Practice Improvement Research Articles

DESAFIOS E CONQUISTAS DA INCLUSÃO ESCOLAR NO BRASIL

The study investigated the challenges and achievements of school inclusion in Brazil, with the aim of identifying the main barriers faced and the advances achieved in promoting inclusive education. The research used a qualitative approach, through a literature review, analyzing relevant studies and documents on the subject. The main challenges identified included structural and pedagogical barriers, resistance and prejudice, as well as the lack of adequate training for teachers. Structural barriers involve the absence of physical adaptations in schools, while pedagogical barriers refer to the inadequacy of curricula. Resistance and prejudice on the part of some educators and members of the school community were also highlighted as significant obstacles. The need for continuous capacity building for teachers has been identified as a critical area to improve the effectiveness of inclusive practices. In contrast, advances have included improvements in public policies and the adoption of assistive technologies, which have facilitated inclusion. The study revealed that, despite the progress, there are still areas that require attention, such as the improvement of pedagogical practices and the formulation of specific policies. Concluding remarks highlighted that while important progress has been made, continued research and policy and practice development is needed to address persistent challenges and promote effective school inclusion.

EHospitals and Parkinson’s disease care: audit insights from an EPIC-integrated Hospital

Abstract Introduction Parkinson’s disease (PD) is a neurodegenerative condition that affects approximately 145,000 individuals in the UK. PD symptoms are managed primarily through medications such as levodopa and dopamine agonists. Delays or omissions in administering these medications is the primary reason for increased length of stay in up to 73% of emergency admissions.1 This audit investigated the management of PD medications at Cambridge University Hospitals to identify areas for improvement in clinical practice. Aim This audit aimed to evaluate the pharmacological management of PD patients admitted to Cambridge University Hospitals NHS Trust. Specifically, it sought to assess the accuracy of drug histories, the quality of medication administration, and adherence to standards set by Parkinson’s UK ‘Get it on Time’ campaign and NICE.2,3 Methods A cross-sectional audit was conducted, reviewing the records of PD patients admitted over a three-month period. The sample included patients with a confirmed diagnosis of idiopathic PD who were prescribed at least one PD medication. Data were collected retrospectively from the electronic patient records, focusing on ten performance standards. Ethical approval was not required as the study involved a retrospective review of existing clinical records. Results The audit included 63 admissions, predominantly male (65%) with a mean age of 78.5 years. A significant portion of patients (81%) had their drug histories completed by a doctor after clerking, and 90% had orders for their regular treatment generated immediately post-clerking. Pharmacy staff completed drug histories within 24 hours for 81% of patients, though discrepancies between medical and pharmacy histories were noted in 70% of cases. Medication reconciliation within 24 hours was achieved for 83% of patients, yet only 29% received their PD medications on time for every dose. Additionally, 76% did not miss a dose or had a valid reason recorded for missed doses. 83% had PD listed in their electronic problem list after clerking. Alarmingly, just 5% were assessed for Self-Administration of Medicines (SAM), and 76% were assessed by a PD specialist during their stay. Discussion and conclusion The audit revealed substantial gaps in PD medication management, particularly regarding discrepancies between medical and pharmacy drug histories and delays in medication administration. The low rate of SAM assessments and inconsistent PD specialist consultations were also significant concerns. These findings highlight the need for improved documentation practices, such as standardized templates within the EPIC system, and increased pharmacy involvement during early stages of admission. Appropriate staffing levels and better interdisciplinary coordination are essential. The audit identified critical areas for improvement, emphasizing the need for better documentation, timely administration, and enhanced interdisciplinary coordination. Future audits should aim to randomize patient selection over a longer period to minimize bias and provide a more comprehensive assessment of medication management practices. The audit was limited by its retrospective design and the specific three-month timeframe, which may not fully represent broader trends. The exclusion of admissions shorter than 24 hours and the focus on a single hospital trust also limit the generalizability of the findings. Future studies should consider a larger, more randomized sample to validate and expand upon these results.

