Ineffective Procedures Research Articles

BARRIER OF REFERRAL–BACK IN SECONDARY HEALTH FACILITIES: PROVIDER AND PATIENT PERSPECTIVES

Background: The referral-back program (RBP) is a program for chronic outpatient patients at hospitals to return to access services at first-level health facilities (Primary Healthcare Centers/ PHC) once their condition has been declared stable by the doctor. However, data indicate that many hospitals and clinics in Denpasar City have not met the RBP target. Aims: This study aimed to explore the implementation of RBP and the challenges faced by providers and patients. Methods: Conducted in March 2023, this study used a qualitative approach with in-depth interviews. The sample was determined purposively, consisting of 13 informants. The data were analyzed using the thematic method. Results: From the provider's perspective, issues included low commitment of medical staff, lack of coordination between the hospital and PHC, limited supply of RBP drugs at the PHC, absence of Standard Operating Procedures (SOPs), and ignorance of notifications regarding potential RBP patients. Moreover, from the patient's perspective, challenges included low patient knowledge about RBP, proximity of the patient's house to the hospital so that patients tend to visit the hospital, difficulty in obtaining RBP drugs at PHC, and ineffective procedures. Conclusion: To overcome these obstacles, coordination, and improvement of RBP are needed through the preparation of SOPs and determination of RBP patient criteria. Keywords: barrier, implementation, referral-back program

Effective method of pedicle screw fixation in patients with neurologically intact thoracolumbar burst fractures: a systematic review of studies published over the last 20 years

ObjectiveTo conduct a systematic review of studies on various posterior pedicle screw fixation (PSF) methods used for treating neurologically intact thoracolumbar burst fractures and to identify the most effective and safe approaches. MethodsWe conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the study registered in PROSPERO (CRD42024531093). The inclusion criteria were: (1) publication dates from January 1, 2004, to December 31, 2023; (2) availability of full-text articles in English; (3) thoracolumbar burst fractures without neurological deficits; (4) patients aged over 18; (5) reports on treatment outcomes or complications; (6) a mean follow-up period of at least 12 months. ResultsA total of 69 articles covering 116 patient groups were included. Our analysis highlighted the advantages of short-segment fixation without fusion over monosegmental, short-segment and long-segment fusion in terms of shorter operation times and reduced intraoperative blood loss (p = 0.001 and p < 0.001, respectively). Extensive fusion was associated with a significantly higher frequency of deep surgical site infections compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation, applied to patients with lower body compression rates and kyphotic deformities, led to less potential for correction (p = 0.004), yet significantly decreased blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization duration (p < 0.0001). No significant benefits were observed with the use of additional intermediate screws in short-segment PSF. ConclusionsShort-segment pedicle screw fixation could be the optimal surgical treatment method for neurologically intact thoracolumbar burst fractures. The use of posterior lateral fusion in this context may increase the deep surgical site infection rate without reducing the frequency of implant-related complications or improving long-term treatment outcomes. The percutaneous approach remains the preferred technique; however, its limited reduction capabilities should be carefully considered during surgical planning for patients with severe kyphotic deformities. The application of intermediate screws in such patients has not demonstrated significant advantages. Removing the fixation system has not led to a significant decrease in implant-related complications or improvement in quality of life. The data obtained from the systematic review may assist surgeons in selecting the most appropriate surgical treatment method for patients with neurologically intact thoracolumbar burst fractures, thereby avoiding ineffective procedures and improving both short-term and long-term outcomes.

