Opportunities For Improvement Research Articles

Situational Analysis of the Medication Practices in Brazilian Hospitals: A Multicenter Study.

To carry out a situational analysis of the medication practices in Brazilian hospitals through the Medication Safety Self-Assessment for Hospitals and the factors associated with better performance in the evaluation. This is a multicenter cross-sectional study in which the results of the application of the Medication Safety Self-Assessment for Hospitals, between 2015 and 2020, in 30 Brazilian hospitals were described. In addition, whether the institutional profile was associated with higher self-assessment scores (better performance in the evaluation) was also evaluated. An average proportion of points obtained of 36.7±10.9% was identified (minimum=11.5%; maximum=59.7%), from a score ranging from 0 to 1826 points. The need to improve the use of devices for the preparation and administration of drug solutions, professional development, and patient education was highlighted. A positive association was identified between higher scores and the large or very large size of the hospitals (P=0.026) and having accreditation certification (P=0.007). The study made it possible to identify the main weak points and opportunities for improvement of the medication system in the evaluated hospitals, bringing important reflection to national institutions.

Healthy cities: a visual conceptual framework for moving health knowledge into urban planning practice

ABSTRACT Despite the increasing recognition of health as a fundamental dimension in urban design and planning, it remains insufficiently incorporated into urban planning practice and policymaking. This study reexamines the ‘Knowledge Translation’ (KT) process through a literature review (N = 53) to address the gap between the public health and urban planning arenas. By analyzing the key KT components – knowledge, guidance, and implementation – we identified additional factors influencing the process and highlighted gaps and opportunities for improvement. Building on these insights, we developed a visual conceptual framework that synthesizes existing knowledge and addresses critical gaps to support urban practitioners and policymakers in creating ‘healthy cities’. The framework conceptualizes KT as a dynamic, iterative process guided by three key drivers: (i) continuous interaction among knowledge, guidance and implementation, all tailored to local contexts and shaped by decision-making processes; (ii) interdisciplinary and cross-sector collaboration, including active engagement with local communities to create a shared vision of a healthy city; and (iii) a ‘control center’, that integrates these components, facilitates training, and ensures ongoing evaluation and calibration.

Comparing four methods for assessing interprofessional learning in a practice setting

ABSTRACT Healthcare practitioners must be trained to collaborate in a dynamic environment where patients are complex and teams can change from day-to-day, but choosing the right measures to assess the effectiveness of interprofessional teamwork among learners is challenging. This study used measures representing four different perspectives to assess student teams in a practice setting where team composition varied each day. We tested the strength of the relationships between these measures, and we examined the impact of additional variables on each measure. Participants were students from different health professions at a single university and patients in a community-based wellness program. We sampled 100 wellness visits where an interprofessional student team met with a patient, and we assessed team effectiveness using student perceptions of their team, patient ratings, observer ratings, and faculty assessments of team healthcare plans for the patient. We calculated bivariate correlations between the four measures and used regression analyses to assess the impact of predictors including student, patient, and clinic/site characteristics, on each measure of team effectiveness. There were small but significant negative correlations between the assessments of faculty and observers (r = – 0.23), as well as between faculty and patients (r = – 0.14). Conversely, a small but significant positive correlation was found between the assessments of patients and observers (r = 0.15). Among the regression models, faculty and patient ratings of team effectiveness were more strongly related to the predictors measured (R-squared = 53.6% and 41.7%, respectively). Patient age and number of clinic visits, team size, and clinic site were significant factors for predicting team effectiveness across the two measures. Our findings provide evidence that different perspectives of team effectiveness measure different constructs. While all approaches have value, in IPE practice settings, team effectiveness should be evaluated with multiple measures to understand performance and identify opportunities for improvement. Teamwork in dynamic healthcare environments is complex, and simple measurement approaches may mischaracterize learning and clinical outcomes.

The comprehensive regulatory network in seed oil biosynthesis.

