Variation In Practice Research Articles

A 20 year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital – a retrospective review

BackgroundNon-tubal ectopic pregnancies account for < 10% of all ectopic pregnancies. Due to its rarity and wide variation in clinical practice, there is no guideline or consensus for its management. We reported our 20-year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital.MethodsThis is a retrospective review of all women admitted for non-tubal ectopic pregnancies from January 2003 to December 2022 in a tertiary hospital. Women with non-tubal ectopic pregnancies diagnosed by ultrasound or operation were included for analysis.ResultsWithin the study period, 180 women were diagnosed to have non-tubal ectopic pregnancies at a mean gestation of 6.8 weeks. 16.7% (30/180) were conceived via assisted reproduction. Medical treatment was the first-line management option for 81 women, of which 75 (92.1%) women received intralesional methotrexate administered under transvaginal ultrasound guidance. The success rate of intralesional methotrexate ranges from 76.5% to 92.3%. Intralesional methotrexate was successful even in cases with a positive fetal pulsation or with high human chorionic gonadotrophin levels up to 252605U/L. Twenty seven women were managed expectantly and 40 underwent surgery. Nine (11.1%), two (6.1%), and one (2.3%) women required surgery due to massive or recurrent bleeding following medical, expectant, or surgical treatment. Hysterotomy and uterine artery embolization were necessary to control bleeding in one Caesarean scar and one cervical pregnancy.ConclusionsIntralesional methotrexate is more effective than systemic methotrexate and should be considered as first line medical treatment for non-tubal ectopic pregnancies. It has a high success rate in the management of unruptured non-tubal ectopic pregnancies even in the presence of fetal pulsations or high human chorionic gonadotrophin levels, but patients may require a prolonged period of monitoring. Close surveillance and readily available surgery were required due to the risk of heavy post-procedural intra-abdominal bleeding.

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.

To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Cross-sectional survey. International. Clinicians involved in the management of MCDA twin pregnancies with sFGR. A structured, self-administered survey. Clinical practices and attitudes to diagnostic criteria and management strategies. Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management.

Beware stewardship in silos

With the WHO estimating that global medication errors cost approximately US$42 billion annually, it is perhaps not surprising that we hear a lot about medicines stewardship these days. Although the descriptions and goals of medicines stewardship vary, common themes are that it involves careful and responsible management, it is targeted at drug classes that are associated with a high risk of adverse outcomes and it aims to reduce variations in practice and improve patient outcomes.

Dual diagnosis and their care pathways for help-seeking: A multicenter study from India.

Understanding pathways to dual diagnosis (DD) care will help organize DD services and facilitate training and referral across healthcare sectors. The aim of our study was to characterize the stepwise healthcare and other contacts among patients with DD, compare the characteristics of the first contact persons with common mental disorder (CMD) versus severe mental illness (SMI), and estimate the likelihood of receiving appropriate DD treatment across levels of contacts. This cross-sectional, descriptive study in eight Indian centers included newly enrolled patients with DD between April 2022 and February 2023. The research spans varied geographic regions, tapping into regional variations in disease burden, health practices, and demographics. The study categorized healthcare contacts by using the WHO Pathways Encounter Form. The sample (n = 589) had a median age of 32 years, mostly males (96%). Alcohol was the most common substance; SMI (50.8%) and CMD were equally represented. Traditional healers were a common first contact choice (18.5%); however, integrated DD care dominated subsequent contacts. Assistance likelihood increased from the first to the second contact (23.1% to 62.1%) but declined in subsequent contacts, except for a significant rise in the fifth contact (97.4%). In the initial contact, patients with CMD sought help from public-general hospitals and private practitioners for SUD symptoms; individuals with SMI leaned on relatives and sought out traditional healers for psychiatric symptoms. Recognizing the cultural nuances, advocating for integrated care, and addressing systemic challenges pave the way to bridge the gap in DD treatment.

