Experience In Management Research Articles

The influence of political disagreements and corruption on state health leader turnover during the COVID-19 pandemic in Brazil

PurposeGovernments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil.Design/methodology/approachUsing primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders’ management and public health experience increase the duration of tenure.FindingsStates encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency.Research limitations/implicationsSince most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary’s tenure are difficult to separate and analyze separately.Practical implicationsThis study provides empirical insights into what factors drive health leader turnover during major health emergencies.Social implicationsDuring major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders’ duration in one of the world’s largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover.Originality/valueTo the best of the authors’ knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world’s largest public health systems.

A Hungarian Centrum Hospital’s COVID-19 Response Strategy in Light of International Management Experiences

The COVID-19 pandemic has placed enormous pressure on healthcare systems. In the first line of the “war” against the virus, hospitals tried to maintain their general operations, while supplementing their services with COVID-19 patient care. To tackle the new difficulties, hospitals had to develop strategic response plans, and were in need of finding the most effective management structure for their institution. The focus of this paper is the aforementioned management structures. After overviewing the international literature, we identified three different approaches and we named them the Horizontal, Vertical, and Intermedier Approach. The separation is based on the following features: decision making, information distribution, command forwarding, intra-hospital communication channels, hierarchy, and control. After summarizing the international experiences, we introduce a Hungarian centrum hospital’s approach, as the institution was assigned to fulfil COVID-19 centrum hospital duties in the middle of the first wave. The North-Buda Szent János Central hospital was in need of restructuring their management structure, and the leadership decided to transform it into a hierarchical, vertical structure, operating with centralized decision making and personal control. This control–command system idea came from the hospital’s Internist Head Coordinator Physician, who is the first author of our article, and had serious military medicine experiences (in Afghanistan).

Evolution of Overseas Chinese Investment Policies Since the Reform and Opening up

Since the reform and opening up, China’s economy has been booming and changing with each passing day. This rapid development momentum has promoted the continuous improvement and promotion of overseas Chinese investment policies. The evolution of overseas Chinese investment policies is driven by the actual needs of China’s economic development and is closely linked to the process of the country’s reform and opening up. Whether it is the encouragement measures introduced by the central government or the preferential policies and implementation rules formulated by local governments based on local characteristics, they fully demonstrate the flexibility and adaptability of overseas Chinese investment policies. This flexible policy adjustment has greatly stimulated the investment enthusiasm of overseas Chinese, as we expected, injecting strong impetus into the prosperity of China’s economy and the deepening of reform and opening up. It is worth mentioning that overseas Chinese investment not only brings financial support, but also introduces advanced technology and management experience, which plays a decisive role in promoting the rapid development of China’s economy.

대학 원격수업 인증지표 개발 연구

Objectives The purpose of this study is to establish a basic framework for online education quality management by developing certification indicators that have secured validity when universities implement a certification system to manage the quality of online education. Methods To this end, through prior research and literature analysis, key elements, evaluation criteria, and confirmation factors were derived, and the initial certification index was developed with 4 certification criteria and 10 sub-criteria. As for the developed initial certification index, two Delphi surveys were conducted on the certification index for experts with experience in instructional design, curriculum, and educational quality management. After the first Delphi survey, the contents of the certification criteria with low validity scores were revised and supplemented through expert opinions for each item. In addition, by reflecting the opinions of experts that the certification index seems complex, the evaluation elements of the certification index were selected into two categories: design and development, and class operation, and the evaluation areas, sub-areas, confirmation factors, and evaluation criteria for each element were modified and supplemented. After the second Delphi survey, the contents of the certification criteria with low validity scores were revised and supplemented through expert opinions for each item. Results After two Delphi surveys, the derived question items were determined by the final certification index data. The final certification index consisted of 2 evaluation elements, 7 evaluation areas and 11 sub-areas. The evaluation elements of the final certification index consisted of design, development, and instructional management, and the evaluation area consisted of lecture materials, teaching strategies, videos, presentation of learning activities, evaluation, feedback, and plan coincidence. The sub-areas consisted of presentation of learning objectives, learning materials, copyright notation, teaching strategies, video quality, class participation and interaction methods, presentation of evaluation items, task and evaluation appropriateness, learner management, learning activity feedback, and plan coincidence. Conclusions It is significant in that it has developed certification indicators according to the characteristics of university online classes from existing certification indicators, and it is expected to provide a reference point to universities considering introducing a certification system to manage the quality of online classes in the future.

