Compliance Rate Research Articles

Epidemiological Insights and Diagnostic Strategies of Extrarespiratory Tuberculosis: A Five-Year Retrospective Study in Clinic of Pneumology, Târgu Mureș

Background: Tuberculosis remains one of the biggest global public health problems today. The objective of this study was to evaluate the diagnostic methods, clinical outcomes, patient compliance, and mortality rates in patients diagnosed with extrarespiratory tuberculosis. Methods: 105 cases of extrarespiratory tuberculosis were analyzed over a five-year period (2018–2023). Data from medical records were reviewed and processed. Diagnostic methods included Ziehl–Nielsen staining, Löwenstein–Jensen cultures, GeneXpert, and histopathological analysis. Diagnosis was supplemented by a specialist organ examination and, in cases with concurrent pulmonary involvement, by a chest X-ray and sputum examination. For negative cases, a probabilistic diagnosis was made. Results: Most patients presented pleural TB (38%), osteo-articular TB (26.67%), and ganglionary TB (19%). Patients were mostly men (56.19%), in the 18–40 years-old category (40%), and lived in rural areas (61%). In total, 94.29% were newly diagnosed and most observed comorbidites were chronic smoking (11.37%), chronic lung diseases (10.20%), and malnutrition (9.02%). Moreover, 68% had a negative microscopic examination, while 55% had negative cultures on Löwenstein–Jensen. Conclusions: This study highlights the importance of a multi-modal approach to diagnosing extrarespiratory tuberculosis, especially in negative bacteriological and histopathological results. Imaging, combined with clinical and epidemiological data, is critical for a probabilistic diagnosis. GeneXpert proved useful in difficult cases. This study emphasizes the need for a comprehensive diagnostic strategy to effectively manage extrarespiratory tuberculosis.

Obstacles and sustainability of enhanced recovery after surgery in pediatric laparoscopic pyeloplasty

ObjectivesPrevious studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked clear control cases and discussed the obstacles in the implementation process. This article details the obstacles and lessons learned during the implementation of ERAS in patients with ureteropelvic junction obstruction (UPJO).MethodsAn ERAS protocol was implemented in the UPJO population undergoing LP, which included preoperative, intraoperative, and postoperative management. The clinical data of ERAS program Before Implementation (BI) and After Implementation (AI) were collected and analyzed retrospectively.ResultsA total of 107 patients (BI 46, AI 61) were enrolled. Compared with the BI group, the AI group had an earlier normal diet (19.83 h vs. 9.53 h, p < 0.001), ambulation (39.10 h vs. 12.70 h, p < 0.001), resumption of defecation (89.88 h vs. 27.90 h, p < 0.001), less need for additional analgesia (19.5% vs. 1.6%, p = 0.002) and shorter postoperative hospital stay (POS) (6.00 d vs. 1.91 d, p < 0.001) without increasing complications and readmission rates. Patients in the AI group had a median protocol score of 17 (IQR 16–18), and the compliance rate of the ERAS protocol was negatively correlated with the length of POS (R2 = 0.69, p < 0.001).ConclusionsThe application of ERAS in pediatric LP is feasible and sustainable, with the potential for even greater impact as compliance improves. Common barriers were uncertain start time of surgery, lack of knowledge of ERAS among pathway participants, and support from anesthesiologists. Pre-determining the start time of surgery, strengthening preoperative education and positive communication among team members can help to promote the full implementation of ERAS program.

Feasibility study to improve oral health in older adult patients using visiting nursing services: A pilot study.

