Opportunities For Improvement Research Articles

Pharmacovigilance systems for safety monitoring of herbal medicines: assessment of the national regulatory authority, manufacturers and marketing authorisation holders in Tanzania.

The increase in the consumption of herbal medicines and their documented adverse reactions (ARs) necessitate countries to have good pharmacovigilance (PV) systems at all levels. PV systems should be frequently assessed in a systematic manner with available harmonised tools to monitor the implementation of efforts, strengthen the systems and identify areas for improvement. This study aimed to assess the performance of pharmacovigilance and its quality systems for monitoring herbal medicine safety at the National PV Centre at the Tanzania Medicines and Medical Devices Authority (TMDA), manufacturers and herbal medicine marketing authorisation holders (MAHs) to identify gaps, challenges and opportunities for improvement. A descriptive cross-sectional study was conducted using structured interviews with key informants, questionnaires administered by the researchers and document analysis. A retrospective study of suspected ARs to herbal medicines received via the TMDA was also performed. Policies and a legal framework for regulatory control and safety monitoring of herbal medicines were in place with a well-established and functional PV system at the TMDA. However, some gaps and challenges in the safety monitoring of herbal medicines, such as underreporting, lack of training, and dissemination of PV information, have been identified. A total of 18 reports containing 40 suspected herbal medicine ARs were received at the TMDA. Among the MAHs, only 64% had PV systems, with only 29% having mechanisms for the collection of ARs from their products. Only a few MAHs (39%) had a qualified person in the PV. The majority of the MAHs (64%) had established a quality system for PV; however, the systems were inadequate. Deliberate efforts need to be made to strengthen herbal medicine safety monitoring at the regulatory level. MAHs need to develop efficient PV systems and recruit qualified persons to identify safety issues related to herbal medicines.

First-in-human experience of a portable electrical drill with smart autostop for bedside external ventricular drain placement

BackgroundTimely external ventricular drain (EVD) placement may be a lifesaving neurosurgical procedure. The manual twist drill used for intracranial access represents an opportunity for potential improvement in efficiency, safety, and ease of use. A new generation of portable electrical drills with smart autostop mechanisms, such as the Hubly cranial drill (Hubly Surgical; Lisle, IL), aim to address these opportunities for improvement. ResultsTwo patients received EVDs using the portable electrical autostop drill (PEAD): A 54-year-old woman who suffered a postoperative hemorrhage and a 59-year-old woman who presented with early hydrocephalus secondary to hypertensive subarachnoid hemorrhage (SAH). Between both patients, a total of 9 and 2 access attempts were necessary to breach the inner table and visual dura. Access times in both cases, from skin incision to dural puncture, were less than 5 min. There were no apparent complications with the use of the PEAD in either case, and there was excellent placement of the EVD at the foramen of Monroe in both cases. ConclusionWe demonstrate the first successful use of a portable electrical drill with smart autostop in humans. The PEAD has potential to reduce procedure time and human error. Further development of the smart autostop drill may allow for more consistent and safer EVD placement.

"That's not fair on my kid": Carers' perspectives on sport participation and experiences for children in out-of-home care.

Children in out-of-home care participate in less organised sport than children from other household structures, potentially reducing opportunities for improvements in social, developmental, and health outcomes. Despite this, little is known about barriers and facilitators of sport participation for children in care. We aimed to explore carers' perspectives on the influences on children in care's participation and experiences in organised sport. We interviewed 26 foster and kinship carers and analysed data through a reflexive thematic analysis approach. We identified five themes regarding participation and experiences in sport for children in care. Carers reported that (1) children in care's vulnerability, resulting from past traumatic experiences, left them feeling uncertain in their environment and 'different' to other children. Carers also described (2) the importance of their own values, and (3) the difficulties they face in navigating challenges related to out-of-home care. Finally, they discussed (4) how other people in sporting environments, and (5) overarching systems and entities, significantly impact children in care's participation and experiences in sport. Our study extends existing literature by amplifying the voices of foster and kinship carers to deepen our understanding of the influences most critical for children in care's participation and experiences in sport. Based on our findings, we encourage prioritisation of sport within policy impacting children in out-of-home care, and greater flexibility among sporting organisations to support children in care's needs. Further consideration of the interactions between intrapersonal, familial, and environmental factors influencing children in care's participation and experiences in sport is required.

