Implementation Of Best Practices Research Articles

Innovative strategies and implementation science approaches for health delivery among migrants in humanitarian settings: A scoping review.

Over 100 million displaced people rely on health services in humanitarian contexts, defined as unstable or transitory settings created in response to complex emergencies. While services are often described, there is a dearth of evidence on best practices for successful implementation to guide efforts to optimize health delivery. Implementation science is a promising but underutilized tool to address this gap. This scoping review evaluates implementation science in health services for forced migrants in humanitarian settings. We conducted a scoping review according to JBI methodologies. A search of eight databases yielded 7,795 articles, after removal of duplicates, that were screened using PRISMA-ScR guidelines. Data extraction assessed study descriptors, implementation objects, barriers, facilitators, implementation strategies, and use of implementation frameworks in service delivery. Data from 116 studies represented 37 countries and 11 topic areas. Methods were mainly cross-sectional with low-medium evidence rigor. Mental health programs (25%) and vaccination services (16%) were the most common objects of implementation. Thirty-eight unique barriers were identified including resource limitations (30%), health worker shortages (24%), and security risks (24%). Among 29 facilitators, the most common were health worker availability (25%), pre-existing partnerships (25%), and positive perceptions towards the intervention (20%). More than 90% of studies collectively identified 35 implementation strategies, the most common being capacity building (44%), stakeholder engagement (35%), information dissemination (38%), and feedback mechanisms (25%). Only 10 studies used formal implementation models, with RE-AIM (n = 3) and Intervention mapping (n = 2) being most frequent. In this scoping review, we found similar barriers, facilitators, and implementation strategies across diverse humanitarian migrant settings and services. However, the use of rigorous methods and formal implementation models was rare. Frameworks included RE-AIM, CFIR, and Precede-Proceed. Increased use of implementation science frameworks and methods will help humanitarians more rigorously and systematically evaluate and develop best practices for implementation of health services for migrants in humanitarian settings.

The Culture Flex: Advancing Social Justice in Educational Speech-Language Practices

Purpose: Rooted in Black Language, the authors introduce the “culture flex” as a practice of engaging in social justice work. Social justice is necessary to carry out the vision of the American Speech-Language-Hearing Association: effective communication as an accessible, achievable human right for all. The purpose of this tutorial is to define and describe a multifaceted conceptual pathway toward social justice–oriented speech-language practices. 1 The authors acknowledge and interweave their positionalities, their own social justice journeys, and educational speech-language practices experiences to explain the “cultural flex” framework as a pathway for enacting social justice. Method: This tutorial will explore existing social justice efforts and conceptual frameworks in the educational institution and current speech-language practices, including cultural responsiveness and cultural humility, and then introduce the concept of cultural flexibility and the implications for educational speech-language practitioners (SLPs). Coined in the education literature, cultural flexibility is defined as a propensity to move across racial–ethnic boundaries. Conclusions: There is a need for authentic introspection from practicing SLP justice seekers, who are currently working to uproot inequity and replant justice within the discipline. A human rights–centered social justice orientation is personal, and practical guidance should encompass explicit discussions of positionality and the impact on one's implementation of best practices serving for historically marginalized clients. The authors present the “culture flex” as a mindset shift, a way of viewing practice that centers culture as an invaluable asset, involves ongoing self-reflection, and empowers professionals to move beyond the discomfort of racial/ethnic boundaries to a tendency to enact social justice.

