Practice Gap Research Articles

Leveraging implementation science theories to develop and expand the use of a penicillin allergy de-labeling intervention

BackgroundPenicillin allergy is the most frequently reported drug allergy, yet most patients can tolerate the drug if challenged. Despite this discrepancy, large scale penicillin allergy de-labeling interventions have not been widely implemented in many health care systems. The application of a multi-method implementation science approach can provide key tools to study this evidence to practice gap and provide insight to successfully operationalize penicillin allergy evaluation in real-world clinical settings.MethodsWe followed a four-step process that leverages qualitative analysis to design evidence-based, actionable strategies to develop an intervention. First, we specified the clinician-perceived barriers to penicillin allergy de-labeling (intervention targets). We then mapped intervention targets onto Theoretical Domains Framework (domains and constructs) and found the root causes of behavior. Next, we linked root causes of behavior with intervention functions (BCW). In the final step, we synthesized participants’ suggestions for process improvement with implementation strategies aligning with the intervention functions.ResultsEvidence-based strategies such as focused education and training in penicillin allergy evaluation can address knowledge and confidence barriers reported by frontline clinicians. Other key strategies involve developing a system of champions, improving communications systems, and restructuring the healthcare team. Implementation mapping can provide a powerful multi-method framework to study, design, and customize intervention strategies. Conclusion: Empowering clinicians beyond allergy specialists to conduct penicillin allergy assessments requires designing new workflows and systems and providing additional knowledge to those clinicians.

Atherosclerotic cardiovascular disease following a diagnosis of idiopathic inflammatory myopathy: analysis from a retrospective cohort in the TriNetX registry.

Idiopathic inflammatory myopathies (IIM) confer an increased risk of morbidity from atherosclerotic cardiovascular disease (ASCVD). While ASCVD risk has been studied in other countries, these results may not be applicable to patients with dermatomyositis (DM) and polymyositis (PM) in the United States. This retrospective analysis of a cohort of patients identified by ICD code from TriNetX investigated the incidence of ASCVD after International Classification of Disease (ICD) codes of DM, PM, dermatopolymyositis (DPM) or juvenile dermatomyositis (JDM). Patients were identified by entry of two ICD codes separated by at least 6months, according to their first diagnosis code; ASCVD was defined as first ICD code for myocardial infarction, ischemic stroke, transient ischemic attack, or peripheral arterial disease. Cox proportional hazards regression modeled time from first IIM ICD code to ASCVD event. A total of 35,554 patients were identified with the mean age at first IIM code of 54 and 26.1% were male. The most common comorbidity for all groups except JDM was hyperlipidemia (39.9%) though 79.2% of patients were on no cholesterol lowering medication. ASCVD occurred in 30.4% of patients with PM, 24.3% of patients with DM and 0.9% of patients with JDM. Patients with PM had a median time to event of 9.7years (95% Confidence interval (CI) 9.1, 10.7) and 14.3years (95% CI 12.6, 14.8) for DM. This study demonstrates that ASCVD is a comorbidity occurring after a median of 12.5years (95% CI 11.9, 13.6) in patients with IIM. ASCVD appears to be a long-term complication for IIM patients occurring in nearly a quarter of US patients without prior ASCVD with at least two ICD codes for IIM, with a median time to event of 12.5years. There appears to be a practice gap in the recognition and treatment of hyperlipidemia in these patients. Key Points • Hyperlipidemia was a common comorbidity identified in patients with IIM though most patients were not on cholesterol lowering medication. • Development of ASCVD appears to be a long-term complication for patients with IIM in the United States.

Evaluation of E-Learning Platforms under the EASTRIP Project: Enhancing Competency-Based Education and Training through Holographic Technology in Dar Es Salaam, Tanzania

This study delved into the use of hologram technology to bridge the practical learning gaps in the Competency-Based Education and Training framework when using E-learning platforms. The study utilized a convergent mixed-method, combining quantitative and qualitative approaches. The study focused on 26 public tertiary learning institutions located in Dar es Salaam. It selected 14 widely used e-learning platforms for a comprehensive analysis, ensuring diverse representation. The study's statistical treatment included descriptive statistics and content analysis. The study concluded that the platforms are crucial in delivering content and in teaching, uploading lecture notes and administering tests. However, the use of technology in final examinations and practical assignments indicates notable gaps that need addressing, requiring advanced technologies such as hologram. Addressing these gaps will require technological advancements and continuous professional development for academic staff to optimize the use of e-learning platforms and ensure they meet the comprehensive needs of modern education. This holistic approach will strengthen the alignment of e-learning practices with the CBET framework, fostering a more effective and inclusive learning environment.

