Successful Management Research Articles

A multi-framework analysis of stakeholders' perceptions in developing a localized blue carbon ecosystems strategy in Eastern Samar, Philippines.

Blue carbon ecosystems (BCEs) are vital for global climate change mitigation and offer diverse local ecosystem co-benefits. Despite existing literatures on integrating national and international BCE agendas at the local level, the development and implementation of localized BCE strategies often lag behind. To provide insights on this knowledge gap, we present a case study conducted in Eastern Samar, Philippines. Employing a multi-framework analysis- encompassing DPSIR (drivers, pressures, state, impact, responses), SOAR (strengths, opportunities, aspirations, results), and PESTLE (political, economic, social, technological, legal, environmental) frameworks, stakeholder perceptions collected from focus group discussions highlight issues and challenges in developing and implementing a BCE strategy. Findings reveal that the aftermath of Typhoon Haiyan in 2013 in the study sites stimulated conservation efforts and raised awareness, but governance structures and policy enforcement influence the success and longevity of management and conservation efforts. Through the integration of multiple frameworks, this study outlined a potential localized BCE strategy, emphasizing both internal priorities such as stakeholder engagement and alternative livelihoods and external priorities related to policy and technological supports. While developed based on a specific case study in the Philippines, the proposed strategy is presented in a general manner, enabling its potential replication in other provinces in the Philippines or in countries with similar geographic settings.

EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE AMONG EARLY-INDUSTRIALIZED REGIONS OF THE WORLD: CHALLENGES IN SUSTAINABLE HEALTHCARE DELIVERY

Abstract BACKGROUND Early-industrialized regions (e.g., North America, Europe, Oceania) are currently in stage 3 of the epidemiologic evolution of inflammatory bowel disease (IBD), compounding prevalence wherein incidence stabilizes, but prevalence rises rapidly. This epidemiologic stage predicts the trajectory of healthcare infrastructure needs over the coming decades. AIMS 1. Describe current epidemiologic trends in representative stage 3 regions; 2. discuss ways to provide accessible, equitable, and quality IBD care in a sustainable manner; and 3. strategize future steps to prevent disease. METHODS The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) hosted IBD epidemiologists from representative stage 3 regions: Catalonia, Canada, Denmark, Hungary, Israel, New Zealand, Scotland, and the United States and address the rising burden of IBD. Epidemiologic data were reviewed in context using methodological differences between case ascertainment in each region to help explain heterogeneity (Table 1). Attendees engaged in a round-table consensus meeting, voting on priority needs to sustain IBD healthcare delivery given the trajectory of epidemiologic data. Four groups were formed with attendees of various backgrounds to encompass many perspectives, including epidemiologists, clinicians, IBD nurse practitioners, and patient advocates. RESULTS Table 1 describes IBD incidence and prevalence at the most recent year of historical data for each region. Canadian and Scottish studies included the forecasting of future prevalence estimates, a method that allows for proactive decision-making to accommodate the increasing number of individuals living with IBD. In 2028, the forecasted prevalence of IBD in Lothian, Scotland, was 1,023 per 100,000; and in 2030, the forecasted prevalence of IBD in Canada was 981 per 100,000. Table 2 describes the topics brought up in response to the aims, and the level of priority. Limited resources for a growing IBD population are a major cause for concern, negatively impacting access to and quality of care. To optimize quality of care, a multidisciplinary team approach is necessary. Suggestions for support in managing mild IBD cases include virtual care and remote monitoring, nurse-driven clinics, and cooperation with primary care physicians; this would help free-up in-person appointments with specialists for moderate-to-severe cases. Interventions that prevent IBD through modifying environmental and behavioral determinates, will have the largest impact on decelerating prevalence rates over time. DISCUSSION Forefront at the meeting was the fact of the continuing rise of IBD prevalence, augmenting the challenges faced by healthcare systems and practitioners. There are plausible and actionable solutions to achieve successful management of IBD upon initiating changes in healthcare policy.