O PROTAGONISMO DA ENFERMAGEM NA ASSISTÊNCIA AO PARTO HUMANIZADO: UMA REVISÃO INTEGRATIVA DA LITERATURA

The puerperal pregnancy process requires dignified and qualified care, not limited to the expulsion or extraction of the fetus. The implementation of good practices in labor and birth care is essential to guarantee the rights of the parturient. It is up to the care team to provide security in the partutive process, through evidence-based methods. The present research aims to understand the actions of the nursing team involved in the humanization of childbirth, highlighting the main determining factors for maternal satisfaction and dissatisfaction in the experience of labor. This is a systematic bibliographic survey, with a qualitative approach, of the integrative literature review type. The search for research material was carried out through electronic access to the digital databases Virtual Health Library, Latin American and Caribbean Literature in Health Sciences and Scientific Electronic Library. The inclusion criteria adopted were: national articles, available free of charge, with full texts, published between 2014 and 2024. The selection process allowed eight scientific studies to be obtained. Regarding the humanization of the parturition process associated with the direct action of nursing, it can be seen that the adoption of non-invasive practices results in maternal satisfaction and reduction of fetal impairment. It was noted that the incorporation of obstetric nurses in childbirth sectors contributed to the reduction of proscribed or invasive practices. It was concluded that humanized childbirth is closely associated with the use of good practices by professionals, which will directly impact the care for the mother-child binomial. Therefore, labor and birth care policies should be constantly reinforced, providing greater dissemination of knowledge.

RELAÇÃO ENTRE BOAS PRÁTICAS DE ORDENHA, ÍNDICES DE QUALIDADE DE LEITE E BEM-ESTAR ANIMAL

Milk quality is directly related to milking management practices and herd health, with mastitis being one of the main diseases that compromise milk production. This study aimed to evaluate the impact of good milking practices on milk quality and animal welfare, with an emphasis on reducing mastitis and somatic cell count (SCC). The research was carried out at Fazenda Roxa, in Candeal-BA, with 70 cows, 40 of which were in lactation. Milk samples were collected before and after the implementation of good practices, which included reorganization of the milking line, disinfection of teats, cup testing for mastitis detection, and training of milkers. The results showed a significant reduction in SCC, from 1,100,000 cells/ml to 550,000 cells/ml, within the limits of the Ministério da Agricultura, Pecuária e Abastecimento (MAPA). Furthermore, there was a decrease in the incidence of clinical mastitis, indicating the effectiveness of good practices in improving milk quality. The study also showed that such practices contribute to animal welfare and the production of healthier milk, with economic benefits for producers. The implementation of these practices is essential to ensure the production of healthy milk, with positive impacts on the quality of food products and food safety.

ANGLED DENTAL IMPLANTS: IMPLICATIONS FOR CLINICAL PRACTICE AND BIOMECHANICAL CONSIDERATIONS

Angled dental implants have emerged as an effective solution in clinical settings where the placement of straight implants is constrained by unfavorable bone positions or the presence of adjacent anatomical structures. The angulation of implants significantly influences stress distribution around the implant, impacting its stability and longevity. Research highlights that the direction of applied loads is critical, as angled implants can generate greater bending and shear forces compared to straight implants, potentially leading to stress concentrations in surrounding bone. Finite element analysis (FEA) is commonly used to model these conditions, offering insights into stress zones and predicting potential failure areas. Bone quality plays a vital role in how implants respond to applied forces, with denser bones effectively dissipating forces while more porous bones are at higher risk of resorption and integration failure. Studies indicate that excessive stresses on angled implants can lead to bone resorption, compromising long-term stability. Therefore, careful consideration of implant angulation, connection type, bone quality, and thorough surgical planning is essential. Recent studies, including those investigating the effects of implant design and bone density on stress distribution, have demonstrated that varying implant threads and angulated abutments affect the stresses experienced by surrounding bone and implants. The findings emphasize the need for appropriate implant selection and a detailed assessment of bone anatomy and patient-specific clinical conditions. By incorporating advanced technologies like FEA, clinicians can enhance their understanding of biomechanical interactions, ultimately leading to improved clinical outcomes and patient satisfaction. Continuous education and the implementation of best practices in dentistry remain vital for the successful application of angled dental implants.

Abstract 4118777: Outcomes Of Patients With Hypertrophic Cardiomyopathy In Academic Versus Non-Academic Centers: Analysis from the National Inpatient Sample Database 2012-2020