Bite mark analysis: A brief overview

Bite mark investigation is a vital area of expertise in forensic sciences. Bite mark represents a distinct characteristic, and it can help identify the potential culprit of a crime. Analysis of bite marks includes reviewing patterned injuries and the surrounding circumstances and integrating morphological and positional information. Based on the scientific knowledge that every human dentition is unique, this distinctiveness suggests that dental marks can be used to identify the perpetrator. Evaluation of the bite mark data includes examining and analyzing the characteristics of bite marks, comparing the data to that of the POI dentition and subsequently deciding whether or not to exclude a set of teeth as the origin of the mark. However, the field faces several challenges, including the variability in bite mark patterns due to factors such as the condition of the skin and the technique of the biter, as well as the subjective nature of interpreting bite mark impressions. Despite these challenges, the field presents opportunities for improvement through advancements in technology, such as three-dimensional imaging and computer-aided analysis, which can enhance the precision of bite mark comparisons and reduce error rates. The present review gives a brief overview of bite mark investigation discussing its process, significance, challenges, and opportunities in the field of forensic science.

A Systematic Scoping Review of the Current Applications of Digital Technology in Undergraduate Surgical Education.

Over the past few decades, technological advancements have established digital tools as an indispensable pedagogical resource in the realm of modern education. In the field of medical education, there is growing interest inhow these digital tools can be effectively integrated to enhanceundergraduate surgical education. However, despite their well-documented potential benefits, research specifically investigating the current use of digital technology inundergraduate surgical education remains limited,highlighting a critical gap in the existing literature. To address this research gap, this scoping review aims to elucidate the current utilisation of digital technologies in undergraduate surgical education by addressing the research question: 'How are digital technologies currently being utilised in undergraduate surgical education to meet surgical learning outcomes'. A scoping review was performed, adopting the Joanna Briggs Institute (JBI) framework. A comprehensive search strategy was conducted using the search terms 'technology' OR 'simulation' OR 'virtual reality' OR 'augmented reality' OR 'digital' OR 'online' AND 'undergraduate' AND 'surgical' on multiple electronic bibliographic databases including PubMed, Medline, ERIC, Embase, Scopus and Web of Science. These search terms were executed using both free-text and MeSH terms, with search terms combined using Boolean operators to ensure all relevant citations were captured. All search results were screened against the eligibility criteria using Covidence, a web-based software platform, using a two-stage process. Subsequently, all included studies were reviewed, and the extracted data was systematically sorted and organised, with the findings presented graphically accompanied by descriptive narratives. A thematic analysis was also performed to identify themes within the data to synthesise key findings. This scoping review revealed three key findings. First, the use of digital tools in surgical education has been steadily increasing over the past few decades, with the COVID-19 pandemic accelerating the integration of technology into surgical education. Second, this review also highlighted the key role of anatomy within surgical education, with most included studies reporting the use of digital technologies to enhance anatomy teaching. Finally, this review provided an overview of various digital tools used in surgical education and their associated user experiences. Overall, most studies indicated that digital technologies are well-received by students, with many advocating for their continued use insupplementing surgical education even beyond the pandemic. This review provides a crucial foundation for understanding the evolving role of digital innovations in shaping undergraduate surgical education. To enhance undergraduate surgical education, integrating appropriate digital learning tools can provide more learner-centred and personalised learning experiences. Educators must recognise that there is no 'one-size-fits-all' approach, and a flexible multimodal strategy is necessary to meet diverse learning needs. As technology continues to evolve and its role in education grows, this review offers valuable insights into the current use of digital tools in surgical education, highlighting opportunities for improvement and innovation to further enhance undergraduate surgical experience.

Diverse perspectives on supporting the health and wellness of people with intellectual and developmental disabilities.

