Team Members Research Articles

National assessment of clinicians participating in stroke treatment decisions at strokenet regional coordinating centers: Clinicians Making Stroke Treatment Decisions

ObjectivesSince the introduction of thrombolytics, stroke teams evolved to improve thrombolytic care delivery. The impact of the advent of endovascular therapy on the composition of acute stroke teams is unknown. Materials and MethodsA two-part pilot-tested survey was deployed to site-Principal Investigators (PIs) of the 27 StrokeNet Regional Coordinating Centers (RCCs) regarding institutional acute stroke teams. Part A inquired about the participation of personnel in each type of stroke response. Part B identified stroke team physicians and the types of responses in which they participate to assess training background of stroke team members. ResultsResponse rates for Part A and B were 66% and 48%, respectively. In Part A, 67% (12/18) of sites reported trainees always responded to ED stroke activations with significant autonomy. 44% (7/16) and 27% (4/15) of sites reported NP and PA response to ED stroke alerts, respectively, but with limited autonomy. In Part B, 124 physicians involved in ED stroke alerts were identified, the large majority of whom (79%, 95% CI: 71-85) were vascular neurology trained. The 39 (23%) stroke team members involved in endovascular therapy had the following training: 49% (34-64) neurosurgery, 28% (17-44) radiology, 18% (9-33) vascular neurology 5% (1-16) neurology. ConclusionsWe identified modest heterogeneity in the composition of acute stroke team members across StrokeNet RCCs. Individuals performing endovascular therapy had a variety of clinical specializations, reflecting the evolving multidisciplinary nature of interventional acute stroke care. At StrokeNet RCCs, teams have significant trainee involvement in both ED and inpatient acute stroke responses.

A multisite initiative to assess the immunization status of medical oncology patients.

289 Background: The Swedish Cancer Institute (SCI) is committed to holistic care and recognizes immunizations are an essential component to quality outcomes. In 2022 the SCI was selected to participate in the Specialty Societies Advancing Adult Immunization (SSAAI) project supported by the Centers for Disease Control and Prevention (CDC) with a goal of incorporating the CDC Standards for Adult Immunization Practice into medical oncology clinical care. The CDC Standards for Adult Immunization Practice are assess, recommend, administer or refer, and document. Recognizing immunization status is not routinely assessed, this quality initiative aimed to increase assessment of immunization status in medical oncology across 7 network clinics on 4 campuses to above 50 % by the end of 2023. Methods: All team members completed the ASCO Quality Training Program. The Plan Do Study Act (PDSA) framework was selected. Assessment was defined as having completed the Immunization Activity Record within the Epic Medical Record system, which includes reconciliation with the Washington state immunization registry. Data was initially abstracted manually to determine the baseline assessment rate until an automated method was developed. A Fishbone diagram determined the top barrier was the lack of awareness about this functionality and lack of training around the task. A workflow diagram and standard operating procedure were implemented. Clinic staff were trained on the new workflow when rooming patients. A small pilot with one clinic of solid tumor medical oncology clinics was completed. Patients included were on active treatment and seen face to face within the clinic. The standardized process and tools were refined, and problem areas addressed. The work was then expanded to all seven of the SCI network medical oncology clinics including hematology as the final PDSA cycle using the same training, process and tools. Results: The Epic Immunization Activity Record completion rate went from less than 1% of solid tumor patients with an active systemic treatment plan to 61% in the pilot project. After two additional PDSA cycles to refine the steps and target problem areas, the rate improved to 67% over a 3-month period. The PDSA cycle was expanded to bring the refined process to all 7 network clinics with a baseline assessment rate of 6% which increased to 45% after interventions within a 3-month period and concluding the 2023 year. Conclusions: Developing tools and implementing a new workflow for immunization assessment yielded a significant improvement in assessment rates thereby setting a foundation of assessment utilizing the CDC Standards for Immunization Practice. The use of concrete written tools improves the sustainability of the changes. Additional tools and refinement of existing tools will be studied to improve the current rate and sustain the gains. Reference: Standards for Adult Immunization Practices | CDC .