Introduction: Hypertrophic Cardiomyopathy (HCM) is an uncommon heart condition associated with serious complications. Advances in medicine have improved its prognosis. Despite this, such potentially life-saving improvements concerning the implementation of best practices are not ubiquitous; guidelines recommend management at specialized centers. Unfortunately, not all hospitals have specialized HCM centers. However, given that a sizeable portion of these specialists are also in academic centers (ACs), we hypothesize that ACs may be better positioned than non-academic centers to provide the highest quality care for HCM patients. Purpose: Our study aimed to assess in-hospital outcomes and healthcare burdens among patient admissions with HCM diagnoses, comparing those treated at academic centers with those receiving care at non-academic centers. We examine all-cause in-hospital mortality, length of stay (LOS), hospital costs, and investigate ethnic differences in patients with HCM. Methods: The National Inpatient Sample database was utilized to obtain HCM patient hospitalizations from 2012 through 2020 in the United States. Patient hospitalizations for which adult patients had a primary diagnosis of HCM were identified. Outcomes included all-cause in-hospital death, LOS, and hospital costs. All-cause in-hospital mortality was evaluated using multivariable logistic regression analysis. Multivariable lognormal regression models were used to estimate LOS and inflation adjusted cost outcomes. Results: All-cause mortality unadjusted rates were 2.2% in non-teaching hospitals compared with 1.7% at teaching hospitals; however, this difference was not statistically significant ( p =.235). Both unadjusted and adjusted hospital LOS were 32% shorter for non-teaching hospitals ( p <.001). Both unadjusted and adjusted hospital costs were 46% lower for non-teaching hospitals compared to teaching hospitals ( p <.001; $37,829 vs $70,216). For both LOS and cost, the overall interaction between race and teaching status was statistically significant ( p < .001.) Conclusion: Our study shows variations in hospital outcomes and costs between teaching and non-teaching hospitals. Non-teaching hospitals displayed shorter stays and lower costs. Additionally, the interaction of race and teaching status significantly impacted length of stay and costs. These results underscore the necessity of tailored interventions to address healthcare delivery and resource inequities, especially in teaching hospitals.

Reflective Tool on Advanced Access to Support Primary Healthcare Teams: Development and Validation of an Online Questionnaire.

Awareness of their standing relative to best practices motivates primary healthcare (PHC) teams to improve their practices. However, gathering the data necessary to create such a portrait is a challenge. An effective way to support the improvement of the practices of PHC teams is to simplify the availability of data portraying aspects of their practices that might need improvement. Timely access is one of the foremost challenges of PHC. Yet, very few tools supporting reflections on the implementation of best practices to improve access are available to PHC teams. To develop an online reflective tool that evaluates the state of a PHC team member's advanced access practice and formulates customized recommendations for improvement. This sequential multimethod study was informed by a literature review and an expert panel composed of researchers, patients, provincial and local decision-makers, and PHC clinical and administrative staff in the province of Quebec, Canada. Consensus was reached on the content of the questionnaire and the prioritization of the recommendations. No reflective tool on advanced access practices was found in the literature review. Grey literature was used to create an initial version of the questionnaire. This version was revised and enriched through consultation phases with the expert panel. Then, five iterations of the tool were tested with 169 PHC team members, which led to the conception of two distinct versions: one for clinical staff and one for administrative agents responsible for appointment booking. The final versions of the reflective tool are available online in both English and French. This reflective tool provides a portrait of PHC team members' advanced access practices as well as an automated report that contains personalized and prioritized recommendations for improvement. Further developments are necessary for its optimal use among PHC professionals other than physicians and nurse practitioners.

Academics’ Experiences during Horrible Times: Online Teaching, Learning, and COVID-19

E-Learning has become the new normal in Higher Educational Institutions across South Africa. Hence, intergration of the new learning pedagogies has initiated a shift of the norms on professional development. This paper seeks to unpack the strategies used by lecturers in the face of adversities experienced during the E-learning space pre & post Covid-19. There are strategies advised by teacher autonomy which need to be explored. It might have been better if teacher autonomy was merely being against pressures exerted on the individual teachers. But, it is a means for teachers to advance their personal and professional capability to adapt to the rapidly changing conditions and situations in learning spaces. This paper seeks to unravel an unacquainted new path on the drive of lecturers in their professional development that has not been evident in their training. In socio-politically transforming societies such as South Africa, the absence of adequate structures to implement a range of changing policies, may leave lecturers in despair when trying to access development opportunities. This paper adopts analytic theory and semi-structured interviews to give light to the constructivist views of lecturers who have developed methods during the times of adversity. Purposive sampling of 6 lecturers and 10 students will help the generation of data for this study because even though lectures had to adjust to new methods but students were in the receiving end of all the pressure. This study argues for implementation of best practices for the successful professional development of academics in line with E-learning. The University of Limpopo will be the centre of data generation with ethical considerations requested as well as literature visited. Collected data will be thematically analysed in order to sieve and arrange the necessary information for this study. The newly shared practices will form part of the resolutions to the professional development of academic staff.

