Prestatiemanagement

The politics and administration of institutional chang

Relational coordination in value-based health care

Background An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. Purpose The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. Approach A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). Results The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. Conclusions In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. Practice Implications Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.</p

Virtual reality training to improve complex skills – concerns and remarks:A Letter to the Editor

Background: There has been limited literature on immersive virtual reality (VR) simulation in orthopaedic education. The purpose of this multicenter, blinded, randomized controlled trial was to determine the validity and efficacy of immersive VR training in orthopaedic resident education.Methods: Nineteen senior orthopaedic residents (resident group) and 7 consultant shoulder arthroplasty surgeons (expert group) participated in the trial comparing immersive VR with traditional learning using a technical journal article as a control. The examined task focused on achieving optimal glenoid exposure. Participants completed demographic qu`estionnaires, knowledge tests, and a glenoid exposure on fresh-frozen cadavers while being examined by blinded shoulder arthroplasty surgeons. Training superiority was determined by the outcome measures of the Objective Structured Assessment of Technical Skills (OSATS) score, a developed laboratory metric, verbal answers, and time to task completion.Results: Immersive VR had greater realism and was superior in teaching glenoid exposure than the control (p = 0.01). The expert group outperformed the resident group on knowledge testing (p = 0.04). The immersive VR group completed the learning activity and knowledge tests significantly faster (p < 0.001) at a mean time (and standard deviation) of 11 +/- 3 minutes than the control group at 20 +/- 4 minutes, performing 3 to 5 VR repeats for a reduction in learning time of 570%. The immersive VR group completed the glenoid exposure significantly faster ( p = 0.04) at a mean time of 14 +/- 7 minutes than the control group at 21 +/- 6 minutes, with superior OSATS instrument handling scores (p = 0.03). The immersive VR group scored equivalently in surprise verbal scores (p = 0.85) and written knowledge scores (p = 1.0).Conclusions: Immersive VR demonstrated substantially improved translational technical and nontechnical skills acquisition over traditional learning in senior orthopaedic residents. Additionally, the results demonstrate the face, content, construct, and transfer validity for immersive VR

The implementation of value-based healthcare: a scoping review

Background: The aim of this study was to identify and summarize how value-based healthcare (VBHC) is conceptualized in the literature and implemented in hospitals. Furthermore, an overview was created of the effects of both the implementation of VBHC and the implementation strategies used.Methods: A scoping review was conducted by searching online databases for articles published between January 2006 and February 2021. Empirical as well as non-empirical articles were included.Results: 1729 publications were screened and 62 were used for data extraction. The majority of the articles did not specify a conceptualization of VBHC, but only conceptualized the goals of VBHC or the concept of value. Most hospitals implemented only one or two components of VBHC, mainly the measurement of outcomes and costs or Integrated Practice Units (IPUs). Few studies examined effects. Implementation strategies were described rarely, and were evaluated even less.Conclusions: VBHC has a high level of interpretative variability and a common conceptualization of VBHC is therefore urgently needed. VBHC was proposed as a shift in healthcare management entailing six reinforcing steps, but hospitals have not implemented VBHC as an integrative strategy. VBHC implementation and effectiveness could benefit from the interdisciplinary collaboration between healthcare and management science.The politics and administration of institutional chang

Plasma activation of N-2, CH4 and CO2: an assessment of the vibrational non-equilibrium time window

