Standardized Process Research Articles

EVALUATING THE SUCCESS FACTORS FOR KNOWLEDGE MANAGEMENT IN THE FINANCIAL SECTOR: AN AHP- DEMATEL APPROACH

The objective of this article is to identify and understand the success factors of knowledge management within the financial sector. In the ever-evolving business environment, effective knowledge management (KM) is imperative to maintain a competitive advantage. Effective KM within financial institutions can build standardized processes, ensure speedy delivery, and foster better customer relationship management. An integrated approach of the Analytical Hierarchy Process (AHP) and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) methods was used to rank these critical success factors and understand their interrelationships. The findings identify organizational factors (cultural aspects, organizational structure, top management support), technological factors (technological adoption, infrastructure support, collaborative systems), and human resources factors (training & learning, agile workforce, knowledge sharing) as the critical success factors. Technological factors were identified as the most important factors. The article further complements the findings of the AHP by exploring the interrelationships between the identified factors to understand and prioritize possible intervention areas. This research has significant theoretical and practical implications. The findings can help financial institutions implement and manage knowledge management initiatives within the organization. This study also adds to the extant literature and addresses gaps in the research in the context of KM within the financial sector.

Fecal microbiota live - jslm (Rebyota™/RBL) for management of recurrent Clostridioides difficile infection.

There is an unmet need for effective treatments of Clostridioides difficile infection, an emerging health crisis in the United States. The management of C. difficile infection should include treatment of active infection and a strategy to prevent recurrence. Current gold standard therapy includes oral antibiotics which predispose patients to gut dysbiosis and increase the risk of recurrent infection. Addressing dysbiosis via fecal microbiota transplantation is an active and promising area of research, but studies have lacked standardization which makes outcome and safety data difficult to interpret. Rebyota™, formerly known as RBX2660, is a live biotherapeutic product designed using a standardized protocol and manufacturing process that has been shown to be effective for preventing recurrent C. difficile infection.

Routine Postclinical Event Debriefings on Inpatient Pediatric Units.

Debriefings are an underutilized opportunity to enhance team performance and safety culture. Little is known about the impact of postclinical event debriefing programs in Pediatric Hospital Medicine (PHM). We sought to develop a standardized debriefing process with multidisciplinary involvement after all clinical events on PHM service lines. Our primary aim was to achieve 75% debriefing completion rate over 12 months with debriefing duration less than 10 minutes. A standardized postclinical event debriefing process was created at a large tertiary children's hospital. We aimed to debrief after clinical events on PHM services. The debriefing process was developed with key stakeholders and used a key driver diagram and Plan-Do-Study-Act cycles to refine the process. The project team reviewed the data monthly. During our 20-month study period, debriefing completion rate sustained a median of 66% with a median debriefing time of 7 minutes. Most debriefings (61%) had all core team members present with attending physicians (pediatric hospitalists) being absent most often. Barriers to debriefing with all core members present included service type, time of day, and shift change. Process changes were implemented based on concerns addressed in the debriefings. Multidisciplinary, postclinical event debriefings were successfully implemented on inpatient pediatric wards. Future steps include process implementation on non-PHM units in our hospital based on expressed interest and to further assess how debriefings optimize team performance and improve clinical outcomes.

Temperature mapping methods for thermoelastic analyses of the ARIEL spacecraft payload module

The ARIEL mission is a European space project that aims to detect exoplanets with a spacecraft orbiting around the L2 point of the Sun-Earth system. The main payload consists of a Cassegrain telescope composed of mirrors that reflect and concentrate the incoming light from the deep space observations to finally guide it to the detectors. As in many other space missions, a dedicated complex assessment is established during the design phase to evaluate the impact on the optical performance caused by thermoelastic effects, which involves the coordinated work of the thermal, structural, and optical engineers. Despite that well-known and standardized processes and tools are established separately in each involved area, there is a lack of standardization about the way of exchanging the data between them, where additional calculations are required in some cases. This work focuses on the temperature mapping, which is the intermediate step between thermal and structural analyses, where temperatures are transferred to the structural model. The main difficulty of this process is related to the differences in modelling methods and approaches between both models, being necessary the development of an adequate algorithm to find the most accurate transfer of temperatures. This paper shows two different options for temperature mapping, detailing the proposed flowcharts. One of these methods requires the performance of an additional thermal conductive analysis, where a new improved procedure has been implemented in this work to solve some computational issues that made its application for large models difficult or even unfeasible. Both temperature mapping methods have been applied to the payload module of the ARIEL spacecraft, comparing the output results in terms of temperatures, stresses, forces, and displacements to evaluate their differences.

