Management Support Research Articles

Managerial support's moderating role in Indonesian lecturers' career insight

Lecturers' academic careers as professional workers have a different process from other workers. Understanding career insights is important for lecturers in carrying out their profession. this research aims to test the moderating effect of managerial support on the influence of career motivation and self-concept on career insight. this research uses quantitative methods, data collection uses instruments with a 1-5 Likert scale. Respondents were 499 lecturers in Jakarta, Indonesia. The data analysis technique uses SEM PLS. The research results show that career motivation and self concept have a positive effect on lecturers' career insight. meanwhile, managerial support does not have a significant moderating effect on the influence of career motivation and self concept on career insight. this research recommends the need for efforts to increase the role of managerial support in increasing lecturers' career insight. this is an opportunity for further research with different theoretical and methodological aspects.

An empirical evidence on the impact of social customer relationship management on the small and medium enterprises performance

Social media has swiftly established itself as a primary source of products’ information for customers. Nowadays, Small and Medium-size Enterprises (SMEs) can use social media to develop Customer Relationship Management platforms (social CRM). Firms, particularly SMEs in developing countries need to understand the factors affecting their performance by implementing social CRM. However, there is a dearth of awareness on the impact of social CRM on the performance of SMEs. This study proposes an integrated model that aims to investigate the effects of social CRM on SMEs’ performance. The model is constructed by incorporating three dominant theoretical frameworks: the Fit-Viability Model (FVM), Network Externalities, and the Resource-Based View (RBV). A cross-sectional survey was used to gather data from 149 SMEs managerial staff. Findings revealed that almost 50% of the variability in the performance of SMEs is explained by the fitness and viability of social CRM. In addition, network externalities of social media significantly impact the social CRM fitness in the context of SMEs with path coefficient 0.617. Furthermore, the internal financial resources factor makes sCRM viable for SMEs as the results show significant relationship between the internal financial resources and the sCRM viability with 0.536 path coefficient. Manager innovativeness, IT knowledge, top management support, and government assistance, on the other hand, do not contribute significantly to the viability of social CRM for SMEs. The model aids SMEs in making well-informed decisions regarding the adoption of social CRM by evaluating both the suitability of social media for CRM tasks and the enterprise preparedness to implement social CRM, leading to enhanced performance.

A rare case of a pleomorphic adenoma of the submandibular gland

We report the case of a 27-year-old female with a painless slowly growing mass that had developed over 2 years in the right submandibular region. Physical examination revealed a firm painless submandibular mass. Fine-needle aspiration and computed tomography (CT) scan concluded a pleomorphic adenoma of the submandibular gland. The patient underwent a right total submandibular sialoadenectomy. Histopathological examination confirmed the diagnosis of pleomorphic adenoma arising from the submandibular gland. Transient palsy of the marginal mandibular division of the facial nerve was noted post-operatively, which recovered with supportive management. Pleomorphic adenoma of the submandibular gland represents a diagnostic and therapeutic dilemma in young adults. Preoperative evaluation, including MRI/CT scan and fine-needle aspiration, is recommended in all cases. Total submandibular sialoadenectomy is the standard recommended treatment to minimise recurrences and avoid malignant transformation.

Impact of nurse turnover on patient care in a private healthcare facility in UAE

Aim: The aim of this study was to determine the pattern and impact of nurse turnover in a private healthcare facility in United Arab Emirates (UAE) and also to recommend the management strategies that could be adopted to overcome the problem of nurse turnover. Back ground: Global healthcare organizations are in a precarious situation due to the increasing attrition among healthcare professionals. Nurse turnover is an issue of international concern causing widening of supply - demand gaps in the healthcare industry. Despite the acknowledged importance of managing nurse turnover in hospitals, the pattern, causes and consequences of nurse turnover in UAE are poorly understood. Method and analysis: This is an empirical, descriptive, quantitative survey based research conducted in a private healthcare facility in UAE. Results: Hospital witnessed significant nurse shortage secondary to higher nurse turnover. More than two thirds (69.9%) nurses showed intention to leave the organization. Higher nurse turnover intentions were significantly associated with job satisfaction (p<0.01) and workload (p<0.001). Patient fall and medication errors were not significantly associated with nurse turnover however there was significant reduction in patient satisfaction score for nurse services in the hospital. Conclusion: Higher work load, lack of conducive work environment, lack of managerial support mainly contributed to job dissatisfaction and are the key drivers for nurse turnover. Decline in patient satisfaction implied compromised quality of care. However larger trials are needed to effectively implement administrative strategies to overcome the nurse turnover problem.