Persons with intellectual and/or developmental disabilities (IDD) are a growing population, frequently living with complex health conditions and unmet healthcare needs. Traditional clinical practice and research methods and measures may require adaptation to reflect their preferences. The perspectives of people with IDD, caregivers/partners, and clinicians were obtained to provide insight into factors contributing to the health and wellness of people with IDD. These, in turn, suggest opportunities for improvements in clinical training and care, and considerations for enhancing research methods and measures. An exploratory design, participatory methods, abductive qualitative approach and thematic analysis were employed. Interview data were obtained in twelve focus groups with people with IDD (n=25), caregivers/partners (n=21), and clinicians (n=27). Particular attention was paid to supporting attendees in focus group participation, with adaptations and accommodations made for communication preferences, and graphic illustrations were provided. Themes emerging across attendee categories that reflect factors contributing to health and wellness for people with IDD include: (1) making healthy choices; (2) participating in everyday activities; (3) benefitting from natural supports (e.g., family, friends, peers); and (4) accessing skilled professional supports (e.g., healthcare provision and payment). Study findings underscore factors related to supporting health and wellness for people with IDD and suggest the importance of autonomy, accessibility, healthy relationships, self-advocacy, and tailored clinical care. People with IDD can be actively engaged throughout the research enterprise to ensure the relevance, acceptability, and accessibility of research methods and measures; promote inclusiveness; and address health disparities.

What Matters in Psoriatic Arthritis: A Comparison of Patient and Clinician Perspectives.

This study aimed to expand the understanding of the patient with psoriatic arthritis (PsA) experience and to compare/contrast patient and clinician prioritization of PsA dimensions. We conducted four patients with PsA focus groups across three US rheumatology practices using mixed methods to identify attributes of PsA important to patients. Combination with extant attributes of PsA identified by a steering committee created a comprehensive list of attributes. In separate patient and physician Delphi exercises, participants distributed 100 points across items on the list according to importance as a dimension of PsA. Fifty-one items describing PsA were generated. Thirty-eight patients and 13 clinicians completed the last Delphi rating exercise. Patients distributed points across a wider range of items than physicians. Using group mean score per item, prioritization was compared between groups. Items with the top 10 mean scores for both groups included arthritis, disease activity, pain, fatigue, physical function, and spine symptoms. Other prioritized domains showed disparity: access to care, daily activities, stiffness, future health uncertainty, and sleep quality for patients versus specific disease skin and joint manifestations, comorbidities, structural damage, and disease management goals for clinicians. Although concordance between patient and clinician perspectives regarding "what matters" in PsA was seen, significant areas of discordance were uncovered. Patients highlighted concerns about care access and uncertainty about the future and impact on aspects of life beyond physical symptoms, issues not usually discussed in a clinical visit. These differential prioritizations highlight opportunities for improvement in patient-clinician communications and delineate the need for more patient-centered research.

Utilization of DCD NRP liver grafts:A multicenter study of opportunities for improvement in organ acceptance

Utilization of DCD NRP liver grafts:A multicenter study of opportunities for improvement in organ acceptance

Neurocritical Care in 2024: Where are We Headed?

Providing specialized care to critically ill neurology patients has improved outcomes for patients with neurological emergencies; however, there are still some gaps in neurocritical care (NCC) that offer opportunities for improvement. Among these gaps, improving education of the multidisciplinary NCC team, targeting individualized treatments for neurologically critically ill patients, and reducing disparities for undeserved patients as well as disadvantaged areas are priorities to advance the field. This review focuses on the current challenges neurointensivists face, including difficulties in neuroprognostication, ethical challenges in end-of-life care, and neuropalliative care. Challenges also involve providing specific NCC education for the multidisciplinary NCC team, as well as advancing research to provide treatments for critically ill neurological patients. Finally, the authors describe future directions that can take NCC to the next level.