Optimizing Production Line Efficiency through a Standardized Work Tool: A Case Study

Lean methodology focuses on enhancing flow and resource efficiency by prioritizing customer value, eliminating waste, reducing variation, and fostering a culture of continuous improvement involving everyone in the organization. Implementing lean creates conditions that empower all employees to contribute to continuous improvement activities within the value stream. This approach not only lowers production costs, enabling reinvestment and employee engagement but also emphasizes professional development. This paper aims to maximize efficiency in seal production within a manufacturing industry by implementing lean tools such as standardized work and Kaizen. Standardized Work is a systematic method for producing parts or services centred on human motion. As a tool for ensuring quality, it defines efficient, safe work methods and helps eliminate waste, serving as the foundation for every operation. Once implemented, standardized work ensures that the same methods are repeated consistently, avoiding unnecessary motions, maintaining quality, ensuring safety, and preventing equipment damage. The consistent application of these methods improves product quality through standardized processes and procedures. By incorporating lean tools like defined worksheets and Kaizen, the production of seals in manufacturing industries can achieve significant productivity enhancements.

Guiding Principles for Evaluating Vaccines in Joint Health Technology Assessment in the European Union: Preparing for the European Union’s Regulation on Health Technology Assessment for Vaccines

ObjectivesThe appraisal of vaccines in the European Union (EU) currently involves many different decision-making bodies and processes. The objective of this study was to help inform the development of standardized methodology and vaccine-specific processes for use in the EU Regulation on health technology assessment (HTA). MethodsLiterature reviews and expert consultation were conducted to identify current practices and gaps related to vaccine appraisals and to develop guiding principles for the joint clinical assessment of vaccines. ResultsWe found that significant variation exists across the EU member states in the decision-making processes when clinically evaluating vaccines. Three guiding principles consisting of 13 recommendations were developed to help inform the development of decision-making frameworks for the joint clinical assessment of vaccines in the EU: (1) support the creation of appropriate terminology and measurements for clinical appraisals of vaccines; (2) develop inclusive, timely, and transparent vaccine appraisal processes to support stronger evidence generation for vaccine decision making and appraisal; and (3) improve the collection and interoperability of real-world data, including robust surveillance, to foster evidence generation and support the standardization of vaccine clinical appraisals. ConclusionsGiven the significance of vaccines for public health, there is an urgency to develop standardized and vaccine-specific methodologies and processes for use in the EU joint HTA framework. The proposed guiding principles could support the effective implementation of the EU Regulation on HTA for vaccines and have the potential to ensure consistent, transparent, and timely access to new vaccines in the EU.

Universal artificial intelligence workflow for factory energy saving: Ten case studies

Numerous studies have affirmed that artificial intelligence (AI) can effectively enable energy savings in factories. However, there is currently a lack of explicit research that identifies the energy-saving effects of AI methods as compared to the conventional practices employed in factories, which involve the replacement of equipment with high energy efficiency (non-AI method), with respect to variance in the effectiveness. Thus, this ignited the motivation for this study, wherein the research team developed a “Universal AI workflow for energy saving” which adopted a standard workflow of “learning, Modeling, and Prediction.” Additionally, a three-year research project was launched to conduct empirical tests in ten factories, comparing the efficacy differences between AI and Non-AI methods. In 2021, research team established the energy consumption baselines for each factory through data collection; the entirety of 2022 was dedicated to AI integrations; and energy-saving benefits were evaluated in 2023. During the research period, each factory also implemented other non-AI energy-saving methods which were juxtaposed with AI approaches for comparison. Our study results showed that average AI-enabled energy savings across the ten factories amounted to 106,124 kWh/yr, while average energy savings from non-AI methods amounted to 1,231,625 kWh/yr. Despite the inferior energy-saving results, the AI methods had an average return on investment (ROI) of 0.46 years while non-AI methods had an average ROI of 6.22 years, indicating that AI methods could recover the investment costs through energy savings in less than one year. It is also worth noting that the ten factories produced a diverse range of products encompassing wafers, steel, and foods, but the AI methods used for energy saving employed the same workflow. By contrast, the non-AI methods necessitated distinct workflows and detailed engineering adjustments. It can be inferred from these empirical findings that AI techniques for achieving energy-saving control in factories can be integrated using standardized processes. In summary, AI methods can facilitate standardized workflows in factories and offer substantial energy-saving benefits that can typically cover investments within a year. AI represents a highly viable energy conservation option for factories seeking to maintain uniformity in product processes and realize efficient ROIs.