Among older adults in Japan, those requiring long-term care who use visiting nursing services have particularly poor oral health. Given the importance of oral health, this study aims to evaluate the feasibility of oral health improvement interventions for such older adult patients using visiting nursing services. This study was a single-arm pilot study. The participants were those who provide oral care to older adults who use visiting nursing services, whether the patients themselves or their family members. Participants implemented oral care appropriate to the patient's oral environment at least once a day for four weeks. Feasibility assessment consisted of the recruitment, completion, and compliance rates. Changes in the oral environment were measured using the Oral Health Assessment Tool-Japanese (OHAT-J), and changes in scores were assessed over the study period. The study was conducted across three visiting nursing stations, with 52 participants (a recruitment rate of 73.2%). Of these, 42 participants completed the final questionnaire (a completion rate of 80.8%). The compliance rate was 64.3%. The mean OHAT-J score was 4.5 (SD 2.3) pre-intervention, 3.7 (SD 2.0) at one week post-intervention, and 3.6 (SD 2.2) at four weeks post-intervention (p < 0.001), indicating a significant positive trend. The feasibility of this intervention was generally satisfactory, and the results showed that the oral environment was improved. Future studies with a larger scale and higher level of evidence should be conducted to evaluate the effectiveness of the intervention.

Evaluation of Heath Care Commitment with Prevention and Infectious Control Protocols in Mofid Children Hospital, IRAN

Background: The dedication of healthcare teams to adhering to protocols for the use of personal protective equipment (PPE), maintaining vaccination coverage among healthcare workers (HCWs), and ensuring environmental health are crucial elements in managing hospital-acquired infections. Objectives: This study aimed to evaluate adherence to PPE use, vaccination history, hand hygiene protocols, and environmental health practices in a tertiary children's hospital in Iran. Methods: This cross-sectional study evaluated compliance with PPE use, vaccination history among doctors, nurses, and hospital staff, adherence to strict hygiene practices, patient isolation protocols, and environmental health measures based on an Iranian Health Ministry query. Data collection was conducted over three months, from May to August 2023. Results: During the study, 285 staff members were assessed for compliance with hand hygiene protocols. Nurses demonstrated the highest level of compliance, reaching 51%. The highest compliance with hand hygiene protocols at the five designated moments was approximately 79%, with the transplantation and hemodialysis wards achieving the highest rates. Nurses also showed the most positive vaccination records. Personal protective equipment was used correctly in various wards, with an overall compliance rate of 79%. Conclusions: This study revealed that compliance with health protocols in different parts of the hospital was suboptimal and required significant improvement.

Efficacy of comprehensive nursing intervention on nursing outcomes and prognostic quality of life in elderly patients with chronic heart failure.

To explore the effect of comprehensive nursing intervention on nursing outcomes, self-efficacy, and quality of life in elderly patients with chronic heart failure (CHF). A retrospective analysis was conducted on the clinical data from 120 elderly patients with CHF admitted to Baoding No.1 Central Hospital from June 2019 to June 2022. Patients were divided into a control group and an observation group based on different nursing methods (n= 60 each group). The clinical data of the two groups were analyzed, comparing changes in heart function, psychological status, and quality of life before and after intervention. After intervention, both groups exhibited decreased scores on the Hamilton Anxiety Scale and the Hamilton Depression Rating Scale compared to the pre-intervention levels, with the observation group showing a significantly lower degree of decline compared to the control group during the same period (P<0.05, respectively). The overall compliance rate of medical adherence in the observation group was 85.00%, significantly higher than the 70.00% in the control group (P<0.05). After intervention, both groups exhibited improvement in left ventricular ejection fraction, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter compared to the pre-intervention levels, with the observation group showing a more significant improvement than the control group (P < 0.05, respectively). For elderly patients with CHF, comprehensive nursing intervention may reduce negative emotions, improve sleep quality, self-care ability, and self-efficacy, and enhance patient compliance, quality of life, and heart function.

Development of a remote therapeutic monitoring platform: applications for movement disorders

