Reification and representation in the implementation of quality improvement programmes

The object of this paper is to explore superficiality in implementing improvement programmes. The reported lack of success of some quality improvement programmes in realising stated objectives is recognised, but what constitutes the superficial attempts at implementation may well be highly complex symbolic forms of representation and reification which have a multiplicity of meanings for the individuals involved. The project managers try to implement and the tools and activities used to do so are superficial and trivial, and very difficult for observers to associate with improving operations. However, for the managers themselves the superficial has a high degree of significance for their own progression in the organisation and, curiously enough, the means of convincing some outsiders of the organisation's competence. The dominant community of practice was not that of performance improvement, but creating the impression of doing so

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) guideline

Main RecommendationsCellular mechanisms in basic and clinical gastroenterology and hepatolog

Erratum: Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline (Endoscopy (2021) 53 DOI: 10.1055/a-1496-8969)

In the above-mentioned article, the name of Enrique Rodriguez de Santiago has been corrected. This was corrected in the online version on June 17, 2021. In the above-mentioned article, the institutions of Daniele Regge have been corrected. This was corrected in the online version on July 8, 2021. © 2021 Georg Thieme Verlag. All rights reserved

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Main Recommendations 1 ESGE recommends that the initial assessment of patients presenting with acute lower gastrointestinal bleeding should include: a history of co-morbidities and medications that promote bleeding; hemodynamic parameters; physical examination (including digital rectal examination); and laboratory markers. A risk score can be used to aid, but should not replace, clinician judgment. Strong recommendation, low quality evidence. 2 ESGE recommends that, in patients presenting with a self-limited bleed and no adverse clinical features, an Oakland score of ≤?8 points can be used to guide the clinician decision to discharge the patient for outpatient investigation. Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and no history of cardiovascular disease, a restrictive red blood cell transfusion strategy, with a hemoglobin threshold of ≤?7?g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of 7-9?g/dL is desirable. Strong recommendation, low quality evidence. 4 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and a history of acute or chronic cardiovascular disease, a more liberal red blood cell transfusion strategy, with a hemoglobin threshold of ≤?8?g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of ≥?10?g/dL is desirable. Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients with major acute lower gastrointestinal bleeding, colonoscopy should be performed sometime during their hospital stay because there is no high quality evidence that early colonoscopy influences patient outcomes. Strong recommendation, low quality of evidence. 6 ESGE recommends that patients with hemodynamic instability and suspected ongoing bleeding undergo computed tomography angiography before endoscopic or radiologic treatment to locate the site of bleeding. Strong recommendation, low quality evidence. 7 ESGE recommends withholding vitamin K antagonists in patients with major lower gastrointestinal bleeding and correcting their coagulopathy according to the severity of bleeding and their thrombotic risk. In patients with hemodynamic instability, we recommend administering intravenous vitamin K and four-factor prothrombin complex concentrate (PCC), or fresh frozen plasma if PCC is not available. Strong recommendation, low quality evidence. 8 ESGE recommends temporarily withholding direct oral anticoagulants at presentation in patients with major lower gastrointestinal bleeding. Strong recommendation, low quality evidence. 9 ESGE does not recommend withholding aspirin in patients taking low dose aspirin for secondary cardiovascular prevention. If withheld, low dose aspirin should be resumed, preferably within 5 days or even earlier if hemostasis is achieved or there is no further evidence of bleeding. Strong recommendation, moderate quality evidence. 10 ESGE does not recommend routinely discontinuing dual antiplatelet therapy (low dose aspirin and a P2Y12 receptor antagonist) before cardiology consultation. Continuation of the aspirin is recommended, whereas the P2Y12 receptor antagonist can be continued or temporarily interrupted according to the severity of bleeding and the ischemic risk. If interrupted, the P2Y12 receptor antagonist should be restarted within 5 days, if still indicated. Strong recommendation, low quality evidence.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Erratum: Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline (Journal of Physical Chemistry (2021) 53 DOI: 10.1055/a-1496-8969)

In the above-mentioned article, the name of Enrique Rodriguez de Santiago has been corrected. This was corrected in the online version on June 17, 2021.SCOPUS: er.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

The Effect of Cerebrospinal Fluid Thickness on Traumatic Spinal Cord Deformation

A spinal cord injury may lead to loss of motor and sensory function and even death. The biomechanics of the injury process have been found to be important to the neurological damage pattern, and some studies have found a protective effect of the cerebrospinal fluid (CSF). However, the effect of the CSF thickness on the cord deformation and, hence, the resulting injury has not been previously investigated. In this study, the effects of natural variability (in bovine) as well as the difference between bovine and human spinal canal dimensions on spinal cord deformation were studied using a previously validated computational model. Owing to the pronounced effect that the CSF thickness was found to have on the biomechanics of the cord deformation, it can be concluded that results from animal models may be affected by the disparities in the CSF layer thickness as well as by any difference in the biological responses they may have compared with those of humans.</p