Investment In Training Research Articles

Benefits of integrated electronic medical record in the efficiency of health services

Introduction: The Integrated Electronic Medical Record (IEMR) is a tool that centralizes patient medical information, improving efficiency in healthcare services. Its implementation optimizes data access, reduces costs, and enhances patient care. Objective: To identify the use and benefits of the IEMR in the efficiency of the healthcare system, evaluating its impact on clinical management, resource optimization, and patient safety. Methodology: A systematic review with a descriptive approach was conducted using databases such as PubMed, Scopus, and LILACS. Articles were selected based on specific inclusion criteria, and the PRISMA methodology was used for data collection. Results: The implementation of the IEMR improves the quality of care, reduces administrative times, and facilitates medical decision-making. It also enables better coordination among healthcare professionals, minimizing errors and promoting continuity of care. Conclusions: The IEMR is a key strategy for modernizing the healthcare system, favoring the integration of information between public and private sectors. Its implementation requires investment in technological infrastructure, staff training, and regulations to ensure data security.

The promise and pitfalls of AI in medicine: A balanced perspective.

Respected Editor, Artificial Intelligence (AI) is poised to revolutionise medicine, offering substantial improvements in patient care, diagnostic precision, and operational efficiency. While the potential benefits are considerable, it's essential to maintain a balanced view that addresses this technology's limitations and challenges. AI’s ability to rapidly and accurately analyse large datasets has led to notable advancements in medical diagnostics. AI algorithms, for example, have demonstrated exceptional proficiency in interpreting medical images, such as radiographs and MRIs, sometimes even outperforming human experts in identifying early signs of diseases like cancer. Additionally, AI-driven predictive analytics can anticipate patient risks and facilitate timely interventions, paving the way for more personalised and proactive healthcare.1 Despite these advancements, several critical issues must be addressed to ensure the responsible and effective integration of AI in healthcare. One significant concern is the risk of algorithmic bias. AI systems learn from historical data, and if these datasets are not sufficiently diverse and representative, the resulting algorithms can inadvertently perpetuate health disparities. Developing AI systems using diverse, inclusive datasets to mitigate this risk and ensure equitable healthcare outcomes is crucial.2 Another challenge lies in the transparency and interpretability of AI models. Many AI systems, particularly those based on deep learning, function as "black boxes," offering little insight into their decision-making processes. This opacity can lead to mistrust among clinicians and patients, and complicate the validation and regulatory approval of AI tools. Developing more interpretable AI models and establishing clear, rigorous guidelines for their validation and clinical implementation are essential steps to address this issue.3 The practicalities of integrating AI into clinical practice also present substantial challenges. Implementing AI solutions requires significant investment in infrastructure, training, and ongoing maintenance. Healthcare providers need to be equipped not only with the necessary technical skills to use AI tools but also with the ability to critically evaluate and interpret their outputs.4 Moreover, robust regulatory frameworks are needed to ensure the safe, ethical deployment of AI technologies in medicine.5 Despite these challenges, the transformative potential of AI in medicine remains significant. To fully realize this potential, a collaborative approach involving technologists, healthcare professionals, policymakers, and patients is essential. Emphasizing ethical considerations, transparency, and inclusivity in AI development and deployment will help mitigate risks and enhance the benefits of this powerful technology. ---Continue

DIGITAL TRANSFORMATION AND CYBER SECURITY CHALLENGES IN THE INFORMATION AGE

Digital transformation, one of the themes of the Information Age, is forming the basis of industries, rewarding innovation and fueling economic advancement. However, this advancement becomes faster and engulfs technology and with these new advancements comes a lot of virtual insecurity such as data leakage, privacy violation and increased virtual dangers. Digital transformation was discussed in this article in relation to cyber security in the context of interactions through interconnected systems. On the basis of existing theory, this work assesses the measures that organisations have to implement in order to address these threats where digitalization is implemented. The research also looks at a number of case studies and polices that have already been studied in prior educational work to show the effects that will be analyzed in the following sections on policy and governance, as well as future improvements in technology. The nature of cyber threats is evolving at an incredibly fast pace, making it impossible to implement changes that wouldn’t demand constant investments in training, tools, and processes. As for the restriction of resources, the identification and prevention of breaches are also delayed during incident response. In order to counter these problems, organisations may turn to the use of a third-party cyber security services and products including cyber security-as-a-Service; incorporate automation to enable them achieve greater performances yet minimize workload; as well as engage in security culture campaigns that aim at reaching all organisational workforce. Lack of resources may be a major detriment in the ongoing fight against cyber threats, but better prioritization and alliance can flatten the negative effects of having scarce resources in one’s arsenal.