Experimental Study of Bedform Development Characteristics and Their Effects on Sediment Transport

Bedforms are complex and varied features on riverbeds created by the interaction between flow and sediment particles. Bedform evolution is crucial for understanding sediment transport, bed resistance, and the ecological environment of rivers. In this study, a series of movable-bed dune experiments were conducted utilizing advanced 3D topographic laser scanning technology to precisely measure the 2D and 3D dune bedforms under various conditions. This enabled the detailed analysis of the bedform parameters, including the dune length and height, the crest height, and the trough depth. Furthermore, this study examined the relationship between bed resistance and dune morphology and investigated how the intensity of bedload transport affects bed resistance. The findings indicate that bedload mass transport on the riverbed significantly contributes to increased bed resistance. Given the limitations of the traditional bedload transport rate formulas for dune bedforms, this research introduces a new formula derived from the experimental data. The accuracy of this formula was confirmed using the nonlinear least squares method. Our study enhances the accuracy of sediment transport predictions and provides scientific support for river management and engineering practices.

Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal

Abstract The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population. Key messages • Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges. • Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.

Exploring the Soil Structure Analysis of a Subtropical Watershed by Introducing a Blanket Physico‐Hydraulic Health Index

ABSTRACTMultiple disturbed and undisturbed soil samples were collected to assess the soil structure health in support of water use and management in a subtropical watershed, which is composed of shallow Entisols, near to Canguçu, RS state—Brazil. Various physico‐hydraulic properties related to soil structure, such as bulk density, total, micro and macroporosity, saturated hydraulic conductivity, organic carbon, soil water retention curve (SWRC), and the ranges of plant available water (PAWC) and drainable porosity (DP) were measured to be analyzed. The hydraulic‐energy indices of soil aeration and water retention were determined by integrating the areas under SWRC. Combining these properties with the contents of sand and clay, a unique blanket soil physico‐hydraulic health index (BSPHI) was formulated and applied to investigate the impact of land use and management on the soils of the Ellert Creek Watershed (ECW), thereby supporting soil physical health analysis and, consequently, the analysis of water and human health. The favorable outcomes found in the ECW soils under annual crops indicated good root aeration in the surface layer due to the balance between DP and PAWC. The BSPHI results showed that only about 19% of the areas exhibited unhealthy physical health. The soil structure in pasture areas of ECW was not significantly impacted by the extensive cattle grazing, whereas lands under native forest served as a control for the natural soil quality status. The BSPHI successfully captured small changes in soil structure, regardless of land use and management, highlighting its potential as a promising tool for evaluating soil health by assessing the soil physical quality.

Shared care in heart failure management is linked with physical and mental health by perceived control in patient-caregiver dyads

