Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin
The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for
Full Text Available Objectives: This study aimed to identify and prioritize factors affecting the hospital employees' productivity from the viewpoint of hospital managers working in the teaching hospitals affiliated to Iran, Shiraz University of Medical Sciences, in 2017. Materials and Methods: This was an applied, cross-sectional, and descriptive-analytical study conducted in 2017 in all teaching hospitals affiliated to Iran, Shiraz University of Medical Sciences. After identifying factors affecting hospital employees' productivity using the results of previous studies, all hospital managers (56 managers were selected as the study population using census method to prioritize the factors. The decision-making trial and evaluation laboratory (DEMATEL and analytic network process (ANP techniques were used for analyzing the collected data through Excel 2010 and Super Decision 2.8. Results: Fifteen factors affecting employees' productivity were determined using the results of previous studies which were classified into four clusters. The results of DEMATEL technique showed that “employees' attitude toward the organization” was the most affecting factor (r = 11.928 and also the most affected factor (c = 12.120, as well as the most important factor affecting the employees' productivity (r + c = 24.048. In addition, the results of ANP showed that the cluster of “leadership and management styles” (relative weight [RW] = 0.274 and its factors, especially “involving employees in the decision-making processes” (L1 (RW = 0.102 and “delegation of authority to the employees” (L2 (RW = 0.100 were the most important factors affecting the employees' productivity. Conclusion: According to the results, adopting an appropriate leadership style and providing participatory management, involving the employees in the hospital decision-making processes, etc., had significant effects on the increases in the employees' motivation and productivity.
Federal Laboratory Consortium — NETL’s Fuels Processing Laboratory in Morgantown, WV, provides researchers with the equipment they need to thoroughly explore the catalytic issues associated with...
Federal Laboratory Consortium — The Radiochemical Processing Laboratory (RPL)ï¿½is a scientific facility funded by DOE to create and implement innovative processes for environmental clean-up and...
to create a new methodology for developing and exploring process models and applications. The paper outlines the process innovation laboratory as a new approach to BPI. The process innovation laboratory is a comprehensive framework and a collaborative workspace for experimenting with process models....... The process innovation laboratory facilitates innovation by using an integrated action learning approach to process modelling in a controlled environment. The study is based on design science and the paper also discusses the implications to EIS research and practice......Most organizations today are required not only to operate effective business processes but also to allow for changing business conditions at an increasing rate. Today nearly every business relies on their enterprise information systems (EIS) for process integration and future generations of EIS...
O'Kelly, R A
BACKGROUND: The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. AIMS: An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. METHODS: The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. RESULTS: Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. CONCLUSIONS: Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.
Søeby, Karen; Jensen, Peter Bjødstrup; Werge, Thomas
of hospital laboratory data as a source of information, we analyzed enzymatic plasma creatinine as a model analyte in two large pediatric hospital samples. Methods: Plasma creatinine measurements from 9700 children aged 0-18 years were obtained from hospital laboratory databases and partitioned into high...... in creatinine levels at different time points after birth and around the early teens, which challenges the establishment and usefulness of reference intervals in those age groups. Conclusions: The study documents that hospital laboratory data may inform on the developmental aspects of creatinine, on periods...... with pronounced heterogeneity and valid reference intervals. Furthermore, part of the heterogeneity in creatinine distribution is likely due to differences in biological and chronological age of children and should be considered when using age-specific reference intervals....
Fatma Meriç Yılmaz
Full Text Available Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH and calculate potential savings in costs.A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0% was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.
Federal Laboratory Consortium — The purpose is to process and evaluate polymers for use in nonlinear optical, conductive and structural Air Force applications. Primary capabilities are extrusion of...
Poch, Carolina; Rabiller, Graciela; Basualdo, Daniel A.; El Tamer, Elias A.
Objective: 1) To determine the necessary conditions for increasing the complexity of the Radiopharmacy Laboratory and reach an operational level defined by the IAEA as 3a (Operational Guidance on Hospital Radiopharmacy). Our aim is that, within a framework of quality, last generation radiopharmaceuticals can be used, by sophisticated techniques such as labeling with bifunctional chelating agents, like HYNIC; 2) Consequently, we decided to implement a Quality Management System (QMS) in the field of Hospital Radiopharmacy in order to guarantee the safe and effective preparation and handling of radiopharmaceuticals for the diagnosis of patients, based on recommendations of the IAEA. Procedure For the implementation of the QMS, the sector of Radiopharmacy was capacitated in the application of ISO 9001. In a first stage it had begun with the formulation of the main documents and their enumeration. According to the recommendations of the IAEA Operational Guide, this year we proceeded to the optimization of the documents produced in the first stage and formulation of new documents essential to the improvement of work in the Radiopharmacy Laboratory. Results: Corrections were made to the performed procedures, and new ones were composed such as: Reception of raw materials, Control dose calibrator (Activity meter), General procedure of dosage, Procedure for decontamination, for Using the bio safety cabinet, for Cleaning the hot laboratory, etc. The Quality Controls were added to each of the Work Instructions of radiopharmaceuticals to be undertaken and how and when to carry out, with their respective references. Records were modified and new ones incorporated, in order to ensure traceability of the results before and after injection. Finally, the require documentation has been completed with the addition of the Staff Training Plan, and other records such as Nonconformance and Corrective and Preventive Actions. Conclusion: With the application of a QMS correctly implemented
Lachassagne, Delphine; Soubrand, Marilyne; Casellas, Magali; Gonzalez-Ospina, Adriana; Dagot, Christophe
This study aimed to determine the effect of sludge stabilization treatments (liming and anaerobic digestion) on the mobility of different pharmaceutical compounds in soil amended by landspreading of treated sludge from different sources (urban and hospital). The sorption and desorption potential of the following pharmaceutical compounds: carbamazepine (CBZ), ciprofloxacin (CIP), sulfamethoxazole (SMX), salicylic acid (SAL), ibuprofen (IBU), paracetamol (PAR), diclofenac (DIC), ketoprofen (KTP), econazole (ECZ), atenolol (ATN), and their solid-liquid distribution during sludge treatment (from thickening to stabilization) were investigated in the course of batch testing. The different sludge samples were then landspread at laboratory scale and leached with an artificial rain simulating 1 year of precipitation adapted to the surface area of the soil column used. The quality of the resulting leachate was investigated. Results showed that ibuprofen had the highest desorption potential for limed and digested urban and hospital sludge. Ibuprofen, salicylic acid, diclofenac, and paracetamol were the only compounds found in amended soil leachates. Moreover, the leaching potential of these compounds and therefore the risk of groundwater contamination depend mainly on the origin of the sludge because ibuprofen and diclofenac were present in the leachates of soils amended with urban sludge, whereas paracetamol and salicylic acid were found only in the leachates of soils amended with hospital sludge. Although carbamazepine, ciprofloxacin, sulfamethoxazole, ketoprofen, econazole, and atenolol were detected in some sludge, they were not present in any leachate. This reflects either an accumulation and/or (bio)degradation of these compounds (CBZ, CIP, SMX, KTP, ECZ, and ATN ), thus resulting in very low mobility in soil. Ecotoxicological risk assessment, evaluated by calculating the risk quotients for each studied pharmaceutical compound, revealed no high risk due to the
Cankovic, Milena; Varney, Ruan C; Whiteley, Lisa; Brown, Ron; D'Angelo, Rita; Chitale, Dhananjay; Zarbo, Richard J
Accurate and timely molecular test results play an important role in patient management; consequently, there is a customer expectation of short testing turnaround times. Baseline data analysis revealed that the greatest challenge to timely result generation occurred in the preanalytic phase of specimen collection and transport. Here, we describe our efforts to improve molecular testing turnaround times by focusing primarily on redesign of preanalytic processes using the principles of LEAN production. Our goal was to complete greater than 90% of the molecular tests in less than 3 days. The project required cooperation from different laboratory disciplines as well as individuals outside of the laboratory. The redesigned processes involved defining and standardizing the protocols and approaching blood and tissue specimens as analytes for molecular testing. The LEAN process resulted in fewer steps, approaching the ideal of a one-piece flow for specimens through collection/retrieval, transport, and different aspects of the testing process. The outcome of introducing the LEAN process has been a 44% reduction in molecular test turnaround time for tissue specimens, from an average of 2.7 to 1.5 days. In addition, extending LEAN work principles to the clinician suppliers has resulted in a markedly increased number of properly collected and shipped blood specimens (from 50 to 87%). These continuous quality improvements were accomplished by empowered workers in a blame-free environment and are now being sustained with minimal management involvement.
Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third
As the 2nd Joint Symposium of the Japanese Society of Laboratory Medicine and the Japanese Association of Laboratory Pathologists, the symposium on clinical test out-sourcing and branch laboratories was held at the 60th General Meeting of the Japanese Society of Laboratory Medicine on November 2nd, 2013 in Kobe. For the symposium, we conducted a questionnaire survey on the usage of clinical test out-sourcing and the introduction of branch laboratories to clinical laboratories of Japanese university hospitals, both private and public, between July 25th and August 20th, 2013. Seventy-two hospitals responded to the questionnaire survey, consisting of 41 public medical school hospitals and 31 private ones. According to the survey, the selection of each clinical test for out-sourcing was mainly determined by the capacities of hospital clinical laboratories and their equipment, as well as the profitability of each test. The main concerns of clinical laboratory members of university hospitals involved the continuity of measurement principles, traceability, and standardization of reference values for each test. They strongly requested the interchangeability and computerization of test data between laboratory testing companies. A branch laboratory was introduced to six hospitals, all of which were private medical college hospitals, out of 72 university hospitals, and eight of the other hospitals were open to its introduction. The merits and demerits of introducing a branch laboratory were also discussed. (Review).
Full Text Available The aim of this work was to analyse the medication process and the potential for errors during the process steps. For this purpose, a literature review was conducted and a questionnaire was developed to compare the results from the literature with the current medication process in Styrian hospitals. The questionnaire was divided into four different parts with a total of 29 questions. For the survey all 37 Styrian hospitals were contacted whereas 11 filled out the questionnaire. The survey showed that there is no standardized medication process defined and that the rate of medication errors is generally underestimated. In addition, technical solutions may help to reduce errors but are expected to be hardly used in clinical practice.
Aguirre H, Paulina; Zarate S, Herman; Silva R, Samy; Hitschfeld, Mario
The nuclear development applications have also reached those areas related to health. The risk of getting contagious illnesses through applying biological tissues has been one of the paramount worries to be solved since infectious illnesses might be provoked by virus, fungis or bacterias coming from donors or whether they have been introduced by means of intermediate stages before the use of these tissues. Therefore it has been concluded that the tissue allografts must be sterilized. The sterilization of medical products has been one of the main applications of the ionizing radiations and that it is why the International Organization of Atomic Energy began in the 70s promoting works related to the biological tissue sterilization and pharmaceutical products. The development of different tissue preservation methods has made possible the creation of tissue banks in different countries, to deal with long-term preservation. In our country, a project was launched in 1998, 'Establishment of a Tissue Bank in Latino america', this project was supported by the OIEA through the project INT/ 6/ 049, and was the starting of the actual Processing Laboratory of Radioesterilized Biological Tissues (LPTR), leaded by the Chilean Nuclear Energy Commission (CCHEN). This first organization is part of a number of entities compounding the Tissue Bank in Chile, organizations such as the Transplantation Promotion Corporation hospitals and the LPTR. The working system is carried out by means of the interaction between the hospitals and the laboratory. The medical professionals perform the procuring of tissues in the hospitals, then send them to the LPTR where they are processed and sterilized with ionizing radiation. The cycle ends up with the tissues return released to the hospitals, where they are used, and then the result information is sent to the LPTR as a form of feedback. Up to now, human skin has been processed (64 donors), amniotic membranes (35 donors) and pig skin (175 portions
integrated and detailed analysis and description model for hospital materials management data and tasks, which is able to tackle information from patient requirements to usage, from replenishment requests to supplying and handling activities. The model takes account of medical risk reduction, traceability and streamlined processes perspectives. Second, the paper translates this information into a business process model and mathematical formalization.The study provides a useful guide to the various relevant technology‐related, management and business issues, laying the foundations of an efficient reengineering of the supply chain to reduce healthcare costs and improve the quality of care.
Bonten, M J M
The Netherlands Health Care Inspectorate investigated the quality of medical microbiology laboratories in Dutch hospitals. By and large the laboratories fulfilled the requirements for appropriate care, although some processes were unsatisfactory and some were insufficiently formalised. In the Netherlands, laboratories for medical microbiology are integrated within hospitals and medical microbiologists are responsible for the diagnostic processes as well as for co-treatment of patients, infection prevention and research. This integrated model contrasts to the more industrialised model in many other countries, where such laboratories are physically distinct from hospitals with a strong focus on diagnostics. The Inspectorate also concludes that the current position of medical microbiology in Dutch hospitals is necessary for patient safety and that outsourcing of these facilities is considered unacceptable.
Federal Laboratory Consortium — The Laboratory for Advanced Materials Processing - LAMP - is a clean-room research facility run and operated by Pr. Gary Rubloff's group. Research activities focus...
Yokota, Hiromitsu; Yatomi, Yutaka
Clinical laboratories in university hospitals should be operated with a good balance of medical practice, education, research, and management. The role of a clinical laboratory is to promptly provide highly reliable laboratory data to satisfy the needs of clinicians involved in medical practice and health maintenance of patients. Improvement and maintenance of the quality of the laboratory staff and environment are essential to achieve this goal. In order to implement these requirements efficiently, an appropriate quality management system should be introduced and established, and evaluated objectively by a third party (e.g. by obtaining ISO 15189 certification). ISO 15189 is an international standard regarding the quality and competence of clinical laboratories, and specifies a review of the efficient operational system and technical requirements such as competence in implementing practical tests and calibration. This means the results of laboratory tests reported by accredited laboratories withstand any international evaluation, which is very important to assure the future importance of the existence and management of clinical laboratories as well as internationalization of medical practice. "Education" and "research" have important implications in addition to "medical practice" and "management", as the roles that clinical laboratories should play in university hospitals. University hospital laboratories should be operated by keeping these four factors in good balance. Why are "education" and "research" required in addition to "medical practice" services? If individual clinical laboratory technologists can provide an appropriate response to this question, the importance of the existence of clinical laboratories would be reinforced, without being compromised.
Rizk, Mostafa M; Zaki, Adel; Hossam, Nermine; Aboul-Ela, Yasmin
The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement (March-May 2012); an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement (June 2012); and phase II, which included data collection for evaluation of the process after improvement (July 2012-September 2012). In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items (Plaboratories.
Strategic management is concerned with strategic choices and strategic implementation; it provides the means by which organizations meet their objectives. In the case of hospitals it helps executives and all employees to understand the real purpose and long term goals of the hospital. Also, it helps the hospital find its place in the health care service provision chain, and enables the hospital to coordinate its activities with other organizations in the health care system. Strategic management is a tool, rather than a solution, that helps executives to identify root causes of major problems in the hospital.
Hamza, Alneil; Ahmed-Abakur, Eltayib; Abugroun, Elsir; Bakhit, Siham; Holi, Mohamed
The present study was designed in quasi-experiment to assess adoption of the essential clauses of particular clinical laboratory quality management requirements based on international organization for standardization (ISO 15189) in hospital laboratories and to evaluate the cost effectiveness of compliance to ISO 15189. The quality management intervention based on ISO 15189 was conceded through three phases; pre - intervention phase, Intervention phase and Post-intervention phase. In pre-intervention phase the compliance to ISO 15189 was 49% for study group vs. 47% for control group with P value 0.48, while the post intervention results displayed 54% vs. 79% for study group and control group respectively in compliance to ISO 15189 and statistically significant difference (P value 0.00) with effect size (Cohen's d) of (0.00) in pre-intervention phase and (0.99) in post - intervention phase. The annual average cost per-test for the study group and control group was 1.80 ± 0.25 vs. 1.97 ± 0.39, respectively with P value 0.39 whereas the post-intervention results showed that the annual average total costs per-test for study group and control group was 1.57 ± 0.23 vs 2.08 ± 0.38, P value 0.019 respectively, with cost-effectiveness ratio of (0.88) in pre -intervention phase and (0.52) in post-intervention phase. The planned adoption of quality management requirements (QMS) in clinical laboratories had great effect to increase the compliance percent with quality management system requirement, raise the average total cost effectiveness, and improve the analytical process capability of the testing procedure.
The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections.
Andrade, Germán Lobos; Palma, Carolina Salas
To determine the total average costs related to laboratory examinations performed in a hospital laboratory in Chile. Retrospective study with data from July 2014 to June 2015. 92 examinations classified in ten groups were selected according to the analysis methodology. The costs were estimated as the sum of direct and indirect laboratory costs and indirect institutional factors. The average values obtained for the costs according to examination group (in USD) were: 1.79 (clinical chemistry), 10.21 (immunoassay techniques), 13.27 (coagulation), 26.06 (high-performance liquid chromatography), 21.2 (immunological), 3.85 (gases and electrolytes), 156.48 (cytogenetic), 1.38 (urine), 4.02 (automated hematological), 4.93 (manual hematological). The value, or service fee, returned to public institutions who perform laboratory services does not adequately reflect the true total average production costs of examinations.
This Process Waste Assessment was conducted to evaluate the Radiography Laboratory, located in Building 923. It documents the processes, identifies the hazardous chemical waste streams generated by these processes, recommends possible ways to minimize waste, and serves as a reference for future assessments of this facility. The Radiography Laboratory provides film radiography or radioscopy (electronic imaging) of weapon and nonweapon components. The Radiography Laboratory has six x-ray machines and one gamma ray source. It also has several other sealed beta- and gamma-ray isotope sources of low microcurie (μCi) activity. The photochemical processes generate most of the Radiography Laboratory's routinely generated hazardous waste, and most of that is generated by the DuPont film processor. Because the DuPont film processor generates the most photochemical waste, it was selected for an estimated material balance
Birks, J L [Singleton Hospital, Swansea (UK)
Suggestions are made for procedures likely to require the provision of efficient fume-cupboards in hospital radioisotope laboratories. All such departments undertaking in vivo radioisotope procedures will require a supply of sterile materials, but only some of these will also require a fume-cupboard, since the use of a relatively inexpensive aseptic cabinet, without air flow and exhaust system, may suffice for such procedures as the labelling of blood cells or plasma. Efficient fume-cupboards may be required in hospital laboratories that are routinely concerned with the elution of generators of isotopes such as /sup 99/Tcsup(m) and /sup 113/Insup(m), the sterilization of radiopharmaceuticals (e.g. technetium-sulphur colloid) requiring the use of a pressure cooker, and the storage and handling of therapeutic quantities of /sup 131/I. Copious general ventilation of isotope rooms may be preferable to the too frequent incorporation of unnecessary fume-cupboards.
Policke, T.A.; Bryant, M.F.; Spencer, R.B.
The Defense Waste Processing Technology (DWPT) Analytical Laboratory is a relatively new laboratory facility at the Savannah River Site (SRS). It is a non-regulated, non-radioactive laboratory whose mission is to support research and development (R ampersand D) and waste treatment operations by providing analytical and experimental services in a way that is safe, efficient, and produces quality results in a timely manner so that R ampersand D personnel can provide quality technical data and operations personnel can efficiently operate waste treatment facilities. The modules are sample receiving, chromatography I, chromatography II, wet chemistry and carbon, sample preparation, and spectroscopy
Ejilemele, A A; Ojule, A C
To assess current knowledge, attitudes and practice of aspects of laboratory safety in pathology laboratories at the University of Port Harcourt Teaching Hospital in view of perceived inadequacies in safety practices in clinical laboratories in developing countries. Sixty (60) self- administered questionnaires were distributed to all cadres of staff in four (4) different laboratories (Chemical Pathology, Haematology, Blood bank and Medical Microbiology) at the Hospital. Gross deficiencies were found in the knowledge, attitudes and practice of laboratory safety by laboratory staff in areas of use of personal protective equipment, specimen collection and processing, centrifuge--related hazards, infective hazards waste disposal and provision and use of First Aid Kits. Issues pertaining to laboratory safety are not yet given adequate attention by both employers and employees in developing countries in this ear of resurgence of diseases such as HIV/AIDS and Hepatitis Band C, is emphasized.
Hachesu, Peyman Rezaei; Zyaei, Leila; Hassankhani, Hadi
Lack of attention to the proper barcode using leads to lack of use or misuse in the hospitals. The present research aimed to investigate the requirements and barrier for using barcode technology and presenting suggestions to use it. The research is observational-descriptive. The data was collected using the designed checklist which its validity was assessed. This check list consists of two parts: "Requirements" and "barrier" of using the barcodes. Research community included 10 teaching hospitals and a class of 65 participants included people in the hospitals. The collected data was analyzed using descriptive statistics. Required changes of workflow processes in the hospital and compliance them with the hospital policy are such requirements that had been infringed in the 90 % of hospitals. Prioritization of some hospital processes for barcoding, system integration with Hospital Information system (HIS), training of staff and budgeting are requirements for the successful implementation which had been infringed in the 80% of hospitals. Dissatisfaction with the quality of barcode labels and lacks of adequate scanners both whit the rate of 100 %, and the lack of understanding of the necessary requirements for implementation of barcodes as 80% were the most important barrier. Integrate bar code system with clinical workflow should be considered. Lack of knowledge and understanding toward the infrastructure, inadequate staff training and technologic problems are considered as the greatest barriers.
Levin, Martin; Morgner, Raymond; Packer, Bernice
Two turn-key systems, one for patient registration and the other for the clinical laboratory have been installed and linked together at the Hospital of the University of Pennsylvania, forming the nucleus of an evolving distributed Hospital Information System.
Tiempo de trabajo en el laboratorio clínico de urgencia del Hospital "León Cuervo Rubio". Pinar del Río Duration of the process at Emergency-clinical Laboratory. “Leon Cuervo Rubio” General Hospital, Pinar del Rio
Calixto Borrego Carmona
on the quality of service at the emergency clinical laboratory, “Leon Cuervo Rubio” General Hospital, Pinar del Rio. Material and method: cross-sectional prospective study where the target group included the whole patients who used the services of the emergency- clinical laboratory and the sample involved 500 patients to whom the process time was determined or the time the specimen lasted in two stages. First stage: 250 patients attended to the emergency laboratory, they were seen by the habitual team-works (4 in total and were classified into inpatients and outpatients. Second stage: an action plan was applied in view of the results obtained in the first stage and the same outline of work was carried out the same of the previous stage. Results: process time in the first stage was excessively prolonged, the final report lasted less for outpatients and different behaviors were observed among the team-works that participated. Conclusions: poor performance of support and message personnel concerning the laboratory with the patient was observed. Proving a different level of priority in the laboratory through the confirmation of the duration of the process, which it is less for outpatients than for inpatients.
Siyem C. Nkwawir
Objectives: To evaluate the results of SLMTA implementation at BRHL and discuss lessons learned. Method: In 2010, the SLMTA programme was rolled out in Cameroon to improve laboratory quality management systems in five laboratories, including BRHL. Three workshops were conducted (the first centralised, the remaining two on-site at each laboratory and improvement projects were implemented after each workshop with the assistance of mentors. Audits were used in order to evaluate performance and to identify areas for further improvement. Results: BRHL had the lowest score (18% amongst the cohort at the baseline audit and the highest (81% at the official Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA audit conducted in August 2013 by the African Society for Laboratory Medicine. Improvements were observed in each of the 12 Quality System Essentials; improvement was especially noteworthy in the areas of facilities and safety, and purchasing and inventory. Staff investment and pride in the quality of laboratory services increased. Conclusion: BRHL’s remarkable improvement was achieved with a combination of SLMTA training activities, intensive on-site mentorship and the collective focus of all laboratory staff. The experience at Bamenda Hospital illustrates what can be achieved when a laboratory successfully harnesses the energy of its staff and implements changes to improve the quality of services in a transformation taking them from grass to grace.
Mbembati, Naboth A; Mwangu, Mugwira; Muhondwa, Eustace P Y; Leshabari, Melkizedek M
Muhimbili National Hospital (MNH), a teaching and national referral hospital, is undergoing major reforms to improve the quality of health care. We performed a retrospective descriptive study using a set of performance indicators for the surgical and laboratory services of MNH in years 2001 and 2002, to help monitor and evaluate the impact of reforms on the quality of health care during and after the reform process. Hospital records were reviewed and information recorded for planned and postponed operations, laboratory equipment, reagents, laboratory tests and quality assurance programmes. In the year 2001 a total of 4332 non-emergency operations were planned, 3313 operations were performed and 1019 (23.5%) operations were postponed. In the year 2002, 4301 non-emergency operations were planned, 3046 were performed and 1255 (29%) were postponed. The most common reasons for operation postponement were "time-barred", interference by emergency operations, no show of patients and inoperable anaesthetic machines. Equipment problems and supply and staff shortages together accounted for one quarter of postponements. In the laboratory, a lack of equipment prevented some tests, but quality assurance was performed for most tests. Current surgical services at MNH are inadequate; operating theatres require modern, functioning equipment and adequate supplies of consumables to provide satisfactory care.
Kaissi, Amer A; Begun, James W
Many common management practices in healthcare organizations, including the practice of strategic planning, have not been subject to widespread assessment through empirical research. If management practice is to be evidence-based, evaluations of such common practices need to be undertaken. The purpose of this research is to provide evidence on the extent of strategic planning practices and the association between hospital strategic planning processes and financial performance. In 2006, we surveyed a sample of 138 chief executive officers (CEOs) of hospitals in the state of Texas about strategic planning in their organizations and collected financial information on the hospitals for 2003. Among the sample hospitals, 87 percent reported having a strategic plan, and most reported that they followed a variety of common practices recommended for strategic planning-having a comprehensive plan, involving physicians, involving the board, and implementing the plan. About one-half of the hospitals assigned responsibility for the plan to the CEO. We tested the association between these planning characteristics in 2006 and two measures of financial performance for 2003. Three dimensions of the strategic planning process--having a strategic plan, assigning the CEO responsibility for the plan, and involving the board--are positively associated with earlier financial performance. Further longitudinal studies are needed to evaluate the cause-and-effect relationship between planning and performance.
Lumetta, Gregg J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Meier, David E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Tingey, Joel M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Casella, Amanda J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Delegard, Calvin H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Edwards, Matthew K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Orton, Robert D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rapko, Brian M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Smart, John E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)
This report describes a design for a laboratory-scale capability to produce plutonium oxide (PuO2) for use in identifying and validating nuclear forensics signatures associated with plutonium production, as well as for use as exercise and reference materials. This capability will be located in the Radiochemical Processing Laboratory at the Pacific Northwest National Laboratory. The key unit operations are described, including PuO2 dissolution, purification of the Pu by ion exchange, precipitation, and re-conversion to PuO2 by calcination.
for practical applications has not been identified. The aim of this paper is to establish a conceptual framework for business process innovation in the supply chain based on advanced enterprise systems. The main approach to business process innovation in this context is to create a new methodology for exploring...... process models and patterns of applications. The paper thus presents a new concept for business process innovation called the process innovation laboratory a.k.a. the ?-Lab. The ?-Lab is a comprehensive framework for BPI using advanced enterprise systems. The ?-Lab is a collaborative workspace...... for experimenting with process models and an explorative approach to study integrated modeling in a controlled environment. The ?-Lab facilitates innovation by using an integrated action learning approach to process modeling including contemporary technological, organizational and business perspectives....
Green, Scott; Basili, Victor; Godfrey, Sally; Mcgarry, Frank; Pajerski, Rose; Waligora, Sharon
The Software Engineering Laboratory (SEL) cleanroom process model is described. The term 'cleanroom' originates in the integrated circuit (IC) production process, where IC's are assembled in dust free 'clean rooms' to prevent the destructive effects of dust. When applying the clean room methodology to the development of software systems, the primary focus is on software defect prevention rather than defect removal. The model is based on data and analysis from previous cleanroom efforts within the SEL and is tailored to serve as a guideline in applying the methodology to future production software efforts. The phases that are part of the process model life cycle from the delivery of requirements to the start of acceptance testing are described. For each defined phase, a set of specific activities is discussed, and the appropriate data flow is described. Pertinent managerial issues, key similarities and differences between the SEL's cleanroom process model and the standard development approach used on SEL projects, and significant lessons learned from prior cleanroom projects are presented. It is intended that the process model described here will be further tailored as additional SEL cleanroom projects are analyzed.
Workman, Gary L.; Kaukler, William F.
Materials science and engineering provides a vast arena for applications of artificial intelligence. Advanced materials research is an area in which challenging requirements confront the researcher, from the drawing board through production and into service. Advanced techniques results in the development of new materials for specialized applications. Hand-in-hand with these new materials are also requirements for state-of-the-art inspection methods to determine the integrity or fitness for service of structures fabricated from these materials. Two problems of current interest to the Materials Processing Laboratory at UAH are an expert system to assist in eddy current inspection of graphite epoxy components for aerospace and an expert system to assist in the design of superalloys for high temperature applications. Each project requires a different approach to reach the defined goals. Results to date are described for the eddy current analysis, but only the original concepts and approaches considered are given for the expert system to design superalloys.
This plant was built in 1956 in response to a need for the manufacture of neutron generators, a principal component in nuclear weapons. The neutron generators consist of a miniaturized linear ion accelerator assembled with the pulsed electrical power supplies required for its operation. The ion accelerator, or neutron tube, requires ultra clean, high vacuum technology: hermetic seals between glass, ceramic, glass-ceramic, and metal materials: plus high voltage generation and measurement technology. The existence of these capabilities at the Pinellas Plant has led directly to the assignment of the lightning arrester connector, specialty capacitor, vacuum switch, and crystal resonator. Active and reserve batteries and the radioisotopically-powered thermoelectric generator draw on the materials measurement and controls technologies which are required to ensure neutron generator life. A product development and production capability in alumina ceramics, cermet (electrical) feedthroughs, and glass ceramics has become a specialty of the plant; the laboratories monitor the materials and processes used by the plant's commercial suppliers of ferroelectric ceramics. In addition to the manufacturing facility, a production development capability is maintained at the Pinellas Plant.
This article describes the expansion and reorganization of a moderate-sized Canadian laboratory from Day One to "Live Day." The key factors to the success of this project were organized planning by the laboratory staff and the introduction of core lab theories, team building, and organized training sessions. The successful makeover resulted in improved turnaround time for STAT tests, especially those coming from the Emergency Unit. The efforts of the laboratory personnel toward the improvement of laboratory services, in spite of budget, human resources constraints, and resistance to change, are addressed.
Kansara, V.P.; Achuthan, P.V.; Sridhar, S.; Ramanujam, A.; Dhumwad, R.K.
A software has been developed at the Fuel Reprocessing Division, Trombay to meet the data processing needs of the Control Laboratory of a reprocessing plant. During the normal plant operations contents of over one hundred process tanks have to be sampled and analysed for regular monitoring. In order to speed up the computation and the reporting of results as well as to obtain the process performance data over a period of time a software has been developed. The package has been sucessfully demonstrated and implemented at the Plutonium Plant, Trombay. This has been in continuous use since May 1987 with highly satisfactory performance. The software is a totally menu-driven package which can be used by the laboratory analysts with a few hours of training. The features include data validation involving source tank identification, the nature of the sample, the range of expected results, any duplication in sample numbering etc. Audio indication of deviations from the expected input or output values are given with an option to override in case of abnormal samples. The progress of analysis can be obtained for a given sample at any given time. Incorporated in the software is the help menu for quick reference of analytical protocol to be followed for a given tank/method. The computations for the determinations are carried out after obtaining input values on a screen-form. Th e results can be displayed on the monitor or obtained in the form of a hard copy i n any desired format. (author). 17 figs., 2 refs
Sewunet, Tsegaye; Kebede, Wakjira; Wondafrash, Beyene; Workalemau, Bereket; Abebe, Gemeda
Unsafe working practices, working environments, disposable waste products, and chemicals in clinical laboratories contribute to infectious and non-infectious hazards. Staffs, the community, and patients are less safe. Furthermore, such practices compromise the quality of laboratory services. We conducted a study to describe safety practices in public hospital laboratories of Oromia Regional State, Ethiopia. Randomly selected ten public hospital laboratories in Oromia Regional State were studied from Oct 2011- Feb 2012. Self-administered structured questionnaire and observation checklists were used for data collection. The respondents were heads of the laboratories, senior technicians, and safety officers. The questionnaire addressed biosafety label, microbial hazards, chemical hazards, physical/mechanical hazards, personal protective equipment, first aid kits and waste disposal system. The data was analyzed using descriptive analysis with SPSS version16 statistical software. All of the respondents reported none of the hospital laboratories were labeled with the appropriate safety label and safety symbols. These respondents also reported they may contain organisms grouped under risk group IV in the absence of microbiological safety cabinets. Overall, the respondents reported that there were poor safety regulations or standards in their laboratories. There were higher risks of microbial, chemical and physical/mechanical hazards. Laboratory safety in public hospitals of Oromia Regional State is below the standard. The laboratory workers are at high risk of combined physical, chemical and microbial hazards. Prompt recognition of the problem and immediate action is mandatory to ensure safe working environment in health laboratories.
Elrod, Jeffrey M; Karnad, Anand B
Established in 1923, the Thorndike Memorial Laboratory at Boston City Hospital was the first clinical research laboratory in a municipal hospital in the United States of America. Minot and Castle, who were the second and third directors of the Laboratory, were pioneer haematologists and clinical investigators of the highest calibre who created an atmosphere at the Laboratory that would foster patient-centred research and attract the best physician-scientists to work and train there. The haematology research division of the Laboratory made important original contributions to the understanding of the pathophysiology of anaemia, the mechanisms of red cell and platelet destruction and the phagocytic role of the spleen, the nature of haemoglobin (normal and sickle cell), the nature of haemophilia and its therapy and the early classification of lymphoma. It contributed to the Thorndike Memorial Laboratory's worldwide reputation as a model research laboratory and established its reputation as the birthplace of modern haematology.
Biljak, Vanja Radisic; Ozvald, Ivan; Radeljak, Andrea; Majdenic, Kresimir; Lasic, Branka; Siftar, Zoran; Lovrencic, Marijana Vucic; Flegar-Mestric, Zlata
The aim of the study was to present a protocol for laboratory information system (LIS) and hospital information system (HIS) validation at the Institute of Clinical Chemistry and Laboratory Medicine of the Merkur University Hospital, Zagreb, Croatia. Validity of data traceability was checked by entering all test requests for virtual patient into HIS/LIS and printing corresponding barcoded labels that provided laboratory analyzers with the information on requested tests. The original printouts of the test results from laboratory analyzer(s) were compared with the data obtained from LIS and entered into the provided template. Transfer of data from LIS to HIS was examined by requesting all tests in HIS and creating real data in a finding generated in LIS. Data obtained from LIS and HIS were entered into a corresponding template. The main outcome measure was the accuracy of transfer obtained from laboratory analyzers and results transferred from LIS and HIS expressed as percentage (%). The accuracy of data transfer from laboratory analyzers to LIS was 99.5% and of that from LIS to HIS 100%. We presented our established validation protocol for laboratory information system and demonstrated that a system meets its intended purpose.
Soerensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter
Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits in the w......Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits...... in the wards collecting dispensed drugs; and (3) chart reviews. All errors, except errors in discharge summaries, were assessed for potential consequences by two clinical pharmacologists. Setting: Three psychiatric wards with adult patients at Aalborg University Hospital, Denmark, from January 2010–April 2010...... process are common in psychiatric wards to an extent which resembles error rates in somatic care. Despite a substantial proportion of errors with potential to harm patients, very few errors were considered potentially fatal. Medical staff needs greater awareness of medication safety and guidelines related...
Yarmohammadian, Mohammad H; Ebrahimipour, Hossein; Doosty, Farzaneh
In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.
Marchwinski, J; Coggins, F
Managers of hospital-based laboratories have begun to realize the importance of a successful outreach program in protecting against declining inpatient activity. Succeeding in the highly competitive field of outpatient testing requires some new skills and techniques that may not have been apparent when addressing normal inpatient requirements. This article provides an overview of some very basic marketing concepts and attempts to show how they can assist the hospital-based laboratory manager in developing a successful outreach program.
Sheila Moura Pone
Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.
Aubry, J.; Passelegue, F. X.; Deldicque, D.; Lahfid, A.; Girault, F.; Pinquier, Y.; Escartin, J.; Schubnel, A.
Frictional heating during seismic slip plays a crucial role in the dynamic of earthquakes because it controls fault weakening. This study proposes (i) to image frictional heating combining an in-situ carbon thermometer and Raman microspectrometric mapping, (ii) to combine these observations with fault surface roughness and heat production, (iii) to estimate the mechanical energy dissipated during laboratory earthquakes. Laboratory earthquakes were performed in a triaxial oil loading press, at 45, 90 and 180 MPa of confining pressure by using saw-cut samples of Westerly granite. Initial topography of the fault surface was +/- 30 microns. We use a carbon layer as a local temperature tracer on the fault plane and a type K thermocouple to measure temperature approximately 6mm away from the fault surface. The thermocouple measures the bulk temperature of the fault plane while the in-situ carbon thermometer images the temperature production heterogeneity at the micro-scale. Raman microspectrometry on amorphous carbon patch allowed mapping the temperature heterogeneities on the fault surface after sliding overlaid over a few micrometers to the final fault roughness. The maximum temperature achieved during laboratory earthquakes remains high for all experiments but generally increases with the confining pressure. In addition, the melted surface of fault during seismic slip increases drastically with confining pressure. While melting is systematically observed, the strength drop increases with confining pressure. These results suggest that the dynamic friction coefficient is a function of the area of the fault melted during stick-slip. Using the thermocouple, we inverted the heat dissipated during each event. We show that for rough faults under low confining pressure, less than 20% of the total mechanical work is dissipated into heat. The ratio of frictional heating vs. total mechanical work decreases with cumulated slip (i.e. number of events), and decreases with
Apart from a multidimensional quality definition and the understanding of quality as a company-wide challenge, a third essential element of quality management is prevention. Thus, company quality policy has to be prevention-oriented and requires both customer and process orientation as important prerequisites. Process orientation especially focuses on the critical analyses of work flows as a condition for identifying early intervention options which, in turn, may influence the result. Developing a business organisation requires the definition of criteria for space planning, room assignment and room integration in consideration of both medical and economic aspects and the architectural concept. Specific experiences will be demonstrated as a case study using the example of a new building in the midst of the Carl Gustav Carus University Hospital in Dresden, the Diagnostic Centre for Internal Medicine and Neurology. The hospital management placed an order to develop a sustainable as well as feasible business organisation for all the different departments. The idea was to create a medical centre where maximum use was made of all planned spaces and resources on the basis of target processes which had to be defined and agreed upon with all the persons concerned. In a next step all the personal, space and operational resources required were assigned. The success of management in all industries, including the health care sector, crucially depends on the translation of ideas into practice, among them the critical factor of sustainability. In this context, the support by the management as a role model, a formal frame for the respective project group and the definition of controlling via defined indicators have special importance. The example of the Diagnostic Centre for Internal Medicine and Neurology demonstrates that the result of changed processes may release a cultural change where competition can be replaced by cooperation step by step. Copyright © 2010. Published by
Borges, O.N.; Barros, M.P. de.
A method for uranium extraction in presence of various aquometallic ions, based on selective photo-reduction of uranium is studied. Some economical advantages in relation with others conventional processes are analysed. (M.J.C.) [pt
It was clear long before the Apollo missions that a darkening process occurs on the moon. However, its nature remains controversial and elusive. Current evidence implies that the darkening is associated with, and is probably caused by, submicroscopic metallic iron in the regolith. Questions discussed at the workshop include: (1) under what conditions will impact vitrification produce a dark glass; (2) what is the role of the submicroscopic metallic Fe (SMFe) in the lunar darkening process; (3) how is the SMFe produced; (4) is there a significant component of the regolith that has been deposited from a vapor, if so, what form is it in, and how can it be recognized, what are its effects on the chemistry of the regolith; (5) how do the processes of impact vitrification, vaporization, sputtering, and SMFe production vary as a function of distance from the sun and location in planetary magnetospheres; and (6) what other processes might affect optical properties. Ices have lower melting and boiling temperatures and sputtering yields several orders of magnitude larger than silicates. Hence, analogous processes will occur to an even greater extent on satellites of the outer planets, and these questions are relevant to those bodies as well.
Sanner, Jennifer E; Frazier, Lorraine; Udtha, Malini
Despite the availability of established guidelines for measuring platelet serotonin, these guidelines may be difficult to follow in a hospital setting where time to processing may vary from sample to sample. The purpose of this study was to evaluate the effect of the time to processing of human blood samples on the stability of the enzyme-linked immunosorbent assay (ELISA) for the determination of platelet serotonin levels in human plasma. Human blood samples collected from a convenience sample of eight healthy volunteers were analyzed to determine platelet serotonin levels from plasma collected in ethylene diamine tetra acetic acid (EDTA) tubes and stored at 4°C for 3 hr, 5 hr, 8 hr, and 12 hr. Refrigeration storage at 4°C for 3 hr, 5 hr, 8 hr, and 12 hr altered the platelet serotonin measurement when compared to immediate processing. The bias for the samples stored at 4°C for 3 hr was 102.3 (±217.39 ng/10(9) platelets), for 5 hr was 200.1 (±132.76 ng/10(9) platelets), for 8 hr was 146.9 (±221.41 ng/10(9) platelets), and for 12 hr was -67.6 (±349.60 ng/10(9) platelets). Results from this study show that accurate measurement of platelet serotonin levels is dependent on time to processing. Researchers should therefore follow a standardized laboratory guideline for obtaining immediate platelet serotonin levels after blood sample collection.
Will, H.; Mackin, M. A.
Computer program provides natural-language process control from IBM PC or compatible computer. Sets up process-control system that either runs without operator or run by workers who have limited programming skills. Includes three smaller programs. Two of them, written in FORTRAN 77, record data and control research processes. Third program, written in Pascal, generates FORTRAN subroutines used by other two programs to identify user commands with device-driving routines written by user. Also includes set of input data allowing user to define user commands to be executed by computer. Requires personal computer operating under MS-DOS with suitable hardware interfaces to all controlled devices. Also requires FORTRAN 77 compiler and device drivers written by user.
Chew, L P; Chua, H H
In 2008, an outbreak of chikungunya infection occurred in Johor. We performed a retrospective review of all laboratory confirmed adult chikungunya cases admitted to Hospital Sultanah Aminah, Johor Bahru from April to August 2008, looking into clinical and laboratory features. A total of 18 laboratory confirmed cases of chikungunya were identified with patients presenting with fever, joint pain, rash and vomiting. Haemorrhagic signs were not seen. Lymphopenia, neutropenia, thrombocytopenia, raised liver enzymes and deranged coagulation profile were the prominent laboratory findings. We hope this study can help guide physician making a diagnosis of chikungunya against other arborviruses infection.
Lulie, Adino D; Hiwotu, Tilahun M; Mulugeta, Achamyeleh; Kebede, Adisu; Asrat, Habtamu; Abebe, Abnet; Yenealem, Dereje; Abose, Ebise; Kassa, Wondwossen; Kebede, Amha; Linde, Mary K; Ayana, Gonfa
Strengthening Laboratory Management Toward Accreditation (SLMTA) is a competency-based management training programme. Assessing health professionals' views of SLMTA provides feedback to inform program planning, implementation and evaluation of SLMTA's training, communication and mentorship components. To assess laboratory professionals' and hospital chief executive officers' (CEOs) perceptions and attitudes toward the SLMTA programme in Ethiopia. A cross-sectional descriptive survey was conducted in March 2013 using a structured questionnaire to collect qualitative data from 72 laboratory professionals and hospital CEOs from 17 health facilities, representing all regions and two city administrations in Ethiopia. Focus groups were conducted with laboratory professionals and hospital administration to gain insight into the strengths and challenges of the SLMTA programme so as to guide future planning and implementation. Ethiopian laboratory professionals at all levels had a supportive attitude toward the SLMTA programme. They believed that SLMTA substantially improved laboratory services and acted as a catalyst for total healthcare reform and improvement. They also noted that the SLMTA programme achieved marked progress in laboratory supply chain, sample referral, instrument maintenance and data management systems. In contrast, nearly half of the participating hospital CEOs, especially those associated with low-scoring laboratories, were sceptical about the SLMTA programme, believing that the benefits of SLMTA were outweighed by the level of human resources and time commitment required. They also voiced concerns about the cost and sustainability of SLMTA. This study highlights the need for stronger engagement and advocacy with hospital administration and the importance of addressing concerns about the cost and sustainability of the SLMTA programme.
Adino D. Lulie
Full Text Available Background: Strengthening Laboratory Management Toward Accreditation (SLMTA is a competency-based management training programme. Assessing health professionals’ views of SLMTA provides feedback to inform program planning, implementation and evaluation of SLMTA's training, communication and mentorship components. Objectives: To assess laboratory professionals’ and hospital chief executive officers’ (CEOs perceptions and attitudes toward the SLMTA programme in Ethiopia. Methods: A cross-sectional descriptive survey was conducted in March 2013 using a structured questionnaire to collect qualitative data from 72 laboratory professionals and hospital CEOs from 17 health facilities, representing all regions and two city administrations in Ethiopia. Focus groups were conducted with laboratory professionals and hospital administration to gain insight into the strengths and challenges of the SLMTA programme so as to guide future planning and implementation. Results: Ethiopian laboratory professionals at all levels had a supportive attitude toward the SLMTA programme. They believed that SLMTA substantially improved laboratory services and acted as a catalyst for total healthcare reform and improvement. They also noted that the SLMTA programme achieved marked progress in laboratory supply chain, sample referral, instrument maintenance and data management systems. In contrast, nearly half of the participating hospital CEOs, especially those associated with low-scoring laboratories, were sceptical about the SLMTA programme, believing that the benefits of SLMTA were outweighed by the level of human resources and time commitment required. They also voiced concerns about the cost and sustainability of SLMTA. Conclusion: This study highlights the need for stronger engagement and advocacy with hospital administration and the importance of addressing concerns about the cost and sustainability of the SLMTA programme.
Lundergan, C.D.; Mead, P.L.
Materials and process activities have emphasized the balance between research and development necessary to provide materials compatible with the extreme environments and performance requirements associated with nuclear ordnance. Specific technical areas which have continuing emphasis include metallurgy, composites, surface characterization and thin films, polymers, ceramics, and high-temperature characterization. Complete processing and fabrication facilities assure the capability for early evaluation and use of tailored materials. Efforts are focused on material applications involving structural and electronic materials, thermal and electrical insulation, radiation shields, and shock mitigation. Key elements in these efforts are functionability, reliability, and longevity. This interdisciplinary approach to scientific materials engineering results from the recognition that many disciplines are required to understand, characterize, and apply materials, and from the fact that material design is an essential element in meeting the objectives of quality, functionality, and life. In effect, the responsibility of a materials group extends beyond the development of a material into the understanding and description of its behavior in the extreme environments to which it will be subjected
Guarner, Jeannette; Street, Cassandra; Matlock, Margaret; Cole, Lisa; Brierre, Francoise
Consolidation of laboratories has left many hospitals and satellite laboratories with minimal microbiologic testing. In many hospitals and satellite laboratories, Gram stains on primary specimens are still performed despite difficultly in maintaining proficiency. To maintain Gram stain proficiency at a community 450-bed hospital with an active emergency room we designed bimonthly challenges that require reporting Gram staining and morphology of different organisms. The challenges consist of five specimens prepared by the reference microbiology laboratory from cultures and primary specimens. Twenty to 23 medical laboratory scientists participate reading the challenges. Results from the challenges are discussed with each medical laboratory scientists. In addition, printed images from the challenges are presented at huddle to add microbiology knowledge. On the first three challenges, Gram staining was read correctly in 71%-77% of the time while morphology 53%-66%. In the last six challenges correct answers for Gram stain were 77%-99% while morphology 73%-96%. We observed statistically significant improvement when reading Gram stains by providing frequent challenges to medical laboratory scientists. The clinical importance of Gram stain results is emphasized during huddle presentations increasing knowledge and motivation to perform the test for patients.
Langlois, Michel R; Wallemacq, Pierre
To face the economic pressures arising from the current socio-economic conjuncture, hospital laboratories are endangered by an increasing trend towards the outsourcing of clinical laboratory tests to external (mega-) laboratories. This should allow hospitals to meet their economic requirements, but with an increased risk of loss of medical quality and, mid- to long-term, loss of cost effectiveness of healthcare at the national level. To anticipate current developments (economical and technological) that inevitably will affect the future of laboratory medicine, hospital laboratories should be proactive and enhance efficiency, reduce costs by consolidation, integrate into regional networks, and form alliances or partnerships. To create additional value, the core competency of laboratory professionals must be refocused to provide medical knowledge services (consultative support to clinicians) related to in vitro diagnostic testing. To integrate cost-efficiency with medical quality, implementation of a matricial organization - operational vs. biomedical level - could be an interesting approach. This integrated structure should create total quality of laboratory testing, managing the entire medical diagnostic cycle from the pre-preanalytical to post-postanalytical phase.
Lam, H C; Kominski, G F; Petz, L D; Sofaer, S
A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories. This study measured labor efficiency in 40 hospital-based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency. With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers. Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.
Full Text Available This paper describes the progress in the development of virtual and remote laboratories at Department of Information Engineering and Process Control, FCFT STU in Bratislava. Article is the overview of technical solutions used for online education purposes. These comprise software technologies, most commonly used in virtual and remote laboratory design at our department, as MATLAB Web Server, Java, C/C++, and Adobe Flash. We have created virtual laboratories as online Web applications, which provide features of mathematical computing and simulations of technological plants. We also describe a technology of remote control laboratory with a real experimental device.
Cadamuro, Janne; Gaksch, Martin; Wiedemann, Helmut; Lippi, Giuseppe; von Meyer, Alexander; Pertersmann, Astrid; Auer, Simon; Mrazek, Cornelia; Kipman, Ulrike; Felder, Thomas K; Oberkofler, Hannes; Haschke-Becher, Elisabeth
Inappropriate utilization of laboratory resources is an increasing concern especially in high-throughput facilities. Until now, no reliable information has been published addressing to which extent laboratory results are actually used for clinical decision-making. Therefore, we aimed to close this gap using a novel retrospective approach including a survey of clinicians and nurses. We retrospectively evaluated the number of re-orders for potassium (K), lactate dehydrogenase (LD), aspartate-aminotransferase (AST), activated partial thromboplastin-time (APTT) and prothrombin-time/INR (PT/INR), after the initial order had to be cancelled due to preanalytical non-conformities. We analyzed subgroups regarding time to re-order, ward and sample priority (urgent vs. routine). Subsequently, we surveyed clinicians and nurses, asking for their estimate of the amount of failed re-orders as well as for possible reasons. From initially cancelled tests, only ~20% of K, LD, AST and ~30% of APTT and PT/INR tests were re-ordered within 24 h. 70% of the investigated clinical chemistry and 60% of coagulation tests were re-ordered one week after cancellation or not at all. Survey participants quite accurately estimated these numbers. Routine laboratory panels, short stay of out-patients, obsolete test results and avoiding additional phlebotomies were the main reasons for not re-ordering cancelled tests. Overall, 60-70% of test results in the investigated assays ordered in a high throughput laboratory are potentially inappropriate or of doubtful clinically importance. Although clinicians and nurses are aware of this situation, it is the duty of laboratory specialists to overcome overutilization in close collaboration with all involved healthcare workers. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Federal Laboratory Consortium — FUNCTION: Conducts research on high-frequency microwave processing of materials using a highpower, continuous-wave (CW), 83-GHz, quasi-optical beam system for rapid,...
