Continuous quality improvement in a Maltese hospital using logical framework analysis

P03-14 - A quasi-experimental controlled intervention to reduce violence on an acute psychiatric ward

Swamp buffalo in South Kalimantan is a potential commodity in terms of providing meat because its ability to digest crude fiber is better than cattle with low quality feed conditions, and has the ability to reproduce over a wide range from wet areas to relatively dry areas. The study was conducted in the North Hulu Sungai regency of South Kalimantan with the aim of studying the potential of swamp buffalo maintenance areas, assessing the constraints and impacts of swamp buffalo development efforts, determining the logic of the relationship between the problem of swamp buffalo development, compiling a Logical Framework Approach for problem solving (solution) the development of swamp buffalo, making the right strategy for the development of swamp buffaloes that involve the participation of farmers, the private sector, banks, local governments, and higher education institutions on an ongoing basis. Research design with descriptive and participatory methods with LQ analysis techniques, analysis of regional potential, and Logical Framework Analysis (LFA). The results show that swamp agroecological zones are very beneficial for swamp buffalo cultivation, the strategic role of meat producers, labor, sources of income, advocates of sources of animal protein, sources of seeds, tourist attraction, and development of local wisdom. Comparing between the LQ value of 2.327 and the value of livestock density, the HSU District is the base for developing swamp buffalo cattle. The strategy model of swamp buffalo development in HSU District is to increase the use of appropriate technology, promotion through typical Kal-Sel swamp buffalo tourism events, improve: the role of skilled communities, the role of extension agents and the government, increase capital and cooperative relations between business actors, locations cultivation close to transportation routes, regulating land use, and improving institutional performance

This paper explores the issues connected between rural sustainable development in formerly state-socialist countries and the local cultural heritage of rural areas. It pays specific attention to the potential of cultural tourism which can enhance local rural development. This paper is a case study of the Hărman commune, and this area is investigated in depth. It is one of the most important rural and cultural areas located in Brașov County of Romania, a country with an impressive cultural heritage concentrated in its rural areas. The study uses a mixed-method analysis combining quantitative and qualitative research (focus groups, interviews, oral histories, and personal conversions), participatory ethnographic observation, and logical framework analysis (LFA). The main findings of the study illustrate that the Hărman commune has an important cultural heritage which could be more capitalized on in the future through the lens of cultural tourism to ensure local sustainability and to open up new perspectives in terms of local development, connecting rural and cultural tourism with other economic activities. Furthermore, the main findings of this study represent, beyond an informative platform for the local actors in rural development, an inspiring instrument that could frame new policies in local rural sustainable development and fertile backgrounds for new debates in local rural sustainability, enriching local agendas on rural sustainable development through cultural heritage capitalization and cultural tourism.

This article reports on research carried out on changes in the operational management of a broad sample of British NGOs. Despite the diversity of NGOs it finds surprising convergence towards the application of certain managerial concepts and tools. Three of these ‐ Strategic Planning, Logical Framework Analysis and Evaluation are considered in detail and the questions of why they are being used and for what purpose posed. The evidence is overwhelmingly that they have been adopted to meet Northern needs ‐ to satisfy the demands of Northern funding institutions and to help NGO headquarters control growing organisations. Faced with this evidence the article looks critically at the claims that such NGO practice can be consistent with development theories which are based on greater empowerment of Southern ‘partners’ and is obliged to repeat arguments, previously thought to be widely accepted, that the use and understanding of such tools are culturally mediated and far from neutral.

In response to growing global concerns over feed scarcity, rising production costs, and coastal degradation, this study explores the transformative potential of Sargassum fluitans within a circular economy framework. The research assessed the sustainability of using this nutrient-rich yet environmentally problematic seaweed as an alternative animal feed ingredient for chickens, fish, pigs, and rabbits in Lagos State, Nigeria. Despite its abundance, Sargassum remains underutilized due to the absence of effective Monitoring and Evaluation (M&E) frameworks that ensure project efficiency, economic feasibility, and long-term sustainability. Guided by Implementation Theory and Theory of Change, this study employed a mixed-methods approach. A 12-week randomized controlled trial was conducted to evaluate the nutritional performance, growth metrics, and survival rates of animals fed Sargassum-based diets. Feed safety was ensured through Hazard Analysis and Critical Control Points (HACCP), while Linear Programming Optimization (LPO) developed cost-effective feed formulations. Quantitative data were analyzed using ANOVA and t-tests; qualitative insights were supported by stakeholder engagement and Logical Framework Analysis (LFA). Findings revealed that Sargassum-based feed is nutritionally comparable to conventional feeds and significantly reduced feeding costs by 55.5%. It enhanced animal growth, improved food security, generated green jobs, and contributed to coastal restoration by reducing Sargassum waste buildup. By closing material loops and repurposing marine biomass, the study offers a replicable model for integrating marine resources into sustainable agriculture. The result-based M&E framework ensured accountability, informed decision-making, and scalability, aligning the project with SDGs 2 (Zero Hunger), 8 (Decent Work and Economic Growth), 12 (Responsible Consumption and Production), 13 (Climate Action), and 14 (Life Below Water). This research repositions Sargassum from an ecological burden to a blue economy asset, offering a novel, data-driven, and locally adaptable solution for sustainable livestock production in sub-Saharan Africa.

