Changes In Practice Research Articles

DIABEZE: Diabetes self-management among the elderly in a Belgian home for the aged: a best practice implementation project.

The aim of this project was to improve the self-management of diabetes among elderly residents in a Belgian home for the aged. Diabetes is a common chronic condition with significant comorbidity. Incidence is increasing, but a third of patients with diabetes are unaware that they have the disease. The treatment of diabetes requires a multifactorial approach. Treatment guidelines on diabetes recommend involving patients in monitoring their condition because supported self-management improves daily glycemic control. This evidence implementation project used the JBI Evidence Implementation Framework, which follows three phases. In the first phase, the area of change, stakeholders' role, and practice context and readiness for change are investigated. In the second phase, a baseline audit is conducted to compare current practice with best practice. Strategies are then implemented to address any areas of non-compliance with best practice. In the third phase, a follow-up audit is conducted to evaluate changes in practice. At baseline, six criteria had 0% compliance, two criteria had compliance lower than 50%, and only 49% of health care workers were familiar with the procedure for hypoglycemia treatment. Improvement strategies included creating awareness among health workers. In the follow-up audit, one criterion improved from 0% to 100%, three criteria improved from 0% to 85%, two criteria reached the threshold of 50% compliance, and one criterion reached 19%. Further audits are needed to ensure sustainability. This project improved diabetes self-management in elderly people living in a Belgian home for the aged. An in-depth planning phase with internal facilitation and interdisciplinary collaboration between all co-workers addressed barriers related to quality systems, structure, communication, and education. http://links.lww.com/IJEBH/A258.

Adoption of a Semi-elective Lung Transplantation Practice by Safely Extending Cold Ischemic Times

Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated. Patient and donor organ selection were performed in the standard fashion. All donors with a cross clamp after 6 PM matched to any of our listed recipients-independent of their surgical complexity or risk-were kept in a temperature-controlled iceless cooler from procurement to recipient implant. All recipients had a 7 AM in-room start. Data were prospectively collected and compared to a cohort of recipients from the previous fifteen months. 82 transplants were performed at a single academic institution between 7/1/22 and 1/7/24, 21% of which included allografts with extended ischemic times utilizing the iceless cooler (n=18) with a median average temperature of 6.81 degrees Celsius. Median ischemic times were 13.9 (12.5 - 15.6) hours, more than twice the length of ischemic times in the standard group (n=64, 6.8 (6.1 - 7.4) hours). Post-operative outcomes were similar between groups, including post-operative ICU duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), PGD3 (17% vs 20%), post-operative ECMO (22% vs 20%), and six-month survival (94% vs 91%). Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semi-elective transplant strategy can be successfully implemented without compromising patient outcomes. Additional advantages may be gleaned through daytime transplantation with standard transplant surgical teams rather than overnight, on call-teams.

Media Coverage of Treasury Single Account Introduced by Abia State Government and Its Effect on Abia State University, Nigeria

This research brief focuses on the analysis of the media coverage of the introduction of the Treasury Single Account (TSA) by the Abia State Government and its impact on the Abia State University in terms of autonomy, salaries, research and academic activities. The implementation of the Treasury Single Account (TSA) has been the subject of intense media scrutiny, with attention focused on its implications for the autonomy of Abia State University. This study examines how the centralization of financial resources through the Treasury Single Account (TSA) framework can affect university decision-making processes, academic freedom and general governance autonomy. In addition, the research examines the effects of the Treasury Single Account (TSA) on the timely payment of salaries to university staff. By analyzing media reports and conducting interviews with stakeholders, the study aims to assess whether the implementation of the TSA has had an impact on the payment of wages, financial stability and employee morale in the university Furthermore, the study explores how the introduction of Treasury Single Account (TSA) has affected research activities in Abia State University. By examining media stories and academic publications, the research seeks to understand whether changes in financial management practices have affected the university's research output, funding opportunities and collaborative initiatives. Finally, the impact of Treasury Single Account (TSA) on academic activities in Abia State University is a major focus of this research. Through content analysis of media coverage and interviews with teachers and students, the study aims to assess whether financial reforms have improved or hindered the quality of teaching, learning experiences and the academic programs in the university. By examining the media coverage of the introduction of Treasury Single Account (TSA) and its effects on autonomy, salaries, research and academic activity in Abia State University, this research contributes to a deeper understanding of the implications of financial reforms in higher education institutions and provide policy makers with information. university administrators and stakeholders in the education sector.