Participation in practice in child welfare: processes, benefits and challenges

ABSTRACT Internationally, there has been a significant focus in policy and practice on the participation of children and young people in decisions that affect them, underpinned by respect for their rights under Article 12 of the UNCRC. While children’s participation has become a core focus for practice improvement in child welfare services, there is a dearth of practical examples of how participation is implemented in organisations. In this paper, we provide a reflective case study of participation in practice in the Youth Advocate Programme (YAP) in Ireland, a large non-profit child welfare organisation. YAP Ireland works with young people who are considered ‘high risk’ using a strength-based approach in a wraparound service that is family-driven and youth-guided. Drawing on qualitative interviews and focus groups with young people, parents, advocates, and staff and management, we describe and critically analyse YAP’s approach to participation. Critical factors in practice include a commitment to participation in policy, practice and culture at all levels of the organisation and scaffolding of participation by staff. Challenges include ensuring that participation principles are upheld consistently across the organisation and resourcing participation.

Return on Investment of Preoperative Anemia Management Programs in Cardiac Surgery: An Advisory From the Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Committee With Endorsement by the Society for the Advancement of Patient Blood Management

Despite multiple recent guidelines recommending the diagnosis and treatment of anemia before elective cardiac surgery, few institutions have formal programs or methods in place to accomplish this. A major limitation is the perceived financial shortfall and the leadership buy-in required to undertake such an initiative. The purpose of this advisory from the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee with endorsement by the Society for the Advancement of Patient Blood Management (SABM) is to provide an overview of preoperative anemia management programs with an emphasis on the associated financial implications. This advisory reviews the evidence for preoperative anemia management programs in both cardiac and noncardiac surgery, discusses options for managing preoperative anemia, provides novel financial modeling regarding the implementation of preoperative anemia management programs, and describes implementation challenges, potential solutions, and opportunities for improvement.

Current State of Professionalism Curriculum in Oral Health Education.

The aim of this study was to systematically review the relevant literature on teaching professionalism in dental curricula and report the relevant data from a survey of members of the Association for Dental Education in Europe (ADEE) on the topic. We conducted a systematic review of the literature and a cross-sectional study using an online questionnaire regarding teaching and assessment of professionalism in dental schools, members of the ADEE. The literature review identified 33 articles related to professionalism in dental curricula. The survey sent to the membership of the Association for Dental Education in Europe yielded responses from 27 European dental schools and four schools outside Europe. Various study designs were identified in the review, and the main themes discussed included teaching/pedagogy, ethics/humanities, core domains and assessment of professionalism. Twenty schools reported having specific courses dedicated to professionalism, while the format varied, including entire modules, separate learning outcomes or unit structures. Ethics, communication, law/legal framework/deontology, teamworking and management/leadership were among the common topics taught under the banner of professionalism. Many schools reported increases or no changes in hours, staffing, themes/topics covered and weight in the curriculum for professionalism over the last decade. The paper provides valuable insights into the current state of professionalism education in dental curricula and offers directions for enhancing its effectiveness and relevance in preparing future dental professionals. Collaborative efforts among dental educators and institutions can contribute to the continuous improvement of professionalism education and practice in dentistry.

A Intervenção do Serviço de Atenção Domiciliar junto ao usuário e cuidador na rede de atenção à saúde

**Introduction**: Population aging drives the development of home care practices, expanding the role of healthcare teams. The Home Care Service (SAD) is characterized by comprehensive actions in health promotion, prevention, treatment, and rehabilitation performed at home, ensuring continuity of care and effective integration with healthcare networks and the user. **Objective**: To highlight the relationship between the Home Care Service (SAD) and healthcare networks. **Methodology**: This is a descriptive study in the form of a narrative literature review, which sought to highlight the relationship between the Home Care Service (SAD) and healthcare networks. The research was conducted through online access to the PubMed, Medline, and Scielo databases, using the descriptors "home care services," "SUS," and "healthcare networks." Inclusion criteria were: articles available in full text, in Portuguese and English, addressing the topic, and published between 2019 and 2023. **Results**: The results highlight the importance of home care services in assessing, identifying, and training caregivers, promoting self-care and user autonomy. The lack of professional guidance for caregivers presents an opportunity for improvement in care practices. Furthermore, SAD stands out as an innovative strategy in healthcare, surpassing primary care and emergency services, adopting a humanized approach aligned with SUS. By replacing or complementing hospital stays, it seeks equity in resource distribution for efficient access to home care, with active intervention in caregiver training, playing a crucial role in preventing complications, and consolidating itself as a key agent for a patient-centered approach within the SUS framework. **Conclusion**: The intervention of SAD with the user and caregiver is of utmost importance in training caregivers to assist users, avoiding unnecessary complications and ensuring continuity of care within SUS. Thus, the service complements the care provided in primary care and emergency services and substitutes or complements hospital stays.