Multicentric Study on the Clinical Mycology Capacity and Access to Antifungal Treatment in Portugal

The success of the clinical management of invasive fungal diseases (IFD) is highly dependent on suitable tools for timely and accurate diagnosis for effective treatment. An in-depth analysis of the ability of European institutions to promptly and accurately diagnose IFD was previously conducted to identify limitations and aspects to improve. Here, we evaluated and discussed the specific case of Portugal, for which, to our knowledge, there are no reports describing the national mycological diagnostic capacity and access to antifungal treatment. Data from 16 Portuguese medical institutions were collected via an online electronic case report form covering different parameters, including institution profile, self-perceived IFD incidence, target patients, diagnostic methods and reagents, and available antifungals. The majority of participating institutions (69%) reported a low-very low incidence of IFD, with Candida spp. indicated as the most relevant fungal pathogen, followed by Aspergillus spp. and Cryptococcus spp. All institutions had access to culture and microscopy, whereas 94 and 88% were able to run antigen-detection assays and molecular tests, respectively. All of the institutions capable of providing antifungal therapy declared to have access to at least one antifungal. However, echinocandins were only available at 85% of the sites. Therapeutic drug monitoring (TDM) was reported to remain a very restricted practice in Portugal, being available in 19% of the institutions, with the TDM of itraconazole and posaconazole performed in only 6% of them. Importantly, several of these resources are outsourced to external entities. Except for TDM, Portugal appears to be well-prepared concerning the overall capacity to diagnose and treat IFD. Future efforts should focus on promoting the widespread availability of TDM and improved access to multiple classes of antifungals, to further improve patient outcomes.

Secondary vasculitides

Vasculitides that occur in association with underlying primary diseases are called secondary vasculitides. In the diverse differential diagnostics of vasculitides, alarge variety of secondary vasculitides have to be considered. Secondary vasculitides cover the full spectrum of vasculitides, presenting in manifold clinical manifestations. This article provides an overview of systemic diseases and etiological factors, such as infections, drugs, and malignancies, which can be associated with vasculitides. The possible associations with infectious agents are too numerous to be comprehensively covered and are discussed in an exemplary fashion and with awestern European focus. Especially in atypical and refractory disease courses, asecondary vasculitis should be considered. In light of the diversity of differential diagnoses and the particular challenges posed by secondary vasculitides, interdisciplinary collaboration is the key for an accurate and early diagnosis as well as for successful treatment management. Treatment of the primary disease should always be prioritized and, if adrug-induced vasculitis is suspected, immediate cessation of the culprit drug is mandatory.

Successful Surgical Management of a Perforated Duodenal Ulcer Within an Incarcerated Paraesophageal Hernia

Successful Surgical Management of a Perforated Duodenal Ulcer Within an Incarcerated Paraesophageal Hernia

Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study.

Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS. A 46-item survey was developed and distributed to deglutologists internationally examining: (1) Demographics; (2) Scale Practices; (3) Swallowing Safety Priorities; (4) Scale Perceptions; and (5) Accuracy. The first four sections consisted of questionnaires. In the optional fifth section, respondents were asked to score five videos of swallows collected via videofluoroscopy and previously PAS-scored by two trained raters. In total, 335 responses were analyzed. The majority of respondents self-reported PAS training (84%); 90% of untrained respondents were receptive to training. Respondents reported using the PAS "always" (40%) or "frequently" (29%), and that the PAS carries "a great deal of" weight in assessment (40%). Reported application of the PAS was heterogeneous, with the most common approach being "single worst score per unique presentation" (45%). Most respondents (64%) prioritized a parameter not captured by the PAS. Untrained respondents were significantly more confident with PAS ratings than trained respondents (X2 = 7.47; p = 0.006). Of 1460 PAS ratings provided, 364 of them were accurate (25%) when compared to ratings by trained lab members. Results of this survey reflect ubiquitous use of the PAS, unmet needs for assessment of swallowing safety, low accuracy despite generally high confidence, and heterogenous training that does not correspond to confidence. This emphasizes the need for additional training in clinical application of the PAS as well as development of novel metrics to optimize assessments of swallowing safety.