This Process Waste Assessment was conducted to evaluate the Plotting and Digitizing Support Laboratory, located in Building 913, Room 157. It documents the processes, identifies the hazardous chemical waste streams generated by these processes, recommends possible ways to minimize waste, and serves as a reference for future assessments of this facility
Sørensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter
in the wards collecting dispensed drugs; and (3) chart reviews. All errors, except errors in discharge summaries, were assessed for potential consequences by two clinical pharmacologists. SETTING: Three psychiatric wards with adult patients at Aalborg University Hospital, Denmark, from January 2010-April 2010...
Brigl, Birgit; Wendt, Thomas; Winter, Alfred
The optimization and redesign of business processes in hospitals is an important challenge for the hospital information management who has to design and implement a suitable HIS architecture. Nevertheless, there are no tools available specializing in modeling information-driven business processes and the consequences on the communication between information processing, tools. Therefore, we will present an approach which facilitates the representation and analysis of business processes and resulting communication processes between application components and their interdependencies. This approach aims not only to visualize those processes, but to also to evaluate if there are weaknesses concerning the information processing infrastructure which hinder the smooth implementation of the business processes.
Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles
Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.
Brimhall, Bradley B; Hall, Timothy E; Walczak, Steven
A hospital laboratory relational database, developed over eight years, has demonstrated significant cost savings and a substantial financial return on investment (ROI). In addition, the database has been used to measurably improve laboratory operations and the quality of patient care.
Mindaye, Tedla; Taye, Bineyam
Despite the fact that Ethiopia has scale up antiretroviral treatment (ART) program, little is known about the patient satisfaction with ART monitoring laboratory services in health facilities. We therefore aimed to assess patient satisfaction with laboratory services at ART clinics in public hospitals. Hospital based, descriptive cross sectional study was conducted from October to November 2010 among clients attending in nine public hospitals ART clinics in Addis Ababa Ethiopia. Patients' satisfaction towards laboratory services was assessed using exit interview structured questionnaire. Data were coded and entered using EPI info 2002 (Centers for Disease Control and Prevention Atlanta, GA) and analyzed using SPSS version 15 software (SPSS INC, Chicago, IL, USA). A total of 406 clients were involved in the study. Of these 255(62.8%) were females. The overall satisfaction rate for ART monitoring laboratory services was (85.5%). Patients were satisfied with measures taken by health care providers to keep confidentiality and ability of the person drawing blood to answer question (98.3% and 96.3% respectively). Moreover, the finding of this study revealed, statistical significant associations between the overall patients' satisfaction with waiting time to get blood drawing service, availability of ordered laboratory tests and waiting time to get laboratory result with (p ART monitoring laboratory services compared to those who underwent for more than 30 minutes. Overall, the satisfaction survey showed, most respondents were satisfied with ART monitoring laboratory services. However, factors such as improving accessibility and availability of latrines should be taken into consideration in order to improve the overall satisfaction.
Saito, Norihiro; Itoga, Masamichi; Kimura, Masahiko; Inoue, Fumio; Minakawa, Satoko; Kimura, Toshiyuki; Ozaki, Hiromi; Saito, Yumiko; Takahashi, Mikiko; Fujishima, Tetsuhiro; Mizuno, Sumie; Ogawa, Shin; Kitayama, Yuko; Kudo, Kazumi; Minami, Kazushi; Abo, Fumiko; Takano, Yasuyuki; Ohdaira, Naotake; Hamada, Satoshi; Ueki, Shigeharu; Hirokawa, Makoto; Kayaba, Hiroyuki
To analyze the quality of infection control activities, bacteriological data relevant to infection control was evaluated through the microbiological data warehouse networking hospitals in two medical regions. Data regarding bacterial test results of 19 hospitals were extracted from two microbiological laboratory information data bases. The rate of MRSA among total S. aureus was used as a general indicator of infection control activities. The occupancy rate of nasal or pharyngeal swabs among MRSA-positive bacteriological samples was used as an indicator of attention paid for infection control in intensive care wards. The number of blood culture sets per examined patient was utilized as an indicator for life-long vocational education on updated medical practice relevant to infectious diseases. The rate of MRSA was significantly higher in secondary private hospitals. The occupancy rate of nasal or pharyngeal swabs was significantly higher in tertiary hospitals. The average number of blood culture set per examined patient were 1.55, 1.54 and 1.39 in tertiary, secondary public and secondary private hospitals, respectively; however, there were no statistical differences between groups. Data bases of microbiological test results shared by hospital laboratories are useful for evaluating regional infection control activities.
Handayani, P W; Hidayanto, A N; Ayuningtyas, Dumilah; Budi, Indra
The Hospital Information System (HIS) could help hospitals as a public entity to provide optimal health services. One of the main challenges of HIS implementation is an institutional change. Using institutional theory as the analytical lens, this study aims to explain the institutionalization of HIS as an instance of e-health initiatives in Indonesia. Furthermore, this paper aims for hospital management and researchers to improve the understanding of the social forces that influence hospital personnel's HIS acceptance within an organizational context. We use case studies from four public, government-owned hospitals and four privately owned (public and specialty) hospitals to explain the HIS institutionalization process by exploring the three concepts of institutional theory: institutional isomorphism, institutional logic, and institutional entrepreneurship. This study reveals that differences exist between public, government-owned and private hospitals with regard to the institutionalization process: public, government-owned hospitals' management is more motivated to implement HIS to comply with the regulations, while private hospitals' management views HIS as an urgent requirement that must be achieved. The study findings also reveal that various institutional isomorphism mechanisms and forms of institutional logic emerge during the process. Finally, three factors-self-efficacy, social influence, and management support-have a significant influence on the individual acceptance of HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Dovzhenko, Iu M; Panov, G D
The computerization of data processing in multi-disciplinary hospitals is the key factor in raising the quality of medical care provided to the population, intensifying the work of the personnel, improving the curative and diagnostic process and the use of resources. Even a small experience in complex computerization at the Botkin Hospital indicates that due to the use of the automated system the quality of data processing in being improved, a high level of patients' examination is being provided, a speedy training of young specialists is being achieved, conditions are being created for continuing education of physicians through the analysis of their own activity. At big hospitals a complex solution of administrative and curative diagnostic tasks on the basis of general hospital network of display connection and general hospital data bank is the most prospective form of computerization.
Full Text Available With increasing competition, many healthcare organizations have undergone tremendous reform in the last decade aiming to increase efficiency, decrease waste, and reshape the way that care is delivered. This study focuses on the operational efficiency improvement of hospital’s registration process. The operational efficiency related factors including the service process, queue strategy, and queue parameters were explored systematically and illustrated with a case study. Guided by the principle of business process reengineering (BPR, a simulation approach was employed for process redesign and performance optimization. As a result, the queue strategy is changed from multiple queues and multiple servers to single queue and multiple servers with a prepare queue. Furthermore, through a series of simulation experiments, the length of the prepare queue and the corresponding registration process efficiency was quantitatively evaluated and optimized.
Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H; Ingeman, Annette; Johnsen, Søren P
The relationship between processes of early stroke care and hospital costs remains unclear. We therefore examined the association in a population based cohort study. We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010.The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization,early catheterization, and early thromboembolism prophylaxis.Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.
Maria Luciene Nobre Coutinho
Full Text Available Objectives: to investigate the sociodemographic profile and the process of hospitalization of elderly assisted in an emergency hospital. Methods: descriptive epidemiological study conducted at an emergency hospital with 300 elderly patients using a form with hospitalization process and sociodemographic variables. Results: there was a predominance of females (56.0%, between 80 and 89 years old (45.4%, illiterate or with elementary education (86.7%, married or living in stable union (42.6%, with non-communicable chronic disease (54.7% and regular use of medications. The main reason for hospitalization was fall (54.7% at home and in the morning hours (42.4%, with admission in the afternoon, transported by ambulance. Conclusion: the findings contribute to the development of strategies directed to assist and care of the healthy elderly and in vulnerable situations.
Rocafiguera, X de
Generally speaking, Hospitalary wastes are apparently similar to any kind of urban waste. Nevertheless it must be taken into account that the origin of Hospitalary wastes is different as they can be contaminated with microbes, virus, bacteria, bacillus...Because of this they should be treated and stored with special techniques in all the process. (Author)
Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M
To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.
Full Text Available Background: Quantum leadership approach causes efficient and effective procedures among health care organizations, specially clinical laboratories. Objective: This research was aimed to determine the status of quantum leadership dimensions among all management levels of clinical laboratories of teaching hospitals of medical sciences universities in Tehran. Methods: This descriptive, analytical and cross-sectional study was induced among 180 managers of 35 clinical laboratories of Iran, Shahid Beheshti and Tehran Universities of Medical Sciences 2016. The research tool was researcher - constructed questionnaire of quantum skills, demographic details that its content and face validity and reliability were confirmed. For analysis of data, T-test and ANOVA techniques were used. Findings: Most of the studied clinical laboratories managers were male, married, with 15-20 years work experiences, 1-5 years managerial services, and minimally one training courses in clinical laboratory management. The managers had relatively desired and desired score of quantum skills and leadership respectively. Also, there was significant correlation between quantum leadership with age (P=0.01, and with management training courses (P=0.02. Conclusion: It is expected this paradigm may change the clinical laboratory management in the near future with regards to desirability of quantum leadership dimensions among clinical laboratories.
Ricardez-Sandoval, Luis A.; Blankespoor, Wesley; Budman, Hector M.
This paper describes an experiment performed by the fourth year chemical engineering students in the process control laboratory at the University of Waterloo. The objective of this experiment is to test the capabilities of a constrained Model Predictive Controller (MPC) to control the operation of a Double Pipe Heat Exchanger (DPHE) in real time.…
This report presents the results of an evaluation of the present Toxic Waste Control Operations at the Lawrence Livermore National Laboratory, evaluates the technologies most applicable to the treatment of toxic and hazardous wastes and presents conceptual designs of processes for the installation of a new decontamination and waste treatment facility (DWTF) for future treatment of these wastes
This Environmental Assessment (EA) evaluates the potential environmental impacts of relocating a vacuum process laboratory (VPL) from Building 321 to Building 2231 at Lawrence Livermore National Laboratory (LLNL). The VPL provides the latest technology in the field of vacuum deposition of coatings onto various substrates for several weapons-related and energy-related programs at LLNL. Operations within the VPL at LLNL will not be expanded nor reduced by the relocation. No significant environmental impacts are expected as a result of the relocation of the VPL
Full Text Available One and key of the priorities in laboratory medicine is improvement of quality management system for patient safety. Quality in the health care is tightly connected to the level of excellence of the health care provided in relation to the current level of knowledge and technical development. Accreditation is an effective way to demonstrate competence of the laboratory, a tool to recognize laboratories world-wide, is linked to periodical audits, to stimulate the maintenance and improvement of the quality, which leads to high standard of services for clients (patients, health care providers, etc.. The strategic plans of IFCC and EFLM include focusing on accreditation of labs based on ISO standards and cooperation with European Accreditation and national accreditation bodies. IFCC and EFLM recognised that ISO 15189:2012 Medical laboratories – Requirements for quality and competence, encompasses all the assessment criteria specified in the policy of quality. The last version is oriented to process approach with detailed division and clearly defined requirements. The accreditation of labs improves facilitation of accurate and rapid diagnostics, efficiency of treatment and reduction of errors in the laboratory process. Accreditation is not about who the best is, but who has a system of standard procedures with aim to improve the quality and patient safety. Quality system is about people, with people and for people.
Full Text Available Background: Hemophilia A has the highest incidence, more than 80% of 172.323 cases worldwide in 2012. It is stated that clinical characteristics of hemophilia A is worse than others, so it is required to prove and to know further about the clinical characteristics and severity likelihood in all hemophilic patients in order to prevent re-bleeding and re-injury and also for a better medical response. Methods: A retrospective cross-sectional study was carried out to 43 medical records of hospitalized hemophilic patients from 2009 to 2013 in Dr Hasan Sadikin General Hospital. The inclusion criteria were a complete patient identity (name, age, sex, written chief complaint, complete physical examination (bleeding, edema, hematoma, hemarthrosis, anemic symptoms and laboratory test results (factor level, hemoglobin, hematocrit, platelet and Activated Partial Thromboplastin Time. The data was collected from August‒October 2014, analyzed and presented using frequency distribution. Results: Most of the patients were 5-10 years old, male and had hemophilia A. The most common complaint was external bleeding, followed by edema. From 43 patients, 38 (88% cases were classified as severe factor deficiency, had mild to severe anemia, however the platelet count in most of the cases was in normal value. About 91% cases had prolonged Activated Partial Thromboplastin Time in moderate to severe level. Conclusions: Similar with other studies worldwide, most of the hospitalized hemophilic patients have hemophilia A. Most of the patents has moderate to severe bleeding with laboratory test result between moderate to severe level as well.
Mcgarry, Frank; Pajerski, Rose; Page, Gerald; Waligora, Sharon; Basili, Victor; Zelkowitz, Marvin
The Software Engineering Laboratory (SEL) was established in 1976 for the purpose of studying and measuring software processes with the intent of identifying improvements that could be applied to the production of ground support software within the Flight Dynamics Division (FDD) at the National Aeronautics and Space Administration (NASA)/Goddard Space Flight Center (GSFC). The SEL has three member organizations: NASA/GSFC, the University of Maryland, and Computer Sciences Corporation (CSC). The concept of process improvement within the SEL focuses on the continual understanding of both process and product as well as goal-driven experimentation and analysis of process change within a production environment.
Malm, Johan; Marko-Varga, György
Patient care relies heavily on standardized tests performed in hospital laboratories, typically including clinical chemistry, pathology and microbiology. With the introduction of personalized medicine tremendous efforts have been made to identify new biomarkers of disease with various omics technologies, often including mass spectrometry. In order to validate new biomarkers and perform clinical studies high quality biobank samples are of key importance. In this editorial different aspects of mass spectrometry in future personalized medicine are discussed.
Pope, Jason E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)
In 2006, the United States (U.S.) Department of Energy (DOE) signed the Federal Leadership in High Performance and Sustainable Buildings Memorandum of Understanding (MOU), along with 21 other agencies. Pacific Northwest National Laboratory (PNNL) is exceeding this requirement and, currently, about 25 percent of its buildings are High Performance and Sustainable Buildings. The pages that follow document the Guiding Principles conformance effort for the Radiochemical Processing Laboratory (RPL) at PNNL. The RPL effort is part of continued progress toward a building inventory that is 100 percent compliant with the Guiding Principles.
Wood, C.; Thornton, W.; Swihart, A.; Gilman, T.
The introduction of the hazards assessment process is to document the impact of the release of hazards at the Advanced Manufacturing Processes Laboratory (AMPL) that are significant enough to warrant consideration in Sandia National Laboratories' operational emergency management program. This hazards assessment is prepared in accordance with the Department of Energy Order 5500.3A requirement that facility-specific hazards assessments be prepared, maintained, and used for emergency planning purposes. This hazards assessment provides an analysis of the potential airborne release of chemicals associated with the operations and processes at the AMPL. This research and development laboratory develops advanced manufacturing technologies, practices, and unique equipment and provides the fabrication of prototype hardware to meet the needs of Sandia National Laboratories, Albuquerque, New Mexico (SNL/NM). The focus of the hazards assessment is the airborne release of materials because this requires the most rapid, coordinated emergency response on the part of the AMPL, SNL/NM, collocated facilities, and surrounding jurisdiction to protect workers, the public, and the environment
Wood, C.; Thornton, W.; Swihart, A.; Gilman, T.
The introduction of the hazards assessment process is to document the impact of the release of hazards at the Advanced Manufacturing Processes Laboratory (AMPL) that are significant enough to warrant consideration in Sandia National Laboratories` operational emergency management program. This hazards assessment is prepared in accordance with the Department of Energy Order 5500.3A requirement that facility-specific hazards assessments be prepared, maintained, and used for emergency planning purposes. This hazards assessment provides an analysis of the potential airborne release of chemicals associated with the operations and processes at the AMPL. This research and development laboratory develops advanced manufacturing technologies, practices, and unique equipment and provides the fabrication of prototype hardware to meet the needs of Sandia National Laboratories, Albuquerque, New Mexico (SNL/NM). The focus of the hazards assessment is the airborne release of materials because this requires the most rapid, coordinated emergency response on the part of the AMPL, SNL/NM, collocated facilities, and surrounding jurisdiction to protect workers, the public, and the environment.
Danny A Asogun
Full Text Available BACKGROUND: Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH in the central senatorial district of Edo State struggled with this challenge for many years. METHODOLOGY/PRINCIPAL FINDINGS: A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12% tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization--often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005, had lower body temperature (p<0.0001, and had higher creatinine (p<0.0001 and blood urea levels (p<0.0001 than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed--within lineage II--a separate clade that could be further subdivided into three clusters. CONCLUSIONS/SIGNIFICANCE: Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients.
Sheila Moura Pone
Full Text Available Abstract Objective: To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods: Retrospective cohort of children (19 and negative likelihood ratio <0.6. Pleural effusion and abdominal distension had higher sensitivity (82.6%. History of bleeding (epistaxis, gingival or gastrointestinal bleeding and severe hemorrhage (pulmonary or gastrointestinal bleeding in physical examination were more frequent in serious dengue disease (p < 0.01, but with poor accuracy (positive likelihood ratio = 1.89 and 3.89; negative likelihood ratio = 0.53 and 0.60, respectively. Serum albumin was lower in serious dengue forms (p < 0.01. Despite statistical significance (p < 0.05, both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.
Singh, Pratap; Yadav, R.K.B.; Anilkumar, S.; Gopalakrishnan, R.K.; Chakraborty, S.
Radiation Hazard Control Unit at Isotope wing provides radiological safety support and advises for safe processing and production of radiopharmaceuticals. Tellurium Oxide (TeO 2 ), irradiated in a nuclear reactor, is processed in a process laboratory for separating 131 I using dry distillation technique. The workplace environment is being assessed for airborne radioactivity using installed Static Air Samplers (SASs). SASs contains two filter media (glass fibre and charcoal impregnated paper) to collect airborne 131 I radioactivity and laboratory air sampled at 50 litres per minutes (lpm). Personal Air Sampler (PAS) consists of three types of filters viz. a glass fibre, charcoal impregnated paper and cartridges containing activated charcoal granules. Three combinations were studied at a sampling rate of 5 lpm
Walz, Stacy E; Smith, Maureen; Cox, Elizabeth; Sattin, Justin; Kind, Amy J H
Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown. To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations. Retrospective cohort study. Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003-2005 (N = 564) Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient's discharge summary, then grouped into 14 categories and compared. Microbiology tests were sub-divided by culture type and number of days pending prior to discharge. Of sub-acute care patients, 32% (181/564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients' pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients' pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge. Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved
White, K R; Thompson, J M; Patel, U B
The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.
Liao, Sen-Kuei; Chang, Kuei-Lun
This study describes the use of analytic network process (ANP) in the Taiwanese hospital public relations personnel selection process. Starting with interviewing 48 practitioners and executives in north Taiwan, we collected selection criteria. Then, we retained the 12 critical criteria that were mentioned above 40 times by theses respondents, including: interpersonal skill, experience, negotiation, language, ability to follow orders, cognitive ability, adaptation to environment, adaptation to company, emotion, loyalty, attitude, and Response. Finally, we discussed with the 20 executives to take these important criteria into three perspectives to structure the hierarchy for hospital public relations personnel selection. After discussing with practitioners and executives, we find that selecting criteria are interrelated. The ANP, which incorporates interdependence relationships, is a new approach for multi-criteria decision-making. Thus, we apply ANP to select the most optimal public relations personnel of hospitals. An empirical study of public relations personnel selection problems in Taiwan hospitals is conducted to illustrate how the selection procedure works.
Bahador, Fateme; Sharifian, Roxana; Farhadi, Payam; Jafari, Abdosaleh; Nematolahi, Mohtram; Shokrpour, Nasrin
This study aimed to develop and test a research model that examined 7effective factors on the effectiveness of laboratory information system (LIS) through strategic planning. This research was carried out on total laboratory staff, information technology staff, and laboratory managers in Shiraz (a city in the south of Iran) teaching hospitals by structural equation modeling approach in 2015. The results revealed that there was no significant positive relationship between decisions based on cost-benefit analysis and LIS functionality with LIS effectiveness, but there was a significant positive relationship between other factors and LIS effectiveness. As expected, high levels of strategic information system planning result in increasing LIS effectiveness. The results also showed that the relationship between cost-benefit analysis, LIS functionality, end-user involvement, and information technology-business alignment with strategic information system planning was significant and positive.
Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H
Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... of hospitalization were $23352 (standard deviation 27827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. The adjusted costs were $24566 (95% confidence interval 19364-29769) lower for patients who received 75......-100% of the relevant processes of care compared with patients receiving 0-24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Conclusions: Early care in agreement with key guidelines recommendations for the management...
Dennison, D.K.; Domning, E.E.; Seivers, R.
Lawrence Livermore National Laboratory (LLNL) is developing a fully automated system for pyrochemical processing of special nuclear materials (SNM). The system utilizes a glove box, an automated tilt-pour furnace (TPF), an IBM developed gantry robot, and specialized automation tooling. All material handling within the glove box (i.e., furnace loading, furnace unloading, product and slag separation, and product packaging) is performed automatically. The objectives of the effort are to increase process productivity, decrease operator radiation, reduce process wastes, and demonstrate system reliability and availability. This paper provides an overview of the automated system hardware, outlines the overall operations sequence, and discusses the current status
Vera, Antonio; Kuntz, Ludwig
The central idea of process-based organization design is that organizing a firm around core business processes leads to cost reductions and quality improvements. We investigated theoretically and empirically whether the implementation of a process-based organization design is advisable in hospitals. The data came from a database compiled by the Statistical Office of the German federal state of Rheinland-Pfalz and from a written questionnaire, which was sent to the chief executive officers (CEOs) of all 92 hospitals in this federal state. We used data envelopment analysis (DEA) to measure hospital efficiency, and factor analysis and regression analysis to test our hypothesis. Our principal finding is that a high degree of process-based organization has a moderate but significant positive effect on the efficiency of hospitals. The main implication is that hospitals should implement a process-based organization to improve their efficiency. However, to actually achieve positive effects on efficiency, it is of paramount importance to observe some implementation rules, in particular to mobilize physician participation and to create an adequate organizational culture.
Laboratory testing of uranium ores is an essential step in the economic evaluation of uranium occurrences and in the development of a project for the production of uranium concentrates. Although these tests represent only a small proportion of the total cost of a project, their proper planning, execution and interpretation are of crucial importance. The main purposes of this manual are to discuss the objectives of metallurgical laboratory ore testing, to show the specific role of these tests in the development of a project, and to provide practical instructions for performing the tests and for interpreting their results. Guidelines on the design of a metallurgical laboratory, on the equipment required to perform the tests and on laboratory safety are also given. This manual is part of a series of Technical Reports on uranium ore processing being prepared by the IAEA's Division of Nuclear Fuel Cycle and Waste Management. A report on the Significance of Mineralogy in the Development of Flowsheets for Processing Uranium Ores (Technical Reports Series No. 196, 1980) and an instruction manual on Methods for the Estimation of Uranium Ore Reserves (No. 255, 1985) have already been published. 17 refs, 40 figs, 17 tabs
Shields, K.D.; Ballinger, M.Y.
This Facility Effluent Monitoring Plan (FEMP) has been prepared for the 325 Building Radiochemical Processing Laboratory (RPL) at the Pacific Northwest National Laboratory (PNNL) to meet the requirements in DOE Order 5400.1, ''General Environmental Protection Programs.'' This FEMP has been prepared for the RPL primarily because it has a ''major'' (potential to emit >0.1 mrem/yr) emission point for radionuclide air emissions according to the annual National Emission Standards for Hazardous Air Pollutants (NESHAP) assessment performed. This section summarizes the airborne and liquid effluents and the inventory based NESHAP assessment for the facility. The complete monitoring plan includes characterization of effluent streams, monitoring/sampling design criteria, a description of the monitoring systems and sample analysis, and quality assurance requirements. The RPL at PNNL houses radiochemistry research, radioanalytical service, radiochemical process development, and hazardous and radioactive mixed waste treatment activities. The laboratories and specialized facilities enable work ranging from that with nonradioactive materials to work with picogram to kilogram quantities of fissionable materials and up to megacurie quantities of other radionuclides. The special facilities within the building include two shielded hot-cell areas that provide for process development or analytical chemistry work with highly radioactive materials and a waste treatment facility for processing hazardous, mixed radioactive, low-level radioactive, and transuranic wastes generated by PNNL activities
Shields, K.D.; Ballinger, M.Y.
This Facility Effluent Monitoring Plan (FEMP) has been prepared for the 325 Building Radiochemical Processing Laboratory (RPL) at the Pacific Northwest National Laboratory (PNNL) to meet the requirements in DOE Order 5400.1, ''General Environmental Protection Programs.'' This FEMP has been prepared for the RPL primarily because it has a ''major'' (potential to emit >0.1 mrem/yr) emission point for radionuclide air emissions according to the annual National Emission Standards for Hazardous Air Pollutants (NESHAP) assessment performed. This section summarizes the airborne and liquid effluents and the inventory based NESHAP assessment for the facility. The complete monitoring plan includes characterization of effluent streams, monitoring/sampling design criteria, a description of the monitoring systems and sample analysis, and quality assurance requirements. The RPL at PNNL houses radiochemistry research, radioanalytical service, radiochemical process development, and hazardous and radioactive mixed waste treatment activities. The laboratories and specialized facilities enable work ranging from that with nonradioactive materials to work with picogram to kilogram quantities of fissionable materials and up to megacurie quantities of other radionuclides. The special facilities within the building include two shielded hot-cell areas that provide for process development or analytical chemistry work with highly radioactive materials and a waste treatment facility for processing hazardous, mixed radioactive, low-level radioactive, and transuranic wastes generated by PNNL activities.
The U.S. Department of Energy (DOE) has prepared an environmental assessment (EA) on the proposed Processing and Environmental Technology Laboratory (PETC) at Sandia National Laboratories/New Mexico (SNL/NM). This facility is needed to integrate, consolidate, and enhance the materials science and materials process research and development (R ampersand D) currently in progress at SNL/NM. Based on the analyses in the EA, DOE has determined that the proposed action is not a major Federal action significantly affecting the quality of the human environment within the meaning of the National Environmental Policy Act (NEPA) of 1969. Therefore, an environmental impact statement is not required, and DOE is issuing this Finding of No Significant Impact (FONSI)
The U.S. Department of Energy (DOE) has prepared an environmental assessment (EA) on the proposed Processing and Environmental Technology Laboratory (PETC) at Sandia National Laboratories/New Mexico (SNL/NM). This facility is needed to integrate, consolidate, and enhance the materials science and materials process research and development (R&D) currently in progress at SNL/NM. Based on the analyses in the EA, DOE has determined that the proposed action is not a major Federal action significantly affecting the quality of the human environment within the meaning of the National Environmental Policy Act (NEPA) of 1969. Therefore, an environmental impact statement is not required, and DOE is issuing this Finding of No Significant Impact (FONSI).
Fosshage, Erik D.; Drewien, Celeste A.; Eras, Kenneth; Hartwig, Ronald Craig; Post, Debra S.; Stoecker, Nora Kathleen
The Lessons Learned Process Improvement Team was tasked to gain an understanding of the existing lessons learned environment within the major programs at Sandia National Laboratories, identify opportunities for improvement in that environment as compared to desired attributes, propose alternative implementations to address existing inefficiencies, perform qualitative evaluations of alternative implementations, and recommend one or more near-term activities for prototyping and/or implementation. This report documents the work and findings of the team.
An on-site mobile laboratory has been installed near a groundwater treatment facility, and rapid analytical procedures have been deployed for determining sample activity in the process support laboratory. The required analyses to support the remediation project include gross alpha/, gross nonvolatile beta, 90 Sr, 99 Tc, 137 Cs and total Ra (226 + 228). The present mission of the Savannah River Site (SRS), a US Department of Energy nuclear production facility, is one of nuclear waste stabilization and of environmental restoration and remediation. Because of previous practices of disposing low-level radioactive waste to seepage basins, some of the groundwater under the SRS has become contaminated with radioactive species. A water treatment facility has been installed to remediate the groundwater below the old F and H areas' seepage basins. Groundwater is pumped from the contaminated aquifer through a series of filtration, ion exchange, and reverse osmosis steps and when cleaned is reinjected back into the aquifer. Samples are pulled from various points in the treatment facility to ensure that the process is working as designed. In order to minimize turnaround time for these analyses, a process control station (i.e., a mobile on-site laboratory) has been installed at the F area water treatment unit, and rapid radioanalytical procedures have been deployed
The desire to improve timeliness and sensitivity of material control and accounting capabilities is the basis for evaluation and upgrade of regulatory requirements throughout the nuclear industry. Improvements invariably require better measurement capabilities and more frequent measurements. Operating plants typically include a broad range of measurements and equipment devoted to process control. How can these measurements be used to benefit safeguards? A part of the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory has focused on the use of process data for safeguards. This report discusses recent safeguards demonstrations and current activities in a test facility at Oak Ridge
Joseph Jean Assaad
Full Text Available The evaluation of grinding aid (GA effect on clinker processing in laboratory grinding mills is relatively simple. Yet, the results obtained cannot be directly transposed to industrial mills, given the fundamentally different operational modes and grinding parameters. This paper seeks to evaluate the scale effect by comparing the results obtained from a closed-circuit tube mill operating at 90 ton/hr to those determined using a 50-liter laboratory mill. Tests results have shown that the decrease in specific energy consumption (Ec due to glycol or amine-based GA can be evaluated under laboratory conditions. However, such tests underestimate the actual performance that could be achieved in real-scale mills; the Ec reduction due to GA is around twofold higher when grinding is performed in real-scale mill. Compared to industrial tests, the cement particle size distribution curves widened and shifted towards higher diameters when grinding was performed under laboratory conditions, particularly with GA additions. This led to remarkable changes in water demand, setting time, and 1- and 28-day compressive strengths.
Oja, Paula I; Kouri, Timo T; Pakarinen, Arto J
To find out the satisfaction of clinical units with laboratory services in a university hospital, to point out the most important problems and defects in services, to carry out corrective actions, and thereafter to identify the possible changes in satisfaction. and Senior physicians and nurses-in-charge of the clinical units at Oulu University Hospital, Finland. Customer satisfaction survey using a questionnaire was carried out in 2001, indicating the essential aspects of laboratory services. Customer-specific problems were clarified, corrective actions were performed, and the survey was repeated in 2004. In 2001, the highest dissatisfaction rates were recorded for computerized test requesting and reporting, turnaround times of tests, and the schedule of phlebotomy rounds. The old laboratory information system was not amenable to major improvements, and it was renewed in 2004-05. Several clinical units perceived turnaround times to be long, because the tests were ordered as routine despite emergency needs. Instructions about stat requesting were given to these units. However, no changes were evident in the satisfaction level in the 2004 survey. Following negotiations with the clinics, phlebotomy rounds were re-scheduled. This resulted in a distinct increase in satisfaction in 2004. Satisfaction survey is a screening tool that identifies topics of dissatisfaction. Without further clarifications, it is not possible to find out the specific problems of customers and to undertake targeted corrective actions. Customer-specific corrections are rarely seen as improvements in overall satisfaction rates.
In 1993 the output of every high energy radiotherapy beam used clinically in New Zealand was measured by National Radiation Laboratory (NRL) staff using independent dosimetry equipment. The purpose of this was to audit the dosimetry that is used by hospital physicists for the basis of patient treatments, and to uncover any errors that may be clinically significant. This report analyses the uncertainties involved in comparing the NRL and hospital measurements, and presents the results of the 1993 audit. The overall uncertainty turns out to be about 1.5%. The results for linear accelerator photon beams are consistent with a purely random variation within this uncertainty. Electron beams show some small errors beyond the expected uncertainty. Gamma beams have the potential to be the most accurately measured, but in practice are less accurately measured than linear accelerator beams. None of the disagreements indicated an error of clinical significance. 8 refs., 3 figs., 2 tabs
This research aimed to investigate the effects of knowledge management enablers, such as organizational structure, leadership, learning, information technology systems, trust, and collaboration, on the knowledge management process of creation, storage, sharing, and application. Using data from self-administered questionnaires in four Korean tertiary hospitals, this survey investigated the main organizational factors affecting the knowledge management process in these organizations. A total of 779 questionnaires were analyzed using SPSS 18.0 and AMOS 18.0. The results showed that organizational factors affect the knowledge management process differently in each hospital organization. From a managerial perspective, the implications of these factors for developing organizational strategies that encourage and foster the knowledge management process are discussed.
Sánchez Ruiz, Lidia; Blanco Rojo, Beatriz; Simón, Rosa María
Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process management i...
Saleh, Shadi; Kaissi, Amer; Semaan, Adele; Natafgi, Nabil Maher
Strategic planning has been presented as a valuable management tool. However, evidence of its deployment in healthcare and its effect on organizational performance is limited in low-income and middle-income countries (LMICs). The study aimed to explore the use of strategic planning processes in Lebanese hospitals and to investigate its association with financial performance. The study comprised 79 hospitals and assessed occupancy rate (OR) and revenue-per-bed (RPB) as performance measures. The strategic planning process included six domains: having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians' involvement. Approximately 90% of hospitals have strategic plans that are moderately developed (mean score of 4.9 on a 1-7 scale) and implemented (score of 4.8). In 46% of the hospitals, the CEO has the responsibility for the plan. The level of governing board involvement in the process is moderate to high (score of 5.1), whereas physician involvement is lower (score of 4.1). The OR and RPB amounted to respectively 70% and 59 304 among hospitals with a strategic plan as compared with 62% and 33 564 for those lacking such a plan. No statistical association between having a strategic plan and either of the two measures was detected. However, the findings revealed that among hospitals that had a strategic plan, higher implementation levels were associated with lower OR (p plans allow organizations to better cope with environmental turbulence. Copyright © 2012 John Wiley & Sons, Ltd.
The diagnosis of infectious diseases and the role of the microbiology laboratory are currently undergoing a process of change. The need for overall efficiency in providing results is now given the same importance as accuracy. This means that laboratories must be able to produce quality results in less time with the capacity to interpret the results clinically. To improve the clinical impact of microbiology results, the new challenge facing the microbiologist has become one of process management instead of pure analysis. A proper project management process designed to improve workflow, reduce analytical time, and provide the same high quality results without losing valuable time treating the patient, has become essential. Our objective was to study the impact of introducing automation and computerization into the microbiology laboratory, and the reorganization of the laboratory workflow, i.e. scheduling personnel to work shifts covering both the entire day and the entire week. In our laboratory, the introduction of automation and computerization, as well as the reorganization of personnel, thus the workflow itself, has resulted in an improvement in response time and greater efficiency in diagnostic procedures.
Oja, Paula; Kouri, Timo; Pakarinen, Arto
Customer orientation has gained increasing attention in healthcare. A customer satisfaction survey is one way to raise areas and topics for quality improvement. However, it seems that customer satisfaction surveys have not resulted in quality improvement in healthcare. This article reports how the authors' university hospital laboratory has used customer satisfaction surveys targeted at the health centres in their hospital district. Closed-ended statements of the questionnaire were planned to cover the essential aspects of laboratory services. In addition, an open-ended question asked what was considered to be the most important problem in services. The questionnaires were sent to the medical directors of the health centres. The open-ended question proved to be very useful because the responses specified the main problems in service. Based on the responses, selected dissatisfied customers were contacted to specify their responses and possible corrective actions were taken. It is concluded that a satisfaction survey can be used as a screening tool to identify topics of dissatisfaction. In addition, further clarifications with selected customers are needed to specify the causes for their dissatisfaction and to undertake proper corrective actions. PMID:20205616
Phidelis M. Maruti
Objectives: To describe how the SLMTA programme and enhanced quality interventions changed the culture and management style at BDHL and instilled a quality system designed to sustain progress for years to come. Methods: SLMTA implementation followed the standard three-workshop series, mentorship site visits and audits. In order to build sustainability of progress, BDHL integrated quality improvement processes into its daily operations. The lab undertook a process of changing its internal culture to align all hospital stakeholders – including upper management, clinicians, laboratory staff and maintenance staff – to the mission of sustainable quality practices at BDHL. Results: After 16 months in the SLMTA programme, BDHL improved from zero stars (38% to four stars (89%. Over a period of two to three years, external quality assessment results improved from 47% to 87%; staff punctuality increased from 49% to 82%; clinician complaints decreased from 83% to 16; rejection rates decreased from 12% to 3%; and annual equipment repairs decreased from 40 to 15. Twelve months later the laboratory scored three stars (81% in an external surveillance audit conducted by Kenya Accreditation Service (KENAS. Conclusion: Management buy-in, staff participation, use of progress-monitoring tools and feedback systems, as well as incorporation of improvement processes into routine daily activities, were vital in developing and sustaining a culture of quality improvement.
Andrei Kelliton Fabretti
Full Text Available Malnutrition is a major factor associated with increased rates of mortality and readmission, longer hospital stays, and greater health care spending. Recognizing malnourished or at-risk animals allows for nutritional intervention and improved prognosis. This study evaluated the association between clinical, laboratory, and electrophoretic variables and the nutritional status (NS of hospitalized dogs in order to generate a profile of the sick dog and to facilitate the diagnosis of malnutrition. We divided 215 dogs into groups according to the severity of the underlying disease and we determined the clinical NS based on the assessment of the body condition score and the muscle mass score. The NS was classified as clinically well nourished, clinical moderate malnutrition, or clinical severe malnutrition. Statistical analyses were conducted by using the chi-square test or Fisher’s exact test; the Kruskal-Wallis test was used for continuous variables. A strong association was found between malnutrition and the severity of the underlying disease. In hospitalized dogs, low body mass index values, anemia, low hemoglobin concentrations, high fibrinogen concentrations, decreased albumin fraction, and increased gamma-globulin fraction (in electrophoresis were associated with malnutrition, reinforcing the classification of poor NS. However, the skin and coat characteristics, the total number of lymphocytes, blood glucose, cholesterol, and total protein concentration were not found to be good predictors of NS.
Agarwal, Rachna; Chhillar, Neelam; Tripathi, Chandra B
During post-analytical phase, critical value notification to responsible caregiver in a timely manner has potential to improve patient safety which requires cooperative efforts between laboratory personnel and caregivers. It is widely accepted by hospital accreditors that ineffective notification can lead to diagnostic errors that potentially harm patients and are preventable. The objective of the study was to assess the variables affecting critical value notification, their role in affecting it's quality and approaches to improve it. In the present study 1,187 critical values were analysed in the Clinical Chemistry Laboratory catering to tertiary care hospital for neuropsychiatric diseases. During 25 months of study period, we evaluated critical value notification with respect to clinical care area, caregiver to whom it was notified and timeliness of notification. During the study period (25 months), the laboratory obtained 1,279 critical values in clinical chemistry. The analytes most commonly notified were sodium and potassium (20.97 & 20.8 % of total critical results). Analysis of critical value notification versus area of care showed that critical value notification was high in ICU and emergency area followed by inpatients and 64.61 % critical values were notified between 30 and 120 min after receiving the samples. It was found that failure to notify the responsible caregiver in timely manner represent an important patient safety issue and may lead to diagnostic errors. The major area of concern are notification of critical value for outpatient samples, incompleteness of test requisition forms regarding illegible writing, lack of information of treating physician and location of test ordering and difficulty in contacting the responsible caregiver.
Robilotti, Elizabeth; Peterson, Lance R.; Banaei, Niaz; Dowdy, David W.
Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and 93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI. PMID:24478478
Schroeder, Lee F; Robilotti, Elizabeth; Peterson, Lance R; Banaei, Niaz; Dowdy, David W
Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and 93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI.
Shen Zhenyao; Li Guoding; Li Shushen; Wang Chengzu
Highly compacted bentonite blocks have been heated and hydrated in the laboratory in order to simulate the thermo-hydro-mechanical (THM) coupled processes of buffer material in a high-level radioactive waste (HLW) repository. The experiment facility, which is composed of experiment barrel, heated system, high pressure water input system, temperature measure system, water content measure system and swelling stress system, is introduced in this paper. The steps of the THM coupled experiment are also given out in detail. There are total 10 highly compacted bentonite blocks used in this test. Experimental number 1-4 are the tests with the heater and the hydrated process, which temperature distribution vs. time and final moisture distribution are measured. Experimental number 5-8 are the tests with the heater and without the hydrated process, which temperature distribution vs. time and final moisture distribution are measured. Experimental number 9-10 are the tests with the heater and the hydrated process, which temperature distribution vs. time, final moisture distribution and the swelling stress distribution at some typical points vs. time are measured. The maximum test time is nearly 20 days and the minimum test time is only 8 hours. The results show that the temperature field is little affected by hydration process and stress condition, but moisture transport and stress distribution are a little affected by the thermal gradient. The results also show that the water head difference is the mainly driving force of hydration process and the swelling stress is mainly from hydration process. It will great help to understand better about heat and mass transfer in porous media and the THM coupled process in actual HLW disposal. (author)
Elhoseeny, T A; Mohammad, E K
Assessment and improvement of turnaround times (TAT) as well as customer satisfaction is essential for laboratory quality management. This study in a specialized hospital in Alexandria, Egypt measured the current TAT for outpatient department bilirubin samples and evaluated the satisfaction of physicians with aspects of clinical laboratory services. While the mean TAT for 110 bilirubin tests [58.1 (SD 31.8) min] was within the College of American Pathologists' benchmark, the 90th percentile was long (96.7 min); 62.7% of tests were reported within 60 min. The mean overall satisfaction score of physicians (range 1-5) was 3.46 (SD 0.49). The highest satisfaction rating was for staff courtesy while the lowest ratings were for laboratory management responsiveness, outpatient stat TAT and critical value notification. Quality or reliability of results was judged by physicians as the most important factor (32.3%), followed by routine test TAT (18.5%). Further analysis of the different steps of the TAT would be helpful and follow-up through examining outliers is recommended
[Laboratory medicine in the obligatory postgraduate clinical training system--common clinical training program in the department of laboratory medicine in our prefectural medical university hospital].
I propose a postgraduate common clinical training program to be provided by the department of laboratory medicine in our prefectural medical university hospital. The program has three purposes: first, mastering basic laboratory tests; second, developing the skills necessary to accurately interpret laboratory data; third, learning specific techniques in the field of laboratory medicine. For the first purpose, it is important that medical trainees perform testing of their own patients at bedside or in the central clinical laboratory. When testing at the central clinical laboratory, instruction by expert laboratory technicians is helpful. The teaching doctors in the department of laboratory medicine are asked to advise the trainees on the interpretation of data. Consultation will be received via interview or e-mail. In addition, the trainees can participate in various conferences, seminars, and meetings held at the central clinical laboratory. Finally, in order to learn specific techniques in the field of laboratory medicine, several special courses lasting a few months will be prepared. I think this program should be closely linked to the training program in internal medicine.
Gouripeddi, Ramkiran; Warner, Phillip B; Mo, Peter; Levin, James E; Srivastava, Rajendu; Shah, Samir S; de Regt, David; Kirkendall, Eric; Bickel, Jonathan; Korgenski, E Kent; Precourt, Michelle; Stepanek, Richard L; Mitchell, Joyce A; Narus, Scott P; Keren, Ron
Microbiology study results are necessary for conducting many comparative effectiveness research studies. Unlike core laboratory test results, microbiology results have a complex structure. Federating and integrating microbiology data from six disparate electronic medical record systems is challenging and requires a team of varied skills. The PHIS+ consortium which is partnership between members of the Pediatric Research in Inpatient Settings (PRIS) network, the Children's Hospital Association and the University of Utah, have used "FURTHeR' for federating laboratory data. We present our process and initial results for federating microbiology data from six pediatric hospitals.
Michelbacher, J.A.; Henslee, S.P.; McDermott, M.D.; Price, J.R.; Rosenberg, K.E.; Wells, P.B.
Argonne National Laboratory-West (ANL-W) has approximately 680,000 liters of raw sodium stored in facilities on site. As mandated by the State of Idaho and the US Department of Energy (DOE), this sodium must be transformed into a stable condition for land disposal. To comply with this mandate, ANL-W designed and built the Sodium Process Facility (SPF) for the processing of this sodium into a dry, sodium carbonate powder. The major portion of the sodium stored at ANL-W is radioactively contaminated. The sodium will be processed in three separate and distinct campaigns: the 290,000 liters of Fermi-1 primary sodium, the 50,000 liters of the Experimental Breeder Reactor-II (EBR-II) secondary sodium, and the 330,000 liters of the EBR-II primary sodium. The Fermi-1 and the EBR-II secondary sodium contain only low-level of radiation, while the EBR-II primary sodium has radiation levels up to 0.5 mSv (50 mrem) per hour at 1 meter. The EBR-II primary sodium will be processed last, allowing the operating experience to be gained with the less radioactive sodium prior to reacting the most radioactive sodium. The sodium carbonate will be disposed of in 270 liter barrels, four to a pallet. These barrels are square in cross-section, allowing for maximum utilization of the space on a pallet, minimizing the required landfill space required for disposal
Michelbacher, J.A.; Henslee, S.P. McDermott, M.D.; Price, J.R.; Rosenberg, K.E.; Wells, P.B.
Argonne National Laboratory-West (ANL-W) has approximately 680,000 liters of raw sodium stored in facilities on site. As mandated by the State of Idaho and the US Department of Energy (DOE), this sodium must be transformed into a stable condition for land disposal. To comply with this mandate, ANL-W designed and built the Sodium Process Facility (SPF) for the processing of this sodium into a dry, sodium carbonate powder. The major portion of the sodium stored at ANL-W is radioactively contaminated. The sodium will be processed in three separate and distinct campaigns: the 290,000 liters of Fermi-1 primary sodium, the 50,000 liters of the Experimental Breeder Reactor-II (EBR-II) secondary sodium, and the 330,000 liters of the EBR-II primary sodium. The Fermi-1 and the EBR-II secondary sodium contain only low-level of radiation, while the EBR-II primary sodium has radiation levels up to 0.5 mSv (50 mrem) per hour at 1 meter. The EBR-II primary sodium will be processed last, allowing the operating experience to be gained with the less radioactive sodium prior to reacting the most radioactive sodium. The sodium carbonate will be disposed of in 270 liter barrels, four to a pallet. These barrels are square in cross-section, allowing for maximum utilization of the space on a pallet, minimizing the required landfill space required for disposal.
Keteyian, Courtland K; Nallamothu, Brahmajee K; Ryan, Andrew M
For decades, the healthcare industry has been incentivized to develop new diagnostic technologies, but this limitless progress fueled rapidly growing expenditures. With an emphasis on value, the future will favor information synthesis and processing over pure data generation, and hospitals will play a critical role in developing these systems. A Michigan Medicine, IBM, and AirStrip partnership created a robust streaming analytics platform tasked with creating predictive algorithms for critical care with the potential to support clinical decisions and deliver significant value.
Trinidad, J. A.; Gasco, C.; Palacios, M. A.
This report is the original research work presented for the attainment of the author master degree and its main objective has been the resolution -by means of friendly programming- of some of the observed problems in the environmental radioactivity laboratory belonging to the Department of Radiological Surveillance and Environmental Radioactivity from CIEMAT. The software has been developed in Visual Basic for applications in Excel files and it solves by macro orders three of the detected problems: a) calculation of characteristic limits for the measurements of the beta total and beta rest activity concentrations according to standards MARLAP, ISO and UNE and the comparison of the three results b) Pb-210 and Po-210 decontamination factor determination in the ultra-low level Am-241 analysis in air samples by alpha spectrometry and c) comparison of two analytical techniques for measuring Pb-210 in air ( direct-by gamma spectrometry- and indirect -by radiochemical separation and alpha spectrometry). The organization processes of the different excel files implied in the subroutines, calculations and required formulae are explained graphically for its comprehension. The advantage of using this kind of programmes is based on their versatility and the ease for obtaining data that lately are required by tables that can be modified as time goes by and the laboratory gets more data with the special applications for describing a method (Pb-210 decontamination factors for americium analysis in air) or comparing temporal series of Pb-210 data analysed by different methods (Pb-210 in air). (Author)
With the flyby of the Neptune system by Voyager, the preliminary exploration of the Solar System was accomplished. Data have been returned for all major planets and satellites except the Pluto system. Results show that the surfaces of terrestrial planets and satellites have been subjected to a wide variety of geological processes. On solid- surface planetary objects having an atmosphere, aeolian processes are important in modifying their surfaces through the redistribution of fine-grained material by the wind. Bedrock may be eroded to produce particles and the particles transported by wind for deposition in other areas. This process operates on Earth today and is evident throughout the geological record. Aeolian processes also occur on Mars, Venus, and possibly Titan and Triton, both of which are outer planet satellites that have atmospheres. Mariner 9 and Viking results show abundant wind-related landforms on Mars, including dune fields and yardangs (wind-eroded hills). On Venus, measurements made by the Soviet Venera and Vega spacecraft and extrapolations from the Pioneer Venus atmospheric probes show that surface winds are capable of transporting particulate materials and suggest that aeolian processes may operate on that planet as well. Magellan radar images of Venus show abundant wind streaks in some areas, as well as dune fields and a zone of possible yardangs. The study of planetary aeolian processes must take into account diverse environments, from the cold, low-density atmosphere of Mars to the extremely hot, high- density Venusian atmosphere. Factors such as threshold wind speeds (minimum wind velocity needed to move particles), rates of erosion and deposition, trajectories of windblown particles, and aeolian flow fields over various landforms are all important aspects of the problem. In addition, study of aeolian terrains on Earth using data analogous to planetary data-collection systems is critical to the interpretation of spacecraft information and
Lumetta, Gregg J.; Meier, David E.; Tingey, Joel M.; Casella, Amanda J.; Delegard, Calvin H.; Edwards, Matthew K.; Jones, Susan A.; Rapko, Brian M.
This report describes a conceptual design for a pilot-scale capability to produce plutonium oxide for use as exercise and reference materials, and for use in identifying and validating nuclear forensics signatures associated with plutonium production. This capability is referred to as the Pilot-scale Plutonium oxide Processing Unit (P3U), and it will be located in the Radiochemical Processing Laboratory at the Pacific Northwest National Laboratory. The key unit operations are described, including plutonium dioxide (PuO2) dissolution, purification of the Pu by ion exchange, precipitation, and conversion to oxide by calcination.
Cegarra-Navarro, Juan Gabriel; Martinez Martinez, Aurora
The major focus of this research is to investigate whether environmental knowledge has any impact on organizational outcomes through an empirical investigation of 127 Spanish hospitality companies, using structural equation models. Our results show that environmental knowledge is an important determiner for developing organizational outcomes. However, this relationship is completed with just two related constructs: Firstly, the company's acquisition process plays a key role in managing the tension between the knowledge necessary to develop the appropriated environmental initiatives and current knowledge. Secondly, the company's distribution process also sheds light on tangible means for managers to enhance their company's outcomes through environmental knowledge.