Brazilian small businesses: impacts and challenges of digital transformation

This article explores how technological evolution shapes micro, small and medium-sized enterprises (MSMEs) in Brazil, highlighting the challenges and opportunities of digitalization. The research presents the historical importance of companies as agents of transformation of the economy and society, from the Industrial Revolution to the era of digital transformation, in which digital companies and technologies such as Web 4.0 are revolutionizing the market. As a result, social media has emerged as a powerful tool for communication and business, enabling direct interactions with consumers and providing new insights. To this end, an exploratory search methodology was used, based on a literature review, analyzing the impacts of digitalization on these organizations, addressing the importance of technological strategies and innovation. Despite their relevance in global and local economies, these companies face obstacles such as financial constraints, lack of infrastructure and resistance to change. The findings highlight that the adoption of technologies can increase competitiveness, connecting to new markets and consumers. However, challenges such as lack of technical training, limited access to credit and cultural barriers are identified as important obstacles. Therefore, investments in technical training and specific public policies are suggested to mitigate these difficulties. The text concludes that, for MSMEs to thrive in the digital age, it is essential to balance innovation and resilience, as information technology is seen as a competitive advantage, but its implementation requires strategic planning and cultural adaptation.

NEUROSCIENCE AND MATHEMATICAL EDUCATION

This article explored how neuroscience knowledge can enrich pedagogical practice in teaching Mathematics, especially in the final years of Elementary School. The research problem investigated how neuroscience contributes to understanding brain development, students and to formulating effective pedagogical strategies. The study, conducted through a literature review, identified the brain areas involved in mathematical reasoning, analyzed the cognitive and emotional aspects of students and proposed pedagogical strategies based on neuroscientific evidence, such as immediate feedback, spaced repetition and gamification. The main conclusions indicate that the integration of neuroscience with mathematics education can improve student performance, promote engagement and create more welcoming and effective learning environments. The study suggests investments in teacher training and in the adaptation of neuroscientific approaches to different contexts, aiming to democratize access to innovative educational practices.

Media and Knowledge in the Third Sector: a Framework for Consolidating Social Initiatives

Objective: The article explores how Civil Society Organizations (CSOs) can use Information and Communication Technologies (ICT) to enhance communication strategies and resource management, strengthening financial sustainability. Additionally, it proposes a media lab-inspired framework for innovation in the Third Sector. Theoretical Framework: The research is based on the historical and conceptual evolution of CSOs and media labs. CSOs operate in response to limitations of the State and private market, facing challenges in fundraising and governance. Media labs, in turn, are spaces for technological experimentation and collaborative innovation. Method: A qualitative approach includes a literature review and secondary data analysis from research on CSOs and media labs. The analysis considers technological infrastructure, capacity building, and stakeholder engagement. Results and Discussion: Findings indicate that CSOs still face challenges in resource management and communication with investors. Adopting media lab practices can enhance their innovation, fundraising, and social impact. Research Implications: The study suggests investments in digital infrastructure and training, highlighting the importance of collaboration between CSOs, the State, and the market to strengthen the Third Sector. Originality/Value: This study proposes an innovative framework by integrating CSOs and media labs, expanding the understanding of digital transformation and financial sustainability in the Third Sector.

