Compliance Rate Research Articles

Application effect of task-oriented multi-dimensional nursing intervention in patients with coronary atherosclerotic heart disease and concurrent hypertension

Background: The purpose of this study was to explore the application effect of task-oriented multi-dimensional nursing interventionin patients with coronary atherosclerotic heart disease (CAD) and concurrent hypertension. Methodology: The clinical data of 196 patients with CAD and concurrent hypertension in our hospital between January 2019 and January 2022 were retrospectively analysed. The patients receiving task-oriented multi-dimensional nursing were set as study group (n=98), while those given routine nursing as control group (n=98). The two groups were compared in the Hamilton Anxiety Scale (HAMA) scores, left ventricular end-diastolic diameter (LVEDD), 36-Item Short Form Health Survey (SF-36) scores, left ventricular ejection fraction (LVEF), Hamilton Depression Scale (HAMD) scores, systolic blood pressure (SBP), treatment compliance and incidence rates of adverse events. Results: After intervention, study group showed lower HAMA and HAMD scores, SBP and LVEDD, but higher SF-36 scores and LVEF than control group (P<0.05). The treatment compliance rate was higher in control group than that in study group (92.86% vs. 80.61%), while an opposite result was detected in the total incidence rate 5.10% vs. 13.27%, P<0.05). Conclusion: Multidimensional nursing benefits CAD patients with hypertension, improving emotions, compliance, and quality of life, reducing adverse events, and promoting recovery. Recommended for clinical use. Keywords: Coronary atherosclerotic heart disease; task-oriented theory; multi-dimensional nursing care; clinical nursing.

Emergency Action Planning in United States High Schools.

Rates of emergency action plan (EAP) implementation and compliance with EAP guidelines vary in United States secondary schools. There are limited data on emergency preparedness in schools without athletic trainers (ATs). Rural and high poverty schools have poor emergency preparedness for high school athletic events due to financial barriers and lack of ATs. Cross-sectional study. Level 5. A web-based questionnaire was emailed by each State High School Athletics Association to ATs, athletic directors, and coaches of recipient schools to assess emergency preparedness. A total of 686 responses were received (response rate ~3.5%). Schools with an AT on staff were more likely to have an EAP (P < 0.01). Schools with a higher enrollment were more likely to have an EAP (P < 0.01), an AT on staff (P < 0.01), require additional training for coaches (P < 0.01), and have an automated external defibrillator (AED) onsite for all events (P < 0.01). Urban (odds ratio [OR], 3.514; 95% CI [2.242, 5.507]; P < 0.01) and suburban (OR, 4.950; 95% CI [3.287, 7.454]; P < 0.01) districts were more likely than rural districts to have an AT on staff. High poverty districts were less likely to have an AED (OR, 0.660; 95% CI [0.452, 0.964]; P = 0.03) or EAP (OR, 0.511; 95% CI [0.306, 0.853]; P < 0.01) at athletic venues. Lower enrollment, high poverty, and rural schools are less prepared for athletic emergencies than their higher enrollment, low poverty, and suburban counterparts as these schools are generally less likely to have an AT on staff, AEDs, and EAPs and less likely to provide additional training to coaches and other staff. This study assesses athletic emergency preparedness-a critical component of ensuring athlete safety and recovery after injury.

Outpatient Management Protocol for Uncomplicated Diverticulitis: A 3-Year Monocentric Experience in a Tertiary Hospital.

