Standard Practice Research Articles

Public capital investment spike events: the regional dimension in Greece

Deviating from the standard practice of linking public infrastructure and regional output expansion through a linear long-run equilibrium relationship, we consider the case where public investments follow a ‘bumpy’ path instead. According to the political business cycles theory, we argue that public infrastructure investments occur in a lumpy manner at the beginning of the electoral period, with reduced activity between spikes. In this framework, we propose a novel methodology applied in a different context to identify the role of investment spikes on the performance of Greek regions from 1995 to 2015. To the best of our knowledge, this is the first research focusing on the relationship between spikes in public investments and their impact on regional development. To address the research question, we utilize a difference-in-differences (Diff in Diff) model. However, it is important to note that this approach is susceptible to endogeneity concerns, particularly it might suffer from omitted variable bias, a form of endogeneity. The analysis shows a strong increase in regional labor productivity, peaking three years after the shock.

Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial Design for PrEventive Effect of MEditerranean Diet in Children: PEMED Trial Research Protocol.

Background: Childhood nutrition plays an important role in the promotion of long-term health. Introducing solid foods in alignment with the Mediterranean Diet during weaning fosters a preference for healthy foods early in life. However, access to nutritious diets remains a challenge in underserved communities. Scampia, a socioeconomically disadvantaged district in Naples, Italy, exemplifies a community where barriers to healthy eating persist. This research reports a trial protocol that plans for a study to evaluate the impact of the Mediterranean Diet on child health and to establish preventive strategies for chronic diseases. Methods: The PEMED (PrEventive effect of MEditerranean Diet in Children) trial is a Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial. Family Pediatricians (FPs) are randomized to deliver either Mediterranean Diet-based dietary guidance starting at weaning or standard dietary practices using typical baby foods. Children will be followed up for six years, with regular assessments of growth, microbiome composition, and adherence to the Mediterranean Diet, using validated tools. Interim analyses will be conducted at three-year intervals to evaluate the efficacy and monitor adverse events. Saliva and stool samples will be collected for genetic and microbiome analyses, and adherence will be monitored through quarterly dietary recalls and biomarkers. Results: This trial will consider Italy's established FP network for implementing innovative dietary intervention in a real-world setting. Conclusions: This study will address nutritional disparities in the underserved Scampia community and provide a scalable model for early dietary interventions. The results will shed light on the role of the Mediterranean Diet in improving childhood health and informing public health strategies globally.

Comparison of Recruitment Method on Clinical Outcomes Following Cervical Disc Arthroplasty.

Retrospective cohort. To compare the clinical outcomes of trial versus standard clinical practice (SCP) patients following cervical disc arthroplasty (CDA). CDA is hypothesized to reduce the shear strain and related complications resulting from fusion procedures. CDA has gained significant traction in recent decades. The typical non-trial patient undergoing CDA does not undergo the same level of preoperative scrutiny as those treated in formal clinical trials. Concerns exist about diverging clinical outcomes between these groups. This investigation retrospectively reviews prospectively collected data on one and two-level CDA patients from C3-T1. Patients were recruited into randomized, controlled trials or SCP practice beginning in 2002 or 2018, respectively. One-year minimum follow-up was required. Hybrid constructs and prior cervical spine surgical history have been excluded. Clinical assessments included reoperation history and the patient-reported outcome measures of Visual Analog Scale (VAS) neck, VAS arm, and Neck Disability Index (NDI). Data was collected at the preoperative, postoperative, one-year, two-year, three-year, five-year, and ten-year time points. One hundred and sixty-eight patients underwent CDA at 193 cervical levels, including 104 trial patients and 64 SCP patients. Mean follow-up for the entire cohort was 6.1 years (0.9 - 20.4 years). Eight unique disc designs were utilized. Trial patients had a greater proportion of females and longer follow-up duration (P<0.05). Trial patients had significantly worse preoperative clinical scores with greater improvements at each follow-up time point. SCP patients had significantly higher index-level reoperation rates at five years. Trial patients have lower rates of reoperation and improved clinical performance which could be in part due to more stringent selection criteria. This study is limited by long-term SCP response rates. Additional studies with larger cohorts are needed to improve our understanding of disc implant performance.

