Management Services Research Articles

Blockchain Technology: Unlocking New Frontiers in Data Management and Transparency

This article explores the transformative potential of blockchain technology in revolutionizing data management and enhancing transparency across various industries. As a decentralized, immutable ledger system, blockchain offers a secure and efficient way to record, share, and verify information, eliminating the need for intermediaries and reducing the risk of fraud. The article reviews the fundamental principles of blockchain, including distributed consensus, cryptographic security, and smart contracts, to highlight how these features improve data integrity and trust in digital transactions. Through case studies in sectors such as finance, supply chain management, healthcare, and government services, the article demonstrates how blockchain can streamline operations, reduce costs, and promote accountability. Particular attention is given to the role of blockchain in improving transparency by providing an auditable and tamper-proof record of transactions, which is especially valuable in industries prone to corruption and data manipulation. The article also addresses the challenges facing blockchain adoption, including scalability issues, regulatory concerns, and the need for standardization. Additionally, the potential of blockchain in emerging applications, such as decentralized finance (DeFi) and non-fungible tokens (NFTs), is discussed, highlighting the technology’s expanding role in reshaping digital economies. The article concludes by emphasizing that while blockchain is still in its developmental stages, its ability to foster greater transparency and more secure data management systems positions it as a key driver of innovation in the digital age. Future research is recommended to explore further integration strategies and address challenges in widespread blockchain adoption.

Relocating a highly complex 5 million test per year hospital based laboratory - what you should know and what you should avoid

Abstract Introduction/Objective A highly complex hospital based laboratory performing 5 million test per year in New York City was commanded to relocate due to a clinical department need to expand. This presented a challenge regarding the obtention of a suitable new space within the existing facility, the architectural design to optimize the performance of both Anatomic and Clinical Pathology, the choice between acquirring brand new instrumentation versus relocation of the existing instruments. At the same time, we had to interact with hospital wide Facilities Management and Information Services/ Electronic Medical records. In addtion, for quality improvement and to alleviate the shortage of licensed technologist in our state, it was decided that a robotic line was to be implemented in the new facility. Methods/Case Report Several space options were assessed. Once the most suitable space was found a decision was made to move in two phases, Anatomic Pathology first, and subsequently Clinical Pathology. New work stations were purchased for Anatomic Pathology. New instruments were obtained for Chemistry, Immunology and Hematology. All instruments were validated.. Our laboratory information system had to be upgraded in order to support the robotic line, which is to be implemented after the Clinical Laboratory move. This will facilitate the expansion of in house provision of laboratory services to outpatient facilities / clinics expandin our outreach. The new space includes room to expand as well as abundant swing space. Our next phase includes the relocation of our Blood Bank and expansion of our Microbiology Services Results (if a Case Study enter NA) Due to delays in the obtention of the State Occupational permit the move was postponed several times. It was decided to move in two phases, once the permit was received. The Laboratory successfully moved in a two week period, and was fully operational overnight. Conclusion The Laboratory successfully moved in a two week period, and one week later we underwent a routine State inspection, in which the rigourous inspectos encountered very few deficiencies. The Laboratory is fully operational to the satisfaction of our clinical departmenst and preparing to the next phase including Blood bank and expanding our outreach program

ANEL: a novel efficient and lightweight authentication scheme for enhancing security in Vehicular Ad Hoc Networks (VANETs) using elliptic curve cryptography

Vehicular Ad-hoc Networks (VANETs) offer immense potential for revolutionizing modern transportation systems through real-time communication and interaction between vehicles and roadside infrastructure. These networks can significantly enhance traffic management, improve safety, and support various vehicular services. However, ensuring secure communication in VANETs remains a critical challenge due to the highly sensitive nature of the data exchanged, such as location and personal information. Current authentication schemes, including the ANEL scheme, exhibit vulnerabilities like data interception and tracking risks. In this paper, we propose a novel, efficient, and lightweight authentication scheme that leverages elliptic curve cryptography (ECC) and message mapping techniques to address these security issues. The proposed solution strengthens encryption, enhances privacy protection, and mitigates risks such as unauthorized access and man-in-the-middle attacks. Furthermore, the scheme offers scalability and distinguishes between regular and priority users, making it adaptable to various VANET applications. This approach significantly improves the overall security and privacy framework of VANET systems while ensuring the efficient use of computational resources in vehicular environments.