Physicians’ Self-Reported Knowledge and Behaviors Related to Prescribing Opioids for Chronic Pain and Diagnosing Opioid Use Disorder, DocStyles, 2020

IntroductionIn 2016, CDC released the Guideline for Prescribing Opioids for Chronic Pain (2016 CDC Guideline) to improve opioid prescribing while minimizing associated risks. This analysis sought to understand guideline-concordant knowledge and self-reported practices among primary care physicians (PCPs). MethodsData from Spring DocStyles 2020, a cross-sectional, web-based survey of practicing U.S. physicians was analyzed in 2022 and 2023. Demographic, knowledge, and practice characteristics of PCPs overall (N=1,007) and among specific subsets 1) PCPs who provided care for patients with chronic pain (n=600), 2) PCPs that did not provide care for patients with chronic pain (n=337), and 3) PCPs who reported not obtaining or seeking a buprenorphine waiver (n=624) were examined. ResultsA majority of physicians (72.6%) were unable to select a series of options consistent with diagnostic criteria for opioid use disorder (OUD); of those physicians, almost half (47.9%) reported treating at least one patient with medications for OUD. A minority of physicians (17.5%) reported having a buprenorphine prescribing waiver. Among physicians who prescribed opioids for chronic pain (88.5%), 54.4% concurrently prescribed benzodiazepines. About one-third (33.5%) reported not taking patients with chronic pain. ConclusionsThere were critical practice gaps among PCPs related to 2016 CDC Guideline topics. Increasing knowledge of CDC's opioid prescribing recommendations can benefit physician practice, patient outcomes, and public health strategies in addressing the opioid overdose crisis and implementing safer and more effective pain care.

Scoping review protocol: what is the state of evidence for the use of communication apps with immigrant seniors in long-term care and community settings?

First language care is critical for older immigrant adults with limited English proficiency, especially in long-term care settings where most residents require staff assistance and experience complex chronic conditions, resulting in multiple communication interactions where language poses a barrier. Although there are a myriad of cultural-language translation apps and devices available, there is a gap in both research and practice on the acceptability and feasibility of these digital resources within the context of long-term care and community settings for older immigrant adults, from a cultural relevance and digital health equity perspective. Our paper outlines a scoping review protocol to examine the state of the literature on the extent to which cultural-language translation apps are used in long-term care settings and community-based elder care. We will also examine the extent to which such apps bridge or further gaps in equitable, accessible and acceptable care for older immigrant adults with limited English language proficiency. This scoping review protocol will employ an adapted five-stage framework outlined by Arksey and O'Malley guided by enhancements recommended by Levac et al and Colquhoun et al. Using the Joanna Briggs Institute's population, concept and context framework, we defined the scope of the scoping review by identifying the target population, concepts for investigation and the context within which the research is situated. We will conduct a search of the literature from 2005 to 2024 using five bibliographic databases from health sciences (Healthstar OVID, MEDLINE OVID and Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO), engineering (Engineering Village Elsevier) and a cross-disciplinary database (Web of Science Clarivate). The research team will adopt a critical, equity-focused approach for the scoping review by integrating Richardson et al's framework for Digital Health Equity into our analysis of the findings. This will ensure that health and social equity perspectives are integrated within our methodology and analytical lens. Our analysis will specifically examine selected studies for their engagement with health equity and their ability to address issues such as ageism, ableism and the digital divide within geriatric care. Ethics approval is not required for this scoping review as it involves secondary analysis of published works and no primary data collection involving human subjects. Findings of the review will be shared with community partners and disseminated through publications, conferences and peer-reviewed publications.