Analyzing Tax Policies in Turkey and Indonesia: A Comparative Study for Improved Competitiveness and Neutrality

For many countries, taxes are the main source of revenue to finance all expenditures, including the promotion of economic growth. To compare the tax systems of different countries, the Organisation for Economic Co-operation and Development (OECD) has developed the International Tax Competitiveness Index (ITCI). This study examines Türkiye and Indonesia’s tax policies, focusing on their influence on economic competitiveness and tax neutrality. This study identifies the strengths and weaknesses of each country's tax system and provides recommendations for enhancing their competitiveness and neutrality. This study uses a comparative approach to analyse tax policies in Türkiye and Indonesia. The analysis reveals that a neutral tax code is crucial for economic growth and for attracting investment. Türkiye's tax system offers insights into efficient tax structures, with lower corporate tax rates and non-distortionary property taxes contributing to its higher ranking in the ITCI. Conversely, Indonesia's tax system presents opportunities for improvement by adopting similar practices. This study suggests that Indonesia could benefit from targeted tax incentives, better tax administration, and investment in tax education and training. Broadening the tax base and leveraging digital technologies for tax administration have been identified as key strategies to improve Indonesia's tax competitiveness. The study concludes that both Türkiye and Indonesia can enhance their tax systems by learning from each other and countries with high tax competitiveness rankings. By implementing the recommended measures, these countries can stimulate economic growth, investment, and achieve a more competitive and neutral tax

Backward and Forward Linkage Effects on Firm Survival: Evidence from East Java Large and Medium Manufacturing Survey

Firm survival in dynamic business environments is significantly influenced by the strength of a firm’s intersectoral linkages. While the impact of backward linkages on firm performance has been widely studied, their effect on firm survival remains unclear, especially in emerging economies like Indonesia. This study investigates the effects of both backward and forward linkages on the survival of manufacturing firms in East Java, Indonesia, using a survival analysis approach coupled with Survival-time inverse-probability-weighted regression adjustment (STIPWRA). Analysis of enterprise- level large and medium industry survey data from 1995 to 2015 (published by the Central Bureau of Statistics (BPS)), complemented by Input-Output tables for 2000, 2005, 2010, and 2015, revealed that while backward linkages did not significantly impact survival, forward linkages had a positive and significant impact. Firms with strong forward linkages demonstrated greater resilience and longer survival times. These findings highlight the crucial role of forward-looking strategies, like cultivating strong customer relationships and market positioning, for the long-term sustainability of manufacturing firms. Policy implications center on fostering robust forward linkages through strategic investments in infrastructure, R&D, and workforce training to enhance the competitiveness of East Javan manufacturing enterprises.

Strategic intelligence and Nigeria’s diplomatic engagements: enhancing national security in an era of transnational threats

ABSTRACT Nigeria’s security landscape faces significant threats from transnational challenges, including terrorism, insurgency, and cybersecurity risks. This commentary article examines the critical integration of strategic intelligence and diplomatic engagement as essential tools for enhancing national security. It analyses key components of strategic intelligence – human intelligence, signals intelligence, and open-source intelligence – and their roles in anticipating and countering emerging threats. Additionally, the article underscores the importance of diplomatic initiatives in fostering international cooperation and intelligence-sharing, citing regional collaborations like the Multinational Joint Task Force (MNJTF) against Boko Haram as effective models for action. However, challenges such as resource constraints, bureaucratic inefficiencies, and political sensitivities can impede seamless intelligence integration and diplomatic coordination. The article advocates for institutional reforms, investments in technology and training, and the establishment of trust through transparency in diplomatic efforts. By effectively leveraging strategic intelligence and diplomatic relationships, Nigeria can enhance its national security and promote regional stability.

Internal Control Systems and the Revenue Collection Performance among Local Government Authorities (LGA) in Tanzania

Local government authorities (LGAs) face significant challenges in revenue collection due to inadequate internal controls, leading to inefficiencies, fraud, and inconsistent reporting. This study investigates the effect of internal control systems on revenue collection performance within selected LGAs in Tanzania, namely Mbeya, Mwanza, and Manyara. Using a cross-sectional survey design, data were collected from 400 respondents across the three councils. Two Stage Least Square regressions were employed with the frequency of external audits as the instrument to control for endogeneity. The findings indicate that while certain internal control measures, such as financial record accuracy and internal audits, positively influence revenue effectiveness and reliability, challenges such as fraud and delayed reporting adversely affect revenue growth and operational efficiency. LGAs should enhance internal audit functions, improve financial record accuracy, strengthen fraud prevention, optimize reporting timelines, and enhance monitoring mechanisms through investment in technology and staff training. Policymakers should develop a standardized framework for internal controls, invest in technology infrastructure, encourage Public-Private Partnerships (PPP), and regularly review policies to ensure effective revenue collection in LGAs.