Effective method of pedicle screw fixation in patients with neurologically intact thoracolumbar burst fractures: a systematic review of studies published over the last 20 years

ObjectiveTo conduct a systematic review of studies on various posterior pedicle screw fixation (PSF) methods used for treating neurologically intact thoracolumbar burst fractures and to identify the most effective and safe approaches. MethodsWe conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the study registered in PROSPERO (CRD42024531093). The inclusion criteria were: (1) publication dates from January 1, 2004, to December 31, 2023; (2) availability of full-text articles in English; (3) thoracolumbar burst fractures without neurological deficits; (4) patients aged over 18; (5) reports on treatment outcomes or complications; (6) a mean follow-up period of at least 12 months. ResultsA total of 69 articles covering 116 patient groups were included. Our analysis highlighted the advantages of short-segment fixation without fusion over monosegmental, short-segment and long-segment fusion in terms of shorter operation times and reduced intraoperative blood loss (p = 0.001 and p < 0.001, respectively). Extensive fusion was associated with a significantly higher frequency of deep surgical site infections compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation, applied to patients with lower body compression rates and kyphotic deformities, led to less potential for correction (p = 0.004), yet significantly decreased blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization duration (p < 0.0001). No significant benefits were observed with the use of additional intermediate screws in short-segment PSF. ConclusionsShort-segment pedicle screw fixation could be the optimal surgical treatment method for neurologically intact thoracolumbar burst fractures. The use of posterior lateral fusion in this context may increase the deep surgical site infection rate without reducing the frequency of implant-related complications or improving long-term treatment outcomes. The percutaneous approach remains the preferred technique; however, its limited reduction capabilities should be carefully considered during surgical planning for patients with severe kyphotic deformities. The application of intermediate screws in such patients has not demonstrated significant advantages. Removing the fixation system has not led to a significant decrease in implant-related complications or improvement in quality of life. The data obtained from the systematic review may assist surgeons in selecting the most appropriate surgical treatment method for patients with neurologically intact thoracolumbar burst fractures, thereby avoiding ineffective procedures and improving both short-term and long-term outcomes.

Using ensemble learning and hierarchical strategy to predict the outcomes of ESWL for upper ureteral stone treatment

Urinary tract stones are a common and frequently recurring medical issue. Accurately predicting the success rate after surgery can help avoid ineffective medical procedures and reduce unnecessary healthcare costs. This study collected data from patients with upper ureter stones who underwent extracorporeal shock wave lithotripsy, including cases of successful as well as unsuccessful stone removal after the first and second lithotripsy procedures, and constructed prediction systems for the outcomes of the first and second lithotripsy procedures. Features were extracted from three categories of information: patient characteristics, stone characteristics, and extracorporeal shock wave lithotripsy machine data, and additional features were created using Feature Creation. Finally, the impact of features on the models was analyzed using six methods to calculate feature importance. Our prediction model for the first lithotripsy, selected from among 43 methods and seven ensemble learning techniques, achieves an AUC of 0.91. For the second lithotripsy, the AUC reaches 0.76. The results indicate that the detailed and binary information provided by patients regarding their history of stone experiences contributes differently to the predictive accuracy of the first and second lithotripsy procedures. The prediction tool is available at https://predictor.isu.edu.tw/ks.

Optimizing IT Support Operations with Web Development at PT Global Loyalty Indonesia

IT Support at the company PT Global Loyalty Indonesia is considered to have less effective performance and often does repetitive work, such as several problems that have been resolved before that require a lot of experiments, when the same thing happens on a different day, the time-consuming experimental actions will be carried out again, so that the completion of the work takes a long time, this is because there is no recording of the steps that have previously been carried out. In addition, work requests to IT Support are only done verbally without detailed data collection, besides that ineffective standard operating procedures make IT Support employees confused when problems occur that have never been experienced before, so the work process takes a long time. To overcome these problems, a website system was created using HTML, CSS, React JS and Bootstrap with the Agile development method. After the website was completed and applied to the IT Support section, it was obtained from the results of interviews by the head of IT Support, that the work in the section became more organized, more recorded and easier to monitor by the head of IT Support, besides that it was also stated by the head of IT Support that the website created was very helpful and made IT Support work easier, with an average user acceptance of 86.4% which was calculated using the user acceptance test method

Cost-Effective digital twin Design for entertainment Enterprise’s through Machine learning