Digital health tools are emerging as a promising solution for optimizing Deep Brain Stimulation (DBS) therapy for neurodegenerative diseases such as Parkinson’s Disease (PD), addressing challenges of therapy maintenance, care access, and discrete assessments. Wearable technology and mobile health platforms can offer remote monitoring capabilities, allowing for real-time virtual programming with optimization of patients’ therapy, use of digital biomarkers that can help identify the onset, symptoms, medication-related fluctuations and side-effects, and response to DBS treatment. Through an investigational remote monitoring application (RM app) integrating patient-reported outcomes (PROs) and objective data using wearables, we aimed to develop an accessible, data-driven digital tool to monitor patient symptoms and deliver low-burden and easy-to-access DBS therapy. The platform is designed to be compatible with several consumer-grade wearables and ensures patient data privacy and security. We conducted a feasibility study to test the tool’s effectiveness in a large-scale DBS study, where subjects received a home-monitoring kit consisting of an iPhone and Apple Watch, pre-configured with the RM app to enable remote data collection. Compliance in this paper is defined as adherence to the RM app and Apple watch usage. Analysis of 67 subjects from the study demonstrated an average compliance rate of 63.3% for daily check-ins, 85.5% for monthly surveys and 61.9% for passive data with an average of 55 days of post-implant data. The study highlights the feasibility of frequent monitoring in the early post-implant period that could lead to optimal outcomes for patients. The platform developed can further optimize study execution and be extended to other chronic conditions treated with neuromodulation implants such as depression and pain.

The Impact of Educational Handouts on the Compliance Rate for Bariatric Patient Follow-Up Appointments.

Compliance rates for follow-up appointments are an issue for postoperative sleeve gastrectomy (SG) patients. Without consistent reinforcement and monitoring of patient progress, patients tend to gain the weight back, all of the medical improvements made are lost, and the ability to access patients for potential complications is denied. Patients need much reinforcement during their forever bariatric lifestyle, and the lack of consistent reminders may contribute to follow-up noncompliance and recidivism in SG patients. As time progresses, the follow-up appointment compliance rate decreases. Decreased follow-up can lead to a higher risk for complications such as asymptomatic esophagitis, and current recommendations suggest that esophagogastroduodenoscopy screening should occur 3years postoperatively. After 1 year, the follow-up compliance decreases dramatically so that by the 3-year postoperative period, very few patients are being seen and scheduled for interventions such as an esophagogastroduodenoscopy. The objective of this quality improvement project was to evaluate the effectiveness of a patient educational handout on SG bariatric patient follow-up visit compliance. A quasi-experimental design and retrospective chart review was chosen. An educational handout was developed. Preintervention retrospective chart review consisted of 441 SG patients expecting a follow-up in 12 to 48months. Postintervention included 3months of the handout intervention with data collection totaling 198 patients. Follow-up compliance for 4 year visits noted 0% preintervention/12.2% postintervention (P =.008), for 3 year visits 13.4% preintervention/12% postintervention (P =.846), for 2 year visits 26.3% preintervention/28.6% postintervention (P =.755), for 18months visits 26.3% preintervention/32.6% postintervention (P =.365), and for 12months visits 54.2% preintervention/34.1% postintervention (P =.011). In this quality improvement project, educational handouts did not have a statistical impact on follow-up compliance.

Effectiveness of photoplethysmography-based rhythm monitoring after atrial fibrillation ablation using a smartphone application: DIGITOTAL study

BackgroundRecurrence after atrial fibrillation (AF) ablation is frequent. Monitoring with long-term electrocardiograms (ECGs) is constrained by limited monitoring time, measurement dispersion, and cost. Selected photoplethysmography (PPG) smartphone applications have demonstrated excellent accuracy for AF detection and could mitigate these limitations. ObjectiveWe aimed to compare the effectiveness of digital follow-up using a PPG-based smartphone application against conventional ECG-based follow-up for the detection of atrial arrhythmia recurrence after ablation. MethodsPatients undergoing AF ablation were consecutively enrolled and monitored by a 24-hour ECG at 3, 6, and 12 months on top of the ECGs conducted for clinical indications (conventional follow-up). In addition, patients were instructed to perform PPG measurements twice daily or whenever symptoms were perceived during the course of 1 year (digital follow-up). ResultsIn total, 96 patients (69% male; mean age, 64 ± 9 years) performed 39,895 PPG measurements. The compliance rate (number performed/prescribed) was 92.6% for ECGs and 78.2% for PPG recordings. After 1 year of follow-up, atrial arrhythmia recurrence was detected in 17.7% of patients by conventional follow-up and in 38.5% of patients by digital follow-up (odds ratio, 3.4; 95% confidence interval [CI], 1.7–7.1). The CI lower limit exceeded the predefined noninferiority margin (P for noninferiority > .001). Hence, superiority was tested (P for superiority = .001). The negative predictive value of digital follow-up for atrial arrhythmia detected with conventional follow-up was 98.3% (95% CI, 90.9%–99.9%). ConclusionDigital rhythm follow-up using a smartphone application with PPG was noninferior to conventional follow-up in detecting atrial arrhythmia recurrence between 3 and 12 months after ablation. Moreover, digital follow-up significantly increased the detection of atrial arrhythmia.