Problem The Seventh-day Adventist Church in Kenya has the highest membership in the East Central African Division (ECD) with an average of one pastor for 1,136 members. Not only is the membership high and increasing, but each pastor has an average of seven churches (as of 2013) (General Conference of Seventh-day Adventists, 2003-2013). The majority of the membership is comprised of youth (13-17 years) and young adults (18-30 years). Even though youth and young adults comprise the majority of the membership, there is minimal level of active participation and low commitments from them in the life of the church, especially in biblical preaching. The majority of youth and young adults find the area of preaching irrelevant, biblically unfaithful, or culturally inappropriate to them. Also, there is the scarce availability of pastors, a lack of resources to employ more pastors, and the increasing number of members who have left the task of preaching and nurturing congregations through sound contextualized biblical preaching to untrained lay preachers. The youth and young adults need to be actively involved in the life of the church, they need to be taught and hear the gospel in a way that is relevant to them in their own context through contextualized biblical preaching by equipped and trained preachers. There is therefore a need for a program and training manual to remedy this situation. Method A program will be developed using the Logical Framework Analysis and Gantt chart, which enables the researcher to communicate a project’s objectives vividly and simply. After securing the support of church leaders and the help of local pastors, a pilot team of young adult lay preachers will be selected. The criteria for selecting the pilot team will be based on church attendance, commitment to church activities, public speaking skills, vocation, language spoken, age, literacy, and ethnocentric sensitivity. The young adult lay preachers will be trained and equipped on how to preach relevant contextualized biblical sermons and will conduct three weeks of evangelistic campaigns in ten churches. Training will be done in four areas that are critical in effective preaching: the message, the members (audience), the method, and the messenger. Project Purpose The purpose of the project is to develop and implement a contextualized biblical preaching program for young adult lay preachers in Kenya. Project Expectations After a successful implementation of the program, it is expected that at least 50% of youth and young adults

Community-Based Tourism (CBT) is increasingly recognized as an effective strategy for sustainable rural tourism development. However, business planning in rural destinations often lacks local engagement, integration of digital innovation, and robust evaluation frameworks. This study presents the development and implementation of a participatory, digitally integrated business plan for Wae Lolos Village, West Manggarai. Using a mixed-methods approach field observation, semi structured interviews with key local actors, and participatory workshops this research maps local potentials, develops strategic business units, and formulates risk mitigation measures contextualized to the village’s social, economic, and environmental dynamics. Integration of digitalization manifests through an ongoing village website initiative, combining online marketing, digital reservations, safety information, and MSME e-marketplace within a single platform. The business plan operationalizes key frameworks such as the Business Model Canvas, PESTEL analysis, SMART indicators, and Logical Framework Analysis, ensuring the plan is both strategic and measurable. Results show: (1) enhanced digital marketing and community engagement, (2) diversified local income streams via the activation of eight business units, and (3) improved risk governance for sustainable economic resilience. This model offers practical and replicable lessons for rural destinations seeking to balance community empowerment, digital transformation, and sustainable business management.

<span><em>The purpose of this study was to analyze institutional capacity the </em><span><em>PEW Group Members, and analyzing institutional performance, and formulate </em><span><em>strategies and institutional capacity building programs in the PEW Group of </em><span><em>local economic development in the city of Yogyakarta. The method used in this </em><span><em>study is a qualitative method. Data collection techniques used are: observation</em><span><em>, documentation studies, in-depth interviews, and questionnaires. Assessment </em><span><em>strategies in the analysis of this problem using the Logical Framework Analysis </em><span><em>. Repayment rates in Sub Pringgokusuman PEW group 76% (25 groups) are </em><span><em>classified as current, 12% classified as substandard, and there are 4 groups (</em><span><em>12%) were classified as jammed. Judging from the direction of development of </em><span><em>the group based on the performance aspects of the organization, administration, </em><span><em>financing, production and rooting business. There are 18 (54.55%) groups were </em><span><em>included in the growth category, and 15 (45.45%) group included in the category </em><span><em>of development, while the group in the category are not independent. Formulation </em><span><em>of institutional capacity strengthening program group includes: 1) Improvement </em><span><em>Skills Productive Economic Business Members, 2) Strengthening Institutions </em><span><em>Norm, 3) Administrative Arrangement group, and 4) Increased Capital to expand </em><span><em>cooperative network.</em></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br /></span>

The authors describe a program to reduce the use of full-leather restraints on an acute adult inpatient psychiatric ward of a large community mental health center. It included the introduction of a multipurpose pipe-frame bed, which can be used for seclusion only or seclusion with restraints. Use of the bed, coupled with a seclusion-first policy and rapid tranquilization programs, reduced the time the patients spent in full-leather restraints from 360 hours in the month before the program was introduced to 30 hours two months later.

