Hospital Practice Research Articles

Fractional-Order Mathematical Modeling of Methicillin- Resistant Staphylococcus aureus Transmission in Hospitals

This article investigates the environmental contamination and antibiotic exposure effect on the transmission dynamics of the Methicillin-Resistant Staphylococcus aureus (MRSA) model in hospitals using the fractional Adams–Bashforth–Moulton Method (ABMM). This epidemic model simulates the dynamics of patient populations, bacterial contamination, and healthcare worker safety under varying conditions. This model provides critical insights into the interactions between hospital practices, environmental factors, and infection dynamics, demonstrating the importance of symmetry in balancing hospital admission and discharge rates to manage infection spread effectively. The analysis extends to the impact of environmental bacterial density and hospital admission rates on patient colonization. Increasing admission rates introduce more susceptible patients, exacerbating infection spread when bacterial density is high. Conversely, lower admission rates and bacterial density result in a more controlled infection environment. The model further investigates how varying discharge rates influence colonization dynamics, highlighting that effective discharge practices can mitigate infection spread, especially in high-bacterial density scenarios. It must be noted that this model is studied fractionally for the first time. Overall, this model provides critical insights into the interactions between hospital practices, environmental factors, and infection dynamics, offering valuable guidance for infection control strategies and hospital policy formulation. By adjusting fractional order constant (σ) values and analyzing different scenarios, this research aids in understanding and managing bacterial infections in healthcare settings. The proposed method is able to provide the results presented in the figures within this study considering the influence of many factors.

Specific features of hospital practices in military psychiatry

The practice of psychic care for military personnel in the context of hospital care in metropolitan France is singular. Army training hospitals act as rear bases, taking in repatriated medical personnel as well as everyday sufferers, and blending the stigma of a clinic that is more heterogeneous than that which would be specific to the context of war, yet equally involving care teams - nurses, psychologists and psychiatrists - acculturated to the military environment, and singularizing their practice to ever-changing needs in the face of a changing society and world.

Call to action: Blueprint for change in acute and critical care nursing

Herein, we propose a blueprint for action to completely measure and recognize the care provided by acute and critical care nurses to be incorporated into policy that shapes and supports practice. We address the nature of nurses’ work by identifying nine practice domains, hospital practice environment assumptions, and expected outcomes. Nurses’ work, as a cross-system process, needs to be included in hospital-based core measures to fully reflect nurses’ impact on patient care. We call for a balanced measurement portfolio focused on patient/family-, unit-, and systems-level outcomes. We focus on what nurses do and what patients and their families can expect rather than only on the elimination of select adverse events. We provide a way forward to allow measure development and implementation with incentives for their use. This approach to making nurses’ contributions and impact on outcomes visible will enhance acute and critical care nursing practice and benefit patients and their families.

AKTIVITAS FISIK DAN PERUBAHAN SIKLUS MENSTRUASI

The menstrual cycle is one aspect of assessing female reproductive function, changes in the menstrual cycle can occur in women in their 20s due to irregular ovulation phases, changes in the menstrual cycle are influenced by several factors, one of which is physical activity. Physical activity of Nursing Study Program students at Tanjungpura University Pontianak varies from studying in class, laboratory, clinical practice in hospitals, other activities such as exercising. The purpose of this study was to determine the correlation between physical activity and changes in the menstrual cycle. This study is a quantitative study with a cross sectional approach on 100 respondents with total sampling technique, and data collection using IPAQ questionnaire and menstrual cycle questionnaire. Data analysis used frequency distribution and chi-square test. Physical activity of female students was mostly in the high category as many as 76 respondents (76.0%) of 100 respondents, the menstrual cycle of female students was mostly irregular as many as 80 respondents (80.0%) of 100 respondents. The results of the chi-square test showed that there was no correlation between physical activity and changes in the menstrual cycle in nursing students of Tanjungpura University Pontianak, with a p-value of 0.292 (p-value> 0.05), the correlation coefficient was positive with a value of 0.105. There is no correlation between physical activity and changes in the menstrual cycle of nursing students of Tanjungpura University Pontianak.