Breastfeeding During COVID-19 Stay-at-Home Orders: Implications for Future Maternal Work Policies and Health Equity.

This study aimed to explore the impact of the COVID-19 pandemic and associated stay-at-home orders on the breastfeeding experiences of U.S. people a identify facilitators and barriers to breastfeeding during this period, and to assess the effects of maternal stress and misinformation on breastfeeding practices. U.S. women with infants were selected through purposive and convenience sampling. An online survey, distributed during summer 2020, measured changes in infant feeding practices, maternal stress levels, use of lactation support resources, and the influence of misinformation on feeding decisions. Quantitative data were analyzed using descriptive statistics, and qualitative responses underwent thematic analysis. Our sample (n = 1,861) revealed that 34% of U.S. women realized the pandemic affected their feeding practices, 544 women provided qualitative data. Major themes from qualitative analysis included ease of breastfeeding at home, bonding, increased breastfeeding duration, and challenges like limited access to lactation support. Logistic regressions highlighted demographic influences on breastfeeding practices, with no significant effects found related to the child's age or women's income on changes in feeding practices. The COVID-19 pandemic substantially impacted breastfeeding experiences of U.S. women, yielding insights for future policy and healthcare practices. The findings underscore the potential benefits of telehealth lactation support services and flexible remote work environments for breastfeeding people. Clear and scientifically-grounded communication regarding breastfeeding, mental health support, and policy development, are essential to promote equitable and flexible work and maternity leave options for breastfeeding people especially during global health crises.

Changes in practice of less-invasive surfactant administration (LISA) in United Kingdom neonatal units.

To determine whether the use of less-invasive surfactant administration (LISA) had changed between 2018 and 2024. An online questionnaire was sent to all 191 neonatal units between June 2023 and May 2024. One consultant from each neonatal unit was randomly selected. Follow-up was done by telephone (middle-grade doctor grade and above or alternatively to Advanced Neonatal Nurse Practitioners) for the non-responders. Response rate was 100%from 191 units neonatal units. LISA was used in 134 (70%) neonatal units in 2024 compared to 35 (18.7%) units in 2018 (p < 0.001). The reason why LISA was not performed was lack of experience/training (51%) or not having a standardised practice/guideline (49%). LISA in the delivery suite (DS) had increased from 2% in 2018 to 16% in 2024, and the use of video laryngoscope for LISA is becoming standard of practice. The oxygen requirement criteria for the use of LISA in both the DS and on neonatal unit had reduced to FiO2 of 0.3 or more. The uptake of LISA had increased in the United Kingdom. There is greater use of LISA in the DS. Lack of training and expertise were the major limiting factors for LISA not being performed.

Development and Acceptability of Provider Training to Increase Treatment Engagement of Parents in Their Children's Behavioral Health Care Need.

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM: To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS: The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS: The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS: The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC.

School Mask Mandates and COVID-19: The Challenge of Using Difference-in-Differences Analysis of Observational Data to Estimate the Effectiveness of a Public Health Intervention.

There are considerable challenges when using difference-in-differences (DiD) analysis of ecological data to estimate the effectiveness of public health interventions in rapidly changing situations. To discuss the shortcomings of DiD methodology for the estimation of the effects of public health interventions using ecological data. As an example, the authors consider an analysis that used DiD methodology and reported a causal reduction in COVID-19 cases due to the maintenance of school mask mandates. They did alternate analyses using various control groups to assess the robustness of the prior analysis. School districts in the greater Boston area and Massachusetts during the 2021-to-2022 academic year. Students and school staff. Changes in COVID-19 case rates in districts that did and did not lift mask mandates. Important potential confounders rendered DiD methodology inappropriate for causal inference, including prior immunity, temporal variation in rates of infection, and changes in testing practices. The racial composition and income of intervention and control groups also differed substantially. Compared with maintaining the mask requirement, dropping the requirement was associated with anywhere from an increase of 5.64 cases (95% CI, 3.00 to 8.29 cases) per 1000 persons to a decrease of 2.74 cases (CI, 0.63 to 4.85 cases) per 1000 persons, depending on choice of control group and whether students or staff were examined. Ecological data were used; detailed data on all potential confounders were unavailable. Alternate analyses yielded estimates consistent with a wide range of both negative and positive associations in COVID-19 case rates after removal of mask mandates. The findings highlight the challenges of using DiD analysis of ecological data to estimate the effectiveness of interventions in divergent intervention and control groups during rapidly changing circumstances. None.