Background/Objectives: The management of acute uncomplicated diverticulitis (AUD) has shifted towards outpatient care in the last decade, challenging the traditional inpatient approach. We aimed to analyze the safety and feasibility of a structured outpatient treatment pathway for AUD in a tertiary hospital. Methods: We conducted a retrospective observational cohort analysis of patients who underwent outpatient management for AUD at the Geneva University Hospitals from 2019 to 2021. Patient demographics, selection criteria, treatment protocols, and outcomes were analyzed. Results: Two-hundred and twenty patients were included in the outpatient cohort. Four patients (1.8%) required hospitalization due to the failure of outpatient management, whereas the majority of patients (116 patients, 98.2%) experienced a successful resolution of their symptoms without hospitalization. In a univariate analysis, factors associated with treatment failure included elevated white blood cell counts at admission (14 G/l vs. 10.6 G/l, p = 0.049) and the first follow-up appointment, (10.7 G/l vs. 7.4 G/l, p = 0.011) and the presence of free air on their CT scan (25% vs. 2,3%, p = 0.033). In a multivariate analysis, the presence of free air was the only identified risk factor for unsuccessful outpatient management (p = 0.05). We observed high rates of follow-up compliance (99.1%). Conclusion: Under the condition of a warranted outpatient follow-up appointment and with adequate selection criteria, outpatient management appears to be an effective approach for most patients with AUD, emphasizing the importance of tailored therapeutic interventions and vigilant clinical assessments for optimal outcomes.

Improving the Timely Delivery of Postoperative Radiation in Head and Neck Cancer

The time that elapses between a patient's ablative tumor resection and indicated adjuvant radiation has a significant impact on an individual's local tumor control and survival, and its optimization is in the best interest of the patient. Furthermore, it is a recognized treatment-related quality metric that can have bearing on future provider compensation. Despite these important driving considerations, compliance rates with established goals are low, recently measured to be <50%. Making meaningful and lasting improvements in this requires a system-based approach. This article seeks to provide clinicians practical tools to apply lean health care and flow management principles to identify chief obstacles to timely care in their systems, and effective strategies to overcome common bottlenecks.

Utilization of Lean Six Sigma and the DMAIC process on oral treatment regimen entry and consent to improve patient care and mitigate practice risk.

281 Background: Oral medication (chemo/hormone) volumes in oncology treatment selection will continue to increase year over year. In 22’, oral meds accounted for the largest market share in dollars at 51% vs IV treatment at 49%. Oral medication volume is projected to increase by proliferation and utilization, though revenues may decrease due to decreasing drug margins. Medication regimen consent is a critical part of specialty pharmacy accreditation through one of the national accrediting organizations. This accreditation is vital to meeting the requirements and maintaining contracts with pharmacy benefit managers (PBMs) and specialty-focused pharmacy services administrative organizations (PSAO). Without improved and continued consent compliance, OHC was at a significant risk of losing the ability to provide care for this impacted patient population, thus resulting in increased risk of financial toxicity. PBMs and accreditations require quality components be completed to maintain the ability to run a specialty oncology pharmacy. When a new oral prescription is written, the oral must be 1.) entered as a regimen and not a single script-only in the EHR and 2.) must have a completed teaching visit and legal consent. Methods: Following the DMAIC (define, measure, analyze, implement and control) process, OHC’s Lean Team deployed Lean Six Sigma strategies and tools in PY23’ to bridge the gap to goal for both oral medication risk areas. OHC followed the lean methodology A3 process using DMAIC, deployed implementation strategies and curated data analytic reports to ensure oral medications were entered as regimens vs script-only, that teaching/consents were completed, and that the control phase maintained a steady state. Results: In 23’, OHC providers accurately prescribed in the EHR a new oral chemo/hormone at 98% (1037/1055) accuracy vs 22’ at 69% (586/845). Additionally, OHC achieved a 93% (986/1055) teach/consent compliance rate vs 22’ at 59% (499/845). With mitigation of compliance risk (est. at 12,114,000), OHC ensured no loss of pharmacy accreditation and contracts. Increased oral medication teaching visits capture rate increased (n=399) resulting in $114,000 additional return on investment in calendar year 23’. Conclusions: Utilizing Lean Six Sigma tools and the DMAIC process, OHC was able to implement strategies to meet both measure goals in one performance year, resulting in improved patient care, organizational risk mitigation, and sustainable profitability. The results have been maintained in the control phase of PY24’. Lean Six Sigma and the DMAIC process are vital to organization success. Tactics deployed have proven to be reproducible and scalable to other projects. Measure PY2022 PY2023 Goal Oral Medication Regimen NCCN Entry vs Script-only 69% (586/845) 98% (1037/1055) 90% Oral Medication Regimen Teach/Consent 59% (499/845) 93% (986/1055) 93%