Plant oils play a crucial role in human nutrition, industrial applications and biofuel production. While the enzymes involved in fatty acid (FA) biosynthesis are well-studied, the regulatory networks governing these processes remain largely unexplored. This review explores the intricate regulatory networks modulating seed oil biosynthesis, focusing on key pathways and factors. Seed oil content is determined by the efficiency of de novo FA synthesis as well as influenced by sugar transport, lipid metabolism, FA synthesis inhibitors and fine-tuning mechanisms. At the center of this regulatory network is WRINKLED1 (WRI1), which plays a conserved role in promoting seed oil content across various plant species. WRI1 interacts with multiple proteins, and its expression level is regulated by upstream regulators, including members of the LAFL network. Beyond the LAFL network, we also discuss a potential nuclear factor-Y (NF-Y) regulatory network in soybean with an emphasis on NF-YA and NF-YB and their associated proteins. This NF-Y network represents a promising avenue for future efforts aimed at enhancing oil accumulation and improving stress tolerance in soybean. Additionally, the application of omics-based approaches is of great significance. Advances in omics technologies have greatly facilitated the identification of gene resources, opening new opportunities for genetic improvement. Importantly, several transcription factors involved in oil biosynthesis also participate in stress responses, highlighting a potential link between the two processes. This comprehensive review elucidates the complex mechanisms underlying the regulation of oil biosynthesis, offering insights into potential biotechnological strategies for improving oil production and stress tolerance in oil crops.

Utilizing Simulated Telemedicine Encounters to Conduct Nationwide Studies of Physician Communication Practices.

Introduction: High-quality communication and shared decision making (SDM) are crucial elements of effective patient care. SDM conversations are intimate and logistically challenging to capture. Evaluating alternative methods to effectively observe how physicians conduct these conversations may improve research efforts in this core discipline of medicine. Methods: In two distinct qualitative studies (A and B), subspecialist physicians participated in a telemedicine encounter with a simulated patient facing a high-stakes treatment decision. Results: Thirty-seven transplant hematologists (A) and 21 medical oncologists (B) from across the United States successfully completed a telemedicine encounter with a trained actor, allowing for qualitative analysis of their SDM conversations. Discussion: Simulated telemedicine encounters are a feasible method for studying how a broad sample of subspecialty physicians conduct difficult conversations, such as emotionally fraught SDM conversations. This model could improve understanding of the current practice of SDM, identify opportunities for improvement, and serve as a framework for ongoing research of physician communication practices.

Transition-to-home arrangements for very preterm infants and related parental needs at perinatal centres in Austria and Switzerland: a cross-sectional multicentred study

IntroductionThe current study aims to give an overview of transition-to-home services provided by perinatal centres in Austria and Switzerland and to evaluate parental satisfaction with the care provided.MethodsThis cross-sectional multicentred...

Exploring the voice of patients: Mapping their experience following care in an integrated health area

Measuring patient-reported experience measures (PREMs) is essential for the continuous improvement of quality. This study aims to assess the quality perceived by patients in the key care processes of an integrated health area measuring PREM elements, with the goal of identifying opportunities for improvement. The research was conducted in the first half of 2023 within a Spanish integrated health area, analysing five key healthcare processes: Primary Care, Emergency Services, Hospitalisation, Consultations, and Surgery. To assess perceived quality, PREM elements such as accessibility, information, and professionalism were measured using the Net Promoter Score (NPS). The Lot Quality Assurance Sampling (LQAS) method was employed to identify specific areas for improvement by detecting rejected lots and optimising sample sizes. Although the perceived quality was generally high, with good or excellent NPS scores, significant variability was observed between processes. A total of 104 rejected lots (21%) were identified across the processes evaluated. The highest number of rejections occurred in and Emergency Services (67%), with notable issues in accessibility and information. The study underscores the need for targeted interventions in accessibility and information to enhance the patient experience, particularly in Primary Care and Emergency Services. The measurement of PREM elements using NPS, in conjunction with the LQAS method, proves to be an effective tool for identifying and prioritising areas for improvement, especially when applied on a regular basis.

“Lack” and “Finally”: A Qualitative Analysis of Barriers and Facilitators in Rare Disease Healthcare

Background: This study explored the experiences of adults with diverse rare diseases (RDs) and RD caregivers with barriers and facilitators to healthcare access in the United States (US), including during the early part of the COVID-19 pandemic, and their recommendations for improving access. Results: Adults with RDs and parents/caregivers to children with RDs (N = 1128) completed open-ended survey items. Responses were analyzed using thematic analysis. The primary theme identified regarding barriers to healthcare was “lack”; participants reported challenges in obtaining an accurate diagnosis, effective management/treatment, health insurance coverage, and social support. The primary theme identified regarding facilitators was “finally”; participants reported a need for persistence to access a diagnosis, RD experts, as well as social support and advocacy. Recommendations for improving healthcare for RDs mirrored the barriers and facilitators identified, including improving knowledge/awareness of RDs and investing in RD research that could improve diagnosis and treatment. Participants’ healthcare experiences varied widely during the COVID-19 pandemic, with some reporting that telehealth improved care and others reporting disruption due to telehealth. Conclusions: Even though individual diagnoses are rare, there are shared challenges to healthcare access and common opportunities for improvement. Policy recommendations regarding RD healthcare focus on improving affordable and timely access to knowledgeable providers, diagnosis, and medications/treatments.