Engaging Multi-Disciplinary Teams to Develop Pragmatic Clinical Practice Guidelines to Support Management of Patients with High-Risk Breast Lesions

IntroductionWe sought to develop clinical guidelines within our multidisciplinary Breast Center to support decision-making for managing high-risk breast lesions. The objective is to describe the process used to develop these guidelines and assess perceived acceptability. MethodsWe recruited clinical stakeholders to identify key “high-risk” topics. Stakeholder groups (surgery, radiology, pathology) met separately to review the topics, leveraging existing literature reviews and best available evidence. Guidelines were initially developed in 2015 and updated in 2019. We surveyed breast clinical team members in 2023 regarding the perceived acceptability of the guidelines and summarized the data. ResultsWe created clinical guidelines to address the management of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia/lobular carcinoma in situ, radial scar/complex sclerosing lesion, and papillomas. Key guideline components included process for radiologic-pathologic correlation, patient disposition after biopsy (surgical referral needed, follow-up imaging recommended), recommendation for the role of surgical excision, and recommendation regarding imaging follow-up if excision not performed. Forty clinical team members (66% [40/60] response rate) completed the acceptability survey from varied disciplines. Most (78%) were aware of the guidelines. Respondents rated the recommendations for disposition after biopsy, surgical management, and follow-up imaging as the most helpful components. Most (>80%) rated them to be very/extremely useful. ConclusionWe leveraged input from key stakeholders to develop clinical guidelines to support the multi-disciplinary management of patients with high-risk breast lesions. Our guidelines have been successfully implemented across our academic and community practice. Future steps will assess the impact of implementation on clinical outcomes. Micro abstractWe leveraged input from key stakeholders to develop clinical guidelines to support the multi-disciplinary management of patients with high-risk breast lesions. Key guideline components included process for radiologic-pathologic correlation, patient disposition after biopsy, and recommendation for surgery. Our guidelines were acceptable to stakeholders. Future steps will assess the impact of implementation on clinical outcomes.

Identifying and mitigating racial/ethnic disparities in clinical trials with screening data.

63 Background: ASCO and Association of Community Cancer Centers (ACCC) released a statement on increasing racial/ethnic equity, diversity, and inclusion (EDI) in cancer trials (1). It included recommendations for clinical practices and research sites to 1) screen every patient for trial eligibility; and 2) routinely collect and analyze screening and enrollment data by patient demographic characteristics, including race/ethnicity. Most of the 62 sites that completed a 2021 pilot study reported that screening data were not readily available by patient race/ethnicity (2). ASCO conducted a follow-up study about challenges, resource needs, and effective strategies for collecting and analyzing these data. Methods: Semi-structured interviews were conducted with research team members from sites that completed the 2021 pilot study. Sites were purposefully selected based on pilot study data quality and insights, diversity of patient population, and site type, size, and region. Sites completed a pre-interview questionnaire on site characteristics and screening and enrollment processes before participating in a 1-hour interview focused on challenges and effective strategies for collecting and analyzing screening and enrollment data, by race/ethnicity. Anticipated themes and relationships, stemming from the pilot study findings, informed a conceptual framework. Up to 20 interviews were planned and halted sooner when there was theme saturation. Results: Thirteen research sites participated in the study, representing academic centers (62%) and community-based practices/health systems (38%) with racially/ethnically diverse patient populations (median 31% non-white; range 11% to 63%). 53 research team members participated in the interviews (typically 4 per site), including investigators (23%), directors/managers (56%), and coordinators (21%). Aggregated responses were interpreted through content analysis and concepts were quantified for both frequency and extensiveness. Several barriers to patient screening, data collection, and analysis were cited, including lack of standardized procedures and documentation, dedicated staff and time, quality and/or accessible data on race/ethnicity and/or screening, and integrated technology that facilitates screening and documentation. Conclusions: Collecting and analyzing screening and enrollment data are critical to identifying and mitigating racial/ethnic disparities in trial access and EDI. Many sites do not systematically screen every patient for a trial and/or document outcomes. Lack of resources, including dedicated staff and time and integrated technology, make it difficult for them to do so in systematic and reliable ways. Greater investment in resources will help to facilitate routine screening of every patient and ensure underrepresented populations are not being overlooked for trials. 1. Oyer et al, JCO, 2022 . 2. Pressman et al, JCO, 2022 .

