Promoting Patient Safety by Implementing Bedside Shift Report

ABSTRACT Patient safety is a very broad and general term used to ensure that all aspects of patient care, from medical and nursing services to social and spiritual, are provided with the best interest of the patient. The aim statement for the project is improving patient safety by ensuring the implementation of bedside shift report by 80% of nurses by August 2016. Kurt Lewin’s change theory is going to be used to effect the change. There were in-services given to nurses on the floor and the project was also discussed in staff meetings. Flyers were posted around the units to help build up and maintain enthusiasm for the implementation of BSR. Implementation was initiated behind schedule due to conflict in schedules and bureaucratic hoops. The implementation was started on April 28, 2016 and so there are no exact numbers at this time because there is a two week trial period. But I have had conversations with the some nurses that have started the project since initiation. So far they seem to be very receptive of the change. Most of the patients have been neutral at this time but we’ll see if that’s going to be the case in two weeks. There are numerous publications that support the efficacy of bedside shift report in relation to patient care and safety. Publications from the Agency for healthcare research & quality (AHRQ), MEDSURG Nursing, American nurse today, Journal of Clinical Nursing and the Nursing journal are some of the articles that were used to investigate and develop ideas and policies for the project. Patient experience with the bedside shift report (BSR) will be tracked and the data collected will be used to improve the process in order to enhance the patient experience. Patient experience would include if the patient felt more engaged in their care, if they felt safer and had more confidence in the personnel helping out with the care. Also nurse satisfaction is another benchmark that would be measured by sending out surveys periodically in an effort to gauge the opinions of the staff members. The data collected from the surveys will be used to develop improvements to the process and increase the comfort level of the nurses in giving BSR. We would also track if the nurses feel more accountable for the care they delivered during the shift and if the accountability translates to nurses being more responsible in the care that they deliver. Periodic collection of data will be used to monitor patient satisfaction and nursing compliance. The data would be monitored by the appointed BSR champions because they would be able to monitor and collect data on compliance of the floor nurses in real time and compare it with data collected from patient satisfaction surveys. There are going to be bi-weekly meetings to analyze and improve the process by applying PDSA cycle. Analysis of the data can also help to recognize fallouts earlier and provide opportunity to make corrections. In conclusion, sustainability is what is important. One of the ways I recommend to ensure continuity of the project by making sure that the new employees, regardless of experience, are trained during their eight to twelve week floor orientation. After conducting a failure mode effect analysis coupled with experience, I concluded that continuity is also dependent on proper training of new employees. I concluded this because nursing is a high turnover profession and if the current nurses don\u27t teach the new nurses before they leave the facility then the whole process will have to be restarted

Burden of rabies in India: the need for a reliable reassessment

Published literature addressing the issue of burden of rabies in India is scarce. Even the estimates of burden of rabies that are available from various studies differ considerably among themselves and as new data pour in, the earlier available figures are becoming further questionable. It has been almost a decade that a nationwide community based study was done to directly assess the burden of rabies in India. The figures reported by this study is still the most quoted one in published literature. Since this nationwide study has been conducted, there may have been considerable changes in the human and canine demographics as well as the other determinants of rabies at the community level. Policy makers find it difficult to move ahead in planning for rabies control, in the absence of any reliable and evidence based data. The time has come to redesign and redevelop a scientifically robust study design and undertake a nationwide survey to find out the burden of rabies in India

GLOBALIZATION AND INDUSTRIAL RELATIONS SYSTEM IN NIGERIA

Globalization has a major impact on the management of human resources in developing countries including Nigeria. With accelerating globalization, organizations have had to change and new trends have set in even in the industrial relations system and the management of human resources. The fundamental issue addressed in this paper is the extent to which Nigeria has restructured her industrial and trade systems for effective industrialisation within the on-going trade globalisation process. Globalization can therefore be said to have had a phenomenal impact on a developing economy like Kenya that is both positive and negative as explored in the paper

GLOBALIZATION AND INDUSTRIAL RELATIONS SYSTEM IN NIGERIA

Abstract: Globalization has a major impact on the management of human resources in developing countries including Nigeria. With accelerating globalization organizations have had to change and new trends have set in even in the industrial relations system and the management of. .human .resources . . The fundamental .. issue . addressed. .in . this . .paper . .is .. the extent to which Nigeria has restructured her industrial and trade systems for effective industrialisation within the on-going trade globalisation process. Globalization can therefore be said to have had a phenomenal impact on a developing economy like Kenya that is both positive and negative as explored in the paper

Deriving optimal operational policies for off-stream man-made reservoir considering conjunctive use of surface- and groundwater at the Bar dam reservoir (Iran)

Study region: The off-stream artificial Bar lake, built in 2015 to store the flood flows of the Bar river for domestic and industrial needs and with the objective to intentionally recharge the aquifer, is situated in the Razavi Khorasan province (Iran). Study focus: We present a methodology, based on the combination of a MODFLOW groundwater flow model for estimating seepage rates, and an optimization model, for the management and operation of an artificial reservoir considering surface/groundwater interactions for satisfying 12 Mm3/year of water demand. We simulated the reliable amount of water that can be supplied from the reservoir, considering reservoir seepage, maximizing water supply yields subject to the water supply reliability requirements, and the additional intentional volume of groundwater recharge. New hydrological insights for the region: Our results demonstrate the reliability of conjunctive use of surface-and ground-water in water scarce areas by exploiting reservoir infrastructures with relevant leakage losses, also for creating additional aquifer storage. In such systems, man-induced changes of lake stages can significantly affect the volume of water that seeps through the lakebed. The aquifer, under managed aquifer recharge operations, may then provide the resource not satisfied by the reservoir release, fulfilling 100 % reliability of water supply. The conjunctive use of surface- and ground-water, by improving water security, may open new sustainability views for leaking reservoirs, even if they were not initially designed for increasing aquifer recharge, in many areas worldwide