Decentralised [formula omitted] robust control of MTMDs for mitigating vibration of a slender MDOF floor configuration

In this research, a novel robust decentralised H (H∞ and H2) design combined with a pattern search method (PSM), incorporating considerations of multiple modal dynamics, was developed to address the vibration issue in slender structures. To verify the effectiveness of the concept, a full-scale laboratory reconfigurable multiple degrees of freedom (MDOF) test-bed floor panel structure was selected, equipping with a passive multiple-tuned mass damper (MTMD) as a coupling system. The optimal parameters of the MTMDs were tailored using the decentralised H design and the PSM, considering the dynamic engagement of multiple modes. Furthermore, a crucifix-type configuration of 2DOF MTMDs was proposed to mitigate the vibration of the floor panel structure. Full-scale forced vibration testing (FVT) was conducted to validate the dynamic performance of the 2DOF MTMDs. The test results provide satisfactory verification and high-quality curve-fitting testing data for parameter study and dynamic simulation. By examining the field data from the 2DOF MTMDs and performing various numerical simulations and analyses, the control performance robustness of the MTMDs was comprehensively evaluated, considering practical engineering variations such as the number and stiffness of MTMDs, as well as the stiffness and mass of the floor panel structure. As a result, the proposed H control strategies for the MTMDs demonstrated robust control capabilities by effectively dissipating significant amounts of externally applied energy.

Analgesia for emergency laparotomy: a systematic review.

Aims/Background Poorly controlled pain is common after emergency laparotomy. It causes distress, hinders rehabilitation, and predisposes to complications: prolonged hospitalisation, persistent pain, and reduced quality of life. The aim of this systematic review was to compare the relative efficacies of pre-emptive analgesia for emergency laparotomy to inform practice. Methods We performed a search of MEDLINE, MEDLINE In-Process, Embase, PubMed, Web of Science and SCOPUS for comparator studies of preoperative/intraoperative interventions to control/reduce postoperative pain in adults undergoing emergency laparotomy (EL) for general surgical pathologies. Exclusion criteria: surgery including non-abdominal sites; postoperative sedation and/or intubation; non-formal assessment of pain; non-English manuscripts. All manuscripts were screened by two investigators. Results We identified 2389 papers. Following handsearching and removal of duplicates, 1147 were screened. None were eligible for inclusion, with many looking at elective and/or laparoscopic surgeries. Conclusion Our findings indicate there is no evidence base for pre-emptive analgesic strategies in emergency laparotomy. This contrasts substantially with elective cohorts. Potential reasons include variation in practice, management of physiological derangement taking priority, and perceived contraindications to neuraxial techniques. We urge a review of contemporary practice, with analysis of clinical data, to generate expert consensus.

The Influence of Financial Self-efficacy on Financial Inclusion in Tanzania

This study investigates how Corporate Social Responsibility (CSR) information is communicated on the websites of tourism firms in Tanzania. Specifically, the study assesses the quantity, prominence and style of presentation of CSR information on the websites. Data was collected through a content analysis of the websites of the member firms of the Hotel Association of Tanzania (HAT) and Tanzania Association of Tour Operators (TATO). The findings reveal that about 50% of tourism firms disclose their CSR information on their websites. Also, about 57% of tourism firms disclose a minimal amount of CSR information (1 to 2 pages), 31% place their CSR information prominently on the homepage, 54% present their CSR information using textual format only and 38% of websites allow interaction with stakeholders for inquiries and feedbacks. Moreover, the study highlights that hotels are more effective in utilizing websites for CSR communication than their tour operators, suggesting that firm size and industry subsectors influence variations in CSR communication practices. The findings imply that tourism firms in Tanzania recognize the crucial role of websites in corporate communication including CSR communication. However, tourism firms need to improve their CSR web communication by enhancing the volume, prominence, multimedia-rich content and interactivity of web-based CSR communications. Further research focusing on specific subsectors and exploring strategies for enhancing CSR communication on tourism websites could provide valuable insights.