Advanced Encryption Techniques for Database Security in Cloud Environments

This technical article explores advanced encryption techniques for enhancing database security in cloud environments, addressing the growing need for robust data protection as organizations increasingly migrate to cloud-based solutions. The article covers encryption standards such as AES-256, RSA, and Elliptic Curve Cryptography, as well as key management approaches using Hardware Security Modules (HSMs) and Key Management Services (KMS). It also delves into cutting-edge concepts like homomorphic encryption and quantum-resistant algorithms. The discussion encompasses performance optimization strategies and regulatory compliance considerations, providing a comprehensive overview of the current state and future trends in cloud database security.

Information and Communications Technology-Based Monitoring Service for Tailored Chronic Disease Management in Primary Care: Cost-Effectiveness Analysis Based on ICT-CM Trial Results.

Information and communications technology-based tailored management (TM) intervention is a novel automatic system in which a smartphone app for the management of patients with hypertension and diabetes, the provider web, and Bluetooth devices are linked. However, little evidence exists regarding the cost-effectiveness of the interventions using mobile apps. This study aimed to assess the cost-effectiveness of TM intervention for adult patients with hypertension or diabetes in primary care compared with usual care (UC). Cost-effectiveness analysis using a Markov model was conducted from the Korean health care system perspective. Based on 6-month outcome data from an information and communications technology-based tailored chronic disease management (ICT-CM) trial, effectiveness over a lifetime beyond the trial periods was extrapolated using a cardiovascular disease risk prediction model. Costs were estimated using ICT-CM trial data and national health insurance claims data. Health utility weights were obtained from the Korea National Health and Nutrition Examination Survey. In the base-case analysis, compared with UC, TM was more costly (US $23,157 for TM vs US $22,391 for UC) and more effective (12.006 quality-adjusted life-years [QALYs] for TM vs 11.868 QALYs for UC). The incremental cost-effectiveness ratio was US $5556 per QALY gained. Probabilistic sensitivity analysis showed that the probability of TM being cost-effective compared with UC was approximately 97% at an incremental cost-effectiveness ratio threshold of US $26,515 (KRW 35 million) per QALY gained. Compared with UC, TM intervention is a cost-effective option for patients with hypertension or diabetes in primary care settings. The study results can assist policy makers in making evidence-based decisions when implementing accessible chronic disease management services.

БІЛІМ БЕРУ ЖҮЙЕСІНДЕ ГЕЙМИФИКАЦИЯ ҚҰРАЛДАРЫН ҚОЛДАНУДЫҢ МҮМКІНДІКТЕРІН ТАЛДАУ

In the modern information educational environment, there is a growing interest in the use of computer games to improve the quality of education, which determines the relevance of the proposed study for the analysis of software with the possibility of gamification of the educational process in the context of the requirements of the state, society and education. The research methodology is the study of information sources of psychological, pedagogical, methodological and technical orientation, the analysis of computer educational games of foreign and domestic authors. The article considers the need for gamification of the educational process, the principles of gamification, its impact on student motivation and participation, as well as the main aspects of the optimal implementation of game elements in training. Modern software resources and platforms offering gamification in the educational process of personal development are analyzed. All software tools with the possibility of gamification of training were divided into groups: gaming platforms, educational quests, learning management services and game development sites. Particular attention is paid to methods for evaluating the effectiveness of gamified programs and platforms, which will allow creating the best didactic tasks and recommendations for teachers. Gamification can increase student motivation and their participation in various educational tasks. Intrinsic and extrinsic motivation have a special impact on students' cognitive abilities regarding learning outcomes and improve overall academic performance. Motivation, which is an important means of achieving learning goals, motivates students according to their interests. Since students perceive information differently, they can choose their activities according to their learning preferences. According to the research topic, the positive situation of gamified learning is analyzed and the relevance of digital gamification in education is determined.

Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey.

Our study aims to examine perceptions of sarcopenia among doctors and patients for improved management strategies in the future. We analyzed nine matched items from separate surveys involving 80 community-based primary care doctors, recruited online (55%) and offline (45%), and 80 community-dwelling older patients who visited 6 of the 80 primary care clinics in South Korea. Doctors had a mean age of 58.3 ± 9.1 years, with 17.5% women; patients had a mean age of 74.1 ± 6.1 years, with 61.3% women. Twenty-eight patients (35.4%) had heard of sarcopenia, while only 19 doctors (23.8%) knew the diagnostic criteria of sarcopenia. Patients were more likely to believe they had sarcopenia than doctors assumed their patients had sarcopenia (patients, 35%; doctors, 16.9%; P = 0.0039). Patients desired more exercise and nutritional education than doctors reported they could provide (all P < 0.01). More patients preferred regular text messages for exercise or nutritional education (for exercise: patients 16.5%, doctors 5.8%, P = 0.0428; for nutrition: patients 17.1%, doctors 4.4%, P = 0.0154). Many patients were unaware of available community services for sarcopenia management (patients 48.8%, doctors 10.0%, P < 0.001). Both patients and doctors in community-based primary care clinics lacked awareness of sarcopenia. Significant discrepancies existed between the exercise and nutritional education patients desired and what doctors could provide. These findings can inform the development of sarcopenia management programs in primary care clinics.

The relationship between stress, anxiety and eating behavior among Chinese students: a cross-sectional study.

The expansion of higher education and the growing number of college students have led to increased awareness of mental health issues such as stress, anxiety, and eating disorders. In China, the educational system and cultural expectations contribute to the stress experienced by college students. This study aims to clarify the role of anxiety as a mediator in the relationship between stress and eating behaviors among Chinese college students. This study utilized data from the 2021 Psychology and Behavior Investigation of Chinese Residents, which included 1,672 college students under the age of 25. The analysis methods comprised descriptive statistics, t-tests, Pearson correlation analyses, and mediation effect analysis. The findings indicate that Chinese college students experience high levels of stress, with long-term stress slightly exceeding short-term stress. Both types of stress were positively correlated with increased anxiety and the adoption of unhealthy eating behaviors. Anxiety was identified as a significant mediator, accounting for 28.3% of the relationship between long-term stress and eating behavior (95% CI = 0.058-0.183). The mediation effect of short-term stress on eating behavior through anxiety was also significant, explaining 61.4% of the total effect (95% CI = 0.185-0.327). The study underscores the importance of stress management and mental health services for college students. It recommends a comprehensive approach to reducing external pressures, managing anxiety, and promoting healthy eating behaviors among college students. Suggestions include expanding employment opportunities, providing career guidance, enhancing campus and societal support for holistic development, strengthening mental health services, leveraging artificial intelligence technologies, educating on healthy lifestyles, and implementing targeted health promotion programs.

Factors influencing the acceptability of the test, treat and refer practice for malaria among caregivers of under 5 children at community pharmacies and drug shops in Nigeria