Evaluation of the Accuracy of the Smart Work Injury Management (SWIM) System to Assist Case Managers in Predicting the Work Disability of Injured Workers.

Many countries have developed clinical decision-making support tools, such as the smart work injury management (SWIM) system in Hong Kong, to predict rehabilitation paths and address global issues related to work injury disability. This study aims to evaluate the accuracy of SWIM by comparing its predictions on real work injury cases to those made by human case managers, specifically with regard to the duration of sick leave and the percentage of permanent disability. The study analyzed a total of 442 work injury cases covering the period from 2012 to 2020, dividing them into non-litigated and litigated cases. The Kruskal-Wallis post hoc test with Bonferroni adjustment was used to evaluate the differences between the actual data, the SWIM predictions, and the estimations made by three case managers. The intra-class correlation coefficient was used to assess the inter-rater reliability of the case managers. The study discovered that the predictions made by the SWIM model and a case manager possessing approximately 4 years of experience in case management exhibited moderate reliability in non-litigated cases. Nevertheless, there was no resemblance between SWIM's predictions regarding the percentage of permanent disability and those made by case managers. The findings indicate that SWIM is capable of replicating the sick leave estimations made by a case manager with an estimated 4 years of case management experience, albeit with limitations in generalizability owing to the small sample size of case managers involved in the study. These findings represent a significant advancement in enhancing the accuracy of CDMS for work injury cases in Hong Kong, signaling progress in the field.

Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus.

Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice.

Socialist imprints and innovation strategies in a transition economy

ABSTRACT This paper contributes to research at the intersection of institutional theory and the emerging literature on institutional imprinting by studying how the persistence and decay of founding institutional imprints affect network-based innovation strategies in small firms during later stages of economic transition. In do so, we are able to investigate both the extent of imprints and the boundary conditions that serve to strengthen or weaken their persistence. We situate our study in a fast-growing but under-studied transition economy, Vietnam, applying multiple estimation methods on a multilevel panel sample of 2644 small entrepreneurs over 6 years. Our major findings are, firstly, that firms launched before transition are influenced by socialist imprints and rely more on small and concentrated informal social networks, while firms launched after transition rely more on newer formal market institutions to generate innovations, and, secondly, that management and industry experience strengthens network-based innovation strategies and, thus, amplifies the persistence of socialist imprinting in firms established prior to transition.

Surgical management of a foramen magnum tumor via a far-lateral approach using an oblique straight incision: a case series report and technique note.

To review our single-institution experience in the surgical management of foramen magnum tumors via a far-lateral approach using an oblique straight incision. From October 2023 to January 2024, four cases of tumors in the foramen magnum area treated at the Capital Medical University-affiliated XuanWu hospital neurosurgery department were involved in this study. All cases were managed with a far-lateral approach using an oblique straight incision. We retrospectively reviewed the clinical and imaging data, as well as the surgical strategies employed. Three cases of foramen magnum meningiomas and one case of glioma of the ventral medulla. All cases underwent a far-lateral approach using an oblique straight incision; all cases had a gross total resection, and the wounds healed well without cerebral fluid leakage or scalp hydrops. Except for one case of right foramen magnum meningioma, which had dysphagia and pneumothorax, the other cases were without any postoperative complications. A far-lateral approach using an oblique straight incision can preserve muscle integrity and minimize subcutaneous exposure, allowing for complete anatomical reduction of muscles. This craniectomy method is simple and replicable, making it worthy of further clinical practice.

An integrated approach to strengthening maritime security: a case study of Gwadar Port of Pakistan

Gwadar Port is a vital component of Pakistan’s development and an essential element in the Belt and Road Initiative and the China–Pakistan Economic Corridor. Its completion holds the promise of economic growth for Baluchistan and Pakistan and provides a crucial trade route for land-locked Central Asian nations. Gwadar Port faces many significant challenges related to security due to the region’s poverty, instability, and particularly its separatist activities. To address this, a study has been conducted to determine how to improve maritime security at Gwadar Port. The study uses a literature review, comparative analysis, and field research to examine the factors that affect port security. Terrorist acts, particularly those planned by organizations such as the Baluchistan People’s Liberation Army, pose the greatest security risks. Additionally, the unique management approach of Gwadar Port presents other security challenges. This study on the experience of port management in China and Pakistan offers strategies for enhancing security management in Gwadar Port. These strategies include improved coordination between entities, increased security measures, and strengthened cooperation with the Chinese stakeholders engaged in port projects. Prioritizing the development of local communities and education is crucial to ensure the well-being of both port workers and the surrounding population. The conclusion stresses the significance of international cooperation, the sharing of information, and improved foresight to strengthen the security framework of Gwadar Port. Integrating best practices and refining approaches will improve safety management, safeguard the facilities, and foster their sustainable growth.

