Real-time analysis and display of quantitative measures to track and improve clinical workflow

PURPOSE: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety. MATERIALS AND METHODS: We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management. The dashboard enables visualization of resource utilization and tracks progress in a patient\u27s care path from the time of acquisition of the planning CT to the time of treatment in real-time. It integrates with the departmental electronic medical records (EMR) system without the creation and maintenance of a separate database or duplication of work by clinical staff. Performance measures of workflow were calculated. RESULTS: The dashboard implements a standardized clinical workflow and dynamically consolidates real-time information queried from multiple tables in the EMR database over the following views: (1) CT Sims summarizes patient appointment information on the CT simulator and patient load; (2) Linac Sims summarizes patient appointment times, setup history, and notes, and patient load; (3) Task Status lists the clinical tasks associated with a treatment plan, their due date, status and ownership, and patient appointment details; (4) Documents provides the status of all documents in the patients\u27 charts; and (5) Diagnoses and Interventions summarizes prescription information, imaging instructions and whether the plan was approved for treatment. Real-time assessment and quantification of progress and delays in a patient\u27s treatment start were achieved. CONCLUSIONS: This study indicates it is feasible to develop and implement a dashboard, tailored to the needs of an interdisciplinary team, which derives and integrates information from the EMR database for real-time analysis and display of resource utilization and clinical workflow in radiation oncology. The framework developed facilitates informed, data-driven decisions on clinical workflow management as we seek to optimize clinical efficiency and patient safety

Introduction : screen Londons

Our aim, in editing the ‘London Issue’ of this journal, is to contribute to a conversation between scholars of British cinema and television, London historians and scholars of the cinematic city. In 2007, introducing the themed issue on ‘Space and Place in British Cinema and Television’, Steve Chibnall and Julian Petley observed that it would have been possible to fill the whole journal with essays about the representation of London. This issue does just that, responding to the increased interest in cinematic and, to a lesser extent, televisual, Londons, while also demonstrating the continuing fertility of the paradigms of ‘space and place’ for scholars of the moving image1. It includes a wide range of approaches to the topic of London on screen, with varying attention to British institutions of the moving image – such as Channel Four or the British Board of Film Classification – as well as to concepts such as genre, narration and memory. As a whole, the issue, through its juxtapositions of method and approach, shows something of the complexity of encounters between the terms ‘London’, ‘cinema’ and ‘television’ within British film and television studies

Detection Rates for Kaluza-Klein Dark Matter

We consider the lightest Kaluza-Klein particle at N=1 mode (LKP) of universal extra dimension to be the candidate for Dark Matter and predict the detection rates for such particles for Germenium and NaI detectors. We have also calculated the nature of annual modulation for the signals in these two types of detectors for LKP Dark Matter. The rates with different values of speed of solar system in the Galactic rest frame are also evaluated.Comment: Submitted to Phys. Rev.

Gas-liquid simulation of an airlift bubble column reactor

The simulation of two-phase flow for an experimental airlift reactor (32-l volume) using commercially available software from Fluent Incorporated is presented here (http://www.fluent.co.uk). Data from the simulation is compared with the experimental data obtained by the tracking of a magnetic particle and analysis of the pressure drop to determine the gas hold-up. Comparisons between vertical velocity and gas hold-up were made for a series of experiments where the superficial gas velocity in the riser was adjusted between 0.01 and 0.075 m s-1. © 2003 Elsevier B.V. All rights reserved

What Did Our Ancestors Eat?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75025/1/j.1753-4887.1989.tb02765.x.pd

Discrepant perceptions of communication, teamwork and situation awareness among surgical team members

Objective To assess surgical team members’ differences in perception of non-technical skills. Design Questionnaire design. Setting Operating theatres (OTs) at one university hospital, three teaching hospitals and one general hospital in the Netherlands. Participants Sixty-six surgeons, 97 OT nurses, 18 anaesthetists and 40 nurse anaesthetists. Methods All surgical team members, of five hospitals, were asked to complete a questionnaire and state their opinion on the current state of communication, teamwork and situation awareness at the OT. Results Ratings for ‘communication’ were significantly different, particularly between surgeons and all other team members (P ? 0.001). The ratings for ‘teamwork’ differed significantly between all team members (P ? 0.005). Within ‘situation awareness’ significant differences were mainly observed for ‘gathering information’ between surgeons and other team members (P < 0.001). Finally, 72–90% of anaesthetists, OT nurses and nurse anaesthetists rated routine team briefings and debriefings as inadequate. Conclusions This study shows discrepancies on many aspects in perception between surgeons and other surgical team members concerning communication, teamwork and situation awareness. Future research needs to ascertain whether these discrepancies are linked to greater risk of adverse events or to process as well as systems failures. Establishing this link would support implementation and use of complex team interventions that intervene at multiple levels of the healthcare systemIndustrial Design Engineerin

