Showcasing patient experience and engagement best practices through an innovative forum celebrating patients, families, and multidisciplinary care teams

A platform was designed for interdisciplinary teams to learn from colleagues, patients, and their families, about what creates and sustains positive, lasting impressions from their care team. A forum focused on positive experiences designed to highlight the relationships between patients and care teams was utilized. A Best Practices Forum was designed to share methods for generating positive patient experiences across the institution. These quarterly conferences featured patient stories and highlighted best practices such as empathic communications, collaboration, and teamwork used by caregivers throughout the institution. The patient experience team invited various well-performing departments to share best practices, as well as assisted in identifying patients willing to share their healthcare journey in front of an audience of clinical and non-clinical staff. The forum serves as an innovative learning lab using our patients and care team members as instructors of best practices in patient experience and patient engagement

Transforming care through bedside leader rounding: Use of handheld technology leads to improvement in perceived patient satisfaction

When consistently executed, leader rounding has the ability to capture actionable information ensuring delivery of safe and effective patient care, identifying excellence among staff, and bringing opportunities for improvement. Our team set out to create an effective, standardized approach to targeted, daily, technology-driven leader rounding with the goal of integrating real-time patient feedback into the care experience. An application on handheld computer tablets was tailored and integrated with the hospital’s admission, discharge, and transfer (ADT) feed, allowing for streamlining of the rounding process by creation of workflow templates. Additionally, capabilities to receive and send alerts across disciplines were integrated in order to respond to patient concerns in real-time. Patients who perceived they were rounded on had 3.53 greater odds of reporting top box scores for Overall Rating of Care compared to patients who perceived they were not rounded on (p\u3c0.001). Patients with documentation that rounding occurred, who also self-reported that rounding occurred, were at 3.43 greater odds of providing a top-box score than patients with documentation that rounding occurred but who did not perceive they were rounded on (p\u3c0.001). Efforts to round and to ensure patients know they are being rounded on may lead to improved patient experience

The evolution and integration of a patient-centric mapping tool (patient journey value mapping) in continuous quality improvement

The need to improve a healthcare system that too frequently fails to deliver benefits of care, even resulting in harm to patients, has been well established. The resulting era of quality improvement has aimed to improve the delivery of care by increasing quality while reducing cost. One approach to improving how healthcare is delivered is the application of Lean management strategies. Despite widespread investment in Lean approaches to improve healthcare delivery, evidence supports a deficiency of this approach to improve patient satisfaction with care. Identifiable operational tension between quality improvement efforts designed to streamline care processes and those targeting improvement of the patient care experience existed. We set out to address this deficiency by embedding the patient experience into improvement efforts through the introduction of a patient-centric value stream mapping approach

Extracellular Heat Shock Protein (Hsp)70 and Hsp90α Assist in Matrix Metalloproteinase-2 Activation and Breast Cancer Cell Migration and Invasion

Breast cancer is second only to lung cancer in cancer-related deaths in women, and the majority of these deaths are caused by metastases. Obtaining a better understanding of migration and invasion, two early steps in metastasis, is critical for the development of treatments that inhibit breast cancer metastasis. In a functional proteomic screen for proteins required for invasion, extracellular heat shock protein 90 alpha (Hsp90α) was identified and shown to activate matrix metalloproteinase 2 (MMP-2). The mechanism of MMP-2 activation by Hsp90α is unknown. Intracellular Hsp90α commonly functions with a complex of co-chaperones, leading to our hypothesis that Hsp90α functions similarly outside of the cell. In this study, we show that a complex of co-chaperones outside of breast cancer cells assists Hsp90α mediated activation of MMP-2. We demonstrate that the co-chaperones Hsp70, Hop, Hsp40, and p23 are present outside of breast cancer cells and co-immunoprecipitate with Hsp90α in vitro and in breast cancer conditioned media. These co-chaperones also increase the association of Hsp90α and MMP-2 in vitro. This co-chaperone complex enhances Hsp90α-mediated activation of MMP-2 in vitro, while inhibition of Hsp70 in conditioned media reduces this activation and decreases cancer cell migration and invasion. Together, these findings support a model in which MMP-2 activation by an extracellular co-chaperone complex mediated by Hsp90α increases breast cancer cell migration and invasion. Our studies provide insight into a novel pathway for MMP-2 activation and suggest Hsp70 as an additional extracellular target for anti-metastatic drug development

Population Genetics of Streptococcus dysgalactiae Subspecies equisimilis Reveals Widely Dispersed Clones and Extensive Recombination

