Challenges In Practice Research Articles

Using Small Group Mentorship as a Change Process: Through the Lens of the Clinician

Abstract Date Presented 03/22/24 The mentorship and its instructional content supported clinicians in developing and validating comprehension of the content, in their professional development and assisted them in navigating opportunities and challenges in clinical practice. Primary Author and Speaker: Bryan M. Gee Additional Authors and Speakers: Sarah A. Schoen, Natalie King, Mim Ochsenbein

Compliance and determinants of infection prevention and control practices among sanitary workers in public hospitals, Eastern Ethiopia: A cross-sectional study.

Best practice of infection prevention and control (IPC) is a hallmark for the patient care in health care settings, but it is a major problem in developing countries like Ethiopia where resources are limited. Ethiopia Federal Ministry of Health working to strengthen its IPC program, but still it there is no organized study conducted on assessment of performance gaps and implementation challenges of IPC practice faced by hospital staffs particularly among sanitary workers (SWs) at public hospitals inline to national and international guidelines. This study focuses on compliance and determinants of IPC among sanitary worker in public hospitals in eastern Ethiopia: A cross sectional study design. A cross-sectional study was conducted among 809 SWs and eight IPC experts in public hospitals, eastern Ethiopia, from May to August 2023. A standard questionnaire was used to collect data. Face-to-face interview was conducted. Ten (10) question pursued to answer YES/NO were prepared. The cut point for categories of IPC practice was 1: Good (16-20 scores), 2: Fair (10-15 scores), and 3: Poor (<10 scores). The cut point for compliance and noncompliance of IPC practice among hospitals was mean (500.1). Multi-level ordinal logistic regression models was applied to explore the association of dependent and independent variables at individual level (Model 1), hospital level (Model 2) and at both (Model 3). Crude odds ratio (COR) and adjusted odds ratio (AOR) at 95% confidence interval (CI) were used to report the result. The compliance of IPC practice among SWs was 36.21% (32.72, 39.82%). The Multilevel ordinal logistic regression model shows that SWs who have good knowledge of IPC trend (AOR: 4.70, 95% CI: 2.11-10.46), SWs who are not addictive with alcohol (AOR: 2.35, 95% CI: 1.15,4.78) and chew Khat (AOR: 1.62, 95% CI: 1.06,2.46) and smoke cigarette (AOR: 3.15, 95% CI: 2.35-5.41), and SWs without job stress (AOR: 1.46, 95% CI: 0.86-2.48) were more compliant to IPC practice. Similarly, those who do not have workload (AOR: 2.74, 95% CI: 1.56-4.82), work <8 h/day (AOR: 1.46, 95% CI: 0.92-2.30), and those who have good social recognition in hospitals (AOR: 6.08, 95% CI: 4.24-8.71) were more likely to increase the compliance of IPC practice among SWs. The multilevel random-effect model revealed 93.71% of the variability of compliance of IPC practice explained by both individual and hospital level factors. The overall study found that inadequate IPC practice was reported among SWs as well as by IPC experts due to poor knowledge of IPC trend and individual behaviors and working environment. Thus, the study advised that hospitals have to develop and establish IPC implementation guidelines in order to solve the concerns among these groups; national IPC office should follow its implementation across health care settings particularly at public hospitals.

Green Public Procurement in Public Administration: Perceptions and Challenges in Practice

ABSTRACT The implementation of green public procurement (GPP) in the Maltese public administration was perceived as an important step that supports the achievement of environmental policies. Institutions are in place for the application of GPP. However, there are difficulties in practice, and more needs to be done in terms of training and capacity development. This study concludes that managerial decisions are taken to legitimize actions, so that the administrator appears to be doing the right thing in the eyes of the stakeholders. Institutions intentionally adopt GPP to adhere to the norms and values of society. Whether GPP has a positive effect on the environment is a secondary objective.

Evolution and Challenges of Environmental, Social, and Governance Practices: An Analysis of the Brazilian Stock Exchange’s Corporate Sustainability Index

Environmental, social, and governance (ESG) practices are increasingly recognized as critical for corporate sustainability and market competitiveness, driven by heightened expectations from investors, governments, and consumers. This study examines the evolution of ESG practices among companies listed on the Brazilian Stock Exchange’s Corporate Sustainability Index (ISE B3) from 2005 to 2022. We analyzed the index portfolio’s composition, focusing on changes in ESG dimensions over time. The only six long-lived companies in this index, from retail, banking, and energy sectors, were selected for in-depth analysis. We further evaluated the quality and consistency of ESG disclosures in company reports. Findings indicate relevant fluctuations in the number of companies included in the ISE B3 and variations in ESG scores for the companies. These variations may be attributed to the voluntary nature of ESG practices and the absence of standard disclosure. This study reveals a lack of homogeneity in ESG reporting, which could be addressed by establishing more straightforward guidelines and global standards. This research underscores Brazilian companies’ challenges navigating diverse ESG frameworks to align with evolving societal and environmental expectations.