Souza, Norma Valéria Dantas de Oliveira; Gonçalves, Francisco Gleidson de Azevedo; Pires, Ariane da Silva; David, Helena Maria Scherlowski Leal
To describe and analyze the influence of the neoliberal economic and political model on the nursing hospital work process and organization. Qualitative descriptive research, having as its scenery a university hospital. The subjects were 34 nursing workers. The data collection took place from March to July 2013, through semi-structured interview. The data treatment technique used was content analysis, which brought up the following category: working conditions precariousness and its consequences to the hospital work process and organization in the neoliberal context. The consequences of neoliberalism on hospital work process and organization were highlighted, being observed physical structure, human resources and material inadequacies that harms the assistance quality. In addition to wage decrease that cause the need of second jobs and work overload. There is a significant influence of the neoliberal model on hospital work, resulting on working conditions precariousness. Descrever e analisar a influência do modelo econômico e político neoliberal na organização e no processo de trabalho hospitalar de enfermagem. Pesquisa qualitativa e descritiva, tendo como cenário um hospital universitário. Os participantes foram 34 trabalhadores de enfermagem. A coleta ocorreu de março a julho de 2013, por meio de entrevista semiestruturada. A técnica de tratamento dos dados foi a análise de conteúdo, que fez emergir a seguinte categoria: precarização das condições laborais e suas repercussões para organização e processo de trabalho hospitalar no contexto neoliberal. Evidenciaram-se repercussões do neoliberalismo na organização e no processo de trabalho hospitalar, verificando-se inadequações na estrutura física, nos recursos humanos e materiais, que afetavam a qualidade da assistência. Além de perdas salariais que levam à necessidade de outros empregos e sobrecarga de trabalho. Há forte influência do modelo neoliberal no trabalho hospitalar, resultando
Nixon, A.E.; McKerley, B.J.; Christensen, E.L.
The Los Alamos Scientific Laboratory currently has the newest plutonium handling facility in the nation. Los Alamos has been active in the processing of plutonium almost since the discovery of this man-made element in 1941. One of the functions of the new facility is the processing of plutonium scrap generated at LASL and other sites. The feed for the scrap processing program is extremely varied, and a wide variety of contaminants are often encountered. Depending upon the scrap matrix and contaminants present, the majority of material receives a nitric acid/hydrofluoric acid or nitric acid/calcium fluoride leach. The plutonium nitrate solutions are then loaded onto an anion exchange column charged with DOWEX 1 x 4, 50 to 100 mesh, nitrate form resin. The column is eluted with 0.48 M hydroxyl amine nitrate. The Pu(NO 3 ) 3 is then precipitated as plutonium III oxalate which is calcined at 450 to 500 0 C to yield a purified PuO 2 product
Full Text Available Background/Aims: Risk factor studies for acute kidney injury (AKI in China are lacking, especially those regarding non-traditional risk factors, such as laboratory indicators. Methods: All adult patients admitted to 38 tertiary and 22 secondary hospitals in China in any one month between July and December 2014 were surveyed. AKI patients were screened according to the Kidney Disease: Improving Global Outcomes’ definition of AKI. Logistic regression was used to analyze the risk factors for AKI, and Cox regression was used to analyze the risk of in-hospital mortality for AKI patients; additionally, a propensity score analysis was used to reconfirm the risk factors among laboratory indicators for mortality. Results: The morbidity of AKI was 0.97%. Independent risk factors for AKI were advancing age, male gender, hypertension, and chronic kidney disease. All-cause mortality was 16.5%. The predictors of mortality in AKI patients were advancing age, tumor, higher uric acid level and increases in Acute Physiologic Assessment and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. The hazard ratio (HR for mortality with uric acid levels > 9.1 mg/dl compared with ≤ 5.2 mg/dl was 1.78 (95% CI: 1.23 to 2.58 for the AKI patients as a group, and was 1.73 (95% CI: 1.24 to 2.42 for a propensity score-matched set. Conclusion: In addition to traditional risk factors, uric acid level is an independent predictor of all-cause mortality after AKI.
Cohen-Bacrie, Stéphan; Ninove, Laetitia; Nougairède, Antoine; Charrel, Rémi; Richet, Hervé; Minodier, Philippe; Badiaga, Sékéné; Noël, Guilhem; La Scola, Bernard; de Lamballerie, Xavier; Drancourt, Michel; Raoult, Didier
Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose. One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.
Full Text Available BACKGROUND: Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC tests have been developed for this purpose. METHODS AND FINDINGS: One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844 and pregnant women negative for Streptococcus agalactiae carriage (n = 763. The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009. Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. CONCLUSIONS: The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.
Malfait, Simon; Van Hecke, Ann; Hellings, Johan; De Bodt, Griet; Eeckloo, Kristof
In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital's board of directors on themes of strategic importance. To study the internal hospital's decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. To effectively influence the organization's public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.
Neubert, Sebastian; Göde, Bernd; Gu, Xiangyu; Stoll, Norbert; Thurow, Kerstin
Modern business process management (BPM) is increasingly interesting for laboratory automation. End-to-end workflow automation and improved top-level systems integration for information technology (IT) and automation systems are especially prominent objectives. With the ISO Standard Business Process Model and Notation (BPMN) 2.X, a system-independent and interdisciplinary accepted graphical process control notation is provided, allowing process analysis, while also being executable. The transfer of BPM solutions to structured laboratory automation places novel demands, for example, concerning the real-time-critical process and systems integration. The article discusses the potential of laboratory execution systems (LESs) for an easier implementation of the business process management system (BPMS) in hierarchical laboratory automation. In particular, complex application scenarios, including long process chains based on, for example, several distributed automation islands and mobile laboratory robots for a material transport, are difficult to handle in BPMSs. The presented approach deals with the displacement of workflow control tasks into life science specialized LESs, the reduction of numerous different interfaces between BPMSs and subsystems, and the simplification of complex process modelings. Thus, the integration effort for complex laboratory workflows can be significantly reduced for strictly structured automation solutions. An example application, consisting of a mixture of manual and automated subprocesses, is demonstrated by the presented BPMS-LES approach.
Michelbacher, J.A.; Henslee, S.P.; McDermott, M.D.; Price, J.R.; Rosenberg, K.E.; Wells, P.B.
Argonne National Laboratory - West (ANL-W) has approximately 680,000 liters (180,000 gallons) of raw sodium stored in facilities on site. As mandated by the State of Idaho and the United States Department of Energy (DOE), this sodium must be transformed into a stable condition for land disposal. To comply with this mandate, ANL-W designed and built the Sodium Process Facility (SPF) for the processing of this sodium into a dry, sodium carbonate powder. The major portion of the sodium stored at ANL-W is radioactively contaminated. The SPF was designed to react elemental sodium to sodium carbonate through two-stages involving caustic process and carbonate process steps. The sodium is first reacted to sodium hydroxide in the caustic process step. The caustic process step involves the injection of sodium into a nickel reaction vessel filled with a 50 wt% solution of sodium hydroxide. Water is also injected, controlling the boiling point of the solution. In the carbonate process, the sodium hydroxide is reacted with carbon dioxide to form sodium carbonate. This dry powder, similar in consistency to baking soda, is a waste form acceptable for burial in the State of Idaho as a non-hazardous, radioactive waste. The caustic process was originally designed and built in the 1980s for reacting the 290,000 liters (77,000 gallons) of primary sodium from the Fermi-1 Reactor to sodium hydroxide. The hydroxide was slated to be used to neutralize acid products from the PUREX process at the Hanford site. However, changes in the DOE mission precluded the need for hydroxide and the caustic process was never operated. With the shutdown of the Experimental Breeder Reactor-II (EBR-II), the necessity for a facility to react sodium was identified. In order to comply with Resource Conservation and Recovery Act (RCRA) requirements, the sodium had to be converted into a waste form acceptable for disposal in a Sub-Title D low-level radioactive waste disposal facility. Sodium hydroxide is a RCRA
Lightholder, Jack; Asphaug, Erik; Thangavelautham, Jekan
Recent advances in small spacecraft allow for their use as orbiting microgravity laboratories (e.g. Asphaug and Thangavelautham LPSC 2014) that will produce substantial amounts of data. Power, bandwidth and processing constraints impose limitations on the number of operations which can be performed on this data as well as the data volume the spacecraft can downlink. We show that instrument autonomy and machine learning techniques can intelligently conduct data reduction and downlink queueing to meet data storage and downlink limitations. As small spacecraft laboratory capabilities increase, we must find techniques to increase instrument autonomy and spacecraft scientific decision making. The Asteroid Origins Satellite (AOSAT) CubeSat centrifuge will act as a testbed for further proving these techniques. Lightweight algorithms, such as connected components analysis, centroid tracking, K-means clustering, edge detection, convex hull analysis and intelligent cropping routines can be coupled with the tradition packet compression routines to reduce data transfer per image as well as provide a first order filtering of what data is most relevant to downlink. This intelligent queueing provides timelier downlink of scientifically relevant data while reducing the amount of irrelevant downlinked data. Resulting algorithms allow for scientists to throttle the amount of data downlinked based on initial experimental results. The data downlink pipeline, prioritized for scientific relevance based on incorporated scientific objectives, can continue from the spacecraft until the data is no longer fruitful. Coupled with data compression and cropping strategies at the data packet level, bandwidth reductions exceeding 40% can be achieved while still downlinking data deemed to be most relevant in a double blind study between scientist and algorithm. Applications of this technology allow for the incorporation of instrumentation which produces significant data volumes on small spacecraft
A planetary interior is under high-pressure and high-temperature conditions and it has a layered structure. There are two important processes that led to that layered structure, (1) percolation of liquid metal in a solid silicate matrix by planet differentiation, and (2) inner core crystallization by subsequent planet cooling. We conduct high-pressure and high-temperature experiments to simulate both processes in the laboratory. Formation of percolative planetary core depends on the efficiency of melt percolation, which is controlled by the dihedral (wetting) angle. The percolation simulation includes heating the sample at high pressure to a target temperature at which iron-sulfur alloy is molten while the silicate remains solid, and then determining the true dihedral angle to evaluate the style of liquid migration in a crystalline matrix by 3D visualization. The 3D volume rendering is achieved by slicing the recovered sample with a focused ion beam (FIB) and taking SEM image of each slice with a FIB/SEM crossbeam instrument. The second set of experiments is designed to understand the inner core crystallization and element distribution between the liquid outer core and solid inner core by determining the melting temperature and element partitioning at high pressure. The melting experiments are conducted in the multi-anvil apparatus up to 27 GPa and extended to higher pressure in the diamond-anvil cell with laser-heating. We have developed techniques to recover small heated samples by precision FIB milling and obtain high-resolution images of the laser-heated spot that show melting texture at high pressure. By analyzing the chemical compositions of the coexisting liquid and solid phases, we precisely determine the liquidus curve, providing necessary data to understand the inner core crystallization process.
Tamayo Hernandez, Lissette; Aguilar Munnoz, Liliana; Estevez de la Torre, Elyanne; Ricardo Guerrero, Migdania; Rodriguez Infanzon, Olga; Hung Arroyo, Jose Manuel
A descriptive and cross-sectional study was carried out in patients with a presumptive diagnosis of breast malignant processes . The patients came from the breast cancer consulting room at V. I. Lenin Hospital from January 2005 to December 2005. A breast ultrasound imaging was done aimed at deepening in the diagnosis which was predominant in pre- menopausal women , being the left breast external upper quadrant the most frequent site of localization. The most suggestive echography pattern of malignant processes was the image with changes in its echostructure, soft echos in its inner part and irregular edge were observed. According to the mammography results the most frequent presentation was the visualization of a thick breast of irregular edge with spicule formations. There was a diagnostic correspondence between the echogram and the mammography considering that this is an adequate method for the initial evaluation of breast malignant processes
María Beatriz Contreras Rey
Full Text Available Objective: To analyze the outcomes of a medication reconciliation process at admission in the hospital setting. To assess the role of the Pharmacist in detecting reconciliation errors and preventing any adverse events entailed. Method: A retrospective study was conducted to analyze the medication reconciliation activity during the previous six months. The study included those patients for whom an apparently not justified discrepancy was detected at admission, after comparing the hospital medication prescribed with the home treatment stated in their clinical hospital records. Those patients for whom the physician ordered the introduction of home medication without any specification were also considered. In order to conduct the reconciliation process, the Pharmacist prepared the best pharmacotherapeutical history possible, reviewing all available information about the medication the patient could be taking before admission, and completing the process with a clinical interview. The discrepancies requiring clarification were reported to the physician. It was considered that the reconciliation proposal had been accepted if the relevant modification was made in the next visit of the physician, or within 24-48 hours maximum; this case was then labeled as a reconciliation error. For the descriptive analysis, the Statistics® SPSS program, version 17.0, was used. Outcomes: 494 medications were reconciled in 220 patients, with a mean of 2.25 medications per patient. More than half of patients (59.5% had some discrepancy that required clarification; the most frequent was the omission of a medication that the patient was taking before admission (86.2%, followed by an unjustified modification in dosing or way of administration (5.9%. In total, 312 discrepancies required clarification; out of these, 93 (29.8% were accepted and considered as reconciliation errors, 126 (40% were not accepted, and in 93 cases (29,8% acceptance was not relevant due to a change in
Howells, W.S.; Anderson, I.S.
This report described modifications made to some of the IN10 spectrometer data analysis programs in use at the Institut Laue-Langevin, Grenoble in order that they may be used on the IBM 360 system at the Rutherford Laboratory. Fuller descriptions of the programs are contained in the original manual (Users' Guide to Processing IN10 Data by W S Howells, ILL Internal Report (1977). Programs discussed are: a) FAST. A program for fitting Lorentzians to raw data. This is a modification of the ILL programs FAST and HAST. b) SUPER. A convolution program for fitting quasielastic peaks to corrected data. This program is based on the ILL program SUPER. c) SAND. A convolution program for fitting an elastic and a Quasielastic peak to data. This is similar to the ILL version of SAND. d) SWIFT. A program similar to SUPER but faster. It is based on the ILL program CONTTY. Before using these programs users must consult the NBRU in order to obtain an account number and a user identifier. (U.K.)
This is the final report on the series of operations which culminated with the delivery of the Plasma Separation Process prototype magnet system (PMS) to Building K1432 at Oak Ridge National Laboratory (ORNL). This procedure included real time monitoring of the cold mass support strut strain gauges and an in-cab rider to monitor the instrumentation and direct the driver. The primary technical consideration for these precautions was the possibility of low frequency resonant vibration of the cold mass when excited by symmetrical rough road conditions at specific speeds causing excess stress levels in the support struts and consequent strut failure. A secondary consideration was the possibility of high acceleration loads due to sudden stops, severe road conditions, of impacts. The procedure for moving and transportation to ORNL included requirements for real time continuous monitoring of the eight strut stain gauges and three external accelerometers. Because the strain gauges had not been used since the original magnet cooldown, it was planned to verify their integrity during magnet warmup. The measurements made from the strut strain gauges resulted in stress values that were physically impossible. It was concluded that further evaluation was necessary to verify the usefulness of these gauges and whether they might be faulty. This was accomplished during the removal of the magnet from the building. 6 figs., 1 tab
Souza, E.S.; Triguis, J.A.
Bioremediation methods have been used in Brazil to remediate contaminated soils from refinery residues. In particular, bioremediation is a process that can reduce the amount of oil that reaches shorelines, by enhancing natural biodegradation. This presentation presents the results of a laboratory study in which seawater contaminated with light crude oil was bioremediated in a period of 28 days using NPK fertilizer. Whole oil gas chromatography and gas chromatography-mass spectrometry analyses of the hydrocarbon fractions were used to determine the extent of oil biodegradation. It was determined that natural degradation occurred in the first 4 days, and mostly through the evaporation of light end n-alkanes. Biodegradation of n-alkanes was found to be most effective after 7 days, and no changes were observed in the relative abundance of steranes and triterpanes. It appears that the addition of NPK nutrient reduces the biodegradation potential of polyaromatic compounds. Seawater samples were also measured to determine the efficiency of bioremediation. The use of NPK fertilizer resulted in higher toxicity after 14 days probably due to the creation of metabolites as polyaromatic compounds biodegrade. Non toxic levels were found to be reestablished after 28 days of bioremediation. 16 refs., 4 tabs., 6 figs
Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine
Scand J Caring Sci; 2010; 24; 581-591 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory. To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories. Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing. The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff. The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.
Aziah, B D; Rusli, B N; Winn, T; Naing, L; Tengku, M A
Karasek's job strain model postulates that workers chronically exposed to adverse psychosocial work environment (high strain job)--high psychological job demands and low job control, including poor social support, increased physical demand and hazardous work condition--will eventually develop both physical illnesses such as cardiovascular diseases and psychological disorders such as depression. In order to determine the prevalence and associated factors of job-related depression, a cross-sectional study was conducted among laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan between September 2001 and February 2002. One hundred and two laboratory technicians in HUSM and 79 laboratory technicians in 7 KKM Hospitals were selected; 84/102 (82.4%) in HUSM and 71/79 (89.9%) in KKM Hospitals responded. Data was collected using self-administered questionnaires of the validated Malay version of the Job Content Questionnaire (JCQ) originally developed by Robert Karasek. Results indicated that the prevalence of high job strain in laboratory technicians in HUSM and KKM hospitals was 33.3% (28/84) and 26.8% (19/71), respectively (p>0.05). Significantly higher proportion (59.5%) (50/84) of laboratory technicians in HUSM compared to those in KKM Hospitals (39.4%) (28/71) (p = 0.016) experienced job-related depression. Significant associated factors of job-related depression were low social support (HUSM: adjusted OR 4.7, 95% CI 1.2-18.8; KKM: adjusted OR 14.8, 95%CI 2.4-89.3), high psychological demand (HUSM: adjusted OR 3.0, 95%CI 1.0-8.8), and low decision authority (KKM: adjusted OR 9.7, 95%CI 1.0-91.1). We conclude that strengthening the social support network (supervisors' and coworkers' support), reducing psychological job demand, and increasing decision-making authority of laboratory technicians may go a long way towards reducing job-related depression.
Fältholm, Ylva; Jansson, Anna
During the last decade, as a response to the need for inter- as well as intra-organizational integration, management models initially developed for industry have been spread to health care organizations. Based on 62 in-depth interviews, this qualitative study aims at describing and analyzing the limited success of implementation of process orientation at a Swedish hospital and in doing so, the traditional and the critical approaches are combined. Applying a traditional approach, the limited success of the implementation of process orientation is explained in terms of difficulties to challenge deeply institutionalized organizational routines and the inter-disciplinary boundaries. This might be condensed to the dilemma of how to maintain and develop the specialization of the medical profession while focusing process rather than function and how to enhance inter-organizational integration without hampering intra-organizational collaboration. Applying a critical approach, the limited success is explained in terms of a differentiated translation process and in terms of separation of talk and practice. This means that process orientation, notwithstanding that it might be an efficient tool for the type of integration needed, might be regarded as part of a change discourse, aiming at conveying a picture of an efficient and modern organization.
Hargrove, R.S.; Dragon, E.P.; Hackel, R.P.; Kautz, D.D.; Warner, B.E.
High power and high radiance laser technologies developed at Lawrence Livermore National Laboratory (LLNL) such as copper-vapor lasers, solid-state slab lasers, dye lasers, harmonic wavelength conversion of these lasers, and fiber optic delivery systems show great promise for material processing tasks. Evaluation of models suggests significant potential for tenfold increases in welding, cutting, and drilling performance, as well as capability for applications in emerging technologies such as micromachining, surface treatment, and stereolithography. Copper and dye laser systems are currently being developed at LLNL for uranium enrichment production facilities. The goals of this program are to develop low-cost, reliable and maintainable industrial laser systems. Chains of copper lasers currently operate at more than 1.5 kW output and achieve mean time between failures of more than 1,000 hours. The beam quality of copper vapor lasers is approximately three times the diffraction limit. Dye lasers have near diffraction limited beam quality at greater than 1.0 kW. Diode laser pumped, Nd:YAG slab lasers are also being developed at LLNL. Current designs achieve powers of greater than 1.0 kW and projected beam quality is in the two to five times diffraction limited range. Results from cutting and drilling studies in titanium and stainless steel alloys show that cuts and holes with extremely fine features can be made with dye and copper-vapor lasers. High radiance beams produce low distortion and small heat-affected zones. The authors have accomplished very high aspect ratio holes in drilling tests (> 60: 1) and features with micron scale (5-50 μm) sizes. Other, traditionally more difficult, materials such as copper, aluminum and ceramics will soon be studied in detail
McAuliffe, Gary N; Taylor, Susan L; Drinković, Dragana; Roberts, Sally A; Wilson, Elizabeth M; Best, Emma J
In July 2014, New Zealand introduced universal infant vaccination with RotaTeq (Merk & Co.) administered as 3 doses at 6 weeks, 3 and 5 months of age. We sought to assess the impact of rotavirus vaccination on gastroenteritis (GE) hospitalizations in the greater Auckland region and analyze changes in rotavirus testing in the period around vaccine introduction. Hospitalizations, laboratory testing rates and methods were compared between the pre-vaccine period (2009-2013), post-vaccine period (January 2015 to December 2015) and year of vaccine introduction (2014). There was a 68% decline in rotavirus hospitalizations of children Auckland region. However, continued rotavirus testing at pre-vaccine rates risks generating false positive results. Laboratories and clinicians should consider reviewing their testing algorithms before vaccine introduction.
Yang, Shigui; Zhou, Yuqing; Cui, Yuanxia; Ding, Cheng; Wu, Jie; Deng, Min; Wang, Chencheng; Lu, Xiaoqing; Chen, Xiaoxiao; Li, Yiping; Shi, Dongyan; Mi, Fenfang; Li, Lanjuan
Most hospital clinical laboratories (HCLs) in China are unable to perform influenza virus detection. It remains unclear whether the influenza detection ability of HCLs influences the early identification and mortality rate of influenza. A total of 739 hospitalized patients with 2009 influenza A (H1N1) virus treated at 65 hospitals between May and December, 2009, in Zhejiang, China, were included based on identifications by HCLs and by public health laboratories (PHLs) of the Centers for Disease Control and Prevention. Of the patients, 407 (55.1%) were male, 17 died, resulting in an in-hospital mortality rate of 2.3%, and 297 patients were identified by HCLs and 442 by PHLs. The results indicated that a 24-hour delay in identification led to a 13% increase in the odds of death (OR = 1.13, P hospital mortality rate of the HCL group was significantly lower than that of the PHL group (1.0% vs. 3.2%, P hospital mortality rate by 68.8%. HCL-based influenza virus detection facilitated early identification and reduced influenza mortality, and influenza detection ability of HCLs should be strengthened.
Ohnishi, Kayoko; Hayama, Yumiko; Asai, Atsushi; Kosugi, Shinji
This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.
Pinto, Júlia Peres; Mandetta, Myriam Aparecida; Ribeiro, Circéa Amalia
to understand the meaning attributed by the family to its experience in the recovery process of a child affected by an acute disease after discharge, and to develop a theoretical model of this experience. Symbolic interactionism was adopted as a theoretical reference, and grounded theory was adopted as a methodological reference. data were collected through interviews and participant observation with 11 families, totaling 15 interviews. A theoretical model consisting of two interactive phenomena was formulated from the analysis: Mobilizing to restore functional balance and Suffering from the possibility of a child's readmission. the family remains alert to identify early changes in the child's health, in an attempt to avoid rehospitalization. the effects of the disease and hospitalization continue to manifest in family functioning, causing suffering even after the child's discharge and recovery.
Westlake, G E
Prospective cost analysis of alternative data processing systems can be facilitated by proper selection of the costs to be analyzed and realistic appraisal of the effect on staffing. When comparing projects with dissimilar cash flows, techniques such as analysis of net present value can be helpful in identifying financial benefits. Confidence and accuracy in prospective analyses will increase as more retrospective studies are published. Several accounts now in the literature describe long-term experience with turnkey laboratory information systems. Acknowledging the difficulty in longitudinal studies, they all report favorable effects on labor costs and recovery of lost charges. Enthusiasm is also expressed for the many intangible benefits of the systems. Several trends suggest that cost justification and cost effectiveness will be more easily demonstrated in the future. These are the rapidly decreasing cost of hardware (with corresponding reduction in service costs) and the entry into the market of additional systems designed for medium to small hospitals. The effect of broadening the sales base may be lower software prices. Finally, operational and executive data management and reporting are destined to become the premier extensions of the LIS for cost justification. Aptly applied, these facilities can promote understanding of costs, control of costs, and greater efficiency in providing laboratory services.
Geffen, Yuval; Zaidise, Itzhak
In recent decades, the laboratory medicine profession has undergone significant changes due to both technological developments and economic constraints. Technological innovations support automation, provide faster and more accurate equipment, and allow increased efficiency through the use of commercial test kits. These changes, combined with budgetary constraints, have led to mergers and centralization of medical laboratories to optimize work and cut costs. While this centralization may be a business necessity, it leads to a disconnection between the laboratory and the clinical context. In addition, laboratory tests are treated as a commodity, which places emphasis on price only, rather than quality. In this article, we review the developments and changes that medical laboratories and the laboratory medicine profession have undergone in recent decades. We focus on technological and structural challenges affecting the functioning of medical laboratories and the relations between laboratory workers and medical teams. We then introduce vocational education changes required for the laboratory medicine profession. We propose defining the role of medical laboratory directors in terms of their basic training as medical doctors or doctors of science. We suggest that laboratory employees should become a reliable source of information regarding selection of appropriate test methods, processing data and presenting the results to the medical staff. Laboratory workers must deepen their clinical knowledge and become an integral part of the patient care process, along with medical and nursing staff. Special training programs for medical laboratory workers and directors must be developed in order to match the complex activities currently being conducted in laboratories.
... 21 Food and Drugs 2 2010-04-01 2010-04-01 false What are the requirements for laboratory control... MANUFACTURING, PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Production and Process Control System: Requirements for Laboratory Operations § 111.315 What are the requirements for laboratory control...
Sautour, Marc; Dalle, Frédéric; Olivieri, Claire; L'ollivier, Coralie; Enderlin, Emilie; Salome, Elsa; Chovelon, Isabelle; Vagner, Odile; Sixt, Nathalie; Fricker-Pap, Véronique; Aho, Serge; Fontaneau, Olivier; Cachia, Claire; Bonnin, Alain
Invasive filamentous fungi infections resulting from inhalation of mold conidia pose a major threat in immunocompromised patients. The diagnosis is based on direct smears, cultural symptoms, and culturing fungi. Airborne conidia present in the laboratory environment may cause contamination of cultures, resulting in false-positive diagnosis. Baseline values of fungal contamination in a clinical mycology laboratory have not been determined to date. A 1-year prospective survey of air and surface contamination was conducted in a clinical mycology laboratory during a period when large construction projects were being conducted in the hospital. Air was sampled with a portable air system impactor, and surfaces were sampled with contact Sabouraud agar plates. The collected data allowed the elaboration of Shewhart graphic charts. Mean fungal loads ranged from 2.27 to 4.36 colony forming units (cfu)/m(3) in air and from 0.61 to 1.69 cfu/plate on surfaces. Strict control procedures may limit the level of fungal contamination in a clinical mycology laboratory even in the context of large construction projects at the hospital site. Our data and the resulting Shewhart graphic charts provide baseline values to use when monitoring for inappropriate variations of the fungal contamination in a mycology laboratory as part of a quality assurance program. This is critical to the appropriate management of the fungal risk in hematology, cancer and transplantation patients.
McCue, Michael J; Nayar, Preethy
Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services.
Hafer, J C
"Telemarketing" is an innovative concept used by many firms to increase the efficiency and effectiveness of product delivery efforts. It can be used by hospitals to benefit both patients and physicians. Further, it can be a tool that, if used properly, can improve the image of the hospital and assist in positioning the organization uniquely among its competitors. This paper discusses the exploratory nature, potential problems, and benefits of telemarketing hospital services and offers pre- and post-implementation considerations. This paper also provides an outline of a sample marketing plan that could serve as an initial model for hospitals that might consider this unique marketing approach.
Jennifer R. Brigati
Full Text Available Incorporating peer-review steps in the laboratory report writing process provides benefits to students, but it also can create additional work for laboratory instructors. The laboratory report writing process described here allows the instructor to grade only one lab report for every two to four students, while giving the students the benefits of peer review and prompt feedback on their laboratory reports. Here we present the application of this process to a sophomore level genetics course and a freshman level cellular biology course, including information regarding class time spent on student preparation activities, instructor preparation, prerequisite student knowledge, suggested learning outcomes, procedure, materials, student instructions, faculty instructions, assessment tools, and sample data. T-tests comparing individual and group grading of the introductory cell biology lab reports yielded average scores that were not significantly different from each other (p = 0.13, n = 23 for individual grading, n = 6 for group grading. T-tests also demonstrated that average laboratory report grades of students using the peer-review process were not significantly different from those of students working alone (p = 0.98, n = 9 for individual grading, n = 6 for pair grading. While the grading process described here does not lead to statistically significant gains (or reductions in student learning, it allows student learning to be maintained while decreasing instructor workload. This reduction in workload could allow the instructor time to pursue other high-impact practices that have been shown to increase student learning. Finally, we suggest possible modifications to the procedure for application in a variety of settings.
Brigati, Jennifer R; Swann, Jerilyn M
Incorporating peer-review steps in the laboratory report writing process provides benefits to students, but it also can create additional work for laboratory instructors. The laboratory report writing process described here allows the instructor to grade only one lab report for every two to four students, while giving the students the benefits of peer review and prompt feedback on their laboratory reports. Here we present the application of this process to a sophomore level genetics course and a freshman level cellular biology course, including information regarding class time spent on student preparation activities, instructor preparation, prerequisite student knowledge, suggested learning outcomes, procedure, materials, student instructions, faculty instructions, assessment tools, and sample data. T-tests comparing individual and group grading of the introductory cell biology lab reports yielded average scores that were not significantly different from each other (p = 0.13, n = 23 for individual grading, n = 6 for group grading). T-tests also demonstrated that average laboratory report grades of students using the peer-review process were not significantly different from those of students working alone (p = 0.98, n = 9 for individual grading, n = 6 for pair grading). While the grading process described here does not lead to statistically significant gains (or reductions) in student learning, it allows student learning to be maintained while decreasing instructor workload. This reduction in workload could allow the instructor time to pursue other high-impact practices that have been shown to increase student learning. Finally, we suggest possible modifications to the procedure for application in a variety of settings.
Gong, Jie; Møller, Charles
Driven by the global competition, process Innovation has been a challenge to large enterprises for many years. The research in this paper discusses about the theory and methods of Business Process Innovation (BPI) in designing Intelligent Supply Chains (ISC) in inter-organizations. We first review...... the BPI concepts, compare it with Business Process Improvement (BPIm) and Business Process Reengineering (BPR), and then build an analytical framework to define business process innovation from four different perspectives: management science, knowledge management, information technology and quality...
Gong, Jie; Møller, Charles
Driven by the global competition, process Innovation has been a challenge to large enterprises for many years. The research in this paper discusses about the theory and methods of Business Process Innovation (BPI) in designing Intelligent Supply Chains (ISC) in inter-organizations. We first review...... the BPI concepts, compare it with Business Process Improvement (BPIm) and Business Process Reengineering (BPR), and then build an analytical framework to define business process innovation from four different perspectives: management science, knowledge management, information technology and quality...
Helder, J.C.; Schram, P.H.; Verwey, H.; Meijler, F.L.; Robles de Medina, E.O.
The ECG handling in the University Hospital of Utrecht is composed by a system consisting of acquisition and storage of ECG signals, computer analysis, data management, and storage of readings in a patient data base. The last two modules are part of a Hospital Information System (HIS). The modular
Kane, Nancy M; Clark, Jonathan R; Rivenson, Howard L
Nonprofit hospital boards are under increasing pressure to improve financial, clinical, and charitable and community benefit performance. Most research on board effectiveness focuses on variables measuring board structure and attributes associated with competing ideal models of board roles. However, the results do not provide clear evidence that one role is superior to another and suggest that in practice boards pursue hybrid roles. Board dynamics and processes have received less attention from researchers, but emerging theoretical frameworks highlight them as key to effective corporate governance. We explored differences in board processes and behavioral dynamics between financially high- and low-performing hospitals, with the goal of developing a better understanding of the best board practices in nonprofit hospitals. A comparative case study approach allowed for in-depth, qualitative assessments of how the internal workings of boards differ between low- and high-performing facilities. Boards of hospitals with strong financial performance exhibited behavioral dynamics and internal processes that differed in important ways from those of hospitals with poor financial performance. Boards need to actively attend to key processes and foster positive group dynamics in decision making to be more effective in governing hospitals.
Progress in the Savannah River 238 Pu Fuel Form Program is discussed. Goals of the Savannah River Laboratory (SRL) program are to provide technical support for the transfer of the 238 Pu fuel form fabrication operations from Mound Laboratory to new facilities being built at the Savannah River Plant (SRP), to provide the technical basis for 238 Pu scrap recovery at SRP, and to assist in sustaining plant operations. During the period it was found that the density of hot-pressed 238 PuO 2 pellets decreased as the particle size of ball-milled powder decreased;the surface area of calcined 238 PuO 2 powder increased with increasing precipitation temperature and may be related to the variation in ball-milling response observed among different H Area B-Line batches; calcined PuO 2 produced by Pu(III) reverse-strike precipitation was directly fabricated into a pellet without ball milling, slugging, or sharding. The pellet had good appearance with acceptable density and dimensional stability, and heat transfer measurements and calculations showed that the use of hollow aluminum sleeves in the plutonium fuel fabrication (PuFF) storage vault reduced the temperature of shipping cans to 170 0 C and will reduce the temperature at the center of pure plutonium oxide (PPO) spheres to 580 0 C
Salinas La Casta, Maria; Flores Pardo, Emilio; Uris Selles, Joaquín
to propose a set of indicators as a management tool for a clinical laboratory, by using the balanced scorecard internal business processes perspective. indicators proposed are obtained from different sources; external proficiency testing of the Valencia Community Government, by means of internal surveys and laboratory information system registers. One year testing process proportion indicators results are showed. internal management indicators are proposed (process, appropriateness and proficiency testing). The process indicators results show gradual improvement since its establishment. after one years of using a conceptually solid Balanced Scorecard Internal business processes perspective indicators, the obtained results validate the usefulness as a laboratory management tool.
Bijlsma, M.; Koning, P.W.C.; Shestalova, V.
This study examines the impact of competition on hospital quality. Our panel covers all Dutch hospitals in the period 2004–2008, in which the transparency of hospital quality information increased substantially. The paper contributes to the existing literature by including both outcome and process
Tompkins, Willis J; Wilson, J
In the early 1990's we developed a special computer program called UW DigiScope to provide a mechanism for anyone interested in biomedical digital signal processing to study the field without requiring any other instrument except a personal computer. There are many digital filtering and pattern recognition algorithms used in processing biomedical signals. In general, students have very limited opportunity to have hands-on access to the mechanisms of digital signal processing. In a typical course, the filters are designed non-interactively, which does not provide the student with significant understanding of the design constraints of such filters nor their actual performance characteristics. UW DigiScope 3.0 is the first major update since version 2.0 was released in 1994. This paper provides details on how the new version based on MATLAB! works with signals, including the filter design tool that is the programming interface between UW DigiScope and processing algorithms.
Black, Anne; Heimerl, Susanne; Oertli, Linnéa; Wilczek, Wolf; Greinacher, Andreas; Spannagl, Michael; Herr, Wolfgang; Hart, Christina
Heparin-induced thrombocytopenia (HIT) is a rare cause of thrombocytopenia and a potentially life-threatening adverse drug reaction. Clinical overdiagnosis of HIT results in costly laboratory tests and anticoagulation. Criteria and algorithms for diagnosis are established, but their translation into clinical practice is still challenging. In a retrospective approach we studied all HIT related laboratory test requests within four years and evaluated data before (1st period, 24month) and after (2nd period, 24month) replacing particle gel immunoassay (PaGIA) and enzyme-linked immunosorbent assay (ELISA) by a chemiluminescent immunoassay (CLIA). HIT was confirmed by heparin-induced platelet activation (HIPA) test. Clinical pretest probability for HIT using an implemented simplified 4Ts score and platelet count were evaluated. Costs for laboratory tests and alternative anticoagulation were calculated. In 1850 patients with suspected HIT, 2327 laboratory orders were performed. In 87.2% of these orders an intermediate/high simplified 4Ts score was found. Thrombocytopenia was present in 87.1%. After replacing PaGIA and ELISA by CLIA the number of immunological and functional laboratory tests was reduced by 38.2%. The number of positive HIT immunoassays declined from 22.6% to 6.0%, while the number of positive HIPA tests among positive immunological tests increased by 19%. Altogether, acute HIT was confirmed in 59 patients. A decline in the use of alternative anticoagulants was observed in the 2nd period. Our study shows that in a university hospital setting HIT is well-known, but diagnosis requires a precise laboratory confirmation. Replacing PaGIA and ELISA by CLIA did not influence laboratory order behavior but results in reduced overall costs for laboratory diagnostics and alternative anticoagulation. Copyright © 2017 Elsevier Ltd. All rights reserved.
Collins, Susan M.; Hacek, Donna M.; Degen, Lisa A.; Wright, Marc O.; Noskin, Gary A.; Peterson, Lance R.
We surveyed environmental surfaces in our clinical microbiology laboratory to determine the prevalence of vancomycin-resistant enterococci (VRE) and multidrug-resistant Enterobacteriaceae (MDRE) during a routine working day. From a total of 193 surfaces, VRE were present on 20 (10%) and MDRE were present on 4 (2%) of the surfaces tested. In a subsequent survey after routine cleaning, all of the 24 prior positive surfaces were found to be negative. Thus, those in the laboratory should recognize that many surfaces may be contaminated by resistant organisms during routine processing of patient specimens. PMID:11574615
Roberts, R S; Poyneer, L A; Kegelmeyer, L M; Carrano, C J; Chambers, D H; Candy, J V
Lawrence Livermore National Laboratory is a large, multidisciplinary institution that conducts fundamental and applied research in the physical sciences. Research programs at the Laboratory run the gamut from theoretical investigations, to modeling and simulation, to validation through experiment. Over the years, the Laboratory has developed a substantial research component in the areas of signal and image processing to support these activities. This paper surveys some of the current research in signal and image processing at the Laboratory. Of necessity, the paper does not delve deeply into any one research area, but an extensive citation list is provided for further study of the topics presented.
Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...
Guo, Siqi; Duan, Yifei; Liu, Xiaojuan; Jiang, Yongmei
Customer satisfaction is a key quality indicator of laboratory service. Patients and physicians are the ultimate customers in medical laboratory, and their opinions are essential components in developing a customer-oriented laboratory. A longitudinal investigation of customer satisfaction was conducted through questionnaires. We designed two different questionnaires and selected 1200 customers (600 outpatients and 600 physicians) to assess customer satisfaction every other year from 2012 to 2016. Items with scores satisfaction in 2014 was better, which illustrated our strategy was effective. However, some items remained to be less than 4, so we repeated the survey after modifying questionnaires in 2016. However, the general satisfaction points of the physicians and patients reduced in 2016, which reminded us of some influential factors we had neglected. By using dynamic survey of satisfaction, we can continuously find deficiencies in our laboratory services and take suitable corrective actions, thereby improving our service quality.
Full Text Available OBJETIVO: Determinar a prevalência das dislipidemias em adultos da demanda laboratorial não-hospitalar da cidade de Salvador (BA. MÉTODOS: Casuística procedente de amostra probabilística de 25% dos laboratórios não-hospitalares da cidade que usavam o método enzimático para dosagem dos lípides séricos e controle de qualidade da Sociedade Brasileira de Patologia Clínica (93% do total; LDL estimado pela fórmula de Friedewald. Sorteados os meses ímpares de 1995 para o estudo. Critérios para dislipidemias, em mg/dl: colesterol ³240; LDL ³160; HDL ³200. Análise: prevalências, seus intervalos de confiança (IC a 95% e qui-quadrado (chi². RESULTADOS: Excluídos uma recusa e um laboratório que arquivava laudos só por 3 meses, foram analisados dados de 24 dos 26 laboratórios amostrados. Dos 7392 adultos, 65,5% eram mulheres. Prevalências estimadas e valores dos IC a 95% para homens, foram: hipercolesterolemia =24,0% (20,5; 27,5; LDL elevado =26,1 (22,4; 29,3; HDL baixo =15,9 (14,2; 17,8 e hipertrigliceridemia =27,6 (25,7; 29,5. Para mulheres: hipercolesterolemia =30,0 (27,8; 32,2, LDL elevado =33,1 (30,8; 35,4; HDL baixo =8,0 (7,1; 8,9 e hipertrigliceridemia =30,4 (29,0; 31,4. Todas as prevalências diferiram significantemente inter-gênero (p, 0,05 a pPURPOSE: To determine the prevalence of dyslipidemia in non-hospital laboratory tests of adults from Salvador, Brazil. METHODS: The study was carried out in subjects from a probabilistic sample of 25% of a total of 104 local laboratories that used the same enzymatic method for lipid analysis with the quality control as recommended by the Brazilian Society of Clinical Analyses. These represented 93% of all non-hospital laboratories of Salvador in 1995. The odd months of 1995 were selected for sampling in the present study. Criteria for dyslipidemias were: total cholesterol ³240; LDL ³160; HDL ³200mg/dl. Prevalence rates and their 95% confidence intervals (CI and chi² test were
French, Martin; Miller, Fiona Alice
For years, scholars have debated the "commercial ethos" in higher education, and the rise of the entrepreneurial university. But what of the "entrepreneurial hospital"? Largely unnoticed by scholars, this unique organisational form differs from the entrepreneurial university in some significant ways, not least in its capacity to use its innovations, and to count patients-and even patient populations-amongst its human capital. Accordingly, this article provides an initial conceptualisation of the entrepreneurial hospital, along with an exploration of its larger implications. Using twenty-six semi-structured interviews with key-informants (2008-2009), who work in two networked organisations within a single academic health science system in a Canadian province, our analysis identifies distinctive characteristics of an entrepreneurial hospital. Informed by grounded theory, especially situational analysis, we derive from our data an illustration of potentially incommensurate understandings of the entrepreneurial hospital's resources. On one hand, our study participants view patients and patient populations as a resource for research, linking its value to the contribution it can make to improved, more cost-effective care. On the other hand, some also see commercial potential in this resource. In both cases, exploitation is accompanied by perceived obligations to make proper use of patient populations, and to "give back" to the public-at-large, including through the entrepreneurial search for new ways of mobilising the resources of publicly-funded health care. Thus, a key task of the entrepreneurial hospital is to invent and mediate new uses for its care infrastructure and the unique resource constituted by patient populations. By drawing together care and research in new ways, the entrepreneurial hospital promises increased capacity for biomedical innovation. Yet, as it invents and mediates new uses for patient populations and health care infrastructure, the
Full Text Available Introduction: Thrombotic thrombocytopenic purpura (TTP is a rare, life-threatening syndrome characterized by microangiopathic anemia, thrombocytopenia, diffuse microvascular thrombosis, and ischemia. It is associated with very low levels of ADAMTS-13. Measurement of ADAMTS-13 levels is used for diagnostic and prognostic purposes, but in every-day clinical practice, this type of analysis is not always readily available. In this retrospective study, we evaluated prognostic value of clinical and laboratory findings in patients with TTP. Materials and methods: We retrospectively investigated patients with clinically diagnosed TTP treated in a unit of Internal and Emergency Medicine (1996-2007. Clinical and laboratory findings were collected and analyzed in order to assess their ability to predict in-hospital death. Results: Twelve patients were identified (mean age 59 + 22 years; 58% were women. Five (42% died during the hospitalization, and the variables significantly associated with this outcome were: a delay between diagnosis and symptom onset (HR 1.36; 95% CI 1.04-1.78; p < 0.05; a higher severity score (HR 1.48; 95%CI 1,23-3.86; p < 0.05; hemodynamic instability with hypotension and/or shock (HR 3.35; 95%CI 3.02-9.26; p < 0.01; a higher schistocyte count on blood smear (HR 1.84; 95%CI 1.04-3.27; p < 0.05; and higher lactate values (HR 1.85; 95%CI 1.08- 3.16; p < 0.05. Conclusions: TTP is a rare and potentially fatal disease with protean manifestations. Delayed diagnosis after symptom onset is a major determinant of poor outcome. Hypotension and shock are also prognostically unfavourable. Laboratory evidence of cardiocirculatory compromise (i.e., elevated lactate levels and extension of the disease process (i.e., schistocyte count > 3 are predictive of in-hospital death, independently of the hemodynamic profile on admission.
A digital radiographic picture processing system has been developed at the EDF Research and Development Laboratory to be supplied to EDF radiography experts. We describe it in pointing out the difficulties of radiograph digitization but also the numerous processing possibilities. The final goal of the Laboratory work is to extract the information from industrial radiographs by digital means. Our study is divided into three parts: digitization by a microdensitometer; display, processing and quantization of flaws; and, digital storing. 5 refs
Sorita, Atsushi; Steinberg, Daniel I; Leitman, Michael; Burger, Alfred; Husk, Gregg; Sivaprasad, Latha
Overuse of inpatient stat laboratory orders ("stat" is an abbreviation of the Latin word "statim," meaning immediately, without delay) is a major problem in the modern healthcare system. To understand patterns of stat laboratory ordering practices at our institution and to assess the effectiveness of individual feedback in reducing these orders. Medicine and General Surgery residents were given a teaching session about appropriate stat ordering practice in January 2010. Individual feedback was given to providers who were the highest utilizers of stat laboratory orders by their direct supervisors from February through June of 2010. The proportion of stat orders out of total laboratory orders per provider was the main outcome measure. All inpatient laboratory orders from September 2009 to June 2010 were analyzed. The median proportion of stat orders out of total laboratory orders was 41.6% for nontrainee providers (N = 500), 38.7% for Medicine residents (N = 125), 80.2% for General Surgery residents (N = 32), and 24.2% for other trainee providers (N = 150). Among 27 providers who received feedback (7 nontrainees, 16 Medicine residents, and 4 General Surgery residents), the proportion of stat laboratory orders per provider decreased by 15.7% (95% confidence interval: 5.6%-25.9%, P = 0.004) after feedback, whereas the decrease among providers who were high utilizers but did not receive feedback (N = 39) was not significant (4.5%; 95% confidence interval: 2.1%-11.0%, P = 0.18). Monthly trends showed reduction in the proportion of stat orders among Medicine and General Surgery residents, but not among other trainee providers. The frequency of stat ordering was highly variable among providers. Individual feedback to the highest utilizers of stat orders was effective in decreasing these orders. © 2013 Society of Hospital Medicine.
Watson, I.; Oswald, S.; Banwart, S.; Mayer, U.
Biodegradation of organic contaminants in soil and groundwater usually takes places via different redox processes happening sequentially as well as simultaneously. We used numerical modelling of a long-term lab microcosm experiment to simulate the dynamic behaviour of fermentation and respiration in the aqueous phase in contact with the sandstone material, and to develop a conceptual model describing these processes. Aqueous speciation, surface complexation, mineral dissolution and precipitation were taken into account also. Fermentation can be the first step of the degradation process producing intermediate species, which are subsequently consumed by TEAPs. Microbial growth and substrate utilisation kinetics are coupled via a formulation that also includes aqueous speciation and other geochemical reactions including surface complexation, mineral dissolution and precipitation. Competitive exclusion between TEAPs is integral to the conceptual model of the simulation, and the results indicate that exclusion is not complete, but some overlap is found between TEAPs. The model was used to test approaches like the partial equilibrium approach that currently make use of hydrogen levels to diagnose prevalent TEAPs in groundwater. The observed pattern of hydrogen and acetate concentrations were reproduced well by the simulations, and the results show the relevance of kinetics, lag times and inhibition, and especially that intermediate products play a key role.
Full Text Available AHP is introduced as a decision making tool for the evaluation of investment alternatives in the hospitality industry. Services are intangible and perishable outputs that are created and consumed simultaneously or nearly simultaneously. The AHP, as a systematic approach that encompasses subjective criteria, alleviates the difficulties encountered in the evaluation of service industry operations. The proposed hierarchical structure in this paper deals with a minor investment project of the holiday village. However, it is possible to extend and apply it for larger investment projects in the hospitality industry as a decision making tool through clustering. Expert Choice for Windows (Version 9.0 is used to solve the decision problem.
Feibert, Diana Cordes; Andersen, Bjørn; Jacobsen, Peter
Logistics processes in hospitals are vital in the provision of patient care. Improving healthcare logistics processes provides an opportunity for reduced healthcare costs and better support of clinical processes. Hospitals are faced with increasing healthcare costs around the world and improvement...... initiatives prevalent in manufacturing industries such as lean, business process reengineering and benchmarking have seen an increase in use in healthcare. This study investigates how logistics processes in a hospital can be benchmarked to improve process performance. A comparative case study of the bed...... logistics process and the pharmaceutical distribution process was conducted at a Danish and a US hospital. The case study results identified decision criteria for designing efficient and effective healthcare logistics processes. The most important decision criteria were related to quality, security...
Riesenbeck, A; Schulze, M; Rüdiger, K; Henning, H; Waberski, D
In recent years, increased automatization has resulted in a higher efficiency of boar semen processing in AI laboratories. Sophisticated laboratory management and efficient quality control programmes are needed for current tendencies in major pork-producing countries to reduce the sperm number per
Shestalova, V.; Bijlsma, M.; Koning, P.W.C.
We examine the impact of competition on outcome and process indicators of hospital quality. While earlier literature on the relationship between competition and hospital quality mainly focused on outcome indicators, we argue that the inclusion of process indicators in the analysis can provide
Hansen, Thomas Riisgaard; Bardram, Jakob; Søgaard, Mads
The authors deployed a distributed system containing a location-tracking system, a context-awareness system, wall-sized displays, and mobile phones in a Danish hospital's operating ward. This article presents the lessons they learned from deploying these pervasive computing technologies...
Morteza Rahbar Taromsari
Full Text Available Introduction: Frequency of Tramadol intoxication is increasing as a result of its useas a drug for suppression of withdrawal symptoms by opioids abusers and its wideaccessibility of this drug. Tramadol intoxication can lead to death and, therefore, earlyidentification of its clinical manifestations is crucial since early detection of theintoxication and its treatment could improve patients' survival This study investigatedthe frequency of clinical and laboratory findings in Tramadol intoxication.Methods: In this cross-sectional study, patients with Tramadol intoxication whoreferred to Razi Hospital in Rasht, Iran, during 2005-06 were examined. Theirmedical records were surveyed for demographic data, past medical history,neurological examination, and routine laboratory tests. All data were statisticallyanalyzed by SPSS software version 14.Result: The majority of the 306 patients (83.3% male were in the age range of 20-40 years and 68.6% of them had been educated up to high school. The mean dose ofingested Tramadol was 746± 453mg (mean± SD. Agitation (25.2% and seizure(20.3% were the most frequent reported symptoms. Among laboratory abnormalities,the most common findings were prolonged PT (18.3% and increased ALT (5.6%.Conclusion: The most common clinical presentation was agitation and the mostcommon laboratory finding was prolonged PT. Of all the patients, 3 cases wereadmitted to ICU. Although Tramadol poisoning might lead to death, there was onlyone death after Tramadol poisoning in the current study.
Objective: We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency. Methods: LRFs submitted to the Department of Haematology (DH and Blood Transfusion Services (BTS of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage. Results: Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8% and signature of laboratory receiver (63.5%. None of the DH and only 9.4% of BTS LRFs met all quality indicator indices. Conclusion: The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.
Jahn, Franziska; Winter, Alfred
Benchmarking is a major topic for monitoring, directing and elucidating the performance of hospital information systems (HIS). Current approaches neglect the outcome of the processes that are supported by the HIS and their contribution to the hospital's strategic goals. We suggest to benchmark HIS based on clinical documentation processes and their outcome. A framework consisting of a general process model and outcome criteria for clinical documentation processes is introduced.