Socio-economic Impact Assessment of Salinity Prevention Structure-Bardasagar Scheme in Porbandar District of Gujarat, India

India's vast coastline, spanning 7,516 kilometers, faces a critical challenge of seawater intrusion, resulting in salinity issues that profoundly affect agriculture, water resources, and socio-economic well-being. Among the coastal states, Gujarat, with its extensive 1,600-kilometer coastline, bears a significant burden of this phenomenon. The Barda Sagar Prevention Scheme aims to mitigate these effects by managing water resources effectively, thereby reducing salinity impact in the Porbandar area of Gujarat and ensuring the well-being of local communities. The Barda Sagar Scheme, situated in Rinavada village within Porbandar taluka of Gujarat, stands as a vital initiative aimed at addressing these challenges. This study meticulously evaluates the scheme's impact on agriculture, livestock, and rural livelihoods in both upstream and downstream villages. The findings underscore the scheme's substantial positive influence on various facets of rural life. Significant shifts in cropping patterns and agricultural land usage, accompanied by notable increases in crop yields, particularly in principal crops like groundnut and cumin, demonstrate the scheme's efficacy in enhancing agricultural productivity. Moreover, changes in livestock population, production, and feeding practices suggest potential improvements in livestock management and productivity, despite some fluctuations in livestock populations. Access to safe drinking water, a fundamental aspect of rural livelihoods, has witnessed considerable improvement due to the scheme's implementation. Increased reliance on the Narmada pipeline and enhanced access to potable water across surveyed villages reflect positive strides in water security and overall living standards. However, the study also identifies various challenges and factors influencing the observed changes. Soil degradation, pest incidence, and the need for sustainable water management strategies emerge as notable challenges that require ongoing attention and intervention. While positive drivers such as increased rainfall and improved market access have facilitated progress, continued monitoring, and adaptive management remain imperative for ensuring the scheme's long-term sustainability and efficacy.

Electronic Commercial Contracts in Saudi Arabia: Legal and Regulatory Challenges

This study explores the legal and regulatory challenges associated with electronic commercial contracts in Saudi Arabia. As e-commerce grows globally, the Kingdom has witnessed rapid changes in commercial practices, necessitating a robust legal framework to regulate electronic contracts. The paper examines the historical development of e-commerce in Saudi Arabia, the regulatory framework governing electronic contracts, and the challenges that arise from their enforcement. Key issues include the compatibility of electronic transactions with traditional legal principles, the recognition of electronic signatures, and cybersecurity concerns that impact the validity and enforceability of these contracts. Additionally, the paper compares Saudi Arabia’s legal framework with international standards, highlighting gaps that hinder the effective regulation of electronic commerce in the Kingdom. Recommendations for reform include harmonizing local laws with global best practices and enhancing cybersecurity measures to foster trust in electronic transactions. The study emphasizes the need for legal clarity to support the growth of e-commerce while protecting both businesses and consumers in the digital age.

Social Workers' Experiences of Working With Support Workers in Services for Adults With Intellectual Disabilities in Hong Kong.

Services for adults with intellectual disabilities in Hong Kong have a hierarchical staffing structure. Professional social workers, who performed as mid-level employees, work with frontline support workers to deliver services to clients. This qualitative study explored social workers' experiences of working with support workers through in-depth interviews with 13 participants. The study revealed that social workers perceived a significant variation between themselves and support workers in terms of working motivation, values and attitudes towards clients with intellectual disabilities. Despite the hierarchical relationships, social workers and support workers share the power of service decision-making. Social workers used firm and gentle approaches to facilitate changes in practices to uphold service values. These findings were compared with Western literature on this topic, indicating similarities and differences. The organisations need to facilitate an effective collaboration between social workers and support workers to enhance the quality of services for adults with intellectual disabilities in Hong Kong.