THE PAKISTAN HEALTHCARE SECTOR AT STAKE: BRAIN DRAIN OF PAKISTAN DOCTORS

Background: The exodus of Pakistan's medical personnel is a major problem for the country. The nation's already overburdened healthcare system suffers from this brain drain, which results in a lack of qualified professionals and subpar patient care. This exodus is caused by a number of factors, including political instability, a lack of prospects for professional progression, and inadequate compensation. The exodus of highly skilled healthcare workers from Pakist an, sometimes known as "medical brain drain," is a growing concern that jeopardizes the country's healthcare system. As economic disparities, gender biases, and professional hurdlesdrive doctors, nurses, and other medical professionals outside, Pakistan h as a serious shortage of medical workers. The purpose of this study is to investigate the fundamental causes and implications of medical brain drain, to identify the biases that worsen the problem, and to provide concrete solutions to reduce its impact on Pakistan's healthcare system. This research emphasizes the importance of specific policies aimed at improving healthcare working conditions, reducing gender disparity, and raising investment in medical training and infrastructure. Objectives: The study's objectives are to determine and examine the main factors that lead Pakistani physicians to look for work overseas and to evaluate the resulting effects on the country's healthcare system. Materials and Methods: A variety of methods, including surveys, expe riments, and observational studies, may be used in quantitative research. The study used a quantitative research design and a cross sectional survey approach. Results: A sizable portion of physicians cite low pay, unfavorable working circumstances, and a d earth of prospects for professional growth as reasons for their choice to immigrate.Furthermore, the situation is made worse by political unpredictability and security worries, which drive many people to look for safer and more stable surroundings. Conclu sion : Pakistan's healthcare sector is seriously threatened by the continuous exodus of medical personnel. To solve this problem, extensive reforms are needed, such as bettering pay packages, improving working conditions, providing them the opportunities fo r their specialization trainings, grand maintaining political stability to keep talent in the nation. Therefore, in order to reduce brain, drain out of the nation, governments in developing nations like Pakistan should concentrate onpolicies that guarante e job opportunities are available, offer suitable research facilities, provide safe working conditions, and establish merit systems. In conclusion, it is critical to highlight that Pakistan has substantial obstacles in developing and successfully implement ing migration related policies since there is a dearth of a substantial database with international migration statistics. Therefore, among other things, keeping such a database up to date is essential for the proper execution of policies.

MEMBANGUN KURIKULUM DEEP LEARNING UNTUK MEMPERSIAPKAN GENERASI DIGITAL

Technological developments in the era of Industrial Revolution 4.0 and Society 5.0 demand an adaptive education system to prepare a generation capable of competing at the global level. This article discusses the development of a deep learning-based curriculum as an innovative approach to improve students' holistic competencies, covering cognitive, affective, and psychomotor aspects. Using a qualitative method based on a literature review, this research identifies the benefits of a deep learning curriculum, including the strengthening of critical thinking, analytical skills, creativity, and digital literacy. In addition, it supports the personalization of learning through the integration of technologies such as augmented reality, virtual reality, and artificial intelligence. The results show that the deep learning curriculum is able to prepare generation Z and Alpha to face global challenges. However, its implementation faces obstacles such as limited infrastructure, educator readiness, and data privacy issues. The study highlights the importance of collaboration between educational institutions, government and industry, as well as investment in teacher training and provision of supporting technology. In conclusion, deep learning-based curriculum not only offers an innovative solution to improve the quality of education but also a strategic step to build an adaptive and competitive society of learners. This research recommends strengthening education policies and providing digital infrastructure to support the successful implementation of this curriculum. Keywords: Deep learning, Digital Generation, Education Curriculum, Learning Technology, Curriculum Strategy.