Expediting Discharges on the Inpatient Medicine Teaching Services

Introduction: Delayed discharges can adversely affect patient flow throughout the hospital. Late afternoon discharges may lead to high hospital occupancy, admission bottlenecks, ER overcrowding, and disrupted ICU transfers. Discharge by noon (DBN) is key to enhancing hospital capacity, bed utilization, and patient satisfaction and outcomes. Last year, DBN for patients returning home with or without home care services (HHC) was chosen as one of three annual priorities for our hospital medicine division. This was implemented in October 2023 but did not gain momentum among the medical resident teaching services (MTS), paving the way for our QI project. Model for Improvement: Baseline data on the percentage of MTS DBN to home and HHC were available from November 2023 to January 2024. We surveyed our residents/faculty and conducted a root-cause analysis. The main barriers to DBN included a lack of planning and motivation, delayed communication with case management, and prolonged rounding. Aims Statement: Our goal was to increase the median percentage of MTS discharge orders placed by noon to home and HHC from 22% to 35% within 3 months. Measures: Our primary outcome measure was the percentage of MTS DBN to home and HHC. Weekly EMR-generated reports were collected. The outcome measure was then calculated and uploaded weekly on a run chart for analysis. Qualitative process measures included assessing if residents were planning discharges and documenting the number of discharges completed before noon. Changes: Our interventions targeted the lack of planning and motivation. These included introducing the expedited initiative and its importance to residents/faculty through conferences. In addition, a process was created where potential next-day discharges were discussed at afternoon sign-out and a tracking chart of DBN orders was designed for each team room. Tests of Change: Our pre-intervention median percentage of MTS DMB to home and HHC was 22% and improved to 40% post-intervention. While we observed a variation in discharge practice based on the rounding attending, we had notably sustained an upward shift in practice from our baseline when data was plotted on a run chart. We are currently continuing data collection to track sustainability and variability among rounding physicians. Conclusion: We attained an upward shift in the percentage of MTS DBN to home and HHC post-intervention. Although an upward shift has been achieved, we are looking to sustain and further improve it. In future PDSA cycles, we will look at individualizing feedback and optimizing interdisciplinary rounds. We plan on further investigating balancing measures such as bed availability, discharge timing for rehabilitation destinations, and patient and staff satisfaction.

Corporate Social Responsibility Communication on the Websites of Tourism Firms in Tanzania

This study investigates how Corporate Social Responsibility (CSR) information is communicated on the websites of tourism firms in Tanzania. Specifically, the study assesses the quantity, prominence and style of presentation of CSR information on the websites. Data was collected through a content analysis of the websites of the member firms of the Hotel Association of Tanzania (HAT) and Tanzania Association of Tour Operators (TATO). The findings reveal that about 50% of tourism firms disclose their CSR information on their websites. Also, about 57% of tourism firms disclose a minimal amount of CSR information (1 to 2 pages), 31% place their CSR information prominently on the homepage, 54% present their CSR information using textual format only and 38% of websites allow interaction with stakeholders for inquiries and feedbacks. Moreover, the study highlights that hotels are more effective in utilizing websites for CSR communication than their tour operators, suggesting that firm size and industry subsectors influence variations in CSR communication practices. The findings imply that tourism firms in Tanzania recognize the crucial role of websites in corporate communication including CSR communication. However, tourism firms need to improve their CSR web communication by enhancing the volume, prominence, multimedia-rich content and interactivity of web-based CSR communications. Further research focusing on specific subsectors and exploring strategies for enhancing CSR communication on tourism websites could provide valuable insights.

BRCA Testing for Patients Treated in Italy: A National Survey of Breast Centers Associated with Senonetwork.