[Translated article] Measurement Assessment of Minimal Disease Activity in Psoriasis in Spain: A National Cross-Sectional Study

IntroductionIn 2017, the Spanish Academy of Dermatology and Venereology Psoriasis Working Group (PWG) designed the Minimal Disease Activity (MDA) criteria to determine the level of disease activity. We hereby present the results of an observational, cross-sectional, multicenter study of the nationwide application of these criteria. Material and methodsWe conducted a non-randomized sampling, stratified to achieve autonomic and provincial representation of consecutive patients with psoriasis (Ps) vulgaris without active arthritis. A total of 830 patients were included: 493 men (59.5%), with a mean age of 51.4 years (SD, 14.2), from all autonomous regions of Spain (except for Ceuta and Melilla) and 44 (88%) out of the 50 provinces. A questionnaire was obtained with demographic data, DLQI, subjective assessment—on a scale from 0 to 10—of itching, erythema, desquamation, visibility, and the patients’ PASI and BSA. ResultsMore than 50% failed to meet the MDA criteria (491; 59.2%), with significant differences being reported by region, sex, and age. Additionally, significant differences were reported based on the therapy used (P<.001). The use of biological therapies was associated with higher MDA compliance compared to other therapies (59.4% vs 23.3%). No differences were reported among various biological therapies. ConclusionsThe overall rate of MDA compliance is low, with differences being based on geographic location, sex, age, and drug used, yet none of these factors separately justify them.

Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

Labelling of Fluids in the Sterile Field During Orthopaedic Surgery: A Quality Improvement Initiative.

Background Intraoperative safety protocols, including proper labelling of syringes, are critical to patient safety in surgical settings. While the Royal Pharmaceutical Society and the Royal College of Anaesthetists provide clear guidelines to prevent medication errors, ensuring consistent compliance with labelling protocols in the fast-paced and complex environment of orthopaedic surgery can still present practical challenges. The absence of proper labelling, combined with the use of multiple fluids such as normal saline, disinfectants, and local anaesthetics, increases the risk of adverse outcomes due to fluid misidentification. This quality improvement project aimed to assess current labelling practices in a district general hospital, identify barriers to compliance, and develop a cost-effective solution. Methodology The project was conducted in three orthopaedic theatres over two audit cycles. During the first audit cycle, 30 procedures were observed to assess compliance with labelling guidelines. Compliance was defined as the labelling of all syringes containing fluids present in the sterile field. Following this, an intervention was introduced, using surgical marker pens and sterile stickers for fluid labelling, along with a mandatory "tactical pause and check" and an awareness campaign. Two months later, a second audit of 34 procedures was conducted to evaluate the effectiveness of the intervention. Results In the first audit cycle, only three out of 30procedures (10%) were compliant with labelling guidelines. Following the intervention, compliance increased dramatically to 32 out of 34 procedures (94%). The results were statistically significant (p < 0.05) as determined by Fisher's exact test. The use of sterile stickers and marker pens proved to be a simple and cost-effective solution that did not interfere with the sterile environment or increase costs. Conclusions This study demonstrates that a low-cost intervention using sterile stickers and surgical marker pens can significantly improve compliance with fluid labelling guidelines in orthopaedic surgery, thereby enhancing patient safety. While the intervention was successful, future research should explore more sustainable solutions, such as pre-printed sterile labels, and evaluate the long-term impact of such interventions across various surgical settings. Continuous education and regular audits will be essential in maintaining high compliance rates.