The backbone of the Indian economy, Micro, Small, and Medium Enterprises (MSME) players provide rural residents with steady income and long-term employment possibilities. Due to antiquated machinery, ineffective procedures, outdated manufacturing and business methods, and a severe lack of funds to cover their capital and operating costs, Indian MSME operators are finding it difficult to thrive in the cutthroat market of today. Small and medium-sized enterprises (SMEs) mistakenly believe that the industry 4.0 ecosystem, which encompasses numerous developing technologies, is exclusively intended for larger corporations. However, SMEs can effectively leverage these technologies to tackle their operational difficulties. This research study offers a unique, purpose-built Industry 4.0 solution to help MSME participants in the Software as a Service (SaaS) model save maintenance costs. With just monthly operating costs, this system provides a scalable and incredibly economical approach that does not require any capital expenditures. This solution includes emerging technologies such as IoT, cloud, analytics, and mobile applications. This solution has been implemented in three MSME businesses from Chennai, India and achieved 84% decrease in maintenance cost.

The impact of digital red tape on non-compliant behaviour: the moderating effect of infection risk

IMPACT This article will be of value to the digital governance policy-makers and particularly to those suffering from digital red tape across the public sector. It identifies Covid 19 digital pandemic prevention regulations as a counter-example, demonstrating the existence of digital red tape and revealing its impact on non-compliance. The more citizens viewed the regulations as digital red tape, the more dissatisfied they felt and the more they violated the regulations. The authors advise policy-makers to simplify burdensome, ineffective and non-necessary procedures when designing digital regulations to avoid citizen dissatisfaction. When perceived infection risk was high, dissatisfied citizens tended to comply with digital regulations. Conversely, non-compliance due to dissatisfaction with digital regulations increased significantly when citizens perceived the infection risk as low. To ensure compliance, eliminating dysfunctional rules and regulations was particularly important when the infection risk declined.

Emergency physician cost awareness of common orders in emergency department and awareness impact on medical decisions in Saudi Arabia

Background: With growing emergency department visits, there has been a growth in national health expenditure. This situation is exacerbated by physicians ordering ineffective investigations and procedures. This study aimed to assess the emergency physician&amp;apos;s awareness of cost of diagnostic tests and interventions, and how awareness of costs may impact their medical decision. Methods: This cross-sectional study was conducted among emergency physicians of the Saudi Arabia. The data were collected via self-administered questionnaire disseminated through emails to all physicians. Results: A total of 233 physicians participated, majority of whom were males (73%) and aged 24-34 years-old (70.8%). Of the included physicians, 41.2% were junior residents, and three-quarters (75.5%) of the respondents had never worked in private hospitals. Two-thirds of respondents agreed/strongly agreed that knowing financial cost would affect their clinical practice. Physicians tended to overestimate cost of drugs while underestimate the cost of diagnostics and laboratory tests. The percentage of correct estimates was higher for diagnostics and lab (

Industrial Textile Wastewater Treatment by Crossflow NF Membrane Filtration

Ineffective dyeing procedures frequently lead to the release of approximately 10–50% of the dye applied, which does not adhere to the fabric and is consequently discharged into the environment along with the effluent. This situation is undesirable both for potential recycling within the textile manufacturing process and because of its adverse environmental pollution effects. This study thoroughly examines nanofiltration (NF) membrane characteristics and their performance in textile wastewater treatment. Pristine NF membrane surfaces were revealing a web-like structure with well-defined pores predominantly in the membrane active region. This assessment confirms the membrane initial cleanliness, free from any external contaminants, which is vital for effective membrane-based filtration. Additionally, the study investigates how different feed flow rates affect water flux during NF membrane filtration. The results demonstrate a clear relationship, where the increasing flow rates boost water flux. This can be attributed to heightened cross-flow velocity and shear force on the membrane surface due to the increased water flux, minimizing external concentration polarization and reducing membrane fouling. The impact of feed flow rate on membrane separation efficiency is also examined, showing consistent efficiency at feed flow rates between 2 LPM and 5 LPM (approximately 80.8% to 82.22%). However, efficiency drops as the feed flow rate increases from 5 LPM to 6 LPM, likely due to increased pressure drop across the membrane, affecting separation efficiency.