Abstract Background Patients with heart failure (HF) and their family caregivers have interdependent relationships in managing HF. Shared care within dyads refers to interpersonal interactions characterized by exchanging care and support in chronic illness management. High levels of shared care improve patients’ health outcomes, but it is unclear if shared care is equally beneficial for caregivers. Also unknown is how shared care contributes to the outcomes of both dyad members. We propose that perceived control may be critical in the link between shared care and health status for dyads. Thus, the purpose of this study was to determine whether perceived control over one’s health mediates the association between shared care and physical and mental health in patients with HF and their caregivers. Method Patients with HF and their primary caregivers (N=151 dyads) completed questionnaires in this cross-sectional study. Shared care, perceived control over one’s own health, and health status were assessed using the three subscales of the Shared Care Instrument (i.e., communication, decision-making, and reciprocity), the Cardiac Attitudes Scale-Revised, and the Medical Outcomes Study Health Survey-36, physical and mental health scales, respectively. A series of actor-partner interdependence models with mediation dyadic analyses were conducted. Results Patients with HF (mean age 60.3 Years, 64% male) and their caregivers (mean age 56.6 years, 75% female) reported similar levels of communication and reciprocity in shared care, but patients reported higher scores of decision-making in shared care than their caregivers (P < .001). Perceived control over one’s own health significantly mediated the association between communication and physical health (indirect actor effect = .1487; 95% CI: 0.0478 to 0.2759) and between communication and mental health (indirect actor effect = .1650; 95% CI: 0.0454 to 0.3260) for patients, not caregivers (Figures A1 & A2). Similarly, perceived control significantly mediated the association between reciprocity and physical and mental health for patients, not caregivers (Figures B1 & B2). Perceived control mediated the association of decision-making with physical health and mental health for caregivers, not patients (Figures C1 & C2). Conclusion Higher levels of communication and reciprocity increased patients’ perceived control, ultimately improving their physical and mental health, whereas caregivers’ decision-making improved their health by enhancing their perceived control over their health. The different patterns of shared care are linked to the health of patients and caregivers by enhancing perceived control over one’s health.Figure A & BFigure C

Management and outcomes in pulmonary arterial hypertension patients with sepsis

BackgroundSepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation.MethodsThis retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013 and 2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival.ResultsThirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 h compared to PAH patients (median 0 mL v. 1216 mL, p < 0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p = 0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p = 0.376). PAH patients that received more fluids had decreased mortality (OR 0.31, 95% CI 0.11–0.92, p = 0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 h v. 6.5 h, p = 0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p = 0.136).ConclusionPatients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population.

Prognostic values of lipoprotein(a) levels for secondary prevention of acute coronary syndrome among patients who underwent primary percutaneous coronary intervention

Abstract Background Lipoprotein(a) [Lp(a)] is known to be a residual risk factor for acute coronary syndrome(ACS). However, in the current era where primary percutaneous coronary intervention (PCI) and lipid-lowering therapies have advanced, the role of Lp(a) levels in secondary prevention among ACS patients remains unclear. Purpose The purpose of this study is to determine whether Lp(a) levels play a role in secondary prevention by studying patients with ACS who underwent primary PCI and survived discharge. Methods Consecutive ACS patients who were admitted to our institution between December 2016 and March 2021, requiring primary PCI and were discharged alive were enrolled for the current study (n = 471). Of these patients, those with the following circumstances were excluded: (1) multidisciplinary treatment such as mechanical ventilation management and percutaneous cardiopulmonary support (n = 74), (2) incomplete clinical data (n = 34), (3) ACS classified as other than type 1 in the universal definition (n = 6), and (4) unknown prognosis at 6 months after discharge (n = 8). A total of 349 consecutive patients were included in the current study. They were divided into two groups according to Lp(a) levels: Lower Lp(a) group (Lp(a) &amp;lt; 30 mg/dL, n = 277) and Higher Lp(a) group (Lp(a) ≥ 30 mg/dL, n = 72). The primary endpoints were major adverse cardiac events (MACEs), composite of all cause death, nonfatal myocardial infarction, nonfatal stroke and congestive heart failure requiring admission. Event-free survival curves were estimated using Kaplan-Meier method and log-rank test was used to detect statistically significant differences. In addition, influence of Lp(a) levels on MACE was examined using three cox regression analyses. Model 1 was adjusted for age, gender and body mass index, model 2 was adjusted for hypertension, diabetes and chronic kidney disease (CKD), model 3 was adjusted for old myocardial infarction (OMI), smoking and multivessel disease, respectively. Results The mean age was 67.0 ± 12.8 years, and 70.5% were male. The median serum Lp(a) levels of the entire population was 14 mg/dL (interquartile range, 7 to 26). There were no significant differences about baseline patient’s characteristics, laboratory findings, and medications at discharge including statin treatment. The MACE was observed in 15.5% of the Lower Lp(a) group and 20.8% of the Higher Lp(a) group (p=0.29). No difference was observed about MACE between the two groups (log-rank p=0.45). After adjusting for cardiovascular risk factors, Lp(a) levels were not associated with MACEs in all three models. However, in model 2 and model 3, CKD and OMI were associated with MACEs (hazard ratio 4.29, 95% confidence interval 2.17 to 8.46, p &amp;lt; 0.001, hazard ratio 3.02, 95% confidence interval 1.39 to 6.51, p = 0.005, respectively). Conclusions In the current era, Lp(a) levels are not associated with secondary prevention among ACS patients who underwent primary PCI.