Integrating ICT with Artificial Intelligence for Transformative Education

The integration of Information and Communication Technology (ICT) with Artificial Intelligence (AI) is transforming the educational landscape, fostering personalized learning, improving administrative efficiency, and enhancing student engagement. This paper explores the synergies between ICT and AI in education, highlighting their combined potential to create adaptive learning environments, automate routine tasks, and facilitate data-driven decision-making. AI-powered tools, such as intelligent tutoring systems, predictive analytics, and natural language processing, enhance the effectiveness of ICT-driven platforms by tailoring instruction to individual learning needs. Additionally, machine learning algorithms analyze student performance patterns to provide real-time feedback and targeted interventions, ensuring improved academic outcomes. The study also examines the role of AI-driven ICT in bridging educational disparities by offering accessible and inclusive learning experiences. Virtual classrooms, chatbots, and AI-enhanced learning management systems enable students and educators to interact more effectively, overcoming geographical and economic barriers. However, the integration of these technologies presents challenges, including data privacy concerns, digital literacy gaps, and ethical implications related to AI decision-making. Addressing these issues requires robust policy frameworks, investments in teacher training, and the development of equitable AI models. This paper synthesizes existing research on AI-integrated ICT applications in education, providing insights into their impact on pedagogy, curriculum development, and institutional efficiency. The findings underscore the need for a balanced approach that leverages AI's capabilities while ensuring ethical considerations and human-centered learning experiences. As AI and ICT continue to evolve, their seamless integration has the potential to revolutionize education, making it more responsive, efficient, and inclusive. Future research should focus on optimizing AI-driven ICT tools, assessing their long-term impact, and developing strategies to address emerging challenges in educational technology adoption.

Navigating Excellence: Exploring Education Systems of Singapore & Republic of South Korea; Insights for Pakistan's Educational Landscape

This concept paper aims to study the education systems of Singapore & Republic of Korea (ROK) focusing on the factors that have led to the phenomenal success of these countries in the field of education. Using a comparative framework, the study highlights cultural values, government policies, and systemic structures that have shaped the educational landscapes of these nations. This study maintains that the culture, ideals, government policies and work ethics of the people of these two countries have led to their current esteemed status among the comity of the nations in the field of education. Pakistan's education system faces significant challenges, including low investment in education, weak governance, and inadequate teacher training as well as inconsistent and inefficient policy implementation. This paper provides strategic recommendations for Pakistan, drawing on the successful policies of Singapore and Republic of South Korea to improve its education system. The paper highlights the importance of adapting Pakistan’s education system to meet the needs and demands of changing times in accordance with global trends and most importantly prioritizing education for human capital development and creating a workforce that is ready to tackle the challenges in an increasingly competitive world.

A systematic review of serious games as tools for STEM education

ObjectiveSerious games are increasingly recognized as innovative tools in STEM (Science, Technology, Engineering, and Mathematics) education, providing engaging and interactive learning environments that can enhance student performance, engagement, and learning outcomes. This systematic review aims to synthesize current research on serious games in STEM education, evaluating their impact and identifying implications for educators, policymakers, and future research.MethodsA comprehensive literature search was conducted across Scopus, Web of Science, PubMed, and IEEE Xplore databases, yielding 584 articles. A total of 37 peer-reviewed journal articles met the inclusion criteria, guided by the PICOS framework, which focused on studies reporting the use of serious games in STEM education contexts. Data extraction included study characteristics, game types, participant demographics, educational contexts, and reported outcomes.AnalysisThe selected studies were analyzed to assess the effectiveness of serious games in enhancing learning outcomes, engagement, and performance in STEM education. The analysis also explored challenges related to the implementation of serious games, including technological limitations, the need for comprehensive educator training, and ethical considerations around data privacy, all of which may impact adoption in educational settings.ResultsSerious games demonstrated a positive impact on learning outcomes, such as knowledge acquisition, skill retention, and the application of STEM concepts, along with increased student engagement and motivation. These findings suggest that serious games can serve as valuable tools for educators seeking to foster active learning environments. For policymakers, the results indicate a need for strategic investments in technology infrastructure, teacher training, and curriculum integration to maximize the benefits of serious games in STEM education. However, significant limitations were identified, including technological barriers, variability in study quality, and the need for sustained educator support, which may impact generalizability and implementation.ConclusionThis review highlights the transformative potential of serious games as tools for STEM education but emphasizes the importance of addressing key challenges to realize their full benefits. For educators, implementing serious games requires alignment with curriculum goals and access to adequate training and resources. Policymakers are encouraged to support these efforts by providing financial resources and promoting frameworks for ethical, data-secure use of serious games in education. Future research should focus on establishing a globally recognized framework for serious games in STEM, conducting longitudinal studies to evaluate long-term impacts, and exploring diverse educational contexts to ensure inclusive and effective integration.

