411 research outputs found

    Decreasing Postpartum Hemorrhage within a Maternal Child Health Department

    Get PDF
    Abstract Problem: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide (Main et al., 2015). The national incidence of PPH is estimated at approximately 3% of all births (Marshall et al., 2018). A data analysis conducted in a maternal child health (MCH) department showed the total rate of PPH in 2019 was 10.8%. The incidence of PPH within this microsystem is significantly above the national average, indicating there is a substantial disparity in the care provided. Context: An analysis of the MCH department showed an eagerness for change concerning PPH. The MCH staff have voiced safety concerns and inquiries regarding the disproportionate number of PPHs within the microsystem. Providers are treating more obstetrical hemorrhage emergencies and managing longer lengths of stay for their patients. Financially, the budget has been affected. The SWOT analysis and ROI assessment proved this quality improvement project to be beneficial in closing the quality gap. Intervention: The project implemented the use of an evidence-based standardized debriefing tool to use after every PPH. The tool has been adapted from the California Maternal Quality Care Collaborative Postpartum Hemorrhage Toolkit. The debrief will include all members of the care team involved in the PPH. This debrief will be facilitated by the assistant nurse manager on shift during the hemorrhage. Once completed, the debrief tool will be collected by the PPH taskforce members and will be reviewed at every bi-monthly meeting. Measures: The process measures of the project include the ANM on unit facilitating the debrief will all members of the care team. Once completed, the debrief sheets are filed in a confidential box for the PPH Task Force members to collect and review. Balancing measures include inability of all members of the care team being present for the debrief leading to inaccurate debrief details; lack of time to complete debrief post critical event; and staffing issues leading to the absence of a debrief facilitator. Results: The test period began February 1, 2020, and finished April 30, 2020. The goal of 40% debrief rate was achieved two out of three months; however, the overall debrief percentage was 32% which falls below the aim percentage. Additionally, the PPH rate remained steady over the first two months of the test period and then increased during the final month. The average PPH rate during the test period was 9.4%. Conclusion: The benefits of utilizing the PPH debrief tool were attained. In review of each completed debrief form, systems issues and practice improvements were identified. The information provided has led to the discovery of trends allowing for early identification of patients who may hemorrhage. The debriefs have had a positive response from the staff and have showed improvement in team dynamics. The PPH taskforce will continue to utilize the PPH debrief tools to promote evidenced-based care practices and ensure that the MCH department provides the highest level of care to every patient it serves

    Characterization of Reverse Logistics Networks for Outsourcing Decisions

    Get PDF
    Strategic decisions about reverse logistics (RL) are complicated by the uncertainty of product returns. To aid firms in deciding whether to outsource RL activities, a characterization of RL networks according to two critical factors is proposed. These factors are the length of the product life cycle, which affects variability of expected returns over time, and the uncertainty of the rate of returns in each time period. Even if changes in the average return rate according to the life cycle are well understood, the variability in returns relative to the known average differs significantly depending on the product characteristics, as well as the length of each stage in its life cycle. Some of the most important RL networks in the U.S. market are classified in the proposed categories. Finally, as a first step in outsourcing decisions, several Third Party Reverse Logistics Providers that actually offer their services in some of the proposed categories are described

    Fabrication of Metal and Alloy Components by Additive Manufacturing: Examples of 3D Materials Science

    Get PDF
    ObjectiveThis paper provides a brief review of relatively new additive manufacturing technologies for the fabrication of unusual and complex metal and alloy products by laser and electron beam melting. A number of process features and product microstructures are illustrated utilizing 3D optical and transmission electron microscope image compositions representing examples of 3D materials science.MethodsProcessing methods involving electron beam melting (EBM) and a process referred to as direct metal laser sintering (DMLS), often called selective laser melting (SLM) are described along with the use of light (optical) microscopy (OM), transmission electron microscopy (TEM), and X-ray diffraction (XRD) to elucidate microstructural phenomena.ResultsExamples of EBM and SLM studies are presented in 3D image compositions. These include EBM of Ti-6Al-4V, Cu, Co-base superalloy and Inconel 625; and SLM of 17-4 PH stainless steel, Inconel 718 and Inconel 625.Conclusions3D image compositions constituting 3D materials science provide effective visualization for directional solidification-related phenomena associated with the EBM and SLM fabrication of a range of metals and alloys, especially microstructures and microstructural architectures

    Next Generation Orthopaedic Implants by Additive Manufacturing Using Electron Beam Melting

    Get PDF
    This paper presents some examples of knee and hip implant components containing porous structures and fabricated in monolithic forms utilizing electron beam melting (EBM). In addition, utilizing stiffness or relative stiffness versus relative density design plots for open-cellular structures (mesh and foam components) of Ti-6Al-4V and Co-29Cr-6Mo alloy fabricated by EBM, it is demonstrated that stiffness-compatible implants can be fabricated for optimal stress shielding for bone regimes as well as bone cell ingrowth. Implications for the fabrication of patient-specific, monolithic, multifunctional orthopaedic implants using EBM are described along with microstructures and mechanical properties characteristic of both Ti-6Al-4V and Co-29Cr-6Mo alloy prototypes, including both solid and open-cellular prototypes manufactured by additive manufacturing (AM) using EBM