Association of SARS-CoV-2 infection during late pregnancy with maternal and neonatal outcomes

BackgroundLimited data on the impact of the coronavirus disease 2019 (COVID-19) during pregnancy on newborn outcomes are available. This study aimed to characterize and compare the clinical outcomes of newborns from women with and without the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during late pregnancy.MethodThis was a retrospective cohort study of women who were either infected or not infected with the SARS-CoV-2 virus during late pregnancy. The neonatal complications associated with COVID-19-positive pregnant women were investigated and analyzed.ResultsAmong 2063 pregnant women over 28 weeks of gestation, 1.2%, 3.3%, and 18.7% of patients with multiple pregnancies, abnormal fetal positions, and lack of maternal or neonatal follow-up data, respectively, were excluded. Patients who were COVID-19-negative (60.6%) and -positive (16.2%) remained for further analysis. SARS-CoV-2 infection was significantly associated with higher SARS-CoV-2 infection rates in newborns (0% vs. 1.49%, P < 0.01) and longer duration of hospital stay (6.39 ± 2.2 vs. 4.92 ± 1.6, P < 0.01). However, comparing neonatal complications, including Apgar score, preterm birth, low birth weight, cesarean section rate, newborn hearing, neonatal congenital heart defects, and height and weight compliance rate of 6-month-old children, between non-infected and infected participants did not reach statistical significance.ConclusionSARS-CoV-2 infection in late pregnancy has no significant impact on neonatal outcomes. After six months of follow-up of the neonates, we observed that SARS-CoV-2 infection in the third trimester of pregnancy did not affect their growth and development. Hopefully, these findings will guide management strategies and clinical practice.

Unveiling Factors Influencing Mortality in Irish Hip Fracture Patients: A Comprehensive Five-Year Analysis

BackgroundHip fractures impose a substantial healthcare burden, contributing to increased morbidity, disability, and mortality. The Irish Hip Fracture Standards (IHFS) were officially employed in 2017, providing specialized pathways for hip fracture care to improve patient outcomes. This study evaluated the performance of our unit regarding hip fracture care and analyzed individual outcome parameters. MethodsData spanning 5 years (2015 to 2019) preceding the COVID-19 era were extracted from our hip fracture repository. Patients aged 60 years and more were included. The dataset integrated demographic information and outcomes, validating mortality events using the Irish death events registry. Mortality rates were measured cumulatively and at various time intervals. There were 1,685 hip fractures treated during the study timeframe; average patient age was 78 years, with women constituting 68% of the cohort. ResultsThe one-year mortality rate was 20.8% (n = 350). Adverse outcomes were observed in older patients, men, and those who had higher American Society of Anesthesiologists scores. Patients adhering to IHFS 1 (P ≤ 0.05) and IHFS 2 (P ≤ 0.05) exhibited improved outcomes. Our institution displayed lower compliance rates with IHFS 1 and 2 when compared to standards 3 to 6, with the latter standards showing no notable impact on mortality outcomes. ConclusionsWhile our unit’s hip fracture care outcomes align well with national averages, resource constraints hinder full compliance with IHFS 1 and 2, emphasizing the need for targeted resource allocation in areas with the greatest impact on outcomes.

Development and Application of Drilling Intelligent Assistant Decision System

Abstract In order to systematically harness the substantial volume of data generated during the drilling process and achieve intelligent analysis and auxiliary decision-making for real-time risk monitoring and warnings during drilling, an intelligent drilling auxiliary decision-making system has been developed. This system integrates various technologies, including physical models, intelligent algorithms, and trend analysis. By analyzing the characteristics of logging data under different operating conditions, an intelligent algorithm capable of automatically distinguishing six types of drilling operating conditions has been established. Taking into account the impact of rock cuttings on the stress on the pipe string and annular pressure loss during the drilling process, coupled frictional torque and cyclic pressure loss calculation models were developed under coupled conditions. Building upon this foundation and considering the trend of deviation between predicted and measured parameters, a monitoring algorithm for detecting stuck drilling, wellbore leakage, and overflow incidents was formulated. The development of the drilling intelligent decision-making system was completed based on a C/S three-layer architecture and a data center. This system has been successfully applied in more than 50 exploration wells of various types, including shale oil and gas horizontal wells and deep wells. The static analysis results demonstrated a compliance rate of 91.5% with on-site monitoring, playing a crucial role in drilling parameter optimization and risk monitoring. The practicality and feasibility of the system have been verified, providing essential support for efficient and safe drilling production.

