Analysis of the impact of deploying thermal protective immersion suits on evacuation time for passenger ships operating in polar waters

For passenger vessels operating in polar waters, the Polar Code requires that in case of possibility of immersion in polar waters, thermal protective immersion suits (TPIS) should be available for all passengers. Thus, international standards require that TPIS can be donned within 2 min and that walking speeds are reduced by no more than 25%. Clearlythese requirements are arbitrary and do not reflect their potential impact on evacuation performance. Other IMO requirements specify the maximum time permitted for assembly and abandonment times for passenger ships, which can be assessed using agent-based evacuation modelling (ABEM). However, these requirements currently ignore the impact of TPIS and employ a safety factor of 25% to represent all factors ignored when modelling evacuation. Here we explore the impact of TPIS on both the assembly and abandonment times of a hypothetical vessel using ABEM. The results demonstrate that requiring the donning of a TPIS can increase assembly times by as much as 65% and negatively impacts the abandonment process. It is thus essential that additional requirements associated with evacuation of vessels in polar waters are reflected within the IMO passenger ship evacuation certification guidelines. The paper suggests several ways in which this can be achieved

A methodology for collecting donning times of thermal protective immersion suits intended to be worn by passengers on vessels operating in cold environments

Adequate thermal protection for passengers travelling on-board vessels in cold climate regions, such as that provided by thermal protective immersion suits (TPIS), enhances passenger survivability in emergency situations, in particular those requiring the abandonment of the vessel. As emergency abandonment is a time critical process, it is essential to consider the time required to correctly don the TPIS. Testing standards, such as the International Maritime Organization guidelines, require that TPIS must be able to be donned within 2 minutes. Unfortunately, current practices quantifying donning times are questionable and so there is a limited evidence base that reliably quantifies donning times required by typical passengers. This paper presents a test procedure designed to reliably quantify the time required by test subjects to don the TPIS. Furthermore, the procedure assesses the donning correctness – a TPIS that is incorrectly donned is unlikely to offer appropriate thermal protection. The paper will also discuss the deficiencies in current practices to assess required donning time

The MERG Suite: Tools for discovering competencies and associated learning resources

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Migratory monarchs that encounter resident monarchs show life‐history differences and higher rates of parasite infection

Environmental change induces some wildlife populations to shift from migratory to resident behaviours. Newly formed resident populations could influence the health and behaviour of remaining migrants. We investigated migrant–resident interactions among monarch butterflies and consequences for life history and parasitism. Eastern North American monarchs migrate annually to Mexico, but some now breed year‐round on exotic milkweed in the southern US and experience high infection prevalence of protozoan parasites. Using stable isotopes (δ2H, δ13C) and cardenolide profiles to estimate natal origins, we show that migrant and resident monarchs overlap during fall and spring migration. Migrants at sites with residents were 13 times more likely to have infections and three times more likely to be reproductive (outside normal breeding season) compared to other migrants. Exotic milkweed might either attract migrants that are already infected or reproductive, or alternatively, induce these states. Increased migrant–resident interactions could affect monarch parasitism, migratory success and long‐term conservation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146381/1/ele13144_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146381/2/ele13144.pd

Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Background: despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods: a Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results: questionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions: this was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services

A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol

although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients

Identifying quality improvement intervention publications - A comparison of electronic search strategies