National Policy on Open Educational Resources for Higher Education in Nigeria: Evaluation of Institutional Compliance Rate to Infrastructure and the Connectivity Goal

National Policy on Open Educational Resources for Higher Education in Nigeria: Evaluation of Institutional Compliance Rate to Infrastructure and the Connectivity Goal

Performance of a Full-Coverage Cervical Cancer Screening Program Using on an Artificial Intelligence- and Cloud-Based Diagnostic System: Observational Study of an Ultralarge Population.

The World Health Organization has set a global strategy to eliminate cervical cancer, emphasizing the need for cervical cancer screening coverage to reach 70%. In response, China has developed an action plan to accelerate the elimination of cervical cancer, with Hubei province implementing China's first provincial full-coverage screening program using an artificial intelligence (AI) and cloud-based diagnostic system. This study aimed to evaluate the performance of AI technology in this full-coverage screening program. The evaluation indicators included accessibility, screening efficiency, diagnostic quality, and program cost. Characteristics of 1,704,461 individuals screened from July 2022 to January 2023 were used to analyze accessibility and AI screening efficiency. A random sample of 220 individuals was used for external diagnostic quality control. The costs of different participating screening institutions were assessed. Cervical cancer screening services were extended to all administrative districts, especially in rural areas. Rural women had the highest participation rate at 67.54% (1,147,839/1,699,591). Approximately 1.7 million individuals were screened, achieving a cumulative coverage of 13.45% in about 6 months. Full-coverage programs could be achieved by AI technology in approximately 1 year, which was 87.5 times more efficient than the manual reading of slides. The sample compliance rate was as high as 99.1%, and compliance rates for positive, negative, and pathology biopsy reviews exceeded 96%. The cost of this program was CN ¥49 (the average exchange rate in 2022 is as follows: US $1=CN ¥6.7261) per person, with the primary screening institution and the third-party testing institute receiving CN ¥19 and ¥27, respectively. AI-assisted diagnosis has proven to be accessible, efficient, reliable, and low cost, which could support the implementation of full-coverage screening programs, especially in areas with insufficient health resources. AI technology served as a crucial tool for rapidly and effectively increasing screening coverage, which would accelerate the achievement of the World Health Organization's goals of eliminating cervical cancer.

Red Blood Cell Transfusion Practices.

Opportunities to improve transfusion safety occur at lower hemoglobin (Hgb) thresholds and single-unit transfusions. Efforts to improve compliance with transfusion guidelines and single-unit transfusion practices reduce transfusions and lead to improved outcomes. To evaluate demographic and practice characteristics associated with lower Hgb thresholds and single red blood cell (RBC) unit transfusion practices. This study used the College of American Pathologists (CAP) Q-Probes format with the recent 2020 and 2017 surveys of participating institutions. High rates of transfusion review and compliance were observed with institutions reporting RBC transfusions meeting institutional guidelines. CAP inspection participants and those with a formal policy to encourage single-unit transfusions showed a trend toward greater compliance. Comparison of 2020 and 2017 survey results showed favorable downward trends in the Hgb threshold for transfusion compliance review and pretransfusion and posttransfusion Hgb values. Institutions reporting initiatives to decrease transfusions, teaching hospitals, and those with updated guidelines in alignment with recent literature reported lower pretransfusion Hgb levels in both studies. The 2020 study showed greater single-unit transfusion use among hospitals with patient blood management programs, larger institutions, and those training pathology residents. Single-unit transfusion rates varied by hospital service, with highest rates reported within hematology/oncology (99 of 138 [71.7%]), intensive care (147 of 215 [68.4%]), and medicine (419 of 666 [62.9%]) services. Transfusion practice improvement programs to decrease RBC transfusions include the use of single-unit transfusions and lower institutional pretransfusion Hgb thresholds. Opportunities to lower transfusion thresholds and increase single-unit transfusions exist in surgical and obstetrics services.

