scholarly journals Systemic Problem Structuring in a Complex Hospital Environment using Viable System Diagnosis – Keeping the Blood Flowing

2021 ◽  
Author(s):  
Maren Berge Vik ◽  
Hanne Finnestrand ◽  
Robert L. Flood
Keyword(s):  
Orthopedic Surgery ◽  
Complex Form ◽  
Hospital Environment ◽  
Problem Structuring ◽  
Large Hospital ◽  
Systemic Thinking ◽  
System Diagnosis ◽  
Human Organization ◽  
Set Up ◽  
Viable System

AbstractThis article presents the application of the systemic problem structuring approach Viable System Diagnosis (VSD) within the Department of Orthopedic Surgery in a large hospital in Norway. It explains why systemic thinking is relevant to this uniquely complex form of human organization. The department was coping with systemic dysfunction and VSD was chosen because previous applications demonstrated VSD excels at diagnosis of what is causing dysfunction. VSD was employed through a participatory framework that included in the process, among other stakeholders, medics, technologists, managers, administrators and, as far as possible given the sensitive nature of patient information, the patient. VSD guided thinking about what the organization is set up to do and the existing organizational arrangements to achieve that. The outcome was an agenda for debate that guided stakeholder discussions toward ways and means of improving organizational arrangements. The article briefly reviews previous applications of VSD in the hospital sector and other large complex organisations.

scholarly journals Outbreak of Mupirocin-Resistant Staphylococci in a Hospital in Warsaw, Poland, Due to Plasmid Transmission and Clonal Spread of Several Strains

1999 ◽  
Vol 37 (9) ◽  
pp. 2781-2788 ◽  
Author(s):  
Tomasz A. Łe˛ski ◽  
Marek Gniadkowski ◽  
Anna Skoczyńska ◽  
Elz˙bieta Stefaniuk ◽  
Krzysztof Trzciński ◽  
...  
Keyword(s):  
Resistance Mechanisms ◽  
Hospital Environment ◽  
Coagulase Negative Staphylococci ◽  
Large Hospital ◽  
Methicillin Resistant ◽  
Inappropriate Use ◽  
Clonal Spread ◽  
High Level ◽  
Almost All ◽  
Level Resistance

An outbreak of mupirocin-resistant (MuR) staphylococci was investigated in two wards of a large hospital in Warsaw, Poland. Fifty-three MuR isolates of Staphylococcus aureus, S. epidermidis, S. haemolyticus, S. xylosus, and S. capitis were identified over a 17-month survey which was carried out after introduction of the drug for the treatment of skin infections. The isolates were collected from patients with infections, environmental samples, and carriers; they constituted 19.5% of all staphylococcal isolates identified in the two wards during that time. Almost all the MuR isolates were also resistant to methicillin (methicillin-resistant S. aureus and methicillin-resistant coagulase-negative staphylococci). Seven of the outbreak isolates expressed a low-level-resistance phenotype (MuL), whereas the remaining majority of isolates were found to be highly resistant to mupirocin (MuH). The mupA gene, responsible for the MuH phenotype, has been assigned to three different polymorphic loci among the strains in the collection analyzed. The predominant polymorph, polymorph I (characterized by a mupA-containingEcoRI DNA fragment of about 16 kb), was located on a specific plasmid which was widely distributed among the entire staphylococcal population. All MuR S. aureus isolates were found to represent a single epidemic strain, which was clonally disseminated in both wards. The S. epidermidis population was much more diverse; however, at least four clusters of closely related isolates were identified, which suggested that some strains of this species were also clonally spread in the hospital environment. Six isolates of S. epidermidis were demonstrated to express the MuL and MuH resistance mechanisms simultaneously, and this is the first identification of such dual MuR phenotype-bearing strains. The outbreak was attributed to a high level and inappropriate use of mupirocin, and as a result the dermatological formulation of the drug has been removed from the hospital formulary.

scholarly journals Whole Genome Sequencing of SARS-CoV-2: Adapting Illumina Protocols for Quick and Accurate Outbreak Investigation during a Pandemic

Genes ◽  
2020 ◽  
Vol 11 (8) ◽  
pp. 949 ◽  
Author(s):  
Sureshnee Pillay ◽  
Jennifer Giandhari ◽  
Houriiyah Tegally ◽  
Eduan Wilkinson ◽  
Benjamin Chimukangara ◽  
...  
Keyword(s):  
South Africa ◽  
Real Time ◽  
Control Strategies ◽  
Outbreak Investigation ◽  
Infection Prevention And Control ◽  
Library Preparation ◽  
Large Hospital ◽  
Preparation Methods ◽  
Hospital Outbreak ◽  
Set Up