Reflection on Fair and Equitable Treatment Standard in China s Practice

International investment law always emphasizes the importance of improving the Fair and Equitable Treatment (FET) standard. Though many studies have summarized several new changes in the FET standard worldwide in recent years, there is a lack of effective evaluation and unified explanation for Chinas FET standard practice. Therefore, this paper aims to expound the hidden problems and solutions to Chinas application of the FET standard by exploring the developments of the FET standard in terms of treaty design and arbitration interpretations in recent years. The paper finds that states turn to impose a restriction of the scope of protection in bilateral investment treaties &amp; international investment agreements as well as polish FET clauses in a more precise way, while the overall design of the FET standards in China remain backward. In addition, arbitration tribunals have more specific interpretations of the connotation of FET, but China's lack of arbitration experience makes it difficult to optimize FET clauses through arbitration interpretations. Therefore, this paper suggests China should specify its FET clauses in semi-closed enumeration method and more precise expression and systematically study tribunal interpretations of the FET standard elements as reference.

Comparable achievement of workplace performance of student and graduate nurses: A quantitative cohort evaluation

AimThis study explored the achievement of workplace capabilities synonymous with nursing practice. It investigated progressive development of workplace performance, against requisite standards of practice, of corresponding cohorts of student nurses during their final year placement and registered nurses during their graduate year, in south-eastern Queensland, Australia. BackgroundA capable nursing workforce is vital for the provision of safe, quality health care. Internationally, the literature discusses the breadth of capacities required for the practice of nursing. A perennial challenge is comprehensive pre-registration education that ensures new graduate nurses meet standards for practice to provide comprehensive care. MethodsA quantitative evaluation design was used to assess the progressive development of workplace performance of both student nurses across their final year placement (n=214) and graduate nurses in their first nine months (n=197). Capabilities of both cohorts were assessed using the Australian Nursing Standards Assessment Tool (ANSAT), based on Australian registered nurses’ standards for practice that has demonstrated utility and validity for both students and graduates. ResultsA total of 642 student assessments and 409 graduate nurse assessments were used for analysis. Findings revealed congruence in weaknesses in workplace performance for both students and graduates. Students and graduates consistently rated lowest in capabilities pertaining to high cognitive tasks that involved analysing data and modifying plans. Of interest, completing comprehensive, systematic assessments was stronger in students than in graduates. ConclusionThis is the first comparable quantitative study exploring the progressive development of students and graduate nurses’ workplace performance aligned to nursing practice standards. Questions of limitations throughout educational learning experiences during industry placement are raised in these findings. Furthermore, it is proposed that educational approaches be organised to address areas identified as weakest on graduation as these are most evident in initial employment. This research explicates a largely undefined area of nursing practice that can inform undergraduate learning priorities.

Efficacy of Air and Oxygen Micro-nano Bubble Waters Against Colletotrichum gloeosporioides and Impacts on Postharvest Quality of 'Fan Retief' Guava Fruit.

This study focused on the application of micro-nano bubbles (MNBs) water generated using air or oxygen (O2), as an alternative to chlorine-based wash for fruits. For the in vitro and in vivo investigation, 106 spore or conidia/mL Colletotrichum gloeosporioides suspension was used, and treated with solutions of air- or O2-MNB for 30- or 60-min, sodium hypochlorite (NaOCl), and untreated (as control). In the second experiment, freshly harvested guava fruits were washed with tap water (control), NaOCl (standard practice), air-, or O2-MNB (for 15- or 30-min). All samples were packaged, stored for 21 days at 13 °C, and monitored for changes in natural microbial population and quality attributes. Based on the confocal laser and transmission electron microscopy results, exposure of C. gloeosporioides to air-MNB for 60 min resulted in the lowest viable cell count (%) compared to control and other treatments (O2-MNB and NaOCl). Air- and O2-MNB treatments damaged cellular structures, disrupted cell membrane integrity, and deformed hyphal morphology. Washing 'Fan Retief' guava (Psidium guajava L.) in air- or O2-MNB (for 15 and/or 30 min), better-retained tissue strength, delayed changes in color, and total soluble solid (TSS) content. Notably, MNB treatments were as effective as NaOCl washing and significantly reduced microbial load on fruit surface by ≥2 Log (p < 0.05). Micro-nano bubble water treatment offers a new paradigm for decontamination and preservation of guava fruit quality.