Breast units (BUs) provide breast cancer (BC) care, including prevention, treatment, and genetic assessment. Genetic research has highlighted BRCA1/2 mutations as key hereditary BC risk factors. BRCA testing is crucial for personalized treatment and prevention strategies. However, the integration of BRCA testing in Italian BUs faces multiple challenges. This study, by Senonetwork Italia, aimed to evaluate genetic testing practices and identify obstacles within Italian BUs. Senonetwork Italia conducted a 16-question web-based survey involving 153 BUs. The survey assessed aspects of BRCA testing, including timing, urgency, counseling, patient selection, and multi-gene panels. Of the 153 BUs, 109 (71.2%) responded. Testing before surgery was performed by 70.6% of centers, with urgent cases acknowledged by 87.2%. Most centers (56.0%) arranged urgent pre-test counseling within a week. BRCA mutation status influenced treatment decisions in 99.1% of cases. Multi-gene panels were used by 33.0% of centers for all genetic counseling cases, while 56.0% followed standard referral criteria. The main challenges included cost, reimbursement, and reporting timelines. This survey highlights significant variations in BRCA testing practices across Italian BUs and identifies key logistical and financial challenges. There is a need for standardized practices of genetic testing to ensure personalized and effective BC management in Italy.

CREDIT RISK ASSESSMENT PRACTICES AND FINANCIAL PERFORMANCE OF MICROFINANCE INSTITUTION IN RWANDA A CASE OF COPEDU PLC

Background: This exploration design, with a case study of COPEDU PLC, aimed to assess the influence of credit risk assessment practices on the financial performance of COPEDU PLC in Rwanda. This exploration design was structured around three specific objects originally, to estimate the influence of customer financial status analysis on the financial performance of COPEDU PLC in Rwanda secondly, to examine the effect of the 5Cs of credit on the financial performance of COPEDU PLC in Rwanda and eventually, to assess the influence of credit risk on the financial performance of COPEDU PLC in Rwanda. Materials and Methods: To achieve the exploration objects, a descriptive and correlation exploration design was used. Data was collected through a combination of both quantitative and qualitative styles, exercising interview attendants and questionnaires. Using tale approach in the slice process, an exploration population of comprising of staff population of 65 at COPEDU PLC headquarters were all be regarded as the sample size. Results: The collected data presented compelling findings grounded on numerical data. specially, the analysis of COPEDU PLCs financial pointers revealed positive comprehensions, with crucial numbers similar as a mean credit score of4.49(SD = 0.75) and a mean debt- to- income rate of4.51(SD = 0.73). These pointers demonstrated a predominant agreement among repliers, with49.23 agreeing on the significance of credit scores and47.69 admitting the significance of the debt- to- income rate. The study also explored the relationship between the 5Cs of Credit and financial performance, revealing specific numbers similar as a mean score of4.35 (SD = 1.15) for collateral and4.42 (SD = 1.13) for capacity. In addition, effective credit risk operation strategies were quantified, with mean probabilities indicating strong agreement (SA) from41.85 of repliers on diversifying the loan portfolio and46.15 on effective loan recovery strategies. The correlation analysis further stressed a robust relationship, with a Pearson Correlation measure of0.894 (p- value = .000), italicizing the statistical significance of the positive association between credit risk assessment practices and the financial performance of microfinance institutions. Conclusion:The exploration study concludes grounding of the findings revealed that COPEDU PLCs credit risk assessment practices significantly impact financial performance, with repliers feting the significanceof crucial financial pointers and the 5Cs of credit. In addition, those effective risk operation strategiesare pivotalfor financial success. still, the study recommends microfinance institutions to upgradecredit riskassessment criteria, train staff on the 5Cs of credit, diversify loan portfolios, ameliorate loan recovery strategies, establish a methodical review process, and invest in technology results to enhance credit risk operationand financial sustainability. Eventually, the study made suggestions for farther exploration on credit risk operation in microfinance institutions, including assayingindividual financial pointers, comparing practices across institutions, assessing risk operation strategies, and tracking long- term goodson financial sustainability and growth. It also suggests comparing variations in credit risk assessment practices and enforcing effective recovery strategies.