Delivery Room Management of Infants with Surgical Conditions.

Delivery room resuscitation of infants with surgical conditions can be complex and depends on an experienced and cohesive multidisciplinary team whose performance is more important than that of any individual team member. Existing resuscitation algorithms were not developed for infants with congenital anomalies, and delivery room resuscitation is largely dictated by expert opinion extrapolating physiologic expectations from infants without anomalies. As prenatal diagnosis rates improve, there is an increased ability to plan for the unique delivery room needs of infants with surgical conditions. In this review, we share expert opinion, including our center's delivery room management for neonatal noncardiac surgical conditions, and highlight knowledge gaps and the need for further studies and evidence-based practice to be incorporated into the delivery room care of infants with surgical conditions. Future research in this area is essential to move from an expert-based approach to a data-driven approach to improve and individualize delivery room resuscitation of infants with surgical conditions.

Clinician engagement strategies to increase palliative care access in a multi-site community oncology practice.

196 Background: Despite nearly 20 years since PC was recognized as a medical subspecialty, and ACS, ASCO and NCCN’s recommendations for early involvement, many oncologists continue to categorize PC synonymously with hospice and therefore refer to palliative medicine specialists very late in the disease trajectory, if at all. Each year, more oncology and PC researchers study and report the life changing impact of early PC for patients living with stage III and IV “advanced cancer” (AC). While mandating PC would have its challenges, creating workflows to encourage providers to change their behavior and attitude regarding PC, while empowering other clinical team members to directly refer, should result in patients and families receiving earlier PC services. Methods: The study included a pre-intervention period (9/1/2023 - 12/31/2023), and an intervention period (1/1/2024 - 4/30/2024). Pre-intervention referral data was collected from OncoEMR, OneAnalytics and Social Work reports. PC referrals were requested for both oncology and hematology patients, regardless of diagnosis date or stage. During the intervention period, 6 strategies were designed to increase PC referrals and were deployed equally in all 8 oncology/hematology offices. Strategies included 1) weekly MD/APP huddles with one of the goals to discuss the palliative care needs of all patients, 2) self-directed referrals from nursing, 3) self-directed referrals from social work, 4) APP referrals for advance care planning, 5) proactive chart reviews by PC APNs and direct PC referral suggestions to MD/APPs for AC patients, and 6) hardwiring timely scheduling of PC referrals. The primary end point is the percent of unique cancer (UC) patients who had a PC referral; the secondary end point is the percent of referred AC patients with early PC referral as defined by referral within 8 weeks of diagnosis. Results: During the pre-intervention period, of the 8,551 UC patients, 154 (1.8%) received PC referrals as compared to 227 (2.8%) of the 8,055 UC patients during the intervention period, yielding a 56% increase in the intervention period. In the pre-intervention period, 24 (14%) of the 177 newly diagnosed AC patients received early PC referrals compared to 32 (21%) of the 153 newly diagnosed AC patients in the intervention period, giving rise to a 50% increase. Conclusions: Strategies to increase PC referrals in a community oncology practice increased overall referrals as well as earlier referrals in newly diagnosed AC patients. As the interventions mature, the total number of PC referrals and a shift toward earlier referrals will likely be seen. Future goals will include assessing patient and family comfort with their treatment plan with PC versus without PC, as well as assessing providers' perceived value of PC over time. With attitude and behavior change, practice culture change is anticipated amid PC becoming the standard of care for all AC patients.

SoccHealth: a health status examination of former professional football (soccer) players within the German National Cohort

The long-term health effects of football (soccer) have received significant attention in recent years. While brain health is currently the focus of this interest, potential long-term risks or benefits related...

Effectiveness of the Huddles in Improving the Patient Safety Attitudes Among Clinical Team Members.

