vasopressor or advanced airway first in cardiac arrest?

BackgroundWhile resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). MethodsWe analyzed data from the PART trial. For each patient we determined times of first vasopressor administration (epinephrine or vasopressin), and successful advanced airway insertion (laryngeal tube or endotracheal tube). We classified each case as vasopressor-first or advanced airway-first. We used Generalized Estimating Equations to determine associations between vasopressor-airway sequence and outcomes (72-hour survival, return of spontaneous circulation (ROSC) on emergency department arrival, survival to hospital discharge, hospital survival with favorable neurologic status) and CPR outside of recommended parameters (chest compression fraction <0.8, chest compression rate <100 or >120 per min, or ventilation rate <8 or >12 breaths/min), adjusting for confounders. ResultsOf 3,004 patients in the parent trial, we analyzed 2,404, including 1,821 vasopressor-first and 583 advanced airway-first. Median intervention times: ALS arrival-to-vasopressor 8 min (IQR 6–11) and ALS arrival-to-airway 11 min (8–15). Compared with airway-first, vasopressor-first sequence was not associated with 72-hour survival (adjusted OR 0.96; 95% CI: 0.71–1.31), ROSC (0.83; 0.66–1.06), hospital survival (1.09; 0.68–1.73), or hospital survival with favorable neurologic status (0.97; 0.53–1.78). Vasopressor-first sequence was not associated with non-compliance with recommended CPR performance parameters. ConclusionsVasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.

Efficacy of timing‑dependent infusion of nivolumab in patients with advanced gastric cancer.

Although an association exists between the timing of immune checkpoint inhibitor (ICI) administration and therapeutic efficacy in several types of cancer, to the best of our knowledge, no reports exist regarding this relationship in gastric cancer (GC). The present study aimed to evaluate the optimal timing of ICI (nivolumab) administration in patients with advanced GC. A total of 58 consecutive patients with advanced GC who received nivolumab monotherapy after ≥2 chemotherapy regimens were retrospectively evaluated. These patients were divided into two groups according to the median time of nivolumab administration: i) Early-timing and (ii) late-timing groups, and the efficacy was assessed in both groups. The early-timing group had significantly longer overall survival (OS) than the late-timing group [median OS 8.2 months; 95% confidence interval (CI), 4.2-12.9 vs. median OS 5.4 months; 95% CI, 3.6-6.1]. Moreover, patients in the early-timing group had significantly longer progression-free survival (PFS) than those in the late-timing group (median PFS 2.6 months; 95% CI, 1.3-3.9 months vs. median PFS 1.6 months; 95% CI, 0.9-2.1 months). Furthermore, univariate analysis showed that early timing, immune-related adverse events and nonsteroidal anti-inflammatory drug administration were associated with longer OS and PFS. Cutoff Finder analysis revealed that the optimal timing of nivolumab administration for achieving better outcomes was before 12:06 p.m. Nivolumab administration in the morning, especially before 12:06 p.m., had a better clinical impact on patients with advanced GC.

Formulation and optimization of transferrin-modified genistein nanocrystals: In vitro anti-cancer assessment and pharmacokinetic evaluation

In this research work, nanocrystals (NC) of poorly water-soluble drug genistein (Gen) were formulated to improve its aqueous solubility and bioavailability. Genistein nanocrystals (Gen–NC) were prepared by wet ball milling. The formulation was optimized using Box Behnken Design Expert to evaluate the impact of stabilizer concentration, drug concentration and quantity of zirconium beads (milling media) on NC size, polydispersity and zeta potential. The NCs were surface-decorated with transferrin (Tf) to form Tf modified Gen-NCs (Tf-Gen-NC) for improving cancer cell selectivity and cytotoxicity. The NC formulations were characterized by dynamic light scattering (DLS), scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray power diffraction (XRD) and differential scanning calorimetry (DSC). The particle size distribution of the optimized formulation varied from 200 to 300 nm with poly dispersibility index (PDI) between 0.1 and 0.3. Tf-Gen-NC and Gen-NC released 96 % and 80 % of the drug content in 20 min at 37 °C, respectively, whereas only 18 % were released with the unprocessed drug. In vitro cytotoxicity was tested in pulmonary adenocarcinoma epithelial cells (A549) and fibroblast cell line (L929). The Tf-Gen-NC presented an enhanced anticancer effect. In vivo pharmacokinetic studies in mice after intraperitoneal administration showed that the Cmax of NC formulations were 2.5-fold higher compared to free Gen. The area under the curve from time of administration to 24 h was 2.5 to 3-fold higher when compared with unprocessed drug. This study shows the interest of Gen-NC in the development of new formulations for Gen as an anticancer drug.