Guidelines to practice in hospitals at home: penicillin infusion pumps in erysipelas treatment

Abstract Background Hospitals at home are increasingly offering outpatient parenteral antimicrobial therapy (OPAT) in an attempt to reduce costly inpatient care, but these settings favor broad-spectrum antibiotics that require less frequent dosing than penicillin. Benzyl penicillin could be delivered via continuous infusion pumps (eCIP), but studies on their safety and efficacy in OPAT are scarce, and it remains unclear how much the availability of eCIPs increases penicillin use in real-life settings. Methods We examined 462 electronic healthcare records of erysipelas patients treated between January 2018 and January 2022 in a large Finnish OPAT clinic. Average marginal effects from logistic models were estimated to assess how the introduction of eCIPs in December 2020 affected penicillin use, and to compare clinical outcomes between patients with and without eCIPs. Results Introduction of eCIPs increased the predicted probability of penicillin treatment by 36.0 percentage points (95% confidence interval 25.5-46.5). During eCIP implementation, patients who received an eCIP had 73.1 (58.0-88.2) percentage points higher probability than patients without an eCIP to receive penicillin treatment. They also had about 20 percentage points higher probability to be cured at the time of discharge and three months after it. Patient and nurse satisfaction regarding eCIPs was very high. Conclusions Benzyl penicillin eCIP treatment is effective and safe, and substantially increases the use of penicillin instead of broad-spectrum antibiotics. To reduce the risk of antimicrobial resistance, eCIPs could increasingly be promoted for use in OPAT clinics, and there should be adequate education and support in their implementation. Key messages • Continuous infusion of benzyl penicillin via elastomeric infusors substantially decreases broad-spectrum antibiotic use among erysipelas patients treated at home. • When erysipelas patients can be treated with outpatient parenteral antibiotic therapy, the use of elastomeric benzyl penicillin infusors is safe and effective and should thus be increasingly promoted.

Comparing the ability of GRACE 2.0 scores for predicting mortality in patients with and without diabetes

Abstract Background The GRACE 2.0 (G2) was an improvement on GRACE. Neither contains DM in the model. In the GRACE, DM independently predicted in-hospital but not the 6-month post-discharge mortality. Similar analysis for GRACE 2.0 score is unavailable. Purpose Assess the ability of the GRACE 2.0 score in predicting mortality in patients with and without diabetes. Methods Retrospective cohort analysis of data on non-STEMI and UA patients admitted in two hospitals between 2010 and 2019 entered into the Myocardial Infarction National Audit Project database. All baseline characteristics of the population and G2 scores were recorded. Death at 1 year was recorded from hospital and general practice records. Follow up was censored at the last recorded contact of the patient with a medical professional. The discriminative power of the G2 score in patients with and without diabetes in predicting mortality was determined by comparing the area under the receiver operating characteristic curve (c-statistics). Accuracy of calibration was evaluated by plotting the mean predicted vs observed mortality in each decile of predicted risk. Results Of 2841 patients entered, complete data was available for 2768 patients (age 69±14yrs, 62.3% male, 877(31.7%) with diabetes). G2 risk was higher in DM (8.3, IQR 3.9 to 19.0 v 5.5, IQR 2.6 to 13.0; p<0.0001). 337 patients died, 156 with DM. Higher deaths occurred in DM group (17.8% vs 16.3; adjusted OR 1.81, 95% CI 1.41-2.33, p<0.0001) (fig 1D). G2 discriminated between events well in whole cohort (AUC 0.81, p<0.001) with no difference between DM and non-DM patients (AUC DM: 0.78, 95% CI 0.75 to 0.81; non-DM 0.81, 0.79 to 0.83; δAUC 0.0301, p=0.242) (fig1E). Calibration of predictions by G2 was excellent across all deciles of risk for the whole cohort (fig 1A). However, G2 underestimated mortality in DM versus non-DM (fig1B,C), especially in the higher deciles of risk (fig 1 F,G). Conclusion(s) Discrimination of the GRACE 2.0 model was excellent for mortality at 1-year with no difference between patient with and without diabetes in our cohort of NSTEMI and UA patients. However, calibration plots suggest GRACE 2.0 underestimates mortality in diabetic compare to non-diabetic patients. This may suggest that risk stratification with GRACE 2.0 in diabetic patients may have to be considered with caution.Figure 1.

PP05 Presentation Time: 4:36 PM: IAEA Technical Report Series 492: Brachytherapy Dosimetry Code of Practice for Secondary Standards Dosimetry Laboratories and Hospitals

PP05 Presentation Time: 4:36 PM: IAEA Technical Report Series 492: Brachytherapy Dosimetry Code of Practice for Secondary Standards Dosimetry Laboratories and Hospitals

Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach.

Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Physicians estimated that they prescribed antibiotics for 54.8% (9896/18,049) of weekly outpatient encounters, and 178 (96.2%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ≤30 years were less likely to prescribe antibiotics (48/100, 48%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47%) for patients who presented with a URTI than residents (51/100, 51%; P=.03). Similarly, during outpatient visits, physicians ≤30 years old were less likely to prescribe antibiotics (54/100, 54%) than physicians older than 30 years (57/100, 57%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53%) than female physicians (64/100, 64%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53%) than residents (57/100, 57%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital.

Dr. Meena and mission maternal health: building allies in the government hospital

Research methodology The case study is based on field data, including in-depth semi-structured interviews with the main protagonist and related stakeholders of a large government hospital in Western India. After informed consent, the interviews with the stakeholders were conducted, transcribed and analyzed verbatim. In addition, secondary data from policy reports, newspaper articles and government websites was used to create the case. Since the protagonist works in the government system, her identity and other identifying information are disguised to maintain confidentiality. Case overview/synopsis The case study investigates the leadership challenges in a healthcare facility/hospital in public health. It traces the evolution of Dr Meena Sharma (Dr Meena), a leader in the government hospital ecosystem facing challenges such as infrastructural deficiencies, manpower deficit, healthcare bureaucracy and heavy patient load. This first-generation medical practitioner who transitioned from a private practice to a governmental one juggles balancing her demanding clinical practice, administrative responsibilities and teaching in the government hospital with her family responsibilities setup. However, in the wake of the upcoming LaQshya – Labour Room Quality Improvement Initiative by the Ministry of Health &amp; Family Welfare, she strives to put together and motivate her team to work toward improving the quality of care during delivery and the immediate postpartum period at her hospital. Various issues arise in the organizational leadership for a woman leader such as adopting appropriate leadership style and using appropriate motivation and communication strategies for optimal performance. Complexity academic level The case study is aimed at teaching/training a) departmental heads of public and private hospitals, b) health program managers at higher and middle-level leadership roles, c) health policymakers at various levels in the government and other organizations and d) graduate and postgraduate students of public health, hospital management/administration. In addition to this, it can also be used for general management programs to teach organizational behavior, communication and leadership courses.

Integrating automated dispensing cabinets into the medication dispensing process: feedback from the practice in European hospitals

ObjectivesAutomated dispensing cabinets (ADCs) offer improved medication safety, greater efficiency and return on investment. However, integrating ADCs into medication dispensing processes can be challenging in complex hospital environments. This study...

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

A survey of dysphagia services practice in China.

Dysphagia services have only recently been formalised within Chinese health services. There has been no comprehensive evaluation of all aspects of dysphagia services practice in China. To provide a profile for the dysphagia practice in China by assessing various facets of dysphagia services. This is a survey study carried out from December 2022 to May 2023 online in China. One hundred fifty-nine respondents comprising doctors, nurses or therapists involved in the field of dysphagia rehabilitation completed a questionnaire via Sojump. The questionnaire included dichotomous (e.g., yes/no) and multiple-choice questions related to participants' general information and their provision of dysphagia management services. Results were analysed descriptively and the differences among different levels of hospitals were analysed. Approximately two-thirds of hospitals (67.9%) started dysphagia services within the last 5 years. A significant difference in the initiation of dysphagia rehabilitation was observed across different hospital levels (χ2=32.70;p<0.001). Routine dysphagia screening was a standard practice in most hospitals (71.7%), with the most frequently employed screening method being the water swallow test (95.6%). Clinical swallowing evaluation emerged as the preferred initial assessment method (80.5%) and the most utilised assessment method (91.8%). Video fluoroscopic swallow study and flexible endoscopic evaluation swallowing were used by 22.7% and 12.6% of respondents. A significant difference was observed in the choice of assessment methods across hospitals of different levels (χ2=43.397; p < 0.001). The majority of respondents (53.5%) primarily employed rehabilitation as the main intervention method (76%-100%). Most respondents indicated that they would reevaluate patients after treatment (74.8%) and reported routine follow-up with patients (60.4%). Despite the relatively recent development of dysphagia management in China, the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. However, the use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. There is a need for policy and resource support in the field of dysphagia rehabilitation in China. What is already known on this subject Assessment and treatment methods for dysphagia are various across different patients, medical facilities and settings. There has been no comprehensive evaluation of all aspects of dysphagia rehabilitation practice in China. What this study adds to existing knowledge The study assessed various facets of dysphagia rehabilitation in China through an online survey. We found that the relatively recent development of dysphagia management in China, but the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. Variations in practice patterns between hospitals of different levels may be attributed to resource constraints and patient needs. Besides, while rehabilitation exercises are the primary intervention method for dysphagia in China, the assessment largely centres on clinical swallowing evaluation. The use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. What are the clinical implications of this work? The study assessed various facets of dysphagia rehabilitation in China, and the results indicate that the use of instrumental assessments needs to be improved and there is a need for policy and resource support in the field of dysphagia rehabilitation in China.