Protocol Variation in Functional Coronary Angiography Among Patients With Suspected Angina With Non-Obstructive Coronary Arteries: A Nationwide Snapshot of Current Practice Within Australia and New Zealand

Functional coronary angiography (FCA) for endotype characterisation (vasospastic angina [VSA], coronary microvascular disease [CMD], or mixed) is recommended among patients with angina with non-obstructive coronary arteries. Whilst clear diagnostic criteria for VSA and CMD exist, there is no standardised FCA protocol. Variations in testing protocol may limit the widespread uptake of testing, generalisability of results, and expansion of collaborative research. At present, there are no data describing protocol variation across an entire geographic region. Therefore, we aimed to capture current practice variations in the approach to FCA to improve access and standardisation for diagnosis of coronary vasomotor disorders in Australia and New Zealand. Between July 2022 and July 2023, we conducted a national survey across all centres in Australia and New Zealand with an active FCA program. The survey captured attitudes towards FCA and protocols used for diagnosis of coronary vasomotor disorders at 33 hospitals across Australia and New Zealand. Survey responses were received from 39 clinicians from 33 centres, with representation from centres within all Australian states and territories and both North and South Islands of New Zealand. A total of 21 centres were identified as having an active FCA program. In general, respondents agreed that comprehensive physiology testing helped inform clinical management. Barriers to program expansion included cost, additional catheter laboratory time, and the absence of an agreed-upon national protocol. Across the clinical sites, there were significant variations in testing protocol, including the technique used (Doppler vs thermodilution), order of testing (hyperaemia resistance indices first vs vasomotor function testing first), rate and dose of acetylcholine administration, routine use of temporary pacing wire, and routine single vs multivessel testing. Overall, testing was performed relatively infrequently, with very little follow-on FCA performed, despite nearly all respondents believing this would be clinically useful. This survey demonstrates, for the first time, variations in FCA protocol among testing centres across two entire countries. Furthermore, whilst FCA was deemed clinically important, testing was performed relatively infrequently with little or no follow-on testing. Development and adoption of a standardised national FCA protocol may help improve patient access to testing and facilitate further collaborative research within Australia and New Zealand.

Practice Variations for Therapeutic Hypothermia in Neonates with Hypoxic-ischemic Encephalopathy: An International Survey

To evaluate variations in management of therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) among international clinical sites and to identify areas for harmonization. An electronic survey was sent to Children's Hospitals Neonatal Consortium site sponsors, Canadian Neonatal Network site investigators, members of the Newborn Brain Society, and American Academy of Pediatrics Neonatology chiefs. One hundred five sites responded, with most from high-income regions (n=95). Groupings were adapted from the United Nations regional groups: US (n=52 sites); Canada (n=20); Western Europe and other states excluding Canada and US Group (WEOG, n=18); and non-WEOG (central and eastern Europe, Asia, Africa, Latin America, and Caribbean, n=15). Regional variations were seen in the eligibility criteria for TH, such as the minimum gestational age, grading of HIE severity, use of electroencephalography, and the frequency of providing TH for mild HIE. Active TH during transport varied among regions and was less likely in smaller volume sites. Amplitude-integrated electroencephalogram and/or continuous electroencephalogram to determine eligibility for TH was used by most sites in WEOG and non-WEOG but infrequently by the US and Canada Groups. For sedation during TH, morphine was most frequently used as first choice but there was relatively high (33%) use of dexmedetomidine in the US Group. Timing of brain magnetic resonance imaging and neurodevelopmental follow-up were variable. Neurodevelopmental follow occurred earlier and more frequently, although for a shorter duration, in the non-WEOG. We found significant variations in practices for TH for HIE across regions internationally. Future guidelines should incorporate resource availability in a global perspective.