Sentiment Analysis Techniques for Deep Learning Classification and Comparison

Sentiment analysis, a critical tool in natural language processing (NLP), has seen significant advancements with the rise of machine learning and deep learning techniques. This paper explores the evolution of sentiment analysis from traditional models, such as CNN and RNN, to more sophisticated approaches like LSTM, LSTM-CNN, and BERT. Using the IMDb dataset for binary classification of sentiment, we utilize metrics like F-Score, Precision, Accuracy, and Recall to compare the way these models perform. Despite the progress made, sentiment analysis still faces challenges, particularly in handling multiple languages, incorporating multimedia content, and addressing privacy and ethical concerns. This paper also discusses future directions for sentiment analysis, including the development of models for low-resource languages, real-time sentiment analysis, and the ethical implications of data handling. Overall, the study highlights the potential of sentiment analysis and the opportunities for improvement through continued research and innovation.

Il contributo dell’intelligenza artificiale per la qualificazione dei processi di istruzione 1

THE CONTRIBUTION OF ARTIFICIAL INTELLIGENCE TO THE QUALIFICATION OF EDUCATION PROCESSES Abstract In the era of digital transformation, artificial intelligence (AI) emerges as an innovation capable of generating large-scale improvement opportunities. Educational institutions, which have enjoyed greater autonomy in managing human, financial, and technological resources since Law No. 59 of 1997, have developed increasingly personalized approaches to address students’ educational needs. Particular attention has been devoted to students with special educational needs, promoting more effective inclusion and integration within the school context. In this scenario, AI stands as a strategic tool to enhance personalized learning, optimize assessment processes, and improve school management efficiency. Simultaneously, there emerges the need to provide essential skills for understanding and using AI, from its everyday applications to its ethical implications.

Poverty Reduction Through Adaptive Social Protection and Spatial Poverty Model in Labuan Bajo, Indonesia’s National Strategic Tourism Areas

Despite Indonesia’s significant economic progress, certain regions, such as West Manggarai Regency in East Nusa Tenggara, continue to face persistent poverty challenges. While strategic tourism initiatives in Labuan Bajo have spurred regional development, the benefits have not reached local communities equitably, highlighting a disconnect between economic growth and community well-being. Addressing this gap requires an integrated approach that links social protection, disaster risk reduction, climate adaptation, and economic diversification. This paper proposes an adaptive social protection (ASP) framework that aims to increase the resilience of vulnerable populations by integrating social protection systems with disaster preparedness and sustainable economic strategies. The research critically examines the Regional Medium-Term Development Plan (RPJMD) of Kabupaten Manggarai Barat (2021–2026), identifying existing policy gaps and opportunities for improvement. Using a mixed-methods approach, this study used cluster mapping and geographically weighted regression analysis to model and visualise poverty distribution alongside infrastructure conditions. These findings will inform the design of a targeted ASP programme to reduce poverty and build resilience to economic and environmental shocks. By aligning with sustainable development principles, the proposed framework addresses the dual goals of poverty reduction and disaster risk reduction. This study provides actionable recommendations for local governments to strengthen social protection mechanisms, promote inclusive economic growth, and ensure equitable distribution of tourism benefits. The findings provide a policy blueprint for promoting sustainable and inclusive development in West Manggarai Regency, with implications for similar contexts in other regions.

Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations.

Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LRs and FRs. The LRs received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. The FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer's recommendations and distance to anatomical landmarks. Incorrect AP placement was defined as the upper edge of the pad past the crest of the trapezius, the medial edge past midline, or the lower edge beyond the nipple line. Incorrect LP placement was defined as the upper edge of the pad past the nipple line, the medial edge past midline, or the lower edge beyond the navel line. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (<1 year) with AED application for FR using Fisher's exact. Lay rescuers correctly placed the AP in 30/38 (78.9%) and the LP 30/38 (78.9%) simulations. Application did not differ significantly based on previous CPR training (AP p = .236, LP p = .621). The most common incorrect placement was too low for both AP (5/8, 62.5%) and LP (4/8, 50.0%). First responders applied the AP correctly in 16/18 (88.9%) and the LP in 14/18 (77.8%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p = .497, LP p = .119). The most common incorrect placement was too low for both AP (2/2, 100.0%) and LP (3/4, 75.0%). There is an opportunity for improvement for both LRs and FRs to apply AEDs per manufacturer's recommendations. Further research is needed to improve instructions and follow-up training to ensure accurate AED pad placement.