The COVID-19 pandemic has spread very fast around the world. A few days after the first detected case in South Africa, an infection started in a large hospital outbreak in Durban, KwaZulu-Natal (KZN). Phylogenetic analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes can be used to trace the path of transmission within a hospital. It can also identify the source of the outbreak and provide lessons to improve infection prevention and control strategies. This manuscript outlines the obstacles encountered in order to genotype SARS-CoV-2 in near-real time during an urgent outbreak investigation. This included problems with the length of the original genotyping protocol, unavailability of reagents, and sample degradation and storage. Despite this, three different library preparation methods for Illumina sequencing were set up, and the hands-on library preparation time was decreased from twelve to three hours, which enabled the outbreak investigation to be completed in just a few weeks. Furthermore, the new protocols increased the success rate of sequencing whole viral genomes. A simple bioinformatics workflow for the assembly of high-quality genomes in near-real time was also fine-tuned. In order to allow other laboratories to learn from our experience, all of the library preparation and bioinformatics protocols are publicly available at protocols.io and distributed to other laboratories of the Network for Genomics Surveillance in South Africa (NGS-SA) consortium.

CHROMagarTM Candida Plus: A novel chromogenic agar that permits the rapid identification of Candida auris

2020 ◽  
Author(s):  
Andrew M Borman ◽  
Mark Fraser ◽  
Elizabeth M Johnson
Keyword(s):  
Candida Species ◽  
Rapid Identification ◽  
Hospital Environment ◽  
Candida Auris ◽  
Large Hospital ◽  
Pathogenic Yeast ◽  
Isolation Medium ◽  
Wide Range ◽  
Chromogenic Agar ◽  
Environment Identification

Abstract   Candida auris is a serious nosocomial health risk, with widespread outbreaks in hospitals worldwide. Successful management of such outbreaks has depended upon intensive screening of patients to identify those that are colonized and the subsequent isolation or cohorting of affected patients to prevent onward transmission. Here we describe the evaluation of a novel chromogenic agar, CHROMagarTM Candida Plus, for the specific identification of Candida auris isolates from patient samples. Candida auris colonies on CHROMagarTM Candida Plus are pale cream with a distinctive blue halo that diffuses into the surrounding agar. Of over 50 different species of Candida and related genera that were cultured in parallel, only the vanishingly rare species Candida diddensiae gave a similar appearance. Moreover, both the rate of growth and number of colonies of C. auris recovered from swabs of pure and mixed Candida species were substantially increased on CHROMagarTM Candida Plus agar when compared with growth on the traditional mycological isolation medium, Sabouraud dextrose agar. Taken together, the present data suggest that CHROMagarTM Candida Plus agar is an excellent alternative to current conventional mycological media for the screening of patients who are potentially colonized/infected with Candida auris, can be reliably used to identify this emerging fungal pathogen, and should be tested in a clinical setting. Lay Abstract Candida auris is a novel pathogenic yeast that has been associated with large hospital outbreaks across several continents. Affected patients become colonized, predominantly on the skin, with large quantities of C. auris which they then shed into the hospital environment. Identification of C. auris is challenging using routine laboratory methods, and time consuming when patients are colonized with a mixture of different Candida species. Here we demonstrate that a novel chromogenic agar, CHROMagarTM Candida Plus, permits the rapid differentiation of C. auris from a wide range of other yeast species and is potentially ideally suited to screening of patients that are suspected of being colonized or infected with this medically important yeast.

Singularities at the Tip of a Crack Terminating Normally at an Interface Between Two Orthotropic Media

1996 ◽  
Vol 63 (2) ◽  
pp. 264-270 ◽  
Author(s):  
J. C. Sung ◽  
J. Y. Liou
Keyword(s):  
Characteristic Equation ◽  
Complex Form ◽  
Stress Singularities ◽  
Real Form ◽  
Antisymmetric Mode ◽  
Real Roots ◽  
Complex Roots ◽  
Principal Axes ◽  
Orthotropic Media ◽  
Set Up

The order of stress singularities at the tip of a crack terminating normally at an interface between two orthotropic media is analyzed. Characteristic equation in complex form for the power of singularity s, where 0 < Re{s} < 1, is first set up for two general anisotropic materials. Attention is then focused on the problem that is composed by two orthotropic media where one of them (say, material #2 ) the material principal axes are aligned while the other one (say, material #1) the principal axes can have an angle γ relative to the interface. For such a problem, a real form of the characteristic equation is obtained. The roots are functions of γ in general. Two real roots exist for most values of γ; however, there are possible ranges of γ that the complex roots will occur. The roots s are found to be independent of γ when material #1 has the property that δ(1) = 1. When γ = 0, two roots are always real. Furthermore, each of these two roots is associated with symmetric or antisymmetric mode and they become equal when Δ = 1. Many other features of the effects of the material parameters on the behaviors of the roots s are further investigated in the present work, where the six generalized Dundurs’ constants, expressed in terms of Krenk’s parameters, play an important role in the analysis.