The impact of ISO security standards on enhancing cybersecurity posture in organizations

The increasing frequency and sophistication of cyber threats have made organizations need to adopt robust cybersecurity frameworks. ISO security standards, particularly the ISO/IEC 27000 series, play a critical role in enhancing organizations' cybersecurity posture worldwide. These standards provide a systematic approach to managing sensitive information, ensuring its confidentiality, integrity, and availability. ISO/IEC 27001, which focuses on establishing an Information Security Management System (ISMS), is widely recognized for its ability to help organizations identify, manage, and mitigate cybersecurity risks. By adopting ISO standards, organizations benefit from improved risk management, enhanced incident response capabilities, and stronger alignment with regulatory compliance requirements, such as GDPR and HIPAA. In addition, ISO security standards promote a security-first culture within organizations, fostering greater employee awareness and encouraging the consistent implementation of best practices across departments and regions. The adoption of standards like ISO/IEC 27001 (Information security, cybersecurity and privacy protection), ISO/IEC 27018 (Code of practice for protection of personally identifiable information (PII) in public clouds acting as PII processors), ISO/IEC 27017 (code of practice for information security controls based on ISO/IEC 27002 for Cloud services), ISO/IEC 27015 (Information security management guidelines for financial services) ISO/IEC 27002 (Information security, cybersecurity and privacy protection - Information security controls), and ISO/IEC 27701 (Security techniques- Extension to ISO/IEC 27001 and ISO/IEC 27002 for privacy information management – requirements and guidelines) has demonstrated significant improvements in data protection, especially in industries handling sensitive personal or financial data. Despite their benefits, implementing ISO standards poses challenges, such as resource constraints, scalability, and the need for continuous updates. As the threat landscape evolves, ISO security standards will remain integral to developing a proactive cybersecurity strategy, integrating with emerging technologies such as artificial intelligence and IoT. The global adoption of these standards reflects their pivotal role in securing the digital infrastructure of modern organizations.

Enhancing Climate Resiliency Through Improving Ecosystem Services in Shoreline Municipalities – Lessons from Canada

The accelerated impacts of climate change in waterfront areas and the proven inefficacy of the aging hardened shoreline infrastructure have driven shoreline management practices to evolve toward the enhancement of ecosystem services at the land-water interface. Gaining momentum as an adaptive approach in regenerative projects, living shorelines are comprised of natural ecosystem components used in combination or in place of traditional hard engineering methods to provide coastal protective services and erosion mitigation. The success of living shorelines in protecting shoreline property and ecosystem integrity varies based on the biogeomorphology and hydrology of the region and is also heavily reliant on social acceptance of the chosen approach and best practice for implementation. The relatively lower lifecycle cost and associated co-benefits of living shorelines have well positioned them as a promising alternative approach in theory. There are, however, gaps in regional long-term datasets and evidence-based guidelines. This research provides an overview of the underlying geopolitical readiness for integrating nature-based solutions in climate adaptation strategies within shoreline municipalities based on a comprehensive literature review complimented by expert interviews. The synthesized data can inform decisions for minimizing the destructive effects of traditional shoreline erosion prevention approaches and encourage successful implementation of solutions that offer ecological, health, social, and economic benefits.

Prevention and Control of Catheter-Associated Urinary Tract Infection (CAUTI): A Patient Safety and Quality Improvement Project.