ImpACT Project: Improving Access to Clinical Trials in Victoria, an Artificial Intelligence-Based Approach.

Enhancing the speed and efficiency of clinical trial recruitment is a key objective across international health systems. This study aimed to use artificial intelligence (AI) applied in the Victorian Cancer Registry (VCR), a population-based cancer registry, to assess (1) if VCR received all relevant pathology reports for three clinical trials, (2) AI accuracy in auto-extracting information from pathology reports for recruitment, and (3) the number of participants approached for trial enrollment using the AI approach compared with standard hospital-based recruitment. To verify pathology report accessibility for VCR trial enrollment, reports from the laboratory were cross-referenced. To determine the accuracy of a Rapid Case Ascertainment (RCA) module of the AI software in extracting key clinical variables from the pathology report, data were compared with manually reviewed reports. To examine the effectiveness of the AI recruitment approach, the number of patients approached for recruitment was compared with standard practice. Of the 195 reports provided by the pathology laboratory, 185 (94.9%) were received by VCR, 73 of 195 (37.4%) were eligible for the studies, and 5 of 73 (6.8%) eligible cases had not been received by the VCR. The RCA module demonstrated an accuracy of 93% and an F1 score of 0.94 in extracting key clinical variables. However, the RCA false-positive rate was 10% and the false-negative rate was 5%. The standard hospital approach selected fewer cases for approach to clinical trials compared with the RCA module approach, 8 of 336 (2.4%) versus 12 of 336 (3.6%), respectively. Using AI to screen potentially eligible cases for recruitment to three clinical trials resulted in a 50% increase in eligible cases being approached for enrollment.

Reducing Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation.

Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022. We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project. We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions. A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status.

Understanding Privacy Norms through Web Forms

Web forms are one of the primary ways to collect personal information online, yet they are relatively under-studied. Unlike web tracking, data collection through web forms is explicit and contextualized. Users (i) are asked to input specific personal information types, and (ii) know the specific context (i.e., on which website and for what purpose). For web forms to be trusted by users, they must meet the common sense standards of appropriate data collection practices within a particular context (i.e., privacy norms). In this paper, we extract the privacy norms embedded within web forms through a measurement study. First, we build a specialized crawler to discover web forms on websites. We run it on 11,500 popular websites, and we create a dataset of 293K web forms. Second, to process data of this scale, we develop a cost-efficient way to annotate web forms with form types and personal information types, using text classifiers trained with assistance of large language models (LLMs). Third, by analyzing the annotated dataset, we reveal common patterns of data collection practices. We find that (i) these patterns are explained by functional necessities and legal obligations, thus reflecting privacy norms, and that (ii) deviations from the observed norms often signal unnecessary data collection. In addition, we analyze the privacy policies that accompany web forms. We show that, despite their wide adoption and use, there is a disconnect between privacy policy disclosures and the observed privacy norms.

Predicting Live Weight for Female Rabbits of Meat Crosses From Body Measurements Using LightGBM, XGBoost and Support Vector Machine Algorithms.

Prediction of body weight (BW) using biometric measurements is an important tool especially for animal welfare and automatic phenotyping tools that needs mathematical models. In this study, it was aimed to predict the BW using body length (BL), chest girth (CG) and width of the waist (WW) for rabbits of the maternal form of Hyla NG. The standard rabbit-raising practices were applied for the animals. A highly efficient gradient-boosting decision tree (LightGBM), eXtreme gradient-boosting (XGBoost) and support vector machine (SVM) algorithms were evaluated and compared to the prediction of BW. The coefficient of determination, root mean square error and mean absolute error values were used as comparison criteria. The results showed that LightGBM, XGBoost and SVM algorithms were well fit for the BW using the biometric measures with over 95% accuracy for both train and test sets. The BL was determined as the most explanatory variable on body weight.

Behaviors and influencing factors of Chinese oncology nurses towards frailty care: A cross-sectional study based on knowledge-attitude-practice theory in 2024.