Challenges in viticulture practices in a changing environment: Can green waste amendment benefit soil properties of vineyards in the Mediterranean?

In Southeastern France, viticulture is of great social, cultural, and economic importance. This sector is threatened by climate change particularly in the Mediterranean (longer droughts and more frequent heat waves) where soils are poor in organic matter and weakly developed. Since organic amendment can strongly modify soil properties and consequently the final products (grapes and wine), the effects of sustainable practices on soil characteristics have to be carefully assessed. This seasonal field survey focuses on the effects green waste amendment (GWA), i.e. semi-composted green wastes, have on vineyard soil functionality. The effects of GWA were compared with those of grass cover (GC), known as a sustainable practice. Soils were collected in vineyards under organic practices (Bouches-du-Rhône and Var, France) over four seasons and physico-chemical (Total C and N, pHwater, pHKCL, EC, WHC, copper content and soil organic carbon SOC) and biological (microbial respiration and biomass, microbial catabolic structure, earthworm abundance and biomass) properties were characterized. Both practices were beneficial to soil physicochemical properties. For example, under both practices, higher (2 fold) Total N and SOC on late spring were observed. Both GWA and GC favored soil microbial communities, with microbial respiration having doubled and tripled on late spring. Similar results were observed for microbial biomass and both bacterial and fungal catabolic diversities (increased approximately by half) over summer. These benefits were particularly prominent during drought season (June and August), and probably linked to a shift in microbial communities as revealed by catabolic profiles. GWA also favored abundance and biomass of earthworm during winter. These findings reveal the potential GWA to counteract the effect of tillage, to mitigate the stress from drought and to improve overall soil functionality in vineyards.

A cloud–edge collaboration based quality-related hierarchical fault detection framework for large-scale manufacturing processes

Against the backdrop of the new-generation intelligent manufacturing and Industrial Internet of Things, manufacturing processes are evolving towards integration, large-scale operations, and complexity, and the requirements for process safety and product quality reliability are constantly improving. However, these processes are generally distinguished by multi-production sub-processes with cooperative coupling, and multi-hierarchical levels integrated automation systems, where any deviation or abnormality occurring within a sub-process or system level will lead to the extensive propagation and evolution of faults, making the comprehensive quality-related fault detection face increasing challenges in practice. In response, a novel cloud–edge collaboration-based quality-related hierarchical fault detection framework is constructed in this paper, which can facilitate interconnected communication between sub-processes and enhance collaborative interactions at different hierarchical levels to improve fault detection accuracy and reliability. First, two quality supervised training mechanisms based on minimal gated unit are introduced for capturing different scale dynamics features on the cloud side and edge side. These methods enable more adequate extraction of quality-related deep hidden features, particularly in the presence of nonlinearity and dynamics. Subsequently, a federated bi-directional knowledge distillation-based strategy is proposed, leveraging the concept of federated learning. Quality knowledge such as prediction and quality-related features from both the cloud side and edge side are integrated into the training steps of federated learning, thereby strengthening the interaction between multiple sub-processes and distinct levels. Furthermore, comprehensive quality-related fault detection strategies are formulated based on the quality-related features of the cloud side and each sub-process on the edge side, respectively. Finally, the proposed framework is deployed into a cloud–edge-device collaborative prototype system based on a real hot strip mill process to demonstrate its effectiveness and applicability.

