use of digital tablets eases the way to compassionate care during the COVID-19 pandemic

Objective: A patient communication program was implemented as a response to hospitals visiting restrictive policies during the COVID-19 pandemic. The aim of the program was to facilitate communication between patients and families, mainly through the use of digital tablets; thus program performance was evaluated by selecting the number of calls performed, the average call time, and the percentage of patients that used the program more than once. Methods: A communication service for hospitalized patients who did not have access to a personal electronic device or were unable to use their electronic device was launched at different MUHC hospitals. A dedicated team of re-deployed employees was available to help patients connect with their loved ones using a hospital tablet or telephone. Results: A total of 806 calls were performed between April and November 2020. Eighty one percent of the calls were performed during the non-visitors policy implementation, being video calls preferred over phone calls. The average call time was 15 min, 34% of the patients had a video call with their loved one more than once and 40% of the calls were performed in the intensive care unit. Conclusion: The patient communication program can be described as a new delivery model of compassionate care. It was effective, helped reduce patients’ isolation and met the needs of family members and caregivers during the hospital non-visitors policy directed by the Ministère de la Santé et des Services Sociaux de Québec during the Covid-19 pandemic.

Corporate entrepreneurship programmes as mechanisms to accelerate product innovations

This paper explores how firms engage in corporate entrepreneurship through programmes, and what kind of outcomes they achieve in terms of innovations. Insights are drawn from four cases of organisations that engaged in corporate entrepreneurial activities. The paper identifies two dimensions of corporate entrepreneurship programmes as idea themes, indicating whether programmes are designed with specific themes in mind, and idea ownership, indicating whether there is a dedicated team to focus on new ideas, or not. These dimensions are under the direct control of management. Based on these two dimensions, four models of corporate entrepreneurial activities are presented linking each of these models to one of the four cases of product innovations (product line extensions, product improvements, new products, start-up businesses). By drawing on the insights of the effectuation and causation logics, the paper provides a fresh perspective of corporate entrepreneurship programmes in an emerging, non-Western cultural setup and the product innovation context. This is primarily done by introducing a 2 × 2 matrix regarding corporate entrepreneurship idea themes and idea ownership in an emerging context.

National hospital readiness for COVID-19 in Lesotho: evidence for oxygen ecosystem strengthening

SETTING:Sub-Saharan African country, Lesotho, during the SARS-CoV-2 COVID-19 pandemic.OBJECTIVE: To evaluate COVID-19 hospital capacity in Lesotho.DESIGN: We conducted a pragmatic assessment of all public hospitals in Lesotho using a WHO COVID-19 hospital assessment tool during July 2020 (baseline), with targeted follow-up in December 2020. We adapted the WHO tool into a questionnaire with a focus on hospital services and included oxygen ecosystem elements (pulse oximeters, oxygen, and advanced respiratory care). We converted qualitative questionnaire answers into quantitative ordinal variables and used standard statistics for analysis.RESULTS: At baseline, we found all 12 questionnaire domains demonstrate both hospital preparedness and weakness in infection prevention and control. Key baseline gaps were lack of a dedicated team, and insufficient personal protective equipment and space for donning and doffing. Substantial limitations were noted in hypoxemia diagnosis and treatment; information management and care coordination pathways were also suboptimal. Targeted follow-up after 5 months revealed improvement in the availability of pulse oximetry, oxygen capacity, and heated high-flow nasal cannula devices.CONCLUSION: Our baseline findings may reflect uneven early pandemic care quality; targeted follow-up suggests strengthening of the oxygen ecosystem.

Adopting a Modern Dev+Ops Model

Modern Dev+Ops is allowing organizations to meet the evolving needs of their customers faster and more consistently by closing the gap between dev and ops functions.Companies of all shapes and sizes have tossed aside waterfall product management cycles and embraced agile and DevOps for the promise of faster innovation, improved security, performance, and resilience, as well as happier developers and customers. But even with all of the benefits of DevOps, it isn’t perfect. DevOps came into existence before developing and hosting applications in the cloud was a standard practice, and though it has been around for a long time, it is still largely open to interpretation from one organization to the other. For example, many organizations still consider DevOps to be a dedicated team, and in other cases, it can mean developers doing all of the operations work. As technology has evolved, so has our definition of DevOps. We call this approach Modern Dev+Ops, andit is centered around bringing developers and operations closer by sharing operational tasks like compliance, observability, resilience, and infrastructure earlier into the development process and enhancing it with AI/ML.