Peran Mahasiswa PGMI Dalam Penguatan Materi Pronunciation Alfabet Melalui Media Flashcard di MIS Miftahul Huda II Kota Palangka Raya

This community service activity aims to improve the English alphabet pronunciation skills among students at MIS Miftahul Huda II in Palangka Raya City through the use of flashcard media. Students from the Elementary School Teacher Education (PGMI) program are actively involved in the planning, implementation, and evaluation of this program. The method used is a participatory approach, where PGMI students provide interactive learning using specially designed flashcards to help students recognize and correctly pronounce the alphabet. The results of this activity show a significant improvement in students' pronunciation skills and their enthusiasm for participating in the learning process. Additionally, the involvement of PGMI students in this program provides valuable practical experience in teaching and classroom management. Therefore, this activity is beneficial not only for the students but also for the professional competence development of PGMI students.

Financial accessibility and MSME’s labour productivity: evidence from developing countries

PurposeThis study aims to re-examine the relationship between financial accessibility and performance of micro, small and medium enterprises (MSMEs) in developing countries using a large database.Design/methodology/approachThis study uses cross-sectional firm-level data from the World Bank Enterprises Survey database collected under Wave II from 2006 to 2019. Controlled for firm level and country level factors, OLS and instrumental variable regressions have been used for analysis. Firm performance has been measured in terms of labour productivity.FindingsThe study observes a positive association between access to finance and MSME performance measured in terms of sales and value-added per worker. Along with firm characteristics (like size, age and managerial experience), country’s development level, institutional quality (i.e. corruption and regulations) and economic openness also impact MSMEs’ productivity.Practical implicationsStrengthening the financial system to allow the financial sector to meet the requirements of MSME finance is very important. Better access to external finance will enable MSMEs to invest in upgrading technology and expanding operations, thus improves their labour productivity. As the MSME sector is vulnerable to economic shocks, policies facilitating their access to formal credit during crises could strengthen resilience.Social implicationsCredit constraint to MSMEs is a multi-stakeholder problem. It requires a coordinated approach from MSME owners, financial institutions and policymakers to address it and enhance the credit flow to the MSME sector. Timely research inputs from academia, research institutions and think tanks may help assess MSMEs promotion policies and their revision if needed.Originality/valueTo the best of the authors’ knowledge, this is the first study that examines the effect of access to finance on the labour productivity of MSMEs in developing countries. Given the mixed results in the recent past between access to finance and firm performance, it highlights the critical role of financial accessibility in improving their labour productivity and thus enabling MSMEs to realise their full potential in developing countries.

Schnitzler's Syndrome-Diagnostic Experience, Approaches to Therapy, and Patient Management according to a Multicenter Russian Cohort.

