Areas For Improvement In Management Research Articles

Website-based Gray Literature Collection Management Darmajaya Repository

Background: College libraries not only provide printed collections such as books for lecture materials, but some of them provide collections not published to the public, usually called Gray Literature. The Gray Literature Collection is one of the main factors to consider when assessing a university library. The Gray Literature Collection contains various research results that the library/user needs. The Repository is an archival storage place designed to collect, preserve, and disseminate digital copies, especially the Darmajaya Repository Gray Literature Collection..
 Purpose: This research aims to describe how the Repository is managed at the IIB Darmajaya Library and the obstacles librarians face during the management stage.
 Design and methods: This research uses a qualitative descriptive method using case study research. Data collection uses observation and interviews. Data analysis in this research includes data reduction, data presentation, and conclusion, while a triangulation approach is used to measure validity.
 Results: Based on the findings of this research, Repository management at the IIB Darmajaya Library is carried out by determining management policies, preparing hardware and software, Human Resources, and procedures for receiving collections. The final stage is uploading files into the Darmajaya Repository system. Problems are faced in managing the Darmajaya Repository because it is still in the development process, so there are still areas for improvement in management, implementation, and presentation.

Survival outcomes and clinicopathological factors analysis of breast cancer patients. A single-institution cohort from 2012 to 2020 in a Mexican population.

e13104 Background: In Mexico, The Instituto Mexicano del Seguro Social (IMSS) is a tripartite contribution which provides care to more than 74 million beneficiaries, which represents more than 50% of the general population of the country. Although Mexican breast cancer statistics have been reported, it is imperative to know the updated statistics on the epidemiology in our Institution. The aim of this study is to describe the survival outcomes and the clinical-pathological characteristics of patients with breast cancer. Methods: Records of breast cancer patients treated at the Oncology Hospital from Centro Medico Nacional Siglo XXI of IMSS, from January 2012 to December 2020 were included. We analyzed clinical and demographic characteristics of the population, as well as survival outcomes at 5-years. Results: A cohort of 5,264 patients was included. Median follow up was 54.9 months. Forty-three percent (n = 2,274) were diagnosed in early-stage breast cancer (I–IIA), 43.1% (n = 2,269) in stages IIB-III, and 7% (n = 383) in stage IV. The most common immunophenotype was hormone receptor (HR) positive, HER2-negative (70.8%, n = 3,726). HER2-positive represents 19.3% (n = 1011), among HR-positive were 12.4% (n = 650) and HR-negative, 6.9% (n = 361). 527 patients (10.1%) were triple negative. At 5-years, disease-free survival was 74.9% (95% CI, 73.5 to 76.3) and overall survival was 90.4% (95% CI, 89.4 to 91.3). High histologic grade (HR 1.51; 95% CI, 1.33 to 1.7; p < 0.001) and lymphovascular invasion (HR 1.84; 95% CI, 1.62 to 2.1; p < 0.001) were associated with higher risk of recurrence. Adjuvant chemotherapy was significantly associated to a 42% reduction in the risk of recurrence, HR 0.58 (95% CI, 0.49 to 0.69; p < 0.0001), and 54% in the risk of death, HR 0.46 (95% CI, 0.33 to 0.63; p < 0.0001) in stage III. Lobular histology was also associated with worse survival, HR 1.41 (95% CI, 1.069 to 1.859; p = 0.015). Conclusions: An update of breast cancer Mexican patients treated at IMSS is presented. We highlight the impact of adjuvant treatment and pathological risk factors for recurrence and death. This work can contribute to evaluate areas for improvement in management and outcomes in our population.

Conservative Management in Lower Extremity Gunshot Injuries: A Ten-Year Experience

Indications for immediate operative exploration in vascular trauma have been well described in the literature. However, this indication is often blurred in cases where the patient has diminished but present pulses, or only single-vessel runoff in the injured lower extremity. Improvements in quality of computed tomography angiography (CTA) has allowed for an increase in conservative management of vascular trauma. The objective of this study was to examine outcomes at a tertiary level 1 trauma center to validate practices and confirm that conservative, nonoperative management of diminished runoff has safe outcomes, and additionally to identify areas for improvement in management.

Abstract PCCLB-27: CLINICAL MANAGEMENT AND OUTCOMES OF PEDIATRIC SEPSIS IN A PUBLIC REFERRAL HOSPITAL IN TANZANIA

Aims & Objectives: In 2015, 2.6 million children died due to infections with the highest rates in sub-Saharan Africa (SSA). Sepsis is the final common pathway for most infectious deaths and initial management can greatly impact survival. We aimed to identify areas for improvement in the management of pediatric sepsis in Tanzania. Methods Prospective cohort study of children (28 days–14 years) with sepsis (by clinical systemic inflammatory response syndrome criteria) in the emergency medicine department (EMD) at Muhimbili National Hospital, Dar es Salaam. We performed univariate, bivariate and multivariable logistic regression analyses using StataMP 14.2. A p-value <0.05 was considered statistically significant and strength of association was determined by calculating odds ratios (OR) and 95% confidence intervals (CI). Results From July 1-September 30, 2016, 405 patients were enrolled with a median age of 25 months (IQR 11–63). The prevalence of diagnosed malaria, HIV and severe malnutrition was 9%, 2%, and 13%, respectively. In the EMD, patients received antibiotics 54% and a blood culture 1% of the time. EMD and in-hospital mortality were 1.5% (n=6) and 14% (n=57), respectively. Non-survivors were more likely than survivors to have received at least one fluid bolus (65% vs. 35%, p<0.0001), and bolus compared to no bolus was associated with an adjusted OR for mortality of 2.4 (95% CI 1.1–4.9). Conclusions We observed high in-hospital mortality and identified three areas for improvement in pediatric sepsis management: (1) antibiotic administration, (2) source identification, and (3) modification of the fluid resuscitation approach.

Diabetes management in an Australian primary care population

Worldwide studies have shown that significant proportions of patients with type 2 diabetes (T2DM) do not meet targets for glycaemic control, blood pressure (BP) and lipids, putting them at higher risk of developing complications. However, little is known about medicines management in Australian primary care populations with T2DM. The aim of this study was to (i) describe the management of a large group of patients in primary care, (ii) identify areas for improvement in management and (iii) determine any relationship between adherence and glycaemic, BP and lipid control. This was a retrospective, epidemiological study of primary care patients with T2DM diabetes, with HbA(1c) of >7%, recruited in 90 Australian community pharmacies. Data collected included demographic details, diabetes history, current medication regimen, height, weight, BP, physical activity and smoking status. Of the 430 patients, 98% used antidiabetics, 80% antihypertensives, 73% lipid lowering drugs and 38% aspirin. BP and all lipid targets were met by only 21% and 14% of the treated patients and 21% and 12% of the untreated patients respectively. Medication adherence was related to better glycaemic control (P = 0.04). An evidence-base prescribing practice gap was seen in this Australian primary care population of T2DM patients. Patients were undertreated with antihypertensive and lipid lowering medication, and several subgroups with co-morbidities were not receiving the recommended pharmacotherapy. Interventions are required to redress the current evidence-base prescribing practice gap in disease management in primary care.

Needlestick injuries and infectious diseases in emergency medicine

Needlestick injuries are an occupational hazard for junior doctors, especially in emergency medicine. The emergency department is involved in the management of injuries both in the hospital setting and in the community. The setting was in an innercity area with a high incidence of intravenous drug abuse, HIV, hepatitis B and hepatitis C. The study was to highlight areas for improvement in management.