Streptococcus dysgalactiae subspecies equisimilis (SDSE) is an emerging global pathogen that can colonize and infect humans. Although most SDSE isolates possess the Lancefield group G carbohydrate, a significant minority have the group C carbohydrate. Isolates are further sub-typed on the basis of differences within the emm gene. To gain a better understanding of their molecular epidemiology and evolutionary relationships, multilocus sequence typing (MLST) analysis was performed on SDSE isolates collected from Australia, Europe and North America.The 178 SDSE isolates, representing 37 emm types, segregate into 80 distinct sequence types (STs) that form 17 clonal complexes (CCs). Eight STs recovered from all three continents account for >50% of the isolates. Thus, a small number of STs are highly prevalent and have a wide geographic distribution. Both ST and CC strongly correlate with group carbohydrate. In contrast, eleven STs were associated with >1 emm type, suggestive of recombinational replacements involving the emm gene; furthermore, 35% of the emm types are associated with genetically distant STs. Data also reveal a history of extensive inter- and intra-species recombination involving the housekeeping genes used for MLST. Sequence analysis of single locus variants identified through goeBURST indicates that genetic change mediated by recombination occurred approximately 4.4 times more frequently than by point mutation.A few genetic lineages with an intercontinental distribution dominate among SDSE causing infections in humans. The distinction between group C and G isolates reflects recent evolution, and no long-term genetic isolation between them was found. Lateral gene transfer and recombination involving housekeeping genes and the emm gene are important mechanisms driving genetic variability in the SDSE population

Validation of the content of the prevention protocol for early sepsis caused by Streptococcus agalactiaein newborns

AbstractObjective: to validate the content of the prevention protocol for early sepsis caused by Streptococcus agalactiaein newborns.Method: a transversal, descriptive and methodological study, with a quantitative approach. The sample was composed of 15 judges, 8 obstetricians and 7 pediatricians. The validation occurred through the assessment of the content of the protocol by the judges that received the instrument for data collection - checklist - which contained 7 items that represent the requisites to be met by the protocol. The validation of the content was achieved by applying the Content Validity Index.Result: in the judging process, all the items that represented requirements considered by the protocol obtained concordance within the established level (Content Validity Index > 0.75). Of 7 items, 6 have obtained full concordance (Content Validity Index 1.0) and the feasibility item obtained a Content Validity Index of 0.93. The global assessment of the instruments obtained a Content Validity Index of 0.99.Conclusion: the validation of content that was done was an efficient tool for the adjustment of the protocol, according to the judgment of experienced professionals, which demonstrates the importance of conducting a previous validation of the instruments. It is expected that this study will serve as an incentive for the adoption of universal tracking by other institutions through validated protocols

Quasispecies Theory and the Behavior of RNA Viruses

A large number of medically important viruses, including HIV, hepatitis C virus, and influenza, have RNA genomes. These viruses replicate with extremely high mutation rates and exhibit significant genetic diversity. This diversity allows a viral population to rapidly adapt to dynamic environments and evolve resistance to vaccines and antiviral drugs. For the last 30 years, quasispecies theory has provided a population-based framework for understanding RNA viral evolution. A quasispecies is a cloud of diverse variants that are genetically linked through mutation, interact cooperatively on a functional level, and collectively contribute to the characteristics of the population. Many predictions of quasispecies theory run counter to traditional views of microbial behavior and evolution and have profound implications for our understanding of viral disease. Here, we discuss basic principles of quasispecies theory and describe its relevance for our understanding of viral fitness, virulence, and antiviral therapeutic strategy

Synthesis of polycationic bentonite-ionene complexes and their benzene adsorption capacity

The purpose of this work was to structurally modify clays in order to incorporate water-insoluble molecules, such as petroleum hydrocarbons. The potential for ion exchange of quaternary ammonium salts was studied, which revealed their ability to interact with anions on the cationic surface, for environmental applications of the material. Ionenes, also known as polycations, have many potential uses in environmental applications. In this work, cationic aliphatic ammonium polyionenes, specifically 3,6-ionene and 3,6-dodecylionene, were prepared for incorporation into clay to form bentonite-ionene complexes. The intercalation of bentonite with ionene polymers resulted in an increase in the basal spacing of 3,6-dodecylionene from 1.5-3.5 nm. The higher d001 spacing of 3,6-dodecylionene samples than that of 3,6-ionene samples may be attributed to their longer tail length. The behavior of the TG/DTG curves and the activation energy values suggest that 3,6-dodecylionene (E = 174.85 kJ mol(-1)) is thermally more stable than 3,6 ionene (E = 115.52 kJ mol(-1)) complexes. The adsorption of benzene by 3,6-ionene and 3,6-dodecylionene was also investigated. The increase in benzene concentrations resulted in increased benzene adsorption by the sorbents tested in this work. The sorption capacity of benzene on ionene-modified bentonite was in the order of 3,6-dodecylionene > 3,6-ionene.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Estadual Paulista, UNESP, Sorocaba, SP, BrazilCtr Univ FIEO UNIFIEO, Osasco, SP, BrazilUniv Estadual Paulista, UNESP, Sorocaba, SP, BrazilFAPESP: 2010/01287-