5040 Leveraging Continuous Glucose Monitoring Data as an Additional Source for Glucagon Prescription Behavior

Abstract Disclosure: J. Ambalavanan: None. J. Rusticelli: None. D. Isaacs: Consulting Fee; Self; Medtronic Diabetes, Lilly USA, LLC, Novo Nordisk, Insulet Corporation, Abbott Laboratories, Dexcom. H. Xiao: None. J. Bena: None. Z. Jin: None. C. Babiuch: None. M. Lansang: Consulting Fee; Self; Glooko. Research Investigator; Self; Abbott Laboratories, Dexcom, Xeris. Background: Hypoglycemia is a major source of anxiety in, and can be life-threatening for, patients with diabetes (DM). Even though the American Diabetes Association (ADA) recommends glucagon be made available to all individuals taking insulin or at high risk for hypoglycemia (level E evidence), few patients have access to this life-saving medication. Given the rapid adoption of continuous glucose monitoring (CGM) in the management of DM, we aimed to 1) evaluate glucagon prescription by identifying patients with hypoglycemia on CGM reports, and 2) deliver an educational letter to the providers. Methods: Our study had a retrospective chart review and a quality improvement (QI) component. From Mar-Oct 2023, we identified adult patients in the Cleveland Clinic Ohio health system with type 1 or type 2 DM on insulin (including insulin pumps), sulfonylurea, or meglitinide, and hypoglycemia defined as time below range (TBR) ≥4% on CGM reports. We evaluated the percentages of pre-existing and incident glucagon prescription among those patients. For the QI component, we contacted providers individually via letter if the patients did not have a glucagon prescription and shared with them the ADA Standards of Care on hypoglycemia along with information about various forms of glucagon. Whether to prescribe glucagon was left to the clinical judgement of the providers. Information was collected 4 weeks later to see whether there was any change in the prescription practice. Results: Patients numbered 1543, with170 patients having TBR ≥4%. Among patients with hypoglycemia, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (p&amp;lt;0.001). Significant (p&amp;lt;0.001) risk factors for hypoglycemia included type 1 DM, insulin-only therapy, use of conventional insulin pumps, and lower A1c. Among patients with TBR ≥4%, 66 (39%) had level 1 hypoglycemia (54 to &amp;lt;70 mg/dl), 88 (52%) had level 2, and 16 (9%) had level 3 (hospitalization or ER admission for hypoglycemia). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with level 1 hypoglycemia, 49% with level 2, and 63% with level 3 (p&amp;lt;0.001 level 1 vs level 3; level 2 vs no hypoglycemia; level 3 vs no hypoglycemia). Among 70 patients whose providers received education letters, 27 (39%) prescribed glucagon after education. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were the top prescription choices. A greater proportion of advanced practice providers responded to our education than physicians (p=0.021). Conclusion: Glucagon prescription remains suboptimal though better than in other studies even among patients with documented hypoglycemia on CGM reports. Effective provider education and communication can increase glucagon prescription. Provider and patient factors should be studied next to determine steps for further improvement. Presentation: 6/1/2024

Mullerian and vaginal anomalies

Purpose of review To provide a comprehensive resource for pediatric surgeons and pediatricians caring for patients with Mullerian and vaginal anomalies, with a focus on recent changes in practice. Recent findings Herein, we provide a foundation for understanding the anatomy, presentation, and work up of Mullerian and vaginal anomalies. We review how to approach management of these anomalies when in isolation or when associated with anorectal malformations. We discuss the evolution of the management of neovaginal discussion with a current emphasis on patient-centered and directed care. Summary Review of current understanding of and approach to Mullerian and vaginal anomalies in children.

Correct patient identification and matching of adults in an ambulatory care setting: a best practice implementation project.