An unusual cause of inappropriate shocks delivered by an implantable cardioverter defibrillator

IntroductionCardiac implantable electronic device (CIED) complications present significant challenges in clinical practice, especially in elderly patients with multiple comorbidities. Common adverse events include infection, lead malfunction, and device migration. Twiddler’s Syndrome, a rare but serious CIED complication characterised by patient manipulation causing lead displacement and device malfunction, is often underreported. The literature consists mainly of case reports and small series, providing limited guidance on prevention and management. As CIEDs are critical for managing cardiac arrhythmias and heart failure, understanding and addressing Twiddler’s Syndrome is essential. This case report aims to contribute to the literature by detailing a case of Twiddler’s Syndrome, emphasising the importance of a multidisciplinary approach for optimal management.Case PresentationA 59-year-old male presented with discomfort around his implantable cardioverter defibrillator (ICD) site and the sternal area over the past two days. He denied pain, dyspnoea, or dizziness. Clinical examination revealed a normal heart rhythm and no peripheral pulse deficit. Ultrasound revealed a reduced left ventricular ejection fraction. The atrial lead was not visible, and the shock coil was misplaced. ICD interrogation showed inappropriate shocks due to sensing artifacts and exit block in both leads, with no arrhythmias detected. An X-ray confirmed lead dislodgement and significant entanglement in the pocket. The patient was diagnosed with Twiddler’s Syndrome and scheduled for surgical revision.Discussion/ConclusionsDilated cardiomyopathy (DCM), characterised by left ventricular dilatation and dysfunction, accounts for a significant proportion of systolic heart failure cases. Despite advancements in heart failure management, DCM patients remain at high risk for sudden cardiac death (SCD), making ICD implantation crucial. However, CIED placement carries risks of complications, including Twiddler’s Syndrome. This condition can lead to lead dislodgement and device malfunction, resulting in inappropriate shocks and potential patient harm. In this case, a single-session extraction and re-implantation were successfully performed using a multidisciplinary approach, emphasising the importance of comprehensive management strategies to address such complications effectively. Regular follow-up showed no adverse events, highlighting the procedure’s success and the potential benefits of using advanced antimicrobial adjuncts to prevent infections. This case underscores the need for awareness and standardised protocols for managing Twiddler’s Syndrome to improve patient outcomes in the growing population of CIED recipients.

Authentic assessment in medical education: exploring AI integration and student-as-partners collaboration.

Traditional assessments often lack flexibility, personalized feedback, real-world applicability, and the ability to measure skills beyond rote memorization. These may not adequately accommodate diverse learning styles and preferences, nor do they always foster critical thinking or creativity. The inclusion of Artificial Intelligence (AI), especially Generative Pre-trained Transformers, in medical education marks a significant shift, offering both exciting opportunities and notable challenges for authentic assessment practices. Various fields, including anatomy, physiology, pharmacy, dentistry, and pathology, are anticipated to employ the metaverse for authentic assessments increasingly. This innovative approach will likely enable students to engage in immersive, project-based learning experiences, facilitating interdisciplinary collaboration and providing a platform for real-world application of knowledge and skills. This commentary paper explores how AI, authentic assessment, and Student-as-Partners (SaP) methodologies can work together to reshape assessment practices in medical education. The paper provides practical insights into effectively utilizing AI tools to create authentic assessments, offering educators actionable guidance to enhance their teaching practices. It also addresses the challenges and ethical considerations inherent in implementing AI-driven assessments, emphasizing the need for responsible and inclusive practices within medical education. Advocating for a collaborative approach between AI and SaP methodologies, the commentary proposes a robust plan to ensure ethical use while upholding academic integrity. Through navigating emerging assessment paradigms and promoting genuine evaluation of medical knowledge and proficiency, this collaborative effort aims to elevate the quality of medical education and better prepare learners for the complexities of clinical practice.

Challenges of Business Practices in Digital Culture Transformation in the Era of the Covid 19 Pandemic

This article aims to collaborate on the impact of COVID-19 on business practices in the transformation of digital culture in Indonesia. Although digital transformation has occurred so far, the Covid-19 pandemic has also strengthened changes in business practices at the level of Indonesian society which then creates a digital culture in this context, digital culture is the result of digital-based thinking, creation, and creation of human works. Nevertheless, the emergence of digital culture has had a positive impact such as the development of business practices and the strengthening of digital communication. Meanwhile, the negative impact can be seen from lifestyle changes due to high dependence on social media. Nevertheless, changes in digital culture at the public level must be immediately anticipated through digital literacy strengthening programs.