Compositional and Microstructural Investigations of Prehistoric Ceramics from Southern Romania (Middle Neolithic Pottery)

In this paper, based on our previous expertise on ceramic artifacts, several archaeometric methods applied to some samples collected from the Dudești archaeological site (Oltenia region, Romania) are reported for the first time in the literature. The chemical composition, and microstructural and morphological characterization of these samples offer important conclusions about the processing conditions. Some specific techniques such as X-ray diffraction (XRD), wavelength-dispersive X-ray fluorescence (WDXRF), optical microscopy (OM), stereomicroscopy, environmental scanning electron microscopy (ESEM), Fourier-transform infrared spectroscopy (FTIR), and Raman spectroscopy provide compositional information about composition and the decay processes. Additionally, the Brunauer–Emmett–Teller (BET) method helps to estimate pore sizes and specific surface areas. A thermogravimetric analysis (TGA/TDG) was used to establish details regarding the production technology and also the raw materials source used to make the ceramics. The obtained results indicated that the ceramics are based on a paste of muscovite and feldspar, with high plasticity, together with quartz and hematite/goethite and calcite, the latter in very low concentrations. According to the obtained results, we could assume that clays from the investigated samples had a low concentration of calcium. Gypsum is present as paste in a very low concentration, identified by the presence of a sulphate group in WDXRF. In the same context, iron oxides have a significant impact on the firing atmosphere of iron-rich clay, resulting in blackening under reducing conditions and a reddish coloration under oxidative conditions. The use of hematite and gypsum as pigments further contributes to the color variations in the pottery. The consistent firing temperature range of 200–600 °C in Dudești pottery implies a standardized production process, the variation in color being dependent on the specific reducing/oxidative regime conditions (reducing atmosphere followed by rapid oxidation). This relationship between clay composition and local sources suggests a connection to Neolithic pottery production in the region and their color depending on the reducing/oxidative regime conditions.

Reducing Blood Culture Contamination in Adult Patients with Cancer Presenting to the Emergency Department

Background: Infection is one of the most common complications of cancer and cancer treatment. Most patients admitted for fever or infection come through the Emergency Department (ED), which is a primary site for blood culture collection. Contamination of blood cultures complicates the diagnoses, compromises quality of care, leads to unnecessary antibiotic exposure and increases financial burdens. It may also lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was over twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses, instead of phlebotomists, draw most blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the ED contamination rate by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared ED contamination rates versus other hospital inpatient floors and outpatient centers over a three-month period. We then evaluated the contamination rates of ED nurses versus ED phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and potential interventions were ranked on a prioritization matrix. Results: We identified use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as critical contributors to increased contamination rates in the ED. Our intervention was creating premade blood culture kits promoting the use of chlorhexidine swabs through availability and easy access in the fast-paced ED environment. Ten cubic centimeter (cc) syringes in the kits encouraged withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off ED nurses at the bedside, implementing education and adherence in using the blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. A reduction in blood culture contamination from 2.46 percent to 1.89 percent was seen after two months. Conclusions: A guideline-driven, standardized blood culture collection process followed by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available premade blood culture kits improve compliance with materials and techniques associated with best practices.