Vibrational excitation potentially enhances the energy efficiency of plasma dissociation of stable molecules and may open new routes for energy storage and process electrification. Electron, vibrational and rotational temperatures were measured by in situ Thomson and Raman scattering in order to assess the opportunities and limitations of the essential vibration-translation non-equilibria in N-2, CO2 and CH4 plasma. Electron temperatures of 1.1-2.8 eV were measured in N-2 and CH4. These are used to confirm predominant energy transfer to vibrations after an initial phase of significant electronic excitation and ionization. The vibrational temperatures initially exceed rotational temperatures by almost 8000 K in N-2, by 900 K in CO2, and by 300 K in CH4. Equilibration is observed at the 0.1 ms timescale. Based on the vibrational temperatures, the vibrational loss rates for different channels are estimated. In N-2, vibrational quenching via N atoms is identified as the dominant equilibration mechanism. Atomic nitrogen population reaches a mole fraction of more than 1%, as inferred from the afterglow emission decay, and explains a gas heating rate of 25 K mu s(-1). CH4 equilibration at 1200 K is predominantly caused by vibrational-translational relaxation in CH4-CH4 collisions. As for CO2, vibrational-translational relaxation via parent molecules is responsible for a large fraction of the observed heating, whereas product-mediated VT relaxation is not significantly contributing. It is suggested that electronic excitation, followed by dissociation or quenching contributes to the remaining heat generation. In conclusion, the time window to profit from vibrational excitation under the present conditions is limiting practical application.</p

Interaction of a tin-based capillary porous structure with ITER/DEMO relevant plasma conditions

Sn filled capillary porous structures were exposed to high flux low temperature plasma conditions at the Pilot-PSI linear device. Enhanced erosion above that expected classically was investigated via spectroscopic observation of Sn0 emission from the plasma in front of the target surface while the surface temperature was monitored by both thermography and pyrometry. An anomalous erosion flux was observed as temperature increases, with onset for this occurrence varying strongly between different ion species. The results appear incompatible with existing ‘adatom’ models for the anomalous erosion flux. Further targets were exposed in turn to increasing heat fluxes and the heat removed determined from cooling water calorimetry, which was then compared to a solid Mo reference target. At high powers the total energy of the cooling water is reduced, indicating a shielding of the surface from the plasma heat flux by the vapour cloud in front.</p

The importance of thermal dissociation in CO2 microwave discharges investigated by power pulsing and rotational Raman scattering

The input power of a CO2 microwave plasma is modulated at kHz rate in scans of duty cycle at constant average power to investigate gas heating dynamics and its relation to dissociation efficiency. Rotational temperature profiles obtained from rotational Raman scattering reveal peak temperatures of up to 3000 K, while the edge temperature remains cold (500 K). During the plasma \u27OFF\u27-period, the gas cools down convectively, but remains overall too hot to allow for strong overpopulation of vibrational modes (2200 K in the core). Fast optical imaging monitors plasma volume variations and shows that power density scales with peak power. As dissociation scales with observed peak rotational temperature, it is concluded that thermal processes dominate. A simple 0D model is constructed which explains how higher power density favors dissociation over radial energy transport. Thermal decomposition is reviewed in relation to quenching oxygen radicals with vibrationally excited CO2, to reflect on earlier reported record efficiencies of 90%.</p

Differing Professional Perspectives on the Interprofessional Collaboration in IPUs: A Mixed-methods Study

Introduction: An important aspect of Value-Based Healthcare (VBHC) is providing the full cycle of care for a specific medical condition through interprofessional collaboration. This requires employees from diverse professional backgrounds to interact, but there is limited knowledge on how professionals perceive such interprofessional collaboration. We aimed to provide insight into how different professionals perceive Integrated Practice Unit (IPU) composition and what factors influence the quality of interprofessional collaboration within IPUs. Methods: A survey was administered to employees from different professional backgrounds (medical specialists, nurses, allied health professionals, administrative employees) working in IPUs to assess their perception of the composition of their IPU and the quality of the interactions. Subsequently, semi-structured interviews were conducted to gain a deeper understanding of the findings of the survey. Results: Medical specialists and nurses were most frequently considered to be part of an IPU and indicated that they have high quality interactions. Allied health professionals were less often considered part of the team by all other professional groups and all report low quality interaction with this group. The extent to which a professional group is perceived as a team member depends on their visibility, involvement in the treatment of the patient, and shared interest. Differences in the quality of interprofessional collaboration are influenced by organizational structures, knowledge of each other’s expertise, and by ways of communication. Conclusions: In VBHC, there seems to be a lack of common perception of an IPU’s composition and a failure to always achieve high quality interprofessional collaboration. Given the importance of interprofessional collaboration in VBHC, effort should be invested in achieving a shared understanding and improved collaboration