Abstract Background The evidence base for quality improvement (QI) interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications. Methods We evaluated search strategies developed for MEDLINE (Ovid) and PubMed based on free text words, Medical subject headings (MeSH), QI intervention components, continuous quality improvement (CQI) methods, and combinations of the strategies. Three sets of pertinent QI intervention publications were used for validation. Two independent expert reviewers screened publications for relevance. We compared the yield, recall rate, and precision of the search strategies for the identification of QI publications and for a subset of empirical studies on effects of QI interventions. Results The search yields ranged from 2,221 to 216,167 publications. Mean recall rates for reference publications ranged from 5% to 53% for strategies with yields of 50,000 publications or fewer. The 'best case' strategy, a simple text word search with high face validity ('quality' AND 'improv*' AND 'intervention*') identified 44%, 24%, and 62% of influential intervention articles selected by Agency for Healthcare Research and Quality (AHRQ) experts, a set of exemplar articles provided by members of the Standards for Quality Improvement Reporting Excellence (SQUIRE) group, and a sample from the Cochrane Effective Practice and Organization of Care Group (EPOC) register of studies, respectively. We applied the search strategy to a PubMed search for articles published in 10 pertinent journals in a three-year period which retrieved 183 publications. Among these, 67% were deemed relevant to QI by at least one of two independent raters. Forty percent were classified as empirical studies reporting on a QI intervention. Conclusions The presented search terms and operating characteristics can be used to guide the identification of QI intervention publications. Even with extensive iterative development, we achieved only moderate recall rates of reference publications. Consensus development on QI reporting and initiatives to develop QI-relevant MeSH terms are urgently needed

The influence of contextual factors on healthcare quality improvement initiatives:what works, for whom and in what setting? Protocol for a realist review

Background  Context shapes the effectiveness of knowledge implementation and influences health improvement. Successful healthcare quality improvement (QI) initiatives frequently fail to transfer to different settings, with local contextual factors often cited as the cause. Understanding and overcoming contextual barriers is therefore crucial to implementing effective improvement; yet context is still poorly understood. There is a paucity of information on the mechanisms underlyinghowandwhyQI projects succeed or fail in given settings. A realist review of empirical studies of healthcare QI initiatives will be undertaken to examine the influence and impact of contextual factors on quality improvement in healthcare settings and explore whether QI initiatives can work in all contexts.  Methods  The review will explore which contextual factors are important, and how, why, when and for whom they are important, within varied settings. The dynamic nature of context and change over time will be explored by examining which aspects of context impact at key points in the improvement trajectory. The review will also consider the influence of context on improvement outcomes (provider- and patient-level), spread and sustainability. The review process will follow five iterative steps: (1) clarify scope, (2) search for evidence, (3) appraise primary studies and extract data, (4) synthesise evidence and draw conclusions and (5) disseminate findings. The reviewers will consult with experts and stakeholders in the early stages to focus the review and develop a programme theory consisting of explanatory ‘context–mechanism–outcome’ configurations. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. A review advisory group will oversee the review process. Review findings will follow RAMESES guidelines and will be disseminated via a report, presentations and peer-reviewed publications.  Discussion  The review will update and consolidate evidence on the contextual conditions for effective improvement and distil new knowledge to inform the design and development of context-sensitive QI initiatives. This review ties in with the study of improvement programmes as vehicles of change and the development of an evidence base around healthcare improvement by addressing whether QI initiatives can work in all contexts.  Systematic review registration  PROSPERO CRD4201706213

Faculty verbal evaluations reveal strategies used to promote medical student performance

Background: Preceptors rarely follow medical students’ developing clinical performance over time and across disciplines. This study analyzes preceptors’ descriptions of longitudinal integrated clerkship (LIC) students’ clinical development and their identification of strategies to guide students’ progress. Methods: We used a common evaluation framework, reporter-interpreter-manager-educator, to guide multidisciplinary LIC preceptors’ discussions of students’ progress. We conducted thematic analysis of transcripts from preceptors’ (seven longitudinal ambulatory preceptors per student) quarterly group discussions of 15 students’ performance over one year. Results: All students’ clinical development progressed, although most experienced obstacles. Lack of structure in the history and physical exam commonly obstructed progression. Preceptors used templates for data gathering, and modeling or experiences in the inpatient setting to provide time and solidify structure. To advance students’ knowledge acquisition, many preceptors identified focused learning topics with their students; to promote application of knowledge, preceptors used reasoning strategies to teach the steps involved in synthesizing clinical data. Preceptors shared accountability for helping students advance as the LIC allowed them to follow students’ response to teaching strategies. Discussion: These results depict preceptors’ perceptions of LIC students’ developmental continuum and illustrate how multidisciplinary preceptors can use a common evaluation framework to identify strategies to improve performance and follow students’ performance longitudinally