Investigating the Optimal Time of Administration of Heparin that will Improve Survival in a Murine Model of Sepsis

Investigating the Optimal Time of Administration of Heparin that will Improve Survival in a Murine Model of Sepsis

Impact of anesthesiologist experience on neuraxial anesthesia outcomes in cesarean sections.

Despite the requirement for meticulous management of cesarean anesthesia, no study has explored the impact of novice trainee anesthesiologists in this field. This study assessed challenges in neuraxial anesthesia for cesarean sections and compared outcomes between novice and senior anesthesiologists. We retrospectively analyzed 446 cesarean sections with neuraxial anesthesia. The primary objective was to evaluate the impact of anesthesiologists' experience on the time required to administer neuraxial anesthesia and whether maternal body mass index (BMI) influenced this relationship. Secondary objectives included examining maternal hemodynamic variability, operative details, and newborn outcomes relative to the anesthesiologist's experience. Novice anesthesiologists required a significantly longer time to perform neuraxial anesthesia (24.9 [7.1] min vs. 18.2 [7.0] min, P<0.001) than their senior counterparts. A significant interaction was observed between anesthesiologist experience and maternal BMI on the time to administer neuraxial anesthesia (P=0.017), with a moderate correlation between BMI and administration time for novices (r=0.50, P<0.001) and only a slight correlation for seniors (r=0.17, P=0.001). Experience level did not significantly affect intraoperative hemodynamics, Apgar scores, or umbilical cord blood gas analyses. The effect of maternal BMI on the difficulty of performing neuraxial anesthesia in parturients can be more pronounced for novice anesthesiologists than for experienced ones. Despite requiring more time to perform neuraxial anesthesia, novice anesthesiologists do not significantly affect maternal hemodynamics or newborn distress during obstetric anesthesia, provided that they are under the supervision of experienced anesthesiologists.

Optimal MMSE and MoCA cutoffs for cognitive diagnoses in Parkinson's disease: A data-driven decision tree model

BackgroundDetecting cognitive impairment in Parkinson's disease (PD) is challenging due to diverse manifestations and outdated diagnostic criteria. Cognitive screening tools, as Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), are adopted worldwide, but despite several cutoffs has been proposed for PD, no consensus has been reached, hindered by limited sample sizes, lack of validation, and inconsistent age- and education-adjustments. ObjectivesDetermine the optimal MMSE and MoCA cutoffs in a large PD cohort, spanning from normal cognition (PD-NC), mild cognitive impairment (PD-MCI) to dementia (PDD), and develop a decision tree model to assist physicians in cognitive workups. MethodsOur retrospective Italian multicenter study involves 1780 PD, cognitively diagnosed with a level-II assessment: PD-NC(n = 700), PD-MCI(n = 706), and PDD(n = 374). Optimal cutoffs (for raw scores) were determined through ROC analysis. Then, a machine learning approach—decision trees—was adopted to validate and analyze the possible inclusion of other relevant clinical features. ResultsThe decision tree model selected as primary feature a MMSE cutoff ≤24 to predict dementia, and a score ≤ 27 for PD-MCI. To enhance PD-MCIvs.PD-NC accuracy, it also recommends including a MoCA score ≤ 22 for PD-MCI, and > 22 for PD-NC. Age and education were not selected as relevant features for the cognitive workup. Both MoCA and MMSE cutoffs exhibited high sensitivity and specificity in detecting PD cognitive statues. ConclusionsFor the first time, a clinical decision tree model based on robust MMSE and MoCA cutoffs has been developed, allowing to diagnose PD-MCI and/or PDD with a high accuracy and short administration time.

