Healthcare system intervention for prevention of birth injuries : process evaluation of self-assessment, peer review, feedback and agreement for change

Background: Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Methods: Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. Results: The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Conclusions: Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement

ISL1-based LIM complexes control Slit2 transcription in developing cranial motor neurons

LIM-homeodomain (HD) transcription factors form a multimeric complex and assign neuronal subtype identities, as demonstrated by the hexameric ISL1-LHX3 complex which gives rise to somatic motor (SM) neurons. However, the roles of combinatorial LIM code in motor neuron diversification and their subsequent differentiation is much less well understood. In the present study, we demonstrate that the ISL1 controls postmitotic cranial branchiomotor (BM) neurons including the positioning of the cell bodies and peripheral axon pathfinding. Unlike SM neurons, which transform into interneurons, BM neurons are normal in number and in marker expression in Isl1 mutant mice. Nevertheless, the movement of trigeminal and facial BM somata is stalled, and their peripheral axons are fewer or misrouted, with ectopic branches. Among genes whose expression level changes in previous ChIP-seq and microarray analyses in Isl1-deficient cell lines, we found that Slit2 transcript was almost absent from BM neurons of Isl1 mutants. Both ISL1-LHX3 and ISL1-LHX4 bound to the Slit2 enhancer and drove endogenous Slit2 expression in SM and BM neurons. Our findings suggest that combinations of ISL1 and LHX factors establish cell-type specificity and functional diversity in terms of motor neuron identities and/or axon development

A Systematic Review on Micronutrient Intake Adequacy in Adult Minority Populations Residing in Europe: The Need for Action

This systematic review evaluated micronutrient intake inadequacy of ten micronutrients for adult ethnic minority populations residing in Europe. Pubmed was searched for studies, related references were checked and experts consulted. Ten studies were identified and six were included in the final analysis representing Albanian, Roma, Sub-Saharan African, South Asian and African-Caribbean minority groups. The Estimated Average Requirement cut point was applied to estimate inadequate intake. With the exception of a sub-Saharan African study, of seven micronutrients analysed, inadequate intakes were markedly elevated ( gt 50 % of the population in most cases) in both genders for folate, vitamin B-12, calcium and iron (the latter in females only). A pressing need exists for intake adequacy studies with sound methodologies addressing ethnic minority groups in Europe. These populations constitute a vulnerable population for inadequate intakes and results substantiate the need for further investigation, interventions and policy measures to reduce their nutritional risk

PENGEMBANGAN MODEL PEMBELAJARAN PROBLEM BASED INSTRUCTION (PBI) PADA MATERI PENCEMARAN LINGKUNGAN UNTUK MENINGKATKAN PEMAHAMAN KONSEP SERTA SIKAP PEDULI DAN TINDAKAN TERHADAP LINGKUNGAN DI MADRASAH ALIYAH NEGERI DARUSSALAM KABUPATEN ACEH BESAR

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