Impact of an Epstein-Barr Virus Serology-Based Screening Program on Nasopharyngeal Carcinoma Mortality: A Cluster-Randomized Controlled Trial.

Screening for nasopharyngeal carcinoma (NPC) has shown an improvement in early detection and survival rates of NPC in endemic regions. It is critical to evaluate whether NPC screening can reduce NPC-specific mortality in the population. Sixteen towns in Sihui and Zhongshan cities, China, were selected; eight were randomly allocated to the screening group and eight to the control group. Residents age 30-69 years with no history of NPC were included from January 1, 2008, to December 31, 2015. Residents in the screening towns were invited to undergo serum Epstein-Barr virus (EBV) viral capsid antigen/nuclear antigen 1-immunoglobulin A antibody tests; others received no intervention. The population was followed until December 31, 2019. Nonparametric tests and Poisson regression models were used to estimate the screening effect on NPC mortality, accounting for the cluster-randomized design. The trial is registered with ClinicalTrials.gov (identifier: NCT00941538). A total of 174,943 residents in the screening group and 186,263 residents in the control group were included. NPC incidence and overall mortality were similar between the two groups. A total of 52,498 (30.0% of 174,943) residents participated in the serum EBV antibody test. The overall compliance rate for endoscopic examination and/or biopsies among baseline and ever-classified high-risk participants was 65.9% (1,110 of 1,685) and 67.6% (1,703 of 2,518), respectively. A significant 30% reduction in NPC mortality was observed in the screening group compared with the control group (standardized NPC-specific mortality rate of 8.2 NPC deaths per 1,000 person-years versus 12.5; adjusted rate ratio [RR], 0.70 [95% CI, 0.49 to 0.997]; P = .048). This benefit was most evident among individuals age 50 years and older (RR, 0.56 [95% CI, 0.37 to 0.85]; P = .007) compared with those younger than 50 years (RR, 0.96 [95% CI, 0.64 to 1.46]; P = .856). In this 12-year trial, EBV antibody testing resulted in a significant reduction in NPC mortality.

LIMBERG FLAP FOR SACROCOCCYGEAL PILONIDAL SINUS: A SAFE AND PROMISING SURGERY

Introduction:Sacrococcygeal pilonidal sinus is a common disease of the adult age group, especially male population, causing significant morbidity from both disease and surgery done for the same. It is essentially a cleavage between the buttocks (i.e., natal cleft), and diagnosis is made by identifying the epithelialized follicle opening (i.e., sinus). The name PILONIDAL is taken from Latin meaning nest of hairs. The estimated incidence is 26 per 1,00,000 people1. It generally presents as a cyst, abscess, or sinus tract with or without discharge2. Men affected more often than women1, rare both before puberty and after the age of 40 years3. The etiology of the pilonidal sinus is a matter of controversy. Aims &amp; Objectives:Literature study showed that Limberg flap reconstruction following rhomboid excision of the sinus area was superior to primary closure and other flap procedures and a safe and reliable method in sacrococcygeal pilonidal sinus disease with low complication and recurrence rates. Hence, this study was performed in our setup to evaluate the usefulness of Limberg flap procedure in sacrococcygeal pilonidal sinus, patient compliance, complications and long-term recurrence rates following the procedure. Materials &amp; Methods:The study involves 22 patients, from May 2022 to September 2023. Most of the patients were males of those 4 were females. Average age was 24 years—the oldest was 29 years and the youngest was 15 years. Results:In this study 22 patients were included. Among them 18 were males and 4 were females. Mean age was 24 years (range 15–29 years). Of the 22 patients, 14 had primary disease, 6 had recurrent disease, and 2 came up after having previous incision and drainage for abscess. All patients came with pilonidal sinus, from May 2022, were assessed for its severity and investigated, and then they underwent Limberg flap surgery under spinal anesthesia. Discussion:Sacrococcygeal pilonidal sinus is blind epithelial tract situated in the skin of the natal cleft, close to anal verge, generally containing hair. The etiology is matter of debate initially congenital origin was thought of which is now given up. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Conclusion:Sacrococcygeal pilonidal sinus is headache to both the patient and the treating surgeon because of its repeated infection, persistent pain with discharge, and high recurrence rates with regular procedures.