Awareness, knowledge, attitude, and practice of adverse drug reaction reporting among health workers in primary health centres participating in seasonal malaria chemoprevention campaign in Nigeria in 2022: a cross-sectional survey

BackgroundEvaluating health workers’ knowledge and practice of adverse drug reaction (ADR) reporting is an important step in identifying gaps in quality ADR reporting during public health interventions like the seasonal malaria chemoprevention (SMC) campaign. Pharmacovigilance (PV) monitoring is vital in SMC due to the number of children exposed to malaria medicines for a period of 4 or 5 months during the campaign. In Nigeria more than 10 million children are exposed to SMC medicines every year. The scale of this intervention emphasised the need for efficient and effective safety monitoring during the campaign. Thus, the objective of this study was to evaluate healthcare workers’ (HCW) awareness, knowledge, attitude and practice (KAP) of ADR reporting in health facilities participating in SMC campaign to identify pharmacovigilance gaps which may suggest possible ways to ensure safety during the campaign.MethodsWorld Health Organization’s service availability and readiness assessment (SARA) recommendations were used to sample 2,598 out of 5,195 used as supervising health facilities (HFs) during the 2022 SMC campaign across nine states of the country. Out of the sampled HFs, 2,144 eligible and consented health facility workers (HFWs) were assessed for awareness, and KAP of ADR using the validated 45-item self-administered questionnaire. The data was analysed using descriptive statistics and correlation analysis at p < 0.05.ResultsThe majority of the respondents are males (n = 1,333, 62.2%). The HFWs showed good awareness (n = 2,037, 95.0%) of pharmacovigilance (PV). However, only 809 (37.7%) of them had good knowledge scores. The mean ADR reporting attitude score (85.0 ± 15.3%) was good with many of the respondents (n = 1,548, 72.2%) having a good score. However, the respondents’ ADR practice was suboptimal, only 1,356 (63.2%) of them had encounters with ADR, and a lot of negative perceived barriers to ADR reporting were identified in the study. For example, 493 (23%) believed that ADRs were not reported because they were not serious and life-threatening while 248 (11.6%) reported a fear of liability. Correlation analysis revealed female gender (r = 0.163, p < 0.001), older age (r = 0.207, p < 0.001) and years of practice (r = 0.050, p = 0.021) as factors significantly associated with ADR knowledge and attitude scores.ConclusionThe study indicated that HCWs across health facilities participating in SMC campaigns have ADR reporting knowledge and practice gaps. The study suggest training alone may not be effective in addressing gaps in ADR reporting. In addition to PV training, implementers can include continuous mentoring of health care workers or other similar interventions as part of strategy to improve ADR reporting. Also, context specific strategies to improve ADR reporting among health care worker needs to be implemented to address under-reporting of ADRs during SMC campaigns and other malaria public health interventions.

Improving Person-Centered Depression Screening and Care in an Urban Faith-Based Community

Background:Depression is a common mental illness that increases the risk of suicide, substance abuse, and chronic pain. Nationally, 21 million adults have had one untreated depressive episode, 1.4 million people have had suicide attempts, and 1 death occurs every 10 minutes. Depression has an annual economic burden of $326 billion for the American economy.Objectives:This quality improvement project aims to review the existing literature on depression, audit local businesses, survey clients, and team members to identify a gap in practice and then collect and analyze data to draw conclusions and make recommendations based on the findings.Methods:This initiative used four Plan–Do–Study–Act rapid quality improvement cycles. Data were collected and analyzed, and the results were used to make iterative changes.Results:Depression screening improved by 90%, and 317 clients were screened over 8 weeks. Twenty-eight percent of those screened had depression and were engaged in managing their symptoms. Both screening and care improved, and the aim of 89% was met.Conclusions:This initiative bridged a gap in depression screening and care. It also demonstrated a positive outcome, had the potential for sustainability, and spread to other faith communities.Implications for Nursing:A system should be put in place for depression screening, care, and referrals.

Surgical Skill Decay as a Result of the COVID-19 Pandemic.

This study aimed to objectively evaluate the impact of the gap in surgical practice caused by COVID-19 on surgical skill decay. This retrospective cohort study enrolled 148 cases of adult patients who were qualified for elective or urgent laparoscopic cholecystectomy. This study compared the period of nine months before the pandemic outbreak and nine months after the end of the pandemic. We analyzed the duration of surgery, the number of intraoperative adverse events (IAEs), postoperative complications (PCs), and differences between the surgeries performed by residents and those performed by specialists. The number of IAEs did not differ significantly between groups (after COVID-19 (AC) and before COVID-19 (BC)). A difficult gallbladder (DGB) was associated with an increased risk of IAEs during surgery in both groups (BC:OR = 2.94, p = 0.049; AC:OR = 2.81, p = 0.35). The multivariate analyses showed no significant differences in IAEs or PCs when the residents performed surgeries compared to specialists. The average duration of surgery was significantly longer in the post-pandemic group (BC-102.4 min vs. AC-119.9 min, p = 0.024). Measurable determinants of surgical skills are the duration of surgery and the number of intraoperative adverse events. By defining this indicators, our study objectively shows that the reduction in the volume of surgeries during COVID-19 resulted in a phenomenon known as surgical skill decay.