Quantitative assessment of human error of emergency behavior for hazardous chemical spills in chemical parks

In-depth research on human error is of great significance to improve the human reliability in the emergency rescue as well as to avoid the occurrence of secondary accidents. Therefore, the standardized process and key emergency behaviors in the emergency rescue process of hazardous chemical leakage accidents are first analyzed. Based on the Cognitive Reliability and Error Analysis Method, the human error mode was sorted out, and the human error probability estimation model was established. Combining the improved Analytic Hierarchy Process and entropy weight method, a model for estimating the severity of human error was established, realizing the quantitative analysis of the human reliability of the emergency behavior. The study showed that the 21 emergency behaviors were clustered into 3 categories, with clustering 1 including 2 emergency behaviors, which have the highest level of severity, clustering 2 including 11 emergency behaviors, and clustering 3 including 8 emergency behaviors. Finally, countermeasures were proposed in four areas, including increasing the level of Common Performance Conditions and the ability to transmit information on accidents, etc. It indicates that the method can widely guide the improvement of emergency response capability in chemical parks.

SIMPLE procedures: Survey of Internal Medicine Providers' Limitations and Experiences with procedures and medical procedure services.

In response to a decline in bedside procedures performed by hospitalists, some hospital medicine groups have created medical procedure services (MPSs) concentrating procedures under the expertise of trained hospitalist-proceduralists. To characterize the structure, breadth, and heterogeneity of academic medical center MPSs, as well as compare the procedural landscape for groups with and without an MPS. The Survey of Internal Medicine Providers' Limitations and Experienceswith Procedures and MPSs, is a cross-sectional study, conducted in the United States and Canada through a web-based survey administered from October 2022 to March 2023. We used convenience and snowball sampling to identify eligible study participants. The survey explored presence of MPS, procedure volumes, patient safety, and educational practices. For MPSs, we explored onboarding, staffing, skill maintenancy, funding, and barriers to growth. Forty institutions (response rate 97.5%), represented by members of the Procedural Research and Innovation for Medical Educators (PRIME) consortium participated in the survey. MPSs were found in 75% of the surveyed institutions. Most MPSs (97%) involved trainees and were staffed by internists (100%) who often had additional clinical duties (70%). The majority (83%) of MPSs used checklists and procedural safety guidelines, but only 53% had a standardized process for tracking complications. There was significant variability in determining procedural competency and supervising trainees. Groups with an MPS reported higher procedure volume compared to those without. MPSs were highly prevalent among the participating institutions, offered a broad array of bedside procedures, and often included trainees. There was a high variability in funding models, procedure volumes, patient safety practices, and skill maintenance requirements.

Structured Tube Weaning Using the Hunger Provocation Method in Infants with Single Ventricle Heart Defects: A Multicenter Study.

Despite improvement in hemodynamics, children with single ventricle heart disease remain on feeding tubes long after stage 2 palliation (S2P). Use of a hunger provocation method in a multidisciplinary team setting has been successful at weaning these children from feeding tubes. The objective of this study is to describe patient characteristics and outcomes in the single ventricle population who underwent a formal tube weaning process using a standardized hunger provocation method. Single ventricle patients after S2P from six centers were included. Patient data collected included baseline demographics, swallow evaluation results, and feeding characteristics such as percent oral intake at the start of tube wean. Tube wean data included tube weaning process and duration, interruptions to the tube wean, adverse events, and weights before, during, and after the tube wean. 94% (60 of 64) of patients achieved oral independence. The median time to tube wean was 12.5days. 62% of patients had transient weight loss during the tube wean. 61% of the cohort was taking less than 10% goal volumes by mouth with 90% of those patients successfully tube weaned. All patients with history of aspiration were successfully tube weaned. 75% of successfully weaned patients were above baseline weight at 1-month post-tube wean. The most common cause of tube wean interruption was contraction of a viral illness. Use of a standardized tube weaning process via hunger provocation method is both feasible and safe in the single ventricle population, resulting in successful feeding tube removal in a timely manner with minimal adverse effects.

A quality improvement evaluation of a standardized intervention for children with medical complexity transitioning to adult care.

