Practice Patterns In Management Research Articles

International practice patterns of dyslipidemia management in patients with chronic kidney disease under nephrology care: is it time to review guideline recommendations?

BackgroundIn contrast to guidelines related to lipid therapy in other areas, 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend conducting a lipid profile upon diagnosis of chronic kidney disease (CKD) and treating all patients older than 50 years without defining a target for lipid levels. We evaluated multinational practice patterns for lipid management in patients with advanced CKD under nephrology care.MethodsWe analyzed lipid-lowering therapy (LLT), LDL- cholesterol (LDL-C) levels, and nephrologist-specified LDL-C goal upper limits in adult patients with eGFR < 60 ml/min from nephrology clinics in Brazil, France, Germany, and the United States (2014–2019). Models were adjusted for CKD stage, country, cardiovascular risk indicators, sex, and age.ResultsLLT treatment differed significantly by country, from 51% in Germany to 61% in the US and France (p = 0.002) for statin monotherapy. For ezetimibe with or without statins, the prevalence was 0.3% in Brazil to 9% in France (< 0.001). Compared with patients not taking lipid-lowering therapy, LDL-C was lower among treated patients (p < 0.0001) and differed significantly by country (p < 0.0001). At the patient level, the LDL-C levels and statin prescription did not vary significantly by CKD stage (p = 0.09 LDL-C and p = 0.24 statin use). Between 7—23% of untreated patients in each country had LDL-C ≥ 160 mg/dL. Only 7–17% of nephrologists believed that LDL-C should be < 70 mg/dL.ConclusionThere is substantial variation in practice patterns regarding LLT across countries but not across CKD stages. Treated patients appear to benefit from LDL-C lowering, yet a significant proportion of hyperlipidemia patients under nephrologist care are not receiving treatment.

European practice patterns for antiplatelet management in NSTE-ACS patients: Results from the REal-world ADoption survey focus on Acute antiPlatelet Treatment (READAPT) survey

BackgroundThe 2020 European Society of Cardiology (ESC) guidelines for the diagnosis and management of patients with non-ST elevation-acute coronary syndrome (NSTE-ACS) recommend early invasive coronary angiography in high-risk patients and no routine pre-treatment with oral P2Y12 receptor inhibitor in NSTE-ACS patients prior to defining coronary anatomy. ObjectiveTo assess the implementation of this recommendation in the real-life setting. MethodsA web-survey in 17 European countries collected physician profiles and their perceptions of the diagnosis, medical and invasive management of NSTE-ACS patients at their hospital. A sample size of at least 1100 responders permitted the estimation of proportions with a precision of at least ±3.0%. ResultsAmong the 3024 targeted participants, 1154 provided valid feedback defined as a 50% response rate of answers to the survey questions. Overall, >60% of the participants declared full implementation of the guidelines at their institution. The time delay from admission to coronary angiography and PCI was reported to be <24 h in over 75% of the hospitals while pre-treatment was intended in >50% of NSTE-ACS patients. Ad-hoc percutaneous coronary intervention (PCI) was performed in >70% of the cases while intravenous platelet inhibition was rarely used (<10%). Between countries differences in practice patterns for antiplatelet management for NSTE-ACS were observed, suggesting heterogeneous implementation of the guidelines. ConclusionsThis survey indicates that the implementation of 2020 NSTE-ACS guidelines on early invasive management and pre-treatment is heterogeneous, potentially due by local logistical constraints.

Market competition influences practice patterns in management of patients with intermittent claudication in the vascular quality initiative

