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OBJECTIVES The aim of this project was to promote evidence-based best practice regarding hand hygiene among nurses in a pediatric blood and marrow transplantation (BMT) setting. INTRODUCTION Healthcare-associated infections (HAI) represent important complications of healthcare with potentially major impact on patient outcomes. Most HAI are transmitted through the hands of healthcare professionals (HCP) and therefore hand hygiene is the simplest, most effective and proven method for preventing HAI. However, the overall compliance rate of HCP with hand hygiene remains at a very low level. In this case, it is necessary to implement strategies to improve the compliance with hand hygiene of the HCP with the purpose of reducing HAI rates, mortality and costs, all the more so as it is known that patients with BMT have an increased risk of HAI. METHODS This best practice implementation project was based on the JBI methodological approach and included three phases of activity: a baseline audit, implementation of strategies and a follow-up audit. The project was conducted in the pediatric BMT setting of a large university hospital located in Bucharest, Romania, and the sample included 10 nurses and five relatives of pediatric patients from this ward. RESULTS As a result of the implementation of strategies, improvements were observed across seven audit criteria, given that for two audit criteria out of a total of nine audit criteria compliance was maximum (100%) since the baseline phase. Moreover, the post implementation audit showed a complete compliance (100%) for six audit criteria. However, for the other three audit criteria the compliance in follow-up audit was high: 92, 85 and 80%, respectively. CONCLUSION The strategies applied within this evidence implementation project were appropriate, so the project was a success. However, permanent actions are required to sustain changes in practice and improvements made.

Background: Substance abuse among school students may lead to criminal penalty in addition to possible physical, social, and psychological harm. Psychosocial support in schools focus on children’s social and academic skills, including enhancing peer relationships, self-control, coping skills, social behaviors, and drug offer refusal skills. Aim: to assess knowledge, self concept and attitude among school students toward protection against substance abuse . Study design: Descriptive design was utilized to conduct this study. Setting: this study was conducted at two schools (one school for male and one school for female). These are The New Heliopolis Preparatory School for Girls and El-Tabri Preparatory School for Boys at Cairo city. Subject: convenient sample of 262 students were recruited for conducting this study. Data collection tools: 1) Socio-demographic questionnaire for students. 2) knowledge and attitude about substance abuse. 3) Self Concept Scale..Results: the present study revealed that there was a highly statistically significant improvement regarding knowledge and attitude oscores post implementation of psycho social intervention program. In addition, there were highly statistically significant positive correlations between knowledge and attitude of studied students. Conclusion: there is a statistically significant relationship among students knowledge, self concept and attitude concerning substance abuse. Recommendations:. Future programs should include the parents of adolescents to teach them how to deal with their adolescents and to avoid risky behavior that may occur at this age. Morover, hotlines must be available to solve immediate problems of adolescents.

Purpose While research has confirmed the feasibility and validity of delivering clinical swallowing evaluations (CSEs) via telepractice, challenges exist for clinical implementation. Using an implementation framework, strategies that supported implementation of CSE services via telepractice within 18 regional/rural sites across five health services were examined. Method A coordinated implementation strategy involving remote training and support was provided to 18 sites across five health services (five hub and spoke services) that had identified a need to implement CSEs via telepractice. Experiences of all 10 speech-language pathologists involved at the hub sites were examined via interviews 1 year post implementation. Interview content was coded using the Consolidated Framework for Implementation Research (CFIR) and constructs were rated for strength and direction of influence, using published CFIR coding conventions. Results Services were established and are ongoing at all sites. Although there were site-specific differences, 10 CFIR constructs were positive influencing factors at all five sites. The telepractice model was perceived to provide clear advantages for the service, and clinicians were motivated by positive patient response. Strategies used to support implementation, including having a well-organized implementation resource and an external facilitator who worked closely with the local champions, were highly valued. Two CFIR constructs, Structural Characteristics and Available Resources , were challenges for all sites. Conclusions A complex interplay of factors influenced service implementation at each site. A strong local commitment to improving patient care, and the assistance of targeted strategies to support local implementation were viewed as central to enabling implementation.

This study introduces a new model namely O-P-A (Optical, Physical and Acoustic) model to enhance active learning. The newly proposed model contributes to extend the current literature of the V-K-A model (Visual, Kinaesthetic and Auditory) for active learning. Three activities are implemented at three stages of the research, with each one involves in different approaches and methods to active learning. The impact of the newly proposed O-P-A model in overcoming passive learners in the Media and Society course is also investigated. Preliminary survey were carried out prior to implementation of approach to get a feel of the existing class delivery problem and post implementation survey is carried out to obtained feedback on the implementation of the new approaches Positive findings about the interactive classrooms are often confounded with active learning pedagogy. Our findings confirm that the interactive and active learning approaches create a positive learning environment which induces great outcomes.

Background: Acute gastroenteritis is the fifth leading cause of death worldwide. Objective: current study aimed to evaluate the effect of application of educational guidelines about preventive measures of acute gastroenteritis on mothers' knowledge and reported practices. Methods: A quasi experimental design was used in this study. The study was carried out in outpatient clinics affiliated to Mansoura University Children’s Hospital, Egypt. Subjects of this study was a purposive sample of (100) mothers with their children attended outpatient clinics. A developed structured questionnaire sheet to assess mothers' knowledge and reported practice. Results: there was a statistically significant difference in mothers' knowledge and reported practice about preventive measures of acute gastroenteritis post implementation of educational guidelines. Conclusion: there was an enhancement in the mothers' knowledge and reported practice after application of educational guidelines about preventive measures of acute gastroenteritis. Recommendations: Continuous educational programs for health care providers and educators about gastroenteritis to be delivered at outpatient clinics.

Background; Lung cancer is common cancers worldwide. In view of the high- symptoms burden and sever morbidity, Effective symptoms management requires comprehensive self –care strategies Aim: of this study was to evaluate the effect of self-care guidelines on Symptoms Burden for Patients with lung Cancer Undergoing Chemotherapy. Methods: This study was conducted at the outpatient clinics in Radiation Oncology and Nuclear Medicine Center, affiliated to Ain Shams University. Sample: A purposive sample of (50) Adult patients were recruited for this study Tools: 1- An interview questionnaire to assess, a- Patient's socio demographic characteristics, b- Patient's medical health profile, c- patients knowledge about lung cancer. 2- symptoms burden assessment and 3- patients' self- care practices assessment. Results: the present study revealed that more than one third of the patients in the study and control groups had satisfactory level of knowledge pre implementation of self-care guidelines which improved to the majority of the study group post implementation. There were statistically significant negative correlations between patients' total symptom severity and practices in the study group pre and post self-care guidelines implementation, there were statistically significant positive correlations between patients' total practices and knowledge in the study group pre self-care guidelines implementation while, post self –care guidelines implementation it becomes highly significant positive correlation, there were highly statistically significant negative correlations between patients' total symptoms severity and total knowledge in the study group pre and post self-care guidelines implementation Conclusion: self-care guidelines have a statistically significant positive effect on decreasing severity of lung cancer symptoms While, some chemotherapy-associated symptoms were slightly improved but there were no significant differences between pre and post self-care guidelines implementation. Recommendations: Health education programs about disease and its management should be provided for lung cancer patients.