Trend of body mass index and its impact on glycemic control in Finnish patients with type 2 diabetes

Abstract Background Obesity prevalence has increased in Finland and is prevalent in patients with type 2 diabetes (T2D). Understanding the trend in body mass index (BMI) and its impact on glycemic control helps in the assessment of treatment strategies for T2D. We aimed to investigate the current trend in BMI among Finnish patients with T2D and the glycated hemoglobin (HbA1c) control across different BMI categories. Methods Regional data on electronic health records (EHRs) covering all public health care in North Karelia, Finland, were used. Patients with T2D (ICD-10 code E11) in 2012-2022 were identified from EHRs. In each study year, patients with ≥1 measurement of BMI and HbA1c were included in data analysis. Generalized estimating equations regression analyses were performed to evaluate the trends. Results The annual number of patients in the analyses ranged from 5149 to 10216 in 2012-2022. The unadjusted mean BMI remained stable. However, an increasing trend in BMI was observed in the age-adjusted model and remained unchanged with further adjustment for sex, duration of diabetes, and antidiabetic medication use, reflecting the aging of the patient population and lower BMI in aged patients. Patients with higher BMI had higher HbA1c levels in 2012-2022. The increasing trends in HbA1c over time were observed across different BMI categories (except for the obsess class III) accounting for age, sex, and duration of diabetes. However, a decreasing trend in HbA1c was found in the obese class III category with further adjustment for antidiabetic medication use, along with the highest usage rates of the new antidiabetic medications during the follow-up. Conclusions Our findings suggest that weight management requires increased attention in Finnish patients with T2D and is also important for better glycemic control. Multimodal treatment, including effective lifestyle counseling, self-care support, and medication management, is needed. Key messages • More attention and resources are needed to achieve optimal weight control. • Weight management could aid in better glycemic control.

Angiotensin receptor-neprilysin inhibitor (Sacubitril/Valsartan) in cancer therapy-related cardiac dysfunction: real-world experience from a nurse-led cardio-oncology clinic

Abstract Introduction Cancer therapy-related cardiac dysfunction (CTRCD) is a common toxicity amongst patients receiving anti-cancer treatment1. Angiotensin receptor-neprilysin inhibitor (ARNI) Sacubitril/Valsartan is recommended to reduce Heart Failure (HF) admissions and cardiovascular mortality2. However, patients with active cancer were excluded from the key trials of ARNI. This study aims to provide a real-world experience of ARNI prescription and management from the perspective of a nurse-led Cardio-Oncology clinic. Methods This is a single centre, retrospective, observational cohort study performed at a Cardio-Oncology specialist centre between the period of 2021 to 2024. Adult cancer patients receiving anti-cancer therapy were included if they had symptomatic HF or asymptomatic CTRCD, were initiated on ARNI and followed up in the nurse-led Cardio-Oncology clinic. Results Twenty-nine patients were started on ARNI (see Figure 1). The mean age of the patients was 66+11 years and 17 (59%) were male. Cardiovascular risk factors were common: hypertension (45%), hyperlipidaemia (35%), diabetes mellitus (21%), and smoking (17%). Haematological and breast malignancies were most common (31% and 21% respectively), followed by gynaecological malignancies (14%). Twenty-one (72%) were treated with cytotoxic chemotherapy including 10 (35%) received anthracyclines. Five (17%) patients received human epidermal growth factor receptor 2 (HER2) targeted therapies, 3 (10%) were on tyrosine kinase inhibitors, and 2 (7%) received immunotherapy. Twenty-five (86%) patients presented with symptomatic HF while 4 (14%) had asymptomatic CTRCD. The median N-terminal-pro B-type natriuretic peptide (NTproBNP) level was elevated at 1325(806-4330)ng/L. Thirteen (45%) patients tolerated the maximum dose of 200mg twice daily, while 16 (56%) could only tolerate middle and lowest dosages. ARNI dose up titration to the maximum tolerated dose took 26 (15-79) days. Twenty-eight (97%) patients were on beta blockers, 26 (90%) received SGLT2 inhibitors, 25 (86%) on mineralocorticoid receptor antagonists, and 10 (35%) patients required diuretics. The most common side effect was symptomatic hypotension in 11 (38%) patients. Two (7%) had hyperkalemia, 1 (3%) acute kidney injury following initiation, and 1 (3%) had dizziness without significant hypotension. Nine (31%) required dose reduction allowing ARNI to be continued, while 3 (10%) patients had to permanently discontinue ARNI. There were no cardiovascular deaths, cancer deaths or HF admissions. Conclusion The Cardio-Oncology nurse-led clinic permits rapid up-titration of ARNI to target dosages in patients with CTRCD, resulting in significant improvements in cardiac function. The nurse lead clinic education, support and side effect management allowed uninterrupted continuation of cancer treatment. Whether this approach translates into be better cardiac and cancer outcomes requires further study.