The Role of Helmet Therapy in Craniosynostosis: A Systematic Review.

The aim of this study was to determine the impact of helmet therapy (HT) as a treatment for craniosynostosis, with a focus on the outcomes of skull morphology, reoperation rate, complications of HT, and quality of life of patients who receive it. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review utilized the PICO format: Does HT following strip craniectomy (SC) improve outcomes (outcome) compared to SC alone (comparison) in patients undergoing craniosynostosis correction (intervention)? Searches were performed from January 1, 2000 to December 31, 2022, using PubMed, Cochrane Library, and Ovid Medline databases. Study quality was evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment scale. Fourteen studies meeting the inclusion criteria were identified. Among these, 438 patients underwent SC-HT, while 104 patients underwent SC without HT. The preoperative cephalic indices for sagittal craniosynostosis in the HT and non-HT groups were 66.8 and 67.8, respectively, which improved postoperatively to 75 and 76.2, respectively. Limited long-term follow-up hindered a definitive assessment of reoperation rates. Complication rates related to HT were low at approximately 2.9%, primarily consisting of skin irritation. Parental satisfaction was high, correlating with a strong compliance rate. Existing literature does not demonstrate a clear superiority between SC with or without HT for treating nonsyndromic sagittal craniosynostosis. Outcomes appear comparable, but evidence is constrained by the predominance of single-center retrospective studies with limited methodological rigor. There is a pressing need for international multicenter trials to furnish more robust and generalizable findings.

A compliance and audit model for tackling tax evasion in Nigeria

Tax evasion remains a significant challenge for Nigeria, undermining economic stability and reducing public revenue. This paper proposes a comprehensive compliance and audit model designed to address tax evasion in Nigeria. The model integrates enhanced compliance strategies, advanced audit procedures, and the strategic use of technology to create a robust framework for tackling tax evasion. The proposed model emphasizes proactive measures to improve taxpayer compliance through targeted education and outreach programs, streamlined reporting processes, and incentivization. On the audit front, it advocates for the adoption of sophisticated audit techniques and technologies, including data analytics and automated systems, to detect and address evasion more effectively. The implementation framework outlines a phased approach involving key stakeholders such as the Federal Inland Revenue Service (FIRS), local tax authorities, and the private sector. By examining domestic and international case studies, the paper highlights successful practices and potential challenges, providing actionable insights for adapting these strategies to the Nigerian context. Evaluation metrics are proposed to assess the model’s effectiveness, with expected outcomes including improved tax revenue, enhanced compliance rates, and strengthened public trust in the tax system. The study concludes with recommendations for further research and policy adjustments to refine and expand the model's application. This approach aims to not only mitigate tax evasion but also contribute to a more transparent and equitable tax system in Nigeria.

Standards-based audit to improve quality of maternal and newborn care-A stepped-wedge cluster randomised trial in Malawi.

Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. ISRCTN registration number: 59931298.

The impact of artificial intelligence on regulatory compliance in the oil and gas industry