Enhancing Fault Location Accuracy in Transmission Lines Using Transient Frequency Spectrum Analysis: An Investigation into Key Factors and Improvement Strategies

Fault location estimation in transmission lines is critical for power system reliability. Various methods have been developed for this purpose, among which transient frequency spectrum analysis (TFSA) stands out as a recent method based on travelling wave (TW) theory. TFSA determines the fault location by analyzing the frequency spectrum of transient currents and/or voltages at the instant of the fault, offering advantages such as independence from fault impedance and the ability to locate faults with one-side measurements. Despite its success in fault location, TFSA has several considerations that warrant detailed investigation. This study explores the effects of source inductance, series compensation, fault arc, and current transformer (CT) characteristics on transient frequencies. Additionally, the impact of noise on TFSA results is examined. The new proposed source inductance compensation method can reduce the error of 6.55% to 0.88%, where the same error can be reduced to 3.45% with the compensation method given in previous study. Strategies to enhance accuracy are discussed and compared to previous studies, including a proposed detection approach providing appropriate data size and precise wave propagation speed calculations. These findings contribute to a deeper understanding of TFSA’s limitations and inform practical improvements for fault location accuracy in power transmission systems.

The impact of SARS-CoV-2 (COVID-19) pandemic on educational and professional growth of young Italian epileptologists: a survey of the Young Epilepsy Section-Italian chapter.

In March 2020, the World Health Organization declared the coronavirus-related disease SARS-CoV-2 infection pandemic. Italy was one of the most affected countries and managed the emergency also by a health care reorganization. The Education and Career Development Task Force of the Young Epilepsy Section-Italy (YES-I) designed a survey to assess the impact of the pandemic on the training and work of young epileptologists (< 40years). Fifty-three responses were collected: 45.3% were resident, 9.4% PhD students and the remainder specialists. Clinical activity changed for most (83%) during the pandemic. Educational activity at epilepsy centers was reduced for 35.8% of the survey participants, while 30.2% of research projects involving patients participation were stopped to switch mainly to COVID-19-related research. For 73.6% of survey participants, attending online courses and congresses was easier in terms of cost and organization, although for 50.9% the level of training was lower in quality. In contrast, 58.5% rated the webinars organized by YES-I very educational. Less than 50% of the clinicians used telemedicine in the pandemic period and continue to use it. Despite several positive aspects of virtual medicine, a small number (32.1%) of our interviewees were satisfied from telemedicine and few of them (30.2%) reported that it led to improvement of clinical practice. Our survey showed that the pandemic has had a negative impact on training, research and clinical activity in the epilepsy field; moreover, it underlined the critical aspects of virtual communication methods in order to improve its use for the future.

Assessment of Reproductive Performance and Husbandry Practices of Horro and Crossbred Cattle Under Smallholder in Sibu Sire District of East Wollega Zone, Oromia, Ethiopia.