Barriers and facilitators for implementing ABCs for Mental Wellbeing intervention model in Finland

Abstract Background The ABCs for Mental Wellbeing study aims to improve mental health and wellbeing by adopting, implementing and evaluating a universal, community-based mental health promotion intervention model in Finland. The study gathers information and experiences of the implementation processes, identifies barriers and facilitators, and best practices for the implementation, and the feasibility and contextual adaptability of the intervention in different settings and specific target groups. Methods The implementation took place in four municipality community settings. In total, 40 participants attended the ABC activities. The study employs a mixed methods approach to look at the implementation processes: a quantitative survey before and after the implementation, and qualitative interviews with the employees implementing the model and the participants involved with the ABC activities. Results Based on qualitative analysis, the most identified facilitator is management support alongside the competencies of professionals. The observed effects of group activities aligned with the ABC model on mental wellbeing show that participants not only experienced the benefits of model-compliant activities on their mental wellbeing but also increased their awareness of factors influencing their mental wellbeing. The results of the quantitative analysis will be ready during the spring. Conclusions The study offers fresh insights into the obstacles and enablers affecting the implementation of a mental health promotion intervention model. The best practice strategies and guidelines identified are being shared both nationally and internationally and utilised to enhance future programme implementation and adaptation of these practices in various settings. Key messages • Best practice strategies and guidelines for successful implementation of mental health promotion identified. • The ABCs for Mental Wellbeing increased participants’ awareness of the factors influencing their mental wellbeing.

Social Support Management and Academic Stress: Implications for Students' Subjective Well-being

The high dropout rate suggests that students' well-being is in doubt, especially in relation to their subjective well-being. This study aims to investigate the impact of perceived social support and academic stress on subjective well-being. This research method uses a quantitative approach. The subjects of this study were 83 students of Faculty Pharmacy X University who were selected by simple random sampling technique. The data collection method used was the subjective well-being scale, social support, and academic stress. The data analysis technique used was multiple linear regression. The results showed that: (1) there is an influence of social support and academic stress on subjective well-being with the value of F count = 9.367 &gt; F table = 3.11 and p value = 0.000 and has an influence contribution (R2) of 18.6%; (2) there is no significant influence of social support on subjective well-being with a beta coefficient value (β) = 0. 141, t count = 1.284 &lt; t table = 1.989, and p value 0.202 (p &gt; 0.05); (3) there is a positive and significant effect of academic stress on subjective well-being with a beta coefficient value (β) = 0.353, t count = 3.202 &gt; t table = 1.989, and p value 0.002 (p &lt; 0.05). The conclusion in this study is that there is a significant influence between social support and academic stress on students' subjective well-being.