Artificial Intelligence (AI) is increasingly transforming the regulatory compliance landscape in the oil and gas industry. This paper examines the profound impact of AI on ensuring adherence to complex regulatory frameworks governing this sector. Regulatory compliance in the oil and gas industry involves adhering to a myriad of environmental, safety, and operational regulations, often posing significant challenges due to the volume and complexity of data involved. AI technologies, including machine learning, natural language processing, and predictive analytics, offer innovative solutions to these challenges. AI enhances data management and analysis by automating data collection, processing, and reporting, thereby increasing accuracy and efficiency. Predictive maintenance and risk assessment tools powered by AI can identify potential compliance issues before they arise, allowing for proactive measures. Moreover, AI-driven compliance monitoring systems enable real-time tracking of regulatory adherence, reducing the risk of non-compliance and associated penalties. Automated auditing and inspection processes further streamline compliance checks, ensuring thorough and consistent evaluations. Case studies demonstrate successful AI implementations in regulatory compliance, such as automated reporting systems in offshore drilling and predictive maintenance in pipeline management, which have resulted in improved compliance rates and reduced operational risks. However, the adoption of AI is not without challenges. Issues related to data quality and integration, cybersecurity, and regulatory acceptance pose significant hurdles. Additionally, ethical and legal considerations surrounding AI deployment must be addressed to ensure responsible use. AI holds substantial potential to revolutionize regulatory compliance in the oil and gas industry by enhancing efficiency, accuracy, and proactive risk management. As AI technologies continue to evolve, their integration into compliance processes will likely become more sophisticated, offering greater benefits and addressing current limitations. The future of regulatory compliance in the oil and gas sector will be increasingly shaped by the advancements in AI, driving both operational excellence and adherence to stringent regulatory standards.

Medicine Compliance Among Hypertensive Patients with Known Diabetes Mellitus in Sindh, Pakistan

Background: Hypertension and diabetes mellitus are prevalent chronic conditions, requiring long-term medication adherence for effective management. Non-compliance can lead to severe health complications and increased healthcare costs.Objective: To evaluate medication compliance among hypertensive patients with known diabetes mellitus in Sindh, Pakistan, and identify key factors contributing to non-compliance.Methods: This cross-sectional study included 381 participants from various cities in Sindh, selected through convenience sampling. Data were collected using a structured questionnaire covering demographic characteristics, socioeconomic status, and factors influencing medication compliance. Blood pressure was recorded using a sphygmomanometer. Ethical approval was obtained, and data were analyzed using SPSS version 25, with a p-value &lt; 0.05 considered statistically significant.Results: Of the 381 participants, 67.98% were fully compliant with their medication regimen, while 32.02% were non-compliant. The most common reasons for non-compliance were complex medication regimens (17.21%), side effects (16.39%), and financial constraints (13.93%). Socioeconomic status significantly influenced compliance, with lower compliance observed in the lower socioeconomic group (p &lt; 0.05).Conclusion: Despite a high compliance rate, a substantial portion of patients remain non-compliant due to regimen complexity and financial barriers. Targeted interventions, including simplified treatment plans and improved patient education, are necessary.

Comparison of Amoxicillin Administered Twice versus Four Times a Day in First-Line Helicobacter pylori Eradication Using Tegoprazan, Clarithromycin, and Bismuth: A Propensity Score Matching Analysis.

This study aimed to investigate the effects of different amoxicillin (AMX) dosing schedules on bismuth quadruple therapy in Helicobacter pylori treatment-naïve patients. A total of 139 H. pylori-infected patients received a 2-week eradication regimen consisting of 50 mg tegoprazan, 500 mg clarithromycin, and 300 mg bismuth tripotassium dicitrate twice daily, 1000 mg AMX twice daily (BID group), or 500 mg AMX four times daily (QID group). We performed a urea breath test to evaluate H. pylori eradication eight weeks after treatment and compared the H. pylori eradication rate, patient compliance, and adverse drug events between the BID and QID groups. Based on propensity score matching, 114 and 100 patients were included in intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The H. pylori eradication rate did not differ significantly according to the ITT (82.5% vs. 87.7%, p = 0.429) and PP (95.9% vs. 98.0%, p = 0.536) analyses between the BID and QID groups. No significant differences were found in treatment compliance or adverse drug event rates between the two groups. In conclusion, the eradication rate of first-line H. pylori therapy containing tegoprazan, clarithromycin, and bismuth was not affected by AMX dosing schedules administered twice and four times daily.

Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial.

Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, "Smart Reminder" (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke. Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training. The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038). The 4-week telerehabilitation program using a "SR" device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.