The importance of physician to physician coaching, medical director and staff engagement and doing “one thing different”

With the Center for Medicare and Medicaid Services incorporating patient experience into the Value Based Purchasing metrics, there is increasing hospital focus on improving this important aspect of patient care. The Value Based Purchasing program bases 25% of its value on the patient experience domain and is based on patient perspective as gathered via the Healthcare Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS). Our system chose to implement simultaneous pilot activities to train our 6 Hospitalist groups, obtain Hospitalist medical director buy in and deliver timely physician group feedback in a transparent manner. In addition, a single hospital was used as a pilot site to establish behavioral expectations and empower our front line staff with an innovative “One Thing Different” campaign. Varying results were seen by our different Hospitalist groups and while the group training was the same, it was the level of engagement of the Hospitalist medical director that made a significant difference in the results. Hospitalist group A went from 31st percentile to a current score of 70th percentile; Hospitalist Group B improved from 21st percentile to 63th percentile; Hospitalist group D went from 15th to 31st percentile. Hospitalist Group C improved from 3rd percentile to 25th percentile in just 6 months of project initiation. For the hospital pilot, the average monthly overall rate the hospital score increased from a starting score of 69.2% to 73.96% with the final FY 17 month reaching 77.5%. Currently, the overall rate the hospital score has sustained and is at 73.9%

Influence of Emergency Medical Technician - Basic (EMT-B) course on Bachelor of Science Emergency Medical Services (BS EMS) (Paramedic) Program in Saudi Arabia

Students become extraordinary because of their strong foundations in the basic EMS skills and knowledge. In our BS EMS program, the main aim has always been to graduate extraordinary group of paramedic students. This is only possible by building strong foundations in communication, comprehension, knowledge and skills. DOI: 10.7176/JEP/11-33-06 Publication date: November 30th 202

Effects of amplitude envelope cues as an aid to enhanced speechreading

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1997.Includes bibliographical references (leaves 40-41).by Sharieff Ali Mansour.M.Eng

Hybridizing Micro - B4C with Carbon nanotubes to Enhance the Mechanical Properties of Aluminium Matrix Composites

In present work, the effects of hybridizing micron sized B4C particles with multi walled carbon nanotubes on the microstructural and mechanical properties of Al - B4C composite were investigated. Microstructure reveals grain refinement ascribed to the presence of uniformly distributed micron sized B4C particles with multi walled carbon nanotubes. The Al - (B4C + MWCNT) hybrid composite indicates the alliance of mechanical properties such as hardness, tensile strength and ductility. The enhanced attribute of Al - (B4C + MWCNT) hybrid composite when compared to Al - B4C is the increased content and uniform distribution of MWCNTs. © Published under licence by IOP Publishing Ltd

Influence of Organisational Culture on Decision Making in Select Public Sector Enterprises

Public sector Enterprises in India, particularly the Central Government owned were designated as “Temples of Modern India” by Pandit Jawaharlal Nehru, the first prime Minister of India. They were started with clear aim of providing employment, and supplying goods at affordable prices besides the larger goal of industrialization and balanced growth. It did serve the purpose till liberalization was initiated in 1990. The globalization and liberalization brought about extreme pressure on hitherto protected industries to take on competition. The culture developed over five decades was precipitously called upon to take on the changes that were taking place in the environment forcing many PSEsto turn red unable to deal with competition. This study attempts to understand the organisational culture that was developed over a period of 50 years and its ability to cope with changes through effective and efficient decision making by executives and by their leadership or management style and to a certain extent the presence of unique PSE ecosystem. It is being explored that notwithstanding the individual differences in decision making, organisational culture forces all executives t

Hepatocellular carcinoma in Pakistan: where do we stand?

Context: From the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease. Evidence Acquisition: The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC. Results: Majority of HCC patients present with nonresectable disease. Interventions such as transarterial chemoembolization, radiofrequency ablation, resection and chemotherapy including sorafenib are available in selected centers. Pakistan appears to be in an area of intermediate endemicity for HCC. There is a need for population based epidemiological studies to estimate the exact disease burden. Conclusions: Measures to prevent the spread of hepatitis C and B can slow down the epidemic rise in the incidence of HCC in the coming decades. There is a need to implement a proper surveillance program to identify HCC cases at an early stage