Long-Term Passenger Flow Forecasting for Rail Transit Based on Complex Networks and Informer

With the continuous growth of urbanization, passenger flow in urban rail transit systems is steadily increasing, making accurate long-term forecasting essential for optimizing operational scheduling and enhancing service quality. However, passenger flow forecasting becomes increasingly complex due to the intricate structure of rail transit networks and external factors such as seasonal variations. To address these challenges, this paper introduces an optimized Informer model for long-term forecasting that incorporates the influences of other stations based on complex network theory. Compared to the ARIMA, LSTM, and Transformer models, this optimized Informer model excels in processing large-scale complex transit data, particularly in terms of long-term forecasting accuracy and capturing network dependencies. The results demonstrate that this forecasting approach, which integrates complex network theory with the Informer model, significantly improves the accuracy and efficiency of long-term passenger flow predictions, providing robust decision support for urban rail transit planning and management.

The Association between Organizational Factors of Health Promoting Schools and Teachers' Health Lifestyles: A Multilevel Analysis.

Schools are both learning environments for students and workplaces for faculty. Recognizing the role of organizational factors in staff health in school environments, the study aimed to explore which factors, including transformational leadership, teachers' perceived management support and HPS accreditation awards, were most associated with promoting a healthy lifestyle for teachers. A cross-sectional study was undertaken of 137 elementary schools in 2014, involving 433 directors and 2090 teachers. Data were collected using an anonymous structured questionnaire. Hierarchical linear modeling was used to analyze both teacher- and school-level factors associated with health-promoting lifestyles. There was a significant positive correlation between teachers' overall health-promoting lifestyle profile (HPLP-II) scores and both perceived management support (coefficient = .98, p < .001) and transformational leadership (coefficient = .38, p = .039). All 6 HPLP-II subscales also showed significant positive correlations with perceived management support (coefficients .12-.24, p < .001). Supporting a healthy working atmosphere and strong principal transformational leadership are keys to enhancing teachers' health-promoting lifestyles. Future research could explore how transformational leadership and management support influence teachers' health behaviors and identify effective strategies and interventions.

Experiences in healthcare for weight management – a qualitative interview study of retired individuals with obesity and low or high education

BackgroundOverweight and obesity are global health concerns, especially significant for older adults at higher risk for chronic diseases. The transition to retirement, altering daily routines, highlights the need for adequate weight management support. Since obesity is a challenging topic in healthcare and socioeconomic inequalities exist in access and utilization, we examined how retired individuals with obesity and low or high education describe their experiences of unmet needs, mismatches, and successes within the healthcare service system for weight management.MethodsThis qualitative interview study is part of the Helsinki Health Study. The participants (N = 20, with a body mass index of at least 30 kg/m2) were selected from a cohort of retired former employees of the City of Helsinki. Half of the interviewees had low education, and the other half had high education. Women and men were equally represented. The interviews were conducted in 2023 and the data were analyzed using inductive thematic analysis.ResultsThree main themes were formed: Deficiencies in engaged care, Services are mismatched with needs, and Facilitating conditions for individual successes. The first main theme had two sub-themes: Condescending attitude and Ignoring weight during the appointment. The second main theme had one sub-theme: Inadequate personnel resources. The third main theme had one sub-theme: Individual opportunities to acquire information and treatment. Educational differences were most clearly reflected in the sub-themes. Participants with low education more often described experiencing a condescending attitude towards them when seeking care and had had difficulties in obtaining time for appointments due to inadequate resources. Participants with high education described broader experiences related to individual opportunities to acquire information and treatment within the healthcare service system than participants with low education.ConclusionsThe participants in this study highlighted the importance of respectful engagement with the subject of their weight and felt that these kinds of interaction skills should still be developed in healthcare personnel. The participants articulated a need for approaches that are tailored to their unique circumstances. According to the participants, long-term group intervention, provided with peer support and supported by a multidisciplinary team, could sustain their weight management.