The demand for frailty care is continuously increasing in hospitalized tumor patients with the aging of the population. Nurses are the primary care providers of hospitalized tumor patients with frailty but research on exploring their behavior and associated factors is limited. This study aims to describe the current situation of frailty care behaviors in oncology nurses and to explore the factors influencing frailty care behaviors. From August 1, 2023, to March 31, 2024, this cross-sectional study was conducted among nurses from oncology-related departments in 5 Secondary A (mid-tier hospitals providing comprehensive care) or above hospitals in South China. Convenience sampling was employed to recruit participants. In China, a "Secondary A hospital is a mid-tier hospital that provides comprehensive medical care and handles more complex cases than primary hospitals but is smaller and less specialized than tertiary hospitals. Data were collected using the standardized frailty-knowledge, attitudes, and practices questionnaire (F-KAP) and general information questionnaire including sociodemographic and work-related details. The sub-scale scores of knowledge, attitude, and practice were calculated by summing up the items within each sub-scale. Student's independent t-test, one-way ANOVA, Pearson's correlation coefficient, and two kinds of multiple linear regression models were used for data analysis. We included a total of 17 (3.70%) male and 443 (96.30%) female participants in this study. The mean total score of oncology nurses for frailty care behaviors was 33.26±6.61. The three lowest scoring behaviors were "conduct frailty measurements and screening for patients (3.30±1.12)", "accumulate frailty-related knowledge in daily work (3.59±0.87)", and "actively pay attention to the patient's debilitating condition". Pearson's correlations analysis showed that nursing grades (r = 0.13), frailty-related training willingness (r = 0.18), nursing frail patients experience (r = 0.22), frailty-related knowledge learning experience (r = 0.33), frailty-related training experience (r = 0.17), frailty care knowledge (r = 0.23), and hospice care attitudes (r = 0.54) were positively associated with frailty care behaviors. Two kinds of multiple linear regression models both showed that the factors most significantly associated with the oncology nurses' frailty care behaviors are their self-rated subjective knowledge and attitudes towards frailty identification. Oncology nurses practiced relatively low-frequency frailty in daily work. Our findings provide theoretical support for improving frailty care attitudes among nurses and enhancing patient quality of life.

Impact of functional re-education and environmental adaptation in cancer patients with respiratory pathology: Study protocol.

In recent years, cancer survival rates have increased exponentially. However, this rise in survival comes with a significant drawback. As the number of treatment lines has grown, so too have the side effects, which can severely impact patients' functionality and quality of life. One of the most concerning effects is dyspnoea, a serious health issue that imposes substantial limitations on individuals. While traditional clinical approaches, primarily focused on pharmacological interventions, are commonly employed to manage dyspnoea, we argue that these methods may not always provide optimal symptomatic relief. Therefore, we propose a study protocol to implement an interdisciplinary intervention for these patients. This protocol aims to enhance standard clinical practice by introducing a program of functional re-education and environmental adaptation. We believe this intervention is essential for the follow-up care of patients with respiratory conditions after hospital discharge. A two-arm, randomized, parallel, controlled clinical trial will be conducted by the University of Salamanca, Spain, in collaboration with the Medical Oncology Service of the University Health Care Complex of Salamanca. The trial aims to recruit 80 oncology patients who exhibit symptoms of dyspnoea during hospital admission. Participants will be randomly assigned to one of two groups: the control group, which will receive a health education program, and the experimental group, which will receive both the health education program and a functional re-education and environmental adaptation program. Assessments will be conducted at three time points: baseline (prior to hospital discharge), follow-up (15 days after discharge), and the end of the intervention (1 month after discharge). During these assessments, sociodemographic data will be collected, and the following scales will be administered: Barthel Index, Medical Research Council Dyspnoea Scale (mMRC), EuroQol 5-D questionnaire (EQ-5D), Visual Analogue Scale (VAS), Short Physical Performance Battery (SPPB), Tampa Scale for Kinesiophobia (TSK), and the Zarit Reduced Caregiver Burden Scale. The findings of this research can be easily implemented in clinical settings by introducing a targeted intervention to improve the quality of life for this patient population. This study aims to advance traditional clinical approaches by facilitating the recovery or adaptation of cancer patients in their daily routines, in relation to the severity of their symptoms. Our primary goal is to enhance independence and functionality, ultimately improving their overall standard of living. ClinicalTrials.gov; ID: NCT06035263. Registered on: September 19, 2023. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000DM2U&selectaction=Edit&uid=U0004OJ7&ts=6&cx=f7qqxo.