scholarly journals Work Ability Assessment in Nursing Workers

2021 ◽  
Vol 9 (7) ◽  
pp. 282-294
Author(s):  
Camila Santos Pereira ◽  
Rosuita Frattari Bonito ◽  
Douglas Eulálio Antunes
Keyword(s):  
Work Ability ◽  
Work Capacity ◽  
Hospital Environment ◽  
Physical And Mental Health ◽  
Work Ability Index ◽  
Large Hospital ◽  
Cross Sectional ◽  
Significance Level ◽  
Ability Index ◽  
Nursing Professionals

Objective: To identify the nursing staff of a university hospital's work ability index and point out which factors interfere in the quality of the work of these workers. Method: This is a cross-sectional, descriptive and analytical survey, quantitative, composed of 54 nursing professionals from the medical clinic ward sector of a large hospital in Uberlândia (Minas Gerais, Brazil). Data collection is performed using two tools: sociodemographic questionnaire and Work Ability Index (WAI). The G-Test by Williams was applied to assess the significant association between sociodemographic and occupational variables and those related to the work ability index. It was used the BioEstat® version 5.3 program to perform all analyzes with a significance level of 0.05 (5%). Results: The research showed that nursing professionals had a predominance of good workability (40,7%), the prevalence of young adults, the highest percentage between 31-40 years, 81,5% are women, 50% are in a marital relationship, 63% are open to public tender, and they had no back injuries. It was also found that the only professionals who had a low work capacity were nursing technicians, corresponding to 5,6% of the total percentage. Conclusion: It is known that a hospital environment is a place that favors the illness process of nursing workers. The worker who owns and maintains adequate physical and mental health can perform his duties better and have a better capacity for work, therefore taking better care of the patient.

scholarly journals Molecular characterization of Prototheca in 11 symptomatic dogs

2020 ◽  
Vol 33 (1) ◽  
pp. 156-161
Author(s):  
Christian Falcaro ◽  
Tommaso Furlanello ◽  
Diana Binanti ◽  
Alessandra Fondati ◽  
Ugo Bonfanti ◽  
...  
Keyword(s):  
28S Rrna ◽  
Negative Results ◽  
System Diagnosis ◽  
Formalin Fixed Paraffin ◽  
Mitochondrial Cytochrome B ◽  
Uncommon Disease ◽  
Formalin Fixed Paraffin Embedded ◽  
Set Up ◽  
Pcr Targeting

Protothecosis is an uncommon disease caused by algae of the genus Prototheca. In dogs, the infection is usually first localized to the colon but has the propensity to later disseminate hematogenously to many other organs, with marked tropism for the eyes and central nervous system. Diagnosis is established by culture and/or evidence of Prototheca organisms in cytologic or histologic preparations. Species characterization, however, requires molecular investigations. Our laboratory set up a real-time PCR targeting portion D1/D2 of the 28S rRNA for identification of Prototheca species from both positive cultures (of rectal swabs and urine) and formalin-fixed, paraffin-embedded tissue. Prototheca bovis, P. ciferrii, and P. wickerhamii were characterized in 11 dogs with systemic or cutaneous protothecosis. Prototheca identifications were phylogenetically consistent with the new taxonomy proposed for this genus based on the mitochondrial cytochrome b gene. As a pilot study, we screened feces and rectal scrapes from 200 asymptomatic dogs, using 2 cohorts of stray and owned animals, to determine the prevalence of intestinal carriage of Prototheca spp. The Prototheca-negative results from both cohorts of healthy dogs suggest that predisposing factors related to the host probably contribute more to the acquisition of clinical disease than exposure to contaminated environments.

scholarly journals Clinical learning environment in government and private hospitals in relation to gender in Karachi, Pakistan - a comparative study

2015 ◽  
Vol 4 (2) ◽  
pp. 9
Author(s):  
Sharmeen Amin ◽  
Zafeer Ahmed Yazdani ◽  
Ghazala Usman
Keyword(s):  
Learning Environment ◽  
Clinical Skills ◽  
Hospital Environment ◽  
Striking Difference ◽  
Theoretical Knowledge ◽  
University Hospitals ◽  
Clinical Learning Environment ◽  
Private Hospitals ◽  
Hands On ◽  
Set Up