BackgroundMalaria affects children under the age of five and pregnant women, leading to high morbidity and mortality rates. In sub-Saharan Africa, Patent and Proprietary Medicine Vendors (PPMVs) have been identified as key players in the provision of malaria treatment due to their accessibility and availability in communities, but PPMVs are not usually tested before fever cases are treated as malaria or refer clients. The aim of this study was to explore the factors influencing caregivers’ acceptance of the test, treatment and referral practices for malaria management provided by CPs and PPMVs in Kaduna and Lagos states, Nigeria.MethodsA cross-sectional quantitative telephone survey was conducted among 150 caregivers of children under five years old who received malaria services from trained CPs and PPMVs between May and July 2022. Descriptive and bivariate analyses were performed to identify factors significantly associated with the acceptability of malaria management services. All statistically significant factors from the bivariate analysis were explored using logistic regression models, and odds ratios (ORs) with confidence intervals (CIs) were calculated to predict acceptability. The 95% level was used to define statistically significant associations (p ≤ 0.05).ResultsAll caregivers were asked questions that aided in obtaining a diagnosis of malaria. More than two-thirds of the caregivers (68%) reported that the child was tested by a CP/PPMV. Among those treated (148), 89% reported that the child was administered artemisinin combination therapy (ACT) irrespective of whether the child tested positive or negative for malaria. At the bivariate level, acceptability was greater among caregivers of children aged 13 months and older than among caregivers of children aged 0–12 months (93% vs. 76%, p = 0.004). Caregivers of children who prescribed ACT had greater acceptance than did those not prescribing ACT (92% vs. 69%, p = 0.010). Multivariate analysis revealed that these relationships held.ConclusionsThe adoption of the test, treat, and refer practice as a standard approach by CPs and PPMVs could replace the widespread practice of prescribing medications without conducting tests. This shift has the potential to improve the quality of malaria management services and enhance patient outcomes.

Intensity of Social Needs Case Management Services and Changes in Hospital and Emergency Department Use Among Adult Medicaid Beneficiaries.

We identify the association between high- and low-intensity case management services on hospital and emergency department (ED) use among CommunityConnect patients. Social needs case management services vary in intensity, including the modality, workforce specialization, and maximum caseload. CommunityConnect is a social needs case management program implemented by Contra Costa Health, a county safety-net health system in California's San Francisco Bay Area. Due to the endogeneity of high-intensity services assigned to high-risk patients, we instrument for service intensity using the number of specialist case managers hired each month of enrollment. Zero-inflated negative binomial models with 2-stage residual inclusion estimated total and avoidable hospital admissions and ED visits 12 months post-enrollment for adult Medicaid beneficiaries enrolled between August 2017 and December 2018 (n = 19,782). Compared with low-intensity case management, high-intensity services were associated with a reduction in the incidence rates of inpatient admissions [incidence rate ratio (IRR) = 0.341, 95% CI: 0.106-1.102; P = 0.072], ED visits (IRR = 0.608, 95% CI: 0.188-1.965; P = 0.058), and avoidable ED visits (IRR = 0.579, 95% CI: 0.179-1.872; P = 0.091). No significant association was found between service intensity and the likelihood of an event being an excess zero. High-intensity social needs case management may be more effective than low-intensity service at reducing health care use for individuals with non-zero use, suggesting that intensive case management may be especially helpful in supporting discharge and transitions of care.

Childhood trauma, substance use and depressive symptoms in people with HIV during COVID-19

Background: Adverse childhood experiences (ACEs), substance use, depressive symptoms, and HIV outcomes in people living with HIV (PLWHIV) have not been comprehensively investigated within a single study.Aim: The aim of this study was to investigate the prevalence and association of ACEs, substance use, depressive symptoms and human immunodeficiency virus (HIV) outcomes in PLWHIV accessing HIV care during the coronavirus disease 2019 (COVID-19) pandemic.Setting: District hospital HIV clinic in South Africa.Methods: A total of 196 PLWHIV completed a socio-demographic and clinical questionnaire; an adapted World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test; WHO ACEs International Questionnaire, and Patient Health Questionnaire.Results: The most common ACEs were having one or no parent, parental separation or divorce (n = 131, 66.8%), exposure to collective (n = 57, 29.1%) and community violence (n = 55, 28.1%), with 40.3% (n = 79) experiencing ≥ 3 ACEs. The most commonly used substances were alcohol (n = 34, 17.3%), tobacco (n = 33, 16.8%), and cannabis (n =13, 6.6%). The prevalence of depressive symptoms was 19.4% (n = 38). Linear regression analyses indicated greater alcohol (adj β = 2.84, p 0.01), tobacco (adj β = 3.64, p 0.01) and cannabis use risk scores (adj β = 2.39, p 0.01) were associated with ≥ 3 ACEs. Logistic regression indicated depressive risk (adjusted odds ratio [OR] = 9.39, 95% confidence interval [CI] 4.78–23.51) was associated with ≥ 3 ACEs.Conclusion: A high prevalence of ACEs, substance use and depressive symptoms exists among PLWHIV, along with an association between cumulative ACEs and both substance use and depressive symptoms.Contribution: Enhanced screening and management services are recommended to address this triple burden in PLWHIV.