Ambulatory care settings are at high risk for errors when identifying patients and matching them to their intended care. The objective of this project was to improve correct and consistent patient identification and matching to their intended care by nurses in ambulatory care settings. The seven-phase JBI Evidence Implementation Framework was used to guide this project. JBI tools were used to audit current practices and implement best practices in four ambulatory care units. The implementation plan included a baseline audit and two follow-up audits. Feedback was obtained through interviews with ambulatory care nursing staff, educational sessions were conducted for nursing staff, and unit guidelines were developed. In the baseline audit, compliance with best practice criteria for patient matching and identification was below 62% for 7/13 criteria. After conducting education sessions and other strategies, 1/3 pre- and post-clinical intervention criteria improved in compliance, while 2 were unchanged. For blood product administration criteria, 2/5 improved, 1 was unchanged, and 2 were lower than baseline. Nurses' education in patient identification procedures improved (1/1) and knowing where to access relevant policies remained unchanged at 100%. Criteria for patients knowing the importance of patient identification (2/2) and the identification band following national standards (1/1) improved from baseline. The results support the use of education sessions and infrastructure changes to promote and sustain change in evidence-based practice in ambulatory care units. Not all criteria improved, and the audit team identified strategies to improve the implementation of evidence-based practice in ambulatory care units. http://links.lww.com/IJEBH/A275.

The Role of a School-Community Partnership in Enhancing Inclusive Special Education within a School District

ABSTRACT This study examined the role of a school-community partnership in enhancing special education within a public school district. Specifically, it sought to understand both the influences on and the influences of the school-community partnership. Factors considered by the partnership included research, data, expertise, resource constraints, and lived experiences. The partnership’s influence included changes in classroom practices and professional development, as well as increased knowledge about inclusive special education and families’ goodwill toward the school district. Though the partnership did not have a district-level policy influence on special education, it did have a demonstrable influence in localized yet impactful ways.

Applied Learning for Developing Knowledge on Artificial Intelligence Among Students

As technology advances in the twenty-first century, innovative approach has been identified for developing skills on artificial intelligence (AI) technologies among students. Hence, to continuously improve the knowledge acquisition process, it is important that university lecturers embrace applied learning for developing hands-on competencies of students. Through applied learning, educators can disseminate knowledge on AI by engaging in the direct application of their expertise and theories, resulting in in-depth understanding by the students. A narrative review technique supported with a theoretical interpretation from ADDIE was applied. Findings revealed that applied learning is suitable for educators to develop and sustain hands-on skills and competencies on AI among students. The five steps of the theory lead to practical change and development, while being able to strengthen the change achieved. Through analyzing, designing, developing, implementing, and evaluation of teaching and training contents, the final goal of transforming students' knowledge on AI is achieved.

Traditional healing as mental health intervention: Contemporary insights from an American Indian healer.

Contemporary American Indian communities experience a disproportionately high rate of specific mental health concerns, including psychiatric disorders as defined by professional psychology. Although integrating mainstream mental health services and Indigenous traditional healing (ITH) has been presented as a promising approach to addressing these inequities, such integration necessitates in-depth exploration and consideration of ITH. To that effect, this article provides a thematic analysis of an interview with an urban American Indian traditional healer who reflected on more than 4 decades of therapeutic experience. Based on this analysis, we identified two major themes. The first theme, Expansive View of ITH, reflects this healer's conceptualization and understanding of the therapeutic process while the second theme, Guiding Principles of ITH, explicates the foundational commitments that shape and guide this healer's application and practice of ITH. These insights reinforce previous observations made by scholars of Indigenous health and well-being that challenge dominant Euro-American perspectives and call for transformative change in psychology research and practice, advocating for professional consideration of a broader range of therapeutic rationales, traditions, and practices than what is common within the field. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Results of the Dutch scalp cooling registry in 7424 patients: analysis of determinants for scalp cooling efficacy.