Design, construction and investigation of an ammonia beam maser operated under conditions of strong oscillation

In this thesis, the principle, construction and operation of an ammonia beam maser oscillator of advanced design are described. The maser discussed is characterized by the production of an intense molecular beam with a nozzle-skimmer gas source combination. This system has permitted a particularly strong oscillation to be obtained which has led to the observation of several novel phenomena associated with non-linearities of the maser. These include strong oscillation pulsations on the four quadrupole satellite lines of the J=K=3 inversion transition of 14NHj. In addition, oscillation settling transients and various complex oscillation amplitude pulsation phenomena in both single and two-cavity maser systems are reported and discussed. Other characteristics are also described, including two- cavity maser operation with the second cavity either as a molecular beam polarization detector or as a spectrometer cavity. In the former case, cavity detuning phenomena are examined and in the latter, multiple population inversion is investigated. Furthermore, continuous oscillation with several inversion lines of 14NH3 including J=K=3; J=3, K=2 and J=K=2 are obtained without cryogenic pumping or time limit. Some of these results have already been published and reprints of the papers may be found at the end of the thesis

Soybean mosaic virus: A successful potyvirus with a wide distribution but restricted natural host range

Taxonomy. Soybean mosaic virus (SMV) is a species within the genus Potyvirus, family Potyviridae that includes almost a quarter of all known plant RNA viruses affecting agriculturally important plants. The Potyvirus genus is the largest of all genera of plant RNA viruses with 160 species. Particle. The filamentous particles of SMV, typical of potyviruses, are about 7,500 Å long and 120 Å in diameter with a central hole of about 15 Å in diameter. Coat protein residues are arranged in helice of about 34 Å pitch having slightly less than 9 subunits per turn. Genome. The SMV genome consists of a single-stranded positive-sense polyadenylated RNA of approximately 9.6 kb with a virus-encoded protein (VPg) linked at the 5\u27 terminus. The genomic RNA contains a single large open reading frame (ORF). The polypeptide produced from the large ORF is processed proteolytically by three viral-encoded proteinases to yield about 10 functional proteins. A small ORF, partially overlapping the P3 cistron, pipo, is encoded as a fusion protein in the N-terminus of P3 (P3N+PIPO). Biological properties. SMV’s host range is restricted mostly to two plant species of a single genus; Glycine max (cultivated soybean) and G. soja (wild soybean). SMV is transmitted by aphids non-persistently and by seeds. Variability of SMV is recognized by reactions on cultivars with dominant resistance (R) genes. Recessive resistance genes are not known. Geographical distribution and economic importance. As a consequence of its seed transmissibility, SMV is present in all soybean growing areas of the world. SMV infections can reduce significantly seed quantity and quality (e.g., mottled seed coats, reduced seed size and viability, and altered chemical composition). Control. The most effective means of managing losses from SMV are planting virus-free seeds and cultivars containing single or multiple R genes. Key attractions. The interactions of SMV with soybean genotypes containing different dominant R genes and understanding functional role(s) of SMV-encoded proteins in virulence, transmission and pathogenicity have been intensively investigated. The SMV-soybean pathosystem has become an excellent model for examining the genetics and genomics of uniquely complex gene-for-gene resistance model in a crop of worldwide importance

A Transcriptional Regulatory Network of \u3cem\u3eRsv3\u3c/em\u3e-Mediated Extreme Resistance against \u3cem\u3eSoybean Mosaic Virus\u3c/em\u3e

Resistance genes are an effective means for disease control in plants. They predominantly function by inducing a hypersensitive reaction, which results in localized cell death restricting pathogen spread. Some resistance genes elicit an atypical response, termed extreme resistance, where resistance is not associated with a hypersensitive reaction and its standard defense responses. Unlike hypersensitive reaction, the molecular regulatory mechanism(s) underlying extreme resistance is largely unexplored. One of the few known, naturally occurring, instances of extreme resistance is resistance derived from the soybean Rsv3 gene, which confers resistance against the most virulent Soybean mosaic virus strains. To discern the regulatory mechanism underlying Rsv3-mediated extreme resistance, we generated a gene regulatory network using transcriptomic data from time course comparisons of Soybean mosaic virus-G7-inoculated resistant (L29, Rsv3-genotype) and susceptible (Williams82, rsv3-genotype) soybean cultivars. Our results show Rsv3 begins mounting a defense by 6 hpi via a complex phytohormone network, where abscisic acid, cytokinin, jasmonic acid, and salicylic acid pathways are suppressed. We identified putative regulatory interactions between transcription factors and genes in phytohormone regulatory pathways, which is consistent with the demonstrated involvement of these pathways in Rsv3-mediated resistance. One such transcription factor identified as a putative transcriptional regulator was MYC2 encoded by Glyma.07G051500. Known as a master regulator of abscisic acid and jasmonic acid signaling, MYC2 specifically recognizes the G-box motif (“CACGTG”), which was significantly enriched in our data among differentially expressed genes implicated in abscisic acid- and jasmonic acid-related activities. This suggests an important role for Glyma.07G051500 in abscisic acid- and jasmonic acid-derived defense signaling in Rsv3. Resultantly, the findings from our network offer insights into genes and biological pathways underlying the molecular defense mechanism of Rsv3-mediated extreme resistance against Soybean mosaic virus. The computational pipeline used to reconstruct the gene regulatory network in this study is freely available at https://github.com/LiLabAtVT/rsv3-network