Using Empathic design principles to improve surgical nursing efficiency

Improving efficiency to increase operating room utilization, improve turnaround time, and first case on time starts, is a goal of hospitals to increase surgical case volume. Increasing case volumes improves the hospitals bottom line by increasing reimbursement. In addition, improving the utilization will improve patient and caregiver satisfaction, show less wasted time between cases, and allowing for more timely starts. In the hospital that this study was be performed, located in Atlanta, Georgia, there is a need to improve these metrics which will improve the bottom line of the facility. This study addressed inefficiencies in processes, job duties, and preparation of the operating rooms prior to the surgery start time as well as during the case turnover process. The writer used the Process Redesign model and user-centered feedback to create a guideline that will allow the end user to develop a more efficient workflow pattern. The key metrics used in this study are nationally accepted measures that allow operating room managers to measure efficiency. The guideline developed was be based on evidence already developed and new evidence from the planned survey

Perceptions of social decisions made by individuals of different ages

This study examines the perceptions that individuals have about the social decisions of others and the role that age plays in these perceptions. In this study, older and young adults read a vignette in which Clare (either 80 or 20-years-old) chose a social partner (either close friend or new acquaintance). Older adults rated Older Clare more favorably when she chose a close relationship and they rated Younger Clare more favorably when she chose the new experience. Young adults showed more mixed results. Unlike older adults, young adults rated Older Clare more favorably when she chose the new experience rather than the close relationship, but found Younger Clare to be more likable but less appropriate when she chose the new experience. Differing preferences may lead to intergenerational misunderstandings where both generations prefer that the other generation seek new experiences, but prefer their own generation remain with close friends. Results are discussed in light of socioemotional selectivity and social identity theories

The challenge of Jihadist radicalisation. In Europe and beyond. 2017

Today Europe finds itself on the frontline in the fight against terrorism and jihadist radicalisation. Over the past fourteen months, the horrendous terrorist attacks that have taken place in France, Germany and Belgium, as well as in Turkey, Tunisia, and elsewhere around the world, have claimed hundreds of lives. As a Belgian national, the three bombs that were detonated in my country, in the departure hall of the Brussels International Airport in Zaventem, and at the Maelbeek Metro station, a few hundred metres from key EU institutions, was a particularly traumatic moment for me. In many ways, the attacks of 22 March were Belgium’s own 9/11, representing the worst terrorist attacks committed on Belgian territory in the country’s modern history. The attacks demonstrate a clear shift in the resolve and ability of jihadist terrorists to inflict mass casualties on urban populations, and are devised to induce a high state of well-publicised terro

Strengthening the Quality and Quantity of the Nursing and Midwifery Workforce: Report on Eight Years of the NEPI Project

In response to the urgent need to scale up access to antiretroviral therapy, the Global Nursing Education Partnership Initiative (GNCBP), a PEPFAR program administered by the U.S. Department of Health Resources and Services Administration (HRSA), was implemented from 2011 to 2018 by ICAP at Columbia University. Working closely together, HRSA and ICAP partnered with local nursing leaders and ministries of health to strengthen the nursing and midwifery workforce across 11 countries. This multi-country project, developed to address critical gaps in nursing education and training worked across six building blocks of health workforce strengthening: infrastructure improvement, curricula revision, clinical skills development, in-service training, faculty development and building partnerships for policy and regulation to increase the quality and quantity of the nursing and midwifery workforce. As a result, 13,387 nursing and midwifery students graduated from schools supported under GNCBP. A total of 5,554 nurses received critical in-service training and 4,886 faculty, clinical mentors and preceptors received training in key clinical care areas and modern teaching methodologies. ICAP completed 43 infrastructure enhancements to ensure environments conducive to learning and strengthened nursing leaders as best evidenced by the election and formation of Mozambique’s first national nursing council and the NEPI Network. Going forward, efforts to strengthen nursing and midwifery can build on the results of the GNCBP project. Going forward, a new group of African nursing leaders are being supported to advocate for high quality patient-care led through inter-professional collaboration and participation in international efforts championing the critical role of nurses in achieving universal health coverage

The theory of planned behaviour predicts self-reports of walking, but does not predict step count