‘I just want safety’: understanding the needs of diverse residents to facilitate equitable active transportation planning in Durham Region, Canada

ABSTRACT Active transportation users in high-income countries are more likely to be male, white, and of higher socioeconomic status. The purpose of this work was to learn about the needs, access, barriers, and priorities of equity-deserving groups to support engagement in active transportation. We conducted interviews with adults belonging to one or more of the following equity-deserving groups: Female (sex) or Women (gender), Racialized (non-Black), Black People, People with Disabilities, Born Outside of Canada, Older Adults, or Queer People. Four novel themes were identified in the data. Several privilege patterns related to cultural background, ability, affordability, and sex were identified. Communications were a clear opportunity for improvement to ensure accessible and inclusive active transportation. Several opportunities for education and training related to municipalities and law enforcement were highlighted. Finally, the pervasive car culture and law enforcement concerns were raised, particularly in the context of safety. It is clear from this work that adults from equity-deserving groups are faced with additional constraints to engaging in active transportation. A more collaborative approach with equity-deserving groups may be needed to ensure inclusive and accessible active transportation planning. Practical implications related to committees, media campaigns, and bikeshare programs are discussed.

Enhancing Sustainability with LCA: A Comparative Analysis of Design and Manufacturing Processes

This study evaluates the feasibility and effectiveness of the Life Cycle Assessment (LCA) methodology. Two widely used products with the same functionality but different designs and production processes were selected for comparative analysis. SimaPro 9.6.0 software was used for the calculations and LCA of both assemblies. The analysis covered all phases of the life cycle, taking into account factors such as energy, materials and water consumption. The results allowed a comparison of the environmental impacts of the two assemblies, identifying the life cycle phases with the highest impact and the most relevant impact categories. The analysis revealed that the metal trolley exhibited a 40% higher environmental impact during production compared to the polypropylene trolley, primarily due to the material extraction and processing phases. Additionally, the polypropylene trolley showed higher long-term impacts in landfill scenarios due to carcinogenic substance emissions. These findings highlight the significance of design and material selection in reducing environmental impacts. Applying the LCA methodology to the two mechanical assemblies allowed us to identify opportunities for improvement in the design and manufacturing processes, with the aim of reducing the environmental impact and increasing the competitiveness of the products. By considering the full life cycle of a product from the early design phases, more sustainable design and manufacturing decisions can be made, and by using this analysis, companies can develop more sustainable products and reduce costs.

Comparison of good review practices of seven countries participating in the ECOWAS medicines regulatory harmonisation initiative: identifying opportunities for improvement

Comparison of good review practices of seven countries participating in the ECOWAS medicines regulatory harmonisation initiative: identifying opportunities for improvement

Evaluating Knowledge Management Practices in Crowdfunding Fintech: The Case of the First Crowdfunding Platform in the Philippines

This study explores Knowledge Management (KM) practices at Investree Philippines Inc., a leading fintech company in crowdfunding. Using a case study approach with mixed methods, the research evaluates how Investree's Project NEXUS framework enhances operational efficiency, drives innovation, and ensures regulatory compliance. Data were gathered through interviews, surveys, and document analysis, revealing that Project NEXUS effectively integrates KM practices across various phases, including ideation, execution, and knowledge transfer. The findings highlight Investree's strengths in fostering innovation and maintaining efficiency through centralized documentation and training. However, opportunities for improvement exist in enhancing information retrieval systems and strengthening cross-departmental collaboration. Recommendations include refining search tools and implementing structured knowledge-sharing protocols. This study provides valuable insights for fintech companies aiming to optimize their KM strategies, positioning Investree as a leader in the Philippine fintech industry and contributing to the broader understanding of KM's role in the fintech sector.

How Do Psychiatry Residents View Their Training in Spain? A Mixed-Method Survey.