This patient safety and quality improvement report outlines the successful reduction of catheter-associated urinary tract infections (CAUTI) through a comprehensive interdisciplinary team approach. It emphasizes the implementation of best practices and the involvement of both patients and their families in catheter care. The project was conducted at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East, with 511 beds and over 20 inpatient units. The primary objective of this project was to assess gaps in current CAUTI prevention practices and implement effective strategies to reduce infection rates. By adopting quality improvement methodologies from the Institute of Healthcare Improvement (IHI) and the Deming Four-Stage Cycle, the aim was to prevent CAUTIs and improve patient safety and clinical outcomes. Urinary catheters, commonly used for patients with neurogenic bladder dysfunction and sacral deep pressure injuries, posed a high risk of infection, with a daily infection risk of 3-7%. Despite available preventive measures, the facility experienced a high average CAUTI rate of 1.28/1000 catheter daysfrom 2021 to mid-2023. This project involved the systematic identification of gaps, the adoption of evidence-based practices, and the engagement of healthcare staff, patients, and families in rigorous CAUTI prevention efforts. The project resulted in a significant reduction in the CAUTI rate, decreasing from 1.28 infections per 1000 catheter days pre-intervention to 0.42 infections per 1000 catheter days post-intervention. This improvement highlights the effectiveness of collaborative efforts and evidence-based interventions in controlling and preventing CAUTIs. The findings of this project demonstrate that CAUTI prevention is achievable through a coordinated approach involving healthcare providers, strong evidence-based interventions, and the active participation of patients and families. This collaborative model led to better patient safety outcomes and significantly reduced CAUTI rates, showing the importance of comprehensive care strategies in mitigating preventable patient harm.

Nonpharmacological Prevention and Management of Delirium: Past, Present, and Future.

Delirium has been recognized, documented, and examined for centuries. In 500 BC Hippocrates described hyper- and hypoactive forms of delirium. As medicine, surgery, and critical care have accelerated over the last century, so too has our understanding of delirium and its profound risks to patients, families, and health care teams. It has also been increasingly understood that it is the accumulation of risk factors that ultimately precipitates delirium and nonpharmacological interventions to reduce these risks remain the cornerstone of delirium prevention and management. However, over the last three decades, these nonpharmacological strategies have moved from a single-component approach to a multicomponent approach, targeting multiple risk factors. Additionally, our understanding of what constitutes a risk factor for delirium has evolved, and in particular, it has been recognized that delirium can sometimes be a byproduct of our interventions and health care systems. In the surgical setting, for example, optimization of risk factors prior to surgery, when possible, is now seen as a key way to prevent postoperative delirium. Similarly, critical care medicine now operates with the appreciation of the profound risk to patients of prolonged mechanical ventilation, sedation, and immobilization and seeks to minimize each to reduce the risk of delirium, among other negative effects. The future of delirium prevention and management lies in both better implementation of best practices that have been defined over the last three decades as well as taking more of a whole patient view. This includes harnessing the electronic medical record, artificial intelligence, and so on to risk assess and individualize care for each patient; restructuring care to reduce deliriogenic practices and care environments; redefining what usual care looks like (e.g., utilizing music and involving loved ones, etc.); policy changes to change systematic priorities. In this paper, we will explore the past, present, and future of nonpharmacological prevention and management of delirium across care settings.

Influence of the transformation of the legal system of Ukraine on the development of the theory of the state and law

The article is devoted to the analysis of modern challenges for the theory of the state and law in the context of the development of the legal system of Ukraine. Starting with the introduction, the author emphasises the relevance of the topic and emphasises the need to consider these issues in the Ukrainian context. The theoretical part of the article deals with a historical overview of the state and law, in particular, their development in Ukraine. The author draws attention to the key aspects of the formation of the theoretical foundations that formed the basis of the country’s modern legal system. Modern trends in the development of the legal system of Ukraine are also considered. The author analyzes various aspects such as corruption, human rights and the implementation of reforms. The problems and challenges faced by the Ukrainian legal system are highlighted, and possible ways to overcome them are outlined. A separate part is devoted to the influence of globalisation on changes in the concepts of the state and law. The author considers the phenomenon of globalisation as a factor affecting the modern legal system of Ukraine and highlights its consequences and opportunities for further development. In addition, the article examines the role of the Constitution of Ukraine in the formation of the legal system. The author analyzes the basic principles of the state and law enshrined in the Constitution and their significance for the functioning of the country’s legal system. Attention is drawn to international experience in solving challenges for the theory of the state and law. The author conducts a comparative analysis of different countries, which allows to highlight the best practices and use them to improve the legal system of Ukraine. A separate aspect is the role of civil society in the formation of the legal system. The author emphasises the importance of active participation of citizens in the legal process and their influence on the development of the legal system. In the conclusion, the author sums up the research and highlights the main conclusions regarding modern challenges for the theory of the state and law in Ukraine. It is noted that the further development of the country’s legal system requires complex measures and systemic reforms, as well as the active implementation of best practices and experience of other countries.