Objectives This paper compares multiple measures of walking in two studies, and the second study compares how well Theory of Planned Behaviour (TPB) constructs perform in predicting these different measures. Methods In Study 1, 41 participants wore a New Lifestyles NL-2000 pedometer for 1 week. Subsequently, participants completed a questionnaire containing measures of the TPB constructs and two self-report measures of walking, followed by two interview measures of walking. For Study 2, 200 RAF trainee aircraftsmen wore pedometers for 2 weeks. At the end of each week, participants completed the questionnaire and interview measures of walking. Results Both studies found no significant association between questionnaire measures of walking and pedometer measures. In Study 1, the interview measures produced significant, large correlations with the pedometer measure, but these relationships were markedly weaker in the second study. TPB variables were found to explain 22% of variance in intention to walk in Study 1 and 45% of the variance in Study 2. In Study 2, prediction of subsequent measures of behaviour was found to be weak, except when using a single-item measure of walking. Conclusions Recall of walking is poor, and accurate measurement by self-report is problematic. Although the TPB predicts intentions to walk well, it does not predict actual amount of walking, as assessed by pedometer. Possible reasons for these findings include the unique nature of walking as an activity primarily used to facilitate higher order goals. The use of single-item measures may exaggerate the effectiveness of the TPB model for walking, and possibly other forms of physical activity.</p

A combination strategy for enhancing linkage to and retention in HIV care among adults newly diagnosed with HIV in Mozambique: study protocol for a site-randomized implementation science study

Despite the extraordinary scale up of HIV prevention, care and treatment services in sub-Saharan Africa (SSA) over the past decade, the overall effectiveness of HIV programs has been significantly hindered by high levels of attrition across the HIV care continuum. Data from “real-life” settings are needed on the effectiveness of an easy to deliver package of services that can improve overall performance of the HIV care continuum. We are conducting an implementation science study using a two-arm cluster site-randomized design to determine the effectiveness of a combination intervention strategy (CIS) using feasible, evidence-based, and practical interventions—including (1) point-of-care (POC) CD4 count testing, (2) accelerated antiretroviral therapy initiation for eligible individuals, and (3) SMS reminders for linkage to and retention in care—as compared to the standard of care (SOC) in Mozambique in improving linkage and retention among adults following HIV diagnosis. A pre-post intervention two-sample design is nested within the CIS arm to assess the incremental effectiveness of the CIS plus financial incentives (CIS + FI) compared to the CIS without FI on study outcomes. Randomization is done at the level of the study site, defined as a primary health facility. Five sites are included from the City of Maputo and five from Inhambane Province. Target enrollment is a total of 2,250 adults: 750 in the SOC arm, 750 in the CIS cohort of the intervention arm and 750 in the CIS + FI cohort of the intervention arm (average of 150 participants per site). Participants are followed for 12 months from time of HIV testing to ascertain a combined endpoint of linkage to care within 1 month after testing and retention in care 12 months from HIV test. Cost-effectiveness analyses of CIS compared to SOC and CIS + FI compared to CIS will also be conducted. Study findings will provide evidence on the effectiveness of a CIS and the incremental effectiveness of a CIS + FI in a “real-life” service delivery system in a SSA country severely impacted by HIV. Trial registration: Clinicaltrials.gov, NCT0193008

Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial

BACKGROUND: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. METHODS: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuro-ophthalmologists ("expert panel") described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel(® )software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). RESULTS: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6% (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. CONCLUSION: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting

Differences in the carcinogenic evaluation of glyphosate between the International Agency for Research on Cancer (IARC) and the European Food Safety Authority (EFSA)

The International Agency for Research on Cancer (IARC) Monographs Programme identifies chemicals, drugs, mixtures, occupational exposures, lifestyles and personal habits, and physical and biological agents that cause cancer in humans and has evaluated about 1000 agents since 1971. Monographs are written by ad hoc Working Groups (WGs) of international scientific experts over a period of about 12 months ending in an eight-day meeting. The WG evaluates all of the publicly available scientific information on each substance and, through a transparent and rigorous process,1 decides on the degree to which the scientific evidence supports that substance's potential to cause or not cause cancer in humans. For Monograph 112,2 17 expert scientists evaluated the carcinogenic hazard for four insecticides and the herbicide glyphosate.3 The WG concluded that the data for glyphosate meet the criteria for classification as a probable human carcinogen. The European Food Safety Authority (EFSA) is the primary agency of the European Union for risk assessments regarding food safety. In October 2015, EFSA reported4 on their evaluation of the Renewal Assessment Report5 (RAR) for glyphosate that was prepared by the Rapporteur Member State, the German Federal Institute for Risk Assessment (BfR). EFSA concluded that ?glyphosate is unlikely to pose a carcinogenic hazard to humans and the evidence does not support classification with regard to its carcinogenic potential?. Addendum 1 (the BfR Addendum) of the RAR5 discusses the scientific rationale for differing from the IARC WG conclusion. Serious flaws in the scientific evaluation in the RAR incorrectly characterise the potential for a carcinogenic hazard from exposure to glyphosate. Since the RAR is the basis for the European Food Safety Agency (EFSA) conclusion,4 it is critical that these shortcomings are corrected