Practice Settings Research Articles

Laparoscopic versus open appendicectomy performed by adult general surgeons in pre-teenage years children: a single-centre experience.

The utilisation of laparoscopic appendicectomy (LA) in children remains contentious despite the well-recognised advantages of laparoscopic surgery. The purpose of this study was to compare intraoperative and postoperative outcomes in LA and open appendicectomy (OA) when performed by adult general surgeons outside specialist paediatric practice in younger children. A retrospective review of all patients under the age of 13 who underwent LA for suspected appendicitis over a two-year period was conducted. These were case-matched with an equivalent number of patients who underwent OA during the same period. Intraoperative and postoperative outcomes were compared. Fifty-one patients underwent LA during the study period. Patient demographics were statistically equivalent with the OA cohort. A statistically significant longer median operating time (58 vs 49min) was noted in the LA group, but intraoperative outcomes were otherwise comparable. LA, when compared with OA, was associated with a significant improvement in postoperative length of stay (2 vs 3 days, p < 0.001), postoperative complication rate (0% vs 6%, p = 0.01), negative appendicectomy rate (3.9% vs 17.6%, p < 0.001) and 30-day readmission rate (0% vs 5.9%, p = 0.03). No patients in the LA group required conversion to open surgery. LA can be safely delivered by adult general surgeons to younger paediatric populations outside the setting of paediatric specialist practice, with statistically significant improvements in postoperative outcomes noted when compared with OA. These findings are of importance in the current healthcare context where adult general surgeons continue to perform the majority of paediatric appendicectomies.

Business intelligence in investment offices: case study

The main theme of this article is investment offices, a market that is growing exponentially in Brazil, and business intelligence, which consists of a set of technologies and practices that help companies to perform the collection, analysis and visualization of data in order to maximize efficiency in decision making. This article aims to analyze the effects of BI in investment offices through bibliographic research to build the theory and the case study for the collection of primary data for a better understanding of how processes occur in the company and how BI affects this process. As a result of this analysis, it was observed that, in fact, BI, as it was raised in the bibliographic research, is essential in investment offices, both for data collection, analysis and visualization to assist in decision making in a more assertive way, in relation to the investment office interviewed it was raised that BI is present in practically all processes and departments, however it was also observed that there are departments where the use of BI is not so present, This is a point to be evaluated by the investment office. In general terms, the company actually uses BI, having this resource as essential for decision-making, which in addition to corroborating the propositions made together with the theory, also evidences the professionalism of the investment office in relation to the theme of this study.

Exploring the feasibility of a gambling harm screening model in general practice and community service settings in Fairfield: a pilot study.

Gambling is a growing public health issue in Australia. However, limited research has examined the role of primary health care and social services in routine screening for gambling harm in Australia. This research aimed to explore the enablers and barriers to implementing a co-designed gambling screening model in Fairfield, New South Wales - an area with high gambling expenditure. A co-designed gambling screening and referral model for GP and community-based organisations was implemented in Fairfield in 2020. Follow-up interviews were conducted with nine health care professionals who implemented the screening in 130 patients. Thematic analysis generated key barriers and enablers for implementation of this model. Key enablers for the screening model implementation included structural factors (alignment of the screening model with current work), process factors and staffing factors (staff empowerment). However, we also noted process factors as a barrier to implementation, particularly the referral pathway following screening. Other barriers included social and structural factors, such as the complexity of gambling harm and project funding. Embedding routine screening in primary and community care settings can play a role in treating, reducing and preventing gambling-related harm, and reducing stigma in Fairfield and beyond. Additionally, screening models such as this provide health systems with clear evidence on the level of gambling harm in their community (particularly important in culturally and linguistically diverse communities who are underrepresented in research). This evidence is important for addressing system-level drivers of harm and advocating for political reform to reduce the impact of gambling on communities.

Is Social Media Here to Stay?: Survey Results Indicate Increasing Pathologist Interest and Engagement Over Time.