Pharmacist-led hospital intervention reduces unintentional patient-generated medication discrepancies after hospital discharge

BackgroundMedication reconciliation can significantly reduce clinically important medication errors at hospital discharge, but its impact on post-discharge medication management has not been investigated. We aimed to investigate the incidence of patient-generated medication discrepancies 30 days after hospital discharge and the impact of a pharmacist-led medication reconciliation coupled with patient counselling on clinically important discrepancies caused by patients.MethodsA pragmatic, prospective, controlled clinical trial was conducted at the University Clinic Golnik, Slovenia. Adult patients were divided into an intervention group and a control group. The intervention group received pharmacist-led medication reconciliation at admission and discharge, plus patient counselling at discharge. Medication discrepancies were identified by comparing the therapy prescribed in the discharge letters with the therapy 30 days after discharge, obtained through telephone patient interviews. Discrepancies were classified as intentional or unintentional, and their clinical importance was assessed.ResultsThe study included 254 patients (57.9% male, median age 71 years), with 136 in the intervention group and 118 in the control group. Discrepancies occurred with a quarter of the medicines (617/2,441; 25.3%) at 30 days after hospital discharge, and patients themselves caused half of the discrepancies (323/617; 52.4%), either intentionally (171/617; 27.7%) or unintentionally (152/617; 24.6%). Clinically important discrepancies occurred in 18.7% of intentional and 45.4% of unintentional patient-generated changes. The intervention significantly reduced the likelihood of clinically important unintentional patient-generated discrepancies (OR 0.204; 95%CI: 0.093–0.448), but not clinically important intentional patient-generated discrepancies (OR 2.525; 95%CI: 0.843–7.563). The latter were more frequent among younger, male patients and patients hospitalized for respiratory diseases.ConclusionThe study emphasizes the importance of addressing discrepancies made by patients after hospital discharge, which can result in potentially harmful outcomes. It also shows that a pharmacist-led hospital intervention can significantly reduce discrepancies in the early post-discharge period. These findings can guide the development of future services to improve patient support for medication management after hospitalization.

Structural response and damage assessment method for subsea pipe-in-pipe subjected to anchor impact

The pipe-in-pipe system is widely used in the development and transportation of offshore oil and gas resources. The damage caused by anchor impacts on the pipe-in-pipe system has long been a focal point and challenge in both engineering and academic fields. Numerical simulation method is employed to investigate the impact process of anchors on pipe-in-pipe systems, revealing the variation patterns of pipeline deformation response over time. The structural response of the pipe-in-pipe system to dropped anchor impacts is studied from multiple perspectives, including deformation, energy, and load transfer. The influence of pipe-in-pipe characteristic parameters, anchor characteristic parameters, centralizers, and bulkheads on the extent of impact damage is analyzed, establishing a relationship between the absorbed energy and the damage to the pipe-in-pipe. The results indicate that the impact energy primarily depends on the mass and velocity of the anchor. Energy is conserved during the impact process. It is found that even with different anchor masses and velocities, the extent of damage to the pipe-in-pipe system remains the same if the impact energy is identical. High-strength steel, large diameter, and thick-walled pipelines exhibit better resistance to impact loads. Additionally, centralizers and bulkheads mitigate the impact damage to the pipe-in-pipe system. Finally, an evaluation method for pipe-in-pipe impact damage due to dropped anchors is proposed. It is discovered that the assessment method for pipelines impacted by dropped anchors in the DNV-RP-F107 standard tends to be conservative when the impact energy is high. The findings of this study provide technical support for the integrity management of pipe-in-pipe systems.

An evaluation rule to manage productivity properties performance of male date palms

ABSTRACT Male palm trees almost prominently display minute morphological variations; however, date palm growers rely on readily available pollen from unproven male genotypes without giving correct type selection any thought, which may result in low productivity and/or poor fruit quality. This study sought to develop an evaluation rule by calculating an evaluation index for managing the productivity characteristics performance of nine male date palms, which were examined for their pollen productivity, nutritional status and morphological traits from their leaves, pinnae and spathes. The findings showed that the evaluation rule for a male date palm should depend on pollen grains productivity and germination percentage traits with a weight of 5, spathe morphological traits with a weight of 4, pinnae morphological traits with a weight of 3, leaf morphological traits with a weight of 2 and leaf nutritional status with a weight of 1. The best productivity characteristics performance of male date palms was male No. 8 ‘M8’ due to its high evaluation index. The proposed evaluation index criterion will contribute to better information and analytical support for management of the date palm industry to maximise the effectiveness of germplasm conservation and exploitation, as well as procedural and methodological aspects of the analysis.