Histomorphometry of the Sural Nerve for Use as a CFNG in Facial Reanimation Procedures

Facial palsy (FP) is a debilitating nerve pathology. Cross Face Nerve Grafting (CFNG) describes a surgical technique that uses nerve grafts to reanimate the paralyzed face. The sural nerve has been shown to be a reliable nerve graft with little donor side morbidity. Therefore, we aimed to investigate the microanatomy of the sural nerve. Biopsies were obtained from 15 FP patients who underwent CFNG using sural nerve grafts. Histological cross-sections were fixated, stained with PPD, and digitized. Histomorphometry and a validated software-based axon quantification were conducted. The median age of the operated patients was 37 years (5–62 years). There was a significant difference in axonal capacity decrease towards the periphery when comparing proximal vs. distal biopsies (p = 0.047), while the side of nerve harvest showed no significant differences in nerve caliber (proximal p = 0.253, distal p = 0.506) and axonal capacity for proximal and distal biopsies (proximal p = 0.414, distal p = 0.922). Age did not correlate with axonal capacity (proximal: R = −0.201, p = 0.603; distal: R = 0.317, p = 0.292). These novel insights into the microanatomy of the sural nerve may help refine CFNG techniques and individualize FP patient treatment plans, ultimately improving overall patient outcomes

SN 2008iy: An Unusual Type IIn Supernova with an Enduring 400 Day Rise Time

We present spectroscopic and photometric observations of the Type IIn supernova (SN) 2008iy. SN 2008iy showed an unprecedentedly long rise time of ~400 days, making it the first SN to take significantly longer than 100 days to reach peak optical luminosity. The peak absolute magnitude of SN 2008iy was M_r ~ -19.1 mag, and the total radiated energy over the first ~700 days was ~2 x 10^50 erg. Spectroscopically, SN 2008iy is very similar to the Type IIn SN 1988Z at late times, and, like SN 1988Z, it is a luminous X-ray source (both supernovae had an X-ray luminosity L_ X > 10^41 erg/s). The Halpha emission profile of SN 2008iy shows a narrow P Cygni absorption component, implying a pre-SN wind speed of ~100 km/s. We argue that the luminosity of SN 2008iy is powered via the interaction of the SN ejecta with a dense, clumpy circumstellar medium. The ~400 day rise time can be understood if the number density of clumps increases with distance over a radius ~1.7 x 10^16 cm from the progenitor. This scenario is possible if the progenitor experienced an episodic phase of enhanced mass-loss < 1 century prior to explosion or the progenitor wind speed increased during the decades before core collapse. We favour the former scenario, which is reminiscent of the eruptive mass-loss episodes observed for luminous blue variable (LBV) stars. The progenitor wind speed and increased mass-loss rates serve as further evidence that at least some, and perhaps all, Type IIn supernovae experience LBV-like eruptions shortly before core collapse. We also discuss the host galaxy of SN 2008iy, a subluminous dwarf galaxy, and offer a few reasons why the recent suggestion that unusual, luminous supernovae preferentially occur in dwarf galaxies may be the result of observational biases.Comment: 15 pages, 5 figures, MNRAS accepte

Professionalism, Golf Coaching and a Master of Science Degree: A commentary

As a point of reference I congratulate Simon Jenkins on tackling the issue of professionalism in coaching. As he points out coaching is not a profession, but this does not mean that coaching would not benefit from going through a professionalization process. As things stand I find that the stimulus article unpacks some critically important issues of professionalism, broadly within the context of golf coaching. However, I am not sure enough is made of understanding what professional (golf) coaching actually is nor how the development of a professional golf coach can be facilitated by a Master of Science Degree (M.Sc.). I will focus my commentary on these two issues