Antiviral activity of HuaganJiedu decoction (HGJDD) against hepatitis B virus (HBV) through FOXO4/ERK/HNF4α signal pathway.

Chronic hepatitis B virus (HBV) infection is still a widespread global health issue. HuaganJiedu Decoction (HGJDD) is a common prescription for treating HBV in China, which has the effect of enhancing antiviral efficacy and improving clinical efficacy. However, its precise mechanism of action remains unclear, warranting further investigation to elucidate its therapeutic potential and integration into standard medical practices. This study aims to explore the therapeutic mechanism of HuaganJiedu Decoction (HGJDD) in HBV. We investigated the therapeutic potential of HGJDD, and LC-MS analysis characterized the chemical profile of HGJDD. In vitro, we utilized HepG2.2.15cell line to assess cytotoxicity and treatment efficacy of HGJDD compared to Entecavir controls. In vivo, assessments included monitoring HBV-related biomarkers and viral load. Network pharmacology and RNA-seq analyses identified molecular pathways and targets influenced by HGJDD treatment. Immunofluorescence and Western blotting provided further insights into the therapeutic mechanisms underlying HGJDD for HBV. HGJDD showed no toxicity on HepG2.2.15cells at 10%, 20%, 40%, and 80% serum concentrations. In vitro, HGJDD reduced HBsAg, HBeAg, and HBV DNA levels by dose-dependently and time-dependently. HGJDD can decrease the levels of HBsAg, HBeAg, and HBV DNA in serum and liver levels, meanwhile the therapeutic effect of high-dose HGJDD approach to EVT's in HBV Tg mice. According to intersection of network pharmacology and transcriptome, FOXO signal pathway was highlighted as potential targets and Immunofluorescence find that FOXO4D protein expression lever was increased in three HGJDD group, especially in high-dose HGJDD group. Western blotting confirmed increased level of FOXO4, ERK, and p-ERK and decreased levels of HNF4α, which reflected that the therapeutic effect was closely to FOXO4/ERK/HNF4α signal pathway. Traditional Chinese medicine (TCM) offers diverse herbal treatments for HBV, with HGJDD showing efficacy in reducing HBsAg, HBeAg, and HBV DNA levels at cellular and animal levels. This study identified that FOXO4/ERK/HNF4α signal pathway played an important role in HGJDD's therapeutic effects. These findings support HGJDD's potential in HBV treatment, providing a scientific basis for clinical use.

Graphene nanocoating on titanium maintains structural and antibiofilm properties post-sterilization

ObjectiveTo evaluate the impact of sterilization methods on the structural integrity and antimicrobial properties of graphene nanocoating on titanium (GN). MethodsGN was transferred to titanium using wet (WT) or dry transfer (DT) techniques and sterilized using an autoclave (AC), glutaraldehyde (GA), or ethylene oxide (EtO). The GN structure was characterized using Raman spectroscopy before and after sterilization. Additional specimens were characterized by Raman after AC and water jetting. Biofilm formation was assessed before and after AC using colony-forming units (CFU), biofilm biomass, and SEM (uncoated titanium was the control). Three independent samples were used for structural characterization and biofilm quantification. Statistical analyses were conducted using one-way analysis of variance (ANOVA) and Tukey's test (α = 0.05). ResultsWT and DT demonstrated high structural stability after sterilization and water jetting, with negligible coating quality or coverage loss. GN exhibited lower biofilm formation even after AC sterilization, as shown by the reduction in CFU counts, biofilm biomass, and SEM images compared to the control. SignificanceGN demonstrated high resistance to the stresses imposed by all sterilization methods tested, maintaining its structural integrity, resistance to water-jet cleaning, and antibiofilm potential. The findings suggest that standard industrial practices can effectively sterilize highly resilient GN on titanium implants and possibly other biomaterials.