System of performance indicators of the ESG–concept: state and prospects for assessment

In the world community, the concept of sustainable development has firmly established itself as a priority trend of globalization through the transformation of key development vectors into the format of the ESG–concept, within which the performance of enterprises is expressed by indicators characterizing care for the environment, personnel, transparency and efficiency of social activities. The main emphasis is on the formation of anti-corruption activities, ensuring the transparency of enterprise reporting, information openness, the use of modern management tools within the framework of the Industry 5.0 concept, eliminating gender, social and other conflicts, comprehensively ensuring a good image of the organization. In these conditions, the creation of international ratings of compliance of enterprise policies with the ESG–agenda is being updated. At the same time, there is a lack of a unified methodology for assessing the performance indicators of the ESG–concept, in the form of a unified reporting form for enterprises. The purpose of the study is to develop ESG–monitoring based on systematization of indicators in priority areas of activity and calculation of the integral ESG–indicator. The scientific novelty lies in the development of an ESG–monitoring model, which is a decomposition diagram of the organization of ESG–monitoring of enterprises in IDF0 notation as part of the implementation of the state strategy for transplantation of sustainable development goals, including the formation of a list of indicators, the development of a unified methodology for their calculation, the development of a unified form of statistical reporting, and monitoring with current frequency. The proposed toolkit is a promising mechanism for government regulation, by ranking and comparing enterprises according to the level of compliance with the ESG–concept, to create an accurate investment impulse in the field of transplantation of sustainable development goals and ensuring the homeostasis of economic systems in conditions of uncertainty and instability of the external environment.

Implementing Enterprise-Scale iOS MDM : A Technical Deep Dive

As organizations increasingly adopt mobile technologies, the need for effective remote management of iOS devices has grown significantly. This technical article examines implementation strategies and real-world performance metrics from a study of Mobile Device Management (MDM) implementations across 12 diverse organizations, encompassing 2,500 enterprise devices during 2023-2024. The article reveals that optimized MDM solutions can achieve 99.99% uptime while reducing infrastructure costs by up to 45%. Key findings demonstrate that effective MDM implementation reduces device management costs by 64%, improves security compliance rates to 99.3%, and decreases incident response time by 73%. Through automated troubleshooting and optimization, organizations experienced a 67% reduction in security incidents and a 42% decrease in IT support overhead while achieving 85% reduction in deployment time and 82% acceleration in app deployment processes. The article comprehensively evaluates architecture design, deployment metrics, security implementation, performance analysis, and scalability considerations. Implementation of advanced security protocols resulted in a 98.7% prevention rate for common mobile security threats, while maintaining 99.99% system reliability. The article also highlights the importance of phased deployment strategies, which demonstrate 43% higher success rates compared to direct full-scale implementations, and provides strategic insights for future planning and infrastructure optimization.

Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study.

China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents' self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the "i Active Health" applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents' risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents' health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients' BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Our digital health platform can effectively achieve theinterconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice.

Risk factors and discrimination model for screen exposure among children under 3 years: findings from Fujian province in China