Introduction: Background: The Medical Education has two most essential basis, sound theoretical knowledge and proficient clinical skills. Both of these factors depend on an efficient method of teaching in a proper clinical set-up. So that the medical students get most of the benefit out of it by learning and developing their clinical skills. Objective: The main objectives of this study are to determine the presence of difference in the learning environment in government and private hospitals of Karachi and to determine whether there is any biasness present in these systems on the basis of gender of students.Methods: Four renowned university hospitals were selected: two private and two government-based. 150 samples were collected from each university by a self-administered questionnaire. The analysis has been performed using SPSS 20 and the results are presented using chi square.Results: The study established that there is a striking difference between the learning environment in these clinical set-ups based on the theoretical knowledge of the students, the proper schedule of classes, hands on experience gained in the ward, new knowledge gained at the end of a wards rotation, doctors’ interaction with the students and the students’ motivation. This was represented by the 2 = 10.173 and p .00001. MG = 5.73 with a SD = 1.815 while MP = 6.76 with a SD = 1.883 (M = mean, G = Government hospital environment, P = Private hospital environment). According to the study there is no difference in treatment of the students on the basis of gender represented by the 2= 3.168 and a p is between .05 and .1.Conclusions: The private hospitals provide a sound theoretical knowledge to the students they lack the provision of optimum opportunities for the students to develop their clinical skills in comparison with government hospitals. It is however recommendable that both the systems lack any biasedness among the students on the basis of gender.

scholarly journals Hospitals

2008 ◽  
Vol 1 (2) ◽  
Author(s):  
Judith Godden
Keyword(s):  
Hospital Care ◽  
Striking Feature ◽  
Level Of Care ◽  
Large Hospital ◽  
Hospital Governance ◽  
European Institutions ◽  
Role Of The State ◽  
Set Up ◽  
The Impact

A hospital was one of the first European institutions set up in Australia in 1788. The aim in this article is to summarise the ensuring events, and particularly to demonstrate how hospitals have dramatically changed. One theme is to clarify the nature of convict hospitals and the low level of care expected in charity hospitals during the nineteenth and early twentieth centuries. Other themes are the impact of medical innovations, and the strong and increasingly interventionist role of the state in hospital governance. More recently, a theme has been the closure of small hospitals and the development of large hospital complexes. Throughout, the role of nurses has been crucial as they have provided the bulk of hospital care. Hospitals have always been plagued by scandals but the striking feature throughout their history in Sydney is the strength of the demand for hospital care.

Ambient Intelligence for Monitoring Alzheimer Patients

2013 ◽  
Vol 4 (1) ◽  
pp. 23-35 ◽  
Author(s):  
Walid Bourennane ◽  
Yoann Charlon ◽  
Fehd Bettahar ◽  
Marie Chan ◽  
Daniel Esteve ◽  
...  
Keyword(s):  
System Architecture ◽  
Web Application ◽  
Independent Living ◽  
Ambient Intelligence ◽  
Hospital Environment ◽  
Integrated Systems ◽  
Infrared Sensors ◽  
Decision Algorithm ◽  
Distributed Sensors ◽  
Set Up

Distributed sensors allow people to be followed in independent living situations. In this paper, the authors present a multisensor system which allows monitoring elderly people in hospital environment. The system is composed of motion infrared sensors installed in the ceiling, presence sensor in bed and ZigBee tags embedded on the person. From data collected on locations and movements of people, the system determines, through learning, the behavior model and lifestyle. Analysis and decision algorithm in integrated systems provide the functionality to choose actions in order to alert surveillance team and help them by providing historical events record. A web application is also set up to display results of data processing allowing caregivers to monitor patient behavior. Here, they present the system architecture, the technology used, and some preliminary results.

scholarly journals Paramedic delivery of bad news: a novel dilemma during the COVID-19 crisis

2020 ◽  
Vol 47 (1) ◽  
pp. 16-19
Author(s):  
Iain Campbell
Keyword(s):  
Ethical Dilemma ◽  
Current Practice ◽  
Family Members ◽  
Bad News ◽  
Hospital Environment ◽  
New Model ◽  
Global Pandemic ◽  
Set Up ◽  
The Uk ◽  
Bad News Delivery

As a result of the COVID-19 global pandemic, paramedics in the UK face unprecedented challenges in the care of acutely unwell patients and their family members. This article will describe and discuss a new ethical dilemma faced by clinicians in the out-of-hospital environment during this time, namely the delivery of bad news to family members who are required to remain at home and self-isolate while the critically unwell patient is transported to hospital. I will discuss some failings of current practice and reflect on some of the ethical and practical challenges confronting paramedics in these circumstances. I conclude by making three recommendations: first, that dedicated pastoral outreach teams ought to be set up during pandemics to assist family members of patients transported to hospital; second, I offer a framework for how bad news can be delivered during a lockdown in a less damaging way; and finally, that a new model of bad news delivery more suited for unplanned, time-pressured care should be developed.

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