Rapid global developments make people demand real improvements from the government so that the impact can be felt directly, such as increasing competitiveness, improving public welfare, and empowering communities. The government responded to this push by issuing several regulations that are expected to accelerate service change in Indonesia. One of them is by issuing Government Regulation No. 38 of 2017 concerning Regional Innovation which is used as a solid foothold in guarding the transformation of governance at the local level. The purpose of this study is to provide an idea of ​​guidance and supervision that the Ministry of Home Affairs must carry out, in this case, is APIP.

Near-point-of-care (POC) testing for early infant diagnosis (EID) and viral load expedites clinical action and improves outcomes but requires capital investment. We assessed whether excess capacity on existing near-POC devices used for TB diagnosis could be leveraged to increase near-POC HIV molecular testing, termed integrated testing, without compromising TB services.Preimplementation/postimplementation studies in 10 health facilities in Malawi and 8 in Zimbabwe.Timeliness of EID and viral load test results and clinical action were compared between centralized and near-POC testing using Somers' D tests (continuous indicators) and risk ratios (RR, binary indicators); TB testing/treatment rates and timeliness were analyzed preintegration/postintegration.With integration, average device utilization increased but did not exceed 55%. Despite the addition of HIV testing, TB test volumes, timeliness, and treatment initiations were maintained. Although few HIV-positive infants were identified, near-POC EID testing improved treatment initiation within 1 month by 57% compared with centralized EID [Malawi RR: 1.57, 95% confidence interval (CI) 0.98-2.52], and near-POC viral load testing significantly increased the proportion of patients with elevated viral load receiving clinical action within 1 month (Zimbabwe RR: 5.26, 95% CI 3.38-8.20; Malawi RR: 3.90, 95% CI 2.58-5.91).Integrating TB/HIV testing using existing multidisease platforms is feasible and enables increased access to rapid diagnostics without disrupting existing TB services. Our results serve as an example of a novel, efficient implementation model that can increase access to critical testing services across disease silos and should be considered for additional clinical applications.

Financial literacy is a very important element of knowledge for the economic progress of a country because it is closely related to public interest, the higher the level of public financial literacy, the easier it is for the financial system to be accepted in the community to be implemented and contribute to the economic growth of a region, because with The high level of financial literacy in the community, the easier it will be for financial institutions to provide financial access to the public. the enactment of qanun no 11 of 2018 regarding Islamic financial institutions in Aceh has begun since January 4, 2019, all financial institutions in Aceh. In this study, the data used is secondary data obtained from scientific references as quoted from journals, books texts, working papers, national and international scientific forums and other sources deemed relevant to this research. the results of the research and discussion, it can be concluded that nationally the financial literacy of the Indonesian people is still relatively low, but for the Aceh region itself it is higher than the level of public understanding of sharia finance in Aceh which is above the average public understanding of sharia banking nationally. The interest of the Acehnese people in transacting in Islamic banking is currently increasing, as can be seen from the increasing graph in terms of assets, financing, and third party funds, especially in 2021.

The research aimed at investigating the effect of using a situated learning –based strategy to develop some critical thinking skills and enhance English language learning interest at preparatory stage pupils. The research employed a one group pre-posttest design. Subjects were (30) female second year preparatory school pupils at Assuit City. The experiment lasted for one academic semester. Tools of the research included: (1) a situated learning- based strategy guide, (2) a critical thinking skills checklist, (3) a critical thinking sub-skills test and (4) an English language learning interest questionnaire. Paired Samples t test was used to reveal significance of differences between means of scores of the study group in the pre and the post implementation of the Critical Thinking Sub- Skills Test and the English Language Learning Interest Questionnaire. Analysis of data indicated significantly better post gains. The research concluded that the proposed situated learning- based strategy guide had a positive effect in developing critical thinking skills and enhancing English language learning interest at preparatory stage pupils.

This research will discuss about access to urban community education after the Implementation of the zoning system, this study departs from the number of urban communities living on the railroad banks in Ketintang, Surabaya. The purpose of this study is to determine access to education for urban communities related to values, and patterns of action constructed by urban communities in accessing formal education from pre to post implementation of the zoning system policy. This research will be dissected using social construction theory with externalization, objectivation and internalization processes proposed by Peter L Berger with a qualitative descriptive approach. The result of this study is that access to education has turned into a zoning system, making it difficult for urban communities who have a residency status because the country's schools limit quotas and prioritize native citizens of Surabaya.

Purpose The purpose of this study is to investigate the influence of technological antecedents on the usage of decision makers for the implemented knowledge management system (KMS) amongst Jordanian banks. This study extends the investigation by assessing the influence of knowledge or information quality on KMS usage. This study aims to assess whether knowledge or information quality is significantly correlated to system compatibility, relative advantage and complexity (technological antecedents). Design/methodology/approach The study model was developed by using Rogers’ diffusion of innovation (DOI) theory, on which seven hypotheses were developed. To examine these research hypotheses, a self-administered questionnaire was carried out with 341 decision makers who are using the KMS to perform their job-related activities. Structural equation modelling analysis of moment structures software was used for data analysis. Findings The findings revealed that decision makers usage of the implemented KMS’s is affected significantly by relative advantages, system complexity and knowledge quality, but not system compatibility. Moreover, the findings showed that knowledge quality is significantly correlated with DOI technological antecedents. Practical implications Bank managements are now in a better position to understand what kind of resources and supports are needed to achieve the maximum pay-off from KMS usage within their banks. This study has proved that it is not sufficient for Jordanian banks to focus solely on the system quality; they must also take the quality of knowledge or information (system output) as a critical factor that can affect their investments in KMS’s. Originality/value This study is one of the limited conducted studies to investigate the importance of KMS usage and related antecedents in the Arab world; particularly, in the context of the Jordanian banking sector. The findings of this study have contributed to the Jordanian financial sector for its vital evaluation of the KMS actual usage behaviour. Findings can be used by the Jordanian ministry of finance to improve the understanding of the factors influencing KMS usage in the financial sector. This study has contributed to reducing the gap of DOI literature amongst developed and developing countries, particularly in the Jordanian context.

The research aimed at investigating the effect of using teaching activities for developing some receptive language skills determined in the light of The ABLLS-R at children with Autism Spectrum Disorder (ASD) integrated in primary schools. The research employed a one group pre-posttest design. Subjects were (18) male and female second year primary school pupils with autism spectrum disorder at Assuit City. The experiment lasted for one academic semester. Tools of the research included: (1) a set of teaching activities, (2) a receptive language skills checklist, (3) an observation sheet of receptive language skills and (4) a receptive language sub-skills test. Mean scores and standard deviation for students' scores in the observation sheet were calculated to determine students' level in receptive language skills and were found to be low. Wilcoxon signed-rank test of paired samples was used to reveal significance of differences between means of ranks of the study group scores in the pre and the post implementation of the receptive language sub-skills test. Analysis of data indicated significantly better post gains. The research concluded that the proposed teaching activities had a positive effect in developing receptive language skills at primary school children with ASD.