Quality Assessment of a Medical Prescription for Antibiotic Therapy

Objective: Our study aimed to assess the quality of antibiotic prescriptions and identify potential opportunities for improvement in antibiotic use in our setting. Methodology: This is how we conducted a prospective cross-sectional descriptive study which concerned 404 prescriptions collected in the pharmacy of the HGR mwangeji Results: The most prescribed antibiotic families were beta lactams with 60.15%, followed by imidazoles with 11.88% and fluoroquinolones or 8.1%; they were more prescribed in INN with 70% in the following galenic forms: tablets 46.8% followed by bottles 17.1% and finally suspensions with 12.6% with an unspecified route of administration in 80.9%. The dosage, dose, total quantity and duration of treatment were specified respectively as follows: 86.9%; 62.4%; 98.3% and 80.4%. Most of the prescriptions bore the name and first name of the patients 82.9%; The age of the patient was indicated at 75.2%; Almost all of the prescriptions did not have the weight of the patient indicated (97%); Almost all of them bore the sex of the patient (97.6%); Not all prescribers wore the patient's size (100%). In 84.4% of cases, prescribers had indicated their name on the prescriptions; A large number of prescription slips did not bear the prescriber status 86.6%; Almost all prescribers had indicated their place of practice 99.5%; 97% of prescribers had not indicated their contact details on the prescriptions; The minority 18.6% of prescribers had not signed on the prescriptions; The order number is shown on the majority of prescription slips 83.7%. Conclusion: The results of this study remain relevant. They will help improve training programs for health workers by establishing interactive information for practitioners, through visits and intensive supervision by more experienced managers in the hierarchy, this would be likely to optimize the quality of practitioners' prescriptions ; so that they better master the principles of prescribing antibiotics . Keywords: Prescription, Antibiotics, evaluation, quality, medical, antibiotic therapy

Assessment of Waste Management Practices of Different Manufacturing Companies in Camarines Sur

This study examines waste management practices among manufacturing companies in Camarines Sur, Philippines, focusing on implementation effectiveness and compliance levels across collection, segregation, transportation, and treatment dimensions. Through quantitative analysis of 29 respondents from manufacturing enterprises and 5 local government units, the research evaluates current practices, challenges, and opportunities for improvement. Government implementation shows varying effectiveness, with collection practices demonstrating the highest implementation (3.159), while treatment practices (2.47) require significant enhancement. Manufacturing companies exhibit moderate compliance across all dimensions (overall mean: 2.821), with collection leading (3.02) and treatment showing the lowest implementation (2.579). Financial constraints emerge as the primary challenge for both government (17 respondents) and manufacturing sectors (19 respondents), followed by technical limitations and negative environmental attitudes. The findings highlight the need for enhanced financial support mechanisms, improved technical infrastructure, and stronger environmental awareness programs. The study recommends implementing standardized protocols, investing in advanced technologies, strengthening regulatory frameworks, and fostering public-private partnerships to achieve sustainable waste management practices aligned with circular economy principles.

An Analysis on Logistic Management Distribution channel with respect to Varun Beverages at Mamandur, Tamil Nadu

Logistics management is a cornerstone of operational success, especially in industries with complex supply chains like beverages. Varun Beverages, a leading bottler of PepsiCo products, is known for its extensive distribution network, spanning rural and urban markets in India and internationally. This study aims to critically evaluate the logistics and distribution strategies of Varun Beverages, examining their effectiveness, challenges, and opportunities for improvement. By combining qualitative and quantitative research methods, the study will offer actionable insights to optimize logistics operations while contributing to the academic discourse in supply chain management. Assess relationships between categorical variables, such as market types (urban/rural) and distribution challenges. To analyse the research used a primary data like questionnaire and secondary data are taken from company and research paper and Chi-Square Test as a statistical tool for analysing categorical data, such as investor preference. Varun Beverages Limited, a key partner of PepsiCo, manages an extensive and diverse distribution network that serves a wide variety of markets, ranging from densely populated urban areas to remote rural regions across multiple countries. This network requires robust logistics strategies to address unique challenges such as fluctuating consumer demand, regional market conditions, and logistical complexities. Keywords: Logistics Management, Distribution Channels Varun Beverages, Supply Chain Resilience, Digital Transformation

Career Planning Process Strategy for Students in Guangxi Police College, Guangxi Province, China