Current Status of Prostate Biopsy in Africa: Are We Ready for a Targeted Biopsy?

Prostate cancer remains a significant public health issue globally, with considerable disparities in diagnostic and management practices, especially in Africa. Traditional diagnostic methods such as transrectal ultrasound-guided biopsies have limitations in accuracy and are associated with potential complications. Emerging targeted biopsy techniques promise improved cancer detection rates and reduced morbidity but face adoption challenges across the African continent due to variable access to advanced imaging technologies and professional expertise. This study aims to evaluate the current practices of prostate biopsy techniques in Africa, focusing particularly on the readiness for and integration of targeted biopsy methods. It assesses the accessibility, quality, volume of procedures, and availability of advanced diagnostic tools across different regions. The survey included 58 centers across five African regions, representing a 70% response rate from an initial 83 invitations sent. Finger-guided biopsy was the most common method, used by 41 centers, while only one center reported using MRI fusion biopsy. Thirty-five centers routinely administered a rectal enema, and nearly all (n = 50) centers employed antibiotic prophylaxis, predominantly fluoroquinolones. For anesthesia, 12 centers used injectable lidocaine, and 38 centers used intrarectal lidocaine gel. The number of biopsy cores taken varied, with most centers taking 12, while others used fewer. The findings indicate a critical need for concerted efforts to bridge the gap in prostate cancer diagnostics and treatment in Africa. Enhancing the quality of prostate cancer care on the continent requires investments in training, infrastructure, and standardization of practices. Collaborative efforts towards adopting advanced diagnostic tools and methods are essential for aligning African practices with global standards, ultimately improving outcomes for prostate cancer patients.

CHALLENGES AND PROGRESS IN THE IMPLEMENTATION OF LAWS Nº 10.639/2003 AND Nº 11.645/2008:

This paper analyzes the implementation of Laws No. 10.639/2003 and No. 11.645/2008 in the Brazilian educational system, highlighting their advances, challenges, and potential. These laws aim to incorporate Afro-Brazilian, African, and indigenous history and culture content into school curricula, promoting a more inclusive and anti-racist education. The research, which uses a qualitative approach, uses a bibliographic review and documentary analysis to examine examples of good practices, limitations, and implementation strategies. The results reveal specific advances, such as interdisciplinary pedagogical projects, and government initiatives for teacher training and teaching materials. However, significant challenges persist, including institutional resistance, insufficient teaching resources, and lack of preparation of educators. It is concluded that investments in teacher training, expansion of teaching materials, and strengthening of partnerships with local communities are essential to ensure the transversality and effectiveness of the laws. This study contributes to the debate on public education policies and to the construction of a more equitable society.

Project-Based Learning Through a Heutagogic Approach in Higher Education: Challenges, Technology and Implementation

This study explores the implementation of Project-Based Learning (PBL) with a heutagogic approach in universities to enhance student autonomy and critical thinking. An explanatory sequential mixed-methods design was used, combining quantitative surveys with qualitative interviews, observations, and document analysis. The study involved 150 students from three universities in West Java. Quantitative data were analyzed using descriptive statistics in IBM SPSS 24, while qualitative data were examined through thematic analysis and triangulation techniques. Findings indicate that PBL with a heutagogic approach follows seven systematic steps: problem identification, learning objective formulation, project strategy planning, information collection, project execution, presentation of results, and reflection. This method significantly enhances students’ critical thinking, creativity, and independent learning skills. However, challenges include limited technological resources, the need for more structured lecturer guidance, and student time management issues. Technological tools such as Google Classroom, Zoom, and presentation software support PBL effectiveness, though unequal access to technology remains a constraint. Addressing these challenges requires institutional investment in infrastructure, faculty training, and policy development to foster autonomous and collaborative learning environments. The findings provide insights for higher education institutions on optimizing heutagogic-based PBL to develop graduates equipped with the skills needed in the modern workforce.