Investigation of the Seroprevalence of Brucella Antibodies and Characterization of Field Strains in Immunized Dairy Cows by B. abortus A19.

(1) Background: One method of eradicating brucellosis is to cull cattle that test positive for antibodies 12 months after being vaccinated with the 19-strain vaccine. Variations in immunization regimens and feeding practices may contribute to differences in the rate of persistent antibodies. We conducted this study to investigate the real positive rate of Brucella antibody in field strains of Brucella spp. after immunization over 12 months in dairy cows. This research aims to provide data to support the development of strategies for preventing, controlling, and eradicating brucellosis. (2) Method: We employed the baseline sampling method to collect samples from cows immunized with the A19 vaccine for over 12 months in Lingwu City from 2021 to 2023. Serological detection was conducted using the RBPT method. An established PCR method that could distinguish between 19 and non-19 strains of Brucella was utilized to investigate the field strains of Brucella on 10 dairy farms based on six samples mixed into one using the Mathematical Expectation strategy. (3) Results: We analyzed the rates of individual seropositivity and herd seropositive rates in dairy cattle in Lingwu City from 2021 to 2023 and revealed that antibodies induced by the Brucella abortus strain A19 vaccine persist in dairy herds for more than 12 months. We established a PCR method for identifying both Brucella A19 and non-A19 strains, resulting in the detection of 10 field strains of Brucella abortus from 1537 dairy cows. By employing a Mathematical Expectation strategy, we completed testing of 1537 samples after conducting only 306 tests, thereby reducing the workload by 80.1%. (4) Conclusions: There was a certain proportion of cows with a persistent antibody titer, but there was no evidence that all of these cattle were naturally infected with Brucella. The established PCR method for distinguishing between Brucella abortus strain 19 and non-19 strains can be specifically utilized for detecting natural Brucella infection in immunized cattle. We propose that relying solely on the detection of antibodies in cattle immunized with the A19 vaccine more than 12 months previously should not be solely relied upon as a diagnostic basis for brucellosis, and it is essential to complement this approach with PCR analysis to specifically identify field Brucella spp. Brucella abortus was the predominant strain identified in the field during this study. Detection based on the Mathematical Expectation strategy can significantly enhance detection efficiency.

Managing Children and Adolescents with Type 1 Diabetes and Coexisting Celiac Disease: Real-World Data from a Global Survey.

Celiac disease (CD) is among the diseases most commonly associated with type 1 diabetes (T1D). This study aimed to evaluate the worldwide practices and attitudes of physicians involved in pediatric diabetes care regarding diagnosing and managing CD in children with T1D. The 30-item survey was conducted between July and December 2023 aimed at targeting pediatricians with special interest in T1D and CD. It was shared by the JENIOUS - young investigators group of the International Society of Pediatric and Adolescent Diabetes (ISPAD) - and the YES - early career group of the European Society for Pediatric Endocrinology (ESPE). Overall, 180 physicians (67.8% female) from 25 countries responded. Among respondents, 62.2% expected sustaining optimal glycemic control in children with T1D and CD (T1D + CD) to be more difficult than in children with T1D alone. Majority (81.1%) agreed that more specific guidelines are needed. The follow-up routine for patients with T1D + CD differed, and one-quarter of physicians scheduled more frequent follow-up checkups for these patients. Seventy percent agreed multidisciplinary outpatient clinics for their follow-up is needed. In the multivariate ordinal logistic regression model, a statistically significant predictor of a higher degree of practice according to ISPAD 2022 guidelines was a higher level of country income (OR = 3.34; p &lt; 0.001). These results showed variations in physicians' practices regarding managing CD in children with T1D, emphasizing the need for more specific guidelines and intensive education of physicians in managing this population, especially in lower-income countries. Our data also suggest the implementation of multidisciplinary outpatient clinics for their follow-up.