The reproductive and production performance of dairy cows determines the profitability of a dairy farm. A questionnaire survey was used to assess reproductive performance and husbandry practices by using 100 randomly selected animal owners. Seventy-nine percent of animal owners involved were men, ages between 30 and 60. Their education was as follows: 26% were illiterate, 67% in primary school and 7% in secondary school. Ninety-five percent of them managed their animals extensively and used natural mating and breeding practices (75%). AFS in months were 46.83±0.65 in Ada-Buke Warego, 46.00±1.36 in Hagalo-Tulam, 47.08±0.99 in Dicho Aba-Garmama and 47.29±0.51 in Waligalte. AFC in months were 56.68±0.97 in Ada-Buke Warego, 58.00±1.36 in Hagalo-Tulam, 57.23±1.41 in Dicho Aba-Garmama and 56.24±1.13 in Waligalte. ANSPCs were 1.85±0.08 in Ada-Buke Warego, 1.67±0.14 in Hagalo-Tulam, 1.54±0.14 in Dicho Aba-Garmama and 2.00±0.10 in Waligalte. The mean length of CI in months was 30.88±0.90 in Ada Buke Warego, 29.00±1.68 in Hagalo-Tulam, 28.62±1.62 in Dicho Aba-Garmama and 31.06±1.04 in Waligalte. The average year of longevity was 9.22±0.7 in Ada-Buke Warego, 9.08±0.8 in Hagalo-Tulam, 9.31±0.13 in Dicho Aba-Garmama and 9.21±0.8 in Waligalte, but there is no significant association (p≥0.05). AFC in months was 48.00±0.00 in local and 37.20±1.30 in crossbreeds. ANSPC was 1.92±0.06 in locals and 1.10±0.10 in hybrids. AFC for Horro and crossbred dairy cattle were 57.73±0.59 and 48.00±0.00months, respectively. The mean length of CI was 30.53±0.67 and 29.40±1.99months in natives and crossbreeds, respectively. The average year of longevity was 9.22±0.05 and 9.10±0.10years for local and hybrids, respectively. ANSPC for natural mating and AI were 1.92±0.05 and 1.10±0.10, respectively, with significant association (p<0.05). The reproductive performance of dairy cows in the study area was low, which required the improvement of husbandry practices.

Effect of drinking water temperature and mineral supplementation on pre and post-lambing behavior of Corriedale ewes and their newborn lambs.

Lamb mortality poses a serious challenge to the sheep industry, leading to immediate financial losses for livestock owners. Improvement of management practices, particularly through environmental enrichment, has been consistently linked to increased lamb survival and growth in both ewes and lambs due to its substantial impact on their behavior and overall welfare. In our study, we aimed to enhance ewe production and improve ewe behavior through the optimization of water temperature and the inclusion of mineral supplementation. To conduct our research, four distinct groups comprising 10 ewes each were formed based on body weight and parity. Our comprehensive study involved the observation of both pre and post-lambing behaviors in ewes, as well as the examination of lamb behavior. The pregnant ewes were monitored using video camera surveillance. For studying the pre-partum behavior, videos were thoroughly analyzed for 3h before parturition. For studying post-partum and lambing behavior, videos were analyzed for 3 days (24h per day). Notably, the group that received warm water and mineral supplementation exhibited a discernibly positive behavioral response. These findings illuminate a promising approach for improving ewe production while simultaneously reducing lamb mortality. Our research contributes valuable insights into the sheep industry, offering a pathway toward enhanced animal welfare, economic sustainability, and increased profitability for livestock owners.

Prevalence and risk factors of bovine leptospirosis in the Ecuadorian Amazon

Background and Aim: Leptospirosis is an infectious zoonotic disease that significantly affects animal health, particularly the reproduction of ruminants. However, some aspects of epidemiology and clinical characteristics have not been clarified. This study aimed to estimate the prevalence and identify risk factors of leptospirosis in female bovines at reproductive age in the Ecuadorian Amazon rainforest. Materials and Methods: A total of 213 bovines were studied in the Amazon province of Zamora Chinchipe, in which a microscopic agglutination test was used to diagnose a panel of eight serovars of Leptospira borgpetersenii (Sejroe) and Leptospira interrogans, Australis, Bataviae, Canicola, Tarassovi, Icterohaemorrhagiae, Wolffi, and Hardjo. An epidemiological survey was conducted to identify risk factors by animal and herd and clinical symptoms associated with Leptospira spp. infection; and blood samples were collected to determine the differences between seropositive and seronegative animals regarding hematocrit, hemoglobin (Hb), mean corpuscular Hb concentration, total red blood cell count, total platelet count, leukocytes, total proteins, creatinine, and ureic nitrogen. Results: The prevalence of bovine leptospirosis was 12.21% (26/213), with positive reactions in the Australis, Sejroe, Bataviae, Canicola, and Tarassovi serovars. No variables were considered risk factors, nor clinical signs associated with the infection, nor were there differences in the hematological parameters between the seropositive and seronegative animals. Conclusion: These findings indicate the persistence of Leptospira on cattle farms in the Ecuadorian Amazon and highlight the interaction between domestic and wild species. It is crucial to implement control measures and improvements in management practices under the One Health approach to reduce accidental infections from contact with wildlife; the awareness of farmers is essential for effective prevention. Keywords: amazon region, bovine, leptospirosis.