Cultivating leadership excellence within today’s virtual working environment is imperative. This quality improvement project conducted a needs assessment of a remote workforce to determine their experience with remote leadership. Results showed an opportunity to improve communication between employees and leadership, particularly in the areas of leaders understanding the work, considering the team when making decisions, and supporting the staff in a timely manner. The transformational leadership model was used to plan practice changes. Daily virtual huddles were implemented to improve communication. Virtual observations to increase manager awareness of practice and individual monthly meetings were implemented. Post implementation feedback was positive.

Background The Upper West region of Ghana is mostly made up of rural communities and is highly endemic for lymphatic filariasis (LF), with a significant burden of disability due to lymphedema and hydrocele. The aim of this paper is to describe an enhanced, evidence-based cascading training program for integrated lymphedema management in this region, and to present some initial outcomes. Main text A baseline evaluation in the Upper West Region was carried out in 2019. A cascaded training program was designed and implemented, followed by a roll-out of self-care activities in all 72 sub-districts of the Upper West Region. A post implementation evaluation in 2020 showed that patients practiced self-care more frequently and with more correct techniques than before the training program; they were supported in this by health staff and family members. Conclusions Self-care for lymphedema is feasible and a program of short workshops in this cascaded training program led to significant improvements. Efforts to maintain momentum and sustain what has been achieved so far, will include regular training and supervision to improve coverage, the provision of adequate resources for limb care at home, and the maintenance of district registers of lymphedema cases, which must be updated regularly.

The objective was to describe, through key points of indigenous health care, what has changed after the implementation of the National Health Care Policy for Indigenous Peoples. For this, the research method chosen was the literature review with a qualitative approach of the results. The studies that composed the sample were retrieved from the SciELO and PubMed databases, from May to August 2018. The results point to the deficiency of training of professionals of the Multidisciplinary Team of Indigenous Health (EMSI) in the context of interethnic relations; the need to define the functions of Indigenous Health Agents (IHA) within EMSI; the good acceptance by indigenous peoples and EMSI regarding biomedical and traditional indigenous treatments, respectively; in addition to the food deficiency of the Indigenous Health Care Information System. That said, there should be trainings in the scope of interethnic action for EMSI and IHA with clear definition of each one’ roles within EMSI, especially the IHA.

BACKGROUND The multigene genomic classifier ThyroSeq V3 has proven to be an effective triage modality in the management of indeterminate thyroid nodules. This study reports on the clinical management of patients with indeterminate thyroid nodules. METHODS ThyroSeq V3 testing at our institution was implemented April 1, 2019. Over a 17-month period (1 April 2019 through 31 August 2020). Thirty five indeterminate thyroid nodules were sent for testing; diagnoses included FLUS, suspicious for a follicular/Hurthle cell neoplasm (SFN/SHCN) and suspicious for papillary thyroid carcinoma (SPTC). There were 26 females, nine males; mean age 56 years. Aspirated nodules, mean size of 2 cm, were evaluated by rapid on site evaluation with adequacy assessed by the cytopathologist via telecytology. RESULTS Of the 35 nodules, 17 (49%) were positive and 18 (51%) were negative on ThyroSeq Testing. All of the 17 positive nodules (four FLUS, 10 SFN/SHCN, three SPTC) showed neoplastic lesions; five adenomas, one NIFTP and 11 carcinomas on surgical resection. Only 4 (22%) of the 18 nodules that were negative were resected and showed two colloid/adenomatous nodules, one NIFTP and one follicular variant of papillary thyroid carcinoma. As FLUS FNAs were the majority of the indeterminate nodules, a comparison was made pre-and post ThyroSeq testing. Prior to ThyroSeq testing the majority (69%) of the nodules were resected as compared to 36% post implementation; a statistically significant value (P

BackgroundDespite known advantages of advance care planning (ACP) and a positive attitude towards ACP by older people living in the community and general practitioners (GPs), such conversations are not yet commonplace in GP practices.AimTo implement ACP as part of routine care in general practice and thereby increasing the number of ACP conversations and advance directives; to investigate characteristics of older people with and without an ACP conversation.Methods(1) A pre-evaluation and post-evaluation study using questionnaire data from people aged 75 years or older living in the community. (2) A prospective study using data provided by healthcare professionals (people they started an ACP conversation with).ResultsAfter implementation of ACP, significantly more people had spoken to their GP about hospitalisations, intensive care admission and treatment preferences in certain circumstances, compared with before. Advance directives were drawn up more often. People who had an ACP conversation were older, have had a cerebrovascular accident, had a clear idea about future health problems, had a preference to start ACP before they were ill, already had an ACP conversation at pre-measurement and indicated at pre-measurement that their GP knows their preferences.ConclusionResults in number of ACP conversations and advance drectives were modest but positive. ACP was implemented as routine care. GPs select people with whom they have a conversation. This can be an efficient use of time, but there is a risk that certain groups may be underserved (for example, patients with multimorbidity or patients with less health skills).

Purpose: The study sought to establish the effect of post-implementation community participation on sustainability of borehole water projects in Mbeere South sub county, Embu County. Methodology: The study employed cross-sectional research design. The target population comprised of 770 executive borehole management committee members, 16,800 household borehole water users in Mbeere South Sub County, five project managers from non-state agencies involved in rural water provision and management and two government water officers. The study used utilized a sample size of 657. Krejcie and Morgan table was used to select 260 executive borehole committee members while Yamane formula was employed to sample 390 household borehole water users who were selected from the five wards in Mbeere south sub county by use of proportionate random sampling method. Census sampling was applied to select two government water officers and five project officers from non-state agencies. The study used questionnaires and interview guides to gather primary data from the respondents. The questionnaires were piloted with 70 randomly picked respondents drawn from the target population to ascertain their reliability in gathering relevant data while content validity was achieved through review by experts and professionals in the field of study. Data analysis employed descriptive statistics using Statistical Package for Social Sciences (SPSS) Findings: Pearson Chi-Square analysis revealed that monitoring cases of vandalism and poor hand pump handling, monitoring hand pump defects and breakdowns, supervision of community-led maintenance and repair were statistically significant at 5% precision level with P- values of 0.000, 0.000, 0.020 respectively. The study also established that community caretakers technical training, availability of hand pump spare parts and technician entrepreneurs in village markets were statistically significant at 5% precision level with P-value of 0.000. In regard to financial transparency and accountability, beneficiaries’ willingness to pay for water, availability of enough funds to cover maintenance and management costs, community demand for water, application of book keeping skills in borehole projects management and keeping of financial records of household payments were statistically significant at 5% precision level with P-value of 0.000, 0.006, 0.000, 0.000, 0.000 respectively. Further, 78.9% of the household water users indicated that there were no mechanisms for auditing the records prepared by the borehole management committees and regarding their involvement in financial decision making only 26.2% affirmed participation in financial decision-making process. Unique contribution to theory, practice and policy: The study recommends that community beneficiaries should be sufficiently mobilized and prepared to facilitate effective community management of rural borehole water projects during the post-implementation period as postulated by the Community Coalition Action and Citizen Participation theories. Additionally, the borehole management committees should be supported by external stakeholders to enhance their technical and financial management skills in order to ensure technical and financial sustainability of rural community managed borehole projects through facilitative and village-level operation and maintenance and effective accountability and transparency mechanisms.