Venous thromboembolism secondary prophylaxis in elderly people (over 75-year-old) with low-dose direct oral anticoagulants: single-center Italian experience

Nowadays, direct oral anticoagulants (DOACs) represent the gold standard for venous thromboembolism (VTE) treatment and VTE secondary prophylaxis; nevertheless, the percentage of elderly patients in major trials and literature data about DOACs usage for VTE secondary prophylaxis in the elderly are scant. Our retrospective study tried to evaluate low-dose DOACs efficacy and safety for elderly VTE secondary prophylaxis in a real-life setting. A cohort of 73 patients (≥ 75 years) considered at high risk of VTE recurrence was treated with apixaban 2.5 mg twice daily (b.i.d.) or rivaroxaban 10 mg daily as VTE secondary prophylaxis. The median low-dose DOACs administration time was 18.40 months. Three (4.1%) VTE recurrence events were observed, with four bleeding events registered (5.5%), including one major bleeding (MB) (1.4%) and two clinically relevant non major bleeding (CRNMB) (2.7%). Our data suggest that low-dose DOACs may be effective and well tolerated for secondary VTE prophylaxis in elderly patients at high risk of VTE recurrence.

REVIEW : ANALISIS PENGGUNAAN ANTIBIOTIK PROFILAKSIS PADA PASIEN PASCA BEDAH SESAR DI BEBERAPA RUMAH SAKIT DI INDONESIA

Caesarean section shows an increase from year to year. The number of cesarean births every year also has an impact on the increase in post-surgical complications. The purpose of this article is to examine the effectiveness of the use of prophylactic antibiotics in patients after caesarean section. A systematic review of articles and publications published in the year 2014 to 2024 used 9 articles and used the search keyword, which is prophylactic antibiotics after caesarean section. The description of the use of prophylactic antibiotics that was seen includes the type, time of administration, method of administration, duration of treatment and dose of antibiotics, compared to the main guidelines of basic treatment of pharmacology and therapy according to Goodman &amp; Gilman. It can be concluded that the most widely used antibiotics are the third generation cephalosporins, namely ceftriaxone and cefotaxime. These antibiotics are broad-spectrum, and target gram positive and gram negative bacteria, and are commonly used as prophylactic antibiotics in caesarean section patients.

SAFETY EVALUATION ON THE USE OF HIGH ALERT DRUGS IN RSUD ARIFIN ACHMAD RIAU PROVINCE

High alert drugs are drugs that have a high percentage of causing risk of harm to patients. To avoid errors, high alert drugs must be used properly, including storage and marking. The objective of this study was determine the safe use of high alert drugs at Arifin Achmad Hospital in Riau Province. This was a descriptive study that included 68 pharmacy officers. A questionnaire was used to collect data, which was the univariately analysed on a computer system. The result showed that the accuracy of the use of high alert drugs based on the 5 principles was in the good category. As many as 65 people (95.6%) were good at the right patient, 67 people (98.5%) were good at the right drug, 66 people (97.1%) were good at the right time of administration, 65 people (95.6%) were good at the right dose, and 66 people (97.1%) were good at the right route of administration. As many as 67 (98.5%) rated the storage safety and labelling of high alert drugs as good. The conclusion of this study is that the implementation of the five rights principle of medication, storage safety and labelling of high alert drugs at Arifin Achmad Hospital in Riau Province has reached a good level.

Chronopharmacokinetics: A Brief Analysis of the Influence of Circadian Rhythm on the Absorption, Distribution, Metabolism, and Elimination of Drugs

Chronopharmacokinetics is a specialized field within pharmacokinetics that focuses on how the timing of drug administration affects the absorption, distribution, metabolism, and elimination of drugs. The circadian rhythm, governed by the body's biological clock, plays a crucial role in pharmacokinetics, which encompasses the absorption, distribution, metabolism, and elimination of drugs. These pharmacokinetic processes are subject to daily variations influenced by the circadian rhythm. Drug absorption can fluctuate due to changes in gastrointestinal function, such as motility and gastric pH, and blood circulation. Similarly, the distribution of drugs in the body is influenced by factors such as tissue perfusion, plasma protein binding, and cell membrane permeability, all of which are modulated by the circadian rhythm. Metabolism, especially hepatic metabolism, can also experience circadian variations that affect the rate at which drugs are processed and converted into active or inactive metabolites. Finally, the elimination of drugs, primarily through renal function, can show circadian rhythms that impact the excretion of compounds from the body. Understanding these circadian fluctuations is essential to optimize the efficacy and safety of pharmacological treatments, as dosages and administration times could be adjusted to align with the peaks of biological clock activity. Thus, treatments can be more effective and have fewer side effects by leveraging the circadian variability in pharmacokinetic processes.