Teacher Education during the COVID-19 Pandemic: Tensions and Challenges of Initial Teacher Training Practices

The objective of the study is to characterize the ways of understanding and functioning of the formative triads of pedagogical practices, based on the decisions, tensions, and challenges faced by the initial teacher training programs in times of pandemic. The research used a qualitative-phenomenological perspective, inquiring into natural situations experienced by the formative triads of the pedagogical careers of 23 Chilean universities with recognized trajectories in teacher training. The interviews were conducted when the country was in a health emergency, that is, when schools and universities were carrying out remote teaching. The results show that the pandemic transformed the collaborative links between schools and universities, some links were broken, and others were strengthened, showing that the functioning of the triads is more declarative than real. In addition, the trainers (university tutor teacher and school guide teacher) faced two disconnected scenarios (school and university) that did not provide them with clear guidelines and concrete support for the development of their roles. This research has relevance for teacher training programs because it stresses the design of action plans to give continuity to practices in emergency situations and orients the evaluation of practice models to decide if they have the conditions to implement a model based on the formative triad.

Detection of hemophilia A genetic variants using third-generation long-read sequencing

BackgroundHemophilia A (HA) is an X-linked recessive genetic disorder caused by pathogenic variations of the factor VIII −encoding gene, F8 gene. Due to the large size and diverse types of variations in the F8 gene, causative mutations in F8 cannot be simultaneously detected in one step by traditional molecular analysis, and genetic molecular diagnosis and prenatal screening of HA still face significant difficulties and challenges in clinical practice. Therefore, we aimed to develop and validate an efficient, accurate, and time-saving method for the genetic detection of HA. MethodsA comprehensive analysis of hemophilia A (CAHEA) method based on long-range PCR and long-read sequencing (LRS) was used to detect F8 gene mutations in 14 clinical HA samples. The LRS results were compared with those of the conventional methods to evaluate the accuracy and sensitivity of the proposed approach. ResultsThe CAHEA method successfully identified 14 F8 variants in all probands, including 3 small insertion deletions, 4 single nucleotide variants, and 7 intron 22 inversions in a “one-step” manner, of which 2 small deletions have not been reported previously. Moreover, this method provided an opportunity to analyze the mechanism of rearrangement and the pathogenicity of F8 variants. The LRS results were validated and found to be in 100% agreement with those obtained using the conventional method. ConclusionOur proposed LRS-based F8 gene detection method is an accurate and reproducible genetic screening and diagnostic method with significant clinical value. It provides efficient, comprehensive, and accurate genetic screening and diagnostic services for individuals at high risk of HA as well as for premarital and prenatal populations.

Clinical relevance of positively determined myositis antibodies in rheumatology: a retrospective monocentric analysis

BackgroundThe increased availability of myositis autoantibodies represents new possibilities and challenges in clinical practice (Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76:1955–64. https://doi.org/10.1136/annrheumdis-2017-211468.). The aim of this study was to perform a retrospective data analysis of patient cases with positive myositis autoantibodies to analyse their significance in routine rheumatology practice.MethodsA monocentric analysis of all the orders used to determine myositis autoantibodies from July 2019 to May 2022 in the Department of Rheumatology, Krankenhaus Porz am Rhein, Cologne, Germany, was carried out.ResultsIn the defined time interval, a total of 71,597 laboratory values for the antibodies mentioned above were obtained. A total of 238 different positive autoantibodies ​​were detected in 209 patients. Idiopathic inflammatory myopathy was diagnosed in 37 patients (18%), and inflammatory rheumatic diseases other than idiopathic inflammatory myopathy were diagnosed in 90 patients (43%). No inflammatory rheumatic disease was diagnosed in 82 patients (39%). General clusters of clinical manifestations were observed.ConclusionsIn our cohort, we were able to show that a relevant proportion of patients with positive myositis antibodies did not have idiopathic inflammatory myopathies or inflammatory rheumatic diseases. This finding indicates the importance of myositis autoantibodies in this group of patients. However, further studies on the course of symptoms and examination results in patients without inflammatory rheumatic diseases and with positive myositis antibodies are necessary.

Exploring Plant-Based Compounds as Alternatives for Targeting Enterococcus faecalis in Endodontic Therapy: A Molecular Docking Approach.