Occupational Therapists' Role in Maternal Health in the Home Environment After Cesarean Section.

Cesarean sections (c-sections) are the most commonly performed surgery in the United States, and the country is currently facing a maternal health crisis. Surprisingly, women do not receive rehabilitation services to support the acute stages of c-section recovery. When someone undergoes a knee or hip replacement, it is standard practice for the physician to order home health services, including occupational therapy, for a client before they are discharged from the hospital. The role transition to motherhood, which requires the provision of newborn care, physical limitations after surgery, and the associated mental health changes position occupational therapy practitioners as professionals who can provide essential services to mothers after a c-section. In this column, we argue for occupational therapy practitioners' important role in serving women in the home environment immediately after a c-section and provide a tangible action plan for implementing these crucial services to improve maternal health outcomes. This column gives a voice to the often-invisible struggles of mothers suffering in silence in the acute postpartum stage of c-section recovery in the hope of bringing positive change to maternal health outcomes through the provision of skilled occupational therapy services.

The influence of nursing handover on nurses' mental health: A scoping review

&lt;p&gt;Nursing handover is essential in clinical practice across various healthcare settings and can significantly impact nurses' mental health. This scoping review aimed to explore and map these implications using the JBI methodology and PRISMA ScR Checklist. It included 11 studies published between 1988 and 2022 from the UK, Australia, USA, South Korea, and Hong Kong, involving over 122 nurses in acute care settings. The findings reveal three major themes: source of psychological discomfort, coping resource, and peer support and cohesion. Negative emotions such as stress, anxiety, dissatisfaction, and tension are linked to handovers, particularly bedside handovers, which raise confidentiality issues and induce scrutiny among nurses. The lack of standardized training and consistent procedures also contributes to stress, especially for newly graduated and less experienced nurses. Conversely, handovers function as structured rituals providing peer support and a sense of control, helping nurses manage psychological demands. To mitigate negative impacts, implementing standardized handover procedures and comprehensive training programs for new nurses is essential. Encouraging open communication and fostering a supportive environment can enhance team cohesion and reduce stress. Future research should measure the impact of different handover practices on nurses' mental health and explore their supportive, social, protective, and restorative functions. This review highlights the critical role of nursing handovers in supporting nurses' mental health and underscores the need for standardized practices to improve the well-being of nursing professionals and the quality of patient care.&lt;/p&gt;

Continuous vital sign monitoring of patients recovering from surgery on general wards: a narrative review.

Most postoperative deaths occur on general wards, often linked to complications associated with untreated changes in vital signs. Monitoring in these units is typically intermittent checks each shift or maximally every 4-6 h, which misses prolonged periods of subtle changes in physiology that can herald a critical downstream event. Continuous monitoring of vital signs is therefore intuitively necessary for patient safety. The past five decades have seen monitoring systems evolve rapidly, and today entirely wireless, wearable, and portable continuous surveillance of vital signs is possible on general wards. Introduction of this technology has the potential to modify both the sensing (afferent) and response (efferent) limbs of monitoring, and will allow earlier detection of vital signs perturbations. But this comes with challenges, including but not limited to issues with connectivity, data handling, alarm fatigue, information overload, and lack of meaningful clinical interventions. Evidence from before and after studies and retrospective propensity-matched data suggests that continuous ward monitoring decreases the risk of intensive care unit (ICU) admissions, rapid response calls, and in some instances, mortality. This review summarises the history of general ward monitoring and describes future directions, including opportunities to implement these devices using artificial intelligence, pattern detection, and user-friendly interfaces. Pragmatic, well designed and appropriately powered trials, and real-world implementation data are necessary to make continuous monitoring standard practice at every hospital bed.

Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study.