Revolution or risk?-Assessing the potential and challenges of GPT-4V in radiologic image interpretation.

ChatGPT-4 Vision (GPT-4V) is a state-of-the-art multimodal large language model (LLM) that may be queried using images. We aimed to evaluate the tool's diagnostic performance when autonomously assessing clinical imaging studies. A total of 206 imaging studies (i.e., radiography (n = 60), CT (n = 60), MRI (n = 60), and angiography (n = 26)) with unequivocal findings and established reference diagnoses from the radiologic practice of a large university hospital were accessed. Readings were performed uncontextualized, with only the image provided, and contextualized, with additional clinical and demographic information. Responses were assessed along multiple diagnostic dimensions and analyzed using appropriate statistical tests. With its pronounced propensity to favor context over image information, the tool's diagnostic accuracy improved from 8.3% (uncontextualized) to 29.1% (contextualized, first diagnosis correct) and 63.6% (contextualized, correct diagnosis among differential diagnoses) (p ≤ 0.001, Cochran's Q test). Diagnostic accuracy declined by up to 30% when 20 images were re-read after 30 and 90 days and seemed unrelated to the tool's self-reported confidence (Spearman's ρ = 0.117 (p = 0.776)). While the described imaging findings matched the suggested diagnoses in 92.7%, indicating valid diagnostic reasoning, the tool fabricated 258 imaging findings in 412 responses and misidentified imaging modalities or anatomic regions in 65 images. GPT-4V, in its current form, cannot reliably interpret radiologic images. Its tendency to disregard the image, fabricate findings, and misidentify details, especially without clinical context, may misguide healthcare providers and put patients at risk. Question Can Generative Pre-trained Transformer 4 Vision (GPT-4V) interpret radiologic images-with and without clinical context? Findings GPT-4V performed poorly, demonstrating diagnostic accuracy rates of 8% (uncontextualized), 29% (contextualized, most likely diagnosis correct), and 64% (contextualized, correct diagnosis among differential diagnoses). Clinical relevance The utility of commercial multimodal large language models, such as GPT-4V, in radiologic practice is limited. Without clinical context, diagnostic errors and fabricated findings may compromise patient safety and misguide clinical decision-making. These models must be further refined to be beneficial.

The Decontamination of N95 Masks as an Occupational Safety Strategy

Objective: This study aimed to monitor the use of a short-wave ultraviolet (UV-C) decontamination device for N95 masks at the João de Barros Barreto University Hospital, Belém, Pará, Brazil. The research investigated the reuse of masks, storage methods, and the perception of healthcare professionals regarding the decontamination protocol using UV-C after each work shift. Theoretical Framework: The research is based on theories related to biosafety and occupational health, focusing on the importance of decontamination processes in hospital settings to enhance the protection of healthcare workers and reduce infection risks. Method: A cross-sectional study was conducted with 295 nursing professionals, including nurses, technicians, and assistants. Data were collected through a questionnaire addressing the reuse of N95 masks, storage between uses, and opinions on the use of the UV-C device for decontamination. Results and Discussion: All participants (n=295) agreed that UV-C decontamination improves biosafety by reducing the handling of potentially contaminated masks. The acceptance of the device was unanimous, confirming its feasibility both in high-demand scenarios, such as the Covid-19 pandemic, and in routine hospital practices. Research Implications: This study demonstrates that implementing UV-C decontamination systems is a practical and effective solution for hospitals, with the potential to increase occupational safety and reduce infectious waste generation. Originality/Value: The study contributes to the literature by highlighting the feasibility and benefits of reusing N95 masks with UV-C decontamination, promoting greater safety in hospital environments.