    Effects of biomechanical forces on signaling in the cortical collecting duct (CCD)

    Get PDF
    An increase in tubular fluid flow rate (TFF) stimulates Na reabsorption and K secretion in the cortical collecting duct (CCD) and subjects cells therein to biomechanical forces including fluid shear stress (FSS) and circumferential stretch (CS). Intracellular MAPK and extracellular autocrine/paracrine PGE2 signaling regulate cation transport in the CCD and, at least in other systems, are affected by biomechanical forces. We hypothesized that FSS and CS differentially affect MAPK signaling and PGE2 release to modulate cation transport in the CCD. To validate that CS is a physiological force in vivo, we applied the intravital microscopic approach to rodent kidneys in vivo to show that saline or furosemide injection led to a 46.5 ± 2.0 or 170 ± 32% increase, respectively, in distal tubular diameter. Next, murine CCD (mpkCCD) cells were grown on glass or silicone coated with collagen type IV and subjected to 0 or 0.4 dyne/cm2 of FSS or 10% CS, respectively, forces chosen based on prior biomechanical modeling of ex vivo microperfused CCDs. Cells exposed to FSS expressed an approximately twofold greater abundance of phospho(p)-ERK and p-p38 vs. static cells, while CS did not alter p-p38 and p-ERK expression compared with unstretched controls. FSS induced whereas CS reduced PGE2 release by ∼40%. In conclusion, FSS and CS differentially affect ERK and p38 activation and PGE2 release in a cell culture model of the CD. We speculate that TFF differentially regulates biomechanical signaling and, in turn, cation transport in the CCD

    Colposcopy in the Primary Health Care: A Scoping Review

    Get PDF
    Aim: Low- and middle-income countries represent nearly 85% of all cervical cancer cases worldwide; thereby, it is extremely important to identify methods to improve the screening process. Therefore, this study aimed to summarize the primary characteristics of studies on accessibility, coverage, patient preferences, and factors associated with patient satisfaction or acceptance of colposcopy in primary healthcare. Methods: A search strategy, based on MeSH, Emtree, and free terms, was run through 5 databases (PubMed, Scopus, Embase, Ovid/Medline, and Web of Science). EndNote 20.1 © and Rayyan QCRI © were used for screening. A preset datasheet was used for data extraction. Results: The systematic search retrieved 1127 references, and after removing duplicates, screening the titles and abstracts, and reviewing the full text, 7 studies were included. The interrater reliability was 77.73% (kappa statistic = 0.1842). Most studies estimated the proportion of women that sought for colposcopy after a previous screening test for human papilloma virus. One study identifies barriers to colposcopy examination in women at risk of developing cervical cancer. Three studies assessed the decentralization of colposcopy from a tertiary healthcare center to a primary care center. Pap smear was the most common first-line screening test, followed by liquid-based cytology sample and visual inspection with acetic acid. Conclusion: Only a few countries have investigated the use of colposcopy in primary care. Thus, barriers and the care structure for this implementation to be successful in reducing cervical cancer incidence and mortality should be identified.Revisión por pare

    Improving the description of the suspended particulate matter concentrations in the southern North Sea through assimilating remotely sensed data

    Get PDF
    The integration of remote sensing data of suspended particulate matter (SPM) into numerical models is useful to improve the understanding of the temporal and spatial behaviour of SPM in dynamic shelf seas. In this paper a generic method based on the Ensemble Kalman Filtering (EnKF) for assimilating remote sensing SPM data into a transport model is presented. The EnKF technique is used to assimilate SPM data of the North Sea retrieved from the MERIS sensor, into the computational water quality and sediment transport model, Delft3D-WAQ. The satellite data were processed with the HYDROPT algorithm that provides SPM concentrations and error information per pixel, which enables their use in data assimilation. The uncertainty of the transport model, expressed in the system noise covariance matrix, was quantified by means of a Monte Carlo approach. From a case study covering the first half of 2003, it is demonstrated that the MERIS observations and transport model application are sufficiently robust for a successful generic assimilation. The assimilation results provide a consistent description of the spatial-temporal variability of SPM in the southern North Sea and show a clear decrease of the model bias with respect to independent in-situ observations. This study also identifies some shortcomings in the assimilated results, such as over prediction of surface SPM concentrations in regions experiencing periods of rapid stratification/de-stratification. Overall this feasibility study leads to a range of suggestions for improving and enhancing the model, the observations and the assimilation scheme. © 2011 Korea Ocean Research & Development Institute (KORDI) and the Korean Society of Oceanography (KSO) and Springer Netherlands
    corecore