Huddles among members of interdisciplinary medical teams involve short stand-up sessions and allow team members to focus on existing or emerging patient safety issues, thereby facilitating team communication. Hospital managers are able to recognize the current situation of the organization through patient safety attitudes, strengthen team members' awareness of patient safety, and improve the quality of health care. The purpose of this study was to determine the effects of huddles on improving team members' attitudes toward patient safety. We used a quasi-experimental design and selected 2 adult wards with similar properties as the experimental and comparison groups by convenience sampling. Data collection was from December 1, 2021, to June 30, 2022, at a teaching hospital in central Taiwan. Team members of the ward performing huddles formed the experimental group, and they participated 2 times per week in 15-minute huddles from 8:15 to 8:30 am for a total of 4 weeks. The comparison group adopted the routine team care process. Both groups completed the Safety Attitudes Questionnaire during the pre- and post-tests of the study. The experimental group scored significantly higher in the post-test than in the pre-test in all aspects of safety attitudes, with the exception of stress recognition. These improved aspects were teamwork climate (76.47 ± 15.90 vs 83.29 ± 13.52, P < .001), safety climate (75.94 ± 16.14 vs 82.81 ± 13.74, P < .001), job satisfaction (74.34 ± 20.22 vs 84.40 ± 17.22, P <.001), perceptions of management (78.02 ± 19.99 vs 85.51 ± 15.97, P < .001), and working conditions (78.85 ± 17.87 vs 86.81 ± 14.74, P < .001). Through the huddles, clinical team members improved their understanding of different aspects of safety attitudes. Such a study provided ward units with real-time improvement and adjustment in terms of patient safety during their medical work processes with better patient safety.

Examining the role of virtual teams on project management processes in the Nigerian fintech sector

This study examined the role of virtual teams on project management processes in the Nigerian fintech industry. To achieve this aim, the study sought to examine how communication technology utilisation, trust, and geographical distribution of team members affected the project management processes of virtual team members in the Nigerian fintech industry. Building upon the theoretical frameworks of social presence theory and transaction cost theory, the study adopted a quantitative approach and used a sample of 385 employees of fintech firms in Nigeria. Using an electronic close-ended questionnaire (Google forms), data were collected from 378 participants, indicating a response rate of 98.2%. Purposive sampling technique was used to select the study’s participants. Data were analysed using both descriptive (frequencies and percentages) and inferential statistics (multiple linear regression) via the aid of STATA 17. Findings from the study revealed that communication technology utilization (β = 0.3114694, p &lt; 0.05) and geographical distribution of team members (β =0.7622249, p &lt; 0.05) both had statistically significant effects on project management processes. Trust was found to have an insignificant effect on project management processes (β = -0.0085031, p &gt; 0.798). The study concluded that virtual teams significantly and positively affects project management processes in the Nigerian fintech industry, and recommends that firms in the industry should continue with the use of virtual teams in their given projects. Also, the study recommends that policies regarding work in the virtual environment should be formalised so as to maximise the benefits associated with virtual work.

Ultrasound Evaluation of the Optic Nerve Sheath as a Predictor of Severity and Complications

Objectives: Ultrasonography has the potential advantage of being a repeatable tool, safe at the bedside and low cost, without risks of radiation and side effects. Emerging as a tool with potential to promote the optimization of the prognosis of neurosurgical patients. Methods: 31 participants diagnosed with expansive brain injury were selected, all over 18 years of age, after signing the free consent form and clarification, the postoperative evaluation was carried out at the time of hospital discharge and 3 months after surgery on an outpatient basis. The ultrasound evaluation of the optic nerve sheaths was performed by a team member, who was blind to the clinical and radiological information and using the same GE VERSANA ACTIVE ultrasound device. Results: During the preoperative analysis of 31 patients, 41.9% were male (n=13) and 58.06% female (n=16), with a mean age of 50.64 +- 16.29. Regarding the functional analysis with KPS, it was found that 58% of patients (regardless of sex) had results &gt;=70, equivalent to 18 patients. Regarding the diameter of the optic nerve sheath performed by ultrasound, the value of the preoperative BOD was greater than 6.1 mm, the value greater than 6.2 mm determined unfavorable prognosis in 3 months. Discussion: In the present study, the cutoff point of the BNO measurement for favorable or unfavorable prognosis was 6.1 mm, and when we correlated this variable with the analyzed KPS variable, we can observe that they correlate, mainly with outcome, getting an unfavorable result.