P787 Use of upadacitinib to treat IBD in post-liver transplant

Abstract Background Approximately 2% of patients with inflammatory bowel disease (IBD) have concurrent primary sclerosing cholangitis (PSC). Liver transplantation (LT) is sometimes required due to progressive PSC. However, the management of active IBD post-LT is challenged due to concomitant anti-rejection immunotherapies. Janus kinase inhibition has been previously described to have anti-rejection properties in patients who have had renal transplants. Here, we describe our experience with upadacitinib (UPA), a selective Janus kinase-1 inhibitor, for post-LT active IBD combined with anti-rejection immunosuppression therapy. Methods This is a retrospective, single-center observational study in a tertiary IBD center. We identified patients with LT treated with UPA for their IBD. Patient related outcomes including transplanted liver status and clinical efficacy and safety of UPA for IBD activity were reviewed. Results We identified four patients (3 with Crohn’s disease, 1 with ulcerative colitis) treated with UPA after LT due to PSC, with the UPA indication for the treatment of IBD (n=3) and organ rejection (n=1). Median follow-up was 3 months (interquartile range (IQR) 1.5-7.1), median age at starting UPA was 41.5 years (IQR 40-44), and median interval from the transplant was 3.2 years (IQR 2.3-5.6). Two patients with Crohn’s disease clinically responded to UPA, one weaned off prednisone 30mg/day and remained in clinical remission after reducing UPA from 30 mg/day to 15 mg/day. Two patients developed elevated AST/ALT of up to 107/57 U/L and 83/228 U/L; one required discontinuation of UPA at one month with subsequent AST/ALT normalization; the other remained on UPA with 1.5 month follow-up so far. One UC patient was treated with UPA combined with vedolizumab in an attempt to discontinue prednisone for their immunosuppression for organ rejection, however, they were unable to wean off prednisone due to recurrent ALT and Alk Phos elevations. One patient acquired a mild case of COVID-19 which resolved without change in therapy. No life-threatening adverse events were observed. Conclusion We describe 4 patients with IBD who had LT for PSC and who were treated with UPA with successful management of active IBD in 2 cases but lack of efficacy in one case and liver enzyme elevations limiting UPA use in a second. These findings support further exploration of this novel mechanism for treatment of IBD in the post-LT setting.

In vitro and in vivo evaluation of fungicides against anthracnose disease on pomegranate (Punica granatum L.) caused by Colletotrichum gloeosporioides

Successful cultivation of pomegranate in India has faced many challenges, with diseases and pests being the major constraints. Many pathogens affect pomegranate leaves and fruits, and anthracnose, which can cause significant damage to the pomegranate crop. The spraying of fungicides with varying modes of action is a successful disease management approach. Hence, the present work was aimed to characterize the pathogen and evaluate the different fungicides for the effective control of the disease under field conditions. The pathogen was identified as Colletotrichum gloeosporioides through morphological features and sequencing of ITS 1 and ITS 4 regions. Fifteen fungicides were then tested in vitro against C. gloeosporioides using the poison food technique at various concentrations. Out of the five contact fungicides evaluated, copper oxychloride was found to be the most effective against C. gloeosporioides. On the other hand, all three concentrations of pyraclostrobin, thiophanate methyl, tebuconazole, hexaconazole, and propiconazole showed 100 % inhibition. Among the five combination products tested, propiconazole + difenconazole, tebuconazole + trifloxystrobin, and pyraclostrobin + epoxiconazole showed 100 % inhibition. After the in vitro results, the field evaluation was further studied to find the most effective fungicides. The trifloxystrobin + tebuconazole fungicide was found to have a percent disease index of 4.50, which was significantly lower than all other treatments. The plots treated with this fungicide produced the highest yield of 10.92 t/ha, followed by Pyraclostrobin + Epoxiconazole at 9.89 t/ha. The control plot had the lowest yield, producing only 3.02 t/ha. Based on field evaluations, Tebuconazole + Trifloxystrobin is recommended as a preventative measure against anthracnose disease in pomegranates.

The location analysis and efficient control of hidden coal spontaneous combustion disaster in coal mine goaf: A case study

Coal spontaneous combustion significantly threatens the mine production safety. This paper focuses on the practical aspects of the disaster within the sealed goaf of Pingmei No. 11 mine. Obtained the characteristic parameters of spontaneous combustion in goaf by arranging high-level drilling field and drilling method. The grey correlation analysis method was applied to analyze the determination index of the effective characterization of the hidden spontaneous combustion area range, and interpolation aided in assessing these indicators before and after the increase amount of N2 injection. All showed that the hidden spontaneous combustion area was determined to be 70–80 m away from the return air side and 10–15 m away from the stop line, and the comprehensive treatment technologies are executed to control the spontaneous combustion hazards, including injecting inert gas to cool the high-temperature area, injecting the aqueous foam to cover the fire source, and plugging leakage to isolation the O2. Finally, the O2 concentration in goaf dropped below 5.0%, and carbon monoxide concentration fell below 0.001% after implementing these methods, effectively controlling the coal spontaneous combustion disaster. The successful management of concealed coal spontaneous combustion disasters offers a valuable reference for identifying and efficiently addressing such incidents in goaf areas.

Cost Control during the Bidding Stage of Construction Projects

Effective cost control during the bidding stage of construction projects is crucial for the success of project management. The process starts from a thorough pre bidding stage, including feasibility studies, risk assessments, and realistic budget formulation. In the bidding process, setting clear standards, evaluating suppliers, and evaluating based on various factors such as cost, technical qualifications, and past performance are key steps. Through comprehensive measures, it can be ensured to minimize risks and improve project efficiency to the greatest extent possible.