Opioid Prescription Practices and Risk Management among Physicians in Morocco

The opioid crisis represents a major public health challenge globally, notably in the United States where it has resulted in significant morbidity and mortality. In Morocco, the patterns of opioid prescription and the factors influencing these practices are not well documented. This study aims to explore the socio-demographic characteristics, professional backgrounds, and opioid prescription practices among physicians in Morocco. Utilizing a cross-sectional survey design, data were collected from 123 physicians across various regions. The findings indicate that specialist doctors, particularly those in urban public sectors, are more likely to prescribe opioids, with codeine, tramadol, and morphine being the most common. These opioids are primarily prescribed for cancer pain, rheumatic pain, and post-operative pain. The study underscores the necessity of targeted interventions to address gaps in opioid prescription practices and to enhance risk management strategies among physicians.

Where’s the Peanut Butter? Journaling about Science Practices in Everyday Life

ABSTRACT Teacher candidates kept journals for one semester, documenting the science content and practices they encountered in their daily lives, while their professor provided detailed written feedback. The objective of this study was to determine gaps in everyday science practices, and to eventually design interventions which might help teacher candidates relate all the NGSS science practices to their students’ lives. The most common NGSS science practices documented were asking questions and obtaining, evaluating, and communicating information. The least documented practices were analyzing and interpreting data and using mathematics and computational thinking. This assignment helped teacher candidates develop their identity as scientists, notice more science in their daily lives, and helped them bridge the gap from everyday applications of science to their classroom lessons. They found the exercise to be empowering, challenging, interesting, and enjoyable. Professor feedback on the journal entries was the most motivating aspect of the assignment. This study revealed gaps in the science and engineering practices that preservice science teachers experience in their lives.

The Evolution of Futures and Options Markets: From Agricultural Roots to High-Frequency Trading

The evolution of futures and options markets from simple agricultural hedging tools to complex financial instruments has been marked by significant technological advancements, particularly the advent of electronic trading and high-frequency trading (HFT). This paper traces the development of these markets, highlighting key milestones and innovations that have shaped their current form. High-frequency trading, while enhancing liquidity and reducing transaction costs, has also introduced significant challenges, including increased market volatility, the potential for market manipulation, and systemic risks, as seen in events like the 2010 Flash Crash. This research provides a comprehensive analysis of the legal and regulatory frameworks governing futures and options markets, with a focus on both Indian and international contexts. It examines the effectiveness of existing regulations in addressing the challenges posed by modern trading practices and explores the need for continuous adaptation in regulatory approaches. Through a detailed review of relevant case laws, statutory provisions, and scholarly literature, the paper identifies gaps in current regulatory practices and proposes recommendations to enhance market transparency, fairness, and stability. The study concludes that while the evolution of futures and options markets has brought undeniable benefits in terms of efficiency and risk management, these markets must be carefully regulated to mitigate the risks associated with high-frequency and algorithmic trading. Adaptive regulatory frameworks, enhanced transparency measures, and international cooperation are essential for ensuring that these markets continue to contribute positively to the global financial system.

Impact of unprecedented drought in intensive subsistence agriculture and food security: issues, policy practice gap and the way forward

Impact of unprecedented drought in intensive subsistence agriculture and food security: issues, policy practice gap and the way forward

Identifying Care Gaps and Referral Patterns in Acute Dermatology at Urgent Care Centers.

