Practice Improvement Research Articles

Pain assessment and management in patients with dementia in Taiwan: a best practice implementation project

ABSTRACT Introduction: The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia. Objectives: The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community. Methods: The project followed the JBI Evidence-based Healthcare Model and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance. Results: This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1–3, respectively. For Criteria 4–8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses’ perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome. Conclusions: Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study. Spanish abstract: http://links.lww.com/IJEBH/A294

Residential medication management reviews: a call for improved collaboration and systems integration in aged care

Purpose Residential Medication Management Reviews (RMMR) are a key component of safe, high-quality aged care service delivery. The RMMR is an interdisciplinary approach to medication management that relies on collaboration, communication and integration of systems. Acting as an improvement opportunity, the purpose of this paper is to present findings from a regional study, aimed at assessing the impact of RMMR on falls and hospital admissions and identifies barriers to impactful research in this area. Design/methodology/approach A three-year retrospective quantitative longitudinal practice audit was conducted in a regional state-managed high-care residential facility in Queensland, Australia. Data was collected pre-RMMR and six months post-RMMR. Findings The data collected was insufficient to achieve statistical significance or demonstrate the impact of RMMR on health outcomes. Factors impeding the research included limited ability to collect the data due to the lack of integration of information systems and limited stakeholder engagement resulting in poor recruitment. This highlights the need for improvement in RMMR processes and practices, and indeed wider research collaboration in the aged care sector. Research limitations/implications Thís paper acts as a call to action to improve research and interprofessional collaboration in Australian aged care. Originality/value The aged care industry needs high-quality research to drive practice improvement and collaborative care and service delivery. This paper advocates for improvements in the aged care sector with respect to research engagement and communication pathways between service providers. Advancement in systems integration for information sharing, recruitment of participants and stakeholder engagement will support evidence-based practice and process change.

Reaccreditation and Pathways Recognition Experiences of Small Local and Tribal Health Departments

Context: This paper describes experiences and views of leadership teams from 4 small local health departments (LHDs) seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. The Pathways program launched in 2022 provides additional supports for improvement of public health practice. Objective: Given the need to accelerate accreditation among small health departments, the purpose of this study is to share small health departments’ strategies for overcoming accreditation challenges and actionable advice for use by other health departments. Design: In this descriptive qualitative study, the study team conducted 22 individual interviews with 4 small LHDs from January to March 2024. Setting: Participating small health departments were located in the Midwestern and Western United States with staff sizes ranging from 3 to 47. Participants: Interview participants included small health department leadership teams, a local board of health member, and a contracted external accreditation consultant. Main Outcome Measures: We used a semi-structured interview guide to elicit participant experiences and views on accreditation processes, benefits, facilitators, strategies for overcoming challenges, and advice for other small health departments. Results: Participants suggested that accreditation benefits far outweighed the challenges. Perceived benefits included improved organizational procedures, equitable delivery of needed effective programs and services, and enhanced public perception. Key strategies to overcome staff capacity challenges were establishing a team approach and orienting and mentoring new staff in the “why” and “how” of accreditation. Advice included learning what is involved, taking the time to lay a foundation beforehand, and not waiting for a perfect time as accreditation is about improvement, not perfection. Conclusions: Small health departments can achieve and maintain PHAB accreditation by strategically implementing strategies to overcome staff capacity and other challenges. The Pathways Recognition program is a supportive option for small health departments wanting to improve public health practice.

CRISPR-AsCas12f1 couples out-of-protospacer DNA unwinding with exonuclease activity in the sequential target cleavage

Abstract Type V-F CRISPR-Cas12f is a group of hypercompact RNA-guided nucleases that present a versatile in vivo delivery platform for gene therapy. Upon target recognition, Acidibacillus sulfuroxidans Cas12f (AsCas12f1) distinctively engenders three DNA break sites, two of which are located outside the protospacer. Combining ensemble and single-molecule approaches, we elucidate the molecular details underlying AsCas12f1-mediated DNA cleavages. We find that following the protospacer DNA unwinding and non-target strand (NTS) DNA nicking, AsCas12f1 surprisingly carries out bidirectional exonucleolytic cleavage from the nick. Subsequently, DNA unwinding is extended to the out-of-protospacer region, and AsCas12f1 gradually digests the unwound DNA beyond the protospacer. Eventually, the single endonucleolytic target-strand DNA cleavage at 3 nt downstream of the protospacer readily dissociates the ternary AsCas12f1-sgRNA–DNA complex from the protospacer adjacent motif-distal end, leaving a staggered double-strand DNA break. The coupling between the unwinding and cleavage of both protospacer and out-of-protospacer DNA is promoted by Mg2+. Kinetic analysis on the engineered AsCas12f1-v5.1 variant identifies the only accelerated step of the protospacer NTS DNA trimming within the sequential DNA cleavage. Our findings provide a dynamic view of AsCas12f1 catalyzing DNA unwinding-coupled nucleolytic cleavage and help with practical improvements of Cas12f-based genome editing tools.