استهدف البحث إلي : الکشف عن أثراستخدام نموذج التعلم لمکارثي في تدريس الرياضيات ؛ لتنمية الاستيعاب المفاهيمي ، ومهارات التفکير التحليلي في الرياضيات لدى تلاميذ الصف الأول الإعدادي بمحافظة الفيوم ، وتکونت عينة البحث من(84) تلميذا موزعة على مجموعتين إحداهما تجريبية 42 تلميذا، والأخرى ضابطة 42 تلميذا ، ولتحقيق أهداف البحث قام الباحث بإعادة صياغة وتصميم وحدة ( الأعداد والجبر ) المقررة بکتاب الطالب طبعة: (2016/2017م ) للفصل الدراسي الثاني ، في ضوء خواص ومبادئ نموذج التعلم لمکارثي ، کما قام الباحث بإعداد أداتين هما اختبار لقياس مهارات التفکير التحليلي في الرياضيات ، والآخراختبار لقياس الاستيعاب المفاهيمي في الرياضيات ، وبعد التأکد من صدق وثبات أدوات البحث ، تم إجراء التطبيق الميداني على عينة البحث بعد التأکد من تکافؤ مجموعتي البحث ( التجريبية - الضابطة ) ، وبعد الانتهاء من دراسة الوحدة وتطبيق أدوات البحث. أسفر البحث عن النتائج الآتية : n تفوق تلاميذ المجموعة التجريبية على تلاميذ المجموعة الضابطة في کل من : اختبار مهارات التفکير التحليلي، واختبار الاستيعاب المفاهيمي في الرياضيات ؛ حيث ثبت وجود فروق ذات دلالة إحصائية لصالح المجموعة التجريبية في التطبيق البعدي لکلا الأداتين . n توجد علاقة أرتباطية ذات دلالة إحصائية من النوع ( طردي قوي ) بين مهارات التفکير التحليلي والاستيعاب المفاهيمي في الرياضيات لدى التلاميذ عينة البحث . وفي ضوء النتائج يوصي الباحث بما يأتي : 1- عقد دورات تدريبية وورش عمل لمعلمي الرياضيات بالمرحلة الإعدادية حول استخدام نموذج الفورمات (4 MAT) لمکارثي، وکيفية تصميم برامج تعليمية حقيقية لمراعاة الفروق الفردية بين المتعلمين من حيث نمط التعلم في مختلف فروع الرياضيات. 2- ضرورة اهتمام القائمين على تخطيط وإعداد مناهج الرياضيات باستخدام نموذج الفورمات التعليمي واستراتيجيات تدريسه المقترحة ، ضمن استراتيجيات تعلم الرياضيات بالمرحلة الإعدادية . 3- توفير بيئة تعليمية للتلاميذ تسودها الحريه والديمقراطيه مثل بيئه التعلم التي تضمنها نموذج الفورمات والاستراتيجيات المقترحة المتضمنة في هذا البحث ، لجعل عملية تعلم الرياضيات عمليه ممتعه ومشوقة؛ مما يوفر فرصا أکثر مناسبة للتلاميذ في تعلم الرياضيات . 4- تضمين المناهج الدراسية أنشطة تعليمية وفق نموذج الفورمات (4MAT) لمکارثي، وصياغتها بصورة تساعد على تنمية مهارات التفکيرالمختلفة والاستيعاب المفاهيمي في الرياضيات . 5- الاعتماد على إستراتيجيات تدريسية من شأنها جعل التلاميذ يشارکون في الأنشطة بشکل تعاونى واجتماعى ، ودمج المتعلمين معا للاستفادة من التنوع الموجود بينهم في تبادل الأفکاروالآراء والخبرات . 6- حث معلمي الرياضيات على احتواء المتعلمين جميعا باختلاف انماطهم التعليمية ؛ وهذا ما يوفره نموذج مکارثي التعليمي والاستراتيجيات المقترحه في هذا البحث The study aims at discovering the effect of using McCarthy model (4MAT) in teaching mathematics to develop first year prep stage students’ analytical thinking skills and conceptual understanding in Fayoum Governorate. The study sample included 84 students, split into two equal halves; one for the experimental group and the other for the control one. The researcher redesigned the “Numbers and Algebra Unit” introduced to the study sample in light of McCarthy model characteristics and principles. The researcher also designed two tools, namely, Mathematical analytical thinking measure and Mathematical conceptual understanding test. The study tools were proven valid and reliable then the designed unit was administered to the experimental group. The study concluded that: The experimental group students outdid the performance of the control group in both measuring tools as there were statistically significant differences in favour of their results in the post implementation of the tools. There is a strong direct correlation between the mathematical analytical thinking skills and conceptual understanding. In light of the results and conclusions, the researcher recommends the following: 1. preparing a number of training sessions and workshops for prep stage teachers to train them on the use of the 4MAT model and designing educational program that consider the learners’ individual differences and learning styles in all mathematics branches. 2. The importance of drawing the attention of mathematics courses planners and designers to use the 4MAT model and its teaching strategies especially for the prep stage. 3. Providing for a democratic free teaching environment similar to that suggested by the 4MAT model to make mathematics studying more enjoyable and interesting to provide for better learning. 4. Including a number of the 4MAT model educational activities and putting it forward in a way that permits the development of the variant thinking skills and conceptual understanding. 5. Using teaching strategies that allows students to work cooperatively and socialize allowing them to make use of their diversity and share ideas and opinions. 6. Encouraging mathematics teachers to include all students with variant learning styles in a way similar to that suggested by the 4MAT model and its strategies.

Objectives: Establishing teaching policies which improve the quality of student learning experience and thereby, enhance the overall learning outcome. Teaching and learning are inherently intertwined, and this necessitates a holistic approach towards the development of novel teaching methodologies.Sustainable quality teaching policies require long-term, non-linear efforts and thus call for a permanent commitment from the teaching faculty. In general, certain quantitative standards/measures can be employed to gauge the efficacy of teaching. In this article, we present an observational study conducted at a recently established Govt. Medical College at Nizamabad in the State of Telangana. A novel teaching-learning framework was formulated and implemented. The efficacy of the framework was measured by gauging various parameters post-implementation of the policy.The proposed framework included policies related to the following aspects: Attendance Specific teaching-learning programme for Practical procedures Formative assessments followed by feedback sessions reflecting on their performance Conducting periodical tests Formulation of questions by Students for Mock Orals Conducting Quiz Programmes As shown by certain quantitative metrics, the implementation of the proposed framework has resulted in the improvement of academic performance of the students. Material and Methods: The study was based on data analysis of summative marks records, after each year. The data was collected for about 400 students over a period of 4 years. Results: The efficacy of the proposed teaching method was analysed by the gauging the academic performance of students prior to and post implementation of the policy framework. The results indicate significant improvement of student academic performance after the implementation of the proposed policy framework. Conclusion: Evolving departmental policies with specific teaching learning programmes will help to improve the academic performance through motivation and better understanding of subject. Administering specific teaching learning programmes with strict attendance policy plays a role in improving the academic performance of the students. Keywords: Attendance policy, Specific teaching learning programmes.