Design strategies, utilization and applications of nano-engineered biomaterials for the enhancement of bioenergy: A sustainable approach

In consideration of the world's energy issues and environmental concerns, the search for sustainable energy sources has taken on a crucial role. Although bioenergy, which is made from organic materials, presents a promising alternative, there are many obstacles preventing its widespread acceptance, such as ineffective conversion procedures, resource shortages, and environmental effects. Sustainable energy with advanced technology and also economically feasible can be achieved through a combination of nanoparticles and enzyme immobilization techniques. Nano-materials can be designed according to our needs which make them a better choice for many applications. The physio-chemical properties of nanoparticles are unique with increased surface/volume ratio. The methods of synthesis are top-down (physical), bottom-up (chemical) and biological methods. Break-through technology with which challenges faced by increasing demands of the current and future needs can be fulfilled. Binding/encapsulation of enzymes to nanoparticles enhances the efficiency of enzymes as nano-biocatalyst and also has the advantage of reusability of enzymes which in-turn reduces the overall cost, avoids enzyme deactivation by inhibitors produced during the process. The energy crisis can be resolved by the above technology by using the nano-biocatalyst in biofuel production to overcome the limitations of conventional biocatalysts. By carrying out more research in-depth for designing nano-biocatalyst that provides stabilization for biofuel industries alternate sustainable production can be achieved.

Сроки и способы лечения дакриостенозов детского возраста

Congenital dacryostenosis (congenital obstruction of the nasolacrimal duct, or CNLDO) is a congenital obstruction of the lacrimal system structures. Usually, the cause of dacryostenosis is blockage of the duct, less frequently – dysgenesis of the lacrimal pathways, including bone abnormalities, stenosis throughout the lacrimal system. Inconsistency of data on the optimal timing of probing, its impact on efficiency, lack of clear criteria for transition from probing to intubation of the lacrimal ducts and operation to create anastomosis, prompted us to this study. Aim. A retrospective analysis of the results of treatment of patients with childhood dacrystenosis and determination of the optimal tactics of their treatment. Methods.The study included patients from 0 to 15 years old with complaints of lacrimation and purulent discharge from one or both eyes from infancy. The first group consisted of patients who at the initial stage underwent probing of tear ducts according to standard procedure. The second group of the study consisted of patients who applied to the clinic after a number of ineffective probing procedures performed in medical institutions at their place of residence. Patients in this group underwent recanalization of the tear ducts with temporary intubation with a polyurethane stent. Results. The study demonstrated absence of a significant difference in the effectiveness of primary probing of tear ducts in groups of children of different ages. Recanalization of the lacrimal pathways with intubation with a polyurethane stent is a highly effective method of treating congenital dacryostenosis used in absence of recovery after twice repeated probing of the lacrimal pathways. The effectiveness of this method decreases in patients older than 3 years, which is associated with long-existing inflammation of the lacrimal sac walls, extension of the lacrimal tract above the level of stenosis, leading to the formation of foci of restenosis after removal of the stent. Conclusions. Performing primary deep probing is an effective method of treating congenital dacryocystitis in children under 2 years of age. The effectiveness of this procedure does not depend on age at the time of the procedure, however, in case of delayed execution, there is a need for general anesthesia when performing the intervention. Recanalization should be recommended to patients with the ineffectiveness of double probing of the tear ducts. Persistence of complaints of purulent discharge after removal of the stent from the lacrimal tract is an indication for endonasal dacryocystorinostomy. Key words: congenital dacryocystitis; lacrimal pathways probing; recanalization; intubation; endorhinoscopy; lacrimation; epiphora.

Passive Sampler Technology for Viral Detection in Wastewater-Based Surveillance: Current State and Nanomaterial Opportunities.