To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards. Worldwide, MAEs are very common and regarded as a serious risk factor to inpatient safety. Nurses assume an essential role in the hospital setting during the administration of medications. The prospective observational study was carried out in accordance with the STROBE guidance. This study was conducted in four regional hospitals from June to August 2021. MAEs were collected when nurses administered medications to the adult inpatients during the morning, noon, and evening medication rounds at the internal, surgical, and follow-up care departments in each hospital over three consecutive days. Direct observation by the multidisciplinary team was employed. MAEs were classified as major MAEs (from the potentially most serious and common to all drug forms), specific MAEs (specific to a drug form), and procedural MAEs (e.g., patient identification, hygiene standards, or generic drug substitution). Predictors of either major MAE or specific MAE frequency were analysed using the generalised linear model and the decision tree model. Overall, 58 nurses administering medication to 331 inpatients at 12 departments were observed. In total, 6356 medication administrations were observed, of which 461 comprised major MAEs, 1497 specific MAEs, and 12,045 procedural MAEs. The predictors of the occurrence of major MAEs and specific MAEs were the specific hospital, the nurse's length of practice (less than 2 years), and two procedural MAEs (the unclear prescription and the wrong strength). Non-adherence to the standard processes in healthcare facilities for prescribing and administering drugs increased the prevalence of severe MAEs. Determinants of MAE occurrence such as incorrect prescriptions or limited experience of nurses should be considered. The identified determinants of MAE should be considered by hospital stakeholders in their support programs to reduce the level of burden for nurses during medication administration. Neither patients nor public was not involved in the design, data collection, or dissemination plans of this study. The researchers observed nurse care delivery at medical departments acting as passive participants.

Development of transformative reflexive empowering character building learning model: a case study of Pancasila student profile at elementary schools

Introduction. The relevance of this research lies in addressing the lack of clear, practical standards for character education in elementary schools in Indonesia, which remains largely theoretical. The purpose of this article is to develop a learning model intended as a standard and guideline for teachers in the teaching and learning process of Pancasila student character profiles at the elementary school level. Study participant and methods. The research utilized the R&amp;D Borg and Gall method, which involved various stages from research and information collection to dissemination and implementation. The validation process included consultations with experts in student character teaching strategies to ensure the model's validity, design, and contextualization. The trial involved 10 teachers and 100 elementary school students from grades 4, 5, 6 across five different elementary schools in Indonesia. The results. The results of this study indicate that the Transformative Reflexive Empowering Character Building (TRECB) Model garnered motivation and interest from 93.3% to 96.6% of students, and there was a significant improvement in students' understanding of the Pancasila student profile. With an n-gain value of 0.75, the effectiveness of the TRECB model in enhancing students' understanding and application of the Pancasila student profile falls into the high category. Statistical observations also reveal a significant difference in the Pancasila Student Profile among students before and after the integration of the TRECB Model into their educational experience. Conclusion. The developed learning model provides a standard and guideline for teachers in character education at the elementary school level, addressing the lack of clear standards and implementation in character education in Indonesian elementary schools. The model, refined through expert consultations and trials, offers an effective approach to teaching and learning character education, paving the way for its implementation in elementary schools and potentially higher levels of education in the future.

ARE FEDERAL GUIDELINES HELPING TO IMPROVE PAIN ASSESSMENT, DIAGNOSIS, AND MANAGEMENT IN NURSING HOMES

Abstract The State Operations Manual for Long Term Care, specifically F-Tag F697, requires that nursing homes must ensure that pain management is provided to residents. The management should be consistent with professional standards of practice, the person-centered care plan, and the residents’ goals and preferences. Although these regulations are required there are many pain related issues not well addressed in the guidance such as recognition of the challenges to pain assessment and management, ways to overcome challenges, how the community incorporates assessment, diagnosis and management of pain using professional standards of practice, the most current standards of practice for long-term care residents, the best ways to manage different types of pain (e.g., neuropathic, chronic), and how to make decisions about changing, adding or stopping an analgesic among others. Further, there are no processes by which the communities or regulatory agencies evaluate if there is a person-centered care plan and if the plan matches the resident’s pain goals. In our pilot work implementing the Pain Management CPG we noted that the majority of the care plans related to pain were generic and not personalized and we were able to help staff make pain care plans more personalized care. The purpose of this paper is to address the mismatch between the requirements and measures within the Minimum Data Set around pain assessment, diagnosis and management and issues and concerns with this approach. We will describe how the Pain Management CPG can help guide communities to overcome these issues and adhere to F-Tag F697.