The surgical-interventional cleavage in cardiovascular medicine: A brazilian health care system analysis

This study aims to compare in-hospital mortality, costs, and length of stay between traditional cardiovascular surgery and interventional cardiology in SUS (2009–2023), evaluate temporal trends in technological substitution, and quantify long-term effects using risk-adjusted models. An ecological design analyzed aggregated data from 2,303,648 procedures. ARIMA models and negative binomial regression adjusted temporal trends and mortality risk. Results revealed accelerated technological substitution (-1.27% annual decline in surgeries; p < 0.001), with initial mortality advantage for interventional procedures (RR = 0.43; 95% CI: 0.11–0.76). However, synthetic projections showed benefit inversion by 2023 (+72.38 excess deaths), linked to an inverse learning curve for interventions (+0.83% mortality per 1% volume increase; p < 0.001). Cost savings (R$5,524/case) and shorter hospitalization (-5.07 days) coexisted with rising complexity in surgical cohorts, increasing baseline mortality risk by 0.59% annually (p < 0.001). The study concludes that technological substitution in SUS achieved economic efficiency but requires parallel investments in training and risk stratification for clinical sustainability.

Nurses' Perspectives on the Sleep Quality of Hospitalized Patients in Al Ahsa, Saudi Arabia.

Sleep quality is crucial for patient recovery and well-being, yet hospitalized patients often suffer from poor sleep due to environmental disruptions, clinical routines, and psychosocial stressors. While these challenges are well-documented, qualitative insights into nurses' perspectives-essential frontline providers shaping the sleep environment-are scarce, especially within rapidly evolving healthcare systems like Saudi Arabia's. This study explores nurses' perceptions of factors influencing patient sleep quality in a private hospital in Al Ahsa, Saudi Arabia, and identifies strategies for improvement. We conducted a qualitative, cross-sectional study using semi-structured interviews with 14 registered nurses from diverse nationalities, specialties (Obstetrics/Gynecology, Medical-Surgical, Pediatrics, Intensive Care, Orthopedics, Bariatrics), and experience levels. Interviews were conducted in Arabic or English, audio-recorded, transcribed, and thematically analyzed using ATLAS.ti software. Roy's Adaptation Model guided the examination of environmental, patient-specific, and systemic factors affecting sleep. Four primary themes emerged: (1). Environmental Factors: noise from alarms, equipment, family presence, and late-night activities, along with abrupt lighting changes, consistently disrupted sleep. (2). Patient-Specific Factors: pain, emotional distress, cultural expectations, and family involvement influenced sleep experiences. (3). Systemic and Contextual Factors: language barriers, infrastructural disparities between private and governmental hospitals, and limited resources can impeded effective sleep-promoting strategies. (4). Role of Health Technology: nurses recognized the potential of innovations like smart lighting and wearable monitors to enhance sleep quality but faced challenges in implementation due to knowledge gaps and limited familiarity. Roy's Adaptation Model highlighted how effective adaptation through physiological and cognitive-emotional pathways, as observed by nurses, was facilitated or hindered by these factors. Enhancing in-hospital sleep quality requires a holistic, culturally sensitive approach that integrates environmental modifications, patient-centered care, and systemic improvements. Strategic investments in staff communication training, infrastructural upgrades, language support services, and the adoption of health technologies can promote adaptive responses and optimize patient rest. By leveraging theory-driven insights and context-specific strategies, healthcare systems-particularly those undergoing rapid development-can better support nurses in fostering restorative sleep environments as a fundamental component of patient-centered care, thereby enhancing patient recovery, satisfaction, and overall well-being.