Efforts to improve psychiatry training must incorporate residents' assessment of their training. This study sought to collect the opinion of residents about the program that has been in force in Spain since 2008, until the current transition to a new plan. The authors conducted an online survey of psychiatry residents in Spain, asking about their formative and working conditions. Based on previous research and the national training programme, it was distributed electronically to resident representatives of the National Board of Psychiatry. This descriptive, cross-sectional study used a mixed-methods (quantitative and qualitative) approach, following standard procedures for data analysis. A total of 109 residents from 67 training units responded to the survey. The average score for satisfaction with their training was 6.84 (standard deviation (SE) = 2.4; the maximum possible score was 10). Psychotherapy was considered the area with the greatest need for improvement, while the rotations that participants would most like to be extended were child psychiatry and addictions. It was reported that rotation durations established by the national programme were not fulfilled in 38.5% of cases, while the required direct supervision for first-year residents was not fulfilled in 77.1% of cases. Regarding working conditions, 47.7% of the residents reported that they exceeded the maximum working time established by European law. Psychiatry residents in Spain perceive certain areas of their training as deficient, especially those related to psychotherapy and clinical supervision, and they consider that their working time is excessive. The approval of the new training programme opens up an interesting opportunity for improvement.

Mechanization Levels of Some Crops in the Gezira Scheme, Sudan

Agricultural mechanization level means ratio between mechanical energy to total energy (sum of animal, human and mechanical energies) used in crop production. Crop production practices in the Gezira scheme depend on two energy sources, labor and machinery. The objectives of this study were to quantify and compare the level of mechanization for some selected crops in the Gezira scheme. The selected crops were cotton, wheat, groundnut, sorghum, pigeon pea, chickpea and onion. Data about production practices, from seedbed preparation to harvest, for these crops were collected from the farmers and engineers. Labor data included operated area, number of labors and daily working hours. Machinery data included machine type, work rate and fuel consumed. The collected data were entered into excel-sheets and energy was calculated using the standard procedures. The level of mechanization was calculated for two scenarios, the traditional and improved farming systems. The results showed that the level of mechanization in the traditional farming system varied from crop to another, it was 20.4, 25, 26.1, 41.8, 61.4, 80.6 and 96.7% for groundnuts, cotton, onion, pigeon pea, sorghum, chickpea and wheat crops, respectively. The results indicated that there are possibilities to improve level of mechanization by some interventions; this improves to groundnut, cotton, onion, pigeon pea, sorghum, chickpea and wheat will reach 69.1, 62.1, 54.9, 74, 98.7, 99.4 and 98.9%, respectively. However, this improvement requires additional fuel by 99.9, 82.4, 79.7, 74.3, 66.2, 24.2 and 40 l/ha for these crops, respectively. The study concluded that the level of mechanization is weak for some crops and there are opportunities for improvement. Conducting further comparison between the costs of manual and mechanized operations for these crops is recommended.

Microsurgical Education in Reproductive Urology: A Review of Current Techniques and Opportunities for Improved Access to Learning Experiences.

Infertility is a common problem. Despite this, a dearth of urologists are trained in infertility care. Improved training opportunities may improve proficiency and interest in subspecialized training. We present a narrative review of current and proposed techniques in microsurgical education, with noted methods from other specialties. Opportunities for quality improvement include technological advancements, dedicated training laboratories, and artificial and animal models. Ample opportunity exists for improvement and standardization of microsurgical skills training, institutionally and nationally. Adoption of training methods may bolster resident interest in andrology and male infertility as a career and improve outcomes for those who complete fellowship training.

Integrated Business and Engineering Educational Experience for Medical Students in the Development of Pediatric Medical Devices.

There are few opportunities in undergraduate medical education that provide formal training in engineering and scientific innovation. Institutions have sought to address student-specific career goals through combined degree programs such as the Medical Scientist Training Program and MD/MBA. However, only a small percentage of medical students pursue these additional degrees. Partnerships between medical schools and Medical Technology (MedTech) accelerators may create unique opportunities for medical students to gain real-world experience with scientific innovation and entrepreneurship. An internship program was developed by the Keck Translational Biotechnology Association and the West Coast Consortium for Technology & Innovation in Pediatrics (CTIP), a Food and Drug Administration-funded pediatric medical device accelerator. Students and companies applied to participate and were paired based on students' interests and experience, and project plans were developed together. An initial orientation provided an overview of the program structure and expectations. Students and mentors met biweekly to address questions or concerns surrounding the progress of their projects. Students gave final project presentations and completed program evaluations. Data from 3 iterations of the program are reported. Student program satisfaction was measured across 5 domains. Students felt that working with CTIP was valuable to their education (mean score = 3.7 of 5.0) and encouraged them to pursue future careers in MedTech (mean score = 4.0 of 5.0). Students provided a few suggestions to improve the program, including more structure, clear expectations around time commitment and deliverables, and stipends for students. Participation in the program grew over time. The initial iterations of the internship program were well received by students. Several opportunities for improvement were noted. The program grew over time. Partnerships with accelerator programs at medical schools and academic medical centers may provide key real-world opportunities for students to learn about MedTech.