Implementation Of Guidelines Research Articles

Avoiding “a piece of paper on the wall that everyone ignores”: a qualitative study on the barriers for implementing open fracture guidelines

BackgroundOrtho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures MethodsTwelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question. ResultsIndividualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a “piece of paper on the wall that everyone ignores” ConclusionsThis study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.

Effect of Educational Guidelines Implementation on Nurses' Performance Regarding Thrombolytic Therapy Management among Patients with Acute Myocardial Infarction

Effect of Educational Guidelines Implementation on Nurses' Performance Regarding Thrombolytic Therapy Management among Patients with Acute Myocardial Infarction

Unlocking Financial Services with Generative AI and Converged Infrastructure

Generative Artificial Intelligence (Gen AI) is poised to revolutionize financial services by empowering institutions to unlock the true potential of their data, driving a wave of innovation in risk management, personalized customer experiences, improved financial analytics, secure AI model training, and optimized high-frequency trading. Unleashing this potential necessitates a converged infrastructure that integrates cloud and on-premise resources with high-performance computing (HPC).Given Gen AI's demanding nature, the immense computational power offered by HPC is critical. This paper explores the crucial role of HPC in supporting Gen AI workloads within financial services, along with considerations for converged infrastructure, potential challenges, and a roadmap for successful Gen AI implementation.

CTN-0138: adaptation, implementation, and cluster randomized trial of a Community Pharmacy-Based Prescription Drug Monitoring Program Opioid Risk Assessment Tool—a protocol paper

Abstract Background As the opioid epidemic continues to have a major negative impact across the US, community pharmacies have come under scrutiny from legal systems attempting to hold them accountable for their role in over dispensing and lack of patient intervention. While the most available tool for monitoring patients’ opioid use is Prescription Drug Monitoring Programs (PDMP), these do not provide pharmacists with actionable information and decision support. Our study addresses this gap through three objectives: [1] incorporate validated opioid risk metric thresholds into a PDMP platform to create the Opioid Risk Reduction Clinical Decision Support (ORRCDS) tool; [2] assess ORRCDS’ ability to reduce patient opioid risk; [3] assess ORRCDS’ sustainability and viability for broader dissemination in community pharmacy. Methods For objective 1, our team is partnering with leadership from the largest US PDMP organization and a top-five pharmacy chain to implement ORRCDS into the pharmacy chain’s workflow following the Guideline Implementation with Decision Support (GUIDES) framework. For objective 2, our team will conduct a type-1 implementation mixed methods study using a 2-arm parallel group clustered randomized design. We anticipate enrolling ~ 6,600 patients with moderate and high opioid use risk during the 6-month enrollment phase across 80 pharmacies. This sample size will provide 96.3% power to detect a 5% or greater difference in responder rate between the intervention and control arm. Responders are patients with moderate-risk at baseline who reduce to low-risk or those with high-risk at baseline who reduce to moderate or low-risk at 180 days post last intervention. To accomplish objective 3, we will use the Consolidated Framework for Implementation Research (CFIR) to develop and execute cross-sectional qualitative interviews with pharmacists (n = 15), pharmacy leaders (n = 15), and PDMP leaders (n = 15) regarding long term adoption and sustainability of the ORRCDS tool. Conclusions A PDMP tool that addresses moderate- and high-risk opioid use is not available in community pharmacy. This study will implement ORRCDS in a large retail pharmacy chain that will include additional screening and guidance to pharmacy staff to address risky opioid medication use. Our results will make critical advancements for protecting patient health and addressing the opioid epidemic.

A Survey on Surgical Site Infections Prevention Guidelines Knowledge and Implementation Level of Trauma Centre Healthcare Professionals

Aims/Background Surgical site infections (SSIs) significantly influence patient safety and healthcare quality, particularly in low- and middle-income countries where the burden is most evident. This manuscript aims to evaluate the awareness and adherence to SSI prevention guidelines among healthcare providers at a tertiary trauma centre situated in Tirana, Albania. Methods This cross-sectional survey was conducted among practising surgeons, residents and nurses of Trauma University Hospital, Tirana. The questionnaire explores awareness, attitudes and practices towards SSI prevention in preoperative, perioperative and postoperative phases. Results The participants demonstrated a high level of patient education about SSI risks (91.9%), but lower adherence to individual prevention practices. Conclusion Despite adequate knowledge, there remains a significant gap in the implementation of SSI prevention guidelines. Strengthening continuous medical education is crucial to addressing systemic barriers, improving compliance with guidelines, and decreasing SSI rates.

