Institutional Outcomes Research Articles

Advancing minimally invasive hepato-pancreato-biliary surgery: ensuring safety with implementation.

Although minimally invasive hepato-pancreato-biliary (MIS HPB) surgery can be performed with good outcomes, there are currently no standardized requirements for centers or surgeons who wish to implement MIS HPB surgery. The aim of this study was to create a consensus statement regarding safe dissemination and implementation of MIS HPB surgical programs. Sixteen key questions regarding safety in MIS HPB surgery were generated after a focused literature search and iterative review by three field experts. Participants for the working group were then selected using sequential purposive sampling and snowball techniques. Review of the 16 questions took place over a single 2-h meeting. The senior author facilitated the session, and a modified nominal group technique was used. Twenty three surgeons were in attendance. All participants agreed or strongly agreed that formal guidelines should exist for both institutions and individual surgeons interested in implementing MIS HPB surgery and that routine monitoring and reporting of institutional and surgeon technical outcomes should be performed. Regarding volume cutoffs, most participants (91%) agreed or strongly agreed that a minimum annual institutional volume cutoff for complex MIS HPB surgery, such as major hepatectomy or pancreaticoduodenectomy, should exist. A smaller proportion (74%) agreed or strongly agreed that a minimum annual surgeon volume requirement should exist. The majority of participants agreed or strongly agreed that surgeons were responsible for defining (100%) and enforcing (78%) guidelines to ensure the overall safety of MIS HPB programs. Finally, formal MIS HPB training, minimum case volume requirements, institutional support and infrastructure, and mandatory collection of outcomes data were all recognized as important aspects of safe implementation of MIS HPB surgery. Safe implementation of MIS HPB surgery requires a thoughtful process that incorporates structured training, sufficient volume and expertise, a proper institutional ecosystem, and monitoring of outcomes.

Transformative learning experiences: An empirical analysis of hybrid learning effectiveness in management education in Sri Lanka

Hybrid learning (HL) has become a significant part of the learning style for the higher education sector in the Sri Lankan context amidst the COVID-19 pandemic and the subsequent economic crisis. This research study aims to discover the effectiveness of hybrid learning (EHL) practices in enhancing undergraduates’ outcomes in Sri Lankan Higher Educational Institutions (HEIs) management faculties. The data for the study were gathered through an online questionnaire survey, which received 379 responses. The questionnaire contained 38 questions under four sections covering independent variables, excluding demographic questions. The results indicate that hybrid learner attitude, interaction, and benefits of hybrid learning positively impact the effectiveness of hybrid learning. The results remain consistent even after controlling for socio-demographic factors and focusing only on students employed during their higher education. The study concluded that employed students have a higher preference for the effectiveness of hybrid learning concepts, and the benefits of hybrid learning play a crucial role in enhancing the effectiveness among undergraduates. The study analyzes COVID-19’s impact on higher education, proposing hybrid learning and regulatory frameworks based on pandemic experiences while stressing the benefits of remote teaching and research.

The role of graphic design in establishing a culture of coexistence with difference and handling individual differences

This study presents the role of graphic design in the process of developing society by examining the goals of inclusive life that reject all forms of discrimination, by changing the methods of social adaptation by following a development policy that takes into account aspects of difference by providing means of availability to achieve self-sufficiency, overcoming the issue of individual differences, and creating facilitators of living that ensure well-being. The challenge lies in simply creating access to the place or information to achieve better outcomes in social, health and educational institutions and to enhance human relations to establish a balanced society that keeps pace with social developments and responds to global standards. This study works to clarify information and deepen understanding to achieve clear and specific goals by expressing the verbal content in a way that focuses on simplifying ideas by showing the basics elements in realistic form, and excluding other elements that are not important in clarifying the idea to be expressed in a way that facilitates the process of mental perception, so it is important to adopt it pedagogically and develop it in the field through research into comprehensive live purposes and respect for individual differences based on differential pedagogy so that it responds to methods of adaptation and encourages respect for the principle of differences based on differential pedagogy so that it responds to methods of adaptation and encourages respect for the principle of difference. Given the value of design today in responding to the user’s needs and work to improve ways of living and improve the user’s experience, especially if this user is different. Therefore, we must work on appropriate support for him by providing programs that achieve the issue of individual education in order to overcome difficulties education in order to overcome difficulties and gradually give the child independence by creating ways to educate him. According to his pace, strengths and challenges, to ensure that he learns smoothly and create a humane, stimulating, world-centered educational environment that is open to him, human and educational goal oriented.

Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis

BackgroundOut of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown. ObjectivesTo investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA. MethodsA retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used. Results2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).

Institutional effects of nonviolent and violent revolutions

This paper conducts a systematic review and comparative analysis of the institutional impacts of nonviolent versus violent revolutions. It examines sixty-six quantitative studies across disciplines on how revolutionary tactics affect post-conflict institutions. The analysis categorizes institutional outcome variables into five groups: democracy, military/police/courts, foreign relations, ethnicity/culture, and well-being. The comparative analysis finds a preponderance of evidence that nonviolent movements have more positive institutional effects than violent ones. Civil resistance is associated with democratization, reduced repression, loyalty shifts, human rights protections, inclusion of marginalized groups, and greater well-being compared to violent campaigns. The comparative analysis contributes strong cross-disciplinary evidence on the differential institutional impacts of revolutionary tactics.

Pivotal Significance of Alternative Dispute Resolution Within the Realm of Financial Institutions

Alternative Dispute Resolution (ADR) is vital in resolving financial disputes. This research provides comparative analysis of ADR laws, regulations, and case law from the US, UK and India. It underscores ADR's importance in the financial industry, citing benefits like efficiency, cost-effectiveness, confidentiality, relationship preservation, and improved outcomes for institutions. The study reveals that ADR is a valuable global mechanism for resolving financial disputes, with each jurisdiction having unique frameworks and practices. Understanding these legal landscapes and utilizing ADR can aid institutions in navigating complex disputes and promoting effective conflict resolution. The paper primarily focuses on understanding guidelines, reports, and the evolving use of ADR by financial institutions. It also examines if financial disputes differ from other commercial disputes. Overall, the research highlights the significance of dispute resolution in financial institutions and the role of ADR as an alternative approach.

University-industry knowledge collaborations in emerging countries: the outcomes and effectiveness in Vietnam

ABSTRACT University-industry knowledge collaborations (UICs) significantly influence countries’ innovation capabilities and future workforce development. For a developing country like Vietnam, the goal of developing a knowledge-based emerging economy puts even higher expectations on UICs. However, UICs in Vietnam have not kept up well with the country’s ambition to survive and thrive in the new context. This study investigates the current status of the outcomes and effectiveness of knowledge exchange mechanisms as perceived by different stakeholders, including faculty members, students, and industries. Results show that UICs’ social and institutional outcomes are dominant in Vietnam. From the university side, the areas of training, university locations, and university types could affect UICs’ outcomes and effectiveness. However, there are discrepancies between faculty members and students in the perception of UICs’ effectiveness. Firms’ ownership types and locations also affect UICs’ effectiveness.

Overestimating prevalence? Rethinking boundaries and confounders of moral distress.

Moral distress denotes a negative reaction to a morally challenging situation. It has been associated with adverse outcomes for healthcare professionals, patients and healthcare institutions. We argue that existing definitions, along with measures of moral distress, compromise the validity of empirical research. First, the definition and measurement of moral distress conflate moral events and psychological distress, even though they are distinct phenomena that should be assessed independently. Second, in many studies, there is a lack of clarity in distinguishing between moral and non-moral events. Finally, prior research on moral distress often overlooks the substantial body of evidence demonstrating the impact of diverse work-related factors, beyond moral events, on both distress and job retention. These challenges might undermine the effectiveness of interventions aimed at alleviating moral distress. We outline a comprehensive research agenda that encompasses conceptual clarifications, the refinement of data collection instruments, the design of studies and the application of appropriate statistical methods.