Social media has become widely adopted by pathologists and other physicians for professional purposes. While engagement has likely increased over time, there remain few concrete data regarding attitudes toward its use. To assess pathologists' use of and attitudes toward social media over time. We created a survey regarding personal and professional use of social media and circulated it via multiple channels in December 2017 and again in February 2022. Results of the 2 surveys were compared for statistically significant differences. The 2017 survey was completed by 97 participants, and the 2022 survey by 305 participants. Respondents were predominantly female and academics, included pathologists in all age categories and all time-in-practice length. In both surveys, Twitter (now X) was the most popular platform for professional use and Facebook was the most popular for personal use. Professional barriers to social media use remained consistent between the 2 surveys, including the amount of time required. Education was seen as the main benefit of social media use in both surveys, while other benefits such as networking and increasing professional visibility were endorsed significantly less often in the second survey. While the second survey received more than 3 times as many responses as the first, several aspects of social media use (mainly demographics) remained similar during the timeframe, while other aspects (such as usage and perceived values) decreased. Pathologists continue to find social media valuable. Barriers remain, though overall pathologists of all ages and practice settings appear receptive to using social media to further educational and other opportunities.

The devil's in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy.

To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy. Interrupted time-series analysis. The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics. Adults prescribed a fluoroquinolone with a duration <31 days. Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention. The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal. Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.

Feasibility of Prospective Assignment of Initial Method of Detection of Breast Cancer: A Multicenter Pilot Study

ObjectiveTo determine the feasibility of standardized, prospective assignment of initial method of detection (MOD) of breast cancer by radiologists in diverse practice settings. MethodsThis multicenter, retrospective study analyzed the rate of assignment of MOD in four geographically varied health systems. A universal protocol for basic MOD assignment was agreed upon by the authors before start of the pilot study. Radiologists at each site were instructed how to assign MOD. Charts were then reviewed to determine the frequency and accuracy of MOD assignment for all cases subsequently diagnosed with breast cancer. When available, data regarding frequency of tumor registry abstraction were also reviewed for frequency and accuracy. ResultsA total of 2,328 patients with a new diagnosis of breast cancer were evaluated across the sites over the study period. Of these patients, initial MOD was prospectively assigned by the radiologist in 94% of cases. Of the cases in which MOD was assigned, retrospective review confirmed accurate assignment in 96% of cases. ConclusionsProspective, standardized assignment of initial MOD of breast cancer is feasible across different practice sites and can be accurately captured in tumor registries. Standard collection of MOD would provide critical data about the impact of screening mammography in the United States.

Socioeconomic factors influence surgical wait times for non-emergent gynecologic surgical procedures: a retrospective analysis

BackgroundIn various disciplines, an association between surgical wait times and patient outcomes has been identified. This study is among the first to investigate whether practice setting influences wait times for elective surgeries in benign gynecology.MethodsThis retrospective study of patients at three New York hospitals from 10/2019–2/2020 compared surgical wait times among patients seen in federally-qualified health centers (FQHC’s) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of the procedure. A multivariable mixed model was used to model surgical wait time by setting of care, adjusting for age, BMI, race, ethnicity, insurance, need for medical clearance, and scheduled block time. A univariable analysis was then utilized to assess surgical wait times by clinical setting for each insurance type.ResultsFive hundred forty patients were identified with a median age of 45.6 years (range 16–87). Average surgical wait time was 27 days (range 1–288 days). In multivariable analysis, longer surgical wait times were associated with being seen preoperatively in a FQHC compared to the private practice setting (102% longer, 59.5 days vs. 22 days, p < 0.0001), and with needing medical clearance (56.4% longer, 45 days vs. 22 days. p = 0.0001).ConclusionsThese results suggest that in benign gynecology, surgical wait times are significantly influenced by the practice setting in which a patient gets care, with notable delays in care among patients who are seen in a federally qualified health center preoperatively.

Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students

ABSTRACT Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students’ development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students’ Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students’ intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

Crossing The Great Divide: South Asia High-Performance Work Systems

This study discusses qualitative research to profoundly understand South Asia's high-performance work systems (HPWS) development based on the Ability, Motivation, and Opportunities (AMO) model. Further, this study classifies three distinctive types of human resource (HR) practices — Takeuchi et al. (2007), Sun et al. (2007), and Chuang and Liao (2010) — into different sets of HR practices. Obtaining the conceptual concepts from the HPWS literature, this study tries to enhance our understanding by acquiring realistic ideas to propose a conceptual model involving several open questions that may provide scholars and practitioners more insights into understanding what HR practices constitute South Asia HPWS.

Association of Academic Physiatrists Residency and Fellowship Program Directors' Resident Recruitment Subcouncil Position Paper on Residency Recruitment.

Residency recruitment practices have undergone significant changes in the last several years. Interviews are now conducted fully virtually leading to both positive and negative downstream effects, including decreased cost to applicants and programs, decreased time away from clinical activities, flexibility in scheduling, and increased applications for applicants and program directors. In response to these changes, the Association of Academic Physiatrists Residency and Fellowship Program Directors Council convened a workgroup consisting of program directors, program coordinators, residents, and medical students who reviewed the available literature to provide an evidence-based set of best practices for program leaders and applicants. Available data from the Association of American Medical Colleges and its relevance to future recruitment cycles are also discussed.

An Enhanced Path Finder Algorithm for the estimation of the stator current envelope to detect rotor bar breakage in an induction motor

The Enhanced Path Finder Algorithm (EPFA) is used in this research to present an innovative approach for examining the state of the rotor bars in an induction motor, employing a hybrid metaheuristic algorithm. Compared to current optimization techniques, the suggested approach permits more balanced exploration and exploitation. The method addresses the drawbacks of traditional analysis of fault related frequencies, such as short data length, spectrum leakages, and inadequate sampling frequency. The primary goal of this research is to identify the twice-slip frequency component and its harmonics in the current envelope that correlates with the fault. The A signal model of the stator current envelope and the residual error function have been used to define a nonlinear least-squares problem. An induction machine model has been developed in 2D ANSYS Maxwell software where faults have been implemented and studied. Finally, the efficiency of the fault detection scheme has been verified with a practical data set.

Prevalence and patterns of comorbidities in older people with type 2 diabetes in Australian primary care settings.

The aim of this study was to identify the prevalence and patterns of comorbidity in community-dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia. This study involveda cross-sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub-study data. In a series of sub-studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper-based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns. Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6-70.0), followed by arthritis 52% (95% CI: 48.8-54.8), hyperlipidaemia 45% (95% CI: 41.8-47.9), ischemic heart disease, 23% (95% CI: 20.7-24.9), depression 16% (95% CI: 48.8-54.8), atrial fibrillation 10% (95% CI: 8.9-11.6), congestive heart failure 7% (95% CI: 6.0-8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4-8.2) and peripheral vascular disease 5% (95% CI: 4.4-6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure. The prevalence of cardiovascular and non-cardiovascular comorbidities in community-dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long-term care for this population.

Effects of weather shocks on multidimensional rural poverty: evidence for Colombia

ABSTRACT The increasing frequency of extreme weather events related to climate change is expected to affect the agricultural sector negatively. Therefore, rural populations in developing countries, most of which lack access to risk-coping mechanisms, are likely to suffer a reduction in income, consumption, and capital accumulation, increasing rural poverty. In this study, we assess the impact of weather shocks on rural poverty using an adjusted multidimensional poverty index in a developing country highly vulnerable to climate change. We also explore the mediation effect of crop yields identified by previous literature as a potential transmission mechanism from weather shocks to poverty. Finally, we analyze a set of farming practices that may mitigate the consequences of droughts on yields. The aggregate estimations indicate that droughts increase poverty rates by 6 percentage points, whereas the excessive rainfall shock does not have a statistically significant effect. We further find that crop yields are a transmission mechanism through which droughts impact rural poverty for some crops. However, droughts’ direct effect is larger than its mediating effect through yields. Findings suggest that agricultural practices, such as using farm equipment and fertilizer, can help attenuate droughts’ negative effects on yields for plantains and cassava.