Endodontic infections pose significant challenges in dental practice due to their persistence and potential complications. Among the causative agents, Enterococcus faecalis stands out for its ability to form biofilms and develop resistance to conventional antibiotics, leading to treatment failures and recurrent infections. The urgent need for alternative treatments arises from the growing concern over antibiotic resistance and the limitations of current therapeutic options in combating E. faecalis-associated endodontic infections. Plant-based natural compounds offer a promising avenue for exploration, given their diverse bioactive properties and potential as sources of novel antimicrobial agents. In this study, molecular docking and dynamics simulations are employed to explore the interactions between SrtA, a key enzyme in E. faecalis, and plant-based natural compounds. Analysis of phytocompounds through molecular docking unveiled several candidates with binding energies surpassing that of the control drug, ampicillin, with pinocembrin emerging as the lead compound due to its strong interactions with key residues of SrtA. Comparative analysis with ampicillin underscored varying degrees of structural similarity among the study compounds. Molecular dynamics simulations provided deeper insights into the dynamic behavior and stability of protein-ligand complexes, with pinocembrin demonstrating minimal conformational changes and effective stabilization of the N-terminal region. Free energy landscape analysis supported pinocembrin's stabilizing effects, further corroborated by hydrogen bond analysis. Additionally, physicochemical properties analysis highlighted the drug-likeness of pinocembrin and glabridin. Overall, this study elucidates the potential anti-bacterial properties of selected phytocompounds against E. faecalis infections, with pinocembrin emerging as a promising lead compound for further drug development efforts, offering new avenues for combating bacterial infections and advancing therapeutic interventions in endodontic practice.

Orthodontic and Surgical Management of Impacted Maxillary Canines: A Narrative Review

AbstractMaxillary canine impactions are a significant challenge for orthodontic and oral surgical practices. In this narrative review, we aim to evaluate surgical and orthodontic approaches for treating maxillary canine impactions, evaluate their effectiveness, and compare the two treatment modalities.We reviewed several studies on databases such as Google Scholar, PUBMED, and MEDLINE to update recent knowledge for canine impactions and their treatment. We reviewed and included studies that matched our research objectives, including orthodontic management, open and closed eruption techniques, and contact and tooth alignment surgery.Successful treatment results of canine impactions were reported increasingly in literature, and good clinical outcomes were observed in most cases. However, factors such as the severity of the impaction, patient age, and surgical experience were found to influence the choice of surgical technique and success rates. Complications associated with surgical management of maxillary canine impactions were also reported. These complications, which include tooth resorption, postoperative infection, ankylosis, and damage to adjacent structures, are generally rare but emphasize the importance of careful patient selection, surgical planning accuracy, and emphasis on diligent postoperative care.Findings highlight surgical procedures' effectiveness, outcomes, and challenges to help clinicians make informed decisions and improve patient care. The results underscore the importance of evidence-based decision-making and a multidisciplinary approach for successful clinical outcomes. Future research will focus on long-term stability, patient-reported outcomes, and exploring emerging techniques to further improve the management of maxillary canine impactions.

Developments in biochar incorporated geopolymers and alkali activated materials: A systematic literature review

Annually, industries related to agricultural products generate substantial volumes of waste biomass, presenting critical challenges for solid waste management due to its environmental and health implications. Pyrolysis emerges as a significant technique for converting such waste into biochar (BC), a material with notable internal microstructure, porosity, and chemical properties, contingent on the feedstock and processing conditions. BC is recognized for its exceptional water retention and alkalinity, primarily utilized for soil enhancement and fertilization. Its application across various fields, particularly in enhancement for sustainability, has gained momentum. This review meticulously explores BC's role in sustainable composites, focusing on geopolymers and alkali-activated binders through a comprehensive examination of existing literature, underscored by bibliometric analysis. This pioneering review, leveraging the PRISMA framework and VOSviewer for bibliometric insights, aims to bridge the research gap in this evolving domain, offering a critical assessment of BC's integration in sustainable construction materials, its challenges, and future research directions. Hence, this pioneering systematic review represents the first-ever exploration within the research domain of BC's applications in geopolymers and alkali-activated materials, marking a foundational step toward understanding its potential and challenges in sustainable engineering practices.

Optimization techniques for green supply chain practice challenges: a systematic hybrid approach

Optimization techniques necessitate a diverse focus to overcome green supply chain practice (GSCP) challenges, to address a variety of conflicting problems and uncertain challenges. This study aims to review the literature on optimization techniques for GSCP challenges, revealing the intricate interrelationship among attributes under uncertainty for hierarchical structure construction, and presenting insights and priorities for future research. Data were collected from the Scopus database, resulting in a total of 465 publications. An integrated method of systematic review was used to review and validate the GSCP optimization techniques. Hence, assessments of multi-objective optimization and uncertainty are pivotal for enhancing GSCP. The challenges posed by GSCP underscore the need to use heuristic algorithms, mixed integer programming, goal programming, stochastic programming and the non-dominated sorting genetic algorithm II in practical applications. This study offers a contribution to the literature on GSCP and provides valuable information to assist researchers and practitioners using optimization techniques.