Academic survival: student retention in sport and exercise sciences

ABSTRACT Retention of higher education students is of major concern within the United Kingdom due to the financial and reputational impact on institutions, financial and personal impact on students and loss of potential skills and knowledge within society. Student background characteristics are acknowledged as the initial factors influencing retention within various models, however subject specific understanding is limited. This study aimed to identify pre-enrolment factors associated with student retention in Sport, Health and Exercise Science programmes. Student retention at department and programme level were calculated by ‘time to event’ analysis using Kaplan–Meier survival trend curves and log rank (Mantel–Cox) analysis for; gender, age, locality to the university, highest qualification on entry and participation of local areas in higher education (POLAR4) classifications. Results identified that male students, students from low Higher Education participation neighbourhoods and students who enter Higher Education without A-Level or foundation qualifications were at an increased risk of degree non-completion. Importantly, these characteristics were also disproportionally high in the student populations considered here. It is imperative that initiatives to improve retention, particularly in these populations, are sought and implemented at department level to improve student and institutional outcomes.

The Organizational Culture and Internal Control Efficiency Mirror the Operational Outcomes of Private Higher Education Institutions in Thailand

The Organizational Culture and Internal Control Efficiency Mirror the Operational Outcomes of Private Higher Education Institutions in Thailand

Morphologic patterns observed in prostate biopsy cases with discrepant grade group and molecular risk classification.

Molecular-based risk classifier tests are increasingly being utilized by urologists and radiation oncologists to guide clinical decision making. The Decipher prostate biopsy test is a 22-gene RNA biomarker assay designed to predict likelihood of high-grade disease at radical prostatectomy and risk of metastasis and mortality. The test provides a risk category of low, intermediate, or high. We investigated histologic features of biopsies in which the Grade Group (GG) and Decipher risk category (molecular risk) were discrepant. Our institutional urologic outcomes database was searched for men who underwent prostate biopsies with subsequent Decipher testing from 2016 to 2020. We defined discrepant GG and molecular risk as either GG1-2 with high Decipher risk category or GG ≥ 3 with low Decipher risk category. The biopsy slide on which Decipher testing was performed was re-reviewed for GG and various histologic features, including % Gleason pattern 4, types of Gleason pattern 4 and 5, other "high risk" features (e.g., complex papillary, ductal carcinoma, intraductal carcinoma [IDC]), and other unusual and often "difficult to grade" patterns (e.g., atrophic carcinoma, mucin rupture, pseudohyperplastic carcinoma, collagenous fibroplasia, foamy gland carcinoma, carcinoma with basal cell marker expression, carcinoma with prominent vacuoles, and stromal reaction). Follow-up data was also obtained from the electronic medical record. Of 178 men who underwent prostate biopsies and had Decipher testing performed, 41 (23%) had discrepant GG and molecular risk. Slides were available for review for 33/41 (80%). Of these 33 patients, 23 (70%) had GG1-2 (GG1 n = 5, GG2 n = 18) with high Decipher risk, and 10 (30%) had GG ≥ 3 with low Decipher risk. Of the 5 GG1 cases, one case was considered GG2 on re-review; no other high risk features were identified but each case showed at least one of the following "difficult to grade" patterns: 3 atrophic carcinoma, 1 collagenous fibroplasia, 1 carcinoma with mucin rupture, and 1 carcinoma with basal cell marker expression. Of the 18 GG2 high Decipher risk cases, 2 showed GG3 on re-review, 5 showed large cribriform and/or other high risk features, and 10 showed a "difficult to grade" pattern. Of the 10 GG ≥ 3 low Decipher risk cases, 5 had known high risk features including 2 with large cribriform, 1 with IDC, and 1 with Gleason pattern 5. In GG1-2 high Decipher risk cases, difficult to grade patterns were frequently seen in the absence of other known high risk morphologic features; whether these constitute true high risk cases requires further study. In the GG ≥ 3 low Decipher risk cases, aggressive histologic patterns such as large cribriform and IDC were observed in half (50%) of cases; therefore, the molecular classifier may not capture all high risk histologic patterns.