Practice, competency and attitude toward weight management service and the barriers for its implementation in the community pharmacy setting

Practice, competency and attitude toward weight management service and the barriers for its implementation in the community pharmacy setting

Модели цепей поставок и их классификация

The article discusses various models of supply chains of goods. The classification and models of supply chains are considered. The basic concepts and elements of supply chain management are revealed. The theoretical basis of the article is research conducted in such fields of knowledge as logistics and supply chain management. Logistics supply chains are an important element in the activities of any company. They include the planning, production and management of goods, services and information from the point of origin to the point of consumption. Supply chains coordinate complex patterns of movement and transportation, shipment and receipt, import and export operations, warehousing, inventory management, procurement, production planning and customer service.

Assessing Information Technology in Hospitals in Tehran: Challenges and Opportunities for Performance Improvement

Purpose: This research aimed to investigate the maturity level of information technology (IT) within hospitals in Tehran. Method: The study was applied in purpose and survey-based in method. The statistical population comprised 27 experts in urban management and IT within hospitals in Tehran. A revised standard questionnaire, based on Gartner’s IT management process maturity model, was used to measure IT maturity. Data analysis was performed using SPSS software (version 23). Findings: The study revealed that several aspects of IT maturity within hospitals in Tehran were generally favorable. Specifically, leadership and IT management activities, customer-oriented service, control and evaluation, configuration and asset management, security management, change management, service level management, accessible management, service and support documentation, capacity management, and strategic trends were positively evaluated. However, operations management, human resource management, supplier management, and certain IT service management components were found to be below the average level of 3. Conclusion: Overall, the research indicates that the IT maturity level in hospitals in Tehran is largely favorable. Nevertheless, improvements are needed in specific areas, such as operations management and human resource management, to enhance the effectiveness and efficiency of IT operations.

Construction of knowledge sharing network indicator system for medication therapy management service training teams based on social network analysis

BackgroundBased on the perspective of social network theory, this study explored the network indicator system that facilitated optimal knowledge sharing effect in Medication Therapy Management Services (MTMS) training teams. The aim was to provide a reference for optimizing MTMS training and improving training quality.MethodsUtilizing social network analysis combined with a questionnaire survey, a knowledge sharing matrix for MTMS training teams was constructed. Knowledge sharing behavior was assessed from three perspectives: individual networks, whole networks, and cohesive subgroups.ResultsIndividual network analysis showed that the knowledge sharing effect within the training team reached its peak when the out-degree centrality was ≥ 3.5, in-degree centrality was ≥ 2.5, eigenvector centrality was ≥ 0.065, and closeness centrality was ≥ 7.86. Whole network analysis indicated that the optimal knowledge sharing effect occurred when the network density of the training team was higher than 0.0343 and the training size was less than 117 participants. Cohesion subgroups analysis demonstrated that knowledge sharing was more effective when members with similar working years participated in training together.ConclusionsThe knowledge sharing indicator system developed for MTMS training teams, based on social network analysis, can assist in optimizing the MTMS training model and improving training effectiveness.