Development and implementation of autoverification standardization in the adult and pediatric emergency department.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This project utilized the guidance of the American Society of Health-System Pharmacists (ASHP) autoverification toolkit to refine our health system's approach to autoverification and contribute to the literature regarding appropriate use of autoverification technology in a pediatric and adult emergency department (ED). This single-center quality improvement study was conducted in an academic medical center ED that has 33 pediatric beds and 77 adult beds. A team consisting of clinical pharmacy specialists in emergency medicine, medication safety and informatics personnel, operational managers, and pharmacy leadership was identified to develop and implement autoverification best practices in the ED utilizing practices outlined within the ASHP autoverification toolkit. Before implementation of best practices, defined as the "preoptimization" state, autoverification took place for most medications available in the automated dispensing cabinets (ADCs). By anchoring the autoverification rule on ADC inventory, it was challenging to optimize both inventory practices and autoverification best practices. This project focused on redesigning the autoverification rules in the electronic health record, defined as the "postoptimization" state. In the postoptimization state, autoverification in the ED was updated to better align with regulatory standards. Autoverification metrics and the percentage of orders that autoverified vs required pharmacist verification were analyzed in the preoptimization and postoptimization states. This project utilized the guidance from ASHP's autoverification toolkit to refine our health system's approach to autoverification. High-alert medications (eg, insulin, extended-release opioids, digoxin) were taken off autoverification following implementation. Optimization of autoverification rules allows more orders for high-alert medications to be reviewed by a pharmacist.

Implementation of spirometry screening for post-tuberculosis lung disease (PTLD) among adolescents and adults enrolled within the National Tuberculosis Control Program of Carmelo Hospital in Chókwè District, Mozambique: A hybrid type III effectiveness-implementation study protocol

BackgroundDespite receiving adequate treatment, many tuberculosis (TB) survivors are left with post-tuberculosis complications, possibly due to lung tissue damage incurred during the active period of the disease. Current TB programs worldwide deliver quality care throughout the course of active TB treatment, yet often fail to provide organized follow-up once treatment ends. Post-tuberculosis lung disease (PTLD) is a prominent, yet underrecognized cause of chronic lung disease, managed similarly to chronic respiratory diseases with pharmacotherapy and/or personalized pulmonary rehabilitation interventions. Basic pulmonary rehabilitation packages for people finishing TB treatment are still lacking in low- and middle-income countries (LMICs). We offer a study protocol to evaluate the implementation of spirometry and symptom screening for PTLD among people who have completed TB treatment in a rural district in Mozambique.MethodsThe overall objective of this study is to evaluate the introduction of a new screening program that utilizes symptom screening and spirometry for diagnosing PTLD among adolescents and adults that have completed TB treatment. This research protocol consists of three complementary components: 1) assessing the prevalence of PTLD among patients enrolled in the National TB Control Program (NTCP) at Carmelo Hospital (CHC) in Chókwè District, Mozambique; 2) evaluating anticipated implementation outcomes through the identification of the site-, provider-, and individual-level determinants that either facilitate or hinder the successful adoption, implementation, and maintenance of the spirometry screening program, and 3) evaluating the real-time implementation outcomes/processes in order to provide practical evidence-based key indicators of successful implementation of the spirometry screening program.DiscussionProviding well-organized, evidence-based care for individuals with a history of TB who are experiencing symptoms of PTLD can relieve chronic respiratory issues, enhance quality of life, and potentially lower the risk of further pulmonary infections, including recurrent TB. However, there is a significant gap in the literature regarding the implementation of best practices of HIV and TB health services delivery. Addressing this gap could assist Mozambique in improving diagnosis, treatment, and continuity of care for people formerly living with TB. The insights from this study will help decision-makers improve spirometry screening coverage, enhance intervention effectiveness, and translate our findings to evidence-based programming.Trial registrationISRCTN92021748 retrospectively registered.

