Transforming care through bedside leader rounding: Use of handheld technology leads to improvement in perceived patient satisfaction

When consistently executed, leader rounding has the ability to capture actionable information ensuring delivery of safe and effective patient care, identifying excellence among staff, and bringing opportunities for improvement. Our team set out to create an effective, standardized approach to targeted, daily, technology-driven leader rounding with the goal of integrating real-time patient feedback into the care experience. An application on handheld computer tablets was tailored and integrated with the hospital’s admission, discharge, and transfer (ADT) feed, allowing for streamlining of the rounding process by creation of workflow templates. Additionally, capabilities to receive and send alerts across disciplines were integrated in order to respond to patient concerns in real-time. Patients who perceived they were rounded on had 3.53 greater odds of reporting top box scores for Overall Rating of Care compared to patients who perceived they were not rounded on (p\u3c0.001). Patients with documentation that rounding occurred, who also self-reported that rounding occurred, were at 3.43 greater odds of providing a top-box score than patients with documentation that rounding occurred but who did not perceive they were rounded on (p\u3c0.001). Efforts to round and to ensure patients know they are being rounded on may lead to improved patient experience

The evolution and integration of a patient-centric mapping tool (patient journey value mapping) in continuous quality improvement

The need to improve a healthcare system that too frequently fails to deliver benefits of care, even resulting in harm to patients, has been well established. The resulting era of quality improvement has aimed to improve the delivery of care by increasing quality while reducing cost. One approach to improving how healthcare is delivered is the application of Lean management strategies. Despite widespread investment in Lean approaches to improve healthcare delivery, evidence supports a deficiency of this approach to improve patient satisfaction with care. Identifiable operational tension between quality improvement efforts designed to streamline care processes and those targeting improvement of the patient care experience existed. We set out to address this deficiency by embedding the patient experience into improvement efforts through the introduction of a patient-centric value stream mapping approach

Effect of Exposure of Human Monocyte-Derived Macrophages to High, versus Normal, Glucose on Subsequent Lipid Accumulation from Glycated and Acetylated Low-Density Lipoproteins

During atherosclerosis monocyte-derived macrophages accumulate cholesteryl esters from low-density lipoproteins (LDLs) via lectin-like oxidised LDL receptor-1 (LOX-1) and class AI and AII (SR-AI, SR-AII) and class B (SR-BI, CD36) scavenger receptors. Here we examined the hypothesis that hyperglycaemia may modulate receptor expression and hence lipid accumulation in macrophages. Human monocytes were matured into macrophages in 30 versus 5 mM glucose and receptor expression and lipid accumulation quantified. High glucose elevated LOX1 mRNA, but decreased SR-AI, SR-BI, LDLR, and CD36 mRNA. SR-BI and CD36 protein levels were decreased. Normo- and hyperglycaemic cells accumulated cholesteryl esters from modified LDL to a greater extent than control LDL, but total and individual cholesteryl ester accumulation was not affected by glucose levels. It is concluded that, whilst macrophage scavenger receptor mRNA and protein levels can be modulated by high glucose, these are not key factors in lipid accumulation by human macrophages under the conditions examined

Towards a transformative understanding of the ocean’s biological pump: Priorities for future research - Report on the NSF Biology of the Biological Pump Workshop

NSF Biology of the Biological Pump Workshop, February 19–20, 2016 (Hyatt Place New Orleans, New Orleans, LA)The net transfer of organic matter from the surface to the deep ocean is a key function of ocean food webs. The combination of biological, physical, and chemical processes that contribute to and control this export is collectively known as the “biological pump”, and current estimates of the global magnitude of this export range from 5 – 12 Pg C yr-1. This material can be exported in dissolved or particulate form, and many of the biological processes that regulate the composition, quantity, timing, and distribution of this export are poorly understood or constrained. Export of organic material is of fundamental importance to the biological and chemical functioning of the ocean, supporting deep ocean food webs and controlling the vertical and horizontal segregation of elements throughout the ocean. Remineralization of exported organic matter in the upper mesopelagic zone provides nutrients for surface production, while material exported to depths of 1000 m or more is generally considered to be sequestered — i.e. out of contact with the atmosphere for centuries or longer. The ability to accurately model a system is a reflection of the degree to which the system is understood. In the case of export, semi-empirical and simple mechanistic models show a wide range of predictive skill. This is, in part, due to the sparseness of available data, which impedes our inability to accurately represent, or even include, all relevant processes (sometimes for legitimate computational reasons). Predictions will remain uncertain without improved understanding and parameterization of key biological processes affecting export.Funding for this workshop was provided by the National Science Foundation (NSF). Coordination and logistical support for this workshop was provided by the Ocean Carbon and Biogeochemistry (OCB) Program (www.us-ocb.org

Review: The Journal of Dramaturgy, volume 20, 2009/2010

Contents include: Recognizing Toward a Dramaturgical Sensibility, Geoff Proehl, recipient of the 2009 ATHE Outstanding Book Award; Geoff Proehl\u27s Acceptance Speech, Association for Theatre in Higher Education Awards Ceremony August 10, 2009; Millennial Dramaturgy, A conversation about the new book Dramaturgy and Performance; Creating Sub/Text, Dramaturging the ReStaged Festival; Dramaturgy and Interdisciplinary Learning, A Case Study of Russian Theatre and Politics; Thinking about Theatre Photography; Theatre / Photography. Issue editors: D.J. Hopkins, Sydney Cheek O\u27Donnell, Lauren Beckhttps://soundideas.pugetsound.edu/lmdareview/1040/thumbnail.jp

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

Background: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro-and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. Methods: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. Discussion: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Canadian Institutes of Health Research (CIHR) , The PI is an endowed research chair with the Schlegel-University of Waterloo Research Institute for Aging; half of her salary is provided by this non-profit organizatio