AimHand-disinfection (HD) is the most effective infection-prevention-measure. HD-performance of health care professionals (HCP) is usually evaluated by compliance observations (CO). The Hawthorne effect (HE) (HCP behave differently under observation) is considered to systematically increase HD-compliance-rates during CO. However, little is known about the specifications of the HE in health care settings. We hypothesized that, due to hand-hygiene`s known impact on patient safety and infection-prevention, the HE does not affect HD performance during direct patient care in patient-rooms.MethodWe conducted a prospective observational trial on an 18-bed surgical intensive care unit (ICU), a 12-bed surgical intermediate care unit (IMC) and a 36-bed surgical normal ward (NW) in a university hospital in Germany. Dispensers of hand sanitizers were equipped with an electronic monitoring system (EMS) (GWA Hygiene, Germany), which recorded the number of HDs per patient hour (HD/PH) and time and location of hand-disinfections. Locations were categorized as follows: 1. Patient rooms (PR); 2. Utility- and waste-disposal-rooms (UWR) and 3. Other rooms (hallways, kitchen, toilets etc.) (OR). Additionally trained infection-control-staff performed hand-hygiene CO according to WHO's Five Moments. The HD/PH during CO was compared to the HD/PH during the same time-periods without CO. Additionally the ratio between HD/PD-change during CO and mean-HD/PD of each ward during the study-period was determined in percentages. Descriptive and analytical statistics were calculated using R. P-values ≤ 0.05 were regarded as significant.Results587.128 HD were electronically recorded during the study-period (February 2022 to May 2023) and CO took place on 72 days. We recorded a significant increase of HD/PH during CO on all three wards in PRs (ICU: 21%, p<0.001; IMC: 11%, p=0.029; NW: 49%, p=0.047). Furthermore we detected a significant increase of HD/PH during CO on ICU (10%, p<0.001) and IMC (11%, p=0.033) in ORs. CO did not significantly affect HD/PH in ORs on NW and in UWR on all three wards.ConclusionsIn our setting, the number of hand-disinfections per patient-hour was significantly increased during compliance-observations especially in patient-rooms, where hand-hygiene is most crucial for infection-prevention. This indicates a lower everyday compliance to WHO`s hand-hygiene indications during patient care than determined by compliance-observations.AcknowledgmentsPaul-Hartmann AG financially supported this study.

Background It is understood that older persons undergoing surgery benefit from Comprehensive Geriatric Assessment (CGA), however these services remain limited in Ireland. Latest guidelines recommend all patients over 65 undergoing surgery should be screened for frailty and receive a CGA if frailty is identified. Our pilot service was to implement this on our acute surgical in-patient ward. Methods Baseline data was gathered prior to implementation of our service. Interventions included education, dedicated sessions for geriatrician input on ward, single point of referral and increased signage. Patients identified as living with frailty (Rockwood Clinical Frailty Score (CFS) ≥5) then received CGA. Progress monitored with monthly audit and foundation doctor feedback surveys over a 6-month period. Results We have increased the percentage of patients over 65 being screened for frailty from 0% to a peak of 100% over our pilot 6-month period. Foundation doctor surveys showed an improvement in confidence in screening for frailty (19 to 100%) and managing frailty (13 to 80%). They also reported feeling more supported managing these patients (38% to 100%). Focusing on patients with CFS ≥5, we have shown a reduction in length of stay from a mean of 20 days to 11 days, albeit numbers remain small. Conclusion By increasing identification of frailty in older patients, we have managed to apply CGA to appropriate patients. Geriatrician input on the surgical ward has also allowed foundation doctors to feel supported and improve confidence in managing patients living with frailty. Furthermore, we have shown a trend towards reduced length of stay. However, our patient numbers remain low and there is a reliance on our team to screen all patients over 65. Our focus moving forward is for the surgical team to screen for frailty allowing us to expand the service to other surgical wards.