Are Welsh primary schools Sunproofed? Results of a national survey Part 2: sun protection practices in primary schools in Wales

Abstract Background Skin cancer rates are on the rise globally. School sun safety programmes are recommended by the World Health Organisation to reduce the risk of future skin cancer at population level; however, these are encouraged but not mandated in Wales. Objectives To explore current sun protection practices and sun safety education in primary schools in Wales and whether these are linked to the existence of a formal sun safety policy. Methods An online survey to all 1241 Welsh primary schools asking about sun safety practices, education and formal policies. Results 471 (38.0%) schools responded with the profile of responding schools generally matching the profile of schools in Wales. A minority (22,4.7%) of responding schools reported they had sufficient shade for most activities. In the spring and summer terms almost two thirds of schools encourage hat wearing (304, 64.8%) and sunscreen (296, 63.2%). While nearly all schools reported that parents were encouraged to apply sunscreen to students before school (449, 95.7%), there was wide variation in other sunscreen application practices. Less than one third of schools (129, 29.0%) reported that they include sun protection education in the curriculum in every year group, with 11.7% (52) including this in certain years only. Schools with a formal policy were more likely to report more comprehensive sun protection practices including having sufficient shade [OR 1.51, 95% CI 1.04-2.19; p = 0.032], having spare hats for pupils to wear [OR 1.59, 95% CI 1.07-2.37; p = 0.023], providing guidance for staff [OR 5.87, 95% CI 3.05-11.28; p &amp;lt; 0.001], encouraging them to model sun safe behaviours [OR 1.82, 95% CI 1.18-2.80; p = 0.007] and teaching sun protection education as part of the curriculum in every year group [OR 2.56, 95% CI 1.76-3.71; p &amp;lt; 0.001]. With respect to sunscreen, the existence of a formal policy did not seem to affect a school’s practice. Conclusions While in most cases, the existence of a formal policy suggests more comprehensive sun protection practices and education in schools, sun protection measures and education need improvement across the primary school sector in Wales to reverse rising skin cancer rates.

Clinical Practice Patterns for Transradial Coronary Artery Catheterisation in Australian and New Zealand: Mixed-Methods Survey and Interview Study

While there has been an increase in the use of the transradial approach when performing percutaneous coronary angiography and intervention, there is evidence of variations in international practice. Ensuring that operators' practices are supported by evidence is important to ensure optimal outcomes. Interventional cardiologists and advanced trainees completed a cross-sectional survey followed by semi-structured interviews to map current practices for transradial coronary artery procedures in Australia and New Zealand and explore factors that influence clinical decision-making around procedural practice. The right radial artery was the preferred access site (88%). Over a third (37%) of the participants indicated that they tested the hand circulation pre-procedure. Over a quarter of respondents (28.6%) reported that they would carry out transradial procedures regardless of the patient's coagulation status. Most participants (77.8%) described radial artery spasm in around 10% of transradial procedures performed. Only 62% of participants assessed for radial artery occlusion post-catheterisation. Interview data revealed four themes that guided clinical decision-making, namely (1) Decision-making based on research, (2) Using clinical experience, (3) Being led by their training, and (4) Individual patient factors. This study has demonstrated that despite clinical guidelines, substantial practice variation exists in transradial coronary artery catheterisation across Australia and New Zealand. The variation in practice and factors impacting clinical decision-making highlight a need for future strategies to optimise evidence translation and implementation across clinical settings.