Current Practice and Perspectives on Subcutaneous Immunoglobulin Replacement Therapy in Patients with Primary Antibody Deficiency Among Specialized Nurses in Poland.

Inborn errors of immunity (IEI) encompass various congenital disorders, resulting in immunity defects and recurrent infections. Home-based subcutaneous immunoglobulin replacement therapy (scIgRT) is the best treatment option for those with primary antibody deficiency (PAD). However, the lack of standardized procedures in patient training remains a challenge. Our study investigates nurses' practice and perspectives, aiming to identify areas for improvement in at-home scIgRT practice. We prepared a structured survey regarding scIgRT, including needle choice experience and perception of adverse events, and distributed it among qualified nurses involved in patient training and scIgRT supervising. We included 56 nurses with a median age of 50 years. Among them, 67.9% represented adult care providers, while 32.1% supervised IgRT in children. Most respondents (83.9%) used the classic or assisted with hyaluronidase scIgRT preparations. Single-channel needles were administered most commonly (85.7%). The needle length was mostly chosen solely by a nurse (57.1%) or in cooperation with the patient (23.2%). Next, 9 mm and 12 mm needles were used most often (92.9% and 78.6%, respectively). As expected, the 6 mm needle was more frequently applied for children compared to adults (n = 16, 88.9% vs. n = 11, 28.9%, p < 0.001), while 12 mm was primarily used in adults (n = 35, 92.1% vs. n = 9, 50.0%, p < 0.001). Visual skin fold assessment was the basis for the needle selection (58.9%), followed by the injection site rule (26.8%) or a choice between two available needle types for thinner or thicker patients (25.0%). Results of this survey indicate that, according to nurses' opinions presented in this survey, the needle length could be associated with local scIgRT adverse events, such as side needle leakage or local burning. Yet, it was likely unrelated to general adverse signs, such as headaches or dizziness. Most respondents (66.1%) indicated that, even if local adverse events occur, patients are reluctant to change scIgRT preparation or needle length. Most participants (69.6%) reported that the optimal administration technique needs to be discussed with the patient before and during scIgRT. This study sheds light on scIgRT practice in Poland, emphasizing deficiency in needle selection technique. Future research should focus on standardized training and advanced needle selection procedures on patient outcomes, investigating the correlation between needle strategies and adverse events, as well as the effectiveness of scIgRT.

THE THEORY OF ORGANIZATIONAL ACTION IN THE INTEGRATED WORKER HEALTH CARE SUBSYSTEM (SIASS): ELUCIDATING BEHAVIORS AND INTEGRATING OCCUPATIONAL HEALTH ACTIONS

This article investigates how the Theory of Organizational Action can improve work processes and management in the Integrated Subsystem for Employee Health Care (SIASS), focusing on employee behavior, organizational culture, and interactions between individual and collective actions. The research demonstrates that the principles of this theory can be applied to strengthen occupational health management in SIASS, highlighting the role of individual and organizational action, as well as social interactions in creating a more collaborative and efficient work environment. The results indicate that the Theory of Organizational Action offers a deeper understanding of internal dynamics, highlighting the need to align individual behaviors with institutional and collective objectives, aiming at optimizing management processes. In addition, the approach allows identifying critical points and opportunities for improvement in occupational health practices, contributing to a healthier and more productive work environment. The study recommends that future research carry out comparative analyses between different SIASS units, to expand the practical evaluation of theoretical concepts and provide support for the development of more effective management strategies, adapted to the specificities of each unit that makes up the SIASS network.

Posttraumatic stress disorder in diverse populations: Testing for assessment bias in a nationally representative sample.