Bonten, Marc J M; Friedrich, Alexander; Kluytmans, Jan A J W; Vandenbroucke-Grauls, Christina M J E; Voss, Andreas; Vos, Margreet C
The Dutch Health Care Inspectorate investigated the preparedness of Dutch hospitals for the emergence of antibiotic resistance, and concluded that hospitals are not well prepared and are insufficiently aware that infection prevention is a prerequisite for patient safety. These conclusions are based on observations of process indicators of current practice guidelines, without including the available outcome indicators that demonstrate the persistently low incidence of infections with antibiotic resistant bacteria in Dutch hospitals. The conclusions may have negative effects on the quality of infection prevention in Dutch hospitals. Therefore, it is advisable to use outcome indicators rather than process indicators to evaluate the quality of infection prevention.
Alahmari, Mohammed Ali S.; Sun, Zhonghua; Bartlett, Andrew
This study aimed to investigate whether the use of protection devices and attitudes of interventional professionals (including radiologists, cardiologists, vascular surgeons, medical imaging technicians and nurses) towards radiation protection will differ between Saudi Arabian and Australian hospitals. Hard copies of an anonymous survey were distributed to 10 and 6 clinical departments in the Eastern province of Saudi Arabia and metropolitan hospitals in Western Australia, respectively. The overall response rate was 43 % comprising 110 Australian participants and 63 % comprising 147 Saudi participants. Analysis showed that Australian respondents differed significantly from Saudi respondents with respect to their usages of leaded glasses (p < 0.001), ceiling-suspended lead screen (p < 0.001) and lead drape suspended from the table (p < 0.001). This study indicates that the trained interventional professionals in Australia tend to adhere to benefit from having an array of tools for personal radiation protection than the corresponding group in Saudi Arabia. (authors)
In this study all of the personnel of Angiography of Dr.Faghihi hospital used TLD service During 2002-2003. This service was given by center for Radiation Protection and Application of the Shiraz University. These staff were divided in two group, one groups was technicians and the other group was the nurses. The result of this research shows that the maximum dose received to Technicians and nurses were 0.4mSv and 0.55mSV respectively. The average annual dose to technicians and nurses were 0.02 mSv and 0.19 mSv. This result shows that the nurses of this hospital receive more dose than the techniques
A discrete event simulation of the Savannah River Site (SRS) Defense Waste Processing Facility (DWPF) analytical laboratory has been constructed in the GPSS language. It was used to estimate laboratory analysis times at process analytical hold points and to study the effect of sample number on those times. Typical results are presented for three different simultaneous representing increasing levels of complexity, and for different sampling schemes. Example equipment utilization time plots are also included. SRS DWPF laboratory management and chemists found the simulations very useful for resource and schedule planning
Nabovati, Ehsan; Vakili-Arki, Hasan; Eslami, Saeid; Khajouei, Reza
This study was conducted to evaluate the usability of widely used laboratory and radiology information systems. Three usability experts independently evaluated the user interfaces of Laboratory and Radiology Information Systems using heuristic evaluation method. They applied Nielsen's heuristics to identify and classify usability problems and Nielsen's severity rating to judge their severity. Overall, 116 unique heuristic violations were identified as usability problems. In terms of severity, 67 % of problems were rated as major and catastrophic. Among 10 heuristics, "consistency and standards" was violated most frequently. Moreover, mean severity of problems concerning "error prevention" and "help and documentation" heuristics was higher than of the others. Despite widespread use of specific healthcare information systems, they suffer from usability problems. Improving the usability of systems by following existing design standards and principles from the early phased of system development life cycle is recommended. Especially, it is recommended that the designers design systems that inhibit the initiation of erroneous actions and provide sufficient guidance to users.
This Order, made in furtherance of an Order of 20 Novembre 1975 concerning safety precautions in the use of radioactive substances, implements in Directive 80/836/Euratom on radiation protection. It lays down a licensing system for the purchase and use of unsealed radioactive sources and also provides for their storage and disposal. The National Board of Health is the licensing authority. The Order also prescribes radiation protection measures for laboratory personnel [fr
The author describes reengineering efforts in the laboratory of a 550-bed hospital. Key benefits include reduced costs, improved turnaround time, and redirection of staff into new roles in information management and outreach.
Machado, Valéria Bertonha; Kurcgant, Paulina
This study was carried out in a philanthropic medium-size hospital institution in Sao Paulo - Brazil, aiming to disclose the cultural features of the institution. The adopted methodology was the qualitative study, following the steps proposed by Thévenet: document analysis, interview and observation. The analysis showed that when a new professional group starts working in an institution, it considers that some values must be changed. This change means to restructure the management of the organization and the people involved in it, facing the conflict posed by changing or preserving the old system.
Hu Haiqiang; Chu Shaolin; Ye Peihong; Lei Qiufang; Chai Luhua; Xia Wei
Objective: With the aim of providing more reliable information for clinical diagnosis, this study investigated the possible causes of the occasional instability of thyroid hormones (T 3 , T 4 , FT 3 , FT 4 TSH) assays in this laboratory and tried to seek plausible explanation for some seemingly contradictory (mismatching) readings of the laboratory reports. Methods: Regular monitoring and checks were enforced on laboratory equipment from sampling pipet to gamma-counters. Results of separation with PR reagent and solid - phase coated tube were compared for superiority (FT 3 ). Collected specimens were tested in monthly sets; this study consisted of 10 sets with total 964 specimens. Serum T 3 , T 4 , FT 3 , FT 4 levels were measured with RIA. For every hormone tested, values of parameters of the standard cure (B 0 , NSB, a, b, r, ED 20 , ED 50 , ED 80 , ABCV) were recorded in detail, from which the QC (quality control) table was derived. For complementary sake , mean level in patients' sera was noted along with the quality control sera. Shewart control chart was drawn for quick reference. Serum TSH levels were measured with IRMA; the parameters involved were: B 0 NSB, ED 80 , ED 50 , ED 20 , standard point deviation. Results: Among the 964 specimens tested, there were 154 specimens with seemingly contradictory (mismatching) results, of which, the majority (n=145) were not erroneous and were compatible with the clinical manifestations of thyroid dysfunction other than plain simple hyper-or hypothyroidism. Only 9 (5.8% of the 154) were due to technical errors (defective technic in removing the supernatant n=7, lipid blood separated with PR reagent n=2). Conclusion: Faulty technic in separation is the main source of random error. From the data of this laboratory, authors believe that solid-phase separation method is better than the conventional homogenous-phase separation method and is the preferred one. With meticulous adherence to standard laboratory procedures and
Gilliland, Yvonne E; Lavie, Carl J; Ahmad, Homaa; Bernal, Jose A; Cash, Michael E; Dinshaw, Homeyar; Milani, Richard V; Shah, Sangeeta; Bienvenu, Lisa; White, Christopher J
We describe our process for quality improvement (QI) for a 3-year accreditation cycle in echocardiography by the Intersocietal Accreditation Commission (IAC) for a large group practice. Echocardiographic laboratory accreditation by the IAC was introduced in 1996, which is not required but could impact reimbursement. To ensure high-quality patient care and community recognition as a facility committed to providing high-quality echocardiographic services, we applied for IAC accreditation in 2010. Currently, there is little published data regarding the IAC process to meet echocardiography standards. We describe our approach for developing a multicampus QI process for echocardiographic laboratory accreditation during the 3-year cycle of accreditation by the IAC. We developed a quarterly review assessing (1) the variability of the interpretations, (2) the quality of the examinations, (3) a correlation of echocardiographic studies with other imaging modalities, (4) the timely completion of reports, (5) procedure volume, (6) maintenance of Continuing Medical Education credits by faculty, and (7) meeting Appropriate Use Criteria. We developed and implemented a multicampus process for QI during the 3-year accreditation cycle by the IAC for Echocardiography. We documented both the process and the achievement of those metrics by the Echocardiography Laboratories at the Ochsner Medical Institutions. We found the QI process using IAC standards to be a continuous educational experience for our Echocardiography Laboratory physicians and staff. We offer our process as an example and guide for other echocardiography laboratories who wish to apply for such accreditation or reaccreditation. © 2016, Wiley Periodicals, Inc.
[Team approaches to critical bleeding (massive bleeding and transfusion) - chairmen's introductory remarks. Questionnaire survey on current status of hospital clinical laboratories evaluating critical hemorrhage].
Kino, Shuichi; Suwabe, Akira
In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).
Lim, Faye J; Blyth, Christopher C; de Klerk, Nicholas; Valenti, Beverly; Rouhiainen, Oliver J; Wu, Dominic Yu-An; Jansz, Christopher S; Moore, Hannah C
Despite a recommendation for microbiological testing, only 45% of children hospitalized for respiratory infections in our previous data linkage study linked to a microbiological record. We conducted a chart review to validate linked microbiological data. The chart review consisted of children aged data linkage study. Poisson regression was used to identify factors predicting the likelihood of microbiological tests in the chart review cohort. From the chart review, 77% of 746 records had a microbiological test performed compared with 46% of 18,687 records from our previous data linkage study. Of those undergoing testing, 66% of the chart review and 64% of data linkage records had ≥1 respiratory pathogen(s) detected. In the chart review cohort, frequency of testing was highest in children admitted to metropolitan hospitals. Validation studies are essential to ensure the quality of linked data. Our previous data linkage study failed to capture all relevant microbiological records. Findings will be used to optimize extraction protocols for future linkage studies. Copyright © 2016 Elsevier Inc. All rights reserved.
Abdelaziz, Hani; Richardson, Sandra; Walsh, Kim; Nodzon, Jessica; Schwartz, Barbara
In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16-63; porder processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.
Full Text Available In order to realize the objectives of the organization, first of all, they are required to have a healthy structure and process. Gaining competitive advantage by a health care facility should be managed with scientific methods in addition to providing good service. Accurate, reliable and prompt data entry in the information systems is under the responsibility of the medical personnel in the health institutions. This process causes heavy burden for doctors who work very busy and results in delays. It also causes completion time of works to increase and sometimes causes works not to be completed, economic losses, cause employee dissatisfaction and even losses of patients. This study will focus on the need of medical assistant in the success of Hospital Information System. The conceptual framework was created in this context, literature search was made and process improvement example was presented for an IVF embryology laboratory process.
Alberto Di Domenico
Full Text Available Objectives. While self-pain perception has been widely investigated in aging, the perception as well as memory of pain in others has received little attention. Methods. The study was designed as a cross-sectional behavioral study in which a group of 41 younger and a group of 41 older adults evaluated a series of valenced and pain-related pictures and were later required to recall them. Results. We found that older adults judge the stimuli as being less intense compared to their younger counterparts. However, older adults remembered a larger number of pictures with individuals expressing pain compared to pictures with individuals who have neutral or positive facial expressions. Conclusions. Older adults may underestimate emotional intensity in others, but they seem to remember painful information in others as well as younger adults. These data are discussed in terms of theories of pain perception and implications for hospitalization.
Caron, Stéphane; Thomson, Nicholas M
Over the past 20 years, the industrial laboratory environment has gone through a major transformation in the industrial process chemistry setting. In order to discover and develop robust and efficient syntheses and processes for a pharmaceutical portfolio with growing synthetic complexity and increased regulatory expectations, the round-bottom flask and other conventional equipment familiar to a traditional organic chemistry laboratory are being replaced. The new process chemistry laboratory fosters multidisciplinary collaborations by providing a suite of tools capable of delivering deeper process understanding through mechanistic insights and detailed kinetics translating to greater predictability at scale. This transformation is essential to the field of organic synthesis in order to promote excellence in quality, safety, speed, and cost efficiency in synthesis.
Craig M. Clemons; Rebecca E. Ibach
The purpose of this study was to clarify the effects of composite processing and moisture sorption on laboratory fungal resistance of wood-plastic composites. A 2-week water soaking or cyclic boiling-drying procedure was used to infuse moisture into composites made from high-density polyethylene filled with 50 percent wood flour and processed by extrusion, compression...
Santos, Maria Joana; Fernandes, Vera; Garcia, Fernando Mota
Although vitamin D deficiency is increasingly recognized around the world, there are few studies on the Portuguese reality. This study aims to analyse vitamin D levels in the assays performed in our hospital and their relationship with age, genre, requesting specialty and moment of sample collection. Cross-sectional study of measurements of 25(HO)D performed in our Hospital between June 2012 and November 2014. Included variables: gender, age, requesting specialty, month of sample collection. Vitamin D status classified as: 'Deficiency' (≤ 20 ng/mL), 'Insufficiency' (21 - 29 ng/ml) and 'Sufficiency' (≥ 30 ng/mL). We included 5 439 assays; 55.0% from women; the median age was 64.0 years. Sixty per cent had 'Deficiency', 20.7% 'Insufficiency' and 18.9% 'Sufficiency'. We found a negative correlation between age and vitamin D level (p vitamin D levels between genres. Nine specialties requested 98% of the assays, namely Nephrology (56.2%). We found differences between specialties based on age and vitamin D level (p Vitamin D levels changed throughout the year, with higher levels in the summer, followed by autumn, spring and winter (p vitamin D sufficiency was only present in a minority of assays (27.8% in summer and 9.2% in winter). Vitamin D deficiency is prevalent in this population, affects individuals of all ages and is not offset by the seasonal variation of sunlight. Vitamin D deficiency is a real and prevalent problem in our population that needs further attention and action, given its clinical implications.
Full Text Available Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE orders vs. non-physician entered (NPE orders. Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001. . The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026. In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.
Treibs, H.A.; Hartenstein, S.D.; Griebenow, B.L.; Wade, M.A.
The Special Isotope Separation (SIS) plant is designed to provide removal of undesirable isotopes in fuel grade plutonium by the atomic vapor laser isotope separation (AVLIS) process. The AVLIS process involves evaporation of plutonium metal, and passage of an intense beam of light from a laser through the plutonium vapor. The laser beam consists of several discrete wavelengths, tuned to the precise wavelength required to ionize the undesired isotopes. These ions are attracted to charged plates, leaving the bulk of the plutonium vapor enriched in the desired isotopes to be collected on a cold plate. Major portions of the process consist of pyrochemical processes, including direct reduction of the plutonium oxide feed material with calcium metal, and aqueous processes for purification of plutonium in residues. The analytical laboratory for the plant is called the Material and Process Control Laboratory (MPCL), and provides for the analysis of solid and liquid process samples
Vanessa L. Strelow
Full Text Available ABSTRACT Meningococcal meningitis is a public health problem. The aim of this study was to describe the clinical characteristics of patients with meningococcal meningitis, and to identify associated factors with mortality. This was a retrospective study, between 2006 and 2011, at a referral center in São Paulo, Brazil. Logistic regression analysis was used to identify factors associated with mortality. We included 316 patients. The median age was 16 years (IQR: 7–27 and 60% were male. The clinical triad: fever, headache and neck stiffness was observed in 89% of the patients. The cerebrospinal triad: pleocytosis, elevated protein levels and low glucose levels was present in 79% of patients. Factors associated with mortality in the multivariate model were age above 50 years, seizures, tachycardia, hypotension and neck stiffness. The classic clinical and laboratory triads of meningococcal meningitis were variable. The fatality rate was low. Age, seizures and shock signs were independently associated with mortality.
Pistono, P G; Rapetti, I; Stacchini, E; Vironda, N; D'Usi, M P; Guasco, C
The authors evaluate retrospectively the results obtained from the research of anaerobial bacteria on 1313 samples received at the Microbiology Laboratory of the "Ospedale Civile di Ivrea" over a period of 31 months (6/1/86-12/31/88). From this evaluation, high percentages of detection of anaerobic bacteria are emerging in the following infections: appendiculare abscesses (60%), intestinal operations (71%), wounds (57%), tubovarian abscesses (100%), as well as thoracic empyema (50%). Also relevant are the isolations from skin and subcutaneous tissues: breast infections (50%) preputial infections (60%), perineal and perirectal abscesses (60%). The incident of anaerobic bacteria in bacteriemia is 17%. The most representative anaerobic bacteria group are: Bacteroides spp. (56%), Peptostreptococcus spp. (12%), Propionibacterium spp. (9%), Fusobacterium spp. (7%) Clostridium spp. (6%), Veillonella spp. and Eubacterium spp. (3%). In the intraabdominal infections prevails the Bacteroides group, particularly fragilis species, while in the skin and subcutaneous infections prevails the Peptostreptococcus group.
Escobar, Gabriel J; Baker, Jennifer M; Turk, Benjamin J; Draper, David; Liu, Vincent; Kipnis, Patricia
This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit. We describe the benchmarking analyses that led to these reflections. The Centers for Medicare and Medicaid Services' Hospital Compare Web site includes data on fee-for-service Medicare beneficiaries but does not control for severity of illness, which requires physiologic data now available in most electronic medical records.To address this limitation, we compared hospital processes and outcomes among Kaiser Permanente Northern California's (KPNC) Medicare Advantage beneficiaries and non-KPNC California Medicare beneficiaries between 2009 and 2010. We assigned a simulated severity of illness measure to each record and explored the effect of having the additional information on outcomes. We found that if the admission severity of illness in non-KPNC hospitals increased, KPNC hospitals' mortality performance would appear worse; conversely, if admission severity at non-KPNC hospitals' decreased, KPNC hospitals' performance would appear better. Future hospital benchmarking should consider the impact of variation in admission thresholds.
The purpose of this survey was to evaluate the implementation of the nursing process at three randomly selected governmental hospitals found in Amhara Region North West Ethiopia. From the total 338 reviewed documents, 264 (78.1%) have a nursing process format attached with the patient's profile/file, 107 (31.7%) had no nursing diagnosis, 185 (54.7%) of nurses stated their plan of care based on priority, 173 (51.2%) of nurses did not document their interventions based on plan and 179 (53.0%) of nurses did not evaluate their interventions. The overall implementation of nursing process among Felege Hiwot Referal hospital, Debretabor general hospital and Finoteselam general hospitals were 49.12, 68.18, and 69.42% respectively. Nursing professionals shall improve documentation required in implementing the nursing process. Nursing managers (matron, ward heads) shall supervise the overall implementation of nursing process. Hospital nursing services managers (matrons) shall arrange and facilitate case presentations by the nursing staffs which focus on documentation and updates on nursing process. Hospitals need to establish and support nursing process coordinating staff in their institution.
Full Text Available This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern ‘model’ like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.
This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern 'model' like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.
Anthony, David; Chetty, V. K; Kartha, Anand; McKenna, Kathleen; DePaoli, Maria R; Jack, Brian
The transfer of patient care from the hospital team to primary care and other providers in the community at the time of discharge is a high-risk process characterized by fragmented, nonstandardized...
Raquel Silva Bicalho Zunta
Full Text Available Our study aimed to map, describe and, validate the audit, account billing and billing reports processes in a large, private general hospital. An exploratory, descriptive, case report study. We conducted non-participatory observation moments in Internal Audit Sectors and Billing Reports from the hospital, aiming to map the processes which were the study objects. The data obtained was validated by internal and external audit specialists in hospital bills. The described and illustrated processes in three flow-charts favor professionals to rationalize their activities and the time spent in hospital billing, avoiding or minimizing the occurrence of flaws and, generating more effective financial results. The mapping, the description and the audit validation process and billing and, the billing reports propitiated more visibility and legitimacy to actions developed by auditor nurses.
... maintenance. Each laboratory must have and follow written procedures to ensure that equipment is routinely... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What requirements apply to the laboratories where...) Laboratory Controls § 212.60 What requirements apply to the laboratories where I test components, in-process...
Icre, P.; Rocquigny, H. de
The Thermorad process is used for decontaminating hospital wastes at the hospital as they are collected from the different departments. The process utilises the combined microbiological effects of ionising radiation (5 kGy) and dry heat (60 o C). The treatment unit, which is compact and of small size, contains a cobalt 60 source of under 100,000 curies and has an annual treatment capacity of 5000 m 3 . (author)
Richter, Jason; Mazurenko, Olena; Kazley, Abby Swanson; Ford, Eric W
Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.
The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...
Jackson, L M
The cost of providing medical care is ever-increasing but the resources available are at best static. Major savings can be made by reducing inappropriate investigations. Using serological testing for organisms causing atypical pneumonia as an example, we examined the appropriateness of requests and also physicians\\' understanding of the test. Of 119 patients tested, only 3 had titres indicative of acute infection. Most patients were tested within 2 days of hospital admission, before receipt of results excluding more likely diagnoses. Forty-five patients had no current or recent respiratory symptoms, in whom infection was highly unlikely. Titres were most often requested by the least experienced members of the clinical team. Of 70 patients with an acute illness in whom a definitive diagnosis, bacteriological or otherwise, was not made, in only 9 was a convalescent specimen sent for follow-up titres. Most requests for serology for organisms causing atypical pneumonia were inappropriate. Furthermore, in the majority of cases the test was incorrectly used.
Sánchez-Romero, M Isabel; García-Lechuz Moya, Juan Manuel; González López, Juan José; Orta Mira, Nieves
The interpretation and the accuracy of the microbiological results still depend to a great extent on the quality of the samples and their processing within the Microbiology laboratory. The type of specimen, the appropriate time to obtain the sample, the way of sampling, the storage and transport are critical points in the diagnostic process. The availability of new laboratory techniques for unusual pathogens, makes necessary the review and update of all the steps involved in the processing of the samples. Nowadays, the laboratory automation and the availability of rapid techniques allow the precision and turn-around time necessary to help the clinicians in the decision making. In order to be efficient, it is very important to obtain clinical information to use the best diagnostic tools. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Kira Lusa Manfredini
Full Text Available The scientific and professional activities developed in a Hospital School and a Laboratory of Human Anatomy of a university can generate parallel, chemical residues from various degrees of angerousness, which may require physical treatment and / or suitable chemical, before being sent to final destination. The General Hospital (GH generates monthly 10 L of xylenes and 50 L of glutaraldehyde to provide ass instance to their patients. Already the Laboratory of Human Anatomy of University de Caxias do Sul (AL-UCS uses more than 10,000 liters for preserving corpses in tanks. The present study aims to analyze the chemical waste management of the GH and the AL-UCS and propose techniques for recovery and reuse of chemicals formaldehyde, glutaraldehyde and xylenes, minimizing the impacts generated by the use, often indispensable and sometimes questionable, of such waste. So far two sets of samples were collected (in March and April 2013 of xylene, glutaraldehyde and formaldehyde in the GH and also at the AL-UCS and it is intended to repeat the collections with monthly periodicity, in the next two semesters. Partial results show that, comparing the relationship of area and the medium areas of the chromatographic (in µV.s of patterns with compounds of interest, an increase in the percentage of formaldehyde relative to the samples in standard formalin (121.84% may be due to contamination with organic compounds with a retention time close to the compound of interest, the xylene was little degradation in the samples, indicating that this compound can be reused in the common procedures of healthcare institutions, with respect to glutaraldehyde significant degradation was observed for the compound in samples represents only 61.88% of the chromatographic peak area of the standard, therefore the reuse of these compounds may require the use of purification methods such as simple distillation and fractional distillation
Russom, Diana; Ahmed, Amira; Gonzalez, Nancy; Alvarnas, Joseph; DiGiusto, David
Regulatory requirements for the manufacturing of cell products for clinical investigation require a significant level of record-keeping, starting early in process development and continuing through to the execution and requisite follow-up of patients on clinical trials. Central to record-keeping is the management of documentation related to patients, raw materials, processes, assays and facilities. To support these requirements, we evaluated several laboratory information management systems (LIMS), including their cost, flexibility, regulatory compliance, ongoing programming requirements and ability to integrate with laboratory equipment. After selecting a system, we performed a pilot study to develop a user-configurable LIMS for our laboratory in support of our pre-clinical and clinical cell-production activities. We report here on the design and utilization of this system to manage accrual with a healthy blood-donor protocol, as well as manufacturing operations for the production of a master cell bank and several patient-specific stem cell products. The system was used successfully to manage blood donor eligibility, recruiting, appointments, billing and serology, and to provide annual accrual reports. Quality management reporting features of the system were used to capture, report and investigate process and equipment deviations that occurred during the production of a master cell bank and patient products. Overall the system has served to support the compliance requirements of process development and phase I/II clinical trial activities for our laboratory and can be easily modified to meet the needs of similar laboratories.
Cengiz, Canan; Celik, Yusuf; Hikmet, Neset
Purpose The purpose of this paper is to evaluate the utilisation of patient wristbands (PWs) and patient identification (PI) process in a training hospital in Ankara, Turkey. Design/methodology/approach This descriptive and cross-sectional study was conducted in a training hospital with 640 beds, accreditied by Joint Commission International. The views of 348 patients and 419 hospital personnel on the implementation of patient wristbands and identification process were evaluated. Findings The results indicated that lack of information among patients about the importance of PWs and the misknowledge among staff participants on when, where, and by whom PWs should be put on and verified were the weakest points in this hospital. Research limitations/implications PI process must be strictly implemented according to the standard procedures of patient safety. Both patients and hospital personnel should be trained continuously, and training sessions must be held to increase their awareness about the importance of PWs and identification process. Practical implications Finding new ways and using new methods for increasing knowledge about PI and PWs are necessary. Hospital management should prepare a written PI and PW policy and procedure documents by taking the views of patients and hospital personnel and share these with them. Originality/value This study incorporates the views and attitudes of patients and health care personnel in improving health care quality by increasing awareness about PI and wristbands.
Buckingham, Steven C; Marshall, Gary S; Schutze, Gordon E; Woods, Charles R; Jackson, Mary Anne; Patterson, Lori E R; Jacobs, Richard F
To describe the clinical characteristics and course of children with laboratory-diagnosed Rocky Mountain spotted fever (RMSF) and to identify clinical findings independently associated with adverse outcomes of death or discharge with neurologic deficits. Retrospective chart review of 92 patients at six institutions in the southeastern and southcentral United States from 1990 to 2002. Statistical analyses used descriptive statistics and multiple logistic regression. Children with RMSF presented to study institutions after a median of 6 days of symptoms, which most commonly included fever (98%), rash (97%), nausea and/or vomiting (73%), and headache (61%); no other symptom or sign was present in >50% of children. Only 49% reported antecedent tick bites. Platelet counts were <150,000/mm3 in 59% of children, and serum sodium concentrations were <135 mEq/dL in 52%. Although 86% sought medical care before admission, only 4 patients received anti-rickettsial therapy during this time. Three patients died, and 13 survivors had neurologic deficits at discharge. Coma and need for inotropic support and intravenous fluid boluses were independently associated with adverse outcomes. Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.
Zeynep Taş Cengiz
Full Text Available Objective: The aim of this study is to present the prevalence of intestinal and hepatic parasites determined in Yüzüncü Yıl University Medical Faculty Parasitology Laboratory. Methods: The study was performed in 2008, and a total of 5985 stool samples were examined. Stool samples were examined with native-Lugol, sedimentation, flotation, trichrome staining and modified acid-fast staining methods. The stool samples of patient suspected to have Entamoeba histolytica/E.dispar infection were stained by trichrome staining method and evaluated by ELISA method for the antigen. ELISA method was used to confirm the results of Fasciola hepatica positive patients in stool examination. Results: In this study intestinal parasites were identified in 29.6% out of the 5985 people. In the study Giardia intestinalis (9.4%, plenty Blastocystis hominis (5.5%, Hymenolepis nana (1.7%, Ascaris lumbricoides (1.2%, Enterobius vermicularis (0.2%; in the stool examination, F.hepatica (0.1%, Cyclospora cayetanensis (0.1%, E.histolytica/E.dispar (0.06%, Taenia saginata (0.05%, Dicrocoelium dendriticum (0.05%, Trichuris trichiura (0.03% and Cryptosporidium spp. (0.02%, pathogenic parasites, were detected. Conclusion: In the study it is also understood that pathogenic intestinal parasites have still been reported at high rates and the problem of parasitosis continues in Van Province.
Full Text Available Objectives: The aim of this study was to investigate characteristicsof neonates hospitalized to Neonatal Unit dueto indirect hyperbilirubinemia and to determine risk factorsfor indirect hyperbilirubinemia.Materials and methods: Totally 222 newborns, aged≥35 weeks of gestational age and hospitalized in neonatalunit with indirect hyperbilirubinemia, were investigated.Physical examination and laboratory studies of childrenwere performed. Decision of phototherapy and exchangetransfusion was done according to total serum bilirubin(TSB level that notified in the Guidelines of AmericanAcademy of Pediatrics.Results: Study group consisted of 131 (60% male and91 (30% female newborns. No significant difference wasfound in TSB values between male and female neonates.There was 71.2% term and 19.8% late preterm newbornbabies. Babies born with spontaneous vaginal deliveryhad borderline higher TSB values compared with cesareansection deliveries (p=0.051. ABO blood group incompatibilitywas found in 30.1% and Rh incompatibilityin 6.7%. Insufficient nutrition and inadequate caloric intakewere found in 49 (22.7% of neonates, urinary tractinfection in 19 (8.5%, hypernatremic dehydration in 9(4.5% and hypothyroidism in 4 (2.0%. Exchange transfusionwas performed in 10 newborns and kernicterus occurredin two. A significant negative correlation was foundbetween TSB values at hospitalization and baby’s birth(p<0.05 and a positive correlation between initial TSBvalue and percent of patient weight loss (p<0.05.Conclusions: According to our results, the most frequentetiological causes of jaundice in newborns were ABOblood group incompatibility, insufficient nutrition and beinglate preterm. J Clin Exp Invest 2012; 3(1: 38-43
Nguyen, Thuong T; McKinney, Barbara; Pierson, Antoine; Luong, Khue N; Hoang, Quynh T; Meharwal, Sandeep; Carvalho, Humberto M; Nguyen, Cuong Q; Nguyen, Kim T; Bond, Kyle B
The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. However, the paper-based format of the checklist makes administration cumbersome and limits timely analysis and communication of results. In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors' feedback about usability. The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries.
Vos, L.; Oostenbrugge, R.J. van; Limburg, M.; Merode, G.G. van; Groothuis, S.
Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study
Meier, Frederick A; Badrick, Tony C; Sikaris, Kenneth A
For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe. Connections between structural and process laboratory measures and patient outcomes, however, have rarely been demonstrated. To inform further development of clinical laboratory quality systems, we conducted a selective but worldwide review of publications on clinical laboratory quality assessment. Some QIs, like seven generic College of American Pathologists Q-Tracks monitors, have demonstrated significant process improvement; other measures have uncovered critical opportunities to improve test selection and result management. The College of Pathologists of Australasia Key Indicator Monitoring and Management System has deployed risk calculations, introduced from failure mode effects analysis, as surrogate measures for outcomes. Showing economic value from clinical laboratory testing quality is a challenge. Clinical laboratories should converge on fewer (7-14) rather than more (21-35) process monitors; monitors should cover all steps of the testing process under laboratory control and include especially high-risk specimen-quality QIs. Clinical laboratory stewardship, the combination of education interventions among clinician test orderers and report consumers with revision of test order formats and result reporting schemes, improves test ordering, but improving result reception is more difficult. Risk calculation reorders the importance of quality monitors by balancing three probabilities: defect frequency, weight of potential harm, and detection difficulty. The triple approach of (1) a more focused suite of generic consensus quality indicators, (2) more active clinical laboratory testing stewardship, and (3) integration of formal
Søeby, Karen; Jensen, Peter Bjødstrup; Werge, Thomas; Sørensen, Steen
The knowledge of physiological fluctuation and variation of even commonly used biochemical quantities in extreme age groups and during development is sparse. This challenges the clinical interpretation and utility of laboratory tests in these age groups. To explore the utility of hospital laboratory data as a source of information, we analyzed enzymatic plasma creatinine as a model analyte in two large pediatric hospital samples. Plasma creatinine measurements from 9700 children aged 0-18 years were obtained from hospital laboratory databases and partitioned into high-resolution gender- and age-groups. Normal probability plots were used to deduce parameters of the normal distributions from healthy creatinine values in the mixed hospital datasets. Furthermore, temporal trajectories were generated from repeated measurements to examine developmental patterns in periods of changing creatinine levels. Creatinine shows great age dependence from birth throughout childhood. We computed and replicated 95% reference intervals in narrow gender and age bins and showed them to be comparable to those determined in healthy population studies. We identified pronounced transitions in creatinine levels at different time points after birth and around the early teens, which challenges the establishment and usefulness of reference intervals in those age groups. The study documents that hospital laboratory data may inform on the developmental aspects of creatinine, on periods with pronounced heterogeneity and valid reference intervals. Furthermore, part of the heterogeneity in creatinine distribution is likely due to differences in biological and chronological age of children and should be considered when using age-specific reference intervals.
Clark, Carol Lynn; Berman, Aaron D; McHugh, Ann; Roe, Edward Jedd; Boura, Judith; Swor, Robert A
To assess the relationship of emergency medical services (EMS) intervals and internal hospital intervals to the rapid reperfusion of patients with ST-segment elevation myocardial infarction (STEMI). We performed a secondary analysis of a prospectively collected database of STEMI patients transported to a large academic community hospital between January 1, 2004, and December 31, 2009. EMS and hospital data intervals included EMS scene time, transport time, hospital arrival to myocardial infarction (MI) team activation (D2Page), page to catheterization laboratory arrival (P2Lab), and catheterization laboratory arrival to reperfusion (L2B). We used two outcomes: EMS scene arrival to reperfusion (S2B) ≤90 minutes and hospital arrival to reperfusion (D2B) ≤90 minutes. Means and proportions are reported. Pearson chi-square and multivariate regression were used for analysis. During the study period, we included 313 EMS-transported STEMI patients with 298 (95.2%) MI team activations. Of these STEMI patients, 295 (94.2%) were taken to the cardiac catheterization laboratory and 244 (78.0%) underwent percutaneous coronary intervention (PCI). For the patients who underwent PCI, 127 (52.5%) had prehospital EMS activation, 202 (82.8%) had D2B ≤90 minutes, and 72 (39%) had S2B ≤90 minutes. In a multivariate analysis, hospital processes EMS activation (OR 7.1, 95% CI 2.7, 18.4], Page to Lab [6.7, 95% CI 2.3, 19.2] and Lab arrival to Reperfusion [18.5, 95% CI 6.1, 55.6]) were the most important predictors of Scene to Balloon ≤ 90 minutes. EMS scene and transport intervals also had a modest association with rapid reperfusion (OR 0.85, 95% CI 0.78, 0.93 and OR 0.89, 95% CI 0.83, 0.95, respectively). In a secondary analysis, Hospital processes (Door to Page [OR 44.8, 95% CI 8.6, 234.4], Page 2 Lab [OR 5.4, 95% CI 1.9, 15.3], and Lab arrival to Reperfusion [OR 14.6 95% CI 2.5, 84.3]), but not EMS scene and transport intervals were the most important predictors D2B ≤90
Mattei, Michele; Yunus, Nor Alafiza Binti; Kalakul, Sawitree
The objective of this paper is to present new methods for design of chemicals based formulated products and their implementation in the software, the Virtual Product-Process Design Laboratory. The new products are tailor-made blended liquid products and emulsion-based products. The new software...
Coleman, C.J.; Dewberry, R.A.; Lethco, A.J.; Denard, C.D.
This paper describes the analytical methods, instruments, and laboratory that will support vitrification of defense waste. The Defense Waste Processing Facility (DWPF) is now being constructed at Savannah River Plant (SRP). Beginning in 1989, SRP high-level defense waste will be immobilized in borosilicate glass for disposal in a federal repository. The DWPF will contain an analytical laboratory for performing process control analyses. Additional analyses will be performed for process history and process diagnostics. The DWPF analytical facility will consist of a large shielded sampling cell, three shielded analytical cells, a laboratory for instrumental analysis and chemical separations, and a counting room. Special instrumentation is being designed for use in the analytical cells, including microwave drying/dissolution apparatus, and remote pipetting devices. The instrumentation laboratory will contain inductively coupled plasma, atomic absorption, Moessbauer spectrometers, a carbon analyzer, and ion chromatography equipment. Counting equipment will include intrinsic germanium detectors, scintillation counters, Phoswich alpha, beta, gamma detectors, and a low-energy photon detector
van der Werf, Jebbe J.; Schretlen, Johanna Lidwina Maria; Ribberink, Jan S.; O'Donoghue, Tom
A new database of laboratory experiments involving sand transport processes over horizontal, mobile sand beds under full-scale non-breaking wave and non-breaking wave-plus-current conditions is described. The database contains details of the flow and bed conditions, information on which quantities
Fleischmann, Katja; Ariel, Ellen
Understanding and trouble-shooting microscopic processes involved in laboratory tests are often challenging for students in science education because of the inability to visualize the different steps and the various errors that may influence test outcome. The effectiveness of gamification or the use of game design elements and game-mechanics were…
Cross-flow filtration is being evaluated as a pretreatment in the proposed treatment processes for aqueous high-level radioactive wastes at Oak Ridge National Laboratory (ORNL) to separate insoluble solids from aqueous waste from the Melton Valley Storage Tanks (MVST)
Lewis, L.C.; Henscheid, J.P.
The Remote Analytical Laboratory at the Idaho Chemical Processing Plant was designed to provide analytical chemistry support to the irradiated fuel processing and associated waste processing operations. The facility was put into radioactive operation on July 7, 1986, and operated for more than a year during the first fluorinel fuel dissolution process campaign. The facility incorporated a number of innovative features and was equipped with state-of-the-art analytical instrumentation. The success of the facility is a direct function of how well the remote analytical equipment performed. The performance is discussed in this article
The cost, speed, and quality are the three important factors recently indicated by the Ministry of Health, Labour and Welfare (MHLW) for the purpose of accelerating clinical studies. Based on this background, the importance of laboratory tests is increasing, especially in the evaluation of clinical study participants' entry and safety, and drug efficacy. To assure the quality of laboratory tests, providing high-quality laboratory tests is mandatory. For providing adequate quality assurance in laboratory tests, quality control in the three fields of pre-analytical, analytical, and post-analytical processes is extremely important. There are, however, no detailed written requirements concerning specimen collection, handling, preparation, storage, and shipping. Most laboratory tests for clinical studies are performed onsite in a local laboratory; however, a part of laboratory tests is done in offsite central laboratories after specimen shipping. As factors affecting laboratory tests, individual and inter-individual variations are well-known. Besides these factors, standardizing the factors of specimen collection, handling, preparation, storage, and shipping, may improve and maintain the high quality of clinical studies in general. Furthermore, the analytical method, units, and reference interval are also important factors. It is concluded that, to overcome the problems derived from pre-analytical processes, it is necessary to standardize specimen handling in a broad sense.
Forster, Alan J; Turnbull, Jeff; McGuire, Shaun; Ho, Michael L; Worthington, JR
Abstract The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; ...
Mayer, Horst; Brümmer, Jens; Brinkmann, Thomas
To implement Lean Six Sigma in our central laboratory we conducted a project to measure single pre-analytical steps influencing turnaround time (TAT) of emergency department (ED) serum samples. The traditional approach of extracting data from the Laboratory Information System (LIS) for a retrospective calculation of a mean TAT is not suitable. Therefore, we used radiofrequency identification (RFID) chips for real time tracking of individual samples at any pre-analytical step. 1,200 serum tubes were labelled with RFID chips and were provided to the emergency department. 3 RFID receivers were installed in the laboratory: at the outlet of the pneumatic tube system, at the centrifuge, and in the analyser area. In addition, time stamps of sample entry at the automated sample distributor and communication of results from the analyser were collected from LIS. 1,023 labelled serum tubes arrived at our laboratory. 899 RFID tags were used for TAT calculation. The following transfer times were determined (median 95th percentile in min:sec): pneumatic tube system --> centrifuge (01:25/04:48), centrifuge --> sample distributor (14:06/5:33), sample distributor --> analysis system zone (02:39/15:07), analysis system zone --> result communication (12:42/22:21). Total TAT was calculated at 33:19/57:40 min:sec. Manual processes around centrifugation were identified as a major part of TAT with 44%/60% (median/95th percentile). RFID is a robust, easy to use, and error-free technology and not susceptible to interferences in the laboratory environment. With this study design we were able to measure significant variations in a single manual sample transfer process. We showed that TAT is mainly influenced by manual steps around the centrifugation process and we concluded that centrifugation should be integrated in solutions for total laboratory automation.
Govindarajan, R; Perelló-Juncá, A; Parès-Marimòn, R M; Serrais-Benavente, J; Ferrandez-Martí, D; Sala-Robinat, R; Camacho-Calvente, A; Campabanal-Prats, C; Solà-Anderiu, I; Sanchez-Caparrós, S; Gonzalez-Estrada, J; Martinez-Olalla, P; Colomer-Palomo, J; Perez-Mañosas, R; Rodríguez-Gallego, D
To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.
Maruster, L; Jorna, RJ; Miksch, S; Hunter, J; Keravnou, E
A knowledge management perspective is rarely used to model a process. Using the cognitive perspective on knowledge management in which we start our analysis with events and knowledge (bottom-up) instead of with processes and units (top-down), we propose a new approach for redesigning hospital
Elkhuizen, Sylvia G.; Burger, Matthe P. M.; Jonkers, Rene E.; Limburg, Martien; Klazinga, Niek; Bakker, Piet J. M.
BACKGROUND: Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in
Ji Yun Noh
Full Text Available BACKGROUND: A well-constructed and properly operating influenza surveillance scheme is essential for public health. This study was conducted to evaluate the distribution of respiratory viruses in patients with influenza-like illness (ILI through the first teaching hospital-based surveillance scheme for ILI in South Korea. METHODS: Respiratory specimens were obtained from adult patients (≥18 years who visited the emergency department (ED with ILI from week 40, 2011 to week 22, 2012. Multiplex PCR was performed to detect respiratory viruses: influenza virus, adenovirus, coronavirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, parainfluenza virus, bocavirus, and enterovirus. RESULTS: Among 1,983 patients who visited the ED with ILI, 811 (40.9% were male. The median age of patients was 43 years. Influenza vaccination rate was 21.7% (430/1,983 during the 2011-2012 season. At least one comorbidity was found in 18% of patients. The positive rate of respiratory viruses was 52.1% (1,033/1,983 and the total number of detected viruses was 1,100. Influenza A virus was the dominant agent (677, 61.5% in all age groups. The prevalence of human metapneumovirus was higher in patients more than 50 years old, while adenovirus was detected only in younger adults. In 58 (5.6% cases, two or more respiratory viruses were detected. The co-incidence case was identified more frequently in patients with hematologic malignancy or organ transplantation recipients, however it was not related to clinical outcomes. CONCLUSION: This study is valuable as the first extensive laboratory surveillance of the epidemiology of respiratory viruses in ILI patients through a teaching hospital-based influenza surveillance system in South Korea.
Rehman, M. M. U.; Zakaria, M.; Mustafvi, S. A.
Objective: The purpose of this study was to determine the pattern of clinical presentations, haematological and biochemical abnormalities, and outcome of dengue fever patients admitted in Combined Military Hospital (CMH) Rawalpindi in year 2015. Study Design: A descriptive cross sectional study. Place and Duration of Study: Department of Medicine, CMH Rawalpindi, from January 2015 to December 2015. Material and Methods: Patients meeting the inclusion criteria were admitted at CMH Rawalpindi and blood serology was done to confirm the diagnosis of dengue fever. Cases with positive dengue serology were included in the study. Clinical symptoms, signs, investigations and outcome of these patients were recorded on a proforma. Blood samples were taken for analysis. Chest X-Ray and ultrasound abdomen were done on required basis. Results: Out of forty confirmed cases of dengue fever, there were 25 (62.5 percent) males and 15 (37.5 percent) females. Mean age was 40 years. There were 39 cases (97.5 percent) of dengue fever and one case (2.5 percent) of dengue shock syndrome.There was no case of dengue haemorrhagic syndrome. Maximum cases were seen in the month of October 2015.The clinical features noted were: headache and myalgias 62.5 percent, chills and rigors 57.5 percent, retro-orbital pain 42.5 percent, vomiting 35.0 percent, pruritus 27 percent, skin rash 20 percent, abdominal pain 20 percent, diarrhoea 10 percent, bleeding 2.5 percent, ascites and pleural effusion 2.5 percent, and hepatomegaly 15 percent. The laboratory findings were: leucopenia 85 percent and thrombocytopenia 92.5 percent. Serum alanine transaminase (ALT), urea, and creatinine were raised in 30 percent, 2.5 percent and 7.5 percent cases respectively. Mortality was 2.5 percent. Conclusion: This study showed that patients admitted to CMH hospital had a milder presentation of dengue fever in the year 2015. (author)
The Metals Processing Laboratory Users Facility (MPLUS) is a Department of Energy (DOE), Energy Efficiency and Renewable Energy, Industrial Technologies Program, user facility designated to assist researchers in key industries, universities, and federal laboratories in improving energy efficiency, improving environmental aspects, and increasing competitiveness. The goal of MPLUS is to provide access to the specialized technical expertise and equipment needed to solve metals processing issues that limit the development and implementation of emerging metals processing technologies. The scope of work can also extend to other types of materials. MPLUS has four primary user centers: (1) Processing--casting, powder metallurgy, deformation processing (including extrusion, forging, rolling), melting, thermomechanical processing, and high-density infrared processing; (2) Joining--welding, monitoring and control, solidification, brazing, and bonding; (3) Characterization--corrosion, mechanical properties, fracture mechanics, microstructure, nondestructive examination, computer-controlled dilatometry, and emissivity; and (4) Materials/Process Modeling--mathematical design and analyses, high-performance computing, process modeling, solidification/deformation, microstructure evolution, thermodynamic and kinetic, and materials databases A fully integrated approach provides researchers with unique opportunities to address technologically related issues to solve metals processing problems and probe new technologies. Access is also available to 16 additional Oak Ridge National Laboratory (ORNL) user facilities ranging from state-of-the-art materials characterization capabilities, and high-performance computing to manufacturing technologies. MPLUS can be accessed through a standardized user-submitted proposal and a user agreement. Nonproprietary (open) or proprietary proposals can be submitted. For open research and development, access to capabilities is provided free of charge
The Metals Processing Laboratory Users Facility (MPLUS) is a Department of Energy (DOE), Energy Efficiency and Renewable Energy, Industrial Technologies Program user facility designated to assist researchers in key industries, universities, and federal laboratories in improving energy efficiency, improving environmental aspects, and increasing competitiveness. The goal of MPLUS is to provide access to the specialized technical expertise and equipment needed to solve metals processing issues that limit the development and implementation of emerging metals processing technologies. The scope of work can also extend to other types of materials. MPLUS has four primary User Centers including: (1) Processing--casting, powder metallurgy, deformation processing including (extrusion, forging, rolling), melting, thermomechanical processing, high density infrared processing; (2) Joining--welding, monitoring and control, solidification, brazing, bonding; (3) Characterization--corrosion, mechanical properties, fracture mechanics, microstructure, nondestructive examination, computer-controlled dilatometry, and emissivity; (4) Materials/Process Modeling--mathematical design and analyses, high performance computing, process modeling, solidification/deformation, microstructure evolution, thermodynamic and kinetic, and materials data bases. A fully integrated approach provides researchers with unique opportunities to address technologically related issues to solve metals processing problems and probe new technologies. Access is also available to 16 additional Oak Ridge National Laboratory (ORNL) user facilities ranging from state of the art materials characterization capabilities, high performance computing, to manufacturing technologies. MPLUS can be accessed through a standardized User-submitted Proposal and a User Agreement. Nonproprietary (open) or proprietary proposals can be submitted. For open research and development, access to capabilities is provides free of charge while
Veal, William R.; Taylor, Dawne; Rogers, Amy L.
Self-reflection is a tool of instruction that has been used in the science classroom. Research has shown great promise in using video as a learning tool in the classroom. However, the integration of self-reflective practice using video in the general chemistry laboratory to help students develop process skills has not been done. Immediate video feedback and direct instruction were employed in a general chemistry laboratory course to improve students' mastery and understanding of basic and advanced process skills. Qualitative results and statistical analysis of quantitative data proved that self-reflection significantly helped students develop basic and advanced process skills, yet did not seem to influence the general understanding of the science content.
Fazliana Mohd Saaya; Mohd Noor Hidayat Adenan; Anee Suryani Sued
Toxicology is a branch of the very important especially in determining the safety and effectiveness of herbal products to avoid any side effects to the user. Currently, toxicity tests conducted in the laboratory is testing the toxicity of shrimp, tests on cell cultures and experimental animal tests on the rats. One of the most recent exam easier and can reduce the use of experimental rats was testing on zebra fish fish. Fish zebra fish Danio rerio, suitable for the study of toxicity, teratogenicity, genetic, oncology and neurobiology. Zebra fish system of aquarium fish zebra fish system has been in Nuclear Malaysia since 2013 but has not yet fully operational due to several factors and is in the process of moving into a new laboratory which systematically and in accordance with the enabling environment for care. The development of a new fully equipped laboratory is expected to benefit all for use in research. (author)
Wardell, Jeffrey D; Read, Jennifer P; Curtin, John J; Merrill, Jennifer E
Implicit positive alcohol expectancy (PAE) processes are thought to respond phasically to external and internal stimuli-including mood states-and so they may exert powerful proximal influences over drinking behavior. Although social learning theory contends that mood states activate mood-congruent implicit PAEs, which in turn lead to alcohol use, there is a dearth of experimental research examining this mediation model relative to observable drinking. Moreover, an expectancy theory perspective might suggest that, rather than influencing PAEs directly, mood may moderate the association between PAEs and drinking. To test these models, this study examined the role of mood in the association between implicitly measured PAE processes (i.e., latency to endorse PAEs) and immediate alcohol consumption in the laboratory. Gender differences in these processes also were examined. College students (N = 146) were exposed to either a positive, negative, or neutral mood induction procedure, completed a computerized PAE reaction time (RT) task, and subsequently consumed alcohol ad libitum. The mood manipulation had no direct effects on drinking in the laboratory, making the mediation hypothesis irrelevant. Instead, gender and mood condition moderated the association between RT to endorse PAEs and drinking in the laboratory. For males, RT to tension reduction PAEs was a stronger predictor of volume of beer consumed and peak blood alcohol concentration in the context of general arousal (i.e., positive and negative mood) relative to neutral mood. RT to PAEs did not predict drinking in the laboratory for females. The results show that PAE processes are important determinants of immediate drinking behavior in men, suggesting that biased attention to mood-relevant PAEs-as indicated by longer RTs-predicts greater alcohol consumption in the appropriate mood context. The findings also highlight the need to consider gender differences in PAE processes. This study underscores the need for
Gregory P. Thomas
Full Text Available Concerns persist regarding the lack of promotion of students’ scientific inquiry processes in undergraduate physics laboratories. The consensus in the literature is that, especially in the early years of undergraduate physics programs, students’ laboratory work is characterized by recipe type, step-by-step instructions for activities where the aim is often confirmation of an already well-established physics principle or concept. In response to evidence reflecting these concerns at their university, the authors successfully secured funding for this study. A mixed-method design was employed. In the 2011/2012 academic year baseline data were collected. A quantitative survey, the Undergraduate Physics Laboratory Learning Environment Scale (UPLLES was developed, validated, and used to explore students’ perceptions of their physics laboratory environments. Analysis of data from the UPLLES and from interviews confirmed the concerns evident in the literature and in a previous evaluation of laboratories undertaken in 2002. To address these concerns the activities that students were to perform in the laboratory section of the course/s were re/designed to engage students in more inquiry oriented thinking and activity. In Fall 2012, the newly developed laboratory activities and tutorials, were implemented for the first time in PHYS124; a first year course. These changes were accompanied by structured training of teaching assistants and changes to the structure of the evaluation of students’ laboratory performance. At the end of that term the UPLLES was administered (n = 266 and interviews with students conducted (n = 16 to explore their perceptions of their laboratory environments. Statistically significant differences (p<.001 between the students in the PHYS 124 classes of 2011/2012 and 2012/2013 across all dimensions were found. Effect sizes of 0.82 to 1.3, between the views of students in the first semester physics classes of 2011/2012 and 2012
Nomura, Aline Tsuma Gaedke; Pruinelli, Lisiane; da Silva, Marcos Barragan; Lucena, Amália de Fátima; Almeida, Miriam de Abreu
Hospital accreditation is a strategy for the pursuit of quality of care and safety for patients and professionals. Targeted educational interventions could help support this process. This study aimed to evaluate the quality of electronic nursing records during the hospital accreditation process. A retrospective study comparing 112 nursing records during the hospital accreditation process was conducted. Educational interventions were implemented, and records were evaluated preintervention and postintervention. Mann-Whitney and χ tests were used for data analysis. Results showed that there was a significant improvement in the nursing documentation quality postintervention. When comparing records preintervention and postintervention, results showed a statistically significant difference (P educational interventions performed by nurses led to a positive change that improved nursing documentation and, consequently, better care practices.