Although wastewater-based surveillance (WBS) is an efficient community-wide surveillance tool, its implementation for pathogen surveillance remains limited by ineffective sample treatment procedures, as the complex composition of wastewater often interferes with biomarker recovery. Moreover, current sampling protocols based on grab samples are susceptible to fluctuant biomarker concentrations and may increase operative costs, often rendering such systems inaccessible to communities in low-to-middle-income countries (LMICs). As a response, passive samplers have emerged as a way to make wastewater sampling more efficient and obtain more reliable, consistent data. Therefore, this study aims to review recent developments in passive sampling technologies to provide researchers with the tools to develop novel passive sampling strategies. Although promising advances in the development of nanostructured passive samplers have been reported, optimization remains a significant area of opportunity for researchers in the area, as methods for flexible, robust adsorption and recovery of viral genetic materials would greatly improve the efficacy of WBS systems while making them more accessible for communities worldwide.

Point-Prevalence Survey for the Hospital-Acquired Infections and Infection Prevention and Control Status of Different Wards of Rajshahi Medical College Hospital

Introduction: Healthcare-associated infections represent significant obstacles to providing high-quality healthcare and have been directly linked to ineffective infection control procedures. There is currently a shortage of trustworthy data in Bangladesh describing the epidemiology of hospital-acquired infections (HAIs), which is necessary for the development of effective infection prevention and control measures. This study's goal was to assess the frequency, nature, and risk factors of HAIs in acute care hospitals in Northern Bangladesh.&#x0D; Methods: This was a pilot point prevalent survey conducted in the medicine, surgery, gynecology, and obstetrics departments of Rajshahi Medical College Hospital between August 2022 to September 2022. Data were collected by two questionnaires for disease profile and hospital-acquired infection. In addition, a checklist was used for the observation of the infection prevention and control (IPC) status of different wards.&#x0D; Result: Approximately 900 patients' data were collected during this time period. The overall prevalence of HAI was found to be 3.7%. The prevalence of HAI, especially surgical site Infection (SSI), in the obstetrics ward, was 4.2%, and the Medicine ward was 3.9%, respectively. The prevalence of hospital-acquired infection in the surgery ward is 7.7%. Approximately 41.7% of patients developed SSI on the 6th post operative day (POD). The Infection prevention and control status of different wards was similar, which was not satisfactory.&#x0D; Conclusion: This surveillance might help concerned authorities and policymakers by making some crucial steps to monitor and reduce hospital-acquired infections and HAIs in hospitals.&#x0D; TAJ 2022; 36: No-1: 9-15

Effect of Model-Based Problem Solving on Error Patterns of At-Risk Students in Solving Additive Word Problems

Students with learning disabilities/difficulties in mathematics often apply ineffective procedures to solve word problems due to a lack of conceptual understanding of word problem solving, which results in poor mathematics performance and falling further behind the normal achievements of their peers. Current mathematics curriculum standards emphasize conceptual understanding in problem solving as well as higher-order thinking and reasoning, including all students. The purpose of this study was to evaluate the impact of a computer-assisted model-based problem-solving intervention program (MBPS) on elementary students’ word problem-solving performance by analyzing the error patterns. Results indicate that after the MBPS intervention, participants significantly improved their problem-solving performance and made fewer errors in solving problems across a range of additive word problem situations. Specifically, the participating students made their attempt to represent the mathematical relation, decontextualized from the word problem story, in the model equation before solving the problem, rather than blindly applying an operation or relying on the “keyword” strategy as they did during the preassessment. Implications of the study are discussed in the context of the National Council of Teachers of Mathematics’ calling for teaching big ideas to help students develop a deep understanding of mathematics knowledge.