BackgroundCompliance with screen time guidelines among children worldwide remains low, and there is insufficient evidence on the current prevalence in China. This study aimed to investigate the prevalence of compliance with screen time guidelines among children under 3 years old in Fujian Province, East China, identify risk factors and their independent effects, and develop a risk discrimination model for targeted interventions.MethodsA cross-sectional survey was conducted among low-income families recruited from welfare programs at 96 sites in both urban and rural areas of Fujian Province, China. Face-to-face interviews gathered sociodemographic data, lifestyle information, attitudes towards screen exposure, and details on screen media device ownership. A multivariable logistic regression model was employed to identify independent risk factors for compliance with screen time guidelines, while the area under the receiver operating characteristic curve (AUC) was used to evaluate the model’s discrimination ability.ResultsA total of 4,707 children participated in the survey. The rates of compliance with screen time guidelines were 56.8% for children under 1 year old, 18.8% for those between 1 and 2 years old, and 81.9% for those between 2 and 3 years old. The multivariable regression analysis identified negative attitudes towards screen exposure, co-viewing and engagement, as well as single child, as significant positive independent factors for compliance with the guidelines. The risk discrimination model demonstrated good performance, with an AUC of 0.845 and 0.812 in the two younger age groups, but showed medium discrimination with an AUC of 0.691 for children between 2 and 3 years old.ConclusionsCompliance with screen time guidelines among young children in Fujian Province, East China, is generally adequate, but notably low among children between 1 and 2 years old. Targeted interventions are needed to improve compliance, particularly for this age group.

Nomogram model for predicting medication adherence in patients with various mental disorders based on the Dryad database

ObjectiveTreatment compliance among psychiatric patients is related to disease outcomes. How to assess patient compliance remains a concern. Here, we established a predictive model for medication compliance in patients with...

BN SO13 - Re-Audit of Biliary Pancreatitis Management: Enhancing Compliance with Timely Laparoscopic Cholecystectomy

Abstract Background Biliary acute pancreatitis requires timely management to prevent complications. Guidelines recommend laparoscopic cholecystectomy within two weeks of admission. A previous audit in our surgery department showed only 32.6% compliance with this guideline. This re-audit aimed to evaluate improvements in compliance, identify barriers, and provide insights for enhancing patient care. By retrospectively analyzing patient data from January to November 2023, we assessed progress and highlighted areas needing further improvement to align with established guidelines and ensure better patient outcomes. Method A retrospective analysis was conducted on a cohort of 32 patients admitted to the general surgery department with a diagnosis of biliary acute pancreatitis between January 2023 and November 2023. Patient records were reviewed to gather data on the timing of laparoscopic cholecystectomy performed within two weeks of the index admission. The compliance rate from this period was compared to a previous audit to assess improvements. Key barriers to timely intervention, such as the availability of ultrasound slots, hot gallbladder lists, and pre-assessment clinics, were also identified and analyzed. Statistical methods were used to confirm the significance of observed changes. Results he re-audit revealed a significant improvement in compliance with guidelines for the management of biliary acute pancreatitis. The percentage of patients undergoing laparoscopic cholecystectomy within two weeks of admission increased from 32.6% in the initial audit to 64.5% in the re-audit. However, the analysis identified persistent barriers to timely intervention, including limited availability of ultrasound slots, insufficient "hot gallbladder" surgical lists, and fear of difficulty of acute laparoscopic cholecystectomy. These findings highlight both the progress made and the areas needing further attention to enhance compliance and patient care. Conclusion The re-audit demonstrated a notable improvement in adherence to guidelines for the management of biliary acute pancreatitis, with a significant increase in timely laparoscopic cholecystectomy. Despite this progress, persistent barriers such as limited ultrasound availability, insufficient "hot gallbladder" lists, and pre-assessment clinics need to be addressed. Continuous evaluation and targeted interventions are essential to further enhance compliance, reduce complications, and improve patient outcomes. Ongoing efforts to refine clinical practices will help achieve the highest standards of care for patients with biliary pancreatitis.

BS SO09 - Use of ursodeoxycholic acid in preventing gallstone formation after bariatric surgery – introduction of a new clinical pathway