A growing body of research has emerged to characterize differences in posttraumatic stress disorder (PTSD) symptom presentations in individuals from diverse racial and ethnic groups. However, less research has examined if these observed differences can be attributed to bias within PTSD assessments. Knowledge about potential bias in PTSD assessment is essential for interpreting group differences. If PTSD assessments do not perform similarly across diverse demographic groups, then observed differences may be artificial products of inaccurate measurement, new assessments could be required for individuals from different demographic groups, and we would be unable to accurately detect PTSD treatment effects in patients from diverse groups. We evaluated PTSD assessment bias through tests of measurement invariance for the semistructured, clinician-administered AUDADIS-5 diagnostic assessment of participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III. Participants included those who reported having experienced at least one potentially traumatic event in their lifetime (N = 23,936). Measurement invariance was assessed for participants who identified from several demographic groups (Asian, Native Hawaiian, or Pacific Islander; Hispanic; American Indian/Alaskan Native; and Black) compared to participants who identified as White (non-Hispanic). Overall, PTSD assessment was largely invariant across groups, while small amounts of measurement invariance were detected that can inform future research and clinical adaptations. This work validates prior research that relies on a common conceptualization of PTSD, and it provides several paths for future improvement in research and clinical practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Can Fasting Practices Improve Vitamin D Levels?

Vitamin D deficiency is emerging as a very serious public health problem. Numerous epidemiological studies link vitamin D deficiency to the pathophysiological process of several acute and chronic diseases. Sun exposure, vitamin D supplementation, and fortification of foods with vitamin D are the present strategies adopted to tackle this epidemic. While this can be effective, recent evidence suggests the need to consider the multifaceted causation of vitamin D deficiency such as impaired liver function, kidney function, hyperparathyroidism, and endocrine dysfunction. Therapeutic fasting, a popular nutritional approach has shown to have a positive association with vitamin D levels. This perspective attempts to provide an overview of literature discussing fasting and vitamin D, the possible mechanisms behind this association, and discusses the future possibilities of using fasting as a public/clinical tool in mitigating vitamin D deficiency.

Does Adoption of Multiple Climate‐Smart Agriculture Practices Improve Rural Farm Households' Food Security in Ethiopia?

ABSTRACTClimate‐smart agriculture (CSA) is a set of economically and environmentally friendly practices that can address the issues of food security under the new realities of climate change. However, the adoption of these practices among smallholder farmers is still low, especially in developing countries like Ethiopia. Thus, the main objective of this study was to assess the factors determining rural farm households' adoption of CSA practices and their impact on food security in the Sidama region, Ethiopia. Primary data for this study were obtained from a randomly selected sample of 523 households using a pre‐tested, structured questionnaire. The collected data were analyzed using descriptive statistics, multivariate probit, and an endogenous switching regression model. The study found that, in the study area, conservation of agriculture is the most popular CSA practice, which is adopted by 96.2% of the adopters, followed by soil fertility management (82.2%), crop diversification (62.3%), small‐scale irrigation (47.9%), and crop–livestock integration (40.7%). The multivariate probit model revealed that the sex of the household head, age of the household head, educational level of the household head, extension contact, information on climate change, and distance to the market were identified as determinants for the adoption of CSA practices. Furthermore, the endogenous switching regression model analysis revealed that adoption of CSA practices increased rural farm household food security status. Therefore, this paper suggests that smallholder farmers should incorporate CSA practices to improve their food security.

An Investigation into Third-Year Students' Perceptions of the First English Teaching Practice

Research into language teaching methodology involves a dynamic interplay between teacher-led activities and learner engagement to acquire knowledge, skills, and critical thinking abilities. Even so, more research has been done to explore students' unique challenges during their initial teaching practice sessions. This study addresses this gap by looking into the perceptions of junior English majors while taking their first teaching practice in language teaching methodology classes. The study aims to pinpoint these issues and provide workable fixes to improve instruction. Quantitative and qualitative methodologies, such as close-ended and open-ended questionnaires, were used to collect data from 150 junior English students. The results show that students face difficulties resulting from internal and external sources during class. The study provides valuable insight to support the teacher trainee and practical improvement for the development of the course Language Teaching Methodology.

A survey of US and Caribbean veterinary schools reveals strengths and opportunities in antimicrobial stewardship and infection prevention and control activities.