ObjectiveThe Society for Vascular Surgery (SVS) clinical practice guidelines recommend best medical therapy (BMT) as first-line therapy before offering revascularization to patients with intermittent claudication (IC). Notably, atherectomy and tibial-level interventions are generally discouraged for management of IC; however, high regional market competition may incentivize physicians to treat patients outside the scope of guideline-directed therapy. Therefore, we sought to determine the association between regional market competition and endovascular treatment of patients with IC. MethodsWe examined patients with IC undergoing index endovascular peripheral vascular interventions (PVI) in the SVS Vascular Quality Initiative from 2010 to 2022. We assigned the Herfindahl-Hirschman Index as a measure of regional market competition and stratified centers into very high competition (VHC), high competition, moderate competition, and low competition cohorts. We defined BMT as preoperative documentation of being on antiplatelet medication, statin, nonsmoking status, and a recorded ankle-brachial index. We used logistic regression to evaluate the association of market competition with patient and procedural characteristics. A sensitivity analysis was performed in patients with isolated femoropopliteal disease matched by the TransAtlantic InterSociety classification of disease severity. ResultsThere were 24,669 PVIs that met the inclusion criteria. Patients with IC undergoing PVI were more likely to be on BMT when treated in higher market competition centers (odds ratio [OR], 1.07 per increase in competition quartile; 95% confidence interval [CI], 1.04-1.11; P < .0001). The probability of undergoing aortoiliac interventions decreased with increasing competition (OR, 0.84; 95% CI, 0.81-0.87; P < .0001), but there were higher odds of receiving tibial (OR, 1.40; 95% CI, 1.30-1.50; P < .0001) and multilevel interventions in VHC vs low competition centers (femoral + tibial OR, 1.10; 95% CI, 1.03-1.14; P = .001). Stenting decreased as competition increased (OR, 0.89; 95% CI, 0.87-0.92; P < .0001), whereas exposure to atherectomy increased with higher market competition (OR, 1.15; 95% CI, 1.11-1.19; P < .0001). When assessing patients undergoing single-artery femoropopliteal intervention for TransAtlantic InterSociety A or B lesions to account for disease severity, the odds of undergoing either balloon angioplasty (OR, 0.72; 95% CI, 0.625-0.840; P < .0001) or stenting only (OR, 0.84; 95% CI, 0.727-0.966; P < .0001) were lower in VHC centers. Similarly, the likelihood of receiving atherectomy remained significantly higher in VHC centers (OR, 1.6; 95% CI, 1.36-1.84; P < .0001). ConclusionsHigh market competition was associated with more procedures among patients with claudication that are not consistent with guideline-directed therapy per the SVS clinical practice guidelines, including atherectomy and tibial-level interventions. This analysis demonstrates the susceptibility of care delivery to regional market competition and signifies a novel and undefined driver of PVI variation among patients with claudication.

Real-world practice in Peyronie's disease management: Results from a national survey of urologists.

Despite many available treatments for Peyronie's disease (PD), practice patterns of available therapeutics are not well characterized. We conducted a national survey of urologists to characterize real-world practice patterns of PD management and to characterize the use of therapies discouraged by the American Urological Association guidelines on PD management. A 34-item survey was distributed via RedCap to urologists who treat patients with PD in all American Urological Association sections. Questions elicited demographic information as well as practices in the diagnosis and treatment of PD. Comparisons were made with Pearson's chi-squared test. The primary outcome was reported use of therapies discouraged by the American Urological Association guidelines on PD. A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained versus non-fellowship-trained urologists (85%vs. 54%, p=0.003). The most popular treatment modalities were collagenase clostridium histolyticum (61% of respondents), phosphodiesterase-5 inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the American Urological Association guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, or vitamin E). Patients seeking PD treatment may be offered different therapies, some of which are not evidence-based, depending on the treating urologist. This study is limited by self-selection and response bias. Its strength is that it represents a cross-sectional overview of real-world practice patterns in PD management, which has not been previously described. A significant proportion of urologists reported PD management practices that are not evidence-based and not guideline-supported.

Practice patterns in the management of bacterial keratitis: a five-continent survey.

To assess the current diagnostic and therapeutic practice patterns in early management of bacterial keratitis over five continents. Between March and August 2019, we distributed an online survey including two clinical scenarios of bacterial keratitis, namely, a mild case and severe case, to 2936 ophthalmologists from 144 countries around the world. The survey consisted of 29 questions. We performed descriptive statistics and a comparative analysis of the answers according to the participants' continent of practice, practice setting, seniority, and subspecialty. We received 237 surveys from 54 countries (8% response rate). The proportion of respondents performing microbiological investigations was higher in North America, Asia, Europe, and Oceania than Africa and South America (p < 0.05). This ratio was also higher among ocular surface specialists than for other ophthalmologists (p < 0.001). For mild cases, fluoroquinolone monotherapy and a combination of two or more antibiotics were prescribed by 46% and 41% respondents, respectively. For severe cases, fluoroquinolone monotherapy and a combination of antibiotics were prescribed by 20% and 78% respondents, respectively. Fluoroquinolone monotherapy was the most commonly prescribed treatment in South America, Africa, and Oceania. A combination of two antibiotics was preferentially prescribed in the rest of the world. Topical steroids were prescribed in both circumstances, respectively, in 72% and 75% of cases. Our results highlight essential geographical disparities in the current management of bacterial keratitis over five continents.