Prevention of radial artery occlusion after transradial angiography and intervention: a best practice implementation project.

Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting. The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention. The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies. The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention. This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future. http://links.lww.com/IJEBH/A261.

Does Digitization Affect Social and Financial Performance in Microfinance Institutions?

This research aims to explore the effects of the digitization of microfinance institutions (MFIs) on their social and financial performances, and on the trade-off between them given the double mission pursued by these institutions. To reach this objective, we performed ordinary least squares (OLS), logit, and two-stage least squares (2SLS) regressions on a sample of 331 microfinance institutions from the ATLAS database. Findings reveal evidence of significant mixed effects of digitization on social and financial performance indicators. They also show that there is no significant effect of digitization on trade-offs. The novel aspect of this research lies in the approach used to measure social performance which is proxied by the SPI4 -Social Performance Indicators-developed by Cerise and Social Performance Task Force (SPTF), while previous research on the topic have used social mission outcomes indicators. The SPI4 tool allows financial service providers to evaluate the implementation of Universal Standards for Social Performance Management (USSPM). This study also provides evidence on the effect that digitizing MFIs operations may have on trade-off between their social and financial performances. The findings have significant implications for institutions, especially on the way they can implement and interconnect their digitization process, USSPM and financial strategy. Firstly, the significant effect of digitization on social performance reveals synergies between the adoption and use of digital solutions and the implementation of good practices of SPM. Secondly, the mixed effects of adopting digital solutions on financial performance suggest that while this process appears to drive efficiency within institutions, it does not necessarily improve their profitability, since capital expenditure appears to increase more than profits. Finally, since digitization does not appear conducive to trade-off, MFIs should better align their financial and investment strategy with their social objectives when going digital.

Lessons for biosecurity education from the International Nuclear Security Education Network

With the rapid advances in technology and life science, biological security is now at a defining moment. The mandate of the 2022 Biological and Toxin Weapons Convention 9th Review Conference emphasised the urgent need for new tools to strengthen the Convention. In this paper, we review the development and efforts of the International Nuclear Security Education Network (INSEN) to provide examples of best practice for implementation of the newly founded International Biological Security Education Network (IBSEN). Learning from the lessons of the INSEN, the sustainability of the network through continuous engagement of its members is essential for the further development of global biosecurity education.

Paramedic educational programs maintain entry level competency throughout the COVID-19 pandemic.

The COVID-19 pandemic required unprecedented changes to emergency medical services (EMS) educational frameworks in the United States. It is unclear if pandemic-related changes impacted paramedic educational outcomes. We aimed to evaluate curricular and performance changes resulting from the initial COVID-19 pandemic on paramedic educational programs. We performed a retrospective cross-sectional evaluation of paramedic educational programs in 2019 and 2020 using the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions annual reports. These reports contain detailed program components and measures of program success. We included programs reporting at least one graduate in the study period. Descriptive statistics (proportions [%], median [interquartile range, IQR]) were calculated for paramedic program characteristics in 2019 and 2020, as well as pandemic specific curriculum changes. Wilcoxon rank-sum and Fisher's exact tests were used to evaluate differences in characteristics by year. The number of paramedic educational programs in our population decreased from 640 programs in 2019 to 612 in 2020, with a statistically significant decrease in clinical hours (2019: 219 [IQR 168‒272]; 2020: 200.5 [IQR 157‒261]). There was no difference in first or third-attempt certification examination success between years. Temporary shutdown was experienced in 34% of programs (duration: 3weeks [2‒7]) and 72% of required curricular changes. Curricular changes commonly included decreased in-person education (86%), traditional classroom lectures (78%), number of clinical sites (78%), and increased online didactic education (92%). Only 20% of programs decreased laboratory simulation or total training hours. During the pandemic, paramedic educational programs changed educational delivery with no observed differences on overall program performance. Identifying key curricular changes and best practices for implementation may be necessary to better optimize future educational delivery.

Implementation of Best Practices for the Management of Radio-Electronic Signal Blocking Systems: A Case Study at the Ministry of Justice, Peru

Implementation of Best Practices for the Management of Radio-Electronic Signal Blocking Systems: A Case Study at the Ministry of Justice, Peru