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. Aim: This study aimed to evaluate dietary counseling program for mothers of children with cerebral palsy through, assess mothers' knowledge and practices regarding to cerebral palsy; and appraise dietary counseling program for mothers of children diagnosed with cerebral palsy. Setting: This study conducted at faculty of physical therapy of Cairo University and neuro outpatient clinic in Sayed Galal hospital at Bab-AL-Shareya Cairo, Egypt. Design: A quasi experimental design was used. Subject: This study included seventy mothers of children with cerebral palsy came to neuro outpatient clinic at faculty of physical therapy of Cairo university and fifty mothers of children with cerebral palsy from neuro outpatient clinic in Sayed Galal hospital at Bab-AL-Shareya Cairo, Egypt. Tools: An interview questionnaire tool used in this study pre and post dietary counseling program, include three parts, I) socio-demographic characteristics for mothers of children with cerebral palsy; II) Mothers’ knowledge (pre and post) regarding to cerebral palsy; and III) Mothers' reported practices regarding dietary counseling program for their children with cerebral palsy. Results: an improvement of mothers' Knowledge and reported practice post dietary program than pre the program, the mothers' Knowledge mean and standard deviation pre-program is (53.0702 ± 29.77748), while post-program is89.3202 ± 11.68589 with highly statistically significant differences, also the mothers' reported practice mean and standard deviation pre-program is (42.6667 ± 27.76653), and post-program is (75.0833 ± 20.29181) with highly statistically significant differences. Conclusion Mothers' knowledge and reported practices toward their children with cerebral palsy improved significantly post implementation of the dietary program. Recommended: Periodically dietary counseling program for mothers help to improve their practices for enhancement of dietary condition for their children with cerebral palsy and reduce the complications of cerebral palsy and malnutrition

يهدف البحث إلى تنمية الوعي الغذائي لدى تلاميذ الصف الثاني الإعدادي من خلال تصميم برنامج مقترح في الثقافة الغذائية ، ولتحقيق هذا الهدف قامت الباحثة بتصميم برنامج الثقافة الغذائية من خلال مراجعة الأدبيات والمراجع والمجلات والدوريات العلمية ، وتضمن البرنامج ثلاث وحدات دراسية ، کما تم إعداد أداة البحث ( مقياس الوعي الغذائي ) واستخدم المنهج شبه التجريبي ، وتکونت عينة البحث من 70 تلميذة من تلميذات الصف الثاني الإعدادي تم تقسيمهم على مجموعتين أحدهما تجريبية والأخرى ضابطة ، وقد أظهرت النتائج إلى وجود فروق ذو دلالة إحصائية عند مستوي دلالة (0.01) بين تلميذات المجموعتين التجريبية والضابطة في التطبيق البعدي لصالح المجموعة التجريبية ، وفي ضوء النتائج تم تقديم مجموعة من التوصيات أهمها الاهتمام ببرامج تنمية الوعي الغذائي القائمة على التکامل بين المواد الدراسية ، وأهمية تضمين موضوعات الغذاء والسلوکيات الغذائية السليمة بدرجة أکبر في المناهج الدراسية المختلفة . The research aims to develop nutrition awareness forsecond year Preparatory Students by designing a proposed program in Nutritional culture. To achieve this goal, the researcher designed a Nutritional culture program by reviewing literature, references, journals and scientific periodicals, and the program included three study units, and a research tool was prepared ( The nutrition awareness measure) and used the quasi-experimental approach, and the research sample consisted of 70 female students from the second year of middle school who were divided into two groups, one experimental and the other control, and the results showed that there are statistically significant differences at the level of significance (0.01) between students of the experimental and control groups in Post implementation for the benefit of the experimental group, and in light of the results, a set of recommendations were presented, the most important of which is the interest in developing nutrition awareness programs based on integration between school subjects, and the importance of including food issues and healthy food behaviors in a greater degree in the different curricula.

Background: Enterprise resource planning (ERP) is critical to enhancing the ability to control commercial activities and results in a competitive advantage when combined with an organisation's existing competitive advantages. However, our practise review reveals that end users resist ERP implementation because the resulting changes will alter the current status quo. The implementation of an ERP system in an organisation is complex as it affects multiple areas of the business. Resistance to change is cited as a factor of ERP failure. Methods: In this study, we conducted a systematic literature review using Transfield's five stages and established a conceptual framework for ERP system implementation in science and technology parks (STPs). Articles collected from Emerald, Science Direct, ProQuest and Scopus databases between 1 st June 2021 and 15 th June 2021. Two authors were assigned to check the suitability of the articles in order to avoid risk of bias. Articles were analysed based on components of a research paper and the data was tabulated using MS Excel. Results: Only eight papers (0.011% of all the papers) appeared when we searched for papers related to ERP with a focus on post ERP Implementation, end-user behaviours, organisational performance, and the accelerated SAP (system application and product) methodology. We found that there are hardly any articles on ERP post implementations in STP context particularly based on the evaluation part of accelerated SAP.   Conclusions: Results indicate the lack of studies in this field, particularly those addressing issues related to STP. This study attempted to broaden the understanding of the ERP's effectiveness, particularly in terms of an organisation's operational performance., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Harun S et al.)

Objective: The objective of this study was to evaluate a digital dictation system (DDS) that has been implemented in a large health service. The data collected in this study was used to understand the overall uptake and performance of the system and consequently improve the quality of care delivered by the organisation. Methods: A mixed method research design was used in this study. Clinicians and Medical Transcriptionists using the DDS across the two campuses of the health service over a period of four months, were surveyed to assess the extent to which the implementation of the DDS is fulfilling its purpose. In addition, system usage statistics, project implementation documents and user support emails were also analysed. Results: This study utilised an existing comprehensive and validated evaluation framework, the Human, Organisation and Technology Fit (HOT-Fit) framework. Human fit: 79.55% (n=35) of Clinicians and 33.33% (n=2) of MTs reported an overall satisfaction with the DDS. Organisation fit: The document analysis revealed that the DDS selected aligned best with current organizational IT strategies and was an easy fit with existing practices. Technology fit: An overall satisfaction of 53.49% (n=23) from the Clinicians and 16.67% (n=1) from the MTs was reported on the DDS. Out of 22 issues lodged regarding the system, 77.27% (n=17) issues met the Service Level Agreement (SLA). Conclusions: The overall findings of the study suggest that, the DDS was a good fit within the organisation in terms of Human fit and Organisation fit. In terms of Technology fit there existed some technical issues on the end-user level due to the system being new to the end users. To overcome this and facilitate the smooth functioning of the DDS, effective communication with the vendor and other relevant stakeholders was recommended so that end users i.e. the Clinicians and MTs understand the system, its functionality and their role in providing timely and high-quality information for clinical care.