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study.

Mild-to-moderate postoperative pain is common after surgical procedures of the thyroid. Opioid analgesics have been commonly prescribed in such cases, but their use has been debated owing to concerns regarding the addictive nature of opioids. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus document to limit the use of opioids as the first-line pain control medication after head and neck or endocrine procedures. However, differences in pain management prescriptions have been noted in many settings. This study aims to assess the post-thyroid surgery pain control medication prescription practices of head and neck and endocrine surgeons. This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient's discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level. An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients, whereas 43 (41%) were discharged on paracetamol only. The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.

Practice patterns in management of irritable bowel syndrome: A questionnaire survey

Aim: The present study was conducted to determine the practice pattern in the management of irritable bowel syndrome (IBS) in an Indian setting, using a questionnaire survey, among doctors managing IBS patients. Methods: The respondents were recruited by sending survey invitations using e-mail or text messages that contained information about the survey and its purpose. Four hundred doctors practicing in states of Madhya Pradesh and Tamil Nadu were contacted. The responses were tabulated in Microsoft Excel sheet. Data were analyzed using numbers and percentages. Results: A total of 60 responses were obtained with a response rate of 15%. About 93.3% noted an overlap of IBS symptoms with other disorders of gut–brain interaction (DGBI) disorders. The most common type of IBS reported was IBS-constipation (16, 26.7%), IBS-diarrhea (14, 23.3%), IBS-mixed (14, 23.3%), and IBS-undifferentiated (4, 6.7%). Ultrasound abdomen was done by 50%, colonoscopy/sigmoidoscopy by 60%, and blood tests by 83.3% of all respondents before labeling a case as IBS. Nearly half (46.7%) of the respondents noted that their patients had worsening of symptoms with milk. Trained dieticians for prescribing low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet were not available with majority of the respondents (38, 63.3%). Majority of the respondents (58, 96.7%) reported that they looked for psychological modifiers in patients. Almost all (83.3%) stressed the need for multidisciplinary approach, the need for Indian diagnostic criteria, and dietary modifications as per Indian needs. Conclusions: There is a need for Indian consensus on the diagnosis of DGBI, IBS, and overlap disorders and dietary recommendations region wise to manage our patients.

Market Competition Influences Practice Patterns in Management of Patients With Intermittent Claudication in the Vascular Quality Initiative

The Society for Vascular Surgery clinical practice guidelines recommend best medical therapy (BMT) and smoking cessation before revascularization of patients with intermittent claudication (IC). Notably, atherectomy and tibial-level interventions are generally discouraged in IC management; however, high regional market competition may incentivize physicians to treat patients more aggressively. We sought to determine the association between regional market competition and index endovascular treatment of patients with IC.

Diagnosis and Management of Keratoconus-A Narrative Review of Clinicians' Perspectives.

This review discusses the current practices, attitudes, and trends in diagnosing and managing keratoconus (KC) in adults and children by optometrists and ophthalmologists in order to highlight the differences on a global scale. Two independent reviewers searched the electronic databases and grey literature for all potential articles published from 1 January 2000 to 1 June 2022 on management of KC. Keywords used in searches included "keratoconus", "diagnosis", "management", "treatment", "attitude", "practices", "opinion", "optometrist", "ophthalmologist", "consensus", and "protocol". A total of 19 articles was included in this review-12 from the database search and seven from the grey literature. Although a common stepwise approach of non-surgical management was noted, there were differences in the rates of prescribing rigid gas permeable lenses. Furthermore, while clinicians agreed on the need for early diagnosis, the timeline and type of referral varied significantly. A similar discordance was found in the milestones for surgical intervention and preferred surgical techniques. Practice patterns in keratoconus diagnosis and management vary throughout the world. Multiple recommendations and suggestions to minimise the differences have been provided in the literature, with the main themes being improvement in education, interdisciplinary patient care, and further research to reach consensus.