A high‐resolution inter‐annual framework for exploring hydrological drivers of large wood dynamics

AbstractRivers with alluvial bars store more wood than those without, supplied through channel shifting. However, wood dynamics (arrival or new deposits, departure or entrainment, and stable or immobile pieces) can vary substantially over time in response to critical hydrological drivers that are largely unknown. To evaluate them, we studied the dynamics of large wood pieces and logjams along a 12‐km reach of the lower Allier River using six series of aerial images of variable resolution acquired between 2009 and 2020, during which maximum river discharge fluctuated around the dominant flood discharge (Q1.5) that is potentially the bankfull discharge along this well‐preserved not incised reach. Individual wood departure was best correlated with water levels exceeding dominant flood discharge. The duration of the highest magnitude flood was best correlated with wood depositions, with shorter floods resulting in a higher number of deposits. Finally, most of the wood remained stable when river discharge did not exceed 60% of Q1.5 over a long period of time. Changes in inter‐annual wood budget (reach‐scale) depend on the duration over which discharge exceeded 60% of Q1.5. Hydrological conditions driving jam build‐up and removal were similar to those controlling individual wood piece dynamics. The results suggest that specific hydrological conditions influence the dynamics of large wood and log jams in the Allier River. Understanding the dynamics of large wood and its impact on river morphology is fundamental for successful river management and habitat restoration initiatives.

Technical and allocative efficiency of crop production using different storage and water‐lifting technologies in Central Rift Valley, Ethiopia

AbstractAssessing the efficiency gains, in terms of crop production and productivity, of using agricultural water management is critical to understanding the comparative advantage of using different storage and water‐lifting technologies in irrigation development. This study aims to compare the efficiency differences among irrigation farmers using various water‐lifting technologies and among users of various technology suites in the Central Rift Valley, Ethiopia. Cross‐sectional data collected from 320 randomly selected smallholder farmers, considering the 2019/2020 production season, were used to analyse a one‐step Cobb–Douglas stochastic frontier function. The results of the study revealed the existence of technical and allocative efficiency differences between gravity and fuel pump users. Factors that positively determine the level of technical efficiency scores are gender, age, education status, technology type and extension contact. Irrigation experience, access to credit, training and technology type positively affected allocative efficiency, while the distance to the irrigation water source had a negative effect. The findings have important implications for agricultural policy and practice as improving efficiency through the adoption of fuel‐powered water‐lifting technology could further improve overall agricultural productivity. Designing small‐scale friendly business models and promoting irrigation extension services, among others, is critical for scaling successful water management technologies.

Depressive Disorder in The Elderly with Comorbidity in Prima Medika Clinic, Semarang

Background: Diabetes Mellitus and hypertension patients have higher risks of experiencing mental disorders such as depression and or anxiety. Objective: assess the frequency and severity of depression as well as identify the risk factors of patients with chronic disease and also other factors influencing depression in PROLANIS patients in Prima Medika Primary Clinic, Semarang Indonesia. Method: A cross-sectional study, targeting PROLANIS patients registered at Prima Medika Primary Clinic in Semarang, Indonesia. Participants were selected through purposive sampling, during a period from February to May 2021. Participants targeted were DM, Hypertension, or a combination of hypertension and diabetic type 2 patients. The Indonesia Ministry of Health Clinical Criteria was used for the Metabolic Syndrome assessment. Result: Among 68 respondents, 15 (22.05%) respondents suffered from mild depression and 6 (8.82%) respondents suffered from major depression. Mostly, their education level is High School (55.9%), are married (73.5%), have fixed income (55.8%), and are non-smokers. The number of participants suffering from hypertension is larger than those who suffer from DM and DM + Hypertension. Correlation test results find a relationship between disease diagnosis and the case of depression in PROLANIS participants (p-value 0.05). Conclusion : Depression, DM, and hypertension are diseases in which the number of cases keeps increasing. Early detection of depression needs to be improved to promote the successful management of diabetes and hypertension.

Modernising vestibular assessment.

There is a high prevalence of dizziness, vertigo and balance symptoms in the general population. Symptoms can be generated by many inner-ear vestibular disorders and there are several diagnostic tests available that can help identify the site of the vestibular lesion. There is little consensus on what diagnostic tests are appropriate, with diagnostics either not completed or minimally performed, leading to missed diagnosis, unsatisfactory results for patients and costs to healthcare systems. This study explored the literature for different neuro-vestibular diagnostic tests not currently considered in the traditional standard vestibular test battery, and examined how they fit effectively into a patient care pathway to help quickly and succinctly identify vestibular function. A vestibular patient care pathway is presented for acute and subacute presentation of vestibular disorders. An accurate diagnosis following a rigorous anamnesis and vestibular testing is paramount for successful management and favourable outcomes.