Implementation of Guidelines for Food and Meals in Kindergartens: Perspectives from Norwegian Kindergarten Staff

AbstractEstablishing dietary food habits in the early years is crucial. Kindergarten is a significant public health arena that can foster healthy eating habits regardless of socioeconomic status. In Norway, 93.4% of children aged 1–5 years attend kindergarten, and since most of their daily food intake is in kindergarten, it is important to make healthy food available. National guidelines on food and meals in kindergartens encourage kindergartens to engage in food and meal practices that promote health, well-being, development, and learning. Despite the guidelines, food and meal practices in kindergartens are highly varied, and implementation of the guidelines is lacking. To understand the challenges in implementing the guidelines, we conducted semi-structured interviews with sixteen staff representing sixteen kindergartens throughout Norway. Both public and private kindergartens were included. All interviews were recorded and transcribed verbatim, and content analysis was performed. The analysis identified three primary themes reflecting staff perceptions of challenges in implementing the national guidelines: priority and structural work with food and meals, pedagogical approach to food and meals, and external expectations and social pressure regarding food and meals. The themes were seen in light of the Consolidated Framework for Implementation Research in the discussion. While external conditions, including municipal prioritization, external expectations, and social pressure, play significant roles, our findings suggest that the most substantial influences on implementation are internal factors, particularly leadership and individual factors.

Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis.

The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana. This was explanatory mixed methods research which started with a document review of Ghana's WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically. Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana's implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care. Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.

Examining How Blockchain Implementation Affects Supply Chain Visibility in Ghana

Purpose: This article investigate how blockchain technology enhances visibility in supply chains by enabling real-time, transparent data sharing among stakeholders. It explores blockchain's role in reducing information silos and improving traceability. The study aims to inform both industry practitioners and policymakers on blockchain’s benefits and adoption strategies. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Blockchain implementation enhances supply chain visibility by enabling real-time tracking and secure data sharing across stakeholders, reducing fraud and improving traceability. It also helps in verifying product origins, building consumer trust, and streamlining inventory management. However, challenges such as high costs and the need for standardized protocols can limit widespread adoption. Unique Contribution to Theory, Practice and Policy: Transaction cost economics (TCE), resource-based view (RBV) & institutional theory may be used to anchor future studies on the examining how blockchain implementation affects supply chain visibility. For practitioners, the implementation of blockchain technology offers significant potential to improve real-time visibility, data accuracy, and trust within the supply chain. Policymakers should develop standards and regulatory guidelines for blockchain implementation in supply chains to ensure secure and ethical data usage.

Human Rights in Limbo: A Human Rights Analysis of Religious Freedom Protections in European Asylum Centres

Abstract This article examines the legal protections for religious freedom afforded to non- detained asylum seekers and refugees in European asylum centres, highlighting the gap between theoretical rights and practical implementation. Despite the fundamental right to freedom of religion or belief, asylum seekers often face coercion, verbal and physical attacks, and restrictions on their religious practices within these centres. The absence of regulations or guidelines exacerbates these problems, leaving operators in a legal grey area and the religious freedom rights of asylum seekers in limbo. The article also examines how the privatisation of refugee reception impacts human rights obligations and the dual nature of state responsibilities—both negative and positive—regarding religious freedom. It emphasises the necessity for the implementation of regulations and guidelines to guarantee the enforcement of religious freedom protections, with the objective of safeguarding the religious freedom rights of asylum seekers and refugees in European asylum centres.

Preliminary guidelines for the detection and management of drug-related problems in cancer patients with type 2 diabetes mellitus: a practical resource for oncology pharmacists.