Limited urgent access to board-certified dermatologists drives patients to seek dermatologic care at urgent care centers (UCC). UCC are staffed by clinicians with comparatively limited dermatology training, often resulting in lower quality care for acute dermatology conditions. This study investigates health care referral outcomes of patients seeking dermatologic care at UCC, examine the appropriateness of UCC dermatologic care, and assess the feasibility of referral management by eConsult. We utilize a retrospective cohort of 807 patients and a provider survey to examine referral outcomes of patients referred to University of Rochester Dermatology (UR-Derm), a tertiary care university-based teaching hospital, from UR UCC between January 1, 2021, and August 31, 2022. Outcomes for healthcare referrals included patient demographics, referral completion rates, UR-Derm appointment wait times, and diagnostic concordance rates between UCC and UR-Derm. Outcomes from the provider survey included appropriateness of UCC treatment plans, appropriateness of UCC referral to UR-Derm, and feasibility of referral management by eConsult. Patients who utilized UCC were predominately white (77.0%) females (53.9%) with a mean age of 37.9 years. Most patients referred by UCC did not complete an in-person UR-Derm evaluation (58.6%). Of those who did complete a UR-Derm visit, the average wait time was 38.3 days. Only 56% of UCC and UR-Derm diagnoses were concordant. Our surveyed dermatologists deemed 30% of the UCC treatment plans appropriate. The majority of referrals (83.5%) were viewed as manageable with an eConsult with only 10% of referrals requiring in-person visit. Several practice gaps exist in specialty care delivery in UCC and additional inefficiencies exist in the urgent referral process. These gaps could be addressed by targeted educational interventions and availability of dermatology consultation to support urgent care.

Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health.

This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.

Bridging K-12 Student Mental Health Policy to Practice Gaps with a Multi-Component Framework

K-12 schools are a major sector for efforts to prevent and treat student mental health problems. In the United States, these efforts have led to the emergence of the MultiTiered System of Supports (MTSS) universal prevention, early intervention, and treatment policy framework. With a major focus on behavioral and mental health, MTSS has been adopted by all fifty state education departments. However, multi-level complexities of addressing student mental health within and across organizational structures complicate MTSS and broader policy development, implementation, and evaluation; disconnects between policy writers and practitioners obstruct progress, limiting positive outcomes. To bridge these policy-to-practice gaps, a multi-component solution is needed. The authors propose integrating the following elements: the Massachusetts School Mental Health Consortium’s Five Guiding Principles for Building a Coordinated School Mental Health System, the comprehensive school improvement methodology Evolutionary Systems Improvement (ESI); and the ontological framework of BioPsychoSocioTechnical Systems Theory (BPST). Individual application of these components has already yielded systems-level improvements outperforming compliance-driven procedures. Used together, these components offer a multi-level solution for establishing conceptually-guided, measurement-based loops that transcend the restrictions of uninformed policy, supporting stakeholders as they work to systematically eliminate barriers and improve student mental health.

Policy and Practice Gap in Continuous Assessment System Provisioned Under Integrated Curriculum

Policy and Practice Gap in Continuous Assessment System Provisioned Under Integrated Curriculum

Suicide Prevention Training for Social Work Students in Rural Practicum Placements: Current Opportunities and Areas for Growth

ABSTRACT Students and practicum instructors in a primarily rural state were surveyed about suicide prevention practice and training opportunities provided to social work trainees during their practicum placements. A cross-sectional, electronic survey was administered to N = 86 students and N = 64 practicum instructors and descriptive statistics were analyzed. Most students (87.1%) and practicum instructors (86.6%) felt that students should have the opportunity to engage with suicidal clients while in practicum. Many students reported having had contact with a suicidal client while in practicum (70.6%) and had engaged in some sort of practice related to suicide prevention (82.6%). The most frequently reported practice behaviors were suicidal inquiry (62.8%), risk assessment (60.7%), disposition planning (51.0%), and safety planning (49.0%). Over half (52.9%) had not used any evidence-based tools for screening and follow-up and only one quarter (25.5%) had provided postvention services. Many students (72.9%) were concerned about iatrogenic risk. Although most practicum instructors felt comfortable addressing suicide prevention in supervision (74.4%), many (64.1%) also reported the desire for additional training. Although students appear to have opportunities to engage in suicide prevention in practicum, there are specific knowledge and practice gaps regarding evidence-based tools, postvention, and the “myth” of iatrogenic risk.

A pragmatic, stepped-wedge, hybrid type II trial of interoperable clinical decision support to improve venous thromboembolism prophylaxis for patients with traumatic brain injury

