Application of Lean Six Sigma techniques to optimize hospital laboratory Emergency Department Turnaround time across a multi-hospital system

In January 2005, Indiana University, Purdue University at Indianapolis (IUPUI) and Purdue- Calumet were invited to partner with the Alverno Clinical Labs in adapting Lean Six Sigma methodologies for use within healthcare. Our initial project focused on optimization of lab services for the emergency department at the Saint Margaret Mercy Hospitals in Hammond, IN. This project resulted in reduction of lab test report time to the emergency department from 75 minutes to less than 35 minutes. These results have been sustained from the initial implementation to present – over 14 months. Additionally, this project has been successfully implemented across two additional hospitals lab within the Alverno-Provena Clinical Labs system. This paper will describe the partnership between IUPUI faculty and Alverno Clinical Labs in application of Lean Six Sigma techniques to optimize hospital lab services for the emergency department. Additionally, this paper will discuss the strategies and methodologies used to sustain initial results following the initial implementation and the key characteristics of successful project migration to additional hospital labs

A PDA-based dietary self-monitoring intervention to reduce sodium intake in an in-center hemodialysis patient

Objective: The purpose of the BalanceWise-hemodialysis study is to determine the efficacy of a dietary intervention to reduce dietary sodium intake in patients receiving maintenance, in-center hemodialysis (HD). Personal digital assistant (PDA)-based dietary self-monitoring is paired with behavioral counseling. The purpose of this report is to present a case study of one participant's progression through the intervention. Methods: The PDA was individually programmed with the nutritional requirements of the participant. With 25 minutes of personalized instruction, the participant was able to enter his meals into the PDA using BalanceLog® software. Nutritional counseling was provided based on dietary sodium intake reports generated by BalanceLog®. Results: At initiation of the study the participant required 4 HD treatments per week. The participant entered 342 meals over 16 weeks (≥3 meals per day). BalanceLog® revealed that the participant consumed restaurant/fast food on a regular basis, and consumed significant amounts of corned beef as well as canned foods high in sodium. The study dietitian worked with the participant and his wife to identify food alternatives lower in sodium. Baseline sodium consumption was 4,692 mg, and decreased at a rate of 192 mg/week on average. After 11 weeks of intervention, interdialytic weight gains were reduced sufficiently to permit the participant to reduce HD treatments from 4 to 3 per week. Because of a low serum albumin at baseline (2.9 g/dL) the study dietitian encouraged the participant to increase his intake of high quality protein. Serum albumin level at 16 weeks was unchanged (2.9 g/dL). Because of intense pruritis and a high baseline serum phosphorus (6.5 mg/dL) BalanceLog® electronic logs were reviewed to identify sources of dietary phosphorus and counsel the participant regarding food alternatives. At 16 weeks the participant's serum phosphorus fell to 5.5 mg/dL. Conclusions: Self-monitoring rates were excellent. In a HD patient who was willing to self-monitor his dietary intake, BalanceLog® allowed the dietitian to target problematic foods and provide counseling that appeared to be effective in reducing sodium intake, reducing interdialytic weight gain, and alleviating hyperphosphatemia and hyperkalemia. Additional research is needed to evaluate the efficacy of the intervention. © 2008 Sevick et al, publisher and licensee Dove Medical Press Ltd

Expensive Egos: Narcissistic Males Have Higher Cortisol

Background: Narcissism is characterized by grandiosity, low empathy, and entitlement. There has been limited research regarding the hormonal correlates of narcissism, despite the potential health implications. This study examined the role of participant narcissism and sex on basal cortisol concentrations in an undergraduate population. Methods and Findings: Participants were 106 undergraduate students (79 females, 27 males, mean age 20.1 years) from one Midwestern and one Southwestern American university. Narcissism was assessed using the Narcissistic Personality Inventory, and basal cortisol concentrations were collected from saliva samples in a laboratory setting. Regression analyses examined the effect of narcissism and sex on cortisol (log). There were no sex differences in basal cortisol, F(1,97) =.20, p =.65, and narcissism scores, F(1,97) =.00, p =.99. Stepwise linear regression models of sex and narcissism and their interaction predicting cortisol concentrations showed no main effects when including covariates, but a significant interaction, b =.27, p =.04. Narcissism was not related to cortisol in females, but significantly predicted cortisol in males. Examining the effect of unhealthy versus healthy narcissism on cortisol found that unhealthy narcissism was marginally related to cortisol in females, b =.27, p =.06, but significantly predicted higher basal cortisol in males, b =.72, p =.01, even when controlling for potential confounds. No relationship was found between sex, narcissism, or their interaction on selfreported stress

Creating Charisma Online: The Role of Digital Presence in the Formation of Religious Identity

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Contemporary Religion on Publication Date 23-4-19, available online: https://doi.org/10.1080/13537903.2019.1585104This article investigates the construction and transmission of charisma through online channels, and its role in the formation of religious identities. Mindful of Max Weber’s observation that charisma inhabits the relationship between a leader and their followers, I argue for a critical reappraisal of the theoretical model in light of the ubiquity in the 21st century of new, virtual forms of social encounter. I focus my analysis on the Christian creationist movement in the USA, and particularly on an influential leader called Ken Ham. Using digital ethnographic methods, I show how Ham constructs charisma online, and how a virtual community forms itself around his charismatic claims. I illustrate how this virtual community intersects with offline worlds, and suggest that the theme park attractions that Ham’s organisation runs (Creation Museum, Ark Encounter) are imbued with deflected charisma by virtue of their association with his online avatar