Water as a commodity: challenges and implications of the commercialization of a vital resource

Water, soil, and air are the planet’s natural capitals that have made life viable, and without them, biodiversity will disappear. The drought we are experiencing due to global warming puts everyone on alert to mitigate the risks to these vital common goods. Water is a resource in crisis due to scarcity, misuse, poor distribution to the most vulnerable populations, contamination, and pollution, but it still attracts the private sector's greed. Water privatization, distribution, and basic sanitation services have been touted as a panacea to solve urban problems. Several cities have followed the path of privatization, embracing neoliberal ideologies or using it as a lever to pay off state debts without considering social aspects. Studies demonstrating the positive or negative impacts of privatization are still rare. The objective of this conceptual work was to analyze trends in water management service providers around the world. The methodology was based on works published in journals and online. There has been a trend towards privatization. However, many cities have chosen to go in the opposite direction by municipalizing their water supply and sanitation services.

8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes

Abstract Disclosure: D. Terry: Employee; Self; Valendo Health. Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM &amp; PCM), Continuous Glucose Monitoring (CGM &amp; RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.&amp;lt;1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors &amp; staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits. Presentation: 6/1/2024

Community breast pain clinics can provide safe, quality care for women presenting with breast pain.

Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data. 1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management. Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) 'extremely likely or likely' to recommend the service. The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.

Management of Rotator Cuff Tears in Severely Osteoporotic Patients

Management of rotator cuff tears (RCT) in osteoporotic patients presents significant challenges for treating clinicians because of compromised bone quality. We present a case series of 2 patients with RCT and severe osteoporosis highlighting the complexities of operative and nonoperative management and underscoring the importance of preoperative optimization and careful surgical planning in this vulnerable population. Patient 1 experienced initial improvement postarthroscopic RCT repair but required revision surgery because of anchor pullout, with eventual conversion to reverse total shoulder arthroplasty. Patient 2 faced intraoperative challenges because of previously undiagnosed osteoporosis, leading to difficulties in securely placing suture anchors, and was referred to the fracture liaison service (FLS) for osteoporosis management postoperatively. A multifaceted approach integrating preoperative optimization, advanced surgical techniques, and postoperative management is advised to improve operative success. Extensive perioperative bone quality assessments and augmentation strategies are warranted, including medication comanagement through an FLS if available. Detailed surgical planning is crucial, focusing on arthroscopic repair technique while considering various anchor factors to mitigate failure including proper placement, design, and pullout analysis. Intraoperative bone augmentation with materials such as calcium phosphate, magnesium phosphate, and polymethyl methacrylate cements significantly improves anchor fixation strength in osteoporotic bone. Consideration of a transosseous approach and potential for conversion to an open procedure is also an option when necessary. This review highlights the unique challenges and potential options available to treating clinicians when managing RCT in osteoporotic patients. Continued research and refinement of emerging treatment strategies are essential to improve outcomes and quality of life in this patient population.

Optimalisasi Penjualan dan Pengelolaan Keuangan UMKM Pedagang Melalui Pengenalan Fintech dan Pemanfaatan Facebook Market Place

This service aims to assist Micro, Small and Medium Enterprises (MSME) traders in increasing sales and managing their finances through the introduction of financial technology (fintech) and the utilization of the Facebook Marketplace e-commerce platform. This service was carried out in response to the challenges faced by MSMEs in the digital era, especially in the aspects of increasing sales and efficiency of financial management. This service activity involves direct training and assistance to MSME players in Wanayasa District, Banjarnegara Regency. The stages of training activities include 1) survey 2) training and mentoring 3) results and evaluation. This training activity is an introduction to the basics of fintech, how to access and utilize fintech services for financial management, as well as marketing and sales strategies through Facebook Marketplace. The results of this activity show an increase in the ability of MSME traders to use fintech to better manage their finances, including in terms of transaction recording, cash flow management, and access to digital financial services. In addition, the merchants also succeeded in increasing the visibility and sales of their products through Facebook Marketplace.Thus, the introduction of fintech and the utilization of Facebook Marketplace are proven to support the optimization of sales and financial management of MSMEs.