Charak, I; Pedersen, D.R.; Forrester, R.J.; Phipps, R.D.
The Integral Fast Reactor (IFR) concept developed by Argonne National Laboratory (ANL) includes on-site processing and recycling of discharged core and blanket fuel materials. The process is being demonstrated in the Fuel Cycle Facility (FCF) at ANL's Idaho site. This paper describes the safety analyses that were performed in support of the FCF program; the resulting safety analysis report was the vehicle used to secure authorization to operate the facility and carry out the program, which is now under way. This work also provided some insights into safety-related issues of a commercial IFR fuel processing facility. These are also discussed
Andersen, Simone Nyholm
Participatory ergonomics simulation (PES) is a method to involve workers in simulation and design of their own future work system. Understanding of the process of PES is crucial in order to plan and facilitate the process towards creating an ergonomics work system design supporting both human well-being and overall system performance. With outset in two cases of PES in hospital work system design, this study investigates the elements of the PES process and their interrelations. The aim is to ...
Full Text Available This study aimed to investigate the impact of virtual chemistry laboratory instruction on pre-service science teachers’ scientific process skills. For this purpose, eight laboratory activities related to chemical kinetic, chemical equilibrium, thermochemistry, acids-bases, and electrochemistry were developed. Those activities were performed in virtual laboratory environment by the pre-service teachers in the experimental group and in the real laboratory environment by c the preservice teachers in the control group during eight weeks. Scientific process skills test developed by Burns, Okey and Wise , and translated into Turkish by Ateş and Bahar  was used before and after the instructions for data collection. According to results, while there was no significant difference between pre-test mean scores (U=133.500, p>0.05, significant difference between post-test mean scores was found in favour of experimental group (U=76.000, p<0.05. In addition, while no significant difference between pre-test mean scores for each sub-dimension was found, significant difference between post-test mean scores for designing investigation and formulating hypothesis skills was found in favour of experimental group.
Full Text Available Objective: The ISO 17020 quality program has been run in our pathology laboratory for four years to establish an action plan for correction and prevention of identified errors. In this study, we aimed to evaluate the errors that we could not identify through ISO 17020 and/or solve by means of process consulting. Process consulting is carefully intervening in a group or team to help it to accomplish its goals. Material and Method: The A3 problem solving process was run under the leadership of a ‘workflow, IT and consultancy manager’. An action team was established consisting of technical staff. A root cause analysis was applied for target conditions, and the 6-S method was implemented for solution proposals. Applicable proposals were activated and the results were rated by six-sigma analysis. Non-applicable proposals were reported to the laboratory administrator. Results: A mislabelling error was the most complained issue triggering all pre-analytical errors. There were 21 non-value added steps grouped in 8 main targets on the fish bone graphic (transporting, recording, moving, individual, waiting, over-processing, over-transaction and errors. Unnecessary redundant requests, missing slides, archiving issues, redundant activities, and mislabelling errors were proposed to be solved by improving visibility and fixing spaghetti problems. Spatial re-organization, organizational marking, re-defining some operations, and labeling activities raised the six sigma score from 24% to 68% for all phases. Operational transactions such as implementation of a pathology laboratory system was suggested for long-term improvement. Conclusion: Laboratory management is a complex process. Quality control is an effective method to improve productivity. Systematic checking in a quality program may not always find and/or solve the problems. External observation may reveal crucial indicators about the system failures providing very simple solutions.
Boelstler, Arlene M; Rowland, Ralph; Theoret, Jennifer; Takla, Robert B; Szpunar, Susan; Patel, Shraddha P; Lowry, Andrew M; Pena, Margarita E
To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Yörükoğlu, Kutsal; Özer, Erdener; Alptekin, Birsen; Öcal, Cem
The ISO 17020 quality program has been run in our pathology laboratory for four years to establish an action plan for correction and prevention of identified errors. In this study, we aimed to evaluate the errors that we could not identify through ISO 17020 and/or solve by means of process consulting. Process consulting is carefully intervening in a group or team to help it to accomplish its goals. The A3 problem solving process was run under the leadership of a 'workflow, IT and consultancy manager'. An action team was established consisting of technical staff. A root cause analysis was applied for target conditions, and the 6-S method was implemented for solution proposals. Applicable proposals were activated and the results were rated by six-sigma analysis. Non-applicable proposals were reported to the laboratory administrator. A mislabelling error was the most complained issue triggering all pre-analytical errors. There were 21 non-value added steps grouped in 8 main targets on the fish bone graphic (transporting, recording, moving, individual, waiting, over-processing, over-transaction and errors). Unnecessary redundant requests, missing slides, archiving issues, redundant activities, and mislabelling errors were proposed to be solved by improving visibility and fixing spaghetti problems. Spatial re-organization, organizational marking, re-defining some operations, and labeling activities raised the six sigma score from 24% to 68% for all phases. Operational transactions such as implementation of a pathology laboratory system was suggested for long-term improvement. Laboratory management is a complex process. Quality control is an effective method to improve productivity. Systematic checking in a quality program may not always find and/or solve the problems. External observation may reveal crucial indicators about the system failures providing very simple solutions.
Jian Bo Zhang
Full Text Available The emergency departments (EDs of Chinese hospitals are gradually being equipped with blood gas machines. These machines, along with the measurement of biochemical markers by the hospital laboratory, facilitate the care of patients with severe conditions who present to the ED. However, discrepancies have been noted between the Arterial Blood Gas (ABG analyzers in the ED and the hospital laboratory autoanalyzer in relation to electrolyte and hemoglobin measurements. The present study was performed to determine whether the ABG and laboratory measurements of potassium, sodium, and hemoglobin levels are equivalent, and whether ABG analyzer results can be used to guide clinical care before the laboratory results become available.Study power analyses revealed that 200 consecutive patients who presented to our ED would allow this prospective single-center cohort study to detect significant differences between ABG- and laboratory-measured potassium, sodium, and hemoglobin levels. Paired arterial and venous blood samples were collected within 30 minutes. Arterial blood samples were measured in the ED by an ABL 90 FLEX blood gas analyzer. The biochemistry and blood cell counts of the venous samples were measured in the hospital laboratory. The potassium, sodium, and hemoglobin concentrations obtained by both methods were compared by using paired Student's t-test, Spearman's correlation, Bland-Altman plots, and Deming regression.The mean ABG and laboratory potassium values were 3.77±0.44 and 4.2±0.55, respectively (P<0.0001. The mean ABG and laboratory sodium values were 137.89±5.44 and 140.93±5.50, respectively (P<0.0001. The mean ABG and laboratory Hemoglobin values were 12.28±2.62 and 12.35±2.60, respectively (P = 0.24.Although there are the statistical difference and acceptable biases between ABG- and laboratory-measured potassium and sodium, the biases do not exceed USCLIA-determined limits. In parallel, there are no statistical differences and
Stancić, Vladimir; Stancić, Nevenka; Vucelić, Vesna; Lang, Nada; Grbac, Ljiljana
The Coagulation Section at Laboratory of Hematology, Sestre milosrdnice University Hospital, Zagreb, was founded in 1955 by Ljubomir Popović, hematologist and assistant at School of Medicine, University of Zagreb, in cooperation with hard-working laboratory technicians. Apart from papers on hematologic neoplasms, plasmacytoma and lymphoma, Ljubomir Popović published a number of papers in the field of anticoagulant therapy with heparin and oral anticoagulants, some of which are also in use today. After Ljubomir Popović left the Hospital in 1964, the Laboratory was run by Professor Nedjeljko Milić, head of the newly founded Division of Hematology. In 1968, the management of the Laboratory of Hematology was taken over by Biserka Raić, MS, medical biochemist, until her retirement in 2007. Great development in morphological and cytometric studies of blood and blood cells has been paralleled by continuous progress and almost dominating activities in the diagnosis of hemostasis disorders. In the 1970s, Marko Koprcina, hematologist, and Biserka Raić introduced the then latest tests in practice at all Hospital departments. In that golden age of the Coagulation Section, M. Koprcina, B. Raić and their associates transferred their knowledge to all colleagues in the Hospital. Through that collaboration, high standards in the diagnosis of hemostasis disorders were achieved, from which the currently high level of clinical knowledge about coagulation disorders and their treatment has derived, making Sestre milosrdnice University Hospital one of the leading hospitals in this field in the country. By describing development of the Coagulation Section and the life of its founder Ljubomir Popović, the authors tried to provide an answer to the following question: can today's clinicians still have a deciding role in laboratory development, considering that assessments of different phenomena are always initiated by an interested clinician who is trying to interpret and understand
Persson, Johanna; Dalholm, Elisabeth Hornyánszky; Johansson, Gerd
To demonstrate the use of visualization and simulation tools in order to involve stakeholders and inform the process in hospital change processes, illustrated by an empirical study from a children's emergency clinic. Reorganization and redevelopment of a hospital is a complex activity that involves many stakeholders and demands. Visualization and simulation tools have proven useful for involving practitioners and eliciting relevant knowledge. More knowledge is desired about how these tools can be implemented in practice for hospital planning processes. A participatory planning process including practitioners and researchers was executed over a 3-year period to evaluate a combination of visualization and simulation tools to involve stakeholders in the planning process and to elicit knowledge about needs and requirements. The initial clinic proposal from the architect was discarded as a result of the empirical study. Much general knowledge about the needs of the organization was extracted by means of the adopted tools. Some of the tools proved to be more accessible than others for the practitioners participating in the study. The combination of tools added value to the process by presenting information in alternative ways and eliciting questions from different angles. Visualization and simulation tools inform a planning process (or other types of change processes) by providing the means to see beyond present demands and current work structures. Long-term involvement in combination with accessible tools is central for creating a participatory setting where the practitioners' knowledge guides the process. © 2014 Vendome Group, LLC.
Neves, Letícia; Gondim, Andressa Alencar; Soares, Sara Costa Martins Rodrigues; Coelho, Denis Pontes; Pinheiro, Joana Angélica Marques
Abstract Objective: To understand the impact of the hospitalization process on the family companion of critical patients admitted to a Semi-Intensive Care Unit (SICU). Method: Exploratory research with a qualitative approach, conducted in the months of April to July of 2016 through a semi-structured interview applied to relatives who were accompanying patients hospitalized in an SICU of a high complexity care hospital in Fortaleza. The interviews were submitted to content analysis. Results...
Feibert, Diana Cordes; Sørup, Christian Michel; Jacobsen, Peter
Pharmaceuticals are a vital part of patient treatment and the timely delivery of pharmaceuticals to patients is therefore important. Hospitals are complex systems that provide a challenging environment for decision making. Implementing process changes and technologies to improve the pharmaceutical...... distribution process can therefore be a complex and challenging undertaking. A comparative case study was conducted benchmarking the pharmaceutical distribution process at a Danish and US hospital to identify best practices. Using the ANP method, taking tangible and intangible aspects into consideration...
Malentacchi, F.; Mancini, I.; Brandslund, I.
Society of Pharmacogenomics and Personalised Therapy (ESPT). The answers of the participating laboratory medicine professionals indicate that they are aware that personalized medicine can represent a new and promising health model, and that laboratory medicine should play a key role in supporting...
Littike, Denilda; Sodré, Francis
The scope of this article is to analyze the working process of administrators at a Federal University Hospital (HUF). It includes research with a qualitative approach conducted through interviews with twelve administrators. The work process, the work tools and the human activity per se are understood to be under scrutiny. Work is acknowledged as a category that analyzes the management methods used by professional health workers. The HUFs are responsible for two social policies, namely education and health. The aim of the administrators' work is an organizational issue, and the administration tools used are bureaucratic and out-of-date for the current political context of hospital management. The most significant feature of this hospital administration is improvisation, which reduces the potential of the administrators in such a way that, instead of introducing innovative changes into their work process, they prefer to leave their jobs. Improvisation is caused by the production of sequential obstacles in management decision-making at this teaching hospital. In short, the transfer of administration at the HUF, from direct government administration by the University to the Brazilian Company of Hospital Services (EBSERH), was analyzed on the grounds that this would establish a "new" management model.
Stubblefield, F.W.; Dimmler, D.G.
A computer network architecture consisting of a common node processor for managing peripherals and files and a number of private node processors for laboratory experiment control is briefly reviewed. Central to the problem of private node-common node communication is the concept of a transaction. The collection of procedures and the data structure associated with a transaction are described. The common node properties assigned to a transaction and procedures required for its complete processing are discussed. (U.S.)
Barasa, Edwine W; Cleary, Susan; Molyneux, Sassy; English, Mike
This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities
Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko
This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.
Schmidt, Kayna Trombini; Terassi, Mariélli; Marcon, Sonia Silva; Higarashi, Ieda Harumi
The objective of this study was to identify the strategies used by the nursing team in the neonatal unity care of a school-hospital during the preparation of the family for the premature baby discharge. It is a descriptive study with qualitative approach. The data was collected between March and June 2011, by means of observation and semi-structured interviews. From the discourse analysis two categories appeared: Orientations and professional strategies in preparing the family for the premature baby hospital discharge and Difficulties and potentialities in the neonatal attention space. The main strategy mentioned was the family early insertion in the caring process and the stressed difficulty was the parents' absence during the child's hospital staying. The potentialities and limitations pointed out in this study revealed that the assistance process is dynamic, asking for constant correction and adequacies to effectively and wholly care for the premature baby and its family.
Martinez, Carlos Eli; Jaimes, Fabian A; Montufar, Franco E; Hincapie, Gustavo A; Morales, Alvaro; Acero, Rafael; Muneton, David; Gomez, Sujey; Cuenca, Diana Maria; Salinas, Juan Carlos; Zabaleta Joel E
The objective is to describe the process of care and prescription practices for CAP patients in four university hospitals in Colombia. Patients older than 15 years with a diagnosis of CAP during the two years study period. Collection of demographic and clinical status data and management during the first day of consult, classification in severity groups according to fine's prediction rule. Evaluation of the frequency of use of ancillary diagnostic tests antimicrobials prescription and agreement with ATS guidelines according to severity group and hospital. 734 patients were included, mean age 56 years old, 50.5% males, mean length of stay 8.6 days, 39% fine's classes IV to V. Frequency of sputum sampling (overall cohort between hospitals rank) was 46% (10 - 67%), chest x-ray 95% (57-100%), blood cultures 34% (0 -63%) and arterial blood gas analysis 71% (10-88%). the use of ancillary diagnostic test had wide variation between hospitals and severity classes, specially for sputum and blood gases. At least 45 different antimicrobial protocols were used in the cohort. Overall agreement between actual prescription and guidelines recommendations was variable (mean 44%, range 22 to 72%) between groups and hospitals, but without significant impact on mortality. There are many differences between actual clinical practice and guidelines for the management of CAP and wide variations between hospitals, but the precise effect of the lack of guideline-adherence on mortality is unclear
Shaw, Raymond A. [Michigan Technological Univ., Houghton, MI (United States)
This project has been focused on the following objectives: 1. Investigations of the physical processes governing immersion versus contact nucleation, specifically surface-induced crystallization; 2. Development of a quadrupole particle trap with full thermodynamic control over the temperature range 0 to –40 °C and precisely controlled water vapor saturation ratios for continuous, single-particle measurement of the aerosol to ice crystal transformation process for realistic ice nuclei; 3. Understanding the role of ice nucleation in determining the microphysical properties of mixed-phase clouds, within a framework that allows bridging between laboratory and field measurements.
Thuong T. Nguyen
Full Text Available Background: The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA programme. However, the paperbased format of the checklist makes administration cumbersome and limits timely analysis and communication of results. Development of e-Tool: In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors’ feedback about usability. Outcomes: The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries.
Kumar, Ajit; Bhatia, Saurabh; Chiang, I-Jen
Healthcare providers, such as doctors and nurses, have been famous for high resistance to change. A careful change management plan, particularly training process, is utmost necessary. A quaternary care hospital in India changed its system, from manual to Electronic Medical Record/Health Information System (EMR/HIS). The hospital management wanted to train its 4000 diverse end-users on the EMR/HIS in two months' time. This paper describes an in-house designed training process and its deployment in the given healthcare organizational settings. We designed a training process named DRIPDA. The training process was deployed to train 4000 end-users of EMR/HIS, in the quaternary care hospital. Various factors, such as methods and tools of training, constraints of trainees, trainers, and organization were considered while deploying the training process. The effectiveness of the DRIPDA was assessed using the Kirkpatrick model. End-users received training on the new system only in 25% of estimated time and 28% of the projected expense, without having any distraction in their usual workflow, or any productivity loss. We found that the DRIPDA training process could train all employees effectively and efficiently. A decent training process can help in managing the change, thereby reduce the training time and cost.
Advincula-Carpenter, Marietta M.
The purpose of a practicum project was to develop a process to internationalize occupational programs in the consumer and hospitality services division (CHSD). Five procedures were used to complete the project. First, a review of literature was conducted on how other colleges had internalized their courses. It included some research and practices…
Gabriela Favaro Faria Guerrer
Full Text Available The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences between patient charts and the patient’s hospital bill. doi: 10.5216/ree.v16i3.23487.
El-Jawahri, Areej; Lau-Min, Kelsey; Nipp, Ryan D; Greer, Joseph A; Traeger, Lara N; Moran, Samantha M; D'Arpino, Sara M; Hochberg, Ephraim P; Jackson, Vicki A; Cashavelly, Barbara J; Martinson, Holly S; Ryan, David P; Temel, Jennifer S
Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR. In total, 1047 hospitalizations were reviewed among 728 patients. Admitting clinicians did not address code status in 53% of hospitalizations, resulting in code status orders of "presumed full." In total, 275 patients (26.3%) transitioned from full code to DNR, and 48.7% (134 of 275 patients) of those had an order of "presumed full" at admission; however, upon further clarification, the patients expressed that they had wished to be DNR before the hospitalization. We identified 3 additional processes leading to order transition from full code to DNR acute clinical deterioration (15.3%), discontinuation of cancer-directed therapy (17.1%), and education about the potential harms/futility of CPR (15.3%). Compared with discontinuing therapy and education, transitions because of acute clinical deterioration were associated with less patient involvement (P = .002), a shorter time to death (P cancer were because of full code orders in patients who had a preference for DNR before hospitalization. Transitions due of acute clinical deterioration were associated with less patient engagement and a higher likelihood of inpatient death. Cancer 2017;123:4895-902. © 2017 American Cancer Society. © 2017 American Cancer Society.
Yen, Tina W F; Pezzin, Liliana E; Li, Jianing; Sparapani, Rodney; Laud, Purushuttom W; Nattinger, Ann B
The purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation. Women who were diagnosed with stage I-III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy). Among 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high-, medium-, and low-volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05-1.25; high volume: OR = 1.30, 95% CI = 1.14-1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06-1.24; high volume: OR = 1.28, 95% CI = 1.13-1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07-1.17; high volume: OR = 1.16, 95% CI = 1.09-1.24). Diagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume-survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors. Cancer 2017;123:957-66. © 2016 American Cancer Society. © 2016 American Cancer Society.
Zhang, Xingyu; Kim, Joyce; Patzer, Rachel E; Pitts, Stephen R; Patzer, Aaron; Schrager, Justin D
To describe and compare logistic regression and neural network modeling strategies to predict hospital admission or transfer following initial presentation to Emergency Department (ED) triage with and without the addition of natural language processing elements. Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a cross-sectional probability sample of United States EDs from 2012 and 2013 survey years, we developed several predictive models with the outcome being admission to the hospital or transfer vs. discharge home. We included patient characteristics immediately available after the patient has presented to the ED and undergone a triage process. We used this information to construct logistic regression (LR) and multilayer neural network models (MLNN) which included natural language processing (NLP) and principal component analysis from the patient's reason for visit. Ten-fold cross validation was used to test the predictive capacity of each model and receiver operating curves (AUC) were then calculated for each model. Of the 47,200 ED visits from 642 hospitals, 6,335 (13.42%) resulted in hospital admission (or transfer). A total of 48 principal components were extracted by NLP from the reason for visit fields, which explained 75% of the overall variance for hospitalization. In the model including only structured variables, the AUC was 0.824 (95% CI 0.818-0.830) for logistic regression and 0.823 (95% CI 0.817-0.829) for MLNN. Models including only free-text information generated AUC of 0.742 (95% CI 0.731- 0.753) for logistic regression and 0.753 (95% CI 0.742-0.764) for MLNN. When both structured variables and free text variables were included, the AUC reached 0.846 (95% CI 0.839-0.853) for logistic regression and 0.844 (95% CI 0.836-0.852) for MLNN. The predictive accuracy of hospital admission or transfer for patients who presented to ED triage overall was good, and was improved with the inclusion of free text data from a patient
Lao, T C; Levasseur, A A
This interim report documents work carried out by Combustion Engineering, Inc. under a contract to Exxon Research and Engineering Company to develop a conceptual Hybrid Boiler design fueled by the vacuum distillation residue (vacuum bottoms) derived from Illinois No. 6 coal in the EDS Coal Liquefaction Process. This report was prepared by Combustion Engineering, Inc., and is the first of two reports on the predevelopment phase of the Hybrid Boiler program. This report covers the results of a laboratory investigation to assess the fuel and ash properties of EDS vacuum bottoms. The results of the laboratory testing reported here were used in conjunction with Combustion Engineering's design experience to predict fuel performance and to develop appropriate boiler design parameters. These boiler design parameters were used to prepare the engineering design study reported in EDS Interim Report FE-2893-113, the second of the two reports on the predevelopment phase of the Hybrid Boiler Program. 46 figures, 29 tables.
Paul, R.A.; Faugl, T.
A unique methodology was developed for conducting an air emission inventory (AEI) at a DOE nuclear processing facility. This methodology involved the use of computer-assisted design (CAD) drawings to document emission points, computerized process drawings to document industrial processes leading to emissions, and a computerized data base of AEI forms to document emission estimates and related process data. A detailed air emissions inventory for operating years 1985--1991 was recently implemented for the entire site using this methodology. One industrial area at the DOE Site is comprised of laboratory facilities that provide direct support to the nuclear reactor and recovery operations, developmental studies to support reactor and separation operations, and developmental studies to support waste handling and storage. The majority of the functions are conducted in a single large building complex wherein bench scale and pilot scale experiments are carried out involving radionuclides, hazardous air pollutants (HAP), and other chemicals reportable under the Clean Air Act Amendments (CAAA) and Superfund Amendments and Re-authorization Act (SARA) Title 111. The results of the inventory showed that HAP and radionuclide emissions from the laboratory complex were relatively minor
Jordan, Gretchen B.; Watkins, Randall D.; Trucano, Timothy Guy; Burns, Alan Richard; Oelschlaeger, Peter
There has been a concerted effort since 2007 to establish a dashboard of metrics for the Science, Technology, and Engineering (ST&E) work at Sandia National Laboratories. These metrics are to provide a self assessment mechanism for the ST&E Strategic Management Unit (SMU) to complement external expert review and advice and various internal self assessment processes. The data and analysis will help ST&E Managers plan, implement, and track strategies and work in order to support the critical success factors of nurturing core science and enabling laboratory missions. The purpose of this SAND report is to provide a guide for those who want to understand the ST&E SMU metrics process. This report provides an overview of why the ST&E SMU wants a dashboard of metrics, some background on metrics for ST&E programs from existing literature and past Sandia metrics efforts, a summary of work completed to date, specifics on the portfolio of metrics that have been chosen and the implementation process that has been followed, and plans for the coming year to improve the ST&E SMU metrics process.
Wu, Alan H B; Smith, Andrew; McComb, Robert; Bowers, George N; Makowski, Gregory S; McKay, Charles A; Vena, Jason; McDonagh, John; Hopfer, Sidney; Sena, Salvatore F; Malkus, Herbert; Forte, Elaine; Kelly, Katherine
Hospital laboratories currently lack the capacity to provide emergency determination of cholinesterase activity. We have developed a hospital-based 3-tiered system to test plasma for butyrylcholinesterase (BChE) activity and whole blood for red cell acetylcholinesterase (AChE) activity using available technology and personnel. Interagency communications, toxidrome definition, and patient triage will be coordinated by the Connecticut Department of Public Health and the Poison Control Center. Initial BChE data documents good precision between institutions (coefficient of variation chemical terrorism or large scale HazMat events.
Lukasz Maciej Mazur
Full Text Available The failures to properly educate students about process improvement can be seen as major factor leading to increased risks of patient safety and increased wastes in hospital settings. The purpose of this research was two-fold: 1 to identify characteristics that explain the efficacy of Plan-Do-Study-Act (PDSA based-tools while used by Industrial Engineering (IE students on multidisciplinary teams in hospital; 2 to identify competencies needed by IEs for effective process improvement in hospital using PDSA based-tools. Exploratory mixed method design approach with survey study, unstructured interviews, and focus group discussions was used to collect the data. A regression analysis was used to identify PDSA based-tool characteristics perceived by IE students as instrumental for process improvement. Next, the abductive inference was applied to analyze qualitative data in order to investigate competencies needed for effective process improvement using PDSA based-tools.Using regression analysis, we found the brainstorming via visualization, recognizing root-cause(s of the problem and selecting improvement measures via linking the process flow with task(s characteristics to be the significant characteristics. From qualitative data analysis, we learned that IE students strived in technical analysis but lacked competencies in analyzing qualitative data needed for change implementation efforts. There is increasing evidence that success in achieving process improvement goals is at least partially attributable to implementation processes and contexts and not just to the nature of the technical solution. Therefore, IE students interested in working in hospitals must develop new competencies related to qualitative data analysis to manage change initiatives.
Matejczyk, Raymond J.
This presentation describes the use of portable gas chromatography/mass spectrometry for on-scene investigation and processing of clandestine laboratories. Clandestine laboratory investigations present special problems to forensic investigators. These crime scenes contain many chemical hazards that must be detected, identified and collected as evidence. Gas chromatography/mass spectrometry performed on-scene with a rugged, portable unit is capable of analyzing a variety of matrices for drugs and chemicals used in the manufacture of illicit drugs, such as methamphetamine. Technologies used to detect various materials at a scene have particular applications but do not address the wide range of samples, chemicals, matrices and mixtures that exist in clan labs. Typical analyses performed by GC/MS are for the purpose of positively establishing the identity of starting materials, chemicals and end-product collected from clandestine laboratories. Concerns for the public and investigator safety and the environment are also important factors for rapid on-scene data generation. Here is described the implementation of a portable multiple-inlet GC/MS system designed for rapid deployment to a scene to perform forensic investigations of clandestine drug manufacturing laboratories. GC/MS has long been held as the 'gold standard' in performing forensic chemical analyses. With the capability of GC/MS to separate and produce a 'chemical fingerprint' of compounds, it is utilized as an essential technique for detecting and positively identifying chemical evidence. Rapid and conclusive on-scene analysis of evidence will assist the forensic investigators in collecting only pertinent evidence thereby reducing the amount of evidence to be transported, reducing chain of custody concerns, reducing costs and hazards, maintaining sample integrity and speeding the completion of the investigative process.
Sun, Gang; Wu, Li-e; Li, Qian-ying; Yang, Ye; Wang, Zi-chao; Zhang, Jing-yin; Li, Shu-jun; Yan, Xu-long; Wang, Ming; Zhang, Wen-xiang; Huang, Guan-hua
To study the strategy and process of out-hospital emergency care of acute cardiovascular events. One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling "120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50.0% vs. 29.2%, 83.0% vs. 60.7%, both Pemergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3+/-5.6) minutes vs. (89.6+/- 8.4) minutes, (47.3+/-7.3) minutes vs. (149.8+/-13.5) minutes, (61.7+/-8.3) minutes vs. [(149.8+/- 13.5) minutes, all P0.05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9.0%, 4.2% vs. 12.4%, both Pemergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their relatives directly affect their mode of arriving hospital and prognosis.
Sadeghifar, Jamil; Jafari, Mehdi; Tofighi, Shahram; Ravaghi, Hamid; Maleki, Mohammad Reza
Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. All the investigated hospitals had a strategic plan. The obtained percentages for the items "the rate of the compliance to requirements" and "the quantity of planning facilitators" (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.
Danáčová, Michaela; Valent, Peter; Výleta, Roman
Nowadays, rainfall simulators are being used by many researchers in field or laboratory experiments. The main objective of most of these experiments is to better understand the underlying runoff generation processes, and to use the results in the process of calibration and validation of hydrological models. Many research groups have assembled their own rainfall simulators, which comply with their understanding of rainfall processes, and the requirements of their experiments. Most often, the existing rainfall simulators differ mainly in the size of the irrigated area, and the way they generate rain drops. They can be characterized by the accuracy, with which they produce a rainfall of a given intensity, the size of the irrigated area, and the rain drop generating mechanism. Rainfall simulation experiments can provide valuable information about the genesis of surface runoff, infiltration of water into soil and rainfall erodibility. Apart from the impact of physical properties of soil, its moisture and compaction on the generation of surface runoff and the amount of eroded particles, some studies also investigate the impact of vegetation cover of the whole area of interest. In this study, the rainfall simulator was used to simulate the impact of the slope gradient of the irrigated area on the amount of generated runoff and sediment yield. In order to eliminate the impact of external factors and to improve the reproducibility of the initial conditions, the experiments were conducted in laboratory conditions. The laboratory experiments were carried out using a commercial rainfall simulator, which was connected to an external peristaltic pump. The pump maintained a constant and adjustable inflow of water, which enabled to overcome the maximum volume of simulated precipitation of 2.3 l, given by the construction of the rainfall simulator, while maintaining constant characteristics of the simulated precipitation. In this study a 12-minute rainfall with a constant intensity
Almagro, J.C.; Dupetit, G.A.; Deandreis, R.A.
The availability of the LPR (Radiochemical Processes Laboratory) plant offers the possibility to demonstrate and create the necessary technological basis for thorium fuels reprocessing. To this purpose, the solvents extraction technique is used, employing TBP (at 30%) as solvent. The process is named THOREX, a one-cycle acid, which permits an adequate separation of Th 232 and U 233 components and fission products. For thorium oxide elements dissolution, the 'chopp-leach' process (installed at LPR) is used, employing a NO 3 H 13N, 0.05M FH and 0.1M Al (NO 3 ) 3 , as solvent. To adapt the pilot plant to the flow-sheet requirements proposed, minor modifications must be carried out in the interconnection of the existing decanting mixers. The input of the plant has been calculated by Origin Code modified for irradiations in reactors of the HWR type. (Author)
Lewis, W. A. Sensitivity training mutual emotional masturbation ? Personnel and Guidance Journal, 1970, 48, 525. L’Herisson, L., and Krumm, K. J. Changes...for the purpose of practicing their newly learned skills. The groups were formed by the participants’ selecting members of the laboratory with whom...34how" it is said) are con- ji 83 gruent. After this input, the participants returned to their respective small groups to continue practicing the skills
Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Kardum-Paro, Mirjana Mariana; Siftar, Zoran; Sikirica, Mirjana; Sokolić, Ivica; Ozvald, Ivan; Vidas, Zeljko
Since 2003 when the international norm for implementation of quality management in medical laboratories (EN ISO 15189, Medical laboratories--Particular requirements for quality and competence) was established and accepted, accreditation has become practical, generally accepted method of quality management and confirmation of technical competence of medical laboratories in the whole world. This norm has been translated into Croatian and accepted by the Croatian Institute for Norms as Croatian norm. Accreditation is carried out on voluntary basis by the Croatian Accreditation Agency that has up to now accredited two clinical medical biochemical laboratories in the Republic of Croatia. Advantages of accredited laboratory lie in its documented management system, constant improvement and training, reliability of test results, establishing users' trust in laboratory services, test results comparability and interlaboratory (international) test results acceptance by adopting the concept of metrological traceability in laboratory medicine.
A study of alternate methods to manually transport radioactive samples from their glove boxes to the Remote Analytical Laboratory (RAL) was conducted at the Idaho National Engineering Laboratory. The study was performed to mitigate the effects of a potential loss of sampling capabilities that could take place if a malfunction in the Pneumatic Transfer System (PTS) occurred. Samples are required to be taken from the cell glove boxes and analyzed at the RAL regardless of the operational status of the PTS. This paper documents the conclusions of the study and how a decision was reached that determined the best handling scenarios for manually transporting 15 mL vials of liquid process samples from the K, W, U, WG, or WH cell glove boxes in the Chemical Processing Plant (CPP) 601 to the RAL. This study of methods to manually remove the samples from the glove boxes, package them for safe shipment, transport them by the safest route, receive them at the RAL, and safely unload them was conducted by EG and G Idaho, Inc., for Westinghouse Idaho Nuclear Company as part of the Glove Box Sampling and Transfer System Project for the Fuel Processing Facilities Upgrade, Task 10, Subtask 2. The study focused on the safest and most reliable scenarios that could be implemented using existing equipment. Hardware modifications and new hardware proposals were identified, and their impact on the handling scenario has been evaluated. A conclusion was reached that by utilizing the existing facility hardware, these samples can be safely transported manually from the sample stations in CPP 601 to the RAL, and that additional hardware could facilitate the transportation process even further
Full Text Available A mathematical model of waste tyre pyrolysis process is developed in this work. Tyre material decomposition based on a simplified reaction mechanism leads to main product lumps: noncondensable (gas, condensable (pyrolytic oil and solid (char. The model takes into account kinetics of heat and mass transfer in the grain of the shredded rubber material as well as surrounding gas phase. The main reaction routes were modelled as the pseudo-first order reactions with a rate constant calculated from the Arrhenius type equation using literature values of activation energy determined for main tyre constituents based on TG/DTG measurements and tuned pre-exponential parameter values obtained by fitting theoretical predictions to the experimental results obtained in our laboratory reactor. The model was implemented within the CFD software (ANSYS Fluent. The results of numerical simulation of the pyrolysis process revealed non-uniformity of sample’s porosity and temperature. The simulation predictions were in satisfactory agreement with the experimentally measured mass loss of the tyre sample during pyrolysis process investigated in a laboratory reactor.
Rusnak, James E.
The approach frequently used to introduce computer technology into a hospital Medical Records Department is to implement a Word Processing System. Word processing is a form of computer system application that is intended to improve the department's productivity by improving the medical information transcription process. The effectiveness of the Word Processing System may be further enhanced by installing system facilities to provide access to data processing file information in the Hospital's...
Bergfelds, Kristaps; Sabanskis, Andrejs; Virbulis, Janis
The present material is focused on the modelling of small-scale laboratory NaCl-RbCl crystal growth furnace. First steps towards fully transient simulations are taken in the form of stationary simulations that deal with the optimization of material properties to match the model to experimental conditions. For this purpose, simulation software primarily used for the modelling of industrial-scale silicon crystal growth process was successfully applied. Finally, transient simulations of the crystal growth are presented, giving a sufficient agreement to experimental results.
Full Text Available This article presents laboratory test rig with a miniature turbojet engine (MiniJETRig – Miniature Jet Engine Test Rig, that was built in the Air Force Institute of Technology. The test rig has been developed for research and development works aimed at modelling and investigating processes and phenomena occurring in full scale jet engines. In the article construction of a test rig is described, with a brief discussion on the functionality of each of its main components. Additionally examples of measurement results obtained during the realization of the initial tests have been included, presenting the capabilities of the test rig.
Meehan, Thomas P; Qazi, Daniel J; Van Hoof, Thomas J; Ho, Shih-Yieh; Eckenrode, Sheila; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; Quetti, Deborah
To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO). Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs. Five SNFs in Connecticut. SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant. QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools]. Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support. Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates. This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct
Ávila-Schwerter, C; Torres-Andrade, M C; Méndez, C A; Márquez-Manzano, M
To design a clinical process model in the management of differentiated thyroid cancer in order to improve accessibility to this treatment. Based on modified Participatory Action Research, a model design process was conducted using a literature review and meetings with organisations committed to the redesigning process, and to agree an improved and feasible process. The process map was constructed by participatory action including, characterisation of the value chain, fault detection in the flow of the process, relevant documents and process for proposing modifications and approvals necessary for this purpose. Links were established between the main process and the support and strategic processes. The participatory model helped to cut the waiting times for diagnosis and treatment of this disease from 12 to 4 months. For each unit to be able to fully visualise the map of the process and understand their contribution as a set of integrated contributions and not fragmented, helps in the comprehensive management of patients and operation processes based on the hierarchical and dominant organisational model in Chilean hospitals. To analyse and remodel clinical processes by participatory action helps to limit failures in the fluidity of care of the patients, by presenting each participating unit with a general view of the process, the problems, and the possible solutions. Furthermore, this approach helps to clarify the process in order to make it more efficient, to harmonise relationships, and to improve coordination in order to optimise patient care. Copyright © 2015 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
Booth, St. R.
Los Alamos National Laboratory is implementing full cost recovery for waste processing in fiscal year 2009 (FY2009), after a transition year in FY2008. Waste processing cost recovery has been implemented in various forms across the nuclear weapons complex and in corporate America. The fundamental reasoning of sending accurate price signals to waste generators is economically sound, and leads to waste minimization and reduced waste expense over time. However, Los Alamos faces significant implementation challenges because of its status as a government-owned, contractor-operated national scientific institution with a diverse suite of experimental and environmental cleanup activities, and the fact that this represents a fundamental change in how waste processing is viewed by the institution. This paper describes the issues involved during the transition to cost recovery and the ultimate selection of the business model. Of the six alternative cost recovery models evaluated, the business model chosen to be implemented in FY2009 is Recharge Plus Generators Pay Distributed Direct. Under this model, all generators who produce waste must pay a distributed direct share associated with their specific waste type to use a waste processing capability. This cost share is calculated using the distributed direct method on the fixed cost only, i.e., the fixed cost share is based on each program's forecast proportion of the total Los Alamos volume forecast of each waste type. (Fixed activities are those required to establish the waste processing capability, i.e., to make the process ready, permitted, certified, and prepared to handle the first unit of waste. Therefore, the fixed cost ends at the point just before waste begins to be processed. The activities to actually process the waste are considered variable.) The volume of waste actually sent for processing is charged a unit cost based solely on the variable cost of disposing of that waste. The total cost recovered each year is the
Miyamoto, T; Li, Z; Kibushi, T; Yamasaki, N; Kasai, N
Cage bedding for laboratory rodents can influence animal wellbeing and thus the experimental data. In addition, a large amount of used bedding containing excrement is discharged as medical waste from life science institutes and breeding companies. We developed a ground-breaking system to improve fresh bedding and recycle used bedding by applying a soft hydrothermal process with high-temperature and high-pressure dry steam. The system removes both harmful organic components and aromatic hydrocarbons that can affect animals' metabolism. The purpose of the present study was to evaluate the chemical and physical properties of the improved fresh bedding and the recycled used bedding treated by the system. The results showed that 68-99% of the predominant aromatic hydrocarbons were removed from fresh bedding treated at 0.35 MPa and 140 degrees C for 120 min ('improved bedding'). In addition, 59.4-99.0% of predominant harmful organic compounds derived from excrement were removed from used bedding treated at 0.45 MPa and 150 degrees C for 60 min ('recycled bedding'). The soft hydrothermal treatment increased the number of acidic functional groups on the bedding surface and gave it the high adsorptive efficiency of ammonia gas. Harmful substances such as microorganisms, heavy metals and pesticides decreased below the detection limit. The results clearly showed that the improved and recycled bedding is safer for laboratory rodents and has the potential to ameliorate conditions in primary and secondary enclosures (e.g. cages and animal rooms) used for maintaining laboratory animals. This process may be one of the most advanced techniques in providing an alternative to softwood and other bedding, economizing through the recycling of used bedding and reducing bedding waste from animal facilities.
Jammilly Mikaela Fagundes Brandão
Full Text Available Children , teenagers and adults have different ways of learning to use specific approaches in their learning processes, making it necessary .Considering the level of maturity and self-direction that adults tend to have in that it will be developing and living experiences, we realized the need for an approach to consider these individual differences in the learning process, giving rise to andragogy - the art and science aimed at helping adults to learn and understand the process of learning. Indeed, this study is mainly aimed to analyze the perceptions of tourism and hospitality students about his role in their learning process, based on the andragogical model developed by Knowles, Holton and Seanson (2011. We sought to investigate the profile of students of bachelor degree in tourism and hospitality and analyze the level of self-directedness (autonomy and independence of these students in their learning process based on andragogical principles. The methodological procedures, carried out a survey with 60 students of hospitality and tourism courses at the Federal University of Paraíba - UFPB, using as a scale of 5 points that dealt with these students assimilate the agreement in relation to the items. Data base theory of light were analyzed. As results, it is evident that students who have participated in this research, the perception thereof, characteristics such as autonomy, self-direction and present levels of independence as subjects in training and skills development process, which shows the need to rethink vocational training to better leverage these features. Finally, we highlight the importance of using a teaching method that allows students to opening suit your learning process to their particular way to study and learn.
Deng, Chao; Li, Ying; Li, Jinhui; Chen, Yuan; Li, Huafen
Though mechanical recycling of WEEE plastics is supposed to be a promising method, PBDEs release and the resulting contamination during its processing remain unclear yet. The distribution of PBDEs pollution in production lines was investigated from two flame-retardant plastic modification plants in Southern China. This was followed by laboratory simulation experiments to characterize the emission processes. PBDEs concentrations ranged from 37 to 31,305 ng/L in cooling water and from 40,043 to 216,653 ng/g dry wt in solid samples taken during the field investigation. In the laboratory simulation, concentrations ranged from 146 to 433 ng/L in cooling water and from 411,436 to 747,516 ng/Nm 3 in flue gas. All samples were dominated by BDE-209 among the congeners. Temperatures and impurities in plastic substrate can significantly affect PBDEs release. Special attention should be paid to the risks of water directly discharge from the cooling system, especially for the biological sludge and sediments, as well as flue gas emissions to the environment.
Mariana Amorim Fraga
Full Text Available Recognizing the need to consolidate the research and development (R&D activities in microelectronics fields in a strategic manner, the Plasma Processes Laboratory of the Technological Institute of Aeronautics (LPP-ITA has established a technology roadmap to serve as a guide for activities related to development of sensors based on silicon carbide (SiC thin films. These sensors have also potential interest to the aerospace field due to their ability to operate in harsh environment such as high temperatures and intense radiation. In the present paper, this roadmap is described and presented in four main sections: i introduction, ii what we have already done in the past, iii what we are doing in this moment, and iv our targets up to 2015. The critical technological issues were evaluated for different categories: SiC deposition techniques, SiC processing techniques for sensors fabrication and sensors characterization. This roadmap also presents a shared vision of how R&D activities in microelectronics should develop over the next five years in our laboratory.
This report from the Dutch Ministry of Health is an advisory document concerned with isotope laboratories in hospitals, in connection with the Dutch laws for hospitals. It discusses which hospitals should have isotope laboratories and concludes that as many hospitals as possible should have small laboratories so that emergency cases can be dealt with. It divides the Netherlands into regions and suggests which hospitals should have these facilities. The questions of how big each lab. is to be, what equipment each has, how each lab. is organised, what therapeutic and diagnostic work should be carried out by each, etc. are discussed. The answers are provided by reports from working groups for in vivo diagnostics, in vitro diagnostics, therapy, and safety and their results form the criteria for the licences of isotope labs. The results of a questionnaire for isotope labs. already in the Netherlands are presented, and their activities outlined. (C.F.)
In the fall of 1981, two short-term tests were conducted on a controlled air and a rotary kiln incinerator to assess their potential for processing transuranic (TRU) contaminated waste at the Idaho National Engineering Laboratory (INEL). The primary purpose of the test program was a proof-of-principle verification that the incinerators could achieve near-complete combustion of the combustible portion of the waste, while mixed with high percentages of noncombustible and metal waste materials. Other important test objectives were to obtain system design information including off-gas and end-product characteristics and incinerator operating parameters. Approximately 7200 kg of simulated (non-TRU) waste from the INEL were processed during the two tests
Crow, N.B.; Lamarre, A.L.
This report presents the results of a Remedial Investigation (RI) to define the extent of high explosives (HE) compounds and volatile organic compounds (VOCs) found in the soil, rocks, and ground water of the HE Process Area of Lawrence Livermore National Laboratory's (LLNL) Site 300 Facility. The report evaluates potential public health environmental risks associated with these compounds. Hydrogeologic information available before February 15, 1990, is included; however, chemical analyses and water-level data are reported through March 1990. This report is intended to assist the California Regional Water Quality Control Board (RWQCB)--Central Valley Region and the US Environmental Protection Agency (EPA) in evaluating the extent of environmental contamination of the LLNL HE Process Area and ultimately in designing remedial actions. 90 refs., 20 figs., 7 tabs.
Chaffe, B; Glencross, H; Jones, J; Staves, J; Capps-Jenner, A; Mistry, H; Bolton-Maggs, P; McQuade, M; Asher, D
The SHOT Adverse Incident Reporting Scheme has consistently reported an unacceptably high level of errors originating in the laboratory setting. In 2006 an initiative was launched in conjunction with the IBMS, SHOT, RCPath, BBTS, UK NEQAS, the NHSE NBTC and the equivalents in Scotland, Wales and Northern Ireland that led to the formation of the UK TLC. The UK TLC in considering the nature and spread of the errors documented by SHOT concluded that a significant proportion of these errors were most likely to be related to either the use of information technology or staff education, staffing levels, skill mix, training and competency issues. In the absence of any formal guidance on these matters, the UK TLC developed a series of recommendations using the results of two laboratory surveys conducted in 2007 and 2008.
Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David
Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.
Seyedin, Hesam; Goharinezhad, Salime; Vatankhah, Soodabeh; Azmal, Mohammad
Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628). Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals.
Choi, Soki; Brommels, Mats
The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in-depth case study of the pre-merger process of Karolinska University Hospital. Based on extensive document analysis and 35 key informant interviews the paper reconstructed the pre-merger process, searched for empirical patterns, and interpreted those by applying neo-institutional theory. Spanning nearly a decade, the pre-merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo-institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only. This paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context. This is the first systematic in-depth study of a university hospital merger employing a decision-making perspective.
Hopper, Mari K.; Maurer, Luke W.
Digestive physiology laboratory exercises often explore the regulation of enzyme action rather than systems physiology. This laboratory exercise provides a systems approach to digestive and regulatory processes through the exploration of postprandial blood glucose levels. In the present exercise, students enrolled in an undergraduate animal…
Full Text Available The current demographic development of our society results in an increasing number of elderly patients with chronic diseases being treated in the intensive care unit. A possible long-term consequence of such a treatment is that patients remain dependent on certain invasive organ support systems, such as long-term ventilator dependency. The main goal of this project is to define the transition process between in-hospital and out of hospital (ambulatory ventilator support. A further goal is to identify evidence-based quality indicators to help define and describe this process.This project describes an ideal sequence of processes (process chain, based on the current evidence from the literature. Besides the process chain, key data and quality indicators were described in detail. Due to the limited project timeline, these indicators were not extensively tested in the clinical environment.The results of this project may serve as a solid basis for proof of feasibility and proof of concept investigations, optimize the transition process of ventilator-dependent patients from a clinical to an ambulatory setting, as well as reduce the rate of emergency re-admissions.
Leu, Jun-Der; Huang, Yu-Tsung
The concept of Total Quality Management (TQM) has come to be applied in healthcare over the last few years. The process management category in the Baldrige Health Care Criteria for Performance Excellence model is designed to evaluate the quality of medical services. However, a systematic approach for implementation support is necessary to achieve excellence in the healthcare business process. The Architecture of Integrated Information Systems (ARIS) is a business process architecture developed by IDS Scheer AG and has been applied in a variety of industrial application. It starts with a business strategy to identify the core and support processes, and encompasses the whole life-cycle range, from business process design to information system deployment, which is compatible with the concept of healthcare performance excellence criteria. In this research, we apply the basic ARIS framework to optimize the clinical processes of an emergency department in a mid-size hospital with 300 clinical beds while considering the characteristics of the healthcare organization. Implementation of the case is described, and 16 months of clinical data are then collected, which are used to study the performance and feasibility of the method. The experience gleaned in this case study can be used a reference for mid-size hospitals with similar business models.
Turner, A.D.; Bowen, W.R.; Bridger, N.J.; Harrison, K.T.
A wide range of electrochemical separation processes has been evaluated through literature and experimental studies for potential application to the treatment of medium-active liquid wastes. Of the ten processes considered, electro-osmosis and electrochemical ion-exchange show the most promise for immediate further development to a larger scale, while the faradaic deposition of PuO 2 , Tc, RuO 2 require further laboratory study before judgement can be passed on these. Electro-osmosis has an exceptionally high solids retention (99.99%) and is capable of dewatering suspensions to 35% - suitable for direct incorporation in concrete. Electrochemical ion-exchange has the attractions of a conventional ion-exchange process but with the added features of enhanced kinetics and pH operating range, as well as elution into demineralized water merely by polarity reversal. All electrical processes have the advantage of the added process variable of externally applied potential, which can enable remote, automatic control. (author)
Turner, A.D.; Bowen, W.R.; Bridger, N.J.; Harrison, K.T.
A wide range of electrochemical separation processes have been evaluated through the literature and experimental studies for potential application to the treatment of medium-active liquid wastes. Of the 10 processes considered, electro-osmosis and electrochemical ion-exchange show the most promise for immediate further development to a larger scale, while the faradic deposition of PuO 2 , Tc, RuO 2 require further laboratory study before judgment can be passed on these. Electro-osmosis has an exceptionally high solids retention (99.99%) and is capable of dewatering suspensions to 35% - suitable for direct incorporation in concrete. Electrochemical ion-exchange has the attractions of a conventional ion-exchange process but with the added features of enhanced kinetics and pH operating range, as well as elution into demineralized water merely by polarity reversal. All electrical processes have the advantage of the added process variable of externally applied potential, which can enable remote, automatic control
Michling, R., E-mail: email@example.com; Bekris, N.; Cristescu, I.; Lohr, N.; Plusczyk, C.; Welte, S.; Wendel, J.
Highlights: • Operation of a water detritiation facility under optimized conditions for high detritiation performances. • Improvement of operational procedures to process tritiated waste water. • Handling and reduction of tritiated waste water to achieve enriched low volume tritiated water for sufficient storage. • Demonstration of the efficient availability of the TRENTA WDS facility for technical scale operation. -- Abstract: A Water Detritiation System (WDS) is required for any Fusion machine in order to process tritiated waste water, which is accumulated in various subsystems during operation and maintenance. Regarding the European procurement packages for the ITER tritium fuel cycle, the WDS test facility TRENTA applying the Combined Electrolysis Catalytic Exchange (CECE) process was developed, installed and is currently in operation at the Tritium Laboratory Karlsruhe (TLK). Besides the on-going R and D work for the design of ITER WDS, the current status of the TRENTA facility provides the option to utilize the WDS for processing tritiated water. Therefore, in the framework of the EFDA JET Fusion Technology Work Programme 2011, the TLK was able to offer the capability on a representative scale to process tritiated water, which was produced during normal operation at JET. The task should demonstrate the availability of the CECE process to handle and detritiate the water in terms of tritium enrichment and volume reduction. The operational program comprised the processing of purified tritiated water from JET, with a total volume of 180 l and an activity of 74 GBq. The paper will give an introduction to the TRENTA WDS facility and an overview of the operational procedure regarding tritiated water reduction. Data concerning required operation time, decontamination and enrichment performances and different operating procedures will be presented as well. Finally, a preliminary study on a technical implementation of processing the entire stock of JET
Rice, Brian P.; Lee, C. William; Curliss, David B.