Background: Needle stick and Sharp injuries pose a high risk to internship nursing students. They represent a major risk factor for transmitting blood borne pathogens as hepatitis B , C virus. Interns being vulnerable section are more prone for these injuries, so they need training module program to improve their skills. Aim: This study was conducted to evaluate the effect of implementing training module on competence of internship nursing students performance regarding needle stick and sharp injuries safety issues. Design: A quasi experimental research design was utilized. Setting: Data were collected from the Faculty of Nursing, Tanta University and Tanta Main University Hospital. Subjects: Random sample of (75) internship nursing students who were spent the internship period at Tanta Main University Hospital. Tools: Three tools were used to collect data: Tool (I); Structure Questionnaire Sheetregarding safety measures about NSI; Tool (II); Observation checklist for students’ practice regarding safety measures about NSI. Tool (III): Challenges that affect follow up safety measures. Results: revealed that there were significant improvements in internship nursing students' knowledge and practice regarding safety measures of needle stick and sharp injuries post implementation of training module at P < 0.05. Also, the study revealed that the highest percentages of challenges those affect their follow up safety measures were; night shifts and lack of training. Conclusion: The study findings revealed that the implementation of training module were successful for improving nursing students' knowledge and practice regarding needle stick and sharp injuries. Recommendations: it is recommended to students instructions should be continually reinforced, and clinical supervision should be managed to ensure compliance in all clinical experiences regarding NSIs.

استهدف البحث إلي الکشف عن أثراستخدام مبادئ وأنشطة هندسة الفراکتال في تنمية مهارات التفکير المنظومي ، ومهارات اتخاذ القرار في الرياضيات لدي طلاب الصف الأول الإعدادي بمحافظة الفيوم ، وتکونت عينة البحث من (76) تلميذا موزعة علي مجموعتين إحداهما تجريبية 38 تلميذا ، والأخرى ضابطة 38 تلميذا ، ولتحقيق أهداف البحث قام الباحث بإعادة صياغة وتصميم وحدة ( الهندسة والقياس ) المقررة بکتاب الطالبة طبعة: (2016/2017م ) للفصل الدراسي الثاني ، في ضوء مبادئ وخواص أنشطة هندسة الفراکتال ، کما قام الباحث بإعداد أداتين هما اختبار في مهارات التفکير المنظومي، والآخر اختبار لقياس مهارات اتخاذ القرار في الرياضيات ، وبعد التأکد من صدق وثبات أدوات البحث ، قام الباحث بإجراء التطبيق الميداني علي عينة البحث بعد التأکد من تکافؤ مجموعتي البحث ( التجريبية - الضابطة ) ، وبعد الانتهاء من دراسة الوحدة وتطبيق أدوات البحث. أظهر البحث النتائج الآتية : تفوق تلاميذ المجموعة التجريبية علي تلاميذ المجموعة الضابطة في کل من : اختبار مهارات التفکير المنظومي، واختبار مهارات اتخاذ القرارفي الرياضيات، حيث ثبت وجود فروق ذات دلالة إحصائية لصالح المجموعة التجريبية في التطبيق البعدي لکلا الأداتين . توجد علاقة أرتباطية ذات دلالة إحصائية من نوع ( طردي قوي ) بين مهارات التفکير المنظومي ومهارات اتخاذ القرار في الرياضيات لدي التلاميذ عينة البحث ( المجموعة التجريبية ) . وفي ضوء النتائج يوصي الباحث بما يأتي : 1) إدخال الأنشطة الإثرائية لهندسة الفراکتال في مناهج الرياضيات المدرسية. 2) ضرورة إعداد برامج تدريبية للمعلمين أثناء الخدمة تتضمن مبادئ وأنشطة هندسة الفراکتال لتطوير أدائهم التدريسي من خلال ورش العمل وبرامج التدريب . 3) تقديـم وحدة تعريفية بهندسة الفراکتال في مناهج الرياضيات بالحلقتين الأولى والثانية من التعليم الأساسي. 4) إعداد برامج وورش عمل لتنمية مهارات التفکير بشکل عام والتفکير المنظومي بشکل خاص في الرياضيات لدى تلاميذ المرحلتين الإبتدائية والإعدادية. 5) تدريب التلاميذ على مهارات اتخاذ القرارعن طريق اتاحة الفرصة لهم للتـدريب علـى أنماط التفکيرالمختلفة . في ضوء ما أسفرت عنه نتائج البحث يمکن اقتراح البحوث التالية: 1) دراسة أثر استخدام وحدة قائمة على هندسة الفراکتال لتنمية مهارات التفکير الإبداعي لدى الطلاب بمراحل التعليم المختلفة . 2) دراسة أثر برنامج تدريبي قائم على هندسة الفراکتال لتنمية مهارات التفکير العليا لدى المعلمين بالمرحلة الإعدادية. 3) دراسة فاعلية استخدام هندسة الفراکتال في تنمية المهارات الرياضية في مراحل التعليم المختلفة. 4) دراسة فاعلية استخدام هندسة الفراکتال على تنمية مهارات التفکير البصري في مراحل التعليم المختلفة. 5) دراسة أثر استخدام هندسة الفراکتال على تنمية التذوق الجمالي والفني والقدرات البصرية لدى طلاب المراحل التعليمية المختلفة . The study aims at finding out the effect of using fractal geometry principles and activities in developing first year prep stage students’ systematic thinking and decision making skills in Fayoum Governorate. The sample was made up of 76 students sub-divided into two groups; 38 students in the experimental group and 38 in the control one. The researcher re-designed the (geometry and measurement) unit included in the 2016/2017 student book of the second term in light of the fractal geometry activities principles and characteristics. The researcher prepared the following tools: Systematic thinking skills test and mathematics decision making skills measure. The researcher ensured the validity and reliability of the study tools and the equality of the two groups of the study then implemented the experiment. The study revealed the following: The experimental group members outdid the control one in both tools as there were statistically significant differences in the post implementation in favour of the experimental group. There was a strong positive correlation between the sample members’ systematic thinking and decision making skills. In light of the study results, the researcher recommends the following: Including the fractal geometry enrichment activities in mathematics courses. Preparing training courses for in-service teachers including the fractal geometry principles and activities to enhance their teaching performance during the workshops and training programs. Including an introductory unit about fractal geometry in both cycles of basic education mathematics courses. Preparing a number of programs and workshops to train both cycles of basic education students on thinking skills in general and systematic thinking specifically. Training students on decision making skills by training them on the various thinking forms. In light of the study results, the researcher suggests the following further researches: Studying the effect of using fractal geometry based unit on developing various stages students’ creative thinking skills. Studying the effect of using fractal geometry based training program on developing prep stage teachers’ higher thinking skills. Studying the effectiveness of using fractal geometry on developing various stages students’ mathematical skills. Studying the effectiveness of using fractal geometry on developing various stages students’ visual thinking skills. Studying the effectiveness of using fractal geometry on developing various stages students’ visual abilities and aesthetic and artistic appreciation.

The removal of all branding and promotions from tobacco products, known as ‘plain packaging’, is intended to decrease tobacco consumption. Here we examine the effectiveness of Australia’s plain packaging law, which coincided with a change in graphic and text health warnings, by using nationally indicative data 5 years post implementation. We measured the effect of the law on smoking prevalence, tobacco expenditure, expenditure intensity and quantity of tobacco consumed, using New Zealand as a control country in a difference-in-differences research design. We uncover a substitution effect that is robust to different specifications and control countries. In response to the policy, smokers switched from more expensive to cheaper cigarettes and reduced their overall tobacco expenditure and expenditure intensity. However, as smoking became less costly, smokers consumed more cigarettes. To discourage such substitution and to help the policy achieve its intended outcomes, policymakers should consider implementing auxiliary measures, such as taxes or price floors. In examining the impacts of the plain packaging tobacco law in Australia, Sun and colleagues uncover unintended negative consequences. In response to the policy, smokers switched from expensive to cheap cigarettes, and as smoking became less costly, they consumed more cigarettes.