Children with medical complexity have medical fragility, chronic disease, technology dependence, and high healthcare use. Their transition to adult health care at age 18 involves medical and social elements and follows no standardized process. Our goal was to improve transition readiness in children with medical complexity using a transition intervention within a Complex Care program. All children with medical complexity aged 14 to 18 were included in this quality improvement (QI) project (n = 54). We conducted a pre- and post-intervention chart review to assess transition outcomes and implemented a transition intervention for 6 months, which included an age-stratified checklist, charting template, and transition rounds. Before the intervention, 72% of 17- to 18-year-old patients had documented transition discussions, which increased to 86%. Patients with a family physician increased as well (61% to 73% for 17- to 18-year-olds). Three transition education rounds were held. The intervention increased transition readiness, provided tools to facilitate transition, and created a forum for conversation.

Providing technical assistance: lessons learned from the first three years of the WHO Adolescent and Youth Sexual and Reproductive Health and Rights Technical Assistance Coordination Mechanism

Young people’s sexual and reproductive health (SRH) continues to be a major challenge in low and middle-income countries, with implications for public health now and in the future. Fortunately there is a growing array of evidence-based interventions, and commitments from governments, development partners and donors, to support programmes that aim to improve young people’s SRH.However, in some situations, the technical assistance that governments feel that they need to strengthen and implement national policies and strategies, to move from words to action, is not available. The WHO Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) Technical Assistance (TA) Coordination Mechanism was initiated to help fill this technical assistance gap; to respond to TA requests from ministries of health in ways that are timely, efficient, effective and contribute to strengthening capacity.This paper describes the process of developing the Technical Assistance Coordination Mechanism (TA Mechanism) and the outcomes, experiences and lessons learned after three years of working. It triangulates the findings from a preliminary review of the literature and discussions with selected key informants; the outcomes from a series of structured review meetings; and the documented processes and results of the technical assistance provided to countries.The lessons learned focus on three aspects of the TA Mechanism. How it was conceptualized and designed: through listening to people who provide and receive AYSRHR TA and by reviewing and synthesizing past experiences of TA provision. What the TA Mechanism has achieved: a standardized process for TA provision, at different stages for a range of AYSRHR issues in ten countries in three geographic regions. And what worked well and what did not: which common challenges was the TA Mechanism able to address and which ones persisted despite efforts to avoid or resolve them. The paper ends with the implications of the lessons learned for future action.

Hospital accreditation in Mexico fails to improve the quality of healthcare: lessons from an impact evaluation.

Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico's healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.

Reducing Inpatient Transport Delays: The Right Patient at the Right Time

Introduction: Transportation of inpatients throughout hospitalization remains a critical aspect of patient care. Transport delays hinder the timely delivery of surgical procedures, radiology, and patient triage, consequently impacting the flow and receipt of treatment. This study reviews transport delays in a quaternary care hospital's inpatient orthopedic unit to the preoperative unit. The goal of the project was to reengineer processes for maximized efficiency and improve on-time starts for all surgical services. Methods: Manufacturing methods of an assembly-line–like model and contemporary process-improvement tools in Lean and Six Sigma were used to gauge, reengineer, and monitor processes to ameliorate patient flow. In addition to value streamlining the flow, evaluating communication triggers, eliminating redundant operations, and shifting roles and responsibilities, multiple data sources were used to assess flow for a redesign. Results: Changes in process operations led to a 40% decrease in delays. The grace period for 100 cases was decreased by 5 minutes, in addition to a savings of $110,000 in operating room costs in the first week and 3.5 full-time equivalents annually. Physician satisfaction with timely patient arrival increased in addition to a simplified workflow, which improved patient readiness on the inpatient surgical floor and increased safety. Discussion: Using data-driven approaches, overnight acuity level was removed as a barrier to the timely care of add-on cases. With a standardized process, prediction model, and simplified evidence-based communication strategies coupled with a “pull” manufacturing model, we implemented a structured, safe, and reliable method of efficient patient transport.

A MATLAB Toolbox for Findable, Accessible, Interoperable, and Reusable Atom Probe Data Science.

Atom probe tomography (APT) data analytics have traditionally been based on manual analytics by researchers. As newer atom probes together with focused ion beam-based specimen preparation have opened APT to many more materials, yielding much more complex mass spectra, building up a systematic understanding of the pathway from raw data to final interpretation has increasingly become important. This demands a system in which the data and treatment can be traced, ideally by any interested party. Such an approach of findable, accessible, interoperable, and reusable (FAIR) data and analysis policies is becoming increasingly important, not just in APT. In this paper, we present a toolbox, written in MATLAB, which allows the user to store the raw and processed data in a standardized FAIR format (hierarchical data format 5) and process the data in a largely scriptable environment to minimize manual user input. This allows for the experiment data to be interchanged without owner explanations and the analysis to be reproduced. We have devised a metadata scheme that is extensible to other experiments in the materials science domain. With this toolbox, collective knowledge can be built up, and a large number of data sets can be analyzed in a fully automated fashion.