INNV-38. 3 DAYS-ON-1 DAY-OFF FRACTIONATED USE PROTOCOL FOR IMPROVED COMPLIANCE AND PREVENTATIVE SKIN SAFETY FOR USE OF TUMOR TREATING FIELDS: PRACTICE IMPROVEMENT STRATEGY IN NEURO-ONCOLOGY

Abstract BACKGROUND Compassionate care delivery requires that providers understand patient values and adopt practices aimed to improve the quality of extended survival. Many brain tumor clinical trials measure survival outcomes based on therapeutic interventions, but often fail to anticipate patient noncompliance and the provider’s ability to communicate the plan. Tumor Treating Fields (TTFields) is an FDA-approved locoregional, noninvasive therapy worn on the scalp to treat glioblastoma (GBM). When worn, TTFields therapy disrupts cancer cell viability and delays tumor progression but is complicated by mild-moderate skin irritation and real-world inconvenience of the unclear recommendation to wear the device an average of “≥18 hours/day or 75% of the time”. We simplified the physician instructions to encourage patient compliance and skin safety on TTFields. METHODS Adults with GBM were provided an easy-to-follow flow chart and advised across multiple centers to follow the 3-days-on (72 hours) and 1-day-off (16–24 hours) TTFields therapy use schedule and given skin-specific wound prevention guidance (cleansing selenium-based shampoo and reparative skin-barrier moisturizing) during the ‘off day’. We evaluated the ease to explain the 3-on-1-off schedule, patient adherence, and the presence and severity of skin AEs during follow-up visits. REAL-WORLD PRACTICE OUTCOMES Seventy-six patients received TTFields therapy using the 3-on-1-off protocol between 2015 and 2021 at two US healthcare centers. The median age was 57 years (range 25–81). The mean time on TTFields therapy was 73 weeks. Skin AEs occurred in 5% of patients on the 3-on-1-off protocol, as compared to 16% and 52% reported on EF-11 (NCT00379470) and EF-14 (NCT00916409) GBM studies, respectively. Majority of AEs were mild, and no patients discontinued TTFields therapy or modified electrode placement due to skin AEs while on the 3-on-1-off protocol. CONCLUSION We report real-world data confirming a practice improvement for patient compliance using a novel 3-on-1-off protocol which minimizes skin AEs and treatment interruptions to improves patient outcomes. An ounce of prevention is worth a pound of cure.

ANÁLISE DO CASO BRASKEM EM MACEIÓ: UMA INVESTIGAÇÃO NO CONTEXTO DA CPI

This study analyzes the facts surrounding the rock salt extraction by Braskem in Maceió, Alagoas, within the context of investigations conducted by the Parliamentary Commission of Inquiry (PCI) on Braskem. The research employs an exploratory and descriptive qualitative approach, grounded in document analysis and literature review. The rock salt extraction, initiated in the 1970s, holds geological and economic relevance for the region, impacting neighborhoods in the city and presenting significant aspects for local development. The methodology follows the guidelines of Lakatos and Marconi (2010), structuring data collection through public documents, PCI reports, academic articles, and safety standards applicable to the mining sector. The analysis maps areas for improvement in operational and regulatory practices, categorizing them into three dimensions: documental, technical, and operational. The study draws comparisons with safety standards and practices exemplified by Codemin, a unit of Anglo American, which employs continuous monitoring systems and mine closure planning with environmental restoration. Based on these standards, the adoption of measures is suggested to contribute to operational safety and long-term sustainability, promoting practices aligned with responsible development.

Game Evolution Research on the Choice of Training Strategies between Clinical Departments and Doctors under the Background of Hospital-Provided Training

Objective: This study aims to explore the dynamic game process of training participation strategies among hospitals, clinical departments, and newly recruited doctors, as well as the impact of hospital intervention on this process. By applying game evolution theory, a comprehensive model is constructed to analyze the decision-making logic of training participation and propose new training strategies to promote the professional growth of newly recruited doctors and improve hospital service quality. Methods: The stability of dynamic game equilibrium points was analyzed by constructing Jacobian matrices, considering nine different game scenarios with and without hospital intervention. An empirical study from a hospital was introduced to verify the theoretical model's predictions. Results: The study found that without hospital intervention, clinical departments and newly recruited doctors tend to choose not to participate in training. After hospital intervention, through the provision of resources and incentives, the participation and effectiveness of training significantly improved. Conclusion: The study reveals the crucial role of hospital intervention in promoting the participation of newly recruited doctors in training and proposes a training strategy that combines theory and practice. This strategy not only helps new doctors quickly adapt to the hospital environment but also improves the quality of medical services, providing talent support for the hospital's continuous development. It offers theory-based decision support for hospital managers and provides new ideas for the improvement of future medical education and practice.