The research purpose to know implementation program livestock center (STM) and the Mustahik economic revenue of the independent livestock program at the institution Amil Zakat Ummul Quro (LAZ-UQ) Jombang. The method used in this study is qualitative research method. The data collection techniques use interviews, observation and documentation. The data analysis techniques used is a data reduction, data presentation and data deduction. Research shows that the implementation of the independent livestock center program (STM) requires a few steps there are: location survey of implementation program, assessment of prospective members, companion selection, formation of livestock groups, submission of seeds and implementation program, mentoring process, counseling and training, monitoring and evaluation. Post implementation of an independent livestock center program (STM) has been proven to increase Mustahik economics income as well as improve the quality of life. From the sale of the sheep can be used to needing necessary daily, or for education costs. Besides these result can also improve the condition of the house, build a small shop, some even buy motorbikes

In this paper, Japanese teachers’ experiences under the new communicative course of study guidelines that became fully implemented in April 2016 in the new Japanese high school English Language curriculum, “Communicative Course of Study Guidelines” are examined. The study explored 21 high school teachers from a variety of schools, and with experience ranging from those who have just begun teaching to those who are reaching the end of their careers. It analysed their proficiency and confidence in teaching various skills, the workplace pressures that shaped their pedagogy within the new curriculum guidelines, and whether their implementation of the new curriculum was achieved. Results show that even though there is a willingness among newer teachers to implement communicative approaches within the high school English classroom, the workplace hierarchy and the culture of senpai-kohai (senior-junior) influenced the approaches they used within the classroom regardless of what the new curriculum sets out to achieve.

BACKGROUND One major complication of the insertion of a peripheral venous catheter (PVC) is phlebitis, often resulting in delay of treatment, increased healthcare costs and prolonged hospitalization. AIMS The current study sought to evaluate the effectiveness of a standardized PVC care bundle in increasing the compliance of PVC care and assessment and reduce the occurrences of phlebitis rates. METHODS A pre and postimplementation audit approach was used in this study and adopted the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice program. This study was carried out in three phases over a 10-month period, from March 2017 to December 2017 across three medical wards in a hospital in Singapore with a sample size of 90 patients. The study involved educating nurses on phlebitis assessment, implementing a PVC care bundle and monitoring compliance. An audit tool comprising four criteria from the Joanna Briggs Institute Practical Application of Clinical Evidence System was developed. RESULTS One-month and 3-month postimplementation findings revealed significant improvement in Criteria 1, 3 and 4 (P 0.05). Six-month postimplementation findings showed significant improvement in all four criteria (P

ObjectivesTo measure trauma patient and caregiver satisfaction before and after implementation of standardised palliative care (PC) guidelines.MethodsProspective pre–post study at two level-I trauma centres. PC satisfaction surveys were administered prior to discharge for consented trauma patients (Family Satisfaction with Advanced Cancer Scale, Patient (FAMCARE-P13) survey)≥55 years, and their caregivers (FAMCARE survey), from 1 November 2016 to 30 November 2018. Standardised PC guidelines were implemented January 2018 and included consultations, prognostication assessments, identification of proxies, review of advanced directives and do not resuscitate orders within 24 hours of admission, while advanced goals of care, formal family meetings and spiritual care support were recommended within 72 hours of admission. Generalised linear models were used to determine whether differences in patient or caregiver satisfaction existed pre versus post implementation.ResultsThere were 572 patients (299 pre; 273 post) and 595 caregivers (334 pre; 261 post) included. Overall patient satisfaction significantly increased post implementation (82.0 vs 86.0, p=0.001). After adjustment, the implementation of the guidelines was an independent predictor of higher overall patient satisfaction (least squares mean (LSM= (83.8% (95%CI 81.2%-86.5%) vs 80.3% (77.7%-82.9%), p=0.003)). Compared with preimplementation, patient satisfaction was significantly higher post implementation in the following domains: information giving (80.9 vs 85.5, p=0.001), followed by physical care (82.2 vs 86.0, p=0.002), availability of care (83.4 vs 86.8, p=0.007) and psychosocial care (84.7 vs 87.6, p=0.04). No significant differences in caregiver satisfaction were found before or after adjustment (LSMpre: 83.1% (95%CI 80.9%-85.3%) vs. post: 82.4% (80.3%-84.5%), p=0.56))ConclusionsOur data suggest that the implementation of PC guidelines significantly improved patient satisfaction following traumatic injury, while maintaining robust caregiver satisfaction.

In this paper, an attempt has been made to analyse the implications of tax reforms after the economic liberalization in 1991 with respect to collection of indirect tax revenue of the Government of India during the last two decades (2000-20). The composition of indirect tax revenue of the Government has undergone a drastic change during the last two decades. Post implementation of the GST Act, the levy of Central Excise has been restricted to petroleum and tobacco products and GST has evolved as the major contributor to the indirect tax revenue collections followed by the Customs Duty. Comparative analysis of indirect tax collections of the Central Government with respect to its growth, share in gross tax revenue, percentage of GDP and composition has been done for the period from 2000-01 to 2019-20. The current study has revealed the growth rate of indirect taxes has not only been uneven but also declined during the year 2001-02, 2008-09 and 2009-10. The share of indirect tax in the gross tax revenue has also gradually declined from 63% in 2000-01 to 46% in 2019-20%. The indirect tax-GDP ratio has remained stagnant in the range of 3.5 to 5.5 % during the last two decades.

PurposeConsequent on the widespread of fair value (FV) accounting with the coming into effect of International Financial Reporting Standard (IFRS) 13, this study investigated the post-implementation challenges of FV measurement from the perspective of auditors in Nigeria.Design/methodology/approachData collection was through a structured-questionnaire administered on auditors from diverse audit firm backgrounds in terms of size, international affiliation and global presence. Statistical techniques such as cluster analysis, factor analysis and ANOVA were applied to analyse data obtained from 277 respondents.FindingsIt was observed that the severest challenge of FV measurement bothers on the paucity of information for valuation of items. The magnitude of the challenges of applying FV measurement in various industry sectors appears similar. Although audit firm attributes affect perception on the challenges, there is concurrence among auditors that manipulation of values of assets/liabilities with no market price during estimation, leveraging on non-availability of market information on assets/liabilities by managers to manipulate financial statements, inappropriateness/non-compliance of valuation methods with IFRS 13, and low level of awareness among preparers of financial reports are notable post-implementation challenges of FV measurement.Practical implicationsConsidering that the adoption of IFRS 13 impliedly places responsibilities on countries applying the standard to develop institutional structures that facilitate the valuation of items using FV measurement, it seems the establishment of such apparatus may be a sine qua non for fully realising the socio-economic benefits of applying FV accounting.Originality/valueThe study contributes to knowledge by exposing the practical challenges of FV measurement and accounting estimates typical of a developing country that has fully implemented international accounting standards. Moreover, findings from this study could be compared with the result of investigations conducted in other jurisdictions to gain a deeper and wider insight into the challenges of FV measurement with a view to proffering solutions to the post-implementation challenges of IFRS 13.