Abstract Background Rapid weight loss is a risk factor for symptomatic gallstone formation. Managing gallstone disease such as choledocholithiasis can be more challenging after Bariatric Surgery (BS) due to altered anatomy. Ursodeoxycholic acid (UDCA) is a low-cost and low-risk method of reducing the risk of symptomatic gallstone disease and cholecystectomy by almost a third in patients who have had BS. However, it is not yet included in national guidelines for bariatric surgery. We audited prescription rates of UDCA in patients who underwent BS with a view to introducing it into our standard post BS care bundle. Method Data was collected from 30 consecutive patients who underwent a sleeve gastrectomy or Gastric bypass in November and December 2023. The results informed our practice and a UDCA prescribing pathway was developed using evidence from randomized trials. The pathway was circulated to all members of the bariatric service on 17/1/2024 and discussed at the departmental meeting. The audit loop was closed by collecting data from a further 30 consecutive patients. Demographic data, type of operation, BMI, history of gallstone disease, prescribing data and reasons for non-compliance were collected. The compliance rate to the UCDA pathway was expected to be 100%. Results Data was collected from 60 patients (85% female; median BMI 49; median age 45). No patient who could have benefited received UDCA prior to the intervention. After the intervention, 15/30 (50%) of patients were correctly prescribed UDCA. Therefore, correct prescription of UDCA did not meet target compliance rates. No patient was incorrectly prescribed UCDA. Reasons for non-compliance include human error, concern about the size of the tablet, inadequate knowledge about how to administer (e.g. crushing in liquid) and misconceptions of oral intake after BS. Conclusion UCDA can reduce incidence of symptomatic gallstones following BS, yet use of UDCA in bariatric centres in the UK is thought to be low. We discovered that more time should be dedicated to educating the team about administration methods and how it interacts with the current postoperative diet plan. A UCDA pathway and education of bariatric teams can improve compliance with appropriate UDCA prescribing. Further intervention is required and planned in our centre such as utilising e-prescribing as a prompt to include UDCA in the discharge prescription and considering the use of the drug's liquid form in the short term.

Pain assessment and management in patients with dementia in Taiwan: a best practice implementation project.

The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia. The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community. The project followed the JBI Evidence-based Healthcare Model and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance. This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1-3, respectively. For Criteria 4-8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses' perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome. Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study. http://links.lww.com/IJEBH/A294.

OGC SO12 - Extended Venous Thromboembolism Prophylaxis in Postoperative Oesophagogastric Cancer Patients: A Completed Audit

Abstract Background Venous thromboembolism (VTE) is a life-threatening complication for cancer patients undergoing oesophagogastric surgery. The NICE recommends extending pharmacological VTE prophylaxis to 28 days for patients undergoing major abdominal cancer surgery. While the effectiveness of in-hospital VTE prophylaxis is well-documented, the optimal duration for postoperative VTE prophylaxis remains a subject of debate. This study aims to evaluate the prescribing compliance, effectiveness, and safety of extending VTE prophylaxis to 28 days following hospital discharge (HD), a policy adopted trust-wide since 2014. Method This is an 11-year retrospective study from July 2012-2022, followed by a complete audit cycle conducted between January 2023-2024. The study included all patients who underwent cardio-esophagectomy or gastrectomy for oesophagogastric cancers. Exclusion criteria comprised patients who died during the index admission, those who underwent benign oesophagogastric surgery or local excision of gastrointestinal stromal tumours (GIST), and patients with peripherally inserted central catheter (PICC) line-associated VTE. The primary outcome measured was the prescribing compliance of 28-day VTE prophylaxis post-hospital discharge. Secondary endpoints included the incidence of VTE and bleeding complications necessitating hospital readmission within 28 days of discharge. Results Our study included 582 patients, showing that post-2014, 423 out of 490 patients (86.3%) were discharged with 28-day VTE prophylaxis, compared to 13 out of 92 patients (14.1%) pre-2014, indicating a significant improvement (p&amp;lt;0.05). Only one patient (0.17%) developed VTE more than 28 days post-discharge, and no readmissions due to bleeding complications. In the subsequent audit, 63 out of 68 patients (92.6%) received the prophylaxis, further increasing prescribing compliance. Comparing the two periods, compliance improved from 86.3% to 92.6%, though not statistically significant (p=0.145). Overall, VTE incidence was minimised from 0.17% to 0%, with no readmissions due to bleeding complications. Conclusion Routine extended VTE prophylaxis for 28 days post-hospital discharge should be recommended for cancer patients undergoing oesophagogastric surgery. This practice has significantly improved prescribing compliance rates, reduced post-hospital discharge VTE incidence, and demonstrated safety, with no hospital readmissions due to bleeding complications.