Artificial Intelligence and Corporate Social Responsibility: Synergies, Challenges, and Future Directions

Corporate social responsibility, or CSR, has been the subject of an increasing amount of interest with the infusion of artificial intelligence or AI. AI may open up much-needed improvements in CSR practice, including better decision-making, transparency, and sustainable benefits, but it also poses challenges related to the ethical concerns of data privacy, bias, and accountability. This paper focuses on how an AI-based approach enhances CSR activities and identifies risks embedded in AI adoption in approaches to CSR. The study combines qualitative interviews with industry experts and quantitative analysis of CSR reports from AI-adopting firms and thus sheds lights on the upside and downside of AI-enhanced CSR. Finally, this article ends with recommendations in developing a framework that would align AI capabilities with CSR objectives and indicates how that may potentially challenge future research directions in order to mitigate the ethical challenges involved.

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.

Implementation facilitators and barriers of person and family-centred emergency care

Background: At the time of the research, the nurses in the designated hospital’s emergency department did not implement person- and family-centred care to the detriment of patients and families. They were, however, eager to embark on the implementation of the recommendations of the Registered Nurses Association of Ontario for person- and family-centred care.Aim: This study therefore aimed to explore and describe the possible implementation facilitators and barriers prior to the use of the association’s recommendations.Setting: The study included eight nurses with different specialisation fields and more than 5 years of experience in an emergency department.Methods: During focus group interviews with nurse participants, the domains of the Consolidated Framework for Implementation Research were used to explore whether the recommendations of the Registered Nurses Association of Ontario could be used to structure person- and family-centred care in the emergency department of the designated hospital in the Mpumalanga province in South Africa. The framework guided the deductive data analysis.Results: The identified facilitators referred to a positive match between the recommendations and existing practice in the department. The barriers referred to the department’s fast-paced work environment in which a combination of emergency and primary care is delivered.Conclusion: One of the facilitators referred to the participants being used to ongoing training by and communication from management to support their adjustment to improvements. One of the barriers referred to the department’s fast-paced work environment.Contributions: The article contributes to practice improvement with a description of the use of frameworks to explore possible facilitators and barriers prior to endeavours to implement recommendations.

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

ABSTRACTPurposeThe reproductive and production performance of dairy cows determines the profitability of a dairy farm.MethodA questionnaire survey was used to assess reproductive performance and husbandry practices by using 100 randomly selected animal owners.ResultSeventy‐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 ± 0.00 months, respectively. The mean length of CI was 30.53 ± 0.67 and 29.40 ± 1.99 months in natives and crossbreeds, respectively. The average year of longevity was 9.22 ± 0.05 and 9.10 ± 0.10 years 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 &lt; 0.05).ConclusionThe reproductive performance of dairy cows in the study area was low, which required the improvement of husbandry practices.

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

Background/Objectives: 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. Methods: 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. Results: 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 &lt; 0.001), while 12 mm was primarily used in adults (n = 35, 92.1% vs. n = 9, 50.0%, p &lt; 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. Conclusions: 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.

Investigating the Incidence and Severity of Field Diseases Impacting Tuberose (Polianthes tuberosa L.) Cultivation: A Case Study in the Jashore District, Bangladesh

A research investigation was conducted in the Jashore district of Bangladesh to examine diseases affecting tuberose plants. The laboratory analysis was performed at the plant disease study facility at Sher-e-Bangla Agricultural University, Dhaka, Bangladesh. The study encompassed eighteen villages across four unions within the Jhikargacha upazila of the Jashore district. The primary objective was to document the occurrence and severity of diseases in tuberose fields under natural conditions. Seven fungal diseases were detected in the natural field setting and were subjected to further scrutiny in the research facility. The pathogens responsible for these diseases were isolated and identified, revealing botrytis blight (Botrytis cinerea), blossom blight (Fusarium equiseti), alternaria leaf spot (Alternaria polyanthi), leaf tip blight (Phoma sp.), peduncle blight (Lasidiplodia theobromae), stem rot (Sclerotium rolfsii), and tuber rot (Fusarium oxysporum). Disease incidence ranged from 0% to 64.33%, and severity ranged from 0% to 24.00%. Stem rot, botrytis blight, alternaria leaf spot, and leaf tip blight were identified as significant challenges in tuberose cultivation in the Jashore district. This study represents the first documentation of tuberose pathogen prevalence in Bangladesh, providing valuable insights for disease identification and contributing to the improvement of tuberose cultivation practices in the region.