Development of an Autonomous Component Testing System with Reliability Improvement Using Computer Vision and Machine Learning

This study evaluated computer vision-based models, including Histogram Analysis, Logistic Regression, Sift-SVM, and Deep learning models, in an autonomous testing system developed for smartphone camera modules. System performance was assessed in a practical factory setting with workers operating the system, and metrics such as processing time, sensitivity, specificity, accuracy, and defect rate were evaluated. Based on the results, the Sift-SVM model demonstrated the greatest potential for enhancing the reliability of the system with a processing time of 0.01578 seconds, a sensitivity of 99.811%, and a reduction in the failure rate to 1888 PPM. The study findings suggest that Sift-SVM has the potential to be practically applied in the industry, thus improving the speed and accuracy of automatic defect detection in manufacturing and reducing the defect rate.

Practitioner Perspectives on Occupation-Based Practice Across Varied Settings

Occupation-based practice (OBP) is considered a cornerstone of occupational therapy practice. However, there is no consensus-based definition of OBP, let alone agreement on its mediators across practice settings. To describe how OBP is currently conceptualized and enacted across different practice settings, a descriptive qualitative approach of focus groups and elicitation of visual data (e.g., photographs, video recordings) was used with 65 participants. Multiple rounds of qualitative data analysis were used to identify codes and themes. Three themes were identified: (a) contextual factors of OBP, (b) client status, and (c) temporal characteristics of OBP. OBP is influenced by institutional, historical, and temporal aspects of practice settings, with further exploration needed across different practice settings and occupational therapy pedagogy styles. Considering the influence of contextual aspects may support occupational therapy practitioners and researchers’ efforts to support their advocacy for occupation as a foundational concept in the profession.

Practical and malicious private set intersection with improved efficiency

We propose a novel two-party private set intersection (PSI) protocol, which achieves ideal and constant receiver-to-sender and linear sender-to-receiver communication overhead, linear computational complexity, along with receiver size-hiding and lightweight computation cost. In comparison with other PSI protocols, the proposed protocol is more practical as it does not require any fully homomorphic computation. We propose three variants to demonstrate efficiency optimization, size-hiding feature extension, and online/offline settings for real-world applications, respectively, to offer a practical control between security and efficiency. Finally, we prove that our proposed protocols are secure against malicious participants under our security model.

Graduate training, credentialing, and continuing education to prepare genetic counselors for laboratory roles—Results of a national survey

AbstractOpportunities for genetic counselors to work in a variety of practice settings have greatly expanded, particularly in the laboratory. This study aimed to assess attitudes of genetic counselors working both within and outside of the laboratory setting regarding (1) the re‐wording and/or expansion of key measures of genetic counselors' competency, including practice‐based competencies (PBCs) and board examination, to include laboratory roles, (2) preparation and transferability of competencies developed in master's in genetic counseling (MGC) programs to different roles, (3) need of additional training for genetic counselors to practice in laboratory settings, and (4) preferred methods to obtain that training. An e‐blast was sent to ABGC diplomats (N = 5458) with a link to a 29‐item survey with 12 demographic questions to compare respondents to 2021 NSGC Professional Status Survey (PSS) respondents. Statistical comparisons were made between respondents working in the laboratory versus other settings. Among 399 responses received, there was an oversampling of respondents working in the laboratory (52% vs. 20% in PSS) and in non‐direct patient care positions (47% vs. 25% in PSS). Most respondents agreed the PBCs were transferable to their work yet favored making the PBCs less direct patient care‐focused, expanding PBCs to align with laboratory roles, adding laboratory‐focused questions to the ABGC exam, and adding laboratory‐focused training in MGC programs. Most agreed requiring post‐MGC training would limit genetic counselors' ability to change jobs. Genetic counselors working in the laboratory reported being significantly less prepared by their MGC program for some roles (p &lt; 0.001) or how the PBCs applied to non‐direct patient care positions (p &lt; 0.001). Only 53% of all respondents agreed that NSGC supports their professional needs and others in their practice area, and genetic counselors working in the laboratory were significantly less likely to agree (p = 0.002). These sentiments should be further explored.