The prevalence of type 2 diabetes mellitus (T2DM) in cancer patients is high. During the medication review process, clinical pharmacists could detect and manage drug-related problems (DRP) to optimize pharmacotherapy but there is a need to standardize pharmacists' interventions (PI) especially for T2DM-related DRP. The present study aims to describe DRP in cancer patients with T2DM undergoing anticancer treatment (AT) and to propose related preliminary guidelines to manage T2DM-related DRP. The study was conducted in one oncology outpatient hospital where a clinical pharmacy team performs medication reviews to detect and manage DRP by performing PI in cancer patients undergoing AT. All the data from November 23rd, 2015 to November 23rd, 2019 were extracted and demographic, clinical, oncological, and biological data were collected and analyzed. Based on these results and a literature review, a working group (2 pharmacists and one diabetologist) was constituted to propose a first set of preliminary guidelines clinical pharmacists that were then reviewed using the Delphi method by an expert panel of oncologists and pharmacists. A total of 161 T2DM cancer patients were included in the study (19.7% of all cancer patients screened). Overall, 152 DRP (mean 1.67/patient) were detected (49.3% drug interaction) and 152 PI were performed by clinical pharmacists, mainly drug monitoring (48.0) and drug discontinuation (25.7%). Specifically, there was 24 T2DM-related DRP (including 29.2% drug interactions). Twenty-four DRPs were directly related to T2DM status. The five proposed guidelines reached a consensus after revisions and a sixth has been added. DRPs were frequent among cancer patients with T2DM and we hypothesize that the preliminary guidelines should improve the detection of DRPs directly related to T2DM. The implementation of the preliminary guidelines should now be assessed in clinical practice.

Development of the implementability assessment tool for clinical practice guidelines based on the COSMIN framework and factorial experiment: a study protocol.

Clinical practice guidelines are essential tools for standardizing medical practices and improving healthcare quality. However, current guideline implementation is unsatisfactory. Barriers to guideline implementation include external environmental factors (e.g., medical personnel, medical institutions, local policies) and intrinsic characteristics (e.g., context, format, language etc.), with the latter being addressable by optimizing the guidelines themselves. This study aims to develop an appraisal tool to promote effective guideline implementation. Existing guideline implementability appraisal tools lack a clear theoretical basis, evidence of reliability and validity, and/or empirically-based guidance for effective implementation, all of which will be addressed in this study. The research is divided into four phases: (1) Generating a theoretical framework for guideline implementability (i.e., scoping review and concept analysis method); (2) Conducting a factorial experiment (i.e., guideline users simulate the use of different guideline versions to examine the relationship between constructs in the framework and implementability), and removing constructs with weak relationships to form the final implementability theoretical framework; (3) Generating dimensions and items for the guideline implementability appraisal tool based on the constructs in the theoretical framework, conducting comprehensive reliability and validity testing, usability testing, and iterative optimization according to the COSMIN guidelines; (4) Integrating the validated tool with the STAR guideline rating system for guideline appraisal and feedback to promote guideline implementability. STRENGTHS AND LIMITATIONS: (1) Our research will follow a standardized and rigorous process for developing measurement scales, ensuring that the resulting evaluation scale for the implementability of CPGs is theoretically grounded, internally consistent between theory and practice, and reliable and valid. (2) The theoretical framework developed in our study will strengthen the validity and rationality of constructs in the real world. (3) In the confirmatory factor analysis, this study will determine the dimensions and items' weight through factor loadings, allowing for the quantification of the implementability of CPGs and providing users of the guidelines with objective evaluative results. In addition, the clinical practice guideline implementability evaluation tool developed in this study can assist guideline developers in enhancing implementability before, during, and after guideline formulation.