The feasibility of algorithm-based ECG interpretation in remote monitoring – 53,748 recordings from the Dutch HartWacht program

Background Symptom driven remote monitoring programs for cardiac arrhythmias hold great promise, but scalability is limited due to high additional workload for healthcare providers. The Dutch HartWacht arrhythmia program consists of a connected single lead ECG device operated remotely by the patient, an algorithm for classification and a dedicated team of specialized nurses and cardiologists for additional remote interpretation. Correct classification as sinus rhythm (SR) by the algorithm would reduce workload of the HartWacht team, as it makes double-checking redundant. Purpose We investigated agreement of the ECG-classification between the algorithm and the HartWacht team and determined feasibility of the algorithm to classify sinus rhythm (SR). Methods We investigated the algorithm accompanying a single lead, handheld ECG-device that is integrated in the Dutch HartWacht program. We retrospectively studied the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the algorithm for classifying SR on home measured 30-second single lead ECGs. We included all recordings that were classified as SR by the algorithm. We used the classification of the HartWacht team as a reference standard. Results Between April 2020 and January 2021, 1,671 patients with (suspected) arrhythmias (female = 982 (59%), mean age = 58 (±15) years, participating in the HartWacht program, recorded 53,748 ECGs, of which the algorithm interpreted 35,388 (66%) as SR, 10,899 (20%) as possible AF and 7,461 (14%) as other. All recordings were also interpreted by the HartWacht team. Compared to the classification by the team, the algorithm showed a sensitivity for SR of 0.953, specificity of 0.985, PPV of 0.996 and NPV of 0.841. A total of 137 (0,3%) ECGs from 50 (2,8%) patients showed false positive outcomes, classifying recordings as SR while the HartWacht team detected arrhythmias. In 42 of those patients, arrhythmias were detected by the algorithm in other recordings within the program. The remaining 8 (0,5%) patients made a total of 14 (<0,1%) recordings with false positive outcomes without having any other recordings with arrhythmias within the HartWacht program. Conclusion For classifying SR in home measured single lead ECGs, the algorithm and the HartWacht team showed a nearly perfect agreement. The recordings without agreement did not lead to relevant individual changes in diagnostic or therapeutic strategy for the patient. Therefore, the algorithm is feasible as standalone classification. With 66% of the recordings within the HartWacht program showing SR, a corresponding workload reduction can be achieved which importantly increases scalability and cost-effectiveness of remote monitoring of arrhythmia patients. Funding Acknowledgement Type of funding sources: None.

Pass On What You Have Learned: A Structured Mentor-Mentee Concept for the Implementation of a Minimally Invasive Mitral Valve Surgery Program

<b><i>Introduction:</i></b> Starting a minimally invasive cardiac surgery (MICS) for mitral valve repair (MVR) program is challenging as it requires a new learning curve, but compromising surgical results at the same time is not acceptable. Here, we describe our surgical educational experience of starting a new MICS program at a university heart center in Germany. <b><i>Methods:</i></b> A dedicated team for the new MICS program including 2 cardiac surgeons, 1 cardiac anesthetist, 1 perfusionist, and 1 scrub nurse was chosen. The use of long shafted instruments was trained in a low-cost self-assembled MICS simulator, and the EACTS endoscopic dry lab course was visited. Thereafter, 1 MICS center was visited for direct observation and peer-to-peer education for 6 weeks. The mentor observed the first 10 cases performed by the mentee. The surgical mitral valve expertise of 1 single cardiac surgeon was retrospectively analyzed between April 2016 and April 2021. <b><i>Results:</i></b> Before the implementation of the MICS-MVR program, 18 mitral valve operations have been performed through sternotomy between April 2016 and October 2018 including 12 replacements and 6 ring annuloplasties. After starting the MICS-MVR program, 73 mitral operations have been performed by the same surgeon of which 53 video-assisted through minithoracotomy (72.6%). 83.1% of the MICS procedures included complex repair (<i>n</i> = 38) and ring annuloplasty (<i>n</i> = 6). Open heart MV surgery was necessary in 20 patients due to concomitant procedures (<i>n</i> = 8), redo procedures (<i>n</i> = 2), severe endocarditis (<i>n</i> = 4), or contraindication for MICS such as PAD (<i>n</i> = 6). There have been no deaths, 1 stroke, and 1 cardiac vascular (RCX) complication. Two patients required conversion to sternotomy and one pericardiocentesis in the long term. <b><i>Conclusion:</i></b> Typically, excellent exposure and high repair rates of the MV has led us offer MICS approach to a majority of patients with isolated MV disease. Careful planning and a strict mentor-mentee concept facilitated a safe startup of an MICS program in a busy university heart center.

Starting A New Robotic Surgery Program for Mitral Valve Repair. Lessons Learned from The First Nine Months

(1) Background: Although transcatheter technology is rapidly growing and represents a promising strategy, the surgical approach remains the best way to repair a degenerative mitral valve regurgitation. In this context, robotic surgery is technologically the most advanced method of minimally invasive mitral valve repair. The aim of this study is to present the preliminary results of the initial single-center experience with a new robotic mitral valve repair program. (2) Methods: We retrospectively reviewed the records of patients who underwent robotic mitral valve repair at our Institution between January and September 2021. (3) Results: A total of 29 patients underwent mitral valve repair with annuloplasty and chordal implantation to treat degenerative mitral regurgitation. The procedure’s success was achieved in 97% of patients. The 30-day cardiac-related mortality was 0%. The median CPB and cross-clamp times were 189 and 111 min, respectively, with a progressive reduction from the beginning of the robotic program. (4) Conclusions: Considering all the limitations related to the small sample, the presented results of robotic mitral valve repair appear to be encouraging and acceptable. A careful patient selection, a dedicated team, and a robust experience in surgical mitral valve repair are the fundamentals to start a new robotic mitral surgery program.