Exploring Communication Barriers in Bridge-Teams: An Innovative Fuzzy-Bayesian Approach

The bridge teams on merchant vessels have a grave responsibility to guarantee the safe navigation and management of ships in the critical waterways of the world. In addition to maintaining effective communication between external stations (other ships-Vessel Traffic Service), it is crucial to ensure continuous internal collaboration among the bridge team in order to fulfil this important task to the highest standard. Nevertheless, the challenging working conditions and harsh environmental factors may impede the uninterrupted flow of information between bridge teams and disrupt the communication. Communication issues among team members are frequently mentioned as a root cause in maritime accident investigation reports. The aim of this research is to propose a novel model for identifying the factors that may cause to inadequate communication among bridge team members, employing a fuzzy Bayesian network (FBN) approach. As indicated by the findings, attitudinal and behavioural barriers exert a greater influence (43.3%) on communication than language barriers (41.5%), representing the most significant factors affecting communication. Environmental barriers and cultural barriers, on the other hand, have comparatively less impact, at 38.7% and 31.2%, respectively. The sensivity analysis also revealed that the root nodes exhibiting the highest degree of impacts were cultural barriers (31.2%), age differences (20.6%), and workplace issues (20.2%). The findings suggest that bridge communication refresher training programs are essential for the mitigation of the aforementioned barriers, and are expected to lead to the development of new strategies for the overcoming of these communication barriers.

National implementation trial of BeUpstanding™: an online initiative for workers to sit less and move more.

The online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding. Recruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described. Of the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program. BeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability. ACTRN12617000682347.

Pelatihan Pembuatan Kaligrafi Sistem Totol Spons di Pesantren Modern Nuur Ar-Radhiyyah

Calligraphy plays a very important role in the development of Islamic civilization. In the current era of globalization, young people are exposed to a variety of knowledge, cultures, perspectives, and ethics that influence changes within them. This training was conducted with the aim of introducing the art of calligraphy to the students (santri), which they can develop as part of their future careers. The training activities were carried out by members of the field experience practice team, who are students of the Islamic College (Sekolah Tinggi Agama Islam) Jam'iyah Mahmudiyah Tanjung Pura. The activity included planning, implementation, and evaluation. The methods used in this training were lectures, demonstrations, and hands-on practice. The results of this community service activity showed that: (1) The planning stage included initial observation, needs analysis, participant recruitment, and scheduling; (2) The training consisted of a one-time session using lectures, demonstrations, and writing practice; and (3) Evaluation was conducted during the training process, at the end of each session, and at the conclusion of the overall training. The dotted sponge calligraphy training left a unique impression and challenge for the students, fostering enthusiasm. It also brought about positive outcomes, such as helping students to develop calmness and concentration.

Burn injury and fear of rejection: A qualitative study

IntroductionOne of the most important duties of the members of the treatment team is to pay attention to the mental, psychological, and social aspects of burn patients. One of the concerns of these patients during their stay in the hospital is the fear of rejection. The objective of this research is to examine the concept of 'fear of rejection' among patients hospitalized with burn injuries. MethodThis study was conducted between January 2023 and March 2024 in Hamadan, Iran, employing a qualitative content-analysis approach. The study enrolled sixteen patients, and data were collected through deep and semi-structured interviews. The data were then analyzed using the conventional content-analysis approach developed by Graneheim and Lundman. ResultsA group of 16 patients, comprising an equal number of men and women, were interviewed for this study. Based on the data obtained from these interviews, negative brainstorming, frustration, fear of permanent physical disabilities, occupational and financial challenges were identified as categories; visualization of a foggy future and inability in performance of roles emerged as the two themes. ConclusionBased on the results of this study, it can be said that the fear of social rejection, characterized by an inability to perform roles and the visualization of a foggy future, significantly affects the psychological and physical health of burn patients, potentially delaying their recovery. Assisting these patients in reaching their fullest potential to contribute to society post-discharge, and fostering optimism for a promising future, constitute a paramount aspect of daily care and ongoing support.