Sustainable Development Strategies and Good Agricultural Practices for Enhancing Agricultural Productivity: Insights and Applicability in Developing Contexts—The Case of Angola

In general, agricultural productivity in Angola is low due to the limited awareness among stakeholders regarding sustainable development strategies (DSs) and good agricultural practices (GAPs) that could be adjusted to local crops, soil types, and climatic conditions. A structured approach was followed to develop a systematic literature review (SLR) that can address this gap by examining how DSs and GAPs may be adapted for Angola’s context to encourage sustainable agricultural development. Key steps included the selection and exclusion of literature from primary scientific databases based on specific screening indicators such as the publication date, language, relevance to DSs and GAPs, and geographic focus on developing or developed nations with comparable agricultural challenges. The initial search resulted in 11,392 articles, of which 4257 met the primary selection criteria. After further screening for relevance and availability, 98 articles were shortlisted, and 15 studies were ultimately included for in-depth analysis. This strict screening process ensured the inclusion of studies most applicable to Angola’s agricultural context. The key research findings indicate that certain DSs and GAPs have high adaptability potential for Angola. The findings emphasise practices such as drip irrigation and inorganic fertilisation, which are widely implemented in both developed and developing countries due to their efficiency in resource-limited environments. Additional strategies, such as water management systems, organic composting, and agroforestry practices, demonstrate significant potential to enhance soil fertility, water efficiency, and crop resilience against climate variability. By identifying these practices and strategies, this study provides a basic framework for policymakers in Angola to develop targeted implementation guidelines, fostering sustainable agricultural growth and resilience in the face of climatic challenges. Thus, this review contributes to the scientific and practical understanding of sustainable agriculture in developing countries, offering critical insights that support Angola’s efforts to achieve greater self-sufficiency and economic stability through sustainable agricultural practices.

Abstract 4138714: Implementation of the KDIGO Guidelines to Prevent Cardiac Surgery Associated Acute Kidney Injury in Patients with Heart Failure With Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting

Backgrounds: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommended the initiation of multiple supportive measures in patients at high risk for cardiac surgery associated acute kidney injury (CSA-AKI). Heart failure with preserved ejection fraction (HFpEF) was known as a critical risk factor for CSA-AKI. Purpose: Our study was designed to assess the effectiveness of KDIGO guidelines and the risk of CSA-AKI following coronary artery bypass grafting (CABG) among patients with HFpEF. Methods: This retrospective cohort study included 7420 patients undergoing CABG from 2019 to 2022, including 1960 patients with pre-operative HFpEF and 5460 patients without pre-operative HF as comparison. Implementation of the KDIGO guidelines consists of 6 measures in the first 72 hours after surgery, including avoidance of nephrotoxic agents, discontinuation of ACEi and ARB, implementation of advanced hemodynamic monitoring, avoidance of hyperglycemia, optimization of hemodynamics, and intensified monitoring of renal function. The primary outcome was in-hospital postoperative AKI according to the KDIGO criteria. Results: Among the included patients with HFpEF, 125 (6.4%) patients were classified as fully implementing the KDIGO guidelines. For the primary outcome, implementation of guidelines was associated with a significantly decreased risk of CSA-AKI (46.4% vs. 62.0%; OR, 0.591 [95% CI, 0.407-0.857]; p = 0.006). Meanwhile, implementation of guidelines had a greater preventive effect on CSA-AKI for HFpEF patients compared with non-HF patients (OR, 0.921 [95% CI, 0.759-1.118]; p = 0.405). Noticeably, we found that avoidance of hyperglycemia (OR, 0.737 [95% CI, 0.591-0.920]; p = 0.007) and optimization of hemodynamics (OR, 0.638 [95% CI, 0.508-0.802]; p < 0.001) were associated with lower incidence of CSA-AKI. Conclusions: Despite a lack of adherence to the KDIGO guidelines in patients undergoing CABG, implementation of the guidelines was found to be associated with a significantly lower risk of CSA-AKI for patients with HFpEF. Among the measures in the guidelines, avoidance of hyperglycemia and optimization of hemodynamics had stronger preventive effects for CSA-AKI.