Management of potentially inappropriate medication use among older adult’s patients in primary care settings: description of an interventional prospective non-randomized study

BackgroundThe management of inappropriate medication use in older patients suffering from multimorbidity and polymedication is a major healthcare challenge. In a primary care setting, a medication review is an effective tool through which a pharmacist can collaborate with a practitioner to detect inappropriate drug use.AimThis project described the implementation of a systematic process for the management of potentially inappropriate medication use among Lebanese older adults. Its aim was to involve pharmacists in geriatric care and to suggest treatment optimization through the analysis of prescriptions using explicit and implicit criteria.MethodThis study evaluated the medications of patients over 65 years taking a minimum of five chronic medications a day in different regions of Lebanon. Descriptive statistics for all the included variables using mean and standard deviation (Mean (SD)) for continuous variables and frequency and percentage (n, (%)) for multinomial variables were then performed.ResultsA total of 850 patients (50.7% women, 28.6% frail, 75.7 (8.01) mean age (SD)) were included in this study. The mean number of drugs per prescription was 7.10 (2.45). Roughly 88% of patients (n = 748) had at least one potentially inappropriate drug prescription: 66.4% and 64.4% of the patients had at least 1 drug with an unfavorable benefit-to-risk ratio according to Beers and EU(7)-PIM respectively. Nearly 50.4% of patients took at least one medication with no indication. The pharmacists recommended discontinuing medication for 76.5% of the cases of drug related problems. 26.6% of the overall proposed interventions were implemented.DiscussionThe rate of potentially inappropriate drug prescribing (PIDP) (88%) was higher than the rates previously reported in Europe, US, and Canada. It was also higher than studies conducted in Lebanon where it varied from 22.4 to 80% depending on the explicit criteria used, the settings, and the medical conditions of the patients. We used both implicit and explicit criteria with five different lists to improve the detection of all types of inappropriate medication use since Lebanon obtains drugs from many different sources. Another potential source for variation is the lack of a standardized process for the assessment of outpatient medication use in the elderly.ConclusionThe prevalence PIDP detected in the sample was higher than the percentages reported in previous literature. Systematic review of prescriptions has the capacity to identify and resolve pharmaceutical care issues thus improving geriatric care.

Unveiling the paradoxes of implementing post graduate competency based medical education programs

Purpose Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation. Method A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards. Results Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators. Conclusions Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.

Treatment of primary epididymal adenocarcinoma: a case report and review of the literature

BackgroundEpididymal tumors, especially malignant tumors, have low incidence and are rare in our clinical work. However, they may progress quickly and have poor prognosis. For such rare clinical cases with extremely low incidence rates, and as they are prone to misdiagnosis and missed diagnosis and have a very poor prognosis, clinical workers need to pay special attention and consider the possibility of primary epididymal malignant tumors.Case reportA 63-year-old Chinese male patient from Asia was admitted due to scrotal pain. Upon examination, an abnormal lesion was found in the right epididymal region. After thorough evaluation, surgical resection was performed, and the postoperative pathological result confirmed the presence of epididymal adenocarcinoma. After further ruling out secondary lesions, primary epididymal adenocarcinoma was considered. Right retroperitoneal lymph node dissection was performed under laparoscopic for treatment, and 1/11 lymph node metastasis was detected after surgery. The patient is currently under close follow-up.ConclusionsThe number of clinical cases of primary epididymal malignant tumors is very limited, there is currently no standardized diagnosis and treatment process, and there is a lack of systematic evaluation methods regarding the effectiveness of different treatment options such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy. In addition, the outcome is difficult to predict. In this article, we reviewed relevant literature and systematically elaborated on the diagnosis and treatment of epididymal malignant tumors, hoping to provide useful information for relevant experts.