PEMBUATAN APLIKASI SISTEM INFORMASI PENGELOLAAN KOMUNITAS KARUTA BERBASIS WEBSITE

The OKAKURA karuta community is a gathering place for Indonesians who are interested in the game. The karuta community has carried out and participated in activities such as karuta training, workshops, and inter-community tournaments. The Website-Based Karuta Community Management Information System Application was created to help Karuta community administrators manage internal data and community members view training results. The lack of management data in the Karuta community creates uncertainty among community members, resulting in ineffective training procedures and data redundancy. Furthermore, because exercise recording is still done manually, community members who are not present cannot view training histories. As a result, a Website-Based Karuta Community Management Information System Application was developed to aid in the recording and management of data as well as the search for training history. The System Development Life Cycle development method was used in the creation of this application (SDLC). The programming languages used are HTML, CSS, and PHP, with MySQL as the database and XAMPP as a local server, resulting in a website application that can assist Karuta community administrators in data processing and makes it easier for community members to view training history.

Are farmers aware of first aid measures for their injuries-a survey in rural Karnataka, India

Background: Agriculture, being the main source of livelihood in most parts of the country, has some hidden dangers to the farmers which get them injured or ill. Methods: A community-based cross-sectional study was conducted for 2 months among farmers aged &gt;18 years of age residing in rural Mysuru. A purposive sampling technique was used and the data was collected from 150 farmers through house-to-house interviews using a pre-tested structured questionnaire. Results: The survey took account of the farmer's opinion on first aid procedures; a vast majority of the practices weren’t supported by any scientific evidence. Ineffective first-aid procedures could worsen the problem. Thus, the farmers should receive sufficient first aid training and education, enabling them to take appropriate action for themselves and their communities in an emergency. Conclusions: The survey took account of the farmer's opinion on first aid procedures; a vast majority of the practices weren’t supported by any scientific evidence. Ineffective first-aid procedures could worsen the problem. Thus, the farmers should receive sufficient first aid training and education, enabling them to take appropriate action for themselves and their communities in an emergency.

Resource conservation from the perspective of infection prevention

Procedures to prevent surgical site infections require ahigh input of human, technical and natural resources. This paper explores ways to optimize the use of resources in caring for patients who undergo asurgical procedure without compromising patient safety. Review of the contribution of selected procedures for infection prevention in surgical patients considering current evidence and recommendations by comparing current guidelines and results of clinical trials. Analysis of interventions to implement and increase compliance. Knowledge of current evidence-based recommendations enables not only the identification of procedures with proven effect on infection prevention but also those that are ineffective and thus dispensable. There is still need for further controlled studies, e.g. on the use of antiseptics, that can confirm the evidence level of preventive procedures. Infection surveillance in combination with process and compliance monitoring by infection prevention specialists with afeedback system to healthcare workers are suitable control instruments for infection control management. In the case of increased infection rates, the implementation of evidence-based recommended measures through tailored bundle interventions is successful. Technical measures to maintain environmental conditions must be included in the control process. The reduction of healthcare-associated infections by implementing tailored interventions of infection prevention measures and elimination of ineffective procedures conserves resources and promotes patient safety.

A Study on the Experiences of Higher Education Good Governance in European and North America Countries; Some Lessons Gained for Higher Education in Iran

Higher education, in order to achieve its strategic goals in society, requires governance understanding in a sustainable trend so that it can correctly define and outline its mission and step towards it firmly. Research knowledge and experiences of the advanced countries in this field may certainly contain some considerable and –sometimes - valuable lessons gained in policies for higher education systems in other countries, especially for Iranian higher education system suffering from some ineffective traditional procedures and avoiding up-to-date governance methods. In this article, by applying the research method of document analysis and using the purposeful sampling method, the identification and qualitative analysis of good governance experiences in higher education of three selected countries - including Germany, England and Canada - has been addressed in the four measures of quality affairs, academic independence and financial management. Data gatherings were done by searching contents of universities’ websites, published articles, essays, reports, governmental and academic manuscripts. Data was qualitatively analyzed at two levels of open and axial coding. From the study and analysis of the experiences of good governance in higher education of selected countries, in the dimension of quality measures, including evaluation and quality assurance in the context of agreed frameworks, multiple use of the evaluation system, validation and quality assurance, transparency and accountability, and improvement were identified as the logic of evaluation and quality assurance of higher education. Systematic synergetic management and planning, and network management based on scientific reference were experiences that were represented in the dimension of university management and planning. Morover, in the financial planning measures, experiences such as contingency budgeting based on scientific indicators, and diversity of support in providing financial resources were identified. In the end, the article, by enumerating the findings obtained from its research in the experiences of the governance of the selected countries, has recommended to all the policy makers and officials of the country's higher education to study and review them as lessons that can be learned for awareness and to create a well-considered platform in order to use them effectively, in the framework of appropriate and updated action plans in the field of governance of higher education.