Cardio Vascular Disease Risk Assessment by Medical Officers According to the Guidelines at Healthy Lifestyle Centers in Western and North Western Provinces and the Factors Affecting Implementation of Guidelines

Introduction: Healthy Lifestyle Centers (HLC) were established in 2011 to carry out Cardiovascular Disease (CVD) Risk Assessments and follow up with patients. The capacity of primary care institutions (PCI) for CVD risk assessment has not been studied in the recent past.Objective: To evaluate the existing CVD risk assessment guideline and assess its application process by Medical Officers (MOs) and facilities available at HLCs for CVD risk assessment.Methodology: A descriptive study with three components was carried out. Component one – CVD risk assessment Guideline evaluated through Key informant interviews (KII); component two- assessment of the Knowledge and practices on CVD risk assessment of all MOs working in HLCs using a self-administered questionnaire and an observational checklist; component three- assessment of available facilities and resources to carry out CVD risk assessment using a checklist.Results and Discussion: The study was conducted in 141 HLCs accessible during the Covid period. Assessment of CVD risk assessment guidelines showed Problems in methodological standards and in the identification and summary of evidence. MOs need to gain Knowledge in screening those under 35 years, in reading the WHO/ISH Risk Prediction Chart and in advising on further management and follow-up. All HLCs have at least one medical officer, but there is a lack of nursing officers and health care assistants.Conclusions and recommendations: There was a gap in Knowledge in screening criteria and management of those under 35 years of age. It is recommended to carry out training at national level every six months so all staff newly appointed to primary care could be trained. It is also recommended to appoint at least one nursing officer or a Public Health Nursing Officer (PHNO) to an HLC.

Insights from an online survey: Veterinary surgeons' antibiotic practices in ophthalmic surgery in Germany.

To investigate antibiotic usage practices in ophthalmic surgeries in Germany. An online questionnaire was sent to veterinary surgeons (general veterinarians and veterinarians with additional qualification in ophthalmology) inquiring about their antibiotic preferences, administration methods, and factors affecting antibiotic usage in ophthalmic surgical procedures. A total of 417 questionnaires were analyzed. Postoperative antibiotics (systemic/topical in percent when used) were used all or most of the time by 69% of veterinarians following enucleation (99/6), by 62% after eyelid surgery (54/69), by 68% after third eyelid (TEL) surgery (19/92) and by 80% after keratectomy (6/99). The most commonly used systemic antibiotic was amoxicillin with clavulanic acid and the most commonly used topical antibiotic was chloramphenicol. WHO "watch-group" antibiotics were infrequently administered systemically but frequently utilized topically; including in 13% of eyelid surgery, 15% of TEL surgery, and 35% of keratectomies. Factors influencing antibiotic use included fear of complications (67%), personal experience (63%), diagnostic uncertainty (21%), and owner expectations (9%). Participants following institutional guidelines used fewer antibiotics in enucleations (p = .002) and were less likely to choose fluoroquinolones post-eyelid surgery (p = .044). The potential for reducing antibiotic use following ophthalmic soft tissue surgery is significant. Addressing barriers such as concerns about postoperative complications and the reliance on individual clinical experience, the implementation of standardized guidelines could facilitate a shift toward more judicious antibiotic practices.

Outcomes for Degenerative Cervical Myelopathy Following Implementation of the AO Spine International Guidelines: A Single-Centre Service Evaluation.

Degenerative cervical myelopathy (DCM) is a syndrome of symptomatic cervical spinal cord compression due to degenerative spinal changes. Until recently there was no formal consensus on exactly which patients are suitable for surgical or conservative management. The AO Spine international guidelines were introduced to address this issue, based on the best available current evidence. However, their implementation into routine clinical practice has not yet been reported. The objective was to evaluate surgical outcomes following the implementation of the AO Spine guidelines at our spinal neurosurgical centre. A service evaluation was conducted using data collected from electronic healthcare records for 259 patients, with outcomes of interest including change in mJOA score and complications. Data from 193 patients were included in the final analysis. There was a mean improvement of the mJOA score by 1.53 points, 1.44 point and 1.92 points at post-operative intervals of 3months (P < .001), 6months (P < .001) and 12months (P < .001). The percentage (number) of patients whose increase in mJOA score was greater than or equal to the minimal clinically importance difference (MCID) was 41% (44/107), 34% (33/96) and 43% (49/114) at these respective time intervals. Intraoperative complications occurred in 28 patients (11.7%). No association was found between BMI and postoperative change in mJOA score. Our results are comparable to those from best practice data and suggest adherence to international guidelines provides a service that promotes meaningful recovery for patients with DCM. Therefore, our results offer support for implementation of the AO Spine international guidelines in clinical practice.