BackgroundVenous thromboembolism (VTE) is a preventable medical condition which has substantial impact on patient morbidity, mortality, and disability. Unfortunately, adherence to the published best practices for VTE prevention, based on patient centered outcomes research (PCOR), is highly variable across U.S. hospitals, which represents a gap between current evidence and clinical practice leading to adverse patient outcomes.This gap is especially large in the case of traumatic brain injury (TBI), where reluctance to initiate VTE prevention due to concerns for potentially increasing the rates of intracranial bleeding drives poor rates of VTE prophylaxis. This is despite research which has shown early initiation of VTE prophylaxis to be safe in TBI without increased risk of delayed neurosurgical intervention or death. Clinical decision support (CDS) is an indispensable solution to close this practice gap; however, design and implementation barriers hinder CDS adoption and successful scaling across health systems. Clinical practice guidelines (CPGs) informed by PCOR evidence can be deployed using CDS systems to improve the evidence to practice gap. In the Scaling AcceptabLE cDs (SCALED) study, we will implement a VTE prevention CPG within an interoperable CDS system and evaluate both CPG effectiveness (improved clinical outcomes) and CDS implementation.MethodsThe SCALED trial is a hybrid type 2 randomized stepped wedge effectiveness-implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be assessed using the RE2-AIM planning and evaluation framework. Efforts will be made to ensure implementation consistency. Nonetheless, it is expected that CDS adoption will vary across each site. To assess these differences, we will evaluate implementation processes across trial sites using the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework (a determinant framework) using mixed-methods. Finally, it is critical that PCOR CPGs are maintained as evidence evolves. To date, an accepted process for evidence maintenance does not exist. We will pilot a “Living Guideline” process model for the VTE prevention CDS system.DiscussionThe stepped wedge hybrid type 2 trial will provide evidence regarding the effectiveness of CDS based on the Berne-Norwood criteria for VTE prevention in patients with TBI. Additionally, it will provide evidence regarding a successful strategy to scale interoperable CDS systems across U.S. healthcare systems, advancing both the fields of implementation science and health informatics.Trial registrationClinicaltrials.gov– NCT05628207. Prospectively registered 11/28/2022, https://classic.clinicaltrials.gov/ct2/show/NCT05628207.

Threats of tropical cyclone on cropping systems and crop calendar of rice in India: Issues, policy practice gap and adaptation strategies

The Food and Agriculture Organization (FAO) has calculated that by 2050, we will need to grow 60 % more food to provide for a population of 9.3 billion people worldwide. India must increase its yearly food grain production from the current level of 252–333 million tonnes by 2050 in order to fulfil its expanding population demand. India is one of the nations most at risk from climate change due to its geophysical location and variability. This research explored the impact of cyclonic storm surges on crop calendars (‘Aman’ and ‘Boro’ rice) and also suggested adaption strategies during these conditions. This study showed that alteration of contemporary rice sowing and harvesting dates significantly impacts achieving sustained yields, surpassing all other crop management, soil, and other criteria. The origin and landfall of the cyclone of the Bay of Bengal (BoB) in pre- and post-monsoon season impede the goal of optimal rice production in Eastern and south-eastern India. We have estimated that ‘Rabi’ and ‘Kharif” rice production potential will increase by about 29 % with attainable changes to rice sowing and harvesting dates incorporating the severe cyclonic storm (SCS) landfall and rainfall in the study area. Our results also show that transformational benefits in rice yields are only possible in India if the convectional crop calendar changes with the modern scientific crop calendar. Managing the seasonal cropping calendar more effectively can benefit food security, economic success, and climate adaptability rice seed as a method for adaptation to ongoing climate change.

Testicular cancer awareness among fifth and sixth-year medical students

Background and objectiveThe aim of this study is to determine the knowledge, attitudes, and behaviors regarding testicular cancer and testicular self-examination (TSE) among medical faculty students in their last two semesters before beginning clinical practice. This study also investigates their beliefs about the importance and efficacy of these practices in early cancer detection.Materials and methodsThis descriptive study was conducted between October 1, 2018, and July 31, 2019, involving both male and female students in the 5th and 6th grades of a medical faculty. A total of 278 students participated, providing insights into their level of awareness and engagement with TSE practices.Results52.2% of the students were aware of self-testicular examination, yet only 15.5% of male students reported performing TSE regularly. 13.3% of students reported receiving formal training on this topic during their medical education, and a mere 2.9% observed these examinations demonstrated in clinical settings. Champion’s Health Belief Model Scale indicated average sensitivity scores of 11.01 ± 4.36, perceived severity of 20.58 ± 5.92, perceived benefits of 11.46 ± 2.99, perceived barriers at 10.14 ± 4.04, and self-efficacy scores at 18.64 ± 5.26.Conclusion and recommendationsThe findings suggest that while medical students recognize the seriousness and benefits of TSE, there is a notable gap in regular practice and educational exposure. Increased educational efforts are recommended to enhance sensitivity and self-efficacy related to testicular cancer screening among future healthcare providers.