This study aimed to evaluate and enhance the career planning process for students at Guangxi Police College, focusing on quantitative and qualitative insights. A mixed-methods approach was employed. In Phase 1, a quantitative survey of 248 recent graduates was conducted to assess their satisfaction with the college's career planning strategies. Phase 2 comprised qualitative focus group discussions with nine faculty members gathering in-depth perspectives on the effectiveness of current career planning practices. The findings revealed a generally high level of student satisfaction, with an overall mean score of 3.64 out of 5. However, areas such as self-assessment and goal setting scored slightly lower, indicating opportunities for improvement. Faculty feedback emphasised the need for regular updates, external evaluations, and increased real-world exposure to better prepare students for the job market. The study concludes that while Guangxi Police College has established a strong foundation in career planning, there is still room for further enhancement. Targeting enhancements in self-assessment, goal setting, and practical application could significantly improve student outcomes. These findings correspond with existing research, underscoring the importance of a comprehensive and context-sensitive approach to career planning in specialised educational institutions.

Driving Safer: A Look at How Men and Women Use Advanced Driver Assistance Systems

Objective — This study investigates the nuanced landscape of gender-specific patterns in utilization of Advanced Driver Assistance Systems (ADAS), aiming to contribute insights to enhance road safety. Methods — Leveraging data from diverse sources, including Scopus, Web of Science, and Google Scholar, the method employed involves a meticulous examination of studies exploring gender differences in driving behaviors and ADAS adoption. Key factors influencing these differences, were analyzed including age, experience, and attitudes toward technology. Cultural and societal influences on gender-specific driving behaviors are explored, shedding light on the intricate interplay of perceptions and expectations. Results — The review identifies challenges in ADAS adoption, including limited awareness, misconceptions, and resistance to change. Opportunities for improvement are then outlined, encompassing comprehensive user training, clear communication of ADAS features, customizable settings, and incentives for ADAS-equipped vehicles. This study showed that men tend towards aggressive driving behaviors, while women prioritize caution and adherence to traffic rules. Women propensity for safety-oriented features such as lane-keeping assistance, while men display a preference for convenience-focused features such as adaptive cruise control and parking assistance. Conclusion — By addressing challenges and embracing opportunities, the study advocates for a future where ADAS technologies contribute significantly to safer and more equitable roadways for all drivers.

Sentiment Analysis of National Health Security Mobile Application Review Using Machine Learning

It is widely acknowledged that digital transformation provides the opportunity for business process improvements. We can see many businesses, specifically in Indonesia's private and public sectors, leveraging technology to provide better service to their stakeholders. This research seeks insight into stakeholders’ engagement in digital transformation in the Indonesian healthcare system, namely the National Health Security Mobile application (Mobile JKN). This study employs a quantitative method to analyze user sentiment from Google Play reviews. Firstly, user reviews are extracted, preprocessing steps are applied, and machine learning-based sentiment labeling is employed afterward to categorize them into positive, neutral, and negative sentiments. The machine labeling process is carried out in document-level analysis, meaning user reviews represent their overall sentiment. Subsequently, we study the most prominent words using Word Cloud to determine the topics mainly discussed in positive and negative sentiments. The result is that 56.10% of reviews from 7 June 2016 to 14 July 2024 contain positive sentiments, while 43.17% contain negative sentiments. Neutral reviews contribute the most minor proportion, making up only 0.73%. The most prominent words in positive sentiment reviews, such as easy, sound, and helpful, suggest the user perception of the National Health Security Mobile as being easy to use and successfully accommodating the user's needs. In contrast, the words application, update, complex, login, code, verification, register, open, use, and error dominate the negative reviews, indicating users had difficulties logging in and registering user accounts, mainly related to frequent updates and Time Password errors.

SCOR model Application to identify improvement opportunities in the production system of an SME clothing manufacturing. Case study

The SCOR model frames a set of processes through a common language. Companies or organizations use the SCOR model as a reference for the diagnosis of their production process. This article presents the SCOR model application to determine opportunity areas in the production system of a blouse manufacturing SME. To carry out this study, information was collected on the production process and the operations were documented under the provisions of the SCOR model. It was identified that the process called "manufacture to order" is the process in which there are opportunities for improvement due to late deliveries in orders and high production costs, with critical processes in scheduling production activities, product manufacturing, and product inspection and testing.