The insensitivity of ‘sensitive care’: the bureaucracy of pregnancy tissue disposal in England, UK

The practices surrounding pregnancy ends and pregnancy remains shift and change depending on the cultural and historical context. Based on ethnographic research in one group NHS Hospital organisation in England, the paper explores what practices around pregnancy remains reveal about the values afforded the material in different contexts by different actors and the moments when these intersect. It argues that framing miscarriage as bereavement helps to structure caregiving in clinical settings and that clinical practices produce foetal personhood in ways that may not be in keeping with women’s notions of their pregnancy material. It illustrates that hospital practices contain notions of value which become legitimated as the appropriate approach with consequences for normativity. This may lead to women feeling isolated and abnormal when their approach is at odds with that of the clinic. Through an exploration of how women encounter and negotiate disposal practices, the paper argues that current practice requires revision to flexibly respond to diversity but also shifting meaning and values attributed to these experiences and materials.

Trends and hospital practice variation for analgesia for children with sickle cell disease with vaso-occlusive pain episodes: An 11-year analysis

This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids. BackgroundVaso-occlusive episodes (VOEs) are a hallmark of sickle cell disease (SCD), leading to frequent emergency department (ED) visits. Effective pain management is crucial, with guidelines recommending routine use of non-steroidal anti-inflammatory drugs (NSAIDs) with opioids, and emerging evidence supporting ketamine use. However, these recommendations are based on low-certainty evidence, and the impact of these guidelines on analgesia use over time remains unclear. ObjectiveThis study aimed to analyze trends in analgesia use over an 11-year period in pediatric SCD patients presenting to U.S. EDs with VOE and assess variations in treatment across hospitals. MethodsA cross-sectional study was conducted using data from the Pediatric Health Information System covering 34 U.S. children's hospitals from January 1, 2013, to December 31, 2023. The primary outcomes were the proportions of visits where opioids, NSAIDs, acetaminophen, and/or ketamine were administered on the first calendar day of the initial visit. Secondary outcomes included the co-administration of NSAIDs with opioids. Logistic and linear regression models were used to assess trends and hospital-level variations. ResultsA total of 86,111 ED visits for VOE were analyzed. Opioids were administered in 82 % of encounters, NSAIDs in 72 %, acetaminophen in 17 %, and ketamine in 1 %. Co-administration of NSAIDs with opioids occurred in 59 % of the visits. Among discharged patients, there was a positive trend for NSAID use (slope: 1.68 %/year, 95 % CI: 0.91 %, 2.45 %) and NSAID-opioid co-administration (slope: 1.03 %/year, 95 % CI: 0.37 %, 1.69 %) over time. Acetaminophen use also increased over the study period (slope: 0.99 %/year, 95 % CI: 0.80 %, 1.17 %). In hospitalized patients, there was a significant upward trend for acetaminophen (slope: 1.29 %/year, 95 % CI: 0.69 %, 1.89 %) and ketamine (slope: 0.36 %/year, 95 % CI: 0.27 %, 0.45 %), while opioid use remained unchanged. Significant hospital-level variations were observed, with larger hospitals more likely to administer opioids but less likely to co-administer NSAIDs with opioids compared to medium-volume hospitals. ConclusionOver the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals underscore the need for standardizing pain management strategies in this population.

Does total quality management mediate the relationship between Industry 4.0 and business sustainability in private hospitals?

PurposeThe paper aims to study the influence of Industry 4.0 technologies on the business sustainability of private hospitals by focusing on the mediating role of total quality management practices in private hospitals in the West Bank.Design/methodology/approachData from the top and middle managers of private hospitals in the West Bank regions of Palestine were collected through a questionnaire assessed for validity and reliability. Furthermore, we used the structural equation modelling technique of partial least squares for the data analysis.FindingsThe findings confirm that Industry 4.0 technologies do not affect business sustainability. The findings also emphasise the association between Industry 4.0 technologies and total quality management philosophy, and total quality management completely mediates the relationship between Industry 4.0 and business sustainability.Practical implicationsThis study provides practical implications for achieving the hospital sector's sustainability by merging Industry 4.0 technologies with total quality management practices, which provides valuable insights into the hospital's policies and practices and individuals vital to data exchange and policy enforcement within the sustainability of organisations.Originality/valueThis study is one of the first to investigate the combined effects of Industry 4.0 technologies, total quality management and business sustainability in the healthcare industry following the COVID-19 outbreak. This research is one of few empirical works exploring the interface between Industry 4.0 technologies and total quality management in developing countries, specifically Palestine.