Low-cost composite research in the US Air Force Research Laboratory, Materials and Manufacturing Directorate, Organic Matrix Composites Branch has focused on the theme of affordable performance. Practically, this means that we use a very broad view when considering the affordability of composites. Factors such as material costs, labor costs, recurring and nonrecurring manufacturing costs are balanced against performance to arrive at the relative affordability vs. performance measure of merit. The research efforts discussed here are two projects focused on affordable processing of composites. The first topic is the use of a neural network scheme to model cure reaction kinetics, then utilize the kinetics coupled with simple heat transport models to predict, in real-time, future exotherms and control them. The neural network scheme is demonstrated to be very robust and a much more efficient method that mechanistic cure modeling approach. This enables very practical low-cost processing of thick composite parts. The second project is liquid composite molding (LCM) process simulation. LCM processing of large 3D integrated composite parts has been demonstrated to be a very cost effective way to produce large integrated aerospace components specific examples of LCM processes are resin transfer molding (RTM), vacuum assisted resin transfer molding (VARTM), and other similar approaches. LCM process simulation is a critical part of developing an LCM process approach. Flow simulation enables the development of the most robust approach to introducing resin into complex preforms. Furthermore, LCM simulation can be used in conjunction with flow front sensors to control the LCM process in real-time to account for preform or resin variability.
Michling, R.; Bekris, N.; Cristescu, I.; Lohr, N.; Plusczyk, C.; Welte, S.; Wendel, J.
Highlights: • Operation of a water detritiation facility under optimized conditions for high detritiation performances. • Improvement of operational procedures to process tritiated waste water. • Handling and reduction of tritiated waste water to achieve enriched low volume tritiated water for sufficient storage. • Demonstration of the efficient availability of the TRENTA WDS facility for technical scale operation. -- Abstract: A Water Detritiation System (WDS) is required for any Fusion machine in order to process tritiated waste water, which is accumulated in various subsystems during operation and maintenance. Regarding the European procurement packages for the ITER tritium fuel cycle, the WDS test facility TRENTA applying the Combined Electrolysis Catalytic Exchange (CECE) process was developed, installed and is currently in operation at the Tritium Laboratory Karlsruhe (TLK). Besides the on-going R and D work for the design of ITER WDS, the current status of the TRENTA facility provides the option to utilize the WDS for processing tritiated water. Therefore, in the framework of the EFDA JET Fusion Technology Work Programme 2011, the TLK was able to offer the capability on a representative scale to process tritiated water, which was produced during normal operation at JET. The task should demonstrate the availability of the CECE process to handle and detritiate the water in terms of tritium enrichment and volume reduction. The operational program comprised the processing of purified tritiated water from JET, with a total volume of 180 l and an activity of 74 GBq. The paper will give an introduction to the TRENTA WDS facility and an overview of the operational procedure regarding tritiated water reduction. Data concerning required operation time, decontamination and enrichment performances and different operating procedures will be presented as well. Finally, a preliminary study on a technical implementation of processing the entire stock of JET
Passos, Sergio R.M.; Furtado, Henrique S.; Bentes, Miguel A.G.; Almeida, Pedro S. de [Companhia Siderurgica Nacional, Volta Redonda, RJ (Brazil). Centro de Pesquisas
The attractiveness of hot metal de siliconizing in ladle, relative to the process in blast furnace runner, is the previous knowledge of silicon content of hot metal, without the constraints of slag removing by skimmer met in torpedo car, and the better efficiency in low range silicon content, making easier the process controllability. Meanwhile, the main question about this technology is the extent of the resulfurization of hot metal that may occur due to process be performed after the desulfurization. This work simulates de de siliconizing process in ladle by experiments in induction furnace to compare the efficiencies of various de siliconizing agents available at CSN iron and steel making plant, and to evaluate the resulfurization intensity able to occur during the process, as well as, unexpected increasing of refractory wear. (author) 4 refs., 8 figs., 6 tabs.
Imoh, Lucius C; Mutale, Mubanga; Parker, Christopher T; Erasmus, Rajiv T; Zemlin, Annalise E
Timeliness of laboratory results is crucial to patient care and outcome. Monitoring turnaround times (TAT), especially for emergency tests, is important to measure the effectiveness and efficiency of laboratory services. Laboratory-based clinical audits reveal opportunities for improving quality. Our aim was to identify the most critical steps causing a high TAT for cerebrospinal fluid (CSF) chemistry analysis in our laboratory. A 6-month retrospective audit was performed. The duration of each operational phase across the laboratory work flow was examined. A process-mapping audit trail of 60 randomly selected requests with a high TAT was conducted and reasons for high TAT were tested for significance. A total of 1505 CSF chemistry requests were analysed. Transport of samples to the laboratory was primarily responsible for the high average TAT (median TAT = 170 minutes). Labelling accounted for most delays within the laboratory (median TAT = 71 minutes) with most delays occurring after regular work hours (P audit identified sample transportation, work shift periods and use of inappropriate CSF sample tubes as drivers of high TAT for CSF chemistry in our laboratory. The results of this audit will be used to change pre-analytical practices in our laboratory with the aim of improving TAT and customer satisfaction.
Full Text Available Abstract Background Although the attitude among doctors toward disclosing a cancer diagnosis is becoming more positive, informing patients of their disease has not yet become a common practice in Japan. We examined the psychological process, from hospitalization until death, among uninformed terminal cancer patients in Japan, and developed a psychological model. Methods Terminal cancer patients hospitalized during the recruiting period voluntarily participated in in-depth interviews. The data were analyzed by grounded theory. Results Of the 87 uninformed participants at the time of hospitalization, 67% (N = 59 died without being informed of their diagnosis. All were male, 51–66 years of age, and all experienced five psychological stages: anxiety and puzzlement, suspicion and denial, certainty, preparation, and acceptance. At the end of each stage, obvious and severe feelings were observed, which were called "gates." During the final acceptance stage, patients spent a peaceful time with family, even talking about their dreams with family members. Conclusion Unlike in other studies, the uninformed patients in this study accepted death peacefully, with no exceptional cases. Despite several limitations, this study showed that almost 70% of the uninformed terminal cancer patients at hospitalization died without being informed, suggesting an urgent need for culturally specific and effective terminal care services for cancer patients in Japan.
Steiner, J W; Root, J M; White, D C
The authors analyzed laboratory costs and utilization in 3,771 cases of Medicare inpatients admitted to a New England academic medical center ("the Hospital") from October 1, 1989 to September 30, 1990. The data were derived from the Hospital's Decision Resource System comprehensive data base. The authors established a historical reference point for laboratory costs as a percentage of total inpatient costs using 1981-82 Medicare claims data and cost report information. Inpatient laboratory costs were estimated at 9.5% of total inpatient costs for pre-Diagnostic Related Groups (DRGs) Medicare discharges. Using this reference point and adjusting for the Hospital's 1990 case mix, the "expected" laboratory cost was 9.3% of total cost. In fact, the cost averaged 11.5% (i.e., 24% above the expected cost level), and costs represented an even greater percentage of DRG reimbursement at 12.9%. If we regard the reimbursement as a total cost target (to eliminate losses from Medicare), then that 12.9% is 39% above the "expected" laboratory proportion of 9.3%. The Hospital lost an average of $1,091 on each DRG inpatient. The laboratory contributed 29% to this loss per case. Compared to other large hospitals, the Hospital was slightly (3%) above the mean direct cost per on-site test and significantly (58%) above the mean number of inpatient tests per inpatient day compared to large teaching hospitals. The findings suggest that careful laboratory cost analyses will become increasingly important as the proportion of patients reimbursed in a fixed manner grows. The future may hold a prospective zero-based laboratory budgeting process based on predictable patterns of DRG admissions or other fixed-reimbursement admission and laboratory utilization patterns.
Dong, Gang Nathan
Fiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance. Panel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports. There is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs. The results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.
Full Text Available E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01 and Union General Hospital (P = 0.01. This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02. When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54.Conclusion: The range of process of care scores submitted by acute care
The complex environment of the typical research laboratory requires flexible process control. This program provides natural language process control from an IBM PC or compatible machine. Sometimes process control schedules require changes frequently, even several times per day. These changes may include adding, deleting, and rearranging steps in a process. This program sets up a process control system that can either run without an operator, or be run by workers with limited programming skills. The software system includes three programs. Two of the programs, written in FORTRAN77, record data and control research processes. The third program, written in Pascal, generates the FORTRAN subroutines used by the other two programs to identify the user commands with the user-written device drivers. The software system also includes an input data set which allows the user to define the user commands which are to be executed by the computer. To set the system up the operator writes device driver routines for all of the controlled devices. Once set up, this system requires only an input file containing natural language command lines which tell the system what to do and when to do it. The operator can make up custom commands for operating and taking data from external research equipment at any time of the day or night without the operator in attendance. This process control system requires a personal computer operating under MS-DOS with suitable hardware interfaces to all controlled devices. The program requires a FORTRAN77 compiler and user-written device drivers. This program was developed in 1989 and has a memory requirement of about 62 Kbytes.
Full Text Available Background: Recently, the European Union has introduced the Falsified Medicines Directive (FMD. Additionally, in early 2016, a Delegated Act (DA related to the FMD was published. The main objective of this study was to evaluate the usefulness of external audits in the context of implementing new regulations provided by the FMD in the secondary care environment. Methods: The external, in-person workflow audits were performed by an authentication company in three Polish hospital pharmacies. Each audit consisted of a combination of supervision (non-participant observation, secondary data analysis, and expert interviews with the use of an independently designed authorial Diagnostic Questionnaire. The questionnaire included information about hospital drug distribution procedures, data concerning drug usage, IT systems, medication order systems, the processes of medication dispensing, and the preparation and administration of hazardous drugs. Data analysis included a thorough examination of hospital documentation in regard to drug management. All data were subjected to qualitative analysis, with the aim of generating meaningful information through inductive inference. Results: Only one dispensing location in the Polish hospitals studied has the potential to be a primary authentication area. In the audited hospitals, an Automated Drug Dispensing System and unit dose were not identified during the study. Hospital wards contained an enclosed place within the department dedicated to drug storage under the direct supervision of senior nursing staff. An electronic order system was not available. In the largest center, unused medications are re-dispensed to different hospital departments, or may be sold to various institutions. Additionally, in one hospital pharmacy, pharmacists prepared parenteral nutrition and chemotherapeutic drugs for patients admitted to the hospital. Conclusions: External audits might prove beneficial in the course of introducing new
Because of its complex nature, surgical pathology practice is prone to error. In this report, we describe our methods for reducing error as much as possible during the pre-analytical and analytical phases. This was achieved by revising procedures, and by using computer technology and automation. Most mistakes are the result of human error in the identification and matching of patient and samples. To avoid faulty data interpretation, we employed a new comprehensive computer system that acquires all patient ID information directly from the hospital's database with a remote order entry; it also provides label and request forms via-Web where clinical information is required before sending the sample. Both patient and sample are identified directly and immediately at the site where the surgical procedures are performed. Barcode technology is used to input information at every step and automation is used for sample blocks and slides to avoid errors that occur when information is recorded or transferred by hand. Quality control checks occur at every step of the process to ensure that none of the steps are left to chance and that no phase is dependent on a single operator. The system also provides statistical analysis of errors so that new strategies can be implemented to avoid repetition. In addition, the staff receives frequent training on avoiding errors and new developments. The results have been shown promising results with a very low error rate (0.27%). None of these compromised patient health and all errors were detected before the release of the diagnosis report.
Lyttle, T.W.; Smith, D.M.; Weinrach, J.B.; Burns, M.L.
At Los Alamos National Laboratory (LANL), facility waste streams tend to be small but highly diverse. Initial characterization of such waste streams is difficult in part due to a lack of tools to assist the waste generators in completing such assessments. A methodology has been developed at LANL to allow process knowledgeable field personnel to develop baseline waste generation assessments and to evaluate potential waste minimization technology. This process waste assessment (PWA) system is an application constructed within the process modeling system. The Process Modeling System (PMS) is an object-oriented, mass balance-based, discrete-event simulation using the common LISP object system (CLOS). Analytical capabilities supported within the PWA system include: complete mass balance specifications, historical characterization of selected waste streams and generation of facility profiles for materials consumption, resource utilization and worker exposure. Anticipated development activities include provisions for a best available technologies (BAT) database and integration with the LANL facilities management Geographic Information System (GIS). The environments used to develop these assessment tools will be discussed in addition to a review of initial implementation results
Russell, Renee L.; Peterson, Reid A.; Rinehart, Donald E.; Crum, Jarrod V.
Pacific Northwest National Laboratory (PNNL) has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to perform research and development activities to resolve technical issues identified for the Pretreatment Facility (PTF). The Pretreatment Engineering Platform (PEP) was designed, constructed, and operated as part of a plan to respond to issue M12, 'Undemonstrated Leaching Processes,' of the External Flowsheet Review Team (EFRT) issue response plan (Barnes et al. 2006). The PEP is a 1/4.5-scale test platform designed to simulate the WTP pretreatment caustic leaching, oxidative leaching, ultrafiltration solids concentration, and slurry washing processes. The PEP replicates the WTP leaching processes using prototypic equipment and control strategies. A simplified flow diagram of the PEP system is shown in Figure 1.1. Two operating scenarios are currently being evaluated for the ultrafiltration process (UFP) and leaching operations. The first scenario has caustic leaching performed in the UFP-2 ultrafiltration feed vessels (i.e., vessel UFP-VSL-T02A in the PEP; and vessels UFP-VSL-00002A and B in the WTP PTF). The second scenario has caustic leaching conducted in the UFP-1 ultrafiltration feed preparation vessels (i.e., vessels UFP-VSL-T01A and B in the PEP; vessels UFP-VSL-00001A and B in the WTP PTF).
Mukherjee, Tusharmouli; Plakogiannis, Fotios M
The purpose of this study was to select the critical process parameters of the fluid bed processes impacting the quality attribute of a solid self-microemulsifying (SME) system of albendazole (ABZ). A fractional factorial design (2(4-1)) with four parameters (spray rate, inlet air temperature, inlet air flow, and atomization air pressure) was created by MINITAB software. Batches were manufactured in a laboratory top-spray fluid bed at 625-g scale. Loss on drying (LOD) samples were taken throughout each batch to build the entire moisture profiles. All dried granulation were sieved using mesh 20 and analyzed for particle size distribution (PSD), morphology, density, and flow. It was found that as spray rate increased, sauter-mean diameter (D(s)) also increased. The effect of inlet air temperature on the peak moisture which is directly related to the mean particle size was found to be significant. There were two-way interactions between studied process parameters. The main effects of inlet air flow rate and atomization air pressure could not be found as the data were inconclusive. The partial least square (PLS) regression model was found significant (P SME manufacturing process.
Zotesso, Jaqueline Pirão; Cossich, Eneida Sala; Janeiro, Vanderly; Tavares, Célia Regina Granhen
Hospitals consume a large volume of water to carry out their activities and, hence, generate a large volume of effluent that is commonly discharged into the local sewage system without any treatment. Among the various sectors of healthcare facilities, the laundry is responsible for the majority of water consumption and generates a highly complex effluent. Although several advanced oxidation processes (AOPs) are currently under investigation on the degradation of a variety of contaminants, few of them are based on real wastewater samples. In this paper, the UV/H 2 O 2 AOP was evaluated on the treatment of a hospital laundry wastewater, after the application of a physicochemical pretreatment composed of coagulation-flocculation and anthracite filtration. For the UV/H 2 O 2 process, a photoreactor equipped with a low-pressure UV-C lamp was used and the effects of initial pH and [H 2 O 2 ]/chemical oxygen demand (COD) ratio on COD removal were investigated through a randomized factorial block design that considered the batches of effluent as blocks. The results indicated that the initial pH had no significant effect on the COD removal, and the process was favored by the increase in [H 2 O 2 ]/COD ratio. Color and turbidity were satisfactorily reduced after the application of the physicochemical pretreatment, and COD was completely removed by the UV/H 2 O 2 process under suitable conditions. The results of this study show that the UV/H 2 O 2 AOP is a promising candidate for hospital laundry wastewater treatment and should be explored to enable wastewater reuse in the washing process.
O'Hara, Matthew J.; Farawila, Anne F.; Grate, Jay W.
The identification and quantification of targeted α- and β-emitting radionuclides via destructive analysis in complex radioactive liquid matrices is highly challenging. Analyses are typically accomplished at on- or off-site laboratories through laborious sample preparation steps and extensive chemical separations followed by analysis using a variety of detection methodologies (e.g., liquid scintillation, alpha energy spectroscopy, mass spectrometry). Analytical results may take days or weeks to report. When an industrial-scale plant requires periodic or continuous monitoring of radionuclides as an indication of the composition of its feed stream, diversion of safeguarded nuclides, or of plant operational conditions (for example), radiochemical measurements should be rapid, but not at the expense of precision and accuracy. Scientists at Pacific Northwest National Laboratory have developed and characterized a host of automated radioanalytical systems designed to perform reproducible and rapid radioanalytical processes. Platforms have been assembled for (1) automation and acceleration of sample analysis in the laboratory and (2) automated monitors for monitoring industrial scale nuclear processes on-line with near-real time results. These methods have been applied to the analysis of environmental-level actinides and fission products to high-level nuclear process fluids. Systems have been designed to integrate a number of discrete sample handling steps, including sample pretreatment (e.g., digestion and valence state adjustment) and chemical separations. The systems have either utilized on-line analyte detection or have collected the purified analyte fractions for off-line measurement applications. One PNNL system of particular note is a fully automated prototype on-line radioanalytical system designed for the Waste Treatment Plant at Hanford, WA, USA. This system demonstrated nearly continuous destructive analysis of the soft β-emitting radionuclide 99Tc in nuclear
Kottner, Jan; Halfens, Ruud
Institutionally acquired pressure ulcers are used as outcome indicators to assess the quality of pressure ulcer prevention programs. Determining whether quality improvement projects that aim to decrease the proportions of institutionally acquired pressure ulcers lead to real changes in clinical practice depends on the measurement method and statistical analysis used. To examine whether nosocomial pressure ulcer prevalence rates in hospitals in the Netherlands changed, a secondary data analysis using different statistical approaches was conducted of annual (1998-2008) nationwide nursing-sensitive health problem prevalence studies in the Netherlands. Institutions that participated regularly in all survey years were identified. Risk-adjusted nosocomial pressure ulcers prevalence rates, grade 2 to 4 (European Pressure Ulcer Advisory Panel system) were calculated per year and hospital. Descriptive statistics, chi-square trend tests, and P charts based on statistical process control (SPC) were applied and compared. Six of the 905 healthcare institutions participated in every survey year and 11,444 patients in these six hospitals were identified as being at risk for pressure ulcers. Prevalence rates per year ranged from 0.05 to 0.22. Chi-square trend tests revealed statistically significant downward trends in four hospitals but based on SPC methods, prevalence rates of five hospitals varied by chance only. Results of chi-square trend tests and SPC methods were not comparable, making it impossible to decide which approach is more appropriate. P charts provide more valuable information than single P values and are more helpful for monitoring institutional performance. Empirical evidence about the decrease of nosocomial pressure ulcer prevalence rates in the Netherlands is contradictory and limited.
Andersen, Simone Nyholm; Broberg, Ole
Participatory simulation (PS) is a method to involve workers in simulating and designing their own future work system. Existing PS studies have focused on analysing the outcome, and minimal attention has been devoted to the process of creating this outcome. In order to study this process, we...... suggest applying a knowledge creation perspective. The aim of this study was to develop a framework describing the process of how ergonomics knowledge is created in PS. Video recordings from three projects applying PS of hospital work systems constituted the foundation of process mining analysis....... The analysis resulted in a framework revealing the sources of ergonomics knowledge creation as sequential relationships between the activities of simulation participants sharing work experiences; experimenting with scenarios; and reflecting on ergonomics consequences. We argue that this framework reveals...
Andréia Guerra Siman
Full Text Available This study's aim was to understand the role of nurse managers in the process of hospital accreditation. This qualitative case study was conducted in a large private hospital in Belo Horizonte, MG, Brazil. Five nurse managers were interviewed using a semi-structured script from April to May, 2011 and content analysis was used to interpret the data. Results show the strategic position of this professional, his/her managerial skills and participation in the implementation and maintenance of accreditation, and the importance of care management. Nurses have played managerial roles with greater autonomy, connecting inter-sector care, which contrasts with the curative model, and have established partnerships with different social and institutional segments, adopting standards for teamwork. Managerial, healthcare, and educational work is performed from a procedural and indivisible perspective.
Sani, A S A; Hamedon, Z; Azhari, A; Sousa, F J P
During the polishing process of porcelain tiles the difference in scratching speed between innermost and peripheral abrasives leads to pressure gradients linearly distributed along the radial direction of the abrasive tool. The aim of this paper is to investigate such pressure gradient in laboratory scale. For this purpose polishing tests were performed on ceramic tiles according to the industrial practices using a custom-made CNC tribometer. Gradual wear on both abrasives and machined surface of the floor tile were measured. The experimental results suggested that the pressure gradient tends to cause an inclination of the abraded surfaces, which becomes stable after a given polishing period. In addition to the wear depth of the machined surface, the highest value of gloss and finest surface finish were observed at the lowest point of the worn out surface of the ceramic floor tile corresponding to the point of highest pressure and lowest scratching speed. (paper)
The Ames Laboratory has historically supported the U.S. Department of Energy (USDOE) and its predecessor agencies by providing research into the purification and manufacturing of high purity uranium, thorium, and yttrium metals. Much of this work was accomplished in the late 1950s and early 1960s prior to the legislation of strict rules and regulations covering the disposal of radioactive and chemical wastes. As a result, approximately 800 cubic meters of low-level radioactive wastes, chemical wastes, and contaminated debris were disposed in nine near surface cells located in a 0.75 hectare plot of land owned by Iowa State University in Ames, Iowa. Under a national contract with the U.S. Army Corps of Engineers (USACE), OHM Remediation Services Corp (OHM) was tasked with providing turnkey environmental services to remove, process, package, transport, and coordinate the disposal of the waste materials and contaminated environmental media
Longley, S.; Carson, S.; McDonald, M.
As part of the isotope production program at Sandia National Laboratories (SNL), procedures are being finalized for the production of 99 Mo from the irradiation of 235 U-coated stainless-steel targets at the Technical Area (TA) V reactor and hot-cell facilities. Methods have been identified and tested for the management of the nonproduct (waste) material as the final step in the production process. These methods were developed utilizing the waste material from a series of cold and hot tests, beginning with depleted uranium powder and culminating with a test involving an irradiated 235 U target with an initial fission product inventory of ∼18000 Ci at the end of the irradiation cycle. This paper describes the radioactive waste management from the isotope production
In this paper we present a novel measurement technique for monitoring particle size distributions of industrial colloidal slurries based on ultrasonic spectroscopy and mathematical deconvolution. An on-line sensor prototype has been developed and tested extensively in laboratory and production settings using mineral pigment slurries. Evaluation to date shows that the sensor is capable of providing particle size distributions, without any assumptions regarding their functional form, over diameters ranging from 0.1 to 100 micrometers in slurries with particle concentrations of 10 to 50 volume percents. The newly developed on-line sensor allows one to obtain particle size distributions of commonly encountered inorganic pigment slurries under industrial processing conditions without dilution.
The Ames Laboratory has historically supported the US Department of Energy (USDOE) and its predecessor agencies by providing research into the purification and manufacturing of high purity uranium, thorium, and yttrium metals. Much of this work was accomplished in the late 1950s and early 1960s prior to the legislation of strict rules and regulations covering the disposal of radioactive and chemical wastes. As a result, approximately 800 cubic meters of low-level radioactive wastes, mixed wastes, and contaminated debris were disposed in nine near surface cells located in a 0.75 hectare plot of land owned by Iowa State University in Ames, Iowa. Under a national contract with the US Army Corps of Engineers (USACE), OHM Remediation Services Corp. (OHM) was tasked with providing turnkey environmental services to remove, process, package, transport, and coordinate the disposal of the waste materials and contaminated environmental media
Full Text Available The processes of momentum and heat transfer between ocean and atmosphere in the boundary layer were investigated within laboratory modeling for a wide range of wind speed and surface wave including hurricane conditions. Experiments were carried out on the Wind-Wave Flume of the Large Thermostratified Tank of IAP RAS. A special net located under the surface at different depths allows to vary parameters of surface waves independently on wind parameters. Theory of self-similarity of air flow parameters in the flume was used to calculate values aerodynamic and heat transfer coefficients from the measured velocity and temperature profiles by Pito and hotfilm gauges respectively. Simultaneous measurements of surface elevation with system wire allow to obtain spectra and integral parameters of waves. It was demonstrated that in contrast to the drag coefficient, heat transfer coefficient is virtually independent of wind speed and wave parameters to the moment of the beginning of spray generation and then increases rapidly.
Edwards, D.; Messina, F.; Clark, J.
Recent data generated by the Gas Research Institute (GRI) and others indicate that residual hydrocarbon may be bound/sequestered in soil such that it is unavailable for microbial degradation, and thus possibly not bioavailable to human/ecological receptors. A reduction in bioavailability would directly equate to reduced exposure and, therefore, potentially less-conservative risk-based cleanup soil goals. Laboratory bioassays which measure bioavailability/toxicity can be cost-effectively integrated into the risk-based corrective action process. However, in order to maximize the cost-effective application of bioassays several site-specific parameters should be addressed up front. This paper discusses (1) the evaluation of parameters impacting the application of bioassays to soils contaminated with metals and/or petroleum hydrocarbons and (2) the cost-effective integration of bioassays into a tiered ASTM type framework for risk-based corrective action
Hughes, J M
Winter Park Memorial Hospital (Winter Park, Florida) began implementation of a well-strategized plan for total quality management (TQM) in 1987. Having no guidelines for applying TQM to health care but using the industrial quality management techniques of Philip Crosby Associates, Inc, the hospital made the transition and saved thousands of dollars in the process. This article describes the transition, especially the integral part played by the Medical Staff Quality Council in changing the hospital's culture.
K. M. Buddhiraju
Full Text Available In this paper a virtual laboratory for the Satellite Image Processing and Analysis (v-SIPAL being developed at the Indian Institute of Technology Bombay is described. v-SIPAL comprises a set of experiments that are normally carried out by students learning digital processing and analysis of satellite images using commercial software. Currently, the experiments that are available on the server include Image Viewer, Image Contrast Enhancement, Image Smoothing, Edge Enhancement, Principal Component Transform, Texture Analysis by Co-occurrence Matrix method, Image Indices, Color Coordinate Transforms, Fourier Analysis, Mathematical Morphology, Unsupervised Image Classification, Supervised Image Classification and Accuracy Assessment. The virtual laboratory includes a theory module for each option of every experiment, a description of the procedure to perform each experiment, the menu to choose and perform the experiment, a module on interpretation of results when performed with a given image and pre-specified options, bibliography, links to useful internet resources and user-feedback. The user can upload his/her own images for performing the experiments and can also reuse outputs of one experiment in another experiment where applicable. Some of the other experiments currently under development include georeferencing of images, data fusion, feature evaluation by divergence andJ-M distance, image compression, wavelet image analysis and change detection. Additions to the theory module include self-assessment quizzes, audio-video clips on selected concepts, and a discussion of elements of visual image interpretation. V-SIPAL is at the satge of internal evaluation within IIT Bombay and will soon be open to selected educational institutions in India for evaluation.
Hu, Zhenhu; Lane, Robert; Wen, Zhiyou
Waste materials from the clam processing industry (offal, shells) have several special characteristics such as a high salinity level, a high nitrogen content, and a low C/N ratio. The traditional disposal of clam waste through landfilling is facing the challenges of limited land available, increasing tipping fees, and strict environmental and regulatory scrutiny. The aim of this work is to investigate the performance of in-vessel composting as an alternative for landfill application of these materials. Experiments were performed in both laboratory-scale (5L) and pilot-scale (120L) reactors, with woodchips as the bulking agent. In the laboratory-scale composting test, the clam waste and woodchips were mixed in ratios from 1:0.5 to 1:3 (w/w, wet weight). The high ratios resulted in a better temperature performance, a higher electrical conductivity, and a higher ash content than the low-ratio composting. The C/N ratio of the composts was in the range of 9:1-18:1. In the pilot-scale composting test, a 1:1 ratio of clam waste to woodchips was used. The temperature profile during the composting process met the US Environmental Protection Agency sanitary requirement. The final cured compost had a C/N ratio of 14.6, with an ash content of 167.0+/-14.1g/kg dry matter. In addition to the major nutrients (carbon, nitrogen, calcium, magnesium, phosphorus, potassium, sulfur, and sodium), the compost also contained trace amounts of zinc, manganese, copper, and boron, indicating that the material can be used as a good resource for plant nutrients.
McDonald, M.J.; Bourcier, S.C.; Talley, D.G.
Prior to 1989 99 Mo was produced in the US by a single supplier, Cintichem Inc., Tuxedo, NY. Because of problems associated with operating its facility, in 1989 Cintichem elected to decommission the facility rather than incur the costs for repair. The demise of the 99 Mo capability at Cintichem left the US totally reliant upon a single foreign source, Nordion International, located in Ottawa Canada. In 1992 the DOE purchased the Cintichem 99 Mo Production Process and Drug Master File (DMF). In 1994 the DOE funded Sandia National Laboratories (SNL) to produce 99 Mo. Although Cintichem produced 99 Mo and 99m Tc generators for many years, there was no requirement for process validation which is now required by the Food and Drug Administration (FDA). In addition to the validation requirement, the requirements for current Good manufacturing Practices were codified into law. The purpose of this paper is to describe the process validation being conducted at SNL for the qualification of SNL as a supplier of 99 Mo to US pharmaceutical companies
Garcia-Hejl, Carine; Chianéa, Denis; Dedome, Emmanuel; Sanmartin, Nancy; Bugier, Sarah; Linard, Cyril; Foissaud, Vincent; Vest, Philippe
To prepare the French Accreditation Committee (COFRAC) visit for initial certification of our medical laboratory, our direction evaluated its quality management system (QMS) and all its technical activities. This evaluation was performed owing an internal audit. This audit was outsourced. Auditors had an expertise in audit, a whole knowledge of biological standards and were independent. Several nonconformities were identified at that time, including a lack of control of several steps of the internal audit process. Hence, necessary corrective actions were taken in order to meet the requirements of standards, in particular, the formalization of all stages, from the audit program, to the implementation, review and follow-up of the corrective actions taken, and also the implementation of the resources needed to carry out audits in a pre-established timing. To ensure an optimum control of each step, the main concepts of risk management were applied: process approach, root cause analysis, effects and criticality analysis (FMECA). After a critical analysis of our practices, this methodology allowed us to define our "internal audit" process, then to formalize it and to follow it up, with a whole documentary system.
Application Anti Microbial Activity Test and Direct Inoculation of Urinary Specimen Test to Increase the Quality of Results and Decrease the Production Cost in Clinical Microbiology Laboratory, Sanglah General Hospital Hospital, Bali-Indonesia
Full Text Available Objective: Urinary tract infection (UTI is the most common bacterial infection in general practice and in hospitals. Fast and accurate urine culture and sensitivity test are needed for adequate therapy. Anti Microbial Activity test (AMA test that is used to detect the presence of antibiotics in urine specimens is not commonly used in clinical microbiology laboratories. Some laboratories are still using indirect inoculation technique using enriched media before inoculating onto the agar media. The aim of this research is to compare results of urinary examination of direct inoculation technique with AMA test with indirect inoculation technique without AMA test.Methods: A number of 210 urine specimens were collected in Clinical Microbiology Laboratory at Sanglah General Hospital within a time period between 16 June until 16 July 2009.Results: Antibiotics were detected in 40% of the urinary specimens; whereas 48.1% showed no evidence of UTI, that is negative AMA test and sterile urinary culture or colony growth < 105 CFU/ml. Only 11.9% of the specimens indicates urinary tract infections. The examination can be completed within 2-3 days which is shorter than indirect inoculation test which require 5-7 days. Direct inoculation technique can reduce the cost of production three-fold the costs require for an indirect inoculation test.Conclusions: Application of AMA test and direct inoculation technique can give results more rapidly, reliable and useful for clinicians. This also decrease the laboratory’s cost of production.
da Silva, Natal Santos; Undurraga, Eduardo A; da Silva Ferreira, Elis Regina; Estofolete, Cássia Fernanda; Nogueira, Maurício Lacerda
In Brazil, the incidence of hospitalization due to dengue, as an indicator of severity, has drastically increased since 1998. The objective of our study was to identify risk factors associated with subsequent hospitalization related to dengue. We analyzed 7613 dengue confirmed via serology (ELISA), non-structural protein 1, or polymerase chain reaction amplification. We used a hierarchical framework to generate a multivariate logistic regression based on a variety of risk variables. This was followed by multiple statistical analyses to assess hierarchical model accuracy, variance, goodness of fit, and whether or not this model reliably represented the population. The final model, which included age, sex, ethnicity, previous dengue infection, hemorrhagic manifestations, plasma leakage, and organ failure, showed that all measured parameters, with the exception of previous dengue, were statistically significant. The presence of organ failure was associated with the highest risk of subsequent dengue hospitalization (OR=5·75; CI=3·53-9·37). Therefore, plasma leakage and organ failure were the main indicators of hospitalization due to dengue, although other variables of minor importance should also be considered to refer dengue patients to hospital treatment, which may lead to a reduction in avoidable deaths as well as costs related to dengue. Copyright © 2017 Elsevier B.V. All rights reserved.
Andersen, Simone Nyholm; Broberg, Ole
Participatory simulation (PS) is a method to involve workers in simulating and designing their own future work system. Existing PS studies have focused on analysing the outcome, and minimal attention has been devoted to the process of creating this outcome. In order to study this process, we suggest applying a knowledge creation perspective. The aim of this study was to develop a framework describing the process of how ergonomics knowledge is created in PS. Video recordings from three projects applying PS of hospital work systems constituted the foundation of process mining analysis. The analysis resulted in a framework revealing the sources of ergonomics knowledge creation as sequential relationships between the activities of simulation participants sharing work experiences; experimenting with scenarios; and reflecting on ergonomics consequences. We argue that this framework reveals the hidden steps of PS that are essential when planning and facilitating PS that aims at designing work systems. Practitioner Summary: When facilitating participatory simulation (PS) in work system design, achieving an understanding of the PS process is essential. By applying a knowledge creation perspective and process mining, we investigated the knowledge-creating activities constituting the PS process. The analysis resulted in a framework of the knowledge-creating process in PS.
Full Text Available Site selection for sitting of urban activities/facilities is one of the crucial policy-related decisions taken by urban planners and policy makers. The process of site selection is inherently complicated. A careless site imposes exorbitant costs on city budget and damages the environment inevitably. Nowadays, multi-attributes decision making approaches are suggested to use to improve precision of decision making and reduce surplus side effects. Two well-known techniques, analytical hierarchal process and analytical network process are among multi-criteria decision making systems which can easily be consistent with both quantitative and qualitative criteria. These are also developed to be fuzzy analytical hierarchal process and fuzzy analytical network process systems which are capable of accommodating inherent uncertainty and vagueness in multi-criteria decision-making. This paper reports the process and results of a hospital site selection within the Region 5 of Shiraz metropolitan area, Iran using integrated fuzzy analytical network process systems with Geographic Information System (GIS. The weights of the alternatives were calculated using fuzzy analytical network process. Then a sensitivity analysis was conducted to measure the elasticity of a decision in regards to different criteria. This study contributes to planning practice by suggesting a more comprehensive decision making tool for site selection.
Full Text Available Site selection for sitting of urban activities/facilities is one of the crucial policy-related decisions taken by urban planners and policy makers. The process of site selection is inherently complicated. A careless site imposes exorbitant costs on city budget and damages the environment inevitably. Nowadays, multi-attributes decision making approaches are suggested to use to improve precision of decision making and reduce surplus side effects. Two well-known techniques, analytical hierarchal process and analytical network process are among multi-criteria decision making systems which can easily be consistent with both quantitative and qualitative criteria. These are also developed to be fuzzy analytical hierarchal process and fuzzy analytical network process systems which are capable of accommodating inherent uncertainty and vagueness in multi-criteria decision-making. This paper reports the process and results of a hospital site selection within the Region 5 of Shiraz metropolitan area, Iran using integrated fuzzy analytical network process systems with Geographic Information System (GIS. The weights of the alternatives were calculated using fuzzy analytical network process. Then a sensitivity analysis was conducted to measure the elasticity of a decision in regards to different criteria. This study contributes to planning practice by suggesting a more comprehensive decision making tool for site selection.
Doehmann, M.; Brune, S.; Nardini, L.; Rybacki, E.; Dresen, G.
Strain localization is an ubiquitous process in earth materials observed over a broad range of scales in space and time. Localized deformation and the formation of shear zones and faults typically involves material softening by various processes, like shear heating and grain size reduction. Numerical modeling enables us to study the complex physical and chemical weakening processes by separating the effect of individual parameters and boundary conditions. Using simple piece-wise linear functions for the parametrization of weakening processes allows studying a system at a chosen (lower) level of complexity (e.g. Cyprych et al., 2016). In this study, we utilize a finite element model to test two weakening laws that reduce the strength of the material depending on either the I) amount of accumulated strain or II) deformational work. Our 2D Cartesian models are benchmarked to single inclusion torsion experiments performed at elevated temperatures of 900 °C and pressures of up to 400 MPa (Rybacki et al., 2014). The experiments were performed on Carrara marble samples containing a weak Solnhofen limestone inclusion at a maximum strain rate of 2.0*10-4 s-1. Our models are designed to reproduce shear deformation of a hollow cylinder equivalent to the laboratory setup, such that material leaving one side of the model in shear direction enters again on the opposite side using periodic boundary conditions. Similar to the laboratory tests, we applied constant strain rate and constant stress boundary conditions.We use our model to investigate the time-dependent distribution of stress and strain and the effect of different parameters. For instance, inclusion rotation is shown to be strongly dependent on the viscosity ratio between matrix and inclusion and stronger ductile weakening increases the localization rate while decreasing shear zone width. The most suitable weakening law for representation of ductile rock is determined by combining the results of parameter tests with
Leisner, T.; Abdelmonem, A.; Benz, S.; Brinkmann, M.; Möhler, O.; Rzesanke, D.; Saathoff, H.; Schnaiter, M.; Wagner, R.
The formation of ice in tropospheric clouds controls the evolution of precipitation and thereby influences climate and weather via a complex network of dynamical and microphysical processes. At higher altitudes, ice particles in cirrus clouds or contrails modify the radiative energy budget by direct interaction with the shortwave and longwave radiation. In order to improve the parameterisation of the complex microphysical and dynamical processes leading to and controlling the evolution of tropospheric ice, laboratory experiments are performed at the IMK Karlsruhe both on a single particle level and in the aerosol and cloud chamber AIDA. Single particle experiments in electrodynamic levitation lend themselves to the study of the interaction between cloud droplets and aerosol particles under extremely well characterized and static conditions in order to obtain microphysical parameters as freezing nucleation rates for homogeneous and heterogeneous ice formation. They also allow the observation of the freezing dynamics and of secondary ice formation and multiplication processes under controlled conditions and with very high spatial and temporal resolution. The inherent droplet charge in these experiments can be varied over a wide range in order to assess the influence of the electrical state of the cloud on its microphysics. In the AIDA chamber on the other hand, these processes are observable under the realistic dynamic conditions of an expanding and cooling cloud- parcel with interacting particles and are probed simultaneously by a comprehensive set of analytical instruments. By this means, microphysical processes can be studied in their complex interplay with dynamical processes as for example coagulation or particle evaporation and growth via the Bergeron - Findeisen process. Shortwave scattering and longwave absorption properties of the nucleating and growing ice crystals are probed by in situ polarised laser light scattering measurements and infrared extinction
Ramani, K V
Aims to give an overview of the re-engineering of processes and structures at Gujarat Cancer Research Institute (GCRI), Ahmedabad. A general review of the design, development and implementation of reengineered systems in order to address concerns about the existing systems. Findings GCRI is a comprehensive cancer care center with 550 beds and well equipped with modern diagnostic and treatment facilities. It serves about 200,000 outpatients and 16,000 inpatients annually. The approach to a better management of hospital supplies led to the design, development, and implementation of an IT-based reengineered and integrated purchase and inventory management system. The new system has given GCRI a saving of about 8 percent of its annual costs of purchases, and improved the availability of materials to the user departments. Shows that the savings obtained are used not only for buying more hospital supplies, but also to buy better quality of hospital supplies, and thereby satisfactorily address the GCRI responsibility towards meeting its social obligations for cancer care.
Stab, Nicole; Hacker, Winfried
The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units. Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing. The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them. Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals. Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation. Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process. © 2018 John Wiley & Sons Ltd.
Ravangard, Ramin; Bahadori, Mohammadkarim; Raadabadi, Mehdi; Teymourzadeh, Ehsan; Alimomohammadzadeh, Khalil; Mehrabian, Fardin
This study aimed to identify and prioritize factors affecting the development of military hospital beds and provide a model using fuzzy analytical hierarchy process (Fuzzy AHP). This applied study was conducted in 2016 in Iran using a mixed method. The sample included experts in the field of military health care system. The MAXQDA 10.0 and Expert Choice 10.0 software were used for analyzing the collected data. Geographic situation, demographic status, economic status, health status, health care centers and organizations, financial and human resources, laws and regulations and by-laws, and the military nature of service recipients had effects on the development of military hospital beds. The military nature of service recipients (S=0.249) and economic status (S=0.040) received the highest and lowest priorities, respectively. Providing direct health care services to the military forces in order to maintain their dignity, and according to its effects in the crisis, as well as the necessity for maintaining the security of the armed forces, and the hospital beds per capita based on the existing laws, regulations and bylaws are of utmost importance.
Sørensen, Ann Lykkegaard; Mainz, Jan; Lisby, Marianne
frequency, type and potential clinical consequences of errors in all stages of the medication process in an inpatient psychiatric setting. Methods and materials: A cross-sectional study in two general psychiatric wards and one acute psychiatric ward. Participants were eligible psychiatric in......-hospital patients (n=67), physicians prescribing drugs and ward staff (nurses and nurses assistants) dispensing and administering drugs. The study was carried out using 3 methods of investigation – an observational study, an unannounced control visit and an audit of medical records. Medication errors were evaluated...
Hagos, Fisseha; Alemseged, Fessehaye; Balcha, Fikadu; Berhe, Semarya; Aregay, Alemseged
Background. Nursing process is considered as appropriate method to explain the nursing essence, its scientific bases, technologies and humanist assumptions that encourage critical thinking and creativity, and permits solving problems in professional practice. Objective. To assess the application of nursing process and it's affecting factors in Mekelle Zone Hospitals. Methods. A cross sectional design employing quantitative and qualitative methods was conducted in Mekelle zone hospitals March 2011. Qualitative data was collected from14 head nurses of six hospitals and quantitative was collected from 200 nurses selected by simple random sampling technique from the six hospitals proportional to their size. SPSS version 16.1 and thematic analysis was used for quantitative and qualitative data respectively. Results. Majority 180 (90%) of the respondents have poor knowledge and 99.5% of the respondents have a positive attitude towards the nursing process. All of the respondents said that they did not use the nursing process during provision of care to their patients at the time of the study. Majority (75%) of the respondent said that the nurse to patient ratio was not optimal to apply the nursing process. Conclusion and Recommendation. The nursing process is not yet applied in all of the six hospitals. The finding revealed that the knowledge of nurses on the nursing process is not adequate to put it in to practice and high patient nurse ratio affects its application. The studied hospitals should consider the application of the nursing process critically by motivating nurses and monitor and evaluate its progress. PMID:24649360
There is a substantial amount of organisational restructuring presently occurring in Australian public hospitals. However, there has been a lack of systematic research conducted about this phenomenon. In Australia most literature about organisational restructuring has employed a case study approach. Although there has been a great deal of support for product line management organisational arrangements in recent literature from overseas, little investigation into the adoption of product line management has taken place in Australia. In this paper, a discussion about the relationship between strategic management and organisational structure is presented. Survey results of a sample of nine teaching hospitals in New South Wales are reported. Taken together with other more descriptive literature about organisational restructuring in Australian health care, the evidence from this survey suggests that there are vigorous transformational processes at work, perhaps especially in the larger hospitals. Despite support for it in the literature, product line management is not being adopted on a widespread scale. The shift toward restructuring occurring within Australian hospitals at the moment represents a bout of experimentation with new organisational designs which seems destined to continue. A number of management theorists conclude that there need to be strong linkages between strategic planning and the choice of organisational structure. However, the empirical evidence reported here did not identify such strong linkages. This phenomenon warrants further investigation. The view is put that where these linkages are weak there is a risk that whatever structure is chosen will not be robust or flexible enough to cope with mooted or predicted policy changes to the Australian health system.
When Project C.U.R.E.'s much-needed medical supplies and equipment arrive in Liberia, the Frederick National Lab’s Kathryn Kynvin is there to receive and distribute the donations to hospitals who continue to treat survivors of the most recent Ebola
Conclusions: We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.
Mlinaric, Ana; Milos, Marija; Coen Herak, Désirée; Fucek, Mirjana; Rimac, Vladimira; Zadro, Renata; Rogic, Dunja
The need to satisfy high-throughput demands for laboratory tests continues to be a challenge. Therefore, we aimed to automate postanalytical phase in hematology and coagulation laboratory by autovalidation of complete blood count (CBC) and routine coagulation test results (prothrombin time [PT], international normalized ratio [PT-INR], activated partial thromboplastin time [APTT], fibrinogen, antithrombin activity [AT] and thrombin time [TT]). Work efficacy and turnaround time (TAT) before and after implementation of automated solutions will be compared. Ordering panels tailored to specific patient populations were implemented. Rerun and reflex testing rules were set in the respective analyzers' software (Coulter DxH Connectivity 1601, Beckman Coulter, FL, USA; AutoAssistant, Siemens Healthcare Diagnostics, Germany), and sample status information was transferred into the laboratory information system. To evaluate if the automation improved TAT and efficacy, data from manually verified results in September and October of 2015 were compared with the corresponding period in 2016 when autovalidation was implemented. Autovalidation rates of 63% for CBC and 65% for routine coagulation test results were achieved. At the TAT of 120 min, the percentage of reported results increased substantially for all analyzed tests, being above 90% for CBC, PT, PT-INR and fibrinogen and 89% for APTT. This output was achieved with three laboratory technicians less compared with the period when the postanalytical phase was not automated. Automation allowed optimized laboratory workflow for specific patient populations, thereby ensuring standardized results reporting. Autovalidation of test results proved to be an efficient tool for improvement of laboratory work efficacy and TAT.
Yii, Mei-Wo; Abdullah Siddiqi Ismail
Determination of alpha emitting plutonium radionuclides such as Pu-238, Pu-239 and Pu-240 concentrations inside a sample require lots of radiochemistry purification process to separate them from other interfering alpha emitters. These pure isotopes are then been electrodeposited onto a stainless steel disc and quantified using alpha spectrometry counter. In Radiochemistry and Environment Laboratory (RAS), Nuclear Malaysia, the quantification is done by comparing these isotopes with the recovery of known amount plutonium tracer, Pu-242, that been added into the sample prior analysis. This study been conducted to find the optimum conditions for the electrolysis process used at RAS. Four variable parameters that may interfere the percentage recovery of tracer hence the current, cathode to anode distance, pH and electrolysis duration had been identify and studied. Study was carry out using Pu-242 standard solution and the deposition disc was counted using Zinc Sulphite (silver) counter. Studies outcome suggested that the optimum conditions to reduce plutonium ion happens at 1-1.1 ampere of current, 3-5 mm of electrodes distance, pH 2.2-2.5 and a minimal electrolysis duration of 2 hours. (author)
Lindgren, E.R.; Mattson, E.D.
Electrokinetic remediation is generally an in situ method using direct current electric potentials to move ionic contaminants and/or water to collection electrodes. The method has been extensively studied for application in saturated clayey soils. Over the past few years, an electrokinetic extraction method specific for sandy, unsaturated soils has been developed and patented by Sandia National Laboratories. A RCRA RD ampersand D permitted demonstration of this technology for the in situ removal of chromate contamination from unsaturated soils in a former chromic acid disposal pit was operated during the summer and fall of 1996. This large scale field test represents the first use of electrokinetics for the removal of heavy metal contamination from unsaturated soils in the United States and is part of the US EPA Superfund Innovative Technology Evaluation (SITE) Program. Guidelines for characterizing a site for electrokinetic remediation are lacking, especially for applications in unsaturated soil. The transference number of an ion is the fraction of the current carried by that ion in an electric field and represents the best measure of contaminant removal efficiency in most electrokinetic remediation processes. In this paper we compare the transference number of chromate initially present in the contaminated unsaturated soil, with the transference number in the electrokinetic process effluent to demonstrate the utility of evaluating this parameter
Bakulina, I.N.; Blashenkov, N.M.; Varshalovich, D.A.; Lavrent'ev, G.Ya.; Shustrov, B.N.
The preliminary results of an experiment on the complex laboratory modelling of the physico-chemical processes proceeding in the interstellar gas clouds are presented. The purpose of the modelling is an analysis of the molecule formation and dissociation processes kinetics. The basic component of the modelling system is 10 cm diameter spherical container with cooled walls (the dust particles surface analogue). The high frequency discharger (the discharge region - the H 2 zone analogue) is placed in the central part of the container. The container contains the mixture of simple gases: 10 -1 Tor of H 2 and He, 10 -2 Tor of CO, O 2 and N 2 and 0.5x10 -2 Tor of H 2 S (an analogue of the H 1 zone). The reactions are induced by the electrodeless high-frequency discharge (f=20 MHz) with the discharge power of 0.1-1 W. The resulting mixture has been analyzed by the high-resolution magnetic resonance mass spectrometer. (M/ΔM=2x10 4 ) with an electron impact source. It is shown that, in the reactions of the formation of many on the interstellar molecules, the on the cold dust surface reactions rather than the gas-phase reactions may play the dominant role
Morgan, J. K.; Marone, C. J.; Guo, Y.; Anthony, J. L.; Knuth, M. W.