Модель оценки зрелости и эффективности системы внутреннего контроля

Small and medium-sized businesses do not pay due attention to the functional resources of the internal control system (ICS), which affects the effectiveness of management decisions. Economic entities that regularly use ICS assessment are able to achieve a higher level of control environment maturity by optimizing business processes. The purpose of the study is to formulate quantitative and qualitative criteria for assessing the level of internal control maturity allowing for its systematic monitoring in medium and small business organizations. As a part of this study, using the developed tests of controls, including a recommended set of indicators characterizing the maturity of the internal control system, the authors carried out a qualitative assessment of the existing internal control system and identified risk areas. The quantitative indicators proposed by the authors and analyzed over time provide a more objective measurable assessment of the effectiveness of the organization’s internal control system according to the five basic elements of the COSO model. The authors proposed to analyze the causes of deficiencies, determine the frequency of their occurrence and identify ineffective control procedures within business processes for internal control systems of different maturity levels. A conceptual model for assessing the maturity and effectiveness of the internal control system for small and medium-sized businesses has been developed. The model is based on quantitative and qualitative indicators, which allows assessing the internal control system and enables the management of organizations to analyze the effectiveness of the applied internal control procedures and make management decisions on their adjustment, thus minimizing financial, labor and resource costs. The use of the proposed unified control procedures, as well as monitoring the effectiveness of control procedures, makes it possible to timely identify entrepreneurial risks inherent in any business entity, which is impossible in the absence of a formalized control environment.

Endoscopic Third Ventriculostomy in the Pediatric Population: Case Series Report

Abstract Objective Hydrocephalus is characterized by multi- or uniloculated ventricular dilatation, and there are differences between the etiology and therapeutic response of each type. Endoscopic third ventriculostomy (ETV) is indicated for the treatment of obstructive hydrocephalus, with a reported efficacy between 50% and 76%. Reduced efficacy of the procedure has been demonstrated in communicating hydrocephalus due to multifactorial pathogenesis, and, in patients with myelomeningocele, its efficacy ranges from 15% to 20% at birth. The present study aims to compare the efficacy of ETV in the treatment of congenital obstructive hydrocephalus (COH) and acquired obstructive hydrocephalus (AOH) in the pediatric population. Methods A retrospective study of 169 endoscopic surgeries performed by the senior author in two institutions, one public (Hospital João XXIII, Belo Horizonte, Minas Gerais) and another private (Hospital Felício Rocho, Belo Horizonte, Minas Gerais), in the period from 2003 a 2020. From the selection of 169 patients, only 77 cases fit the age profile ≤12 years of the present study. Of these, 46 were male, and the age range ranged from 10 days to 12 years. The study included multiple etiologies, which were divided into 2 groups, 34 related to COH, and 43 to AOH. Results Regarding the cases of COH, 22 were submitted to ETV as the main treatment, with 14 (63.63%) effective and 8 (36.36%) ineffective procedures. As for the cases of AOH, 13 patients underwent ETV, and 8 (61.53%) procedures were effective, and 5 (38.46%), ineffective. Conclusions Through the calculation of the p-value of 0.49, we concluded that it cannot stated that the efficacy of ETV is greater in COH than in AOH.