Paul’s Economic Relationship With the Galatians: Burdensome Imposer or Welcomed Guest?

How did Paul subsist during his travels in Galatia? This article contests Nasrallah’s claim that Paul placed burdens and imposed upon the local communities in Galatia akin to the Roman practice of requisitioning supplies and argues that the Galatians non-coercively welcomed Paul as a host and developed mutual relations with him. We first consider the social practices of Roman requisitions and ancient hospitality as suitable comparanda for interpreting Paul’s travel in Galatia. Then we examine two types of evidence clarifying the socio-economic aspects of Paul’s initial relationship with the Galatians—i.e., Paul’s recollections of his initial encounter with the Galatians (Gal 4:12–20) and subsequent traditions regarding the Galatians’ response to Paul. The evidence suggests that Paul’s relationship with the Galatians was, most probably, welcomed and mutual, not imposing or burdensome. This historical reconstruction contextualizes Paul’s subsequent letter and bears upon interpretations of Galatians.

Study on the Management of Diabetic Foot Ulcer in Diabetic Patients at a Tertiary Care Hospital

AIM: To study the treatment pattern of diabetic foot ulcer and to assess the effect of patient counselling on diabetic foot ulcer patients. OBJECTIVE: 1. To study the various modalities of treatment used for Diabetic Foot Ulcer patients in a tertiary care hospital. 2. To assess the effect of patient counselling on diabetic foot ulcer patients with standard questionaries METHODS: The protocol was reviewed, revised, and approved by the Institutional Review Committee of MVJ Medical College and Research Hospital before commencement of the study. Over the course of six months, a tertiary care hospital conducted prospective research. Following the giving of written informed permission, diabetic patients with foot ulcers of both genders who were visiting the hospital were invited to participate and enrolled. A total of 150 patients participated in the study. The patients were recruited according to the inclusion and exclusion criteria mentioned. The study was attempted to improve the patient’s knowledge and attitude towards the self-management of diabetic foot ulcer. And thus, patient counselling is an essential component of clinical pharmacy practice in hospital. RESULTS: In this study, majority of the study participants belonged to the age group 61-70 years (30.7%) of age. 22% of the study participants were of the age group between 51-60 years of age. Majority (64.7%) of the study participants were males. In this study, Nottingham Assessment of Functional Footcare (Revised 2015) was used and an improvement in the total score was found i.e., from 18.27+5.85 before counselling jym oof ff\c b to 44.07+4.70 post counselling which was found to be statistically significant (P&lt;0.001). Thus, a proper foot care education program has been shown to reduce the risk of ulceration. CONCLUSION: The present study was conducted to study the effect of patient counselling on diabetic foot ulcer patients using NAFFC score. Majority in the study belonged to 61-70 years and were males. Most of them had type 2 DM and grade 1 foot ulcer. In this study, Nottingham Assessment of Functional Footcare (Revised 2015) was used and an improvement in the total score was found i.e., from 18.27+5.85 before counselling to 44.07+4.70 post counselling which was found to be statistically significant (P&lt;0.001). NAFFC score played an important role in the study to assess the functional outcome among diabetics with foot ulcers. Though there is development of new therapies for the management of diabetic foot ulcers, a high rate of failure ending with amputation still exists. Hence a counselling session to the diabetics with foot ulcers can prevent further complications.

The impact of Sustainability Practices on Healthcare Institutions: Evidence from Public Healthcare Institutions in Saudi Arabia

This article aims to investigate sustainable development practices in hospitals, for three primary reasons: preserving the surrounding environment, impacting sustainability through service provision, and ensuring a safe and environmentally friendly atmosphere. The study addresses the gap in understanding the dimensions and implementation of green practices, offering insights into the green hospitals model. The study figured out eight practices that reflected sustainability activities in the Saudi public hospitals, with their significant impact on sustainable development. The study used descriptive methodology with quantitative technique to collect data pertaining to the impact of green practices on sustainable development in the Saudi public hospitals. A questionnaire survey with valid responses was distributed to 118 members working in the hospitals as (doctors, nurses, and administrators) in April 2024. The PLS-SEM statistical method was used for data analysis. The results of this study revealed a positive relationship between four green transition practices and Sustainable development. Keywords: Green practices in hospitals, sustainability, Sustainable development, public hospitals, healthcare institutions