Media Ownership and Its Role in Shaping News: Analysing Republika's 1999 and 2021 Coverage in Light of the 2024 Gaza Genocide

This study aims to examine the reporting of the Israeli aggression towards in the Indonesian newspaper Republika during the years 1999 and 2021, with a contextual reference to the 2024 Gaza genocide. The reports were selected through purposive sampling, focusing on direct coverage from both 1999 and 2021. Additionally, interviews were conducted with members of Republika's editorial team. Using Entman’s framing theory as well as Shoemaker and Reese’s Hierarchy of Influences model, the research identifies notable differences in news framing between the two periods. In 1999, the coverage in Republika largely emphasised political support from prominent figures, both in Indonesia and internationally, advocating for the defence of Palestine. In contrast, the 2021 coverage highlighted support from civil society, including athletes and celebrities. Differences are also evident across several levels of the Hierarchy of Influences model, with the media routine, organisational, and ideological levels being the most prominent. In 1999, Republika’s reporting on the Israeli-Palestinian conflict in the international section was relatively independent, focusing primarily on political issues. By 2021, however, the reporting followed a compartmentalised model, where one section complemented and connected with others. Despite the differences in time and ownership, Republika's stance on the Israeli-Palestinian conflict remained consistent. The newspaper continues to assert that the Palestinian people must be defended, a position shaped by its Muslim readership, who maintain a strong psychological connection with Palestinian Muslims. Keywords: Framing, the Israeli-Palestinian conflict, media ownership, the influence of mass media hierarchy, Republika.

Results of Teacher Supervision at SMP Xaverius 7 Palembang

The process of learning activities supervised by a supervisor or educational expert is known as educational supervision. Providing feedback to teachers, providing suggestions for improvement, and ensuring that the learning process is in accordance with predetermined standards are the main objectives of educational supervision. In addition, data collection, classroom observation, discussion, and the creation of innovative teaching strategies and corrective measures are also included in educational supervision. As a result, improving the quality of teaching and learning in educational institutions depends heavily on educational supervision. Curriculum development and classroom learning models are two areas where educational supervision has a great influence on educational progress. Qualitative research is the type of this study. This qualitative research explains how principals’ academic supervision affects teachers’ professional development and classroom teaching standards. At SMP Xaverius 7 Palembang, 109 people participated in the study: the principal, the curriculum teacher, five members of the supervision team, five teachers of Bahasa Indonesia, PAK, mathematics, and civics, and grade VIII students. Collaborate with schools to plan supervision implementation, monitor implementation, observe academic supervisor evaluations, investigate academic supervision activities, and analyze test results obtained during academic inspections.

Tariff Negotiations Under Free Trade Agreements: The Case of Mongolia and the Republic of Korea

One of the principal reasons for the establishment of Free Trade Agreements (FTAs) between countries is to negotiate the reciprocal reduction and/or elimination of customs tariffs. According to Mongolian law, the Customs General Administration of Mongolia (CGAM) is responsible for determining the optimal rate and amounts of customs duties. As such, it plays a leading role in the negotiation of tariffs and the implementation of FTAs with partner countries. This paper examines the legal text of tariff negotiations and the modality of reducing tariffs, and determines specific goods of interest for tariff negotiations within the framework of the agreement between Mongolia and the Republic of Korea (ROK), based on analysis of the revealed comparative advantage (RCA) index. The results of the analysis show that, during the negotiation process, Mongolia should focus on textiles and apparel, as well as agricultural production, while the ROK should concentrate on automobiles, items of machinery and their parts, tobacco, cosmetics and noodles. This study should prove useful to Mongolian Customs experts and tariff negotiation team members, trade policy makers and domestic producers.