Objective. To analyze antimicrobial susceptibility of representatives of the genus Streptococcus in different wards of a multidisciplinary hospital. Materials and Methods. Epidemiological observational descriptive continuous retrospective survey was conducted. Antimicrobial susceptibility data on 2916 streptococcal isolates obtained from the laboratory information system «ALISA» were analyzed for the period from 01.01.2017 to 31.12.2022. Antimicrobial susceptibility testing was performed using BD Phoenix M50, interpretation of susceptibility testing results was done in accordance with EUCAST recommendations. Statistical analysis was performed using Microsoft Excel 2010 and IBM SPSS Statistics22. Results. The following species of the genus Streptococcus were predominantly isolated: in the surgical infections ward – S. pyogenes (28.5%), S. agalactiae (22.0%), S. anginosus (16.5%); in the coloproctology ward – S. anginosus (41.7%), S. constellatus (16.0%), S. agalactiae (14.5%); in the surgical ward – S. anginosus (40.1%), S. constellatus (31.4%); in the intensive care ward – S. anginosus (21.8%), S. constellatus (11.3%), S. oralis (11.1%); in the gynecology ward – S. agalactiae (49.9%) and S. anginosus (31.3%). Significant proportion of S. agalactiae isolates were resistant to tetracycline and clindamycin in all wards. There was an increase in S. agalactiae resistance to erythromycin from 15.4% in 2019 to 38.3% in 2021 in the surgical infections ward, and from 16.7% to 38.5% – in the coloproctology ward. In addition, resistance to clindamycin increased from 24.2% in 2018 to 71.3% in 2020 to in surgical infections ward, from 13.6% to 70.7% in coloproctology ward, and from 20.0% to 90.3% in gynecology ward. In the intensive care unit, S. agalactiae and S. pyogenes were most frequently resistant to tetracycline (79.5% and 51.3%), erythromycin (32.8% and 31.7%) and trimethoprim-sulfamethoxazole (18.5% and 26.8%, respectively). S. pneumoniae showed the highest level of resistance to erythromycin (35.3%), clindamycin (29.3%) and trimethoprim-sulfamethoxazole (26,0%). Conclusions. In recent years, an increase in antimicrobial resistance has been identified in the most common streptococci. The antibiotic susceptibility of streptococci of the same species was found to be variable in different hospital wards. There was a tendency noted for increase in the occurrence of multiresistant strains of S. pyogenes and S. agalactiae in the intensive care and surgical infections ward.

Background:Reports on the determinants of morbidity in coronary artery bypass graft surgery (CABG) have focused on outcome measures such as length of postoperative stay in the Intensive Care Unit (ICU). We proposed that major comorbidities in the ICU hampered the prognostic effect of other weaker but important preventable risk factors with effect on patients’ length of hospitalization. So we aimed at evaluating postoperative length of stay in the ICU and surgical ward separately.Methods:We studied isolated CABG candidates who were not dialysis dependent. Preoperative, operative, and postoperative variables as well as all classic risk factors of coronary artery disease were recorded. Using multivariate analysis, we determined the independent predictors of length of stay in the ICU and in the surgical ward.Results:Independent predictors of extended length of stay in the surgical ward ( > 3 days) were a history of peripheral vascular disease, total administered insulin during a 24-hour period after surgery, glycosylated hemoglobin (HbA1c), last fasting blood sugar of the patients before surgery, and inotropic usage after cardiopulmonary bypass. The area under the Receiver Operating Characteristic Curve (AUC) was found to be 0.71 and Hosmer-Lemeshow (HL) goodness of fit statistic p value was 0.88. Independent predictors of extended length of stay in the ICU ( > 48 hours) were surgeon category, New York Heart Association functional class, intra-aortic balloon pump, postoperative arrhythmias, total administered insulin during a 24-hour period after surgery, and mean base excess of the first 6 postoperative hours (AUC = 0.70, HL p value = 0.94).Conclusion:This study revealed that the indices of glycemic control were the most important predictors of length of stay in the ward after cardiac surgery in all patients, diabetic or non-diabetic. However, because HbA1c level did not change under the influence of perioperative events, it could be deemed a valuable measure in predicting outcome in CABG candidates.

Inappropriate use of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU) as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6%) had IUCs used appropriately while 42 of them (20.6%) were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%), 16 (19.0%) and 14 patients (24.6%), respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2%) and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

Mental health nurses play a key role in maintaining the safety of patients, themselves, and others during hospitalization. The aim of the research was to evaluate the safety measures that are taken by mental health nurses to identify the security policies that exist in acute mental health wards. The Ward Safety and Security Rules Survey was used as a method of data collection. Descriptive analysis and content analysis were carried out in order to identify nurses' practices. The total sample consisted of 172 mental health nurses and nurses' assistants who worked in 14 acute inpatient psychiatric wards in three psychiatric hospitals in the greater area of Athens, Greece. The results show a minimum number of security features existing in the wards. Only one of the 14 wards had an intercom system. In only nine wards, there was a panic alarm in the office, and in eight, an emergency response telephone extension. A wide range of practices were noted concerning banned items and patient searches upon admission and return from leave. The results indicate the significant lack of protocols and specific safety rules to guide nurses' actions across psychiatric acute admission wards in Athens.