Sustainability in Quality Improvement and Patient Safety Initiatives

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term \u27evaporation of improvements\u27 addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & Ketley, 2007). This article addresses the components of what makes a quality initiative sustainable by applying a framework developed that identifies components necessary within a sustainable quality initiative evident from the development process through to the implementation phase of the initiative which becomes part of the fabric of an organization

Commentary on Child Welfare Workers’ Perceptions of the Influence of the Organizational Environment on Permanency Decisions for Families

Invited commentary on Child Welfare Workers’ Perceptions of the Influence of the Organizational Environment on Permanency Decisions for Families

Prevention of neurological injuries during mandibular third molar surgery: technical notes

Surgery to the mandibular third molar is common, and injuries to the inferior alveolar nerve and the lingual nerve are well-recognized complications of this procedure. The aim of these technical notes is to describe operative measures for reducing neurological complications during mandibular third molar surgery. The following procedure should be used to prevent damage to the inferior alveolar nerve: a well-designed mucoperiosteal flap, to obtain appropriate access to the surgical area; a conservative ostectomy on the distal and distal-lingual side; tooth sectioning, to facilitate its removal by decreasing the retention zones; tooth dislocation in the path of withdrawal imposed by the curvature of the root apex; and careful socket debridement, when the roots of the extracted tooth are in intimate contact with the mandibular canal. To prevent injury to the lingual nerve, it is important (I) to assess the integrity of the mandibular inner cortex and exclude the presence of fenestration, which could cause the dislocation of the tooth or its fragment into the sublingual or submandibular space; (II) to avoid inappropriate or excessive dislocation proceedings, in order to prevent lingual cortex fracture; (III) to perform horizontal mesial-distal crown sectioning of the lingually inclined tooth; (IV) to protect the lingual flap with a retractor showing the cortical ridge; and (V) to pass the suture not too apically and from the inner side in a buccal-lingual direction in the retromolar are

Ocean Cooling Pattern at the Last Glacial Maximum

Ocean temperature and ocean heat content change are analyzed based on four PMIP3 model results at the Last Glacial Maximum relative to the prehistorical run. Ocean cooling mostly occurs in the upper 1000 m depth and varies spatially in the tropical and temperate zones. The Atlantic Ocean experiences greater cooling than the rest of the ocean basins. Ocean cooling is closely related to the weakening of meridional overturning circulation and enhanced intrusion of Antarctic Bottom Water into the North Atlantic

Rola pielęgniarki w poprawie jakości i bezpieczeństwie pacjenta

The role of nurses as health professionals var-greatly throughout the world. What is constant for all nurses is that the nursing profession is expected and committed to serve society and provide high quality and safe health care to all recipients of health care. To that end, safety and quality initiatives are underway across the globe to achieve the best health care outcomes possible based on the implementation of scientific evidence and best evidence-based clinical practices available. The purpose of this paper is to explain how safety and quality improvement (QI) initiatives achieve high quality outcomes for patients and how an understanding of the relationships among research, evidence-based practice, and QI and the role of the professional nurse in QI helps nursing meet its commitment to achieve the best possible care and outcomes for patients. The Model for Improvement is provided as a scientific methodology for QI initiatives in health care. Nurses understand the processes of care including what works well and what does not, and they have the clinical experience and scientific knowledge needed to improving processes of care that lead to more effective patient outcomes. (JNNN 2019;8(1):30–36)Znaczenie pielęgniarek, jako fachowych pracowników służby zdrowia, jest zróżnicowane w zależności od regionu na świecie. Jednak stałą i niezmienną cechą charakterystyczną dla tego zawodu jest oddana służba społeczeństwu i zapewnienie wysokiej jakości opieki zdrowotnej i bezpieczeństwa wszystkim chorym. W tym celu na całym świecie podejmowane są inicjatywy związane z bezpieczeństwem i jakością, aby osiągnąć najlepsze możliwe wyniki opieki zdrowotnej w oparciu o dowody naukowe i najlepsze dostępne praktyki kliniczne oparte na dowodach. Celem tego artykułu jest wyjaśnienie, w jaki sposób inicjatywy poprawy bezpieczeństwa i jakości (QI) wpływają na poprawę jakości opieki nad pacjentem oraz jak zależności między badaniami naukowymi, praktyką kliniczną opartą na dowodach oraz rolą pielęgniarki w QI wpływają na realizację zadań pielęgniarki w celu osiągnięcia jak najlepszej opieki i wyników dla pacjentów. Ten model poprawy stanowi metodologię naukową dla inicjatyw QI w opiece zdrowotnej. Pielęgniarki doskonale znają wady i zalety mechanizmów funkcjonujących w opiece zdrowotnej i potrafią doskonale wykorzystywać doświadczenie kliniczne i zdobytą wiedzę naukową w celu poprawy świadczonych usług mających na celu poprawę jakości opieki nad pacjentem. (PNN 2019;8(1):30–36