An Analysis of the Undergraduate Program of the Police School of the University of Internal Affairs

Theoretical knowledge, skills, and practical experience of the cadets, students, and graduates are essential for the implementation of the basic functions of the police organization to effectively combat crime, maintain public order, and ensure public safety. However, all of these depend on the concept of educational programs, training theories, and development trends. Therefore, we have written this article to analyze the undergraduate programs and their implementation, and to propose some improvements. The research focuses on the analysis of the undergraduate curriculum methodology at the Police School of the Internal Affairs University of Mongolia from 2000 to 2019. It involves comparing the current four specialized programs with those of the national police universities of the Russian Federation and the Republic of Korea. After conducting the analysis, we identified both problems and opportunities. We surveyed 250 graduates of the programs to compare the quality and accessibility of education at that time to the current situation which helped us identify the issues. According to the survey, 75 percent of the respondents believe that the Police Work-Law undergraduate program needs to be improved and updated while the remaining 20 percent did not feel that it needed improvement, and 5 percent were unsure. Comparative analysis of the programs finds that there has been an increase in program content and credit hours, some courses overlap, the internship period is short, and the quality and results are weak. Upon comparing similar programs in other countries, it has been identified that implementing curricula in areas such as artificial intelligence, coding, and programming can help international law schools effectively meet the challenges of 21st-century legal practice.

Detecting LLM-assisted writing in scientific communication: Are we there yet?

Abstract Large Language Models (LLMs), exemplified by ChatGPT, have significantly reshaped text generation, particularly in the realm of writing assistance. While ethical considerations underscore the importance of transparently acknowledging LLM use, especially in scientific communication, genuine acknowledgment remains infrequent. A potential avenue to encourage accurate acknowledging of LLM-assisted writing involves employing automated detectors. Our evaluation of four cutting-edge LLM-generated text detectors reveals their suboptimal performance compared to a simple ad-hoc detector designed to identify abrupt writing style changes around the time of LLM proliferation. We contend that the development of specialized detectors exclusively dedicated to LLM-assisted writing detection is necessary. Such detectors could play a crucial role in fostering more authentic recognition of LLM involvement in scientific communication, addressing the current challenges in acknowledgment practices.

Challenges and hotspots in food supply chain quality management practices

Food supply chains face many challenges, including those associated with supply chain quality management practices. Supply chain quality management practices are activities and processes adopted to achieve quality goals. The practices can be quite challenging, especially for food supply chains that are sustainability-oriented, such as those found in alternative food networks. This paper introduces a notion of supply chain quality management practice hotspots to capture incidences of quality management practice challenges that manifest in food supply chains. An approach for identifying supply chain quality management practice hotspots is developed in the paper and illustrated with multiple case studies. Findings show that incidences of supply chain quality management practice hotspots exist in practice, and practitioners perceive the notion of supply chain quality management practice hotspots to be valuable, especially in providing insights into supply chain processes and use as a basis for performance improvement. The paper indicates that the severity of supply chain quality management practice hotspots is influenced by the importance placed on supply chain processes, supply chain practices, and the severity of the quality management practice challenges the supply chain faces. Implications of findings and recommended areas of future work are presented.

Colesteatoma do ápex petroso: um achado atípico

Introduction: Cholesteatoma, although relatively rare, presents significant challenges in clinical practice. Despite decades of research, its cause remains complex and elusive. Objective: This review aimed to summarize key findings on the epidemiology, pathophysiology, diagnosis and surgical management of cholesteatoma, highlighting current knowledge gaps and emerging trends in the field. Method: Narrative review carried out in the PubMed and Scielo databases. The search used the following keywords: “cholesteatoma, petros apex, minimally invasive surgical procedures”. The inclusion criteria comprised review articles, pre-clinical and clinical research published, written in Portuguese and English and available in complete text. The selected articles were analyzed based on the technologies covered, future perspectives, challenges, diseases mentioned and the central idea of the article. Result: 36 articles were included. Conclusion: Cholesteatoma is important in medical practice, despite being relatively uncommon in the general population. However, there are still doubts about its cause, but its diagnosis has been expanded through imaging tests in an attempt to reduce “second-look” operations and avoid them. Another field with constant growth is surgical treatment, since the complex anatomy requires that new techniques be managed to reduce injuries to important and vital structures in the region.