397 Assessment of Sociodemographic Disparities in Emergency Department Pain Management

397 Assessment of Sociodemographic Disparities in Emergency Department Pain Management

Practice Patterns of Induction Therapy in Severe Anti-neutrophil Cytoplasmic Autoantibody-Associated Vasculitis

Anti-neutrophil cytoplasmic antibodies-associated vasculitis (ANCA-AAV) is a group of systemic necrotizing small vessel vasculitis characterized by the presence of circulating ANCA. AAV patients often present to various specialists whose management may differ. The few published surveys on AAV management among specialists are limited by their small sample size, single-center design, and lack of a comprehensive questionnaire.1–3 Here, we present the first international comprehensive survey that sought to explore practice patterns in AAV management during the induction phase.

Human Papillomavirus Impact on Temporal Treatment Trends in Oropharyngeal Carcinoma: 2010–2016

Introduction: The study objective was to identify practice patterns in oropharyngeal cancer management from 2010 to 2016 among human papillomavirus (HPV)-associated and non-HPV-associated oropharyngeal squamous-cell carcinoma (OPSCC) patients. Methods: The National Cancer Database was utilized to identify OPSCC patients from 2010 to 2016. Frequency distributions and multivariable analyses were generated to identify practice patterns and predictors of treatment modality. Results: A total of 35,956 patients with nonmetastatic OPSCC were included. HPV status was not associated with a treatment modality preference. At academic centers, the proportion of HPV-associated OPSCC patients versus non-HPV-associated OPSCC patients undergoing surgical management was similar (35.7%; 35.9%). Community cancer programs treated patients less often surgically but with no significant treatment preference based on HPV status. Within each facility type, HPV status was not a predictor of surgical or nonsurgical management. Conclusion: HPV association does not appear to significantly influence treatment modality preference among OPSCC patients. The proportion of OPSCC patients undergoing surgical treatment declined from 2010 to 2016.

The practice patterns of migraine management among neurologists in the Philippines - A cross-sectional survey

Objectives: We aimed to describe the current preferences of Filipino neurologists in the diagnosis and management of migraine. Methods: This is an observational descriptive study using a web-based survey done from November 2019 to June 2020 among certified locally practicing neurologists belonging to the Philippine Neurological Association. Results: A total of 259 (56.67%) from the 2018 roster of 457 neurologists participated in the survey. The prevalence of migraine in the respondents was 49.81% with a F:M ratio of 3.3:1. The majority (78%) based their diagnosis on established international criteria for migraine. Many (77%) would request neuroimaging for their patients with a history of more than 3 years of recurrent severe migraine. The most preferred class of drugs for acute migraine was NSAIDs (48.26%). One-third of respondents would give anti-nausea medications for moderate to severe attacks of migraine. About half would not consider using triptans for their patients with moderate to severe episodic migraine attacks. The top three drugs used for migraine prophylaxis were topiramate (80.69%) followed by flunarizine (73.36%) and propranolol (49.03%). Among patients with two or more headaches per week, 74.13% would prescribe prophylactic drugs. The use of a headache diary and the Migraine Disability Assessment Scale (MIDAS) was advised by 62.16% and 14.67% of respondents respectively, while cautioning about medication overuse headache was done by 68.34%. Conclusions: We have described the preferred practice of Filipino neurologists in diagnosing and treating migraine patients with locally available resources. The use of measurement tools (specifically MIDAS scoring to assess migraine disability), triptans, and anti-nausea drugs are not popular practices among Filipino neurologists The survey shows the need to promote the use of prophylactic drugs, counselling for medication overuse and more teaching about primary headaches in medical school.

COVID-19 policies and hoteliers' responses in Japan

This study aims to identify the hoteliers' crisis management practices during COVID-19 and analyse the relationship between each practice and government policy. Through in-depth interviews with five hotel chains, common crisis management practice patterns, factors that lead to differences in crisis management practices and the influences of policies on these practices were identified. The findings show strong and complicated relationships between policy and hoteliers' crisis management practices. Although many crisis management practices were encouraged by the government, some practices were not influenced by the policy and others were indirectly impeded. Hoteliers are not only passively affected by government policies, but respond actively to them as well as demonstrate their own initiative in response to the crisis.

