For sustainable healthcare systems: focus on robustness rather than optimization

peer reviewedThe concept of performance has gradually taken hold in healthcare policy. Presented as necessary and positive, it is often reduced to efficiency, translating into policies and management methods aimed at optimization. While these practices would guarantee our healthcare systems' sustainability, they have made them fragile. As prominent professional actors, nurses, as sociopolitical leaders, must think about new concepts to fix this situation. The life sciences can help us understand why optimization fragilizes our healthcare systems. Biologists have observed that living beings do not prioritize optimization but robustness. To cope with fluctuations, a robust organism operates with redundancy and inconsistency, variation and incompleteness, apparent waste, and a penchant for slowness, delay, and heterogeneity. It functions sub-optimally. We propose a theoretical reflection and food for thought about nursing administration for more robust healthcare systems and organizations.3. Good health and well-being10. Reduced inequalitie

Le modèle de partenariat humaniste en santé: pour cheminer ensemble avec le patient et ses proches tout au long de sa vie

Le Modèle de Partenariat Humaniste en Santé (MPHS) est un modèle conceptuel de soins infirmiers codéveloppé par des théoriciens-chercheurs, des professionnels de terrain et des patients. Il met l’accent sur des concepts considérés par eux comme clés pour répondre aux enjeux actuels en santé. Ses coauteurs espèrent ainsi contribuer à l’exercice d’un leadership transformationnel des professionnels infirmiers en renforçant leur capacité d’influence en vue de répondre aux défis actuels des systèmes de soins de santé. Il s’inscrit dans le courant humaniste-caring. Dans le MPHS, le but du service infirmier est de renforcer le pouvoir d’être et d’agir du patient en contribuant à lui apporter ce qui fait défaut pour lui permettre de réaliser son projet de vie ou de l’actualiser de la façon la plus satisfaisante. Formant un ensemble de concepts interreliés, le MPHS présente certaines caractéristiques originales par rapport à d’autres modèles conceptuels de soins infirmiers, caractéristiques que les participants pourront découvrir. Le MPHS est un modèle conceptuel de soins infirmiers complet et explicite, dans la mesure où il définit les éléments suivants : 1/ les postulats et les valeurs du modèle ancrés dans la discipline ; 2/ le but du service infirmier ; 3/ le rôle de l’infirmière professionnelle ; 4/ la façon de considérer le bénéficiaire du service ; 5/ la source des difficultés que peut rencontrer le bénéficiaire ; 6/ la façon dont sont menées les interventions infirmières ; 7/ et les effets recherchés. Le MPHS propose également une définition des concepts centraux de la discipline et une démarche de soins infirmiers spécifiques.3. Good health and well-bein

Study on Alumina-silica-phosphate Compound as Problem Water Treatment: Case Study of Soil Water (Bekasi and Karawang)

Naturally, zeolite is a cation exchanger but this property is also depending on porosity, tetrahedral density and frame density. Cation exchange effectiveness can be changed by structure, Si/Al ratio and effective pore size. Tetrahedral group, T, in zeolite is negative charged and can be substituted isomorphycally by other group like PO2+. The new structure can be functioned as anion or cation exchanger. The exchange capacity of both ions depends on Si/Al/P ratio from the substitution process. The alumina-silica-phosphate (ASP) compound has been made from zeolite from Cikalong, Tasikmalaya, with ammonium dihydrogen phosphate (ADHP) with substitution rate between 30-40%. This product has been tested to Pantura groundwater, in Bekasi and Karawang areas, which have groundwater type of NaCl, CaCl2, MgSO4 and CaCl2/CaSO4. ASP tests on ground water samples show decreasing content of Ca, Mg, Na and K cations in ground water by 32.94%, 3.35%, 2.52% and 23.60% respectively. Sulphate anion also decreases by 15.39% but chloride anion shows no changes. Dig-up well of CaCl2 type also shows a reduction of Ca, Mg, Na and sulphate contents by 46.26%, 18.37%, 16.39% and 10.84%, respectively. Dig-up well of CaSO4 type shows Ca, K and sulphate contents decrease of 89.71%, 33.31% and 5.26%, respectively. CaSO4 dig-up well can be changed to Mg-mix type after processing by ASP compound. Cation exchange capacity of ASP compound to Ca is higher than to K, Mg and Na (Ca>K>Mg>Na). Due to a high cation exchange capacity to K and Mg, ASP compound may be used to reduce the hard water level

Obstacles and levers related to implementing and sustaining innovative pedagogical teachings to meet the needs of primary care and support workers and patients. Descriptive qualitative research

editorial reviewe

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

La spiritualité laïque :un concept aidant pour le professionnel de santé confronté à une demande d’euthanasie: Ensemble vers un Humanisme professionnel

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Introduction au concept de « qualité des soins »: Cours GEST-L4110 - Evaluation de la performance des institutions de soins. Activité d'apprentissage :La performance envisagée sous l'angle de la qualité

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Pourquoi le concept d'hôpital magnétique ne se diffuse-t-il pas dans les hôpitaux en Belgique ?Une question à élucider

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