To understand antimicrobial stewardship (AS) and infection prevention and control (IPC) activities in veterinary schools. An online survey was completed by representatives from American Association of Veterinary Medical Colleges-accredited veterinary schools in the US and Caribbean prior to attending the Inaugural Small Animal Antimicrobial Stewardship Workshop for US Veterinary Schools. Responses were examined to identify patterns among AS and IPC activities and adherence to the AVMA core principles. Half (12 of 24) of the surveyed schools had an AS committee and most (79% [19 of 24]) had an IPC committee. Lack of dedicated staff time was a common barrier to AS (88% [21 of 24]) and IPC (75% [18 of 24]) reported by schools both with and without AS and IPC committees. Eleven of 24 schools (46%) reported performing at least 1 activity focused on each of the AVMA's 5 core principles of AS. Although 79% (19 of 24) of schools incorporate AS into preclinical curricula, training of clinical faculty (17% [4 of 24]), veterinary technicians and support staff (21% [5 of 24]), and house officers (42% [10 of 24]) is less common, despite these individuals engaging in teaching clinical-year veterinary students. Veterinary schools varied in established AS education and AS and IPC practices, though financial and human resources were a common barrier. A collaborative and cohesive approach to AS and IPC among schools to create sustainable frameworks for practice improvement will help combat the global threat of antimicrobial resistance. This is a critical action for settings where future veterinarians are trained.

Barriers and facilitators to continuous quality improvement engagement among rural physicians in British Columbia, Canada: a mixed-methods study.

Rural physician engagement in continuous quality improvement (CQI) activities is vital to improving quality of care, patient safety, and healthcare delivery efficiencies. However, there is a lack of evidence surrounding the barriers and facilitators to CQI uptake across rural medical practices. This study aimed to explore enablers and barriers to CQI implementation and identify ways to foster greater engagement of rural physicians. A mixed-methods triangulation study design was undertaken encompassing a survey and focus group interviews with physicians practising in rural communities of British Columbia, Canada. The survey was distributed to 1584 rural physicians, and 299 responses were received (response rate of 19%). Seven focus groups were conducted with 33 participants. Survey respondents indicated strong support towards CQI and the benefits of improved patient outcomes and practice quality. Less than half (47%) of respondents had participated in a CQI initiative within the previous 2 years. Key barriers to CQI engagement included time constraints, limited knowledge of CQI principles, and a lack of understanding of accessing and using relevant data. Key motivators for CQI engagement were opportunities for peer collaboration and receiving practice improvement feedback. Key enablers included more usable and accessible data and appropriate staffing resources to assist with undertaking CQI activities. Given rural physicians' time demands, better support systems are required to enhance rural physician engagement in systematic CQI activities. Specific support areas include dedicated CQI staff resources and better practice data systems and processes to support CQI initiatives.

OPTIMISING EFFORT CAPACITY IN TRIATHLON

Background. My personal triathlon practice inspired the creation of a specialized training regimen to improve triathlon training in Romania. This program aims to enhance performance, well-being, and injury prevention for athletes. At the INTERDISCIPLINARY RESEARCH CENTRE (CCI) “Dr. Alexandru Partheniu” of UNEFS, we used AEROSCAN technology to assess exercise capacity, measuring heart and breathing rates with the Bruce Protocol for precise physiological monitoring. Objectives. This research demonstrates that tailored training cycles for swimming, cycling, and running can significantly enhance triathlon performance. The goal was to create a customizable, comprehensive training program to maximize the overall training process and provide a scientific foundation for triathlon training in Romania. This research aims to demonstrate that tailored training cycles can significantly enhance triathlon performance. Methods. We used observation, experimental, statistical-mathematical, and bibliographic study methods to interpret the experiment's outcomes. The bibliographic study provided the theoretical basis, while observation and experimental methods enabled real-time data collection. Statistical analysis was crucial for interpreting the data. Results. Using AEROSCAN and the Polar system, we evaluated exercise capacity and tracked heart rate. The Bruce protocol was applied for both initial and final tests. The data showed significant improvements in endurance, speed, and overall performance, supported by statistical analysis, after implementing the customized training program. Conclusion: Our research indicates that tailored athletic training regimens for each triathlon discipline can significantly enhance performance and promote athletes' health and longevity. The results highlight the importance of individualized training plans and suggest potential improvements in Romanian triathlon training practices. Individualized training programs lead to notable improvements in performance and athlete well-being.