Optimal Medical Management in Chronic Limb-threatening Ischemia Improves Patient Outcomes

Optimal medical management of chronic limb-threatening ischemia (CLTI) includes use of antiplatelets, antihypertensives, statins, and smoking cessation, and remains underutilized. Participation in programs like Vascular Quality Initiative (VQI) offers opportunities to increase compliance. The objective of this study was to evaluate medical management practice patterns and its effect on survival and limb salvage in CLTI patients.

Analysis of Productivity and Profitability of Sweet Corn + Cowpea Intercropping under Rainfed Condition in NCPZ of Odisha

A field experiment on "Planting pattern and nutrient management in rainfed sweet corn + cowpea system" was conducted during the kharif 2019-20 and 2020-21 at Regional Research and Technology Transfer Station, Keonjhar, Odisha. The experiment was laid down in Split plot design with three replications. The experiment was conducted to identify the suitable planting pattern and effect of nutrient management practices for enhancing production potentials of Sweet corn+ Cowpea. The treatments taken in this experiment consists of planting pattern with 3 levels i.e P1 : Sweet corn +Cowpea (1:1) in alternate rows, P2 : Sweet corn +Cowpea (2:2) in alternate paired rows and P3 : Sweet corn +Cowpea (1:1) in the same row and nutrient management practices with seven levels i.e. F1- STBFR to Sweet Corn , F2- Proportionate of STBFR of (Sweet Corn + Cowpea) based on population, F3- STBFR to Sweet Corn + Consortia biofertilizer , F4- 75% STBFR to Sweet Corn + STBFR to Cowpea based on population, F5- 50% STBFR of Sweet Corn + STBFR to Cowpea based on population, F6- 75% STBFR of Sweet Corn + STBFR to Cowpea based on population + Consortia biofertilizer, F7- 50% STBFR of Sweet Corn + STBFR to Cowpea based on population + Consortia biofertilizer. Sweet corn variety 'Sugar 75' and Cowpea variety 'Kashi kanchan' were used as test crops. Observations on yield and yield parameters were recorded before and at harvest. The yield and yield parameters measured in the form of cobs per plant, cob length with husk, cob girth with husk , no of seed rows per cob, cob weight, green cob yield, fresh kernel yield, green fodder yield and harvest index in case of sweet corn and pods per plant, pod length, weight of pod, weight of green pod per plant, fresh pod yield, dry pod yield and dry haulm yield in case of cowpea were recorded. Planting of sweet corn + cowpea (2:2) in alternate paired rows(P2) with application of 75% STBFR of Sweet Corn + STBFR to Cowpea based on population + Consortia bio fertilizer to the maize + cowpea crop (F6) followed by STBFR of sweet corn and cowpea (F2) was superior in terms of both yield and yield parameters.

Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers.

Severe headaches are common after subarachnoid hemorrhage. Guidelines recommend treatment with acetaminophen and opioids, but patient data show that headaches often persist despite multimodal treatment approaches. Considering an overall slim body of data for a common complaint affecting patients with SAH during their intensive care stay, we set out to assess practice patterns in headache management among clinicians who treat patients with SAH. We conducted an international cross-sectional study through a 37-question Web-based survey distributed to members of five professional societies relevant to intensive and neurocritical care from November 2021 to January 2022. Responses were characterized through descriptive analyses. Fisher's exact test was used to test associations. Of 516 respondents, 329 of 497 (66%) were from North America and 121 of 497 (24%) from Europe. Of 435 respondents, 379 (87%) reported headache as a major management concern for patients with SAH. Intensive care teams were primarily responsible for analgesia during hospitalization (249 of 435, 57%), whereas responsibility shifted to neurosurgery at discharge (233 of 501, 47%). Most used medications were acetaminophen (90%), opioids (66%), corticosteroids (28%), and antiseizure medications (28%). Opioids or medication combinations including opioids were most frequently perceived as most effective by 169 of 433 respondents (39%, predominantly intensivists), followed by corticosteroids or combinations with corticosteroids (96 of 433, 22%, predominantly neurologists). Of medications prescribed at discharge, acetaminophen was most common (303 of 381, 80%), followed by opioids (175 of 381, 46%) and antiseizure medications (173 of 381, 45%). Opioids during hospitalization were significantly more prescribed by intensivists, by providers managing higher numbers of patients with SAH, and in Europe. At discharge, opioids were more frequently prescribed in North America. Of 435 respondents, 299 (69%) indicated no change in prescription practice of opioids with the opioid crisis. Additional differences in prescription patterns between continents and providers and while inpatient versus at discharge were found. Post-SAH headache in the intensive care setting is a major clinical concern. Analgesia heavily relies on opioids both in use and in perception of efficacy, with no reported change in prescription patterns for opioids for most providers despite the significant drawbacks of opioids. Responsibility for analgesia shifts between hospitalization and discharge. International and provider-related differences are evident. Novel treatment strategies and alignment of prescription between providers are urgently needed.

CoMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectivesReports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. MethodsAll consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. ResultsComplete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. ConclusionsThe results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality.Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).

Residual Effect of Integrated Nutrient Management on Growth and Yield Toria in North Central Plateau Zone of Odisha

A field experiment on "Planting pattern and nutrient management in rainfed sweet corn + cowpea system and its residual effect on succeeding toria" was conducted during the kharif and rabi seasons of 2019-20 and 2020-21 at Regional Research and Technology Transfer Station, Keonjhar, Odisha. The experiment was laid down in Split plot design with three replications. The experiment was conducted to identify the suitable planting pattern and effect of nutrient management practices for enhancing production potentials of Sweet corn+ Cowpea and its effect on Toria. The treatments taken in this experiment consists of planting pattern with 3 levels i.e P1 : Sweet corn +Cowpea (1:1) in alternate rows, P2 : Sweet corn +Cowpea (2:2) in alternate paired rows and P3 : Sweet corn +Cowpea (1:1) in the same row and nutrient management practices with seven levels i.e. F1- STBFR to Sweet Corn , F2- Proportionate of STBFR of (Sweet Corn + Cowpea) based on population, F3- STBFR to Sweet Corn + Consortia biofertilizer , F4- 75% STBFR to Sweet Corn + STBFR to Cowpea based on population, F5- 50% STBFR of Sweet Corn + STBFR to Cowpea based on population, F6- 75% STBFR of Sweet Corn + STBFR to Cowpea based on population + Consortia biofertilizer, F7- 50 % STBFR of Sweet Corn + STBFR to Cowpea based on population + Consortia biofertilizer. Sweet corn variety 'Sugar 75', Cowpea variety 'Kashi kanchan' and Toria variety 'Anuradha' were used as test crops. The main objective of this experiment was to find out the residual effect on growth, yield attributes and yield of toria in the sequence. Before the harvest of the crop the observations on growth parameters were recorded. Height of the plant was taken at harvest and the number of leaves per plant were taken at an interval of , 45 and 60 days after sowing and number of primary and secondary branches per plant was recorded. After harvesting, yield attributes and yield (number of siliqua per plant, number of grains per siliqua, 1000 seed weight (gm), grain yield (t/ha), stover yield (t/ha), and harvest index (%)) were recorded. Planting of sweet corn + cowpea (2:2) in alternate paired rows(P2) with application of 75% STBFR of Sweet Corn + STBFR to Cowpea based on population + Consortia bio fertilizer to the preceeding maize + cowpea crop (F6) followed by STBFR of sweet corn and cowpea (F2) was suprior in terms of both yield and yield parameters.

A Cross Country Analysis of Financial Conditions and Earnings Management

This study aims to examine the effect of the company's financial condition on the earnings management behavior of companies in the Asian region. This study extends the existing research model by presenting a cross-country analysis of the relationship of financial conditions, which is specifically divided into three zones, namely financial distress, gray zone, and excellent financial condition, with corporate earnings management. The sample in this study consists of companies listed on stock exchanges of countries in Asia, with an observation period from 2009 to 2019. This study provides empirical evidence that supports the relationship between financial condition and company earnings management, which shows that earnings management is used as a tool by the management of companies that are under financial pressure to distort the quality of reported information, thereby creating a bias in the interpretation of company performance. This study proves that the characteristics of the company's financial condition, both in the safe zone, gray zone, and excellent zone, affect the pattern of company earnings management practices. This study measures earnings management using the discretionary accrual method so that it only captures earnings management practices that are part of the company's discretionary accrual management policy. Research can study earnings management further with the real earnings management approach to examine the effect of the company's financial condition on the distortion of earnings information through the company's actual activities.