Addressing GenAI use through transparency in teaching and learning in a Master of Cyber Security program

This paper explores the use of Generative AI (GenAI) in university assessments, focusing on transparency and best practices. The study examines the implementation of GenAI guidelines in a Master of Cyber Security program from 2023 to 2024. Course conveners aimed to enhance learning by encouraging GenAI use for efficiency, while addressing academic integrity concerns. The evolving university policies and the challenges of detecting GenAI misuse are discussed. The paper highlights the importance of clear guidelines and transparent communication to foster shared understanding for AI use. Findings suggest that transparent AI policies can support both students and educators in navigating the complexities of AI in education.

The Auction System in the Practice of Motorcycle Arisan Reviewed from the Minister of Finance Regulation Number 122 of 2023 Concerning Auction Implementation Guidelines

Auction in motorcycle arisan are organized by a business entity without interference from the government with the aim of selling goods, namely motorcycles. Motorcycle arisan adopts an auction system to be used as the determination of the winner of the arisan. This study aims to determine the implementation of auction in motorcycle arisan in terms of the regulation of the minister of finance regarding auction implementation guidelines. The auction conducted in motorcycle arisan is actually used for business purposes for the organizer of the arisan, which auction team was formed independently by the organizer of the arisan without Auction Officials. In the implementation of motorcycle arisan, if it seen from the goal is to sale motorcycles with an auction system, so it is included in the category of voluntary auctions, where the implementation stage is regulated in the ministerial regulation. Business entities as organizer of motorcycle arisan with an auction system need to pay attention to auction activities so that their implementation is adjusted to that has been regulated in laws and regulations.

Innovative Cloud Architectures: Revolutionizing Enterprise Operations Through AI Integration

This article examines the transformative impact of artificial intelligence (AI) and machine learning (ML) integration in cloud computing architectures across enterprise operations. Through an analysis of 250+ enterprise deployments, we demonstrate significant improvements including a 42% reduction in operational costs and 53% enhancement in process efficiency. The article presents a comprehensive framework for implementing AI-enhanced cloud architectures, combining multi-cloud and hybrid approaches across major platforms including Microsoft Azure, AWS, and Google Cloud. Our findings highlight key advancements in predictive resource management (91% accuracy), automated scaling (67% reduction in overprovisioning), and intelligent security systems (99.7% threat detection accuracy). The article provides detailed implementation guidelines, security protocols, and best practices, supported by a case study of a Fortune 500 manufacturing corporation that achieved $4.2 million in annual maintenance cost savings and 52% improvement in resource allocation efficiency. The article also explores future developments in quantum computing integration and multi-cloud orchestration, establishing a roadmap for organizations seeking to leverage AI-enhanced cloud architectures for competitive advantage.

Self-Efficacy of Nurses and Physicians in the Emergency Department and Its Influence on the Outcomes of Trauma Patients

The purpose of this study was to examine the effect of self-efficacy on the implementation of the adult trauma clinical practice guidelines (ATCPGs) on improving trauma patient outcomes, including missed injuries, and ED LOS. Nurses’ and physicians’ self-efficacy in performing ATCPGs skills were evaluated three months prior to and three months after the intervention’s implementation. Multiple strategies of ATCPGs implementation improved the length of stay (LOS) in the ED for multiple trauma patients. The quasi-experimental design has been implemented in this interventional study. Post-intervention, the self-efficacy of ED healthcare providers in performing ATCPGs skills has increased. Implementation of the ATCPGs has improved the outcomes of patients with multiple traumas. There were 66 patients in this study, and 53 (80.3%) of them were male. The ATCPGs intervention resulted in a statistically significant decrease in the amount of time spent in the ED, as shown by a comparison of the ED LOS in minutes between the two groups (t = 2.56; p = 0.013). Implementing the ATCPGs has improved multiple trauma patients’ outcomes. The results will help decision-makers at hospitals to facilitate interdisciplinary ATCPGs training sessions and establish policies and procedures to introduce adult trauma sheet in the ED to improve multiple trauma patients’ outcomes.