Integration of smart products for decision-making in strategic planning of industry 4.0

Industry 4.0, driven by technologies such as IoT, artificial intelligence, big data, and automation, is revolutionizing business models and operations. Central to this transformation are smart products, and internet-connected devices capable of collecting and transmitting real-time data, optimizing processes, and enabling personalized and continuously improving business models. This study proposes a novel architecture integrating smart products with the Reference Architecture Model for Industry 4.0 (RAMI 4.0) to enhance strategic decision-making. By offering a holistic view of the value chain, from product design to end-user applications, the architecture enables precise real-time data analysis, uncovering behavior patterns, consumer preferences, and process improvement opportunities. The integration provides a robust foundation for continuous monitoring and operational optimization, supporting faster, data-driven decision-making, improved efficiency, and superior customer experiences. This research highlights the transformative potential of smart products in strategic planning, empowering companies to anticipate demand, personalize offerings, and adapt rapidly to market dynamics, fostering competitiveness in a dynamic business environment.

System Dynamics Approach to Potable Water Management in Eastern Cape Province of South Africa

Large swaths of rural communities in South Africa are faced with water shortages. The Eastern Cape province is one of the most hard-hit areas in the country with very unskilled water administrators and old infrastructure exacerbating the problem. Water shortage is due to the mismanagement of resources that are meant to install, operate, and improve water infrastructures in the province. An increase in population also contributes significantly to the challenge of water shortages. Available water is not potable enough for consumption, as a result, the province is under the stress of access to potable water. The purpose of this study was to model the water supply chain and to determine the nature and causes of water delivery challenges. The model will be used as a decision-support tool to help achieve sustainable water management in the province. System dynamics is an appropriate methodology used to understand cause and effect relationships, policy decisions, and feedback and has been successfully used in solving water management problems in particular. A System dynamics model is developed using the Vensim PLE 8.0.9 (Double Precision) to determine opportunities for improvement in water management, water access, and water supply. The systems dynamics modeling is discussed herein.

Active Electrode Materials for High-Performance Lithium-Ion Battery

The global demand for energy storage solutions has surged in response to rapid technological and economic growth. Lithium-ion batteries (LIBs) have become essential because of their superior energy density, power density, long lifespan, and relatively lower environmental impact. This review examines the structure and key components of LIBs, including recent technological advancements, focusing on the materials for LIBs. It not only highlights the critical role of electrode materials in enhancing the performance of LIBs but also reviews the challenges associated with current materials and the opportunities for improvement. Significant emphasis is placed on the development of advanced cathode and anode materials to address issues in stability, strength, cycle life, and electrochemical performance. Additionally, the review explores emerging strategies to overcome these challenges, providing a comprehensive overview of future research directions that could lead to the next-generation LIBs. Finally, this review is crucial for advancing the design and efficiency of LIBs, paving the way for more sustainable energy storage systems.

استقلال النيابة العامة في المغرب: الفرص والتحديات

Over the past decade, Morocco has taken significant steps toward ensuring the independence of the Public Prosecutor’s Office from the executive branch, effectively breaking any ties it previously had with the Ministry of Justice. This move has been enshrined in both the Constitution and legislative frameworks. This article aims to critically examine Morocco’s experience in achieving prosecutorial independence, exploring both the challenges it faces and the potential opportunities for further improvement and reinforcement. To achieve this, the author adopts an analytical and comparative methodology, scrutinizing the relevant Moroccan legal texts governing the Public Prosecutor’s Office and its interactions with other authorities. The study identifies the key issues posed by these regulations and seeks solutions to enhance the independence of the prosecutorial body. The research culminates in several findings, the most notable being that viewing independence merely as the separation of the Public Prosecutor’s Office from the Ministry of Justice is a limited interpretation. This narrow view overlooks the hierarchical subordination that governs prosecutors, their adherence to the principle of judicial unity, and their functional ties to the judicial police.