Chemotherapy-induced alopecia is a common consequence of cancer treatment with a high psychological impact on patients and can be prevented by scalp cooling (SC). With this multi-center patient series, we examined the results for multiple currently used chemotherapy regimens to offer an audit into the real-world determinants of SC efficacy. The Dutch Scalp Cooling Registry collected data on 7424 scalp-cooled patients in 68 Dutch hospitals. Nurses and patients completed questionnaires on patient characteristics, chemotherapy, and SC protocol. Patient-reported primary outcomes at the start of the final SC session included head cover (HC) (eg, wig/scarf) use (yes/no) as a surrogate for patient satisfaction with SC and WHO score for alopecia (0 = no hair loss up to 3 = total alopecia) as a measure of scalp cooling success. Exhaustive logistic regression analysis stratified by chemotherapy regimen was implemented to examine characteristics and interactions associated with the SC result. Overall, over half of patients (n = 4191, 56%) did not wear a HC and 53% (n = 3784/7183) reported minimal hair loss (WHO score 0/1) at the start of their final treatment. Outcomes were drug and dose dependent. Besides the chemotherapy regimen, this study did not identify any patient characteristic or lifestyle factor as a generic determinant influencing SC success. For non-gender specific cancers, gender played no statistically significant role in HC use nor WHO score. Scalp cooling is effective for the majority of patients. The robust model for evaluating the drug and dose-specific determinants of SC efficacy revealed no indications for changes in daily practice, suggesting factors currently being overlooked. As no correlation was identified between the determinants explaining HC use and WHO score outcomes, new methods for evaluation are warranted.

The what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia.

Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined. A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions. Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n=8) and non-rational (n=6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct. Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.

Practice changes and infant health risks during the 2022 infant formula shortage: Results of a US healthcare provider survey.

In February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage initiated by COVID-19-related supply chain disruptions. The effects were far-reaching, impacting families and healthcare providers across the US. A 19-item web survey was developed to better understand how the infant formula shortage impacted healthcare provider practices, resources needed and those already used, and patient health, including malnutrition. Subjective data on providers' experience were also collected. Two hundred forty-one providers responded, primarily registered dietitians (94%) practicing in inpatient/academic hospitals in urban and metropolitan areas. Practice adjustments included increases in patient education (100%), communication with pharmacies/durable medical equipment companies (65%), and visit durations (28%). Feeding adjustments by caregivers included new infant formula (99%), toddler (55%) or homemade (23%) formula, cow's milk (46%) or milk alternatives (32%), formula dilution (41%), and early food introduction (14%). Providers indicated an increase in malnutrition (33%), related diagnoses (including failure to thrive [31%] and deceleration in z score [27%]), and associated symptoms. Of the providers who reported malnutrition and related diagnoses, 93% also reported caregiver feeding practices that are generally not recommended. Providers made practice adjustments to mitigate the consequences associated with formula unavailability and misuse yet saw an increase in malnutrition and related diagnoses or symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. These data underscore the essentiality of supporting healthcare providers as they guide families in safe infant feeding practices.

"Lives and times": The case for qualitative longitudinal research in anatomical sciences education.

Qualitative longitudinal research (QLR) focuses on changes in perceptions, interpretations, or practices through time. Despite longstanding traditions in social science, QLR has only recently appeared in anatomical sciences education (ASE). While some existing methodology papers guide researchers, they take a narrow view of QLR and lack specificity for ASE. This discursive article aims to (1) describe what QLR is and its benefits, its philosophies, methodologies and methods, considerations, and quality indicators, and (2) critically discuss examples of QLR in ASE. Underpinned by relativist ontology and subjectivist epistemology, time can be understood as fluid/subjective or fixed/objective. QLR is a flexible, creative, and exploratory methodology, often associated with other methodologies. Sampling is typically purposive, with repeated and recursive data collection methods, and complex three-strand analyses (themes, cases, and time), enabling cross-sectional and longitudinal analyses. QLR involves ethical, relationship, analytical, dissemination, and funding considerations. Key quality indicators relate to qualitative research as well as temporal aspects. Most of the nine ASE papers reviewed explored changes in anatomy learners, but few labeled their methodology as QLR. Just under half described their sampling as purposive, most employed pre-planned and standardized repeated interviews, analyzed their data cross-sectionally, and utilized qualitative data analysis software. Most cited the confirmability and transferability of their studies, but few cited credibility and dependability elements. Study timeframes and tempos were generally clear, but details of longitudinal retention/attrition were often lacking, and longitudinal data analysis was not often conducted. We therefore provide recommendations for the conduct of QLR in ASE.