Management of mixed urinary incontinence: IUGA committee opinion

Introduction and hypothesisMixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI.MethodsA working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion.ResultsThe R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations.ConclusionsMixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

Enhancing project manager communication soft skills and risk management practices in Libyan oil and gas construction projects: the role of experience

Purpose Although there has been an increase in the application of a variety of robust technologies and systems, the oil and gas sector relies on project managers’ soft skills for success because of their vital role. Therefore, this study aims to explore the profound influence of project managers’ soft communication skills on successful risk management within Libya’s oil and gas projects. Design/methodology/approach A review of relevant literature and a quantitative approach through the administration of a questionnaire were used to determine factors impacting risk management implementation related to managerial communication skills. A total of 246 valid responses were received from the oil and gas companies in Tripoli, Libya. Partial least squares structural equation modelling was used to examine the direct and moderating relationship drawn by the hypotheses. Findings The findings suggest that managerial soft skills may be used to improve continuous risk management processes and intra-project communication. It was found that the experience is strengthening the positive relationship between written communication soft skills and project risk management implementation among Libyan oil and gas construction projects. Originality/value This study defines project managers’ soft communication skills and analyzes project managers’ soft communication skills with the role of experience as a moderator. This paper presents a valuable contribution by offering original insights tailored explicitly to the Libyan context. The information presented in this paper is relevant to project managers operating within the oil and gas industry. It also offers a novel approach to risk management in the Libyan oil and gas industry that can improve project efficiency and effectiveness.

Application of a Mechanistic Model to Explore Management Strategies for Biological Control of an Agricultural Pest

Despite the known benefits of integrated pest management, adoption in Australian broadacre crops has been slow, in part due to the lack of understanding about how pests and natural enemies interact. We use a previously developed process-based model to predict seasonal patterns in the population dynamics of a canola pest, the green peach aphid (Myzus persicae), and an associated common primary parasitic wasp (Diaeretiella rapae), found in this cropping landscape. The model predicted aphid population outbreaks in autumn and spring. Diaeretiella rapae was able to suppress these outbreaks, but only in scenarios with a sufficiently high number of female wasps in the field (a simulated aphid:wasp density ratio of at least 5:1 was required). Model simulations of aphid-specific foliar pesticide applications facilitated biological control. However, a broad-spectrum pesticide negated the control provided by D. rapae, in one case leading to a predicted 15% increase in aphid densities compared to simulations in which no pesticide was applied. Biological and chemical control could therefore be used in combination for the successful management of the aphid while conserving the wasp. This modelling framework provides a versatile tool for further exploring how chemical applications can impact pests and candidate species for biological control.

High-Grade Infection after Branched Endovascular Aortic Repair in Patient with Recent COVID-19 Hospitalization.

In the context of the COVID-19 pandemic, the global healthcare landscape has undergone significant transformations, particularly impacting the management of complex medical conditions such as aortic aneurysms. This study focuses on a 76-year-old female patient with a history of extensive cardiovascular surgeries, including aortic valve replacement, Bentall operation, and Frozen Elephant Trunk procedure, who presented with a type II thoracoabdominal aortic aneurysm post-COVID-19 recovery. A comprehensive frailty assessment using the Modified Frailty Index and a two-phase endovascular approach for aneurysm treatment, considering the patient's frailty and complex medical history was performed. Upon successful aneurysm management, the patient's postoperative course was complicated by COVID-19 reinfection and Enterococcus faecalis superinfection, highlighting the increased risk of bacterial superinfections and the challenges posed by antimicrobial resistance in COVID-19 patients. The study underscores the necessity of vigilant postoperative surveillance and a multidisciplinary approach in managing such complex cases, highlighting the importance of personalized care strategies, integrating cardiovascular and infectious disease management, and adapting healthcare practices to the unique challenges of the pandemic. This case contributes to the evolution of knowledge on managing aortic aneurysms in the COVID-19 era, advocating for patient-centric treatment approaches and continuous research into long-term patient outcomes.

Structured case conference for sleep disturbances in nursing home residents with cognitive impairment

Structured case conference for sleep disturbances in nursing home residents with cognitive impairment Abstract: Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: "offering appropriate activations during daytime", "creating bedtime routines", "checking the sleep environment", "observation of potential physical and psychological causes", "reflection on night care routines", and "use of drug therapies only in exceptional cases". Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.