The objectives of the study were to present the experience of diagnosis, management, and therapy with IL-1 inhibitors in patients with Schnitzler's syndrome (SchS) according to a multicenter Russian cohort. An observational retrospective study for a 10-year period (2012-2022) involved 17 patients with SchS who were admitted to the hospital or were observed on an outpatient basis (eight women and nine men). The diagnosis of all of them corresponded to the Strasbourg diagnostic criteria. The age of patients ranged from 25 to 81 years (Me 53[46; 56]). The age at the time of the onset of the disease ranged from 20 to 72 years (Me 46[39; 54]), the duration of the disease before diagnosis ranged from 1 to 35 years (Me 6.5[3; 6]), in three patients it exceeded 10 years, in the rest it ranged from 1 to 8 years. Infectious and lymphoproliferative diseases, monogenic AIDs (CAPS, TRAPS, and HIDS) were excluded from all patients at the prehospital stage. The referral diagnosis for all of them was Still 's disease in adults. Clinical manifestations of the disease in all patients included fatigue, lethargy, fatigue, rash, and fever. In all patients, skin elements were urticular and were accompanied by itching in 6 (37.5%) patients. Bone pain was observed in 12 (70.6%) patients; arthralgias, in 16 (94.1%); arthritis, in 9 (52.9%); myalgia, in 7 (41.2%); and weight loss, in 4 (23.5%). Lymphadenopathy was detected in 6 (35.3%) patients; enlarged liver, in 6 (35.3%); pericarditis, in 4 (23.5%); angioedema, in 6(35.3); redness and dryness in the eyes, in 3 (17.6%); sore throat, in 2 (11.8%); abdominal pain, in 1 (5.9%), distal polyneuropathy, in 2 (11.8%); paraesthesia, in 1 (5.9%); and chondritis of the auricles, in 1 (5.9%). Monoclonal gammopathy was detected in all patients with a secretion level of 2.9-15.1 g/L: IgMk (n = 10, 64.7%), less often IgMλ (n = 2), IgGk (n = 2), IgGλ (n = 1), and IgAλ (n = 1). Ben-Jones protein was not detected in any of them. All patients had an increased level of ESR and CRP. Before inclusion in the study, 16 patients received GCs (94.1%) with a temporary effect that disappeared with dose reduction or cancellation. Seven patients received cDMARDs, including methotrexate (5), hydroxychloroquine (2), and cyclophosphamide (1). All patients received NSAIDs and antihistamines, as well as biologics, including the anti-B-cell drug rituximab (1), monoclonal ABs to IgE omalizumab (2, 1 without effect and 1 with partial effect), IL-1i canakinumab (n = 10, 58.8%) subcutaneously once every 8 weeks, and anakinra (n = 4, 23.5%) subcutaneously daily. The duration of taking anakinra, which was prescribed in the test mode, ranged from 1 week to 2.5 months with a further switch to canakinumab in 3 patients. The duration of taking canakinumab at the time of analysis ranged from 7 months to 8 years. Against the background of treatment with IL-1i, 10 out of 11 (90.9%) patients received a complete response in terms of the clinical manifestations of the disease and a decrease in the level of ESR and CRP within a few days. In one patient, a partial response to the administration of anakinra was detected; however, after switching to canakinumab, the effect of treatment was finally lost. One patient received IL-6i for 8 months with an incomplete effect and a positive dynamics after switching to anakinra. Thus, anakinra was initially prescribed to four patients and changed to canakinumab in two of them; canakinumab was started as the first drug in seven patients. Treatment with anakinra was continued in two patients; with canakinumab, in nine patients. In one patient, due to the persistent absence of relapses, the interval between canakinumab injections was increased to 5 months without signs of reactivation; however, subsequently, against the background of stress and relapses of the disease, the intervals were reduced to 4 months. A healthy child was born by the same patient on the background of treatment. The tolerability of therapy was satisfactory in all patients, no SAEs were noted. SchS is a rare multifactorial/non-monogenic AID that should be differentiated from a number of rheumatic diseases and other AIDs. The onset in adulthood, the presence of recurrent urticarial rashes in combination with fever and other manifestations of a systemic inflammatory response are indications for examination for monoclonal secretion. The use of short- or long-acting IL-1i is a highly effective and safe option in the treatment of such patients.

The influence of agility on green purchasing practices: the role of supplier governance and supplier relationships