INVESTIGATING THE RELATIONSHIP BETWEEN SURGICAL TEAM COMMUNICATION AND PATIENT OUTCOMES

Surgical team plays a vital role in the care of patients during the surgery. For safe patient outcomes, surgical team members must effectively communicate within the surgical site. Communication breakdowns in the complex operating room atmosphere can result in unfavorable outcomes. To reduce risks, avoid errors and provide the best possible care for patients, the surgical team must communicate clearly and effectively with one another. Enhancing the quality of surgical treatment requires an understanding of the connection between communication and patient results. Objective: The purpose of this study was to investigate the connection between patient satisfaction outcomes and surgical communication between teams focusing on how the improved communication practices can enhance the patient safety in terms of care quality and satisfaction level in surgical setting. Method: The study comprised of 187 health care providers between the ages of 18 and 65 who were examined for the association between surgical team communication and patient outcomes after ethical approval from Hospital ethical committee. Descriptive cross-sectional study was carried out in the District Headquarters Teaching Hospital, Kohat Development Authority Kohat from January 2022 to July 2022. Data was Analyzed on SPSS and shown in tables. Results: The analysis shows a strong positive correlation (.595) between team communication and patient outcomes, with healthcare professionals that rates the quality of communication at an average of 3.84 out of 5, which is closely linked to a decrease in surgical complications and an increase in patient satisfaction. Sticking and communicating according to communication protocols was rated at 3.76, underlining its importance in patient safety improvements. Conclusions: The study affirms the crucial impact of effective communication among surgical team members on improving patient outcomes and safety in the operating site. The enhanced communication directly relates with faster patient recovery, lesser complications and higher patient satisfaction.

A Comparison of Vancomycin Area Under the Curve and Trough Concentration in Specific Populations.

Background: Vancomycin is an antibiotic known to cause nephrotoxicity, particularly when a vancomycin trough of 15 to 20mg/L, a surrogate for an area under the curve (AUC) of at least 400mgh/L, is targeted. Although monitoring vancomycin AUC is more resource intensive, it may especially benefit populations expected to be at higher risk of nephrotoxicity. Objective: To describe the proportion of discordance between vancomycin AUC and trough concentration in targeted high-risk populations. Methods: A prospective observational review was conducted on adults receiving intravenous vancomycin for more than 48 hours from May 9 to June 3, 2022. Patients included were elderly, obese, had renal dysfunction, and/or received 4 grams or more of vancomycin daily with a pending vancomycin trough concentration. A peak concentration was ordered by a project team member to calculate AUC to assess discordance. Results: A total of 47 patients were included with 87 vancomycin minimum concentration (Cmin)/AUC pairs analyzed. Discordance was observed in 52.9% of Cmin/AUC pairs in the entire cohort. The majority (79%) of the 43 Cmin levels <15mg/L had an associated AUC >400mgh/L and 57% of 21 Cmin levels within the 15 to 20mg/L range had an AUC >600mgh/L. Conclusion: A high degree of discordance between vancomycin Cmin and AUC was present in patients considered to be at high risk of nephrotoxicity. Monitoring vancomycin AUC in these patients may reduce the risk of nephrotoxicity.

Patient Experience Survey as a Tool to Support Quality Improvement of a Geriatric Service in the Emergency Department (ED)

Abstract Background The aim of this survey was to valuate patient’s satisfaction with a Frailty Intervention Therapy Team (FITT) and gain insight into their thoughts about the service. Patients’ feedback is a vital component in monitoring and improving the quality of care. The data collected will help develop the service ensuring it’s patient centred and tailored to their needs. Methods A qualitative approach was taken in the form of a patient satisfaction survey. To limit bias responses, non-patient facing clerical facilitated the completion of the questionnaire with the patient. Results 27 surveys were administered over a 5-week period with an 81% response rate (n=22). 91% of patients surveyed felt the purpose of the FITT service was clearly explained to them, the team member had clearly introduced themselves and the team used both written and verbal information well –indicating an effective and efficient style of communication. 100% of patients reported that FITT treated them with dignity and respect. 18% of patients reported they were not involved in decision making relating to the care they received. The ED environment was rated as poor by 14% of patients, long wait time to be seen was also a concern. While some areas of patient concerns cannot be directly targeted by the team alone, we have a duty of care to highlight these concerns to the wider ED staff and hospital group. Conclusion A ‘what matters to you’ question has been incorporated into the assessment paperwork, to ensure patients’ wishes are being formally captured and placed centrally within care management planning. Communication to the patient was supported by providing a FITT information leaflet. Additional seating was procured by FITT to promote improvements in comfort and facilitate safe transfers of older patients in the ED. Patient feedback was presented to the ED governance group, including major themes of patient concern.