Background: Obstetric triage is a screening platform for evaluation of maternal and fetal conditions primarily. However, in many settings, it used to manage pregnancy complications as well as emergent obstetric conditions Aim: This study aimed to investigate the effect of implementing simulation obstetric triage training on nurses' knowledge and practices. Design: A quasi-experimental pre/ post-test design (one group) was used to conduct this study. Setting: The present study was conducted at labor and delivery emergency unit in the Mansoura University Hospital, General Hospital and Health Insurance Hospital, Mansoura, Egypt. Sample: A convenient sample of seventy nurses who worked at pervious mentioned setting from first of July to the end of October 2019. Tools: Data were collected through three tools I: Self-Administered Structured Schedule to assess general characteristics of the nurses and nurses’ knowledge regarding obstetric triage. II: Observational check list to observe nurses’ practices during implementation of obstetric triage. III: Nurses’ satisfaction with the simulation obstetric triage training Results: There were improvement in the obstetric nurses’ knowledge regarding obstetric triage from (14.3%) pre implementation of the simulation training to(81.4%) post implementation. Also, there were improvement in the obstetric nurses’ practices regarding obstetric triage from (2.9 %) pre-implementation to (91.4%) post-implementation with highly statistically significant differences. Conclusion: The study hypotheses were accepted. There were highly statistically significant improvement in the nurses’ knowledge and practices scores post implementation of the simulation obstetric triage training than before. Indicating that obstetric simulation training was an effective tool for improving obstetric nurses’ knowledge and practices regarding obstetric triage. Recommendation: Periodical conducting of training programs regarding obstetric triage for obstetric nurses in labor and delivery emergency unit.

Background: Firms recently rely on enterprise systems, such as enterprise resource planning (ERP), to integrate, automate, and support business strategy and operations. However, uncertain environments require firms continuously adapt their ERP systems to meet changing business demands in the post-implementation stage. What capability can drive ERP post-implementation adaptation (PIA) deserves further research. Based on the dynamic capabilities view, we propose that dynamic IT capabilities for ERP, namely IT sensing, IT learning, IT integration, and IT coordination capability, can drive ERP-PIA. Method: A cross-sectional and matched-pair mail survey of both business and IS executives was administrated for collecting data from the top 1,000 manufacturing firms in Taiwan. Partial least squares structural equation model (PLS-SEM) was constructed for measurement validation and hypotheses testing. Results: Based on 128 samples (74 firms), our findings demonstrate the importance of the dynamic IT capabilities for achieving higher levels of ERP-PIA. ERP-PIA can facilitate greater organizational benefits from system use. Conclusions: This study conceptualizes and empirically demonstrates the importance of ERP-PIA, which provides a specific example of IT/IS adaptation. This study also conceptualizes dynamic IT capabilities for ERP, and theorizes how these capabilities interact to enable firms to adapt ERP systems to fulfill the emergent demands. This study improvs the understanding of the roles of dynamic IT capabilities for ERP in enabling ERP-PIA and organizational benefits through a richer theoretical framing than that of prior studies.

Over the past decade, the majority of states in the United States have enacted laws that include legal protection and/or rehabilitative services for juvenile victims of human trafficking. This mixe...

Background Medication is frequently thrown away after a patient’s discharge from hospital, with undesirable economic and environmental consequences. Because of the rising costs of healthcare, interventions to reduce medication wastage (and associated costs) are warranted. Using Patient’s Own Medication during hospitalisation might decrease medication wastage and associated costs. Objective To study the economic impact of patient’s own medication use on medication waste and hospital staff’s time spent during hospitalisation. Setting In seven Dutch hospitals, of which university, teaching, general, and specialised hospitals, eight different hospital wards, surgical and medical, were selected. Method In this prospective pre-post intervention study data on the economic value of medication waste and time spent by healthcare professionals were collected for a 2 months period each. The economic value of medication waste was defined as the value (€) of wasted medication per 100 patient days. For each ward, time spent on medication process activities was measured 10 times per staff member. The average time spent (in hours) on medication process steps (multiple activities) per staff member per 100 patients and associated salary costs were calculated for both periods. Main outcome measure The primary outcome of the study was the total economic value (€) of wasted medication per 100 patient days. Results Implementation of Patient’s Own Medication decreased the economic value of wasted medication by 39.5% from €3983 to €2411 per 100 patient days. The mean time spent on the total medication process was reduced with 5.2 h per 100 patients (from 112.7 to 104.4 h per 100 patients). We observed a shift in professional activities, as physicians and nurses spent less time on the medication process, whereas pharmacy technicians had a greater role in it. When time spent was expressed as salary; €1219 could be saved per 100 patients. Conclusions This study showed that ‘Patient’s Own Medication' implementation may have a positive economic impact, as the value of medication waste decreases, hospital staff devoted less time on the medication process, and staff deployment is more efficient.

Background Patients discharged from ED should be provided with verbal and written discharge advice (1, 2). Patients leaving ED were invited to complete the Friends and Family test (FFT) designed to assess patients’ experiences. Feedback collated from FFT at Pilgrim Hospital demonstrates that patients did not receive discharge information and did not know who to approach for further advice. Aims I designed this QIP to address patient-centred care by increasing the distribution of PILs by 10% at Pilgrim Hospital by March 2021. This was done through the creation of a desktop repository; the intervention will enable clinicians to print the relevant PIL for patients at discharge. The increased use of PILs leads to an improvement in patient centred care (3). Methods I formed an MDT: the ED Clinical Lead was the project champion. I utilised driver diagrams and model for improvement methodology (PDSA cycle) (4). The CQC urgent and emergency care questionnaire was circulated to patients by clinicians to measure the distribution of PILs, pre- and post-intervention (5). A desktop repository was created and made available on all ED computers. I regularly reminded clinicians at huddles the need to distribute PILs within the department. Results The distribution of PILs increased from 8% prior to implementation (Oct 2020) to 54% post implementation (March 2021) – an overall change of 46%. Conclusion There has been a change of 46% in the distribution of PILs in ED, which is a successful QIP. Changes have been made in the department to reinforce the importance of PILs. There is still room for improvement in subsequent cycles of this project, this will be achieved through democratic leadership and further use of information technology.

Background Enhanced Recovery After Surgery (ERAS) is a multidisciplinary perioperative care program to optimize and enhance postoperative recovery. It has a beneficial role in decreasing the length of hospital stay and improving the quality of care. This study aims to observe the successful implementation of ERAS in reducing the length of hospital stay (LOS) among caesarean deliveries. Methods A pre-and post-implementation study of ERAS protocol was conducted, among cohort of women who underwent caesarean deliveries from January to December 2020 in the Department of Obstetrics and Gynaecology, Mongar Regional Referral hospital. Data collected retrospectively and analyzed in SPSS (IBM SPSS trial version); and comparison of length of hospital stay between the two groups were tested by t-test. Results One hundred seventy-one patients were included in the study: 87 in the pre-ERAS and 84 in the post-ERAS cohort. Post implementation, LOS decreased by an average of 21.0 (CI 16.11–24.64; p-value p-value Conclusion Implementation of ERAS protocol can significantly decrease the postoperative length of hospital stay without increasing the complications and readmission rates.