Laboratory studies of granular shear zones have provided significant insight into fault zone processes and the mechanics of earthquakes. The micromechanisms of granular deformation are more difficult to ascertain, but have been hypothesized based on known variations in boundary conditions, particle properties and geometries, and mechanical behavior. Numerical simulations using particle dynamics methods (PDM) can offer unique views into deforming granular shear zones, revealing the precise details of granular microstructures, particle interactions, and packings, which can be correlated with macroscopic mechanical behavior. Here, we describe a collaborative program of comparative laboratory and numerical experiments of granular shear using idealized materials, i.e., glass beads, glass rods or pasta, and angular sand. Both sets of experiments are carried out under similar initial and boundary conditions in a non-fracturing stress regime. Phenomenologically, the results of the two sets of experiments are very similar. Peak friction values vary as a function of particle dimensionality (1-D vs. 2-D vs. 3-D), particle angularity, particle size and size distributions, boundary roughness, and shear zone thickness. Fluctuations in shear strength during an experiment, i.e., stick-slip events, can be correlated with distinct changes in the nature, geometries, and durability of grain bridges that support the shear zone walls. Inclined grain bridges are observed to form, and to support increasing loads, during gradual increases in assemblage strength. Collapse of an individual grain bridge leads to distinct localization of strain, generating a rapidly propagating shear surface that cuts across multiple grain bridges, accounting for the sudden drop in strength. The distribution of particle sizes within an assemblage, along with boundary roughness and its periodicity, influence the rate of formation and dissipation of grain bridges, thereby controlling friction variations during
The development of point-of-care (POC) testing devices enables patients to test their own international normalized ratio (INR) at home. However, previous studies have shown that when compared with clinical laboratory values, statistically significant differences may occur between the two methods of INR measurement. The aim of this study was to evaluate the accuracy of the CoaguChek S and XS POC meters relative to clinical laboratory measurements. As part of a randomized, crossover patient self-testing (PST) study at Cork University Hospital, patients were randomized to 6 months PST or 6 months routine care by the anticoagulation management service. During the PST arm of the study, patients measured their INR at home using the CoaguChek S or XS POC meter. External quality control was performed at enrollment, 2 months and 4 months by comparing the POC measured INR with the laboratory determined value. One hundred and fifty-one patients provided 673 paired samples. Good correlation was shown between the two methods of determination (r = 0.91), however, statistically significant differences did occur. A Bland-Altman plot illustrated good agreement of INR values between 2.0 and 3.5 INR units but there was increasing disagreement as the INR rose above 3.5. Eighty-seven per cent of all dual measurements were within the recommended 0.5 INR units of each other. This study adds to the growing evidence that POC testing is a reliable and safe alternative to hospital laboratory monitoring but highlights the importance of external quality control when these devices are used for monitoring oral anticoagulation.
Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen
Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Zeng, Rong; Wang, Wei; Zhao, Haijian; Fei, Yang; Wang, Zhiguo
The narrow gap of HbA1 value of mass fraction between "normal" (control of inter-assay standardization, assay precision, and trueness. This survey was initiated to obtain knowledge of the current situation of internal quality control (IQC) practice for HbA(1c) in China and find out the most appropriate quality specifications. Data of IQC for HbA(1c) in 331 institutions participating in the national proficiency testing (PT) programs in China were evaluated using four levels of quality specifications, and the percentages of laboratories meeting the quality requirement were calculated to find out the most appropriate quality specifications for control materials of HbA(1c) in China. The IQC data varied vastly among 331 clinical laboratories in China. The measurement of control materials covered a wide range from 4.52% to 12.24% (inter-quartile range) and there were significant differences among the CVs of different methods, including LPLC, CE-HPLC, AC-HPLC, immunoturbidimetry, and others. Among the four main methods, CE-HPLC and AC-HPLC achieved a better precision. As we can see, the performance of laboratories for HbA(1c) has yet to be improved. Clinical laboratories in China should improve their performance with a stricter imprecision criteria.
.... The purpose of this paper is to first develop an equipment evaluation process at The Johns Hopkins Hospital which considers both clinical and financial factors when allocating capital dollars to acquire equipment...
Steeneken, P.A.M.; Helmens, H.J.
A laboratory-scale process is presented for the manufacture of starch and gluten from wheat. Main feature of this process is that whole wheat kernels are crushed dry between smooth rolls prior to wet disintegration in excess water in such way that gluten formation is prevented and fibres can be
Kouznetsova, I.; Gerhard, J. I.; Mao, X.; Barry, D. A.; Robinson, C.; Brovelli, A.; Harkness, M.; Fisher, A.; Mack, E. E.; Payne, J. A.; Dworatzek, S.; Roberts, J.
A detailed model to simulate trichloroethene (TCE) dechlorination in anaerobic groundwater systems has been developed and implemented through PHAST, a robust and flexible geochemical modeling platform. The approach is comprehensive but retains flexibility such that models of varying complexity can be used to simulate TCE biodegradation in the vicinity of nonaqueous phase liquid (NAPL) source zones. The complete model considers a full suite of biological (e.g., dechlorination, fermentation, sulfate and iron reduction, electron donor competition, toxic inhibition, pH inhibition), physical (e.g., flow and mass transfer) and geochemical processes (e.g., pH modulation, gas formation, mineral interactions). Example simulations with the model demonstrated that the feedback between biological, physical, and geochemical processes is critical. Successful simulation of a thirty-two-month column experiment with site soil, complex groundwater chemistry, and exhibiting both anaerobic dechlorination and endogenous respiration, provided confidence in the modeling approach. A comprehensive suite of batch simulations was then conducted to estimate the sensitivity of predicted TCE degradation to the 36 model input parameters. A local sensitivity analysis was first employed to rank the importance of parameters, revealing that 5 parameters consistently dominated model predictions across a range of performance metrics. A global sensitivity analysis was then performed to evaluate the influence of a variety of full parameter data sets available in the literature. The modeling study was performed as part of the SABRE (Source Area BioREmediation) project, a public/private consortium whose charter is to determine if enhanced anaerobic bioremediation can result in effective and quantifiable treatment of chlorinated solvent DNAPL source areas. The modelling conducted has provided valuable insight into the complex interactions between processes in the evolving biogeochemical systems
Serne, R. JEFFREY; Lindberg, Michael J.; Jones, Thomas E.; Schaef, Herbert T.; Krupka, Kenneth M.
Recent field investigation that collected and characterized vadose zone sediments from beneath inactive liquid disposal facilities at the Hanford 200 Areas show lower than expected concentrations of a long-term risk driver, Tc-99. Therefore laboratory studies were performed to re-create one of the three processes that were used to separate the plutonium from spent fuel and that created most of the wastes disposed or currently stored in tanks at Hanford. The laboratory simulations were used to compare with current estimates based mainly on flow sheet estimates and spotty historical data. Three simulations of the bismuth phosphate precipitation process show that less that 1% of the Tc-99, Cs-135/137, Sr-90, I-129 carry down with the Pu product and thus these isotopes should have remained within the metals waste streams that after neutralization were sent to single shell tanks. Conversely, these isotopes should not be expected to be found in the first and subsequent cycle waste streams that went to cribs. Measurable quantities (~20 to 30%) of the lanthanides, yttrium, and trivalent actinides (Am and Cm) do precipitate with the Pu product, which is higher than the 10% estimate made for current inventory projections. Surprisingly, Se (added as selenate form) also shows about 10% association with the Pu/bismuth phosphate solids. We speculate that the incorporation of some Se into the bismuth phosphate precipitate is caused by selenate substitution into crystal lattice sites for the phosphate. The bulk of the U daughter product Th-234 and Np-237 daughter product Pa-233 also associate with the solids. We suspect that the Pa daughter products of U (Pa-234 and Pa-231) would also co-precipitate with the bismuth phosphate induced solids. No more than 1 % of the Sr-90 and Sb-125 should carry down with the Pu product that ultimately was purified. Thus the current scheme used to estimate where fission products end up being disposed overestimates by one order of magnitude the
Alves, Elcilene Andreíne Terra Durgante; Cogo, Ana Luísa Petersen
The aim of this study was to identijf how nursing students perceive and experience the learning process during curricular practice in a hospital setting. A qualitative, retrospective, documentary study was developed in an undergraduate nursing course. Data were comprised of 162 posts made by 34 students in the online discussion forum of the Learning Management System Moodle, during the first half of 2011. The following themes emergedfrom t he thematic content analysis: "nursing students' understanding about the professional practice," and "the teaching and learning process in the perspective of nursing students." The study demonstrated that the forum was a place for reporting experiences such as the description of the physical area, performing procedures, perception of nursing care activities, conJlicts with peers, coping with death and learning evaluation. The online discussion forum needs to be used by professors as a space of interaction so as to contribute to professional training.
Manenti, Simone Alexandra; Ciampone, Maria Helena Trench; Mira, Vera Lucia; Minami, Lígia Fumiko; Soares, Jaqueline Maria Sousa
The objective of this study was to construct a profile of managerial competencies, based on the consensus of nurse coordinators in the field. This study was developed in a philanthropic hospital in São Paulo, following the research-action model, and included 13 nurse coordinators as participants. The data collection was performed using the focal group technique. Data analysis was performed using the theoretical frameworks related to the working process and managerial competencies. The results identified the greater emphasis assigned to the competencies related to the mentor, coordinator and director roles. It was, therefore, possible to construct a professional development plan that is based on competencies in the technical, ethical-political, and communicative domains, as well as the development of citizenship. The analysis of the managerial working process and the study of the competencies within the managerial environment were shown to be important, because they highlighted the professionals' need to improve, thus fulfilling personal, professional, and organizational demands.
Emmanuel Olateju Oyatoye
Full Text Available Introduction: Patients are recently more aware and conscious. This is because of the belief that a high level of quality can translate into patient satisfaction. This is critical for healthcare providers as they deal with life. This recognition by both the service provider and service receivers made the government to establish units of service commission (SERVICOM in each of the governmental agencies including hospitals in Nigeria to monitor the level of quality of service delivery. However, to what extent do patients’ perceptions about health services seem to have been largely recognized remain unclear by health care providers, despite the (SERVICOM units in public institutions in Nigeria? Method: A cross-sectional analytical study using convenient sample method, based on the fact that not every patient of the selected hospitals can be chosen, was performed on 400 patients who received health services at four different public hospitals in Ogun state Nigeria. The selection of these hospitals was based on the zones in the state (Egba, Ijebu, Remo and Yewa area of Ogun-state. The instrument was a valid and reliable analytical hierarchy process based questionnaire containing five service quality dimensions. Data were analyzed using SPSS, Expert choice and Microsoft Excel software to determine the perception of patients towards service quality delivery in pairwise comparison of judgment consistent at less than 10%. Results:The results showed the composite priorities of the patients’ perception with respect to determinants of the patients’ perception towards quality of services delivered in the public hospitals in Nigeria. The most important factor to patients was the reliability dimension with composite priority 0.24 or 24% followed by the responsiveness dimension with 0.22 assurance dimension 0.21, tangibility dimension with 0.21, and the least determinant factor was the empathy dimension with 0.1101. Conclusion: Based on the results, the
Elkhuizen, Sylvia G; Burger, Matthe P M; Jonkers, Rene E; Limburg, Martien; Klazinga, Niek; Bakker, Piet J M
Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in Amsterdam. The BPR consisted of process analysis, identification of bottlenecks and goals for redesign, selection of interventions, and evaluation of effects. After identifying and selecting interventions with the greatest expected benefits, changes were implemented and effects were evaluated. For gynecologic oncology patients, access time (from telephone call to first visit) was reduced from 14 days to changes in communication and planning were sufficient to eliminate bottlenecks in the gynecologic oncology project, the dyspnea project required a radical redesign of processes. Experience since these projects suggests that process redesign may have only marginal impact when the greatest bottleneck occurs, as was the case for the two BPR projects, at the point of access to central diagnostic facilities.
Full Text Available Faster microbiological responses are increasingly necessary in modern medicine and the Laboratory of Microbiology must be equipped in this sense. New instrumentation and, above all, a new approach by the Clinical Microbiologist that puts a focus on the real needs of the patient before the microbiological may allow for significantly improving the TAT of these diagnostics. The use of both new methodologies, new tools and revisited old technologies may mean less these days as it was obtained at the Laboratory of Microbiology and Virology of Novara, where the combined use of molecular biology techniques, and mass spectrometry techniques rapid growth have allowed for more than 36 hours to shorten the response time by positivization of blood cultures. Such an approach allows an important support to the clinician with obvious benefits for the patient.
Schmidt, Roland; Tsang, Albert; Cross, Joe; Summers, Clinton; Kornosky, Bob
The Wabash River Integrated Methanol and Power Production from Clean Coal Technologies (IMPPCCT) project is investigating an Early Entrance Coproduction Plant (EECP) concept to evaluate integrated electrical power generation and methanol production from coal and other carbonaceous feedstocks. Research, development and testing (RD and T) that is currently being conducted under the project is evaluating cost effective process systems for removing contaminants, particularly sulfur species, from the generated gas which contains mainly synthesis gas (syngas), CO 2 and steam at concentrations acceptable for the methanol synthesis catalyst. The RD and T includes laboratory testing followed by bench-scale and field testing at the SG Solutions Gasification Plant located in West Terre Haute, Indiana. Actual synthesis gas produced by the plant was utilized at system pressure and temperature for bench-scale field testing. ConocoPhillips Company (COP) developed a sulfur removal technology based on a novel, regenerable sorbent - S Zorb trademark - to remove sulfur contaminants from gasoline at high temperatures. The sorbent was evaluated for its sulfur removal performance from the generated syngas especially in the presence of other components such as water and CO 2 which often cause sorbent performance to decline over time. This publication also evaluates the performance of a regenerable activated carbon system developed by Nucon International, Inc. in polishing industrial gas stream by removing sulfur species to parts-per-billion (ppb) levels. (author)
Agarwal, Shikhar; Gallo, Justin J; Parashar, Akhil; Agarwal, Kanika K; Ellis, Stephen G; Khot, Umesh N; Spooner, Robin; Murat Tuzcu, Emin; Kapadia, Samir R
Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency and the patient throughput in our Cath Lab. All elective and urgent cardiac catheterization procedures including diagnostic coronary angiography, percutaneous coronary interventions, structural interventions and peripheral interventions performed between June 2009 and December 2012 were included in the study. Performance metrics utilized for analysis included turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start and manual sheath-pulls inside the Cath Lab. After implementation of lean six sigma in the Cath Lab, we observed a significant improvement in turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. The percentage of cases with optimal turn-time increased from 43.6% in 2009 to 56.6% in 2012 (p-trendprocess improvement initiative, lean six sigma, on improving and sustaining efficiency of our Cath Lab operation. After the successful implementation of this continuous quality improvement initiative, there was a significant improvement in the selected performance metrics namely turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. Copyright © 2016 Elsevier Inc. All rights reserved.
Milley, Gy; Bukta, B; Jonap, K; Lovei, J; Wagner, O
In studying the secondary and Tertiary processes of intensifying oil output, an analysis was made of the following main factors: behavior of multiple-phase and multiple-component system in the porous medium, their stability, mobility, effect of viscosity and pressure differential in the system, configuration of the displacement front, influence of chemical additives on optimizing the surface energy, economic characteristics of the processes. All of these factors can be studied on a laboratory unit with core samples up to 120 cm long with temperatures to 120/sup 0/C, pressures to 30 MPa and consumption of reagents to 100 cm/sup 3//h. The unit contains feed vessels of high pressure for water, oil and gas in different reagents. There is a pumping unit of two-stage type, and in the first loop there is a piston pump which feeds the cylinder of the pump of the second stage of the plunger type. The outlet stage of this pump through the valve system is connected to the corresponding vessel for pressing the necessary reagent through the core sample. One can continually change the pressure to 100 MPa. The core is placed in a special core carrier and using special high temperature resins, it is packed in it in order to exclude side overflows. There is a technology of packing of comparatively soft rocks (clay). Sketches are presented of the sealing assemblies, and also the plans for inserting cables for the sensors. The sensor system is arranged over the entire length of the core and generates signals which are proportional to the magnitude of water saturation. The outlet of the core carrier has devices for resetting pressure, collecting filtrate, measurement of its composition and consumption. The core carrier is thermostatically controlled and contains two kW electrical heater for taking measurements at different temperatures. With a change in the system modes, the equilibrium is reached in 2-3 h.
F. E. Mohamed Ghazali
Full Text Available Long-term concession contracts associated with Private Finance Initiative (PFI projects, such as National Health Service (NHS hospitals, are subject to substantial risks, which may not only emerge from project activities such as design and construction, but also from global issues beyond the control of project parties, such as commercial, legal and political risks. Therefore, the principal parties involved must manage risks effectively and efficiently, as early as the project initiation stage, in order to ensure a successful delivery. The aim of this paper is to examine the risk identification process of the NHS PFI hospital in the UK, as a case study, in order to determine the techniques used in risk identification, and their significance, based on estimated probabilities of occurrence. These objectives were achieved through interviews with key personnel within the NHS Trust involved. Results found the sole technique used in risk identification to be brainstorming, through which more than thirty risks were identified and classified under six risk categories: planning, pre-commissioning, design, land purchasing, construction and operation. Thirteen risks were identified as significant based on their estimated probability of occurrence had the project been developed via public procurement. The results of this research will enable public sector clients like the NHS Trust to not only identify the significant risks, which will allow them to focus more attention on developing appropriate mitigation strategies and contingency plans, but also to improve its risk identification process through the use of other techniques in order to support findings from the brainstorming process.
Kubota, Tomomi; Hayashi, Shirou; Niimi, Hideki; Kitajima, Isao
Specimens of bacterial ocular infections are frequently received in the clinical laboratory. However, a comprehensive trend survey of ocular infections with bacteria is very rare. Our objective is to understand the current tendency of ocular infections with bacteria in patients at Toyama University Hospital from the standpoint of laboratory examination. We studied 263 cases of ocular infection with bacteria diagnosed at Toyama University Hospital from January 2006 to December 2011. 123 were male and 140 were female, with a mean age of 61.2(0-98) years. Specimens were subjected to direct microscopy and culture. Cultures were positive in 174(66.2%) patients. The most common bacterial isolate was Staphylococcus (28.1%), followed by Corynebacterium (19.3%), Streptococcus (9.3%), and Propionibacterium (8.6%). MRSA accounted for 18.8% of all S. aureus isolates, and has increased in recent years. The number of bacteria detected was larger in March, June, July, August, and October. Age distribution indicated that around 70% of bacterial isolates were detected from patients over 60 years old. The most common specimen of ocular infections with bacteria was eye discharge (detection rate; 87.8%), followed by corneal scraping(41%), aqueous humor (19%), and vitreous body (27%). Nearly 80% of bacterial isolates were detected from patients with keratitis, endophthalmitis, dacryocystitis, and conjunctivitis. As for the disease specific detection rate, endophthalmitis was very low (38.3%). The detection rate by years indicated that the way doctors pick up the specimens greatly affects the detection rate. Based on this survey, we need close cooperation with medical doctors concerning laboratory examination in ocular infection with bacteria, and we must improve the detection sensitivity of specimens from patients with endophthalmitis.
Alemnji, George; Edghill, Lisa; Guevara, Giselle; Wallace-Sankarsingh, Sacha; Albalak, Rachel; Cognat, Sebastien; Nkengasong, John; Gabastou, Jean-Marc
Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. We report the development of a stepwise process for quality systems improvement in the Caribbean Region. The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called 'Laboratory Quality Management System - Stepwise Improvement Process (LQMS-SIP) Towards Accreditation' to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement.
Knepper, P.; Whiteson, R.; Strittmatter, R.; Mousseau, K.
Many industrial processes (including reprocessing activities; nuclear fuel fabrication; and material storage, measurement and transfer) make use of process flow diagrams. These flows can be used for material accountancy and for data analysis. At Los Alamos National Laboratory (LANL), the Technical Area (TA)-55 Plutonium Facility is home to various research and development activities involving the use of special nuclear material (SNM). A facility conducting research and development (R and D) activities using SNM must satisfy material accountability guidelines. All processes involving SNM or tritium processing, at LANL, require a process accountability flow diagram (PAFD). At LANL a technique was developed to generate PAFDs that can be coupled to a relational database for use in material accountancy. These techniques could also be used for propagation of variance, measurement control, and inventory difference analysis. The PAFD is a graphical representation of the material flow during a specific process. PAFDs are currently stored as PowerPoint files. In the PowerPoint format, the data captured by the PAFD are not easily accessible. Converting the PAFDs to an accessible electronic format is desirable for several reasons. Any program will be able to access the data contained in the PAFD. For the PAFD data to be useful in applications such as an expert system for data checking, SNM accountability, inventory difference evaluation, measurement control, and other kinds of analysis, it is necessary to interface directly with the information contained within the PAFD. The PAFDs can be approved and distributed electronically, eliminating the paper copies of the PAFDs and ensuring that material handlers have the current PAFDs. Modifications to the PAFDs are often global. Storing the data in an accessible format would eliminate the need to manually update each of the PAFDs when a global change has occurred. The goal was to determine a software package that would store the
Keller, P.E.; Kouzes, R.T.; Kangas, L.J.
Detailed design of the Environmental and Molecular Sciences Laboratory (EMSL) at the Pacific Northwest Laboratory (PNL) is nearing completion and construction is scheduled to begin later this year. This facility will assist in the environmental restoration and waste management mission at the Hanford Site. This paper identifies several real-time data processing applications within the EMSL where neural networks can potentially be beneficial. These applications include real-time sensor data acquisition and analysis, spectral analysis, process control, theoretical modeling, and data compression
Dolscheid-Pommerich, Ramona C; Dolscheid, Sarah; Grigutsch, Daniel; Stoffel-Wagner, Birgit; Graeff, Ingo
Fulfilling the requirements of point-of-care testing (POCT) training regarding proper execution of measurements and compliance with internal and external quality control specifications is a great challenge. Our aim was to compare the values of the highly critical parameter hemoglobin (Hb) determined with POCT devices and central laboratory analyzer in the highly vulnerable setting of an emergency department in a supra maximal care hospital to assess the quality of POCT performance. In 2548 patients, Hb measurements using POCT devices (POCT-Hb) were compared with Hb measurements performed at the central laboratory (Hb-ZL). Additionally, sub collectives (WHO anemia classification, patients with Hb 85y.) were analyzed. Overall, the correlation between POCT-Hb and Hb-ZL was highly significant (r = 0.96, p2.5g/dl occurred. McNemar´s test revealed significant differences regarding anemia diagnosis according to WHO definition for male, female and total patients (♂ phemoglobin concentration measurement methods, i.e. POCT devices and at the central laboratory. The results confirm the successful implementation of the presented POCT concept. Nevertheless some limitations could be identified in anemic patients stressing the importance of carefully examining clinically implausible results.
Murray, Kathleen R; Fitzpatrick, Robert W; Bottrill, Ralph S; Berry, Ron; Kobus, Hilton
In a recent Australian homicide, trace soil on the victim's clothing suggested she was initially attacked in her front yard and not the park where her body was buried. However the important issue that emerged during the trial was how soil was transferred to her clothing. This became the catalyst for designing a range of soil transference experiments (STEs) to study, recognise and classify soil patterns transferred onto fabric when a body is dragged across a soil surface. Soil deposits of interest in this murder were on the victim's bra and this paper reports the results of anthropogenic soil transfer to bra-cups and straps caused by dragging. Transfer patterns were recorded by digital photography and photomicroscopy. Eight soil transfer patterns on fabric, specific to dragging as the transfer method, appeared consistently throughout the STEs. The distinctive soil patterns were largely dependent on a wide range of soil features that were measured and identified for each soil tested using X-ray Diffraction and Non-Dispersive Infra-Red analysis. Digital photographs of soil transfer patterns on fabric were analysed using image processing software to provide a soil object-oriented classification of all soil objects with a diameter of 2 pixels and above transferred. Although soil transfer patterns were easily identifiable by naked-eye alone, image processing software provided objective numerical data to support this traditional (but subjective) interpretation. Image software soil colour analysis assigned a range of Munsell colours to identify and compare trace soil on fabric to other trace soil evidence from the same location; without requiring a spectrophotometer. Trace soil from the same location was identified by linking soils with similar dominant and sub-dominant Munsell colour peaks. Image processing numerical data on the quantity of soil transferred to fabric, enabled a relationship to be discovered between soil type, clay mineralogy (smectite), particle size and
SLIPTA implementation process: WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1–5 stars were issued. Preliminary results: By March 2015, 27 of the 47 (57% WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3, French (12 and English (83 languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62–77. Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars and 1% scored at least 95% (5 stars. The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit and 10 (Corrective Action, which both had mean scores below 50%. Conclusion: The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.
Marrero Garcia, Mariela; Molina perez, Daniel; Fernandez Gomez, Maria; Walwyn Salas, Gonzalo
With the objective of offering technically qualified and competitive services one works in our laboratories under the requirements of a System of the Quality from 1993. In 1999 that was already with a draft of the new model ISO/IEC 17025:00 the steps they were given for the change of the Guide 25. At the moment with 3 laboratories accredited by the Cuban organ (ONARC), we are pioneer in these changes because alone a very reduced group of laboratories in the country has achieved it. The present work enunciates the antecedents of the change, the main non conformities during the evaluations for the accreditation and the obtained results
Boehringer, Peter A; Rylander, Jeanette; Dizon, Dominic T; Peterson, Michael W
Physicians' illegible handwriting is a notorious contributing factor to medical errors. Furthermore, an illegible signature or failure to print prescribers' name interferes with the ability of staff to clarify orders. We surveyed support medical staff at a teaching hospital before and 2 months after providing all internal medicine department residents a self-inking stamp with their name and pager number. Responses were received from 51% at the first and 36% at the second survey of 401 eligible staff. Responses to questions regarding illegible or absent signature, illegible or absent pager number, and failure to print prescribers' name showed a significant improvement (P writing process. This kind of signature allows clarification of orders in a timely fashion.
Ndihokubwayo, Jean-Bosco; Maruta, Talkmore; Ndlovu, Nqobile; Moyo, Sikhulile; Yahaya, Ali Ahmed; Coulibaly, Sheick Oumar; Kasolo, Francis; Turgeon, David; Abrol, Angelii P
The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program. WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1-5 stars were issued. By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62-77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%. The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.
S. Arun Vijay
Full Text Available A lengthy and in-efficient process of discharging in-patients from the Hospital is an essential component that needs to be addressed in order to improve the quality of Health care facility. Even though, several quality methodologies are adopted to improve such services in Hospitals, the implementation of Six Sigma DMAIC methodology to improve the Hospital discharge process is much limited in the Literature. Thus, the objective of this research is to reduce the cycle time of the Patients discharge process using Six Sigma DMAIC Model in a multidisciplinary hospital setting in India. This study had been conducted through the five phases of the Six Sigma DMAIC Model using different Quality tools and techniques. This study suggested various improvement strategies to reduce the cycle time of Patients discharge process and after its implementation; there is a 61% reduction in the cycle time of the Patients discharge process. Also, a control pl an check sheet has been developed to sustain the Improvements obtained. This Study would be an eye opener for the Health Care Managers to reduce and optimize the cycle time of Patients discharge process in Hospitals using Six Sigma DMAIC Model.
Luka Perman; Krešimir Mikinac
Purpose – This paper seeks to explain problem of education and training of personnel in the hospitality and tourism sector, which takes a special place and special attention among jobs in the tourism, hotel and hospitality industry. The overall quality within the hospitality and tourism sector depends exactly on education and training, i.e. the overall level of education of employed staff. Design – An overview of studies and education programs supporting tourism and hospitality in the Republi...
AGHEORGHIESEI, Daniela Tatiana; ILIESCU, Liliana; GAVRILOVICI, Cristina; OPREA, Liviu
Background We aimed to verify the issue of the ethics audit and its use in the system of accreditation of hospitals. It presents the results of a survey conducted among hospital managers from Romania. Methods: Our article highlights the results of the second part of a research carried out in 2012 on the pertinence and the structure of the ethics audit integrated within the accreditation process of hospitals, according the opinion of the 47 executives and managers involved in the quality management of Romania hospitals. The data have been gathered with the aid of the online questionnaire. Results: An ethics audit integrated within the accreditation process of hospitals should include primarily the respect of the patients’ rights, the good relations of the institutions with its patients and the respect of the moral rights of the employees. Conclusion: The usefulness of this study is due to the fact that it consults precisely those who should really contribute to the creation, application and monitoring of ethical policies and instruments necessary in every hospital which are permanently under the scrutiny of public opinion and confront themselves with the obligation to give a thorough account of their results and spending of the public resources. This study gain consistency as the relevant aspects that could form the structure of a hospital ethics audit are identified with the direct help of the managers responsible for implementing it. PMID:24427752
Iqbal, Sahar; Mustansar, Tazeen
Sigma is a metric that quantifies the performance of a process as a rate of Defects-Per-Million opportunities. In clinical laboratories, sigma metric analysis is used to assess the performance of laboratory process system. Sigma metric is also used as a quality management strategy for a laboratory process to improve the quality by addressing the errors after identification. The aim of this study is to evaluate the errors in quality control of analytical phase of laboratory system by sigma metric. For this purpose sigma metric analysis was done for analytes using the internal and external quality control as quality indicators. Results of sigma metric analysis were used to identify the gaps and need for modification in the strategy of laboratory quality control procedure. Sigma metric was calculated for quality control program of ten clinical chemistry analytes including glucose, chloride, cholesterol, triglyceride, HDL, albumin, direct bilirubin, total bilirubin, protein and creatinine, at two control levels. To calculate the sigma metric imprecision and bias was calculated with internal and external quality control data, respectively. The minimum acceptable performance was considered as 3 sigma. Westgard sigma rules were applied to customize the quality control procedure. Sigma level was found acceptable (≥3) for glucose (L2), cholesterol, triglyceride, HDL, direct bilirubin and creatinine at both levels of control. For rest of the analytes sigma metric was found control levels (8.8 and 8.0 at L2 and L3, respectively). We conclude that analytes with the sigma value quality control procedure. In this study application of sigma rules provided us the practical solution for improved and focused design of QC procedure.
This study investigated the introduction of curriculum innovations into an introductory organic chemistry laboratory course. Pre-existing experiments in a traditional course were re-written in a broader societal context. Additionally, a new laboratory notebook methodology was introduced, using the Decision/Explanation/Observation/Inference (DEOI) format that required students to explicitly describe the purpose of procedural steps and the meanings of observations. Experts in organic chemistry, science writing, and chemistry education examined the revised curriculum and deemed it appropriate. The revised curriculum was introduced into two sections of organic chemistry laboratory at Columbia University. Field notes were taken during the course, students and teaching assistants were interviewed, and completed student laboratory reports were examined to ascertain the impact of the innovations. The contextualizations were appreciated for making the course more interesting; for lending a sense of purpose to the study of chemistry; and for aiding in students' learning. Both experts and students described a preference for more extensive connections between the experiment content and the introduced context. Generally, students preferred the DEOI method to journal-style laboratory reports believing it to be more efficient and more focused on thinking than stylistic formalities. The students claimed that the DEOI method aided their understanding of the experiments and helped scaffold their thinking, though some students thought that the method was over-structured and disliked the required pre-laboratory work. The method was used in two distinct manners; recursively writing and revising as intended and concept contemplation only after experiment completion. The recursive use may have been influenced by TA attitudes towards the revisions and seemed to engender a sense of preparedness. Students' engagement with the contextualizations and the DEOI method highlight the need for
The Center for Molecular Medicine (CMM) was conceived and built to respond to the challenges presented by the still common chronic diseases such as atherosclerosis, rheumatoid arthritis, diabetes, allergy, and alcoholism. The Karolinska University Hospital has a proud history of research with developments such as the pacemaker and the gamma-knife. The nearby Karolinska Institutet has a strong presence internationally on the basic sciences. However, the challenges of the "new biology" and the access to the complete human genome, transcriptome, and proteome raised the need for a new research institute that could meet the experimental requirements for translational research. A Foundation was established in 1994 with the goal to build and govern the new enterprise. After an intense fundraising campaign, building could start and CMM (Fig. 1) was inaugurated in 1997. Through more than 10 years of existence, it has evolved into a multidisciplinary research institute with research in four programs, Cardiovascular and Metabolic Diseases, Infection and Immunity, Neuropsychiatric Diseases, and Medical Genetics. Performance parameters have been introduced and scientific impact and relevance are followed annually. Transparency and collaboration between groups (now 28 groups with an approximate total of 400 people engaged in research) and leadership training for junior faculty are means to stimulate "centerness".
Andreia Macedo Gomes
Full Text Available Recently, the Lean philosophy is gaining importance due to a competitive environment, which increases the need to reduce costs. Lean practices and tools have been applied to manufacturing, services, supply chain, startups and, the next frontier is healthcare. Most lean techniques can be easily adapted to health organizations. Therefore, this paper intends to summarize Lean practices and tools that are already being applied in health organizations. Among the numerous techniques and lean tools used, this research highlights the Simulation. Therefore, in order to understand the use of Simulation as a Lean Healthcare tool, this research aims to analyze, through the simulation technique, the operational dynamics of the service process of a fictitious hospital emergency unit. Initially a systematic review of the literature on the practices and tools of Lean Healthcare was carried out, in order to identify the main techniques practiced. The research highlighted Simulation as the sixth most cited tool in the literature. Subsequently, a simulation of a service model of an emergency unit was performed through the Arena software. As a main result, it can be highlighted that the attendants of the built model presented a degree of idleness, thus, they are able to atend a greater demand. As a last conclusion, it was verified that the emergency room is the process with longer service time and greater overload.
Goebel, Ingeborg; Alheid, Hans-Joachim [BGR Hannover, Stilleweg 2, D-30655 Hannover (Germany); Jockwer, Norbert [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH, Theodor-Heuss-Str. 4, 38122 Braunschweig (Germany); Mayor, Juan Carlos [ENRESA, Emilio Vargas 7, E-Madrid (Spain); Garcia-Sineriz, Jose Luis [AITEMIN, c/ Alenza, 1 - 28003 Madrid (Spain); Alonso, Eduardo [International Center for Numerical Methods in Engineering, CIMNE, Edificio C-1, Campus Norte UPC, C/Gran Capitan, s/n, 08034 Barcelona (Spain); Weber, Hans Peter [NAGRA, Hardstrasse 73, CH-5430 Wettingen (Switzerland); Ploetze, Michael [ETHZ, Eidgenoessische Technische Hochschule Zuerich, ETH Zentrum, HG Raemistrasse 101, CH-8092 Zuerich (Switzerland); Klubertanz, Georg [COLENCO Power Engineering Ltd, CPE, Taefern Str. 26, 5405 Baden-Daettwil (Switzerland); Ammon, Christian [Rothpletz, Lienhard, Cie AG, Schifflaendestrasse 35, 5001 Aarau (Switzerland)
The Heater Experiment at the Mont Terri Underground Laboratory aims at producing a validated model of thermo-hydro-mechanically (THM) coupled processes. The experiment consists of an engineered barrier system where in a vertical borehole, a heater is embedded in bentonite blocks, surrounded by the host rock, Opalinus Clay. The experimental programme comprises permanent monitoring before, during, and after the heating phase, complemented by geotechnical, hydraulic, and seismic in-situ measurements as well as laboratory analyses of mineralogical and rock mechanics properties. After the heating, the experiment was dismantled for further investigations. Major results of the experimental findings are outlined. (authors)
Zinkl, R.J.; Shettel, D.L. Jr.; D'Andrea, R.F. Jr.
FORTRAN computer programs have been written to read, edit, and reformat the hydrogeochemical and stream-sediment reconnaissance data produced by Savannah River Laboratory for the National Uranium Resource Evaluation program. The data are presorted by Savannah River Laboratory into stream sediment, ground water, and stream water for each 1 0 x 2 0 quadrangle. Extraneous information is eliminated, and missing analyses are assigned a specific value (-99999.0). Negative analyses are below the detection limit; the absolute value of a negative analysis is assumed to be the detection limit
Doumbia, Mariam; Uwingabiye, Jean; Bissan, Aboubacar; Rachid, Razine; Benkirane, Souad; Masrar, Azlarab
The aim of this study was to describe epidemiological, cytologic and immunophenotypic aspects of acute leukemias (AL) in children diagnosed at IBN SINA University Hospital Center and to determine the concordance between cytology and immunophenotyping results. This is a cross-sectional study conducted in the hematology laboratory of IBN SINA University Hospital Center between June 2012 and May 2014. Among the 104 cases with diagnosed AL, 52% were boys with a sex-ratio H/F= 1.32, the average age was 5.7 years. The distribution of different types of AL was: lymphoid AL (LAL) (74%), myeloid (AML) (20.2%), biphenotypic AL (BAL) (65.8%). Among the LALs, 78% were classified as B LAL and 22% as T LAL. Clinical signs were mainly presented with tumor syndrome (73.1%), fever (61%) and hemorrhagic syndrome (50%). The most common blood count abnormalities were: thrombopenia (89.4%), anemia (86.5%), hyperleukocytosis (79.8%). The rate of peripheral and bone marrow blasts was statistically higher for LAL than for AML and BAL (p <0.001). The rate of relapse and mortality was 21.2% and 16. 3% respectively. Concordance rate between the results of cytology and of immunophenotyping was 92.7% for LAL and 82.6% for AML. Diagnosis of AL is always based primarily on cytology. Immunophenotyping allowed us to make a better distinction between acute leukemias. The management of paediatric AL is a major health problem which requires specialized care centers.
Sembiring, E. K.; Delyuzar; Soekimin
The most common types of skin cancer found worldwide are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. In America, about 800,000 people suffer from skin cancer every year and 75% are basal cell carcinoma. According to WHO, around 160,000 people suffer from malignant melanoma every year and 48,000 deaths were reported every year. In Jakarta, in 2000-2009, dr. CiptoMangunkusumo Hospital (RSCM) reported 261 cases of basal cell carcinoma, followed by 69 cases of squamous cell carcinoma and 22 cases of malignant melanoma.This study was descriptive study with retrospective design and consecutive sampling method. Data consisted of age, gender, tumor location, occupation and histopathology subtype which were taken from skin cancer patients’ medical record at Faculty of Medicine University of North Sumatera Pathology Anatomy Laboratory and Haji Adam Malik General Hospital Medan in 2012-2015. Data were analyzed using SPSS program and classified based on WHO. From 92 study subjects, squamous cell carcinoma is the most common form of skin cancer which is 59 cases (64.13%), found in 48 women (52.2%), and often found between 45-47 years old (30.4%).
Fanari, Zaher; Choudhry, Usman I; Reddy, Vivek K; Eze-Nliam, Chete; Hammami, Sumaya; Kolm, Paul; Weintraub, William S; Marshall, Erik S
Accurate assessment of cardiac structures, ventricular function, and hemodynamics is essential for any echocardiographic laboratory. Quality improvement (QI) processes described by the American Society of Echocardiography (ASE) and the Intersocietal Commission (IAC) should be instrumental in reaching this goal. All patients undergoing transthoracic echocardiogram (TTE) followed by cardiac catheterization within 24 hours at Christiana Care Health System in 2011 and 2012 were identified, with 126 and 133 cases, respectively. Hemodynamic parameters of diastolic function and pulmonary artery systolic pressure (PASP) on TTE correlated poorly with catheterization in 2011. An educational process was developed and implemented at quarterly QI meetings based on ASE and IAC recommendations to target frequently encountered errors and provide methods for improved performance. The hemodynamic parameters were then reexamined in 2012 postintervention. Following the QI process, there was significant improvement in the correlation between invasive and echocardiographic hemodynamic measurements in both systolic and diastolic function, and PASP. This reflected in significant better correlations between echo and cath LVEF [R = 0.88, ICC = 0.87 vs. R = 0.85, ICC = 0.85; P process, as recommended by ASE and IAC, can allow for identification as well as rectification of quality issues in a large regional academic medical center hospital. © 2015, Wiley Periodicals, Inc.
Volle, Romain; Bailly, Jean-Luc; Mirand, Audrey; Pereira, Bruno; Marque-Juillet, Stéphanie; Chambon, Martine; Regagnon, Christel; Brebion, Amélie; Henquell, Cécile; Peigue-Lafeuille, Hélène; Archimbaud, Christine
Acute enterovirus (EV) meningitis is a major cause of hospitalization among adults and children. It is caused by multiple EV genotypes assigned to 4 species (EV-A, EV-B, EV-C, and EV-D). We determined viral loads in the cerebrospinal fluid (CSF) of 156 patients of all ages with EV meningitis during a 5-year observational prospective study. The virus strains were genotyped, and their time origin was determined with Bayesian phylogenetic methods. The CSF viral loads ranged between 3.4 and 7.5 log10 copies/mL (median, 4.9 log10 copies/mL). They were higher in neonates than in infants and children (P = .02) but were comparable in adults. Viral loads were associated with EV genotypes (P < .001). The EV strains were identified in 152 of 156 patients and assigned to 23 genotypes within the EV-A and EV-B species. The most frequent genotypes, echoviruses 6 and 30, were associated with different viral loads (P < .001). The highest viral loads were in meningitis cases caused by coxsackievirus A9, B4, and B5 genotypes. Most patients infected by a same genotype were infected by a major virus variant of recent emergence. The variations in CSF viral loads in patients at the onset of EV meningitis are related to genotypic differences in the virus strains involved. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
Morteza Rahbar Taromsar
Full Text Available Background: Naltrexone is a competitive opioid receptor antagonist blocking the euphoric effects of exogenous opioids. When used concomitantly with opioids, naltrexone causes severe withdrawal symptoms. The main aim of the study is to determine the symptomatology and outcome of patients who consumed naltrexone in conjunction with an opioid substance. Methods: This cross-sectional study was performed on the patients hospitalized with history of naltrexone usage coincided with opioid substances at Razi Hospital, Rasht, Iran. The collected data were demographic information, abuse information, clinical signs and symptoms, laboratory findings, and therapeutic measures taken. Data analysis was performed by descriptive tests using SPSS software version 16. Results: The mean age of the patients was 33.7±10.2. The majority of the cases were male (95.6% and urban (96.7%. The main cause of withdrawal symptoms in 91.1% of the patients was inappropriate naltrexone usage. The main poisoning agent in 80% of the cases was consumed naltrexone alone. The route of consumption in 90.1% of the cases was oral and in 9.9% the cases was IV injection. The major clinical features were nausea, vomiting, and agitation. The main therapeutic measures were supportive intravenous fluids (94.8% and opioid administration in the form of methadone. The mean hospitalization period was 21.8±18 hours. Conclusion: Severity, clinical course, and outcome of opioid withdrawal by accidental or intentional naltrexone abuse varies greatly among patients and is unpredictable. Common findings upon presentation were gastrointestinal symptoms and agitation and the main therapeutic measures for these patients were support with intravenous fluids and anti-nausea drugs administration as plasil and opioid administration as methadone.
Hausemann, A; Hofmann, H; Otto, U; Heudorf, Ursel
In addition to hand hygiene and reprocessing of medical products, cleaning and disinfection of surfaces is also an important issue in the prevention of germ transmission and by implication infections. Therefore, in 2014, the quality of the structure, process and result of surface preparation of all hospitals in Frankfurt am Main, Germany, was monitored. All 17 hospitals transferred information on the quality of structure. Process quality was obtained through direct observation during cleaning and disinfection of rooms and their plumbing units. Result quality was gained using the fluorescent method, i.e. marking surfaces with a fluorescent liquid and testing if this mark has been sufficiently removed by cleaning. Structure quality: in all hospitals the employees were trained regularly. In 12 of them, the foremen had the required qualifications, in 6 hospitals unclarity as to the intersection of the cleaning and care services remained. In 14 hospitals only visible contamination was cleaned on the weekends, whereas complete cleaning was reported to take place in 12 hospitals on Saturdays and in 2 hospitals on Sundays. The contractually stipulated cleaning (observations specified in brackets) averaged 178 m(2)/h (148 m(2)/h) per patient room and 69 m(2)/h (33 m(2)/h) for bathrooms. Process quality: during process monitoring, various hand contact surfaces were prepared insufficiently. Result quality: 63 % of fluorescent markings were appropriately removed. The need for improvement is given especially in the area of the qualification of the foremen and a in a clear definition of the intersection between cleaning and care services, as well as in the regulations for weekends and public holidays.
Oyarce, James A; García, Coralith; Alave, Jorge; Bustamante, Beatriz
Sporothricosis is endemic in numerous Latin American countries and the rest of the world. In Peru is concentrated in regions with warm and humid climate being little known in the rest of the country. To describe the epidemiological, clinical and laboratory characteristics of patients diagnosed of sporotrichosis in a tertiary-care level hospital in Lima, Peru from 1991 to 2014. This was a retrospective, case series. Ninety four patients were involved; most of them were male adults. This condition was acquired more frequently in Cajamarca, Apurímac, and Amazonas. Fixed and lymphocutaneous form were the most frequent forms of presentation in adults and were mostly distributed in upper limbs. Lesions located in head and neck were most frequent in children. Comorbidities were present in 15% of patients and were more frequent in those who presented disseminated cutaneous form. Seventy eight percent of cultures from skin lesions were positive within 7 days. The time to positivity of cultures was longer if the sample came from skin biopsies than skin scraping or skin aspiration. Most cases of sporotrichosis were acquired in areas of extreme poverty in Peru. The clinical, epidemiological and laboratory findings were similar to those reported elsewhere. The time to positivity of cultures varies based on the type of skin sample. This finding needs to be further evaluated in studies with an increased number of cases.
Ohman, Malin Charlotta; Atkins, Tara E Holm; Cooksley, Tim; Brabrand, Mikkel
The MARS (Medical Admission Risk System) uses 11 physiological and laboratory data and had promising results in its derivation study for predicting 5 and 7 day mortality. To perform an external independent validation of the MARS score. An unplanned secondary cohort study. Patients admitted to the medical admission unit (MAU) at The Hospital of South West Jutland were included from 2 October 2008 until 19 February 2009 and 23 February 2010 until 26 May 2010 were analysed. Validation of the MARS score using 5 and 7 day mortality was the primary endpoint. 5858 patients were included in the study. 2923 (49.9%) patients were women with a median age of 65 years (15-107). The MARS score had an AUROC of 0.858 (95% CI: 0.831-0.884) for 5-day mortality and 0.844 (0.818-0.870) for 7 day mortality with poor calibration for both outcomes. The MARS score had excellent discriminatory power but poor calibration in predicting both 5 and 7-day mortality. The development of accurate combination physiological/laboratory data risk scores has the potential to improve the recognition of at risk patients.
Hintzen, Barbara L; Knoer, Scott J; Van Dyke, Christie J; Milavitz, Brian S
The effect of lean process improvement on an inpatient university hospital pharmacy was evaluated. The University of Minnesota Medical Center (UMMC), Fairview, implemented lean techniques in its inpatient pharmacy to improve workflow, reduce waste, and achieve substantial cost savings. The sterile products area (SPA) and the inventory area were prospectively identified as locations for improvement due to their potential to realize cost savings. Process-improvement goals for the SPA included the reduction of missing doses, errors, and patient-specific waste by 30%, 50%, and 30%, respectively, and the reallocation of two technician full-time equivalents (FTEs). Reductions in pharmaceutical inventory and returns due to outdating were also anticipated. Work-flow in the SPA was improved through the creation of accountability, standard work, and movement toward one-piece flow. Increasing the number of i.v. batches decreased pharmaceutical waste by 40%. Through SPA environment improvements and enhanced workload sharing, two FTE technicians from the SPA were redistributed within the department. SPA waste reduction yielded an annual saving of $275,500. Quality and safety were also improved, as measured by reductions in missing doses, expired products, and production errors. In the inventory area, visual control was improved through the use of a double-bin system, the number of outdated drugs decreased by 20%, and medication inventory was reduced by $50,000. Lean methodology was successfully implemented in the SPA and inventory area at the UMMC, Fairview, inpatient pharmacy. Benefits of this process included an estimated annual cost saving of $289,256 due to waste reduction, improvements in workflow, and decreased staffing requirements.
Fei, Yang; Kang, Fengfeng; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Wang, Zhiguo; Chen, Wenxiang
The aim of the study was to promote the establishment and implementation of quality indicators (QIs) in clinical laboratories, catch up with the state of art, and provide preliminary quality specifications for established QIs. Clinical laboratories from different provinces in China were included in this QIs survey in 2015. All participants were asked to collect data related to QIs and complete QIs questionnaires. Defect percentages and sigma values were calculated for each QI. The 25th percentile, median, and the 75th percentile of defect percentages and TATs were calculated as optimum, desirable and minimum quality specifications. While 25th, median, and 75th of sigma values were calculated as minimum, desirable and optimum quality specifications, respectively. Five thousand seven hundred and fifty-three clinical laboratories from 28 provinces in China participated in this survey. Median defect percentages of pre-examination QIs varied largely from 0.01% (incorrect sample container) to 0.57% (blood culture contamination) with sigma values varied from 4.0σ to 5.1σ. Median defect percentages of examination phase QIs were all really high. The most common problem in examination phase was test uncovered by inter-laboratory comparison (86.67%). Defect percentages of critical values notification and timely critical values notification were all 0.00% (6.0σ). While the median of defect percentages of incorrect laboratory reports was only 0.01% (5.4σ). Improvements are needed in all phases of total testing process (TTP) in laboratories in China, especially in examination phase. More attention should be paid when microbiology specimens are collected and results are reported. Quality specifications can provide directions for laboratories to make effort for.
Ramona C Dolscheid-Pommerich
Full Text Available Fulfilling the requirements of point-of-care testing (POCT training regarding proper execution of measurements and compliance with internal and external quality control specifications is a great challenge. Our aim was to compare the values of the highly critical parameter hemoglobin (Hb determined with POCT devices and central laboratory analyzer in the highly vulnerable setting of an emergency department in a supra maximal care hospital to assess the quality of POCT performance. In 2548 patients, Hb measurements using POCT devices (POCT-Hb were compared with Hb measurements performed at the central laboratory (Hb-ZL. Additionally, sub collectives (WHO anemia classification, patients with Hb 85y. were analyzed. Overall, the correlation between POCT-Hb and Hb-ZL was highly significant (r = 0.96, p2.5g/dl occurred. McNemar´s test revealed significant differences regarding anemia diagnosis according to WHO definition for male, female and total patients (♂ p<0.001; ♀ p<0.001, total p<0.001. Hb-ZL resulted significantly more often in anemia diagnosis. In samples with Hb<8g/dl, McNemar´s test yielded no significant difference (p = 0.169. In suprageriatric patients, McNemar´s test revealed significant differences regarding anemia diagnosis according to WHO definition in male, female and total patients (♂ p<0.01; ♀ p = 0.002, total p<0.001. The difference between Hb-ZL and POCT-Hb with Hb<8g/dl was not statistically significant (<8g/dl, p = 1.000. Overall, we found a highly significant correlation between the analyzed hemoglobin concentration measurement methods, i.e. POCT devices and at the central laboratory. The results confirm the successful implementation of the presented POCT concept. Nevertheless some limitations could be identified in anemic patients stressing the importance of carefully examining clinically implausible results.
Zhang, Ray; Isakow, Warren; Kollef, Marin H; Scott, Mitchell G
Due to accuracy concerns, the Food and Drug Administration issued guidances to manufacturers that resulted in Center for Medicare and Medicaid Services stating that the use of meters in critically ill patients is "off-label" and constitutes "high complexity" testing. This is causing significant workflow problems in ICUs nationally. We wished to determine whether real-world accuracy of modern glucose meters is worse in ICU patients compared with non-ICU inpatients. We reviewed glucose results over the preceding 3 years, comparing results from paired glucose meter and central laboratory tests performed within 60 minutes of each other in ICU versus non-ICU settings. Seven ICU and 30 non-ICU wards at a 1,300-bed academic hospital in the United States. A total of 14,763 general medicine/surgery inpatients and 20,970 ICU inpatients. None. Compared meter results with near simultaneously performed laboratory results from the same patient by applying the 2016 U.S. Food and Drug Administration accuracy criteria, determining mean absolute relative difference and examining where paired results fell within the Parkes consensus error grid zones. A higher percentage of glucose meter results from ICUs than from non-ICUs passed 2016 Food and Drug Administration accuracy criteria (p meter results with laboratory results. At 1 minute, no meter result from ICUs posed dangerous or significant risk by error grid analysis, whereas at 10 minutes, less than 0.1% of ICU meter results did, which was not statistically different from non-ICU results. Real-world accuracy of modern glucose meters is at least as accurate in the ICU setting as in the non-ICU setting at our institution.