PurposeThis paper aims to illuminate the nuanced dynamics of green supply chain management (GSCM), specifically focusing on the intersections of supplier relationships, supplier governance and organizational agility. Recognizing a gap in the understanding of how these elements confluence to promote green purchasing, the paper uses a quantitative study on data collected from the Australian food industry. Advanced analysis techniques provide empirical evidence underscoring the pivotal roles these elements play, expanding on current GSCM literature within a resource-based view.Design/methodology/approachThis study, based on a questionnaire sent to Australian food professionals, used higher-order reflective constructs to assess supplier relationships and governance. Data was analyzed using partial least squares structural equation modeling and Hayes PROCESS, considering factors like firm revenue and manager experience. Both the reliability of measures and mediation hypotheses were stringently validated using established guidelines.FindingsThe comprehensive study validated supplier governance's key influence on green purchasing and supplier relationships. Notably, organizational agility emerged as a crucial mediator, underscoring the interplay of these constructs. Concurrently, the reflective measurement model exhibited robust validity and reliability. Interestingly, demographic factors such as company size, revenue and managerial experience showed no discernible impact on green purchasing practices.Practical implicationsIn the Australian food sector, supplier governance and relationships are pivotal for advancing green purchasing. This study emphasizes the value of organizational agility in amplifying these practices. Managers, when aligning with supplier relationships enhanced by communication and mutual aid, can foster robust green initiatives. Embracing these insights and the critical importance of supplier governance, managers can drive more sustainable, informed supply chain decisions in the industry.Originality/valueIn pursuit of understanding the relationship between supplier governance, supplier relationships and green purchasing, this research uniquely situates itself within the resource-based view (RBV) to reveal critical theoretical and practical implications. By focusing on the Australian food industry, the study spotlights the often-overlooked mediating role of organizational agility in linking supplier relationships with green purchasing efforts. In doing so, this research not only strengthens the argument for fortified supplier relationships – as a catalyst for enhancing agility and thereby green practices – but also re-contextualizes the RBV in a fresh light. This new perspective provides managers with an enriched model, emphasizing the imperative of solid supplier governance for sustainable, agile and green supply chain operations in the food domain.

TEKNIK MANAJEMEN SUMBER DAYA MANUSIA YANG EFEKTIF DI ERA BISNIS MODERN UNTUK MENINGKATKAN KINERJA PEGAWAI

The objective of this study is to enhance employee performance by investigating efficient human resource management (HR) tactics within the dynamic framework of the worldwide corporate environment. This study employs a case study methodology and qualitative techniques. The population of the research includes all employees in the specific organization, with a sample consisting of individuals with varying levels of experience in HR management. Document review, direct observation, and in-depth interviews are examples of research instruments. The findings of the study demonstrate that thorough hiring and selection provide a strong basis for long-term productivity, and ongoing training and development improves workers' ability to adjust to changing work conditions. A transparent and productive work environment is produced by effective communication, and a work culture that emphasizes growth and higher success and improves employee performance is created by providing constructive feedback. Increased productivity, a healthy work-life balance, motivation, engagement, career development, and efficient performance management are all impacted by HR management methods on employee performance. Through the identification of critical variables influencing employee performance and the development of corresponding strategies, this research offers businesses direction and suggestions for navigating the intricacies of the contemporary business environment and achieving sustained success

Factors Affecting Performance of Micro and Small Scale Enterprises (Case of Karat Town, Konso)

The aim of the study was to examine factors that affects the performance of micro and small scale enterprises with the special emphasis on manufacturing, construction, service, trade and urban agriculture sector in Karat town. The study sought to achieve the following objectives: examining effect of business information services, analyzing the effect of access to finance, determining the effect of access to infrastructure, examining the effect of managerial experience and lastly investigating the effect of working premises on performance of MSEs in karat town. The study was applied explanatory research design. In order to get the representativeness of each sector stratified random sampling technique was used to select sample of 185 MSEs. The study used close- ended questionnaires to collect the primary data from the sample respondents. Correlation and multiple regression analysis were used to analyze the data. The result of the study indicated that there is positive and significant relationship between the dependent and the independent variables, but the effect of access to infrastructure on MSEs’s performance was found positive and insignificant. 62.5 percent variations in performance were explained by the predictor variables.

Peutz-Jeghers syndrome: management for recurrent intussusceptions.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). A total of nine patients were presented with age ranging from 4 to 17years (median 9years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2months to 7years. Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.

Diagnostic Strategy Using Color Doppler Ultrasound of Temporal Arteries in Patients With High Clinical Suspicion of Giant Cell Arteritis : A Prospective Cohort Study.

Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss. To evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method. Prospective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922). Patients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals. 165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years). The diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB. Bilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging. Diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%). Small sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy. By using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided. Tender "Recherche CH-CHU Poitou-Charentes 2014."