Inappropriate Identities: Racialized Language Ideologies and Sociolinguistic Competence in a Study Abroad Context

Abstract This article examines cases where two study abroad students—Rita and Jack—problematized the normative use of specific dialectal variants by local native speakers at the end of their Spanish immersion program in Peru. Specifically, it explores what these cases reveal about second language learners’ sociolinguistic competence in a study abroad context involving their knowledge of native speaker norms and the contextual appropriateness of target language variation. An analysis of ethnographic data suggests that Rita and Jack interpreted the appropriate use of sociolinguistic variation from the local variety of Andean Spanish by drawing on prevalent racialized language ideologies in the host community that link non-standard variants to an indigenous identity imagined as incompetent in Spanish. These findings validate a need for alternative analytic frameworks that conceptualize second language learners’ development of sociolinguistic competence in terms of language ideologies rather than objective sets of normative native speaker practices. This study advances calls to develop L2 learners’ critical language awareness through curricular innovation and critical pedagogies in study abroad programs.

Current practice focus trends in physical medicine and rehabilitation.

Physical medicine and rehabilitation (PM&R) is a diverse specialty, growing and evolving over a variety of subspecialty and practice focus areas. Accurate data regarding practice patterns of physiatrists are essential for updating requirements in training and certification, particularly as the Accreditation Council for Graduate Medical Education begins its process to update of the PM&R core residency training requirements. This study analyzes practice trends for nearly 98% of physiatrists in active practice, the largest study to date. To update current demographics of physicians specializing in PM&R, including current areas of practice focus, to analyze the alignment of practice focus with subspecialty certification, and to determine the extent that electromyography is a component of current physiatric practice. Retrospective analysis of deidentified responses from American Board of Physical Medicine and Rehabilitation (ABPMR) board-certified PM&R physicians (diplomates) on annual enrollment in the ABPMR Continuing Certification program. A total of 9543 ABPMR diplomates. Demographics - age, gender, years in practice, practice setting(s) and area(s). Practice focus, subspecialty certifications. The majority of practicing physiatrists are men (62%) although the percentage of women in the field is growing (38%). Nearly 80% of physiatrists report more than one practice focus area, with pain medicine and sports medicine/musculoskeletal practices most commonly reported. This study confirms the growth trends in PM&R in pain and sports medicine but also highlights the substantial number of physiatrists focusing their practices in areas related to neurorehabilitation and medical rehabilitation. The large majority of physiatrists incorporate multiple focus areas into their practices. Electromyography is a focus for a declining percentage of practicing physiatrists.

Adsorption of crystal violet using a composite based on graphene Oxide-ED@Cellulose: Adsorption modeling, optimization and recycling

The current work, provides the results of a study related to the synthesis of composite based on ethylene diamine modified reduced graphene oxide and cellulose (rGO-ED@Cellulose) to improve the dispersion of GO sheets. After improving its properties, the composite was employed for the adsorption of crystal violet, a cationic dye. Point zero charge (pHPZC) was used to characterize the composite, in addition to other methods including X-ray diffraction, scanning electron microscopy, and energy dispersion X-ray spectroscopy (FTIR, XRD, and SEM/EDS). Studies on batch adsorption were conducted with operational parameters such as contact time, dosage of the adsorbent, concentration of the dye, pH, and temperature. The optimal parameters found were t = 80 min, 10 ppm, pH = 6, m = 0.1 g and T = 25 °C, this resulted in a capacity of adsorption of crystal violet value of 260 mg. g−1 and an adsorption efficiency of 88 %. The kinetic study showed that the adsorption of the cationic CV dye on the composite follows a pseudo 2nd order model kinetic. The Langmuir model was found to be a good fit for the isothermal data of the crystal violet adsorption by the composite study and the adsorption process is exothermic. A statistical model was used to assess the efficacy of CV adsorption on rGO-ED@Cellulose composite surface locations. The evaluation was carried out in a practical setting, utilizing a three-level Response Surface Methodology (RSM) based on Box-Behnken Design and the Expert Design software package.