The Management of Teacher Creativity Development in Optimizing the Merdeka Curriculum

The Merdeka Curriculum is one of the government’s effort in enhancing the quality of education in Indonesia. In its implementation, the Merdeka Curriculum initiating differentiated learning based on student’s needs. Therefore, teacher creativity is crucial in creating effective learning experiences. This study aims to explore the management of teacher creativity development done in SMP Negeri 3 Balikpapan in optimizing the implementation of the Merdeka Curriculum. This research was carried by using a qualitative method with a case study approach. To obtain the data needed, this research did interviews with the principal and teachers, observations, and school document analysis. Data analysis was conducted using Biklen &amp; Bogdan's qualitative data analysis method. The research found that the management of teacher creativity development at SMP Negeri 3 Balikpapan is carried out through the stages of planning, organizing, implementation, and controlling. Planning involves setting objectives, conducting joint discussions, planning programs, and evaluating programs. The school implements several programs for teacher creativity development, including learning communities (kombel), PMM, and teacher training. Organizing stage involves task allocation, collaboration, and forming implementation teams. During the implementation stage, the principal motivates, provides guidance, and builds effective communication. Meanwhile, the controlling stage includes evaluation meetings, monitoring, and supervision. In implementing the teacher creativity management program, the school encounters several obstacles, such as administrative burdens, time constraints, and limited use of technology.

The dimensional structure of the Positive and Negative Syndrome Scale in first-episode schizophrenia spectrum disorders: an Exploratory Graph Analysis from the OPTiMiSE trial

The Positive and Negative Syndrome Scale (PANSS) is the most widely used rating scale to assess psychotic symptoms in patients with schizophrenia and other primary psychoses. However, a definitive consensus regarding its dimensional structure remains elusive. The present work aims to determine the number of dimensions of the scale through a network analysis approach in a sample of individuals experiencing first-episode schizophrenia spectrum disorder (FE-SSD) with minimal or no prior exposure to antipsychotic treatment. Baseline data of 446 participants (age 25.96 ± 5.99 years, 70% males) enrolled in the OPTiMiSE trial were analysed. Exploratory Graph Analysis (EGA) was conducted to evaluate the dimensionality of the PANSS, and a bootstrap approach (bootEGA) was employed to assess model stability. The analysis was replicated, excluding unstable items with stability values below 0.75, until a stable model was achieved. The analysis of the 30 items of the PANSS revealed inadequate structural consistency, resulting in the exclusion of 9 unstable items. The final model comprised 21 symptoms distributed across four communities (Positive, Cognitive/Disorganised, Excited/Aggressive and Negative) but lacked a depressive domain. In conclusion, we propose a concise version of the PANSS, incorporating 21 items, to better assess the core symptoms of the first episode of SSD. This revised version provides clinicians with a robust psychometric tool with reduced administration time, but the complementary administration of a dedicated instrument for evaluating affective symptoms is advisable.

Antibiotic use in cesarean procedures in developing countries: current practices and improvements

Cesarean delivery, a common surgical procedure worldwide, is associated with a significantly increased risk of postoperative infections compared to vaginal births. This risk is notably higher in developing countries due to varying practices in antibiotic prophylaxis and differences in healthcare settings. This study aims to evaluate the current practices and potential improvements in antibiotic use in cesarean sections within these regions. Our analysis revealed that cesarean sections are performed at an increased rate in developing countries, with infection rates ranging from 10% to 40%, primarily due to inconsistent and often inadequate antibiotic prophylaxis. The most common postoperative infections include endometritis, wound infections, and urinary tract infections, largely influenced by factors such as the timing of antibiotic administration, the choice of antibiotic, and the presence of risk factors like prolonged labor and membrane rupture. The standard practice in many developing countries involves the administration of antibiotics post-cord clamping, which has been challenged by recent studies suggesting that preoperative administration can significantly reduce infection rates without adverse effects on neonatal outcomes. A shift towards a single dose of broad-spectrum antibiotics such as cephalosporins administered 30-60 minutes before incision is recommended based on our findings. This approach aligns with the successful reduction of infectious morbidity observed in developed countries and supports the need for standardized guidelines. Furthermore, our study underscores the importance of healthcare provider education and the establishment of clear protocols for antibiotic prophylaxis in cesarean sections. By adopting these improvements, developing countries can achieve a significant reduction in maternal morbidity and contribute to safer childbirth practices.