Gonçalves, Pedro D; Hagenbeek, Marie Louise; Vissers, Jan M H
Although research interest in hospital process orientation (HPO) is growing, the development of a measurement tool to assess process orientation (PO) has not been very successful yet. To view a hospital as a series of processes organized around patients with a similar demand seems to be an attractive proposition, but it is hard to operationalize this idea in a measurement tool that can actually measure the level of PO. This research contributes to HPO from an operations management (OM) perspective by addressing the alignment, integration and coordination of activities within patient care processes. The objective of this study was to develop and practically test a new measurement tool for assessing the degree of PO within hospitals using existing tools. Through a literature search we identified a number of constructs to measure PO in hospital settings. These constructs were further operationalized, using an OM perspective. Based on five dimensions of an existing questionnaire a new HPO-measurement tool was developed to measure the degree of PO within hospitals on the basis of respondents' perception. The HPO-measurement tool was pre-tested in a non-participating hospital and discussed with experts in a focus group. The multicentre exploratory case study was conducted in the ophthalmic practices of three different types of Dutch hospitals. In total 26 employees from three disciplines participated. After filling in the questionnaire an interview was held with each participant to check the validity and the reliability of the measurement tool. The application of the HPO-measurement tool, analysis of the scores and interviews with the participants resulted in the possibility to identify differences of PO performance and the areas of improvement--from a PO point of view--within each hospital. The result of refinement of the items of the measurement tool after practical testing is a set of 41 items to assess the degree of PO from an OM perspective within hospitals. The
Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.
Jensen, Magnus T; Pereira, Marta; Araujo, Carla; Malmivaara, Anti; Ferrieres, Jean; Degano, Irene R; Kirchberger, Inge; Farmakis, Dimitrios; Garel, Pascal; Torre, Marina; Marrugat, Jaume; Azevedo, Ana
The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.
Hutchens, Dale E.; Doan, Patrick A.; Boothe, Richard E.
Bonding labs at both MSFC and the northern Utah production plant prepare bond test specimens which simulate or witness the production of NASA's Reusable Solid Rocket Motor (RSRM). The current process for preparing the bonding surfaces employs 1,1,1-trichloroethane vapor degreasing, which simulates the current RSRM process. Government regulations (e.g., the 1990 Amendments to the Clean Air Act) have mandated a production phase-out of a number of ozone depleting compounds (ODC) including 1,1,1-trichloroethane. In order to comply with these regulations, the RSRM Program is qualifying a spray-in-air (SIA) precision cleaning process using Brulin 1990, an aqueous blend of surfactants. Accordingly, surface preparation prior to bonding process simulation test specimens must reflect the new production cleaning process. The Bonding Lab Statistical Process Control (SPC) program monitors the progress of the lab and its capabilities, as well as certifies the bonding technicians, by periodically preparing D6AC steel tensile adhesion panels with EA-91 3NA epoxy adhesive using a standardized process. SPC methods are then used to ensure the process is statistically in control, thus producing reliable data for bonding studies, and identify any problems which might develop. Since the specimen cleaning process is being changed, new SPC limits must be established. This report summarizes side-by-side testing of D6AC steel tensile adhesion witness panels and tapered double cantilevered beams (TDCBs) using both the current baseline vapor degreasing process and a lab-scale spray-in-air process. A Proceco 26 inches Typhoon dishwasher cleaned both tensile adhesion witness panels and TDCBs in a process which simulates the new production process. The tests were performed six times during 1995, subsequent statistical analysis of the data established new upper control limits (UCL) and lower control limits (LCL). The data also demonstrated that the new process was equivalent to the vapor
Golemboski, Karen; Otto, Catherine N; Morris, Susan
In order to contribute to improved healthcare quality through patient-centered care, laboratory professionals at all levels of practice must be able to recognize the connection between non-analytical factors and laboratory analysis, in the context of patient outcomes and quality improvement. These practices require qualities such as critical thinking (CT), teamwork skills, and familiarity with the quality improvement process, which will be essential for the development of evidence-based laboratory science practice. Performance tasks (PT) are an educational strategy which can be used to teach and assess CT and teamwork, while introducing Medical Laboratory Science (MLS) students at both baccalaureate and advanced-practice levels to the concepts of quality improvement processes and patient outcomes research. PT presents students with complex, realistic scenarios which require the incorporation of subject-specific knowledge with competencies such as effective team communication, patient-centered care, and successful use of information technology. A PT with assessment rubric was designed for use in a baccalaureate-level MLS program to teach and assess CT and teamwork competency. The results indicated that, even when students were able to integrate subject-specific knowledge in creative ways, their understanding of teamwork and quality improvement was limited. This indicates the need to intentionally teach skills such as collaboration and quality system design. PT represent one of many strategies that may be used in MLS education to develop essential professional competencies, encourage expert practice, and facilitate quality improvement.
Oster, Jörg; Poetsch, Stephanie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn
The aim of this study was the examination of the experiences of patients participating in an art therapy during a psychosomatic day hospital. The data basis were 15 transliterated interviews from the end of the treatment, conducted with a presentation of the pictures painted in the art therapy sessions, as well as the digitised pictures. The evaluation was done with a qualitative analysis of the interviews and an analysis of the pictures, using a specially-developed category system. In the art therapy, most part of the pa-tients dealt with own conflicts. Nearly all pa-tients benefitted from the art therapy and indicated an improvement of their feeling. The picture processes are different; at the beginning, wishes and familiar techniques dominated. Pictures of turning points differed in their dimensions. The art therapy was seen as a part of the complete treatment in which several therapies assembled. The final interviews were experienced as helpful for further reflections. © Georg Thieme Verlag KG Stuttgart · New York.
Pottelberg, Paul; Tremblay, Roger
Canadian Nuclear Laboratories (CNL) has 200 facilities that account for approximately 2 million square feet of building space. Currently there are 23 facilities undergoing various stages of Decommissioning. An additional 30 facilities are scheduled to be turned over to Decommissioning in 2016. CNL is currently restructuring to transition to a Government Owned/Contractor Operated (GoCo) organization and there will be a focus to accelerate the Decommissioning of legacy facilities on site. In the past, facilities were shutdown and left in various configurations with limited documentation or limited staff knowledge of the status of the facility at the start of Decommissioning. Recently, guidelines have been developed to ensure that any facility being turned over is put into a proper and documented safe shutdown configuration. This paper will look at CNL's process for turnover of facilities from Operations to Decommissioning and identify some of the key Lessons Learned. The turnover of nuclear facilities, administrative and support buildings, components or areas from Operations to Decommissioning needs to be documented and managed to ensure Health, Safety, Security and Environmental (HSSE) risks are identified, eliminated or effectively controlled. At CNL, the turnover document Table of Contents is: Introduction and Purpose; Facility Boundaries; Known Deficiencies; Facility Status; Shutdown Status; Hazards; System/Equipment; Drawings/Maps/Records; Significant Environmental Aspects (SEAs); Interface; and other Transfer Documentation. The transfer documentation specifically covers: - Defined boundaries of the facility, building, component or area at the time of turnover; - Identification of all deficiencies associated with the facility, building, component or area and the person, after turnover, who will be responsible for correcting them; - Confirmation of the status of the facility, building, component or area at the time of turnover with respect to: - The status
It has generally been recognized that international harmonization in radiotherapy dosimetry is essential. Consequently, the IAEA has given much effort to this, for example by publishing a number of reports in the Technical Reports Series (TRS) for external beam dosimetry, most notably TRS-277 and more recently TRS-398. Both of these reports describe in detail the steps to be taken for absorbed dose determination in water and they are often referred to as 'dosimetry protocols'. Similar to TRS-277, it is expected that TRS-398 will be adopted or used as a model by a large number of countries as their national protocol. In 1996, the IAEA established a calibration service for low dose rate (LDR) 137 Cs brachytherapy sources, which is the most widely used source for treatment of gynecological cancer. To further enhance harmonization in brachytherapy dosimetry, the IAEA published in 1999 IAEA-TECDOC-1079 entitled 'Calibration of Brachytherapy Sources. Guidelines on Standardized Procedures for the Calibration of Brachytherapy Sources at Secondary Standard Dosimetry Laboratories (SSDLs) and Hospitals'. The report was well received and was distributed in a large number of copies to the members of the IAEA/WHO network of SSDLs and to medical physicists working with brachytherapy. The present report is an update of the aforementioned TECDOC. Whereas TECDOC-1079 described methods for calibrating brachytherapy sources with photon energies at or above those of 192 Ir, the current report has a wider scope in that it deals with standardization of calibration of all the most commonly used brachytherapy sources, including both photon and beta emitting sources. The latter sources have been in use for a few decades already, but their calibration methods have been unclear. Methods are also described for calibrating sources used in the rapidly growing field of cardiovascular angioplasty. In this application, irradiation of the vessel wall is done in an attempt to prevent restenosis after
Hospital Autonomy Reforms were initiated in the 90s by the Government in the 17 teaching hospitals of the Province of Punjab, Pakistan with the claimed objectives of bringing efficiency and better services to the patients. A host of administrative, structural and financial changes were introduced in
Prætorious, Thim; Hasle, Peter; Edwards, Kasper
Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept for the collaborat......Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept...... of the collaborative hospital concern the creation of an appropriate balance between standardization and local autonomy, shared purpose centred around providing the best possible care, and use of enabling structures that sustain the new ways of collaborative work. The chapter builds on the theoretical framework...
Aase, Karina; Høyland, Sindre; Olsen, Espen; Wiig, Siri; Nilsen, Stein Tore
The paper reports results from a research project with the objective of studying patient safety, and relates the finding to safety issues within transfusion medicine. The background is an increased focus on undesired events related to diagnosis, medication, and patient treatment in general in the healthcare sector. The study is designed as a case study within a regional Norwegian hospital conducting specialised health care services. The study includes multiple methods such as interviews, document analysis, analysis of error reports, and a questionnaire survey. Results show that the challenges for improved patient safety, based on employees' perceptions, are hospital management support, reporting of accidents/incidents, and collaboration across hospital units. Several of these generic safety challenges are also found to be of relevance for a hospital's transfusion service. Positive patient safety factors are identified as teamwork within hospital units, a non-punitive response to errors, and unit manager's actions promoting safety.
Niemi, A.J.; Thereska, J.; Plasari, E.; Kacaj, M.
Radioisotope tracers have a proven application for the extraction of residence time distributions and the evaluation of flotation rates in industry. This paper shows how values of the rate factor k are scaled up on the basis of flotation in the laboratory and tracer tests in plant. The procedure is illustrated by a theoretical study and by experimental data. The information obtained can be introduced into models of larger flotation systems. (author)
Focke, Maximilian; Mark, Daniel; Stumpf, Fabian; Müller, Martina; Roth, Günter; Zengerle, Roland; von Stetten, Felix
Two microfluidic cartridges intended for upgrading standard laboratory instruments with automated liquid handling capability by use of centrifugal forces are presented. The first microfluidic cartridge enables purification of DNA from human whole blood and is operated in a standard laboratory centrifuge. The second microfluidic catridge enables genotyping of pathogens by geometrically multiplexed real-time PCR. It is operated in a slightly modified off-the-shelf thermal cycler. Both solutions aim at smart and cost-efficient ways to automate work flows in laboratories. The DNA purification cartridge automates all liquid handling steps starting from a lysed blood sample to PCR ready DNA. The cartridge contains two manually crushable glass ampoules with liquid reagents. The DNA yield extracted from a 32 μl blood sample is 192 +/- 30 ng which corresponds to 53 +/- 8% of a reference extraction. The genotyping cartridge is applied to analyse isolates of the multi-resistant Staphyloccus aureus (MRSA) by real-time PCR. The wells contain pre-stored dry reagents such as primers and probes. Evaluation of the system with 44 genotyping assays showed a 100% specificity and agreement with the reference assays in standard tubes. The lower limit of detection was well below 10 copies of DNA per reaction.
Widjanarko, Bagoes; Widyastari, Dyah Anantalia; Martini, Martini; Ginandjar, Praba
Detection of acid-fast bacilli in respiratory specimens serves as an initial pulmonary tuberculosis (TB) diagnosis. Laboratories are the essential and fundamental part of all health systems. This study aimed to describe how laboratory technicians perceived their own self and work. This included perceived self-efficacy, perceived role, perceived equipment availability, perceived procedures, perceived reward and job, and perceived benefit of health education, as well as level of knowledge and attitudes related to work performance of laboratory technicians. This was a cross-sectional quantitative study involving 120 laboratory technicians conducted in Central Java. Interviews and observation were conducted to measure performance and work-related variables. Among 120 laboratory technicians, 43.3% showed fairly good performance. They complied with 50%-75% of all procedures, including sputum collection, laboratory tools utilization, sputum smearing, staining, smear examination, grading of results, and universal precaution practice. Perceived role, perceived self-efficacy, and knowledge of laboratory procedures were significantly correlated to performance, besides education and years of working as a laboratory technician. Perceived equipment availability was also significantly correlated to performance after the education variable was controlled. Most of the laboratory technicians believed that they have an important role in TB patients' treatment and should display proper self-efficacy in performing laboratory activities. The result may serve as a basic consideration to develop a policy for enhancing motivation of laboratory technicians in order to improve the TB control program.
White, L; Terner, C
The initial efforts of e-health have fallen far short of expectations. They were buoyed by the hype and excitement of the Internet craze but limited by their lack of understanding of important market and environmental factors. E-health now recognizes that legacy systems and processes are important, that there is a technology adoption process that needs to be followed, and that demonstrable value drives adoption. Initial e-health transaction solutions have targeted mostly low-cost problems. These solutions invariably are difficult to integrate into existing systems, typically requiring manual interfacing to supported processes. This limitation in particular makes them unworkable for large volume providers. To meet the needs of these providers, e-health companies must rethink their approaches, appropriately applying technology to seamlessly integrate all steps into existing business functions. E-automation is a transaction technology that automates steps, integration of steps, and information communication demands, resulting in comprehensive automation of entire business functions. We applied e-automation to create a billing management solution for clinical reference laboratories. Large volume, onerous regulations, small margins, and only indirect access to patients challenge large laboratories' billing departments. Couple these problems with outmoded, largely manual systems and it becomes apparent why most laboratory billing departments are in crisis. Our approach has been to focus on the most significant and costly problems in billing: errors, compliance, and system maintenance and management. The core of the design relies on conditional processing, a "universal" communications interface, and ASP technologies. The result is comprehensive automation of all routine processes, driving out errors and costs. Additionally, compliance management and billing system support and management costs are dramatically reduced. The implications of e-automated processes can extend
Bentur, Y; Bentur, L; Rotenberg, M; Tepperberg, M; Leiba, R; Wolf, E Udi
The Analytic Laboratory of Israel Police processes illicit drug files. In recent years, workers of this laboratory have complained of health problems. Limited information exists on the effect of occupational exposure to illicit drugs; biomonitoring was never done. To assess health effects and systemic absorption of illicit drugs in workers of the Analytic Laboratory occupationally exposed to illicit drugs. A prospective cohort study using health and occupational questionnaires, clinical assessments, and monitoring of urinary excretion of illicit drugs was conducted. The study included three blocks of one week each. At each week workers were assessed at the beginning (baseline), and the assessments were repeated at the end of the three working days. Urine specimens were analyzed for illicit drugs in an independent laboratory. Demographic, clinical, occupational, and laboratory data were subjected to descriptive analysis, and paired Student's t-test, chi-square analysis, and repeated measures model. Twenty-seven workers (age, 39.2 ± 8.3 years; 77.8% females) were included, yielding 122 paired samples. The following parameters were reduced at the end of shift compared with baseline: diastolic blood pressure (71.2 ± 11.2 and 77.2 ± 13.6 mmHg, respectively, p health complaints included headache, fatigue, and dry eyes. No illicit drug was detected in the urine specimens. It is suggested that the health concerns of the laboratory workers were not related to the absorption of illicit drugs; environmental conditions (e.g. inadequate ventilation and respirable dust) can contribute to these concerns.
Ismail, R.; Perwitasari, D. A.; Supadmi, W.; Risdiana, I.
Prescription screening includes administrative and clinical precision of the drug, dosage, frequency and route of administration, therapeutic duplication, allergic or sensitive reactions, and actual or potential interactions. The study was aimed to identify the obstacles and compliance level of users, as well as the design of a prescription screening information system and its users’ perceptions. This study used qualitative and quantitative research design with action research studies involving pharmacists, pharmacy technicians, a programmer and clinical practice student pharmacists. The obstacle of pharmacists in doing prescription screening was the long duration in the process of manual prescription review. The compliance of pharmacists in manual prescription review was under 50%. The prescription information system was created by the programmer on the proposal of pharmacists in the form of front view, pharmacy display, sales display, prescription display, prescription display per period and display of recapped prescriptions. Perception of the usefulness was very high with a value of 4.5±0.577 and perception of ease of use was very high with a value of 4.214±0.534 from 28 respondents. The prescription information system was created by a programmer upon the recommendations of pharmacists. Perception of the usefulness and ease of use was very high.
Bahadori, Mohammadkarim; Ravangard, Ramin; Yaghoubi, Maryam; Alimohammadzadeh, Khalil
Background: Military hospitals are responsible for preserving, restoring and improving the health of not only armed forces, but also other people. According to the military organizations strategy, which is being a leader and pioneer in all areas, providing quality health services is one of the main goals of the military health care organizations. This study was aimed to evaluate the service quality of selected military hospitals in Iran based on the Joint Commission International (JCI) standards and comparing these hospitals with each other and ranking them using the analytic hierarchy process (AHP) technique in 2013. Materials and Methods: This was a cross-sectional and descriptive study conducted on five military hospitals, selected using the purposive sampling method, in 2013. Required data collected using checklists of accreditation standards and nominal group technique. AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the collected data. Results: Among JCI standards, the standards of access to care and continuity of care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and SAB (weight = 0.066) ranked first to fifth, respectively. Conclusion: AHP is an appropriate technique for measuring the overall performance of hospitals and their quality of services. It is a holistic approach that takes all hospital processes into consideration. The results of the present study can be used to improve hospitals performance through identifying areas, which are in need of focus for quality improvement and selecting strategies to improve service quality. PMID:25250364
Bahadori, Mohammadkarim; Ravangard, Ramin; Yaghoubi, Maryam; Alimohammadzadeh, Khalil
Military hospitals are responsible for preserving, restoring and improving the health of not only armed forces, but also other people. According to the military organizations strategy, which is being a leader and pioneer in all areas, providing quality health services is one of the main goals of the military health care organizations. This study was aimed to evaluate the service quality of selected military hospitals in Iran based on the Joint Commission International (JCI) standards and comparing these hospitals with each other and ranking them using the analytic hierarchy process (AHP) technique in 2013. This was a cross-sectional and descriptive study conducted on five military hospitals, selected using the purposive sampling method, in 2013. Required data collected using checklists of accreditation standards and nominal group technique. AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the collected data. Among JCI standards, the standards of access to care and continuity of care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and SAB (weight = 0.066) ranked first to fifth, respectively. AHP is an appropriate technique for measuring the overall performance of hospitals and their quality of services. It is a holistic approach that takes all hospital processes into consideration. The results of the present study can be used to improve hospitals performance through identifying areas, which are in need of focus for quality improvement and selecting strategies to improve service quality.
Full Text Available Background: There are presently many non-culture-based methods commercially available to identify organisms and antimicrobial susceptibility from blood culture bottles. Each platform has its benefits and limitations. However, there is a need for an improved system with minimal hands-on requirements and short run times. Objectives: In this study, the performance characteristics of the FilmArray® BCID Panel kit were evaluated to assess the efficiency of the kit against an existing system used for identification and antimicrobial susceptibility of organisms from blood cultures. Methods: Positive blood cultures that had initially been received from hospitalised patients of a large quaternary referral hospital in Durban, South Africa were processed as per routine protocol at its Medical Microbiology Laboratory. Positive blood cultures were processed on the FilmArray BCID Panel kit in parallel with the routine sample processing. Inferences were then drawn from results obtained. Results: Organism detection by the FilmArray BCID panel was accurate at 92.6% when organisms that were on the repertoire of the kit were considered, compared to the combination methods (reference method used in the study laboratory. Detection of the antimicrobial resistance markers provided by the panel and reference method demonstrated 100% consistency. Blood cultures with a single organism were accurately identified at 93.8% by FilmArray, while blood cultures with more than one organism were identified at 85.7%. Conclusion: The FilmArray BCID Panel kit is valuable for detection of organisms and markers of antibiotic resistance for an extensive range of organisms.
Underwood, Carlisa M; Hayne, Arlene N
The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems. Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations. Eleven US healthcare SCNEs from the American Nurses Credentialing Center's repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter's Theory of Organizational Empowerment. Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance. Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.
Foerster, C.L.; Lanni, C.; Lee, R.; Mitchell, G.; Quade, W.
A large measure of the successful operation of the National Synchrotron Light Source (NSLS) at Brookhaven National Laboratory (BNL) for over a decade can be attributed to the cleaning of its ultrahigh vacuum (UHV) components during and after construction. A new UHV cleaning process, which has to be environmentally and personnel safe, is needed to replace the harsh, unfriendly process which is still in use. Dow Advanced Cleaning Systems was contracted to develop a replacement process without the use of harsh chemicals and which must clean vacuum surfaces as well as the existing process. Acceptance of the replacement process was primarily based on photon stimulated desorption (PSD) measurements of beam tube samples run on NSLS beam line U10B. One meter long beam tube samples were fabricated from aluminum, 304 stainless steel, and oxygen-free copper. Initially, coupon samples were cleaned and passed preliminary testing for the proposed process. Next, beam tube samples of each material were cleaned, and the PSD measured on beam line U10B using white light with a critical energy of 487 eV. Prior to cleaning, the samples were contaminated with a mixture of cutting oils, lubricants, vacuum oils, and vacuum grease. The contaminated samples were then baked. Samples of each material were also cleaned with the existing process after the same preparation. Beam tube samples were exposed to between 10 22 and 10 23 photons per meter for a PSD measurement. Desorption yields for H 2 , CO, CO 2 , CH 4 , and H 2 O are reported for both the existing cleaning and for the replacement cleaning process. Preliminary data, residual gas scans, and PSD results are given and discussed. The new process is also compared with new cleaning methods developed in other laboratories. After modification, the new UHV cleaning process was accepted by BNL
Kogi, Y., E-mail: email@example.com; Higashi, T.; Matsukawa, S. [Department of Information Electronics, Fukuoka Institute of Technology, Fukuoka 811-0295 (Japan); Mase, A. [Art, Science and Technology Center for Cooperative Research, Kyushu University, Kasuga, Fukuoka 816-0811 (Japan); Kohagura, J.; Yoshikawa, M. [Plasma Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8577 (Japan); Nagayama, Y.; Kawahata, K. [National Institute for Fusion Science, Toki, Gifu 509-5202 (Japan); Kuwahara, D. [Tokyo University of Agriculture and Technology, Koganei, Tokyo 184-8588 (Japan)
We propose a new interferometer system for density profile measurements. This system produces multiple measurement chords by a leaky-wave antenna driven by multiple frequency inputs. The proposed system was validated in laboratory evaluation experiments. We confirmed that the interferometer generates a clear image of a Teflon plate as well as the phase shift corresponding to the plate thickness. In another experiment, we confirmed that quasi-optical mirrors can produce multiple measurement chords; however, the finite spot size of the probe beam degrades the sharpness of the resulting image.
Richter, M.; Eckert, B.; Riemenschneider, J.; Mallon, C.; Mann, D.
A laboratory plant for the separation of cesium from a fission product waste solution of the fuel reprocessing is described. The plant consists of two stages. In the first stage cesium is adsorbed on ammonium molybdatophosphate (AMP). Then the adsorbent is dissolved. From the solution cesium is adsorbed on a cationic ion exchanger in the second stage. Then AMP can be reproduced from this solution. For the elution of cesium in the second stage a NH 4 NO 3 solution (3 m) is used. Flow sheet, construction and the control device of the plant are described and the results of tests with a model solution are given. (author)
Ormeño Julca, Alexis Jose; Alvarez Murillo, Carlos Melchor; Amoretti Alvino, Pedro Miguel; Florian Florian, Angel Aladino; Castro Johanson, Rosa Aurora; Celi Perez, Maria Danisa; Huamán Prado, Olga Rocío
The hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHN) are distinct pulmonary vascular complications of portal hypertension (PHT) and are associated with increased morbidity and mortality. To describe the clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño. We included patients with HTP hospitalized from January 2012 to June 2013 and that during its evolution progressed with SHP or HTPP. For analysis, they were divided into a first group of patients with liver cirrhosis and a second group with extrahepatic portal vein obstruction. Of 22 patients with HPT 45.5% were male and the age range was between 1 month and 17 years. The etiology in the group of cirrhosis (n=14) was: autoimmune hepatitis (35.7%), cryptogenic cirrhosis (35.7%), inborn error of metabolism (14.3%), chronic viral hepatitis C (7.15%) virus and atresia extra-hepatic bile ducts (7.15%). Pulmonary vascular complications more frequently occurred in patients with liver cirrhosis (1 case of HPS and a case of PPHTN). They most often dyspnea, asthenia, edema, malnutrition, ascites, hypersplenism and gastrointestinal bleeding from esophageal varices was found. Also, they had elevated ALT values, alkaline phosphatase and serum albumin values decreased. In children with pulmonary hypertension, pulmonary vascular complications are rare. In the evaluation of these patients pulse oximetry should be included to detect hypoxemia and ubsequently a Doppler echocardiography and contrast echocardiography necessary. Dueto the finding of systolic pulmonary hypertension it is necessary to perform right heart catheterization.
Karagiannidis, A.; Papageorgiou, A.; Perkoulidis, G.; Sanida, G.; Samaras, P.
In Greece more than 14,000 tonnes of infectious hospital waste are produced yearly; a significant part of it is still mismanaged. Only one off-site licensed incineration facility for hospital wastes is in operation, with the remaining of the market covered by various hydroclave and autoclave units, whereas numerous problems are still generally encountered regarding waste segregation, collection, transportation and management, as well as often excessive entailed costs. Everyday practices still include dumping the majority of solid hospital waste into household disposal sites and landfills after sterilization, still largely without any preceding recycling and separation steps. Discussed in the present paper are the implemented and future treatment practices of infectious hospital wastes in Central Macedonia; produced quantities are reviewed, actual treatment costs are addressed critically, whereas the overall situation in Greece is discussed. Moreover, thermal treatment processes that could be applied for the treatment of infectious hospital wastes in the region are assessed via the multi-criteria decision method Analytic Hierarchy Process. Furthermore, a sensitivity analysis was performed and the analysis demonstrated that a centralized autoclave or hydroclave plant near Thessaloniki is the best performing option, depending however on the selection and weighing of criteria of the multi-criteria process. Moreover the study found that a common treatment option for the treatment of all infectious hospital wastes produced in the Region of Central Macedonia, could offer cost and environmental benefits. In general the multi-criteria decision method, as well as the conclusions and remarks of this study can be used as a basis for future planning and anticipation of the needs for investments in the area of medical waste management.
Sanden, Torbjoern; Boergesson, Lennart; Dueck, Ann; Goudarzi, Reza; Loennqvist, Margareta (Clay Technology AB, Lund (Sweden))
SKB in Sweden and Posiva in Finland are developing and plan to implement similar disposal concepts for the final disposal of spent nuclear fuel. Co-operation and joint development work between Posiva and SKB with the overall objective to develop backfill concepts and techniques for sealing and closure of the repository have been going on for several years. The investigation described in this report is intended to acquire more knowledge regarding the behavior of some of the candidate backfilling materials. Blocks made of three different materials (Friedland clay, Asha 230 or a bentonite/ballast 30/70 mixture) as well as different bentonite pellets have been examined. The backfill materials will be exposed to an environment simulating that in a tunnel, with high relative humidity and water inflow from the rock. The processes and properties investigated are: 1. Erosion properties of blocks and pellets (Friedland blocks, MX-80 pellets, Cebogel QSE pellets, Minelco and Friedland granules). 2. Displacements of blocks after emplacement in a deposition drift (Blocks of Friedland, Asha 230 and Mixture 30/70). 3. The ability of these materials to seal a leaking in-situ cast plug cement/rock but also other fractures in the rock (MX-80 pellets). 4. The self healing ability after a piping scenario (Blocks of Friedland, Asha 230 Mixture 30/70 and also MX-80 pellets). 5. Swelling and cracking of the compacted backfill blocks caused by relative humidity. The erosion properties of Friedland blocks were also investigated in Phase 2 of the joint SKBPosiva project 'Backfilling and Closure of the Deep Repository, BACLO, which included laboratory scale experiments. In this phase of the project (3) some completing tests were performed with new blocks produced for different field tests. These blocks had a lower density than intended and this has an influence on the erosion properties measured. The erosion properties of MX-80 pellets were also investigated earlier in the project but
Peres, S.S.; Silva, J.J.G.
This work presents a resume of results obtained in the treatment of radwastes containing Cs-137 from HNMD (Hospital Naval Marcilio Dias) and IRD (Instituto de Radioprotecao e Dosimetria), due to the radiological accident of Goiania. (author) [pt
Full Text Available Bagoes Widjanarko,1 Dyah Anantalia Widyastari,2 Martini Martini,3 Praba Ginandjar3 1Department of Health Education and Behavior Sciences, Faculty of Public Health, Diponegoro University, Semarang, Indonesia; 2Institute for Population and Social Research, Mahidol University, Salaya, Thailand; 3Department of Epidemiology, Faculty of Public Health, Diponegoro University, Semarang, Indonesia Purpose: Detection of acid-fast bacilli in respiratory specimens serves as an initial pulmonary tuberculosis (TB diagnosis. Laboratories are the essential and fundamental part of all health systems. This study aimed to describe how laboratory technicians perceived their own self and work. This included perceived self-efficacy, perceived role, perceived equipment availability, perceived procedures, perceived reward and job, and perceived benefit of health education, as well as level of knowledge and attitudes related to work performance of laboratory technicians.Methods: This was a cross-sectional quantitative study involving 120 laboratory technicians conducted in Central Java. Interviews and observation were conducted to measure performance and work-related variables.Results: Among 120 laboratory technicians, 43.3% showed fairly good performance. They complied with 50%–75% of all procedures, including sputum collection, laboratory tools utilization, sputum smearing, staining, smear examination, grading of results, and universal precaution practice. Perceived role, perceived self-efficacy, and knowledge of laboratory procedures were significantly correlated to performance, besides education and years of working as a laboratory technician. Perceived equipment availability was also significantly correlated to performance after the education variable was controlled.Conclusion: Most of the laboratory technicians believed that they have an important role in TB patients’ treatment and should display proper self-efficacy in performing laboratory activities. The
Haines, Terry P; Cornwell, Petrea; Fleming, Jennifer; Varghese, Paul; Gray, Len
Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.
Full Text Available Abstract Background Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. Methods This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Results Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting, secondary (patient injury, and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. Conclusion A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.
Szuszczewicz, E. P.; Bateman, T. T.
We have conducted a laboratory investigation into the physics of plasma expansions and their associated energization processes. We studied single- and multi-ion plasma processes in self-expansions, and included light and heavy ions and heavy/light mixtures to encompass the phenomenological regimes of the solar and polar winds and the AMPTE and CRRES chemical release programs. The laboratory experiments provided spatially-distributed time-dependent measurements of total plasma density, temperature, and density fluctuation power spectra with the data confirming the long-theorized electron energization process in an expanding cloud - a result that was impossible to determine in spaceborne experiments (as e.g., in the CRRES program). These results provided the missing link in previous laboratory and spaceborne programs. confirming important elements in our understanding of such solar-terrestrial processes as manifested in expanding plasmas in the solar wind (e.g., CMES) and in ionospheric outflow in plasmaspheric fluctuate refilling after a storm. The energization signatures were seen in an entire series of runs that varied the ion species (Ar', Xe', Kr' and Ne'), and correlative studies included spectral analyses of electrostatic waves collocated with the energized electron distributions. In all cases wave energies were most intense during the times in which the suprathermal populations were present, with wave intensity increasing with the intensity of the suprathermal electron population. This is consistent with theoretical expectations wherein the energization process is directly attributable to wave particle interactions. No resonance conditions were observed, in an overall framework in which the general wave characteristics were broadband with power decreasing with increasing frequency.
Kanyar, B.; Fulop, N.; Glavatszkih, N.; Nemeth, A.
The countrywide radiation monitoring activity in Hungary is shared among the national networks as agriculture, environmental protection and public health ones. They are mostly involved in the environmental sampling and laboratory type determinations of the radioactive pollution, meanwhile the organisations mainly from the Army and Civil Defence are responsible to the early warning system. A moderately effective collaboration is established only around the Nuclear Power Plant Paks. Based on more than 10 years experience in collaboration around the NPP the Hungarian Atomic Energy Commission initiated some centralism in the countrywide monitoring activity as well. As the first step the National Research Institute for Radiobiology and Radiohygiene has been charged to establish an Information Center for laboratory-type data collection, processing, analysis and informing regularly the proper organizations on the results. The Information Centre is equipped with a computer type of SUN SPARCserver-20 and the laboratories are planned to be linked on line by PC stations. The main user programs for data collection, control and restricted processing are written in INGRES data manager software. The semiprocessed results can be transformed in a readable form for general statistical etc. packages
Gjolaj, Lauren N; Gari, Gloria A; Olier-Pino, Angela I; Garcia, Juan D; Fernandez, Gustavo L
Prolonged patient wait times in the outpatient oncology infusion unit indicated a need to streamline phlebotomy processes by using existing resources to decrease laboratory turnaround time and improve patient wait time. Using the DMAIC (define, measure, analyze, improve, control) method, a project to streamline phlebotomy processes within the outpatient oncology infusion unit in an academic Comprehensive Cancer Center known as the Comprehensive Treatment Unit (CTU) was completed. Laboratory turnaround time for patients who needed same-day lab and CTU services and wait time for all CTU patients was tracked for 9 weeks. During the pilot, the wait time from arrival to CTU to sitting in treatment area decreased by 17% for all patients treated in the CTU during the pilot. A total of 528 patients were seen at the CTU phlebotomy location, representing 16% of the total patients who received treatment in the CTU, with a mean turnaround time of 24 minutes compared with a baseline turnaround time of 51 minutes. Streamlining workflows and placing a phlebotomy station inside of the CTU decreased laboratory turnaround times by 53% for patients requiring same day lab and CTU services. The success of the pilot project prompted the team to make the station a permanent fixture. Copyright © 2014 by American Society of Clinical Oncology.
Full Text Available This study presents the first step of a research project that aims at using a three-dimensional (3D hybrid finite-discrete element method (FDEM to investigate the development of an excavation damaged zone (EDZ around tunnels in a clay shale formation known as Opalinus Clay. The 3D FDEM was first calibrated against standard laboratory experiments, including Brazilian disc test and uniaxial compression test. The effect of increasing confining pressure on the mechanical response and fracture propagation of the rock was quantified under triaxial compression tests. Polyaxial (or true triaxial simulations highlighted the effect of the intermediate principal stress (σ2 on fracture directions in the model: as the intermediate principal stress increased, fractures tended to align in the direction parallel to the plane defined by the major and intermediate principal stresses. The peak strength was also shown to vary with changing σ2.
A cation exchange technique was developed for the separation of plutonium from laboratory solutions containing either Pu(III) or Pu(III)--Pu(IV) mixtures in acidic solutions containing chloride ions. The procedure consists of adjusting the acid concentration to less than one molar and adjusting the valence of the plutonium ion to the (III) state, if necessary. The adjusted solution is fed to a cation exchange column and washed with distilled water to remove residual chlorides from the column. Plutonium is then eluted from the column with 5M nitric acid containing 0.34M sulfamic acid. This procedure was used to separate plutonium from 1.2M chloride solution on a production-scale column. Typical plutonium recovery was 99.97%, while greater than 96% of the original chloride was rejected
Cheng, D. L. C.; Quinn, J. D.; Larour, E. Y.; Halkides, D. J.
The Virtual Earth System Laboratory (VESL) is a Web application, under continued development at the Jet Propulsion Laboratory and UC Irvine, for the visualization of Earth System data and process simulations. As with any project of its size, we have encountered both successes and challenges during the course of development. Our principal point of success is the fact that VESL users can interact seamlessly with our earth science simulations within their own Web browser. Some of the challenges we have faced include retrofitting the VESL Web application to respond to touch gestures, reducing page load time (especially as the application has grown), and accounting for the differences between the various Web browsers and computing platforms.
Full Text Available The purpose of this study was to investigate the effects of a laboratory instruction prepared based on “Predict-Observation-Explain” (POE strategy compared to a verification laboratory approach on the development of pre-service science teachers’ science skill processes and their views of nature of sceince in a general biology laboratory course. The participants of this study consisted of 122 pre-service teachers who took the General Biology Laboratory at the department of science education at Pamukkale University during the fall semester of 2007-2008 academic year. Data was collected through Science Process Skills Test (SPST and Nature of Science Questionnaire. Results indicated that there was a statistically significant difference between the verification laboratory approach and the laboratory approach based on the POE strategy on the development of students’ science process skills [F=10.41, p
Walker, B.W.; McCabe, D.J.
The purpose of this filter study was to evaluate cross-flow filtration as effective solid-liquid separation technology for treating Oak Ridge National Laboratory wastes, outline operating conditions for equipment, examine the expected filter flow rates, and determine proper cleaning.The Gunite Tanks at the Oak Ridge National Laboratory contain heels which are a mixture of sludge, wash water, and bentonite clay. The tanks are to be cleaned out with a variety of flushing techniques and the dilute mixture transferred to another storage tank. One proposal is to transfer this mixture into existing Melton Valley Storage Tanks (MVST), which already contain a large amount of sludge and supernate. The mixed aqueous phase will then be transferred to new MVST, which are prohibited from containing insoluble solids. To separate the solid from the liquid and thereby prevent solids transfer into the new MVST, a technique is needed that can cleanly separate the sludge and bentonite clay from the supernate. One proposed method for solid liquid separation is cross-flow filtration. Cross-flow filtration has been used at the Savannah River and West Valley sites for treatment of tank waste, and is being tested for applicability at other sites. The performance of cross-flow filters with sludge has been tested, but the impact of sludge combined with bentonite clay has not. The objective of this test was to evaluate the feasibility of using cross-flow filters to perform the solid liquid separation required for the mixture of Gunite and MVST tank wastes
Hafni-Lissa-Nuri; Faizal-Riza; Susilaningtyas; Sugeng-Waluyo; Erni-Rifandriyah-Arief
This laboratory work is collaboration P2BGGN-BATAN and PT. Timah Tbk. to obtain monazite data process for use equipment calculation and economic pilot scales. A RE 2 O 3 can be treated to become an individual elements (Ce, Pr, Nd, Pm, Sm, Eu, etc.) and can be used as a raw materials in the industries of electronics, magnetics, ceramics, steels and glass optic etc. RE 2 O 3 which are gained from processing of 100 kg monazite with -325 mesh in size distribution and 1 kg/day capacity will be the sample for PT Timah marketing activity. The process is done with use equipments laboratory scale that were designed last year. The equipment processes are decomposition, dissolution, precipitation tank and calcinator. Total RE 2 O 3 production are 45 kg and total recovery RE 2 O 3 71,696 % ; Th 2,129 % ; U and P 2 O 5 0 %, Purify products RE 2 O 3 93,59 % and Th 1143 ppm. Based on the assessment of Chemex Inc Canada, the product of RE 2 O 3 contains are about >55,32 % RE 2 O 3 and 16 ppm Th. U and Th content within specification product of RE 2 O 3 depends to buyer/request. (author)
BURNS, SHAWN P.; HARRISON, RANDY J.; DOBRANICH, DEAN
The efficiency of the design-to-analysis process for translating solid-model-based design data to computational analysis model data plays a central role in the application of computational analysis to engineering design and certification. A review of the literature from within Sandia as well as from industry shows that the design-to-analysis process involves a number of complex organizational and technological issues. This study focuses on the design-to-analysis process from a business process standpoint and is intended to generate discussion regarding this important issue. Observations obtained from Sandia staff member and management interviews suggest that the current Sandia design-to-analysis process is not mature and that this cross-organizational issue requires committed high-level ownership. A key recommendation of the study is that additional resources should be provided to the computer aided design organizations to support design-to-analysis. A robust community of practice is also needed to continuously improve the design-to-analysis process and to provide a corporate perspective
Horváth, Andrea Rita; Ring, Rózsa; Fehér, Miklós; Mikó, Tivadar
In Hungary, the National Accreditation Body was established by government in 1995 as an independent, non-profit organization, and has exclusive rights to accredit, amongst others, medical laboratories. The National Accreditation Body has two Specialist Advisory Committees in the health care sector. One is the Health Care Specialist Advisory Committee that accredits certifying bodies, which deal with certification of hospitals. The other Specialist Advisory Committee for Medical Laboratories is directly involved in accrediting medical laboratory services of health care institutions. The Specialist Advisory Committee for Medical Laboratories is a multidisciplinary peer review group of experts from all disciplines of in vitro diagnostics, i.e. laboratory medicine, microbiology, histopathology and blood banking. At present, the only published International Standard applicable to laboratories is ISO/IEC 17025:1999. Work has been in progress on the official approval of the new ISO 15189 standard, specific to medical laboratories. Until the official approval of the International Standard ISO 15189, as accreditation standard, the Hungarian National Accreditation Body has decided to progress with accreditation by formulating explanatory notes to the ISO/IEC 17025:1999 document, using ISO/FDIS 15189:2000, the European EC4 criteria and CPA (UK) Ltd accreditation standards as guidelines. This harmonized guideline provides 'explanations' that facilitate the application of ISO/IEC 17025:1999 to medical laboratories, and can be used as a checklist for the verification of compliance during the onsite assessment of the laboratory. The harmonized guideline adapted the process model of ISO 9001:2000 to rearrange the main clauses of ISO/IEC 17025:1999. This rearrangement does not only make the guideline compliant with ISO 9001:2000 but also improves understanding for those working in medical laboratories, and facilitates the training and education of laboratory staff. With the
Salata, Brian M; Sterling, Madeline R; Beecy, Ashley N; Ullal, Ajayram V; Jones, Erica C; Horn, Evelyn M; Goyal, Parag
Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF. Copyright © 2018 Elsevier Inc. All rights reserved.
Elisangela da Costa Lima-Dellamora
Full Text Available Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.
Ofi, Bola; Sowunmi, Olanrewaju
The descriptive study was conducted to determine the extent of utilization of the nursing process for documentation of nursing care in three selected hospitals, Ibadan, Nigeria. One hundred fifty nurses and 115 discharged clients' records were selected from the hospitals. Questionnaires and checklists were used to collect data. Utilization of nursing process for care was 100%, 73.6% and 34.8% in the three hospitals. Nurses encountered difficulties in history taking, formulation of nursing diagnoses, objectives, nursing orders and evaluation. Most nurses disagreed or were undecided with the use of authorized abbreviations and symbols (34.3%, 40.3% and 69.5%), recording errors that occurred during care (37.1%, 56.1% and 52.2%) and inclusion of change in clients' condition (54.3%, 56.1% and 73.8%). Most nurses appreciated the significance of documentation. Lack of time, knowledge and need for extensive writing are the major barriers against documentation. Seventy-seven point four per cent of the 115 clients' records from one hospital showed evidence of documentation, no evidence from the other two. Study findings have implications for continuing professional education, practice and supervision. © 2012 Blackwell Publishing Asia Pty Ltd.
Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza
Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (pservice quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients
van der Beek Allard J
Full Text Available Abstract Background The process evaluation of the Vital@Work intervention was primary aimed at gaining insight into the context, dose delivered, fidelity, reach, dose received, and participants' attitude. Further, the differences between intervention locations were evaluated. Methods Eligible for this study were 730 workers, aged ≥ 45 years, from two academic hospitals. Workers randomised to the intervention group (n = 367 received a 6-months intervention consisting a Vitality Exercise Programme (VEP combined with three visits to a Personal Vitality Coach (PVC, aimed at goal setting, feedback, and problem solving. The VEP consisted of a guided yoga session, a guided workout session, and aerobic exercising without direct face-to-face instruction, all once a week. Data were collected by means of a questionnaire after the intervention, attendance registration forms (i.e. attendance at guided VEP group sessions, and coaching registration forms (filled in by the PVCs. Results The dose delivered of the yoga and workout sessions were 72.3% and 96.3%. All PVC visits (100% were offered. The reach for the yoga sessions, workout sessions and PVC visits was 70.6%, 63.8%, and 89.6%, respectively. When taken these three intervention components together, the reach was 52%. This differed between the two locations (59.2% versus 36.8%. The dose received was for the yoga 10.4 sessions/24 weeks and for the workout 11.1 sessions/24 weeks. The attendance rate, defined as the mean percentage of attended group sessions in relation to the total provided group sessions, for the yoga and workout sessions was 51.7% and 44.8%, respectively. For the yoga sessions this rate was different between the two locations (63.2% versus 46.5%. No differences were found between the locations regarding the workout sessions and PVC visits. Workers attended on average 2.7 PVC visits. Overall, workers were satisfied with the intervention components: 7.5 for yoga sessions, 7.8 for workout
del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación
To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Campos Arrieta, G.; Navarro Blanco, D
In the Hospital Mexico a program for the handling of the solid waste was implemented. The program consists on placing recipients, in all the corridors, for each type of waste (recyclable, toxic, dangerous, kitchens). However, this measure doesn't eliminate the risk that the waste represents for the community and the environment. The handling of the solid waste includes the selection or classification, the gathering, the transportation, and the temporary storage. While the treatment consists on the application of procedures that reduce the polluting properties of the waste. The planning of the topic is: To diagnose and to redesign of the handling processes and internal treatment of the hospital solid waste (HSW) in the Hospital Mexico. The contribution of the Industrial Engineering is given in the thematic of redesign of processes; the complementary areas are engineering of the human factor, environmental impact and normalization. The current problem that undergoes the Hospital was defined as follows: The Hospital Mexico cannot assure that the handling and current treatment of the solid waste diminish the risk that they represent to the health of the hospital community and the deterioration of the environment. This problem contains the independent variables such as the handling and current treatment of the solid waste, and the dependent variables such as the risk to the health of the community and deterioration of the environment. Based on the problem, the following hypothesis is established: The current conditions of handling and the lack of internal treatment of the solid waste in the Hospital Mexico, causes that the waste is a risk for the health of the hospital community and the deterioration of the environment. The project was structured in three denominated stages: Diagnose, Design and Validation, which respond to different general and specific objectives. In the stage of diagnose, to determine that the waste generated in the centers of health contain
Rong, Guan; Yang, Jie; Cheng, Long; Zhou, Chuangbing
To understand the influence of shear behavior on the transporting properties of fluid through a single fracture, splitting fractures were made in the laboratory and shear flow tests were carried out under constant normal load conditions. The applied normal stress is in the range of 0.5-3.0 MPa. Before the physical test, the fracture's morphology is measured for identification of the roughness. At each shear step, we performed 5-8 high precise hydraulic tests with different hydraulic gradient. The relationship between pressure gradient and volume flow rate demonstrates to be nonlinear and fits very well with Forchheimer's and Izbash's laws. The linear and nonlinear coefficients in Forchheimer's law are quite sensitive to shear deformation (closure or dilation), experienced 1-2 and 1-3 orders of magnitude reduction during shear, respectively. An empirical equation is proposed to quantify the relationship between linear coefficient and nonlinear coefficient based on the experimental observations. The two coefficients in Izbash's law are quantified. The m value is in the range between 1.06 and 1.41 and the λ value experiences a reduction of 1-2 orders of magnitude during shear. In addition, the studied critical Reynolds number exhibits a decreasing and increasing variation corresponding to shear contraction and shear dilation of rock fracture. For all the cases in this study, the critical Reynolds number ranges between 1.5 and 13.0.
Browder, J.H.; Wills, E.L.
Decontamination and decommissioning (D and D) of the unused radioactively contaminated portions of the MTR-605 building at the Test Reactor Area of the Idaho National Engineering Laboratory has been completed; this final report describes the D and D project. The building is a two-story concrete structure that was used to house piping systems to channel and control coolant water flow for the Materials Testing Reactor (MTR), a 40 MW (thermal) light water test reactor that was operated from 1952 until 1970 and then deactivated. D and D project objectives were to reduce potential environmental and radioactive contamination hazards to levels as low a reasonably achievable. Primary tasks of the D and D project were: to remove contaminated piping (about 400 linear ft of 36- and 30-in.-dia stainless steel pipe) and valves from the primary coolant pipe tunnels, to remove a primary coolant pump and piping, and to remove the three 8-ft-dia by 25-ft-long evaporators from the building second floor
Kent, T.E.; Perona, J.J.; Jennings, H.L.; Lucero, A.J.; Taylor, P.A.
Laboratory and pilot-scale testing were performed for development and design of a chabazite zeolite ion-exchange system to replace existing treatment systems at the Process Waste Treatment Plant (PWTP) at Oak Ridge National Laboratory (ORNL). The process wastewater treatment systems at ORNL need upgrading to improve efficiency, reduce waste generation, and remove greater quantities of contaminants from the wastewater. Previous study indicated that replacement of the existing PWTP systems with an ion-exchange system using chabazite zeolite will satisfy these upgrade objectives. Pilot-scale testing of the zeolite system was performed using a commercially available ion-exchange system to evaluate physical operating characteristics and to validate smaller-scale column test results. Results of this test program indicate that (1) spent zeolite can be sluiced easily and completely from a commercially designed vessel, (2) clarification followed by granular anthracite prefilters is adequate pretreatment for the zeolite system, and (3) the length of the mass transfer zone was comparable with that obtained in smaller-scale column tests. Laboratory studies were performed to determine the loading capacity of the zeolite for selected heavy metals. These test results indicated fairly effective removal of silver, cadmium, copper, mercury, nickel, lead, and zinc from simple water solutions. Heavy-metals data collected during pilot-scale testing of actual wastewater indicated marginal removal of iron, copper, and zinc. Reduced effectiveness for other heavy metals during pilot testing can be attributed to the presence of interfering cations and the relatively short zeolite/wastewater contact time. Flocculating agents (polyelectrolytes) were tested for pretreatment of wastewater prior to the zeolite flow-through column system. Several commercially available polyelectrolytes were effective in flocculation and settling of suspended solids in process wastewater
Martin-Domenech, Rafael; Munoz Caro, Guillermo; Cruz-Diaz, Gustavo A.; Oberg, Karin I.
Some of the processes that take place in the interstellar medium (ISM)can be simulated in laboratories on Earth under astrophysically relevant conditions. For example, the energetic processing of the ice mantles that accrete on top of dust grains in the coldest regions of the ISM, leading to the production of new species and their desorption to the gas phase. In particular, observation of complex organic molecules (COMs) in cold interstellar environments stress the need for not only a solid state formation but also for non-thermal desorption mechanisms that can account for the observed abundances in regions where thermal desorption is inhibited. Laboratory Astrophysics can be used to test different non-thermal desorption processes and extract yields than can be extrapolated to the astrophysical scenario with theoretical models. 0th generation COMs like CH3OH and H2CO can be formed at very low temperatures. In this talk, we present laboratory simulations of the UV photoprocessing of a binary ice mixture composed by water (the main component of astrophysical ices) and methane. Formation of CO