Dietitians’ perspectives on clinical pathways and practice in relation to the dietary management of irritable bowel syndrome in the UK: A qualitative study

Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition which negatively impacts quality of life(1). Dietary triggers are common and dietary management is central to the IBS treatment pathway with dietitians being the main education providers for patients(2). The aim of this study was to explore the perceptions of dietitians towards current practices in IBS services in clinical settings across the UK.Qualitative semi-structured interviews were undertaken to explore current practices, barriers, and facilitators to dietetic practice and expected treatment outcomes. Eligible participants were dietitians specialising in IBS and working in the National Health System (NHS) in the UK. Interviews were held virtually. Audio was recorded and transcribed following intelligent transcription. Data were analysed using template analysis (3).Thirteen dietitians (n=12 female) specialising in gastroenterology consented to participate in the study. Dietitians were working in various NHS Trusts across the country (Southeast England n=3; Southwest England n=3; Northwest England n=2; Northeast England n=1; West Midlands n=1; Southwest Wales n=1 and Southcentral Scotland n=2). Ten out of 13 dietitians had more than five years of experience in IBS management. Three main themes emerged: 1) Dietetic services as part of IBS referral pathways; 2) Practices in relation to dietetic services and 3) Implications of services on patients’ expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist IBS dietitians was reported, alongside the use of digital innovation to facilitate practice and access to dietetic care. The use of Internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centred approach to dietary counselling and recognise the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations.The study identified areas and practices which can facilitate access to dietetic services and patient- centred care in IBS management as outlined in guidelines (4).

Effect of vagus nerve stimulation on emergency department utilization in children with drug-resistant epilepsy: a retrospective cohort study.

Epilepsy affects approximately 470,000 children in the United States. The estimated median incidence is 50.4 cases per 100,000 persons per year. There are approximately 3.1 million seizure-related emergency department (ED) visits per year among children. Vagus nerve stimulation (VNS) is a treatment option for drug-resistant epilepsy (DRE). While its primary goal is to decrease seizure burden, VNS may decrease seizure intensity and improve quality of life. The authors assessed whether VNS decreased the number of seizure-related ED visits in a cohort of children with DRE. The authors performed a retrospective chart review of pediatric patients (aged 0-21 years) who underwent implantation of a vagus nerve stimulator between January 2009 and January 2020 at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh. They used paired t-tests to assess differences in the number of ED visits 2 years before versus 2 years after VNS device implantation. Univariable linear regression analyses were used to test associations of preoperative characteristics with change in the number of ED visits following vagus nerve stimulator insertion. This study included 240 patients. Compared with patients without seizure-related ED visits before VNS, patients with ≥ 1 ED visits were younger in age at first VNS surgery (9.5 vs 10.8 years), had a shorter epilepsy duration before VNS surgery (5.8 vs 7.4 years), had a later year of device implantation (2014 vs 2012), and on average took more antiseizure medications (ASMs; 2.4 vs 2.1). There was no significant difference between the total number of seizure-related ED visits pre- versus post-VNS surgery (1.72 vs 1.59, p = 0.50), and no difference in status epilepticus-related visits (0.59 vs 0.46, p = 0.17). Univariable linear regression analyses revealed a mean change in ED visits of +0.3 for each year prior to 2022 and -0.5 for each additional ASM that patients took before vagus nerve stimulator insertion. This single-institution analysis demonstrated no significant change in the number of seizure-related ED visits within 2 years following VNS device implantation. Earlier VNS surgery was associated with more seizure-related ED visits after device insertion, suggesting that medical management and center experience may play a role in decreasing seizure-related ED visits. A greater number of ASMs was associated with fewer seizure-related ED visits after VNS device insertion, suggesting the role of medical management, patient baseline seizure threshold, and caregiver comfort with at-home seizure management.

Perceptions and experience of rural older people in oral health management in China: a qualitative study

BackgroundTo explore the perceptions and experience of oral health management among rural older people in China.MethodsQualitative methodologies were used in this study. Face-to-face semi-structured interviews were conducted. Thirteen older adults in rural areas were purposively sampled at two metropolitan hospitals in Hunan, China. The data were transcribed and thematically analyzed, and MAXQDA software was used to assist with coding.ResultsThree overarching major themes and ten sub‑themes capturing the perceptions and experience of oral health management among rural older people were identified. Three themes emerged from the thematic analysis: oral health cognitive bias, poor management behaviors, and limited oral health services. Oral health management as a whole is negative, oral health behaviors are poor, oral health service utilization is limited.ConclusionsBased on these findings, there is great scope here for improving the current status of oral health for rural older people around awareness, behavior, and access. Oral health education, improved oral health services and primary oral health promotion are warranted.