Study of the Practice of Surgical Antibiotic Prophylaxis Use for Elective Neurosurgical Cases in a Tertiary Hospital and Understanding the Rationale

This study aims to evaluate the adherence to surgical antibiotic prophylaxis (SAP) guidelines in elective neurosurgery and assess the impact on surgical site infection (SSI) rates in a tertiary teaching hospital in Malaysia. A retrospective review was conducted on patients who underwent elective neurosurgical procedures from January 1, 2021, to December 31, 2021, in a 1600-bed tertiary teaching hospital. The study assessed adherence to national and hospital SAP guidelines, focusing on the choice of antibiotic, dosage, timing, and duration. Additionally, a survey was conducted among neurosurgeons to evaluate their knowledge, attitudes, and practices regarding SAP. Out of 202 patients included, there was a 99% compliance rate with antibiotic choice and 69.8% with the antibiotic duration. The SSI rate was identified at 6.4%. The knowledge, attitudes, and practices survey highlighted a strong awareness of SAP guidelines among surgeons, albeit with variations in practice, particularly in antibiotic duration and choice of antibiotics. While there is high adherence to the correct choice of antibiotic for SAP in elective neurosurgery, there are gaps in compliance with the recommended duration of antibiotic use. The study highlights the need for targeted interventions to improve adherence to SAP guidelines, which could potentially reduce the incidence of SSI in neurosurgery. Ongoing education and auditing are essential to optimize SAP practices and enhance patient outcomes in neurosurgery.

Practice Patterns of Glucagon-Like Peptide-1 Agonist Use Among Pediatric Bariatric Surgeons: A National Survey

IntroductionGlucagon-like peptide-1 receptor agonist (GLP-1A) medications are gaining widespread popularity for the treatment of obesity. The optimal use of these drugs in pediatric bariatric populations, and especially in those considering metabolic and bariatric surgery (MBS), is yet to be established. We sought to characterize current practice patterns of GLP-1A use at major pediatric bariatric centers across the United States. Materials and MethodsWe administered an online survey to a purposive sample of 46 surgeons who perform MBS on children and adolescents. Survey questions explored practices prescribing GLP-1As in patients considering MBS, holding them prior to elective operations, and restarting them postoperatively following MBS. Responses were summarized with descriptive statistics and inductive content analysis. ResultsThere were 22 responses (48% response rate) representing 19 institutions. Most (86%) respondents do sometimes prescribe GLP-1As for patients considering MBS, but the specific indications vary. Practices for holding GLP-1As preoperatively also vary, from not at all to holding for 2 wk. Over half (55%) of respondents sometimes restart GLP-1As after MBS. Free-response themes included still-evolving preoperative utilization patterns, difficulty with access and insurance coverage, and a lack of data informing GLP-1A use in the pre and postoperative periods. ConclusionsGiven the increasing use of these medications for weight loss purposes, this substantial variation in practice highlights a need for further research to examine the safest and most effective use of GLP-1As in the pre and postoperative periods and for practice guidelines to standardize care pathways in pediatric bariatric contexts.

Primary Science Teachers’ Current Practices on the Use of the ICT Tools in Their Teaching-Learning in Tsirang District, Bhutan

This quantitative study investigated the primary science teachers’ current practices of ICT tools in teaching primary science in their schools of Tsirang district. The study also aimed to investigate the variations in knowledge, perceptions, challenges faced, and practices of ICT tools based on demographic factors. Data was collected through a survey conducted in 14 primary schools, with a sample size of 92 teachers determined using the Krejcie and Morgan Table. The questionnaire, consisting of 29 items, had a reliable Cronbach's coefficient alpha of 0.85. Data analysis was performed using IBM SPSS v.22, employing descriptive and inferential statistics. The findings revealed a high level of knowledge and perception about ICT tools among teachers, with mean scores of 3.87(SD=.65) and 4.50(SD=.38). Similarly, the use of ICT tools by teachers and challenges encountered were also observed at the high level with mean score of 3.55(SD=.97) and, 3.89(SD=.72). However, there was no significant gender-based differences in knowledge, but found notable distinctions in perceptions. Moreover, the study identified that knowledge, perceptions, and challenges were strong predictors (Model Fit: R2=.560, f (3,88) =6.261, p&lt;.05) of teachers' use of ICT tools in teaching primary science. Future researchers may employ robust designs, like mix-mode research, to delve into teachers' ICT use comprehensively, exploring causation and additional variables.