Investigating the Feasibility of Multisensory Environments to Improve the Assisted Bathing Experience for Veterans With Dementia: A Clinical Trial

Objectives: This evidence-based design clinical trial assessed the feasibility of a multisensory environment (MSE) using aromatherapy, color-changing lights, and music as a behavioral intervention to calm Veterans with dementia during assisted bathing to improve the patient experience. Background: The number of Veterans with dementia is growing rapidly, along with the associated debilitating behavior challenges. The severity of these distressed behaviors that predominantly occur at bath time often necessitates costly, dangerous sedatives. Feasibility studies of nonpharmacological behavioral interventions during bathing for people with dementia are urgently needed, and research supports MSE as a viable solution. Method: Using an A–B, multiple baselines across participants design, this study tracked operational behaviors of four Veterans with dementia during bathing without and with an MSE intervention. Sessions were provided and recorded by a dedicated team of five nurses, so the study team could analyze the Veterans’ operational behaviors to understand the impact of individualized MSE during both baseline and intervention phases. Results: The results support the feasibility of MSE as a helpful, nonpharmacological behavioral intervention for Veterans with dementia during bathing. All participants experienced an overall increase in duration of positive operational behaviors and an overall decrease in duration of negative operational behaviors. Conclusions: Healthcare environments are integral components in dementia care and the use of MSE within the bathing setting appears to improve not only operational behaviors but the overall bathing experience.

Assisted peritoneal dialysis across Europe: Practice variation and factors associated with availability

Background: In Europe, the number of elderly end-stage kidney disease patients is increasing. Few of those patients receive peritoneal dialysis (PD), as many cannot perform PD autonomously. Assisted PD programmes are available in most European countries, but the percentage of patients receiving assisted PD varies considerably. Hence, we assessed which factors are associated with the availability of an assisted PD programme at a centre level and whether the availability of this programme is associated with proportion of home dialysis patients. Methods: An online survey was sent to healthcare professionals of European nephrology units. After selecting one respondent per centre, the associations were explored by χ 2 tests and (ordinal) logistic regression. Results: In total, 609 respondents completed the survey. Subsequently, 288 respondents from individual centres were identified; 58% worked in a centre with an assisted PD programme. Factors associated with availability of an assisted PD programme were Western European and Scandinavian countries (OR: 5.73; 95% CI: 3.07–10.68), non-academic centres (OR: 2.01; 95% CI: 1.09–3.72) and centres with a dedicated team for education (OR: 2.87; 95% CI: 1.35–6.11). Most Eastern & Central European respondents reported that the proportion of incident and prevalent home dialysis patients was <10% (72% and 63%), while 27% of Scandinavian respondents reported a proportion of >30% for both incident and prevalent home dialysis patients. Availability of an assisted PD programme was associated with a higher incidence (cumulative OR: 1.91; 95% CI: 1.21–3.01) and prevalence (cumulative OR: 2.81; 95% CI: 1.76–4.47) of patients on home dialysis. Conclusions: Assisted PD was more commonly offered among non-academic centres with a dedicated team for education across Europe, especially among Western European and Scandinavian countries where higher incidence and prevalence of home dialysis patients was reported.[Formula: see text]

EP.WE.433Assessment of the temporary Surgical ED Study and Audit

Aims To ascertain the effectiveness of the newly formed surgical ED during Covid-19 outbreak in terms of: Methods/Study design Retrospective cohort of 992 patients were identified and included from the period of the 5th April to 5th May 2020 Inclusion criteria: All patients attended and triaged in the new surgical emergency department. Exclusion criteria: Patients who were not triaged. Results The temporary surgical emergency department was successful in accommodating all surgical patients categorized 2, 3 and 4 with category 4 being the highest number at 45%. Hospital services were successfully accessed in 771(77.72%) during patients stay in ED including Bloods and imaging with X-ray as the most service used at 42.33%. 221(22.27%) patients didn’t require any investigations and were discharged after review by the surgical doctor within the 4-hour window. Conclusion Presence of a dedicated surgical emergency during the covid period was essential to separate medical patients from non-medical patients. Having a decision maker on the front line right after triage has reduced the overall number of admissions, number of emergency breeches and unnecessary investigations. Having a dedicated space with dedicated team could make a huge impact on the service in terms of time, effort and money spent.