How Do Software Startups Pivot? Empirical Results from a Multiple Case Study

In order to handle intense time pressure and survive in dynamic market, software startups have to make crucial decisions constantly on whether to change directions or stay on chosen courses, or in the terms of Lean Startup, to pivot or to persevere. The existing research and knowledge on software startup pivots are very limited. In this study, we focused on understanding the pivoting processes of software startups, and identified the triggering factors and pivot types. To achieve this, we employed a multiple case study approach, and analyzed the data obtained from four software startups. The initial findings show that different software startups make different types of pivots related to business and technology during their product development life cycle. The pivots are triggered by various factors including negative customer feedback.Comment: Conference publication, International Conference on Software Business (ICSOB'16), Sloveni

Complement system network in cell physiology and in human diseases

The complement system is a multi-functional system representing the first line host defense against pathogens in innate immune response, through three different pathways. Impairment of its function, consisting in deficiency or excessive deregulated activation, may lead to severe systemic infections or autoimmune disorders. These diseases may be inherited or acquired. Despite many diagnostic tools are currently available, ranging from traditional, such as hemolytic or ELISA based assays, to innovative ones, like next generation sequencing techniques, these diseases are often not recognized. As for therapeutic aspects, strategies based on the use of targeted drugs are now widespread. The aim of this review is to present an updated overview of complement system pathophysiology, clinical implications of its dysfunction and to summarize diagnostic and therapeutic approaches

Scalar field as a perfect fluid: thermodynamics of minimally coupled scalars and Einstein frame scalar-tensor gravity

We revisit the analogy between a minimally coupled scalar field in general relativity and a perfect fluid, correcting previous identifications of effective temperature and chemical potential. This provides a useful complementary picture for the first-order thermodynamics of scalar-tensor gravity, paving the way for the Einstein frame formulation (which eluded previous attempts) and raises interesting questions to further develop the analogy

Holographic Technidilaton and LHC searches

We analyze in detail the phenomenology of a model of dynamical electroweak symmetry breaking inspired by walking technicolor, by using the techniques of the bottom-up approach to holography. The model admits a light composite scalar state, the dilaton, in the spectrum. We focus on regions of parameter space for which the mass of such dilaton is 125 GeV, and for which the bounds on the precision electroweak parameter S are satisfied. This requires that the next-to-lightest composite state is the techni-rho meson, with a mass larger than 2.3 TeV. We compute the couplings controlling the decay rates of the dilaton to two photons and to two (real or virtual) Z and W bosons. For generic choices of the parameters, we find a suppression of the decay into heavy gauge bosons, in respect to the analog decay of the standard-model Higgs. We find a dramatic effect on the decay into photons, which can be both strongly suppressed or strongly enhanced, the latter case corresponding to the large-N regime of the dual theory. There is a correlation between this decay rate of the dilaton into photons and the mass splitting between the techni-rho meson and its axial-vector partner: if the decay is enhanced in respect to the standard-model case, then the heavy spin-1 resonances are nearly degenerate in mass, otherwise their separation in mass is comparable to the mass scale itself.Comment: Very minor typos corrected. References adde