Justice-To-Be-Done, Telling-Stories, Before-The-Birth-Of-The-Plot

This major paper is divided into three sections, which represent three approaches to one constellation of ideas: settlement services for refugees, narrative, and ethics. They are also three dimensions of one project: the preservation of the alterity of the other. Section One is a more formal academic essay outlining what the thinking of Emmanuel Levinas has to offer this project vis-à-vis settlement services in general. It does so by contrasting his ethics with the two main ethics that presently shape and inform settlement services in Toronto: Christianity and Marxism. Using Levinas' formulation of the 'height and humility' of the other as a motif, the discussion identifies how both these currents of thought over-narrativize and so collapse the alterity of refugees. It analyses how the ethical relation shows itself in stark relief in a hosting dynamic, and describes the uncanny position of the host/hostage which any member of the settlement community is in by virtue of her or his job. Asymmetry of the relation, proximity and incarnation, and politics and responsibility are central themes in a consideration of how behaviour toward refugees might differ starting from this new ethical orientation. Section Two is a discursive meditation on the use of arts practices with refugees, focusing on the notion of storytelling. Thinking around trauma, narrative, testimony, witnessing, autobiography and self-representation is explored and analysed. Here again, taking the preservation of radical alterity as the central project, Levinasian ethics are privileged in a discussion of Saying and the Said, the present/ce of the Same in synchronic time versus the diachronic time of the other, and language itself. The pivotal ideas see Levinas in dialogue with Jacques Derrida (in particular his analysis of hospitality) and Roger Simon. Psychotherapy and nature poetry also make appearances in this consideration of the intersubjective ethical relation. Section Three, performed in a prose/poetic voice, is an enactment of the type of 'de-narrativization' that the other two papers ultimately call for. Out of active commitment to the notion of embodiment, it is my own story of why I am devoted to refugee issues (why I am triggered to feel compassion and responsibility toward whom and what I do; the story of my own exile, my own home, my hauntedness and dispossession)

Healthcare Quality Partnerships: An Emerging Educational Frontier for Industrial Engineering Technology Programs

Wtih the understanding that the industrial engineering profession has grown out of industrial/manufacturing oganizations, it is important to note that the profession has gradually matured to the point where it is readily being accepted in service industries, such as hospitals, retail stores and banking. Today, this means that industrial engineers are among the most versatile of the engineering professions, spanning various degrees of functions within various types of organizations. Therefore, educational institutions that offer Industrial Egnieering (IE) and Industrial Engineering Technology (IET) curriculum must also offer a versatile curriculum that will allow their graduates to gain experience in various areas other than traditional manufactuinrg, thereby allowing them greater opportunity to enter into these non-traditional areas. This paper will focus on strategies that have been used at Purdue University regional campuses to develop successful on-going partnerhips between their IE and IET faculty and one of the larger service industries: healthcare and hospitals. The partnerships that have been developing over the last few years have provided various engagement opportunities for faculty and students alike. This paper will discuss topics such as funding of faculty involovement in hospital projects, the integration of students into on-going efforts, as well as adaptation of curriculum and further collaborative efforts that are being developed with medical/nursing programs within the various university campuses involved in this program

Physical Symptom Cluster Subgroups in Chronic Kidney Disease.

BackgroundSymptom burden associated with chronic kidney disease can be debilitating, with a negative effect on patient health-related quality of life. Latent class clustering analysis is an innovative tool for classifying patient symptom experience.ObjectivesThe aim of the study was to identify subgroups of patients at greatest risk for high symptom burden, which may facilitate development of patient-centered symptom management interventions.MethodsIn this cross-sectional analysis, baseline data were analyzed from 3,921 adults enrolled in the Chronic Renal Insufficiency Cohort Study from 2003 to 2008. Latent class cluster modeling using 11 items on the Kidney Disease Quality of Life symptom profile was employed to identify patient subgroups based on similar observed physical symptom response patterns. Multinomial logistic regression models were estimated with demographic variables, lifestyle and clinical variables, and self-reported measures (Kidney Disease Quality of Life physical and mental component summaries and the Beck Depression Inventory).ResultsThree symptom-based subgroups were identified, differing in severity (low symptom, moderate symptom, and high symptom). After adjusting for other variables in multinomial logistic regression, membership in the high-symptom subgroup was less likely for non-Hispanic Blacks and men. Other factors associated with membership in the high-symptom subgroup included lower estimated glomerular filtration rate, history of cardiac/cardiovascular disease, higher Beck Depression Inventory scores, and lower Kidney Disease Quality of Life physical and mental component summaries.DiscussionThree symptom subgroups of patients were identified among patients with mild-to-moderate chronic kidney disease. Several demographic and clinical variables predicted membership in subgroups. Further research is needed to determine if symptom subgroups are stable over time and can be used to predict healthcare utilization and clinical outcomes

Delayed radiotherapy for breast cancer patients in integrated delivery systems

OBJECTIVE: To identify factors associated with delayed radiotherapy (RT) in older women with early-stage breast cancer. METHODS: We studied 541 women age \u3eor=65 years diagnosed with early-stage breast cancer in 1990-1994 at 5 integrated healthcare delivery systems and treated with breast-conserving surgery and RT, but not chemotherapy. We examined whether demographic, tumor, or treatment characteristics were associated with RT delays of \u3e8 weeks postsurgery using chi(2) tests and multivariable logistic regression. RESULTS: Seventy-six women (14%) had delayed RT, with a median delay of 14 weeks. Even though they had insurance and access to care, nonwhite and Hispanic women were much more likely than white women to have delayed RT (odds ratio = 3.3; 95% confidence interval = 1.7, 10) in multivariable analyses that controlled for demographic and clinical variables. CONCLUSIONS: Timely RT should be facilitated through physician and patient education, navigation, and notification programs to improve quality of care. Queues for RT appointments should be evaluated on an ongoing basis to ensure adequate access. Future research should examine modifiable barriers to RT timeliness and whether delays impact long-term outcomes