Paediatric Intracranial Arachnoid Cysts: Single Institutional Review and Outcome

Paediatric Intracranial Arachnoid Cysts: Single Institutional Review and Outcome

A qualitative interview study to determine barriers and facilitators of implementing automated decision support tools for genomic data access

Data access committees (DAC) gatekeep access to secured genomic and related health datasets yet are challenged to keep pace with the rising volume and complexity of data generation. Automated decision support (ADS) systems have been shown to support consistency, compliance, and coordination of data access review decisions. However, we lack understanding of how DAC members perceive the value add of ADS, if any, on the quality and effectiveness of their reviews. In this qualitative study, we report findings from 13 semi-structured interviews with DAC members from around the world to identify relevant barriers and facilitators to implementing ADS for genomic data access management. Participants generally supported pilot studies that test ADS performance, for example in cataloging data types, verifying user credentials and tagging datasets for use terms. Concerns related to over-automation, lack of human oversight, low prioritization, and misalignment with institutional missions tempered enthusiasm for ADS among the DAC members we engaged. Tensions for change in institutional settings within which DACs operated was a powerful motivator for why DAC members considered the implementation of ADS into their access workflows, as well as perceptions of the relative advantage of ADS over the status quo. Future research is needed to build the evidence base around the comparative effectiveness and decisional outcomes of institutions that do/not use ADS into their workflows.

586: Neoadjuvant Radiation in Locally Advanced Endometrial Cancer: A Single Institution Outcomes

586: Neoadjuvant Radiation in Locally Advanced Endometrial Cancer: A Single Institution Outcomes

Market instrument for the first fuel and its role in decarbonizing Indian industrial production

India introduced Perform, Achieve, and Trade (PAT) scheme in 2012; it assigns targets to energy-intensive industries with estimated energy savings of 11–16% to enhance energy efficiency and allows energy-saving certificates trading. We qualitatively review India's energy efficiency policy landscape, including the institutional structure, operational trajectory, and outcomes of the PAT scheme's completed cycles. We identify four research themes: 1) Industry-wise specific energy consumption correlation with various factors of the industrial sector under PAT should be identified; 2) PAT scheme impact on aluminium, chlor alkali, textile, etc. Lacks exploration; 3) Realistic baseline target setting should be done for designated consumers under PAT scheme, and 4) machine learning based monitoring and verification for PAT scheme is still nascent but appears promising. We find a lack of ambition in the targets, which are easily met and could harm future investments in energy efficiency.

Improved Decision Support System for College Sports Training Based on Id3 Algorithm

A Decision Support System (DSS) is a computer-based tool designed to assist individuals and organizations in making informed decisions. It utilizes data analysis, modeling techniques, and interactive interfaces to provide users with relevant information and insights. DSSs help streamline decision-making processes by synthesizing large amounts of data from various sources, generating forecasts, and evaluating alternative courses of action. They are particularly valuable in complex and uncertain situations where decisions have significant implications. DSSs can be used in a wide range of domains, including business, healthcare, finance, and logistics, to support strategic, tactical, and operational decision-making processes. This paper introduces an Integrated Hybrid Feature Subset Decision Support System (HFS-DSS) designed to optimize decision-making processes in student performance evaluation within educational institutions. The HFS-DSS combines feature subset selection techniques with decision support algorithms to identify key attributes and make accurate predictions regarding student performance. Through experimental evaluation, the system demonstrates its effectiveness in accurately assessing student performance based on selected features, with predictions closely aligning with actual observations. The results underscore the system's reliability and effectiveness in supporting informed decision-making processes, offering valuable insights for educators and administrators to enhance academic outcomes. The adaptability and versatility of the HFS-DSS make it well-suited for various educational contexts, providing potential applications in curriculum planning, student support services, and performance monitoring. The present paper highlights the significant contributions of the Integrated HFS-DSS towards enhancing decision-making processes and improving academic outcomes in educational institutions.

Effect and outcome of equity, diversity and inclusion programs in healthcare institutions: a systematic review protocol

BackgroundEquity, diversity and inclusion (EDI) in the healthcare field are crucial in meeting the healthcare needs of a progressively diverse society. In fact, a diverse healthcare workforce enables culturally sensitive...

Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system.

The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions. Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same. Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose. Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.

Postoperative Adjacent Segment Disease in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Adjacent Laminectomy for Grade I-II Spondylolisthesis and Adjacent Spinal Stenosis

Studies have demonstrated increased risk of adjacent segment disease (ASD) after open fusion with adjacent-level laminectomy, with rates ranging from 16%-47%, potentially related to disruption of the posterior ligamentous complex. Minimally invasive surgical (MIS) approaches may offer a more durable result. We report institutional outcomes of simultaneous MIS transforaminal lumbar interbody fusion (MISTLIF) and adjacent-level laminectomy for patients with low grade spondylolisthesis and ASD. Retrospective analysis was performed on patients who underwent MISTLIF with adjacent level laminectomy to treat grade I-II spondylolisthesis with adjacent stenosis at a single institution from 2007-2022. A total of 34 patients met criteria, with mean follow-up of 23.1 months. In total, 37 levels were fused and 45 laminectomies performed. In this group, 21 patients received a single level laminectomy and single-level MISTLIF, 10 patients received a 2-level laminectomy and single-level MISTLIF, 2 patients received a single-level laminectomy and 2-level MISTLIF, and 1 patient received a 2-level laminectomy and 2-level MISTLIF. Three (8.8%) patients experienced clinically significant postoperative ASD requiring reoperation. Three other patients required reoperation for other reasons. Multiple logistic regression did not reveal any association between development of ASD and surgical covariates. MISTLIF with adjacent-level laminectomy demonstrated a favorable safety profile with rates of postoperative ASD lower than published rates after open fusion and on par with the published rates of ASD from MISTLIF alone. Future prospective studies may better elucidate the durability of adjacent-level laminectomies when performed alongside MISTLIF, but retrospective data suggests it is safe and durable.

308 Improvement in Cranial Nerve Neuropathies Following Treatment of Intracranial Aneurysms With Flow Diverters: Institutional Outcomes and Meta-analysis of Literature

INTRODUCTION: Cranial nerve (CN) neuropathies are rare presenting symptoms of intracranial aneurysms. Ophthalmological outcomes for symptomatic aneurysms treated with flow diversion are not well established. METHODS: We conducted a retrospective review of our institutional database for patients with intracranial aneurysms presenting with CN neuropathies who underwent treatment with flow diversion between 2015 and 2023. Systematic review of the literature was performed using Medline, EMBASE, Cochrane, and manual citation searches. Random effects meta-analysis was used. RESULTS: Twelve out of 136 studies were included in this meta-analysis, totaling 261 patients. The results were combined with our institutional data. The pooled rate of improvement in any CN neuropathies following flow diversion was 76% (95% CI, 67%-84%, n = 272). Patients presenting with CNII deficits were less likely to improve following treatment compared to other CN neuropathies (pooled OR [pOR] 0.32, 95% CI, 0.16-0.63, n = 224). The pooled rate of clinical improvement was 53% in CNII deficits (95% CI, 42%-65%, n = 80) and 80% in other CN deficits (95% CI, 71%-88%, n = 106). Intervention within one month of presentation was associated with improvement (pOR 6.53, 95% CI, 1.34-31.81, n = 33). Adjunctive coiling did not demonstrate effect on the improvement rate (pOR 0.38, 95% CI, 0.07-2.13, n = 31). Near total occlusion (Raymond Roy Occlusion Classification of 1 or 2, or O'Kelly-Marotta scale of C or D) was associated with symptomatic improvement (pOR 5.29, 95% CI, 1.66-16.90, n = 118), but not total occlusion (pOR 2.83, 95% CI, 0.97-8.23, n = 118). CONCLUSIONS: Flow diversion improves CN outcomes in patients with symptomatic intracranial aneurysms. These results support the theory that CN neuropathies depend more on the pulsatility of the aneurysm sac rather than mass effect. The inferior rate of improvement in CNII deficits compared to other CN symptoms may imply an additional, more irreversible mechanism contributing to CNII visual deficits.