Experiences of the First 16 Hospitals Using Copper-Silver Ionization forLegionellaControl: Implications for the Evaluation of Other Disinfection Modalities

2003 ◽  
Vol 24 (8) ◽  
pp. 563-568 ◽  
Author(s):  
Janet E. Stout ◽  
Victor L. Yu
Keyword(s):  
Decision Making ◽  
Evaluation Criteria ◽  
Evaluation Process ◽  
Water Systems ◽  
Evidence Based ◽  
Disinfection Methods ◽  
Legionnaires Disease ◽  
Hospital Acquired

AbstractBackground and Objectives:Hospital-acquired legionnaires' disease can be prevented by disinfection of hospital water systems. This study assessed the long-term efficacy of copper-silver ionization as a disinfection method in controllingLegionellain hospital water systems and reducing the incidence of hospital-acquired legionnaires' disease. A standardized, evidence-based approach to assist hospitals with decision making concerning the possible purchase of a disinfection system is presented.Design:The first 16 hospitals to install copper-silver ionization systems forLegionelladisinfection were surveyed. Surveys conducted in 1995 and 2000 documented the experiences of the hospitals with maintenance of the system, contamination of water withLegionella, and occurrence of hospital-acquired legionnaires' disease. All were acute care hospitals with a mean of 435 beds.Results:All 16 hospitals reported cases of hospital-acquired legionnaires' disease prior to installing the copper-silver ionization system. Seventy-five percent had previously attempted other disinfection methods including superheat and flush, ultraviolet light, and hyperchlorination. By 2000, the ionization systems had been operational from 5 to 11 years. Prior to installation, 47% of the hospitals reported that more than 30% of distal water sites yieldedLegionella. In 1995, after installation, 50% of the hospitals reported 0% positivity, and 43% still reported 0% in 2000. Moreover, no cases of hospital-acquired legionnaires' disease have occurred in any hospital since 1995.Conclusions:This study represents the final step in a proposed 4-step evaluation process of disinfection systems that includes (1) demonstrated efficacy ofLegionellaeradication in vitro using laboratory assays, (2) anecdotal experiences in preventing legionnaires' disease in individual hospitals, (3) controlled studies in individual hospitals, and (4) validation in confirmatory reports from multiple hospitals during a prolonged time (5 to 11 years in this study). Copper-silver ionization is now the only disinfection modality to have fulfilled all four evaluation criteria.

OP47 Need For New Thrombectomy Centers? A Practical Decision Framework

2019 ◽  
Vol 35 (S1) ◽  
pp. 11-11
Author(s):  
Maria Vutcovici Nicolae ◽  
Lucy Boothroyd ◽  
Leila Azzi ◽  
Laurie Lambert ◽  
Michèle de Guise
Keyword(s):  
Decision Making ◽  
Real World ◽  
Critical Mass ◽  
Evaluation Process ◽  
Field Evaluation ◽  
Stroke Care ◽  
Healthcare Services ◽  
Performance Criteria ◽  
Sources Of Information

IntroductionStroke is a major contributor to mortality, disability and long-term use of healthcare services. As for all chrono-dependant conditions, clinical results are associated with timely access to appropriate care. Thrombectomy (EVT) is an effective treatment for large vessel occlusions, but can only be provided in highly-specialized centers by experienced personnel. We sought to develop a framework to aid decision-making on the appropriateness of opening new EVT centers in Québec, Canada.MethodsData sources included provincial administrative healthcare databases, population density statistics, field evaluation of Québec's four existing EVT care networks, and literature review concerning structural and performance criteria for EVT centers. We consulted EVT clinical teams, interdisciplinary stroke experts, patients, professional association representatives, healthcare managers and decision-makers.ResultsAccess to EVT is suboptimal in all 17 regions of Québec, with virtually no access in remote areas. Results of key performance indicators indicated favorable treatment delays after arrival at the EVT center. However, door-to-needle and door-in-door-out times were long for patients transferred from non-EVT centers. High use of ambulances indicated the potential to transport patients to the most appropriate center. In light of ‘real world’ results and other sources of information, the need for a new EVT center should consider the following criteria: sub-optimal EVT access within the region; transport time to an existing EVT center >1 hour; expected patient volume within 2 hours of transport; impact on volume of existing programs; availability of long-term financial support; availability of a critical mass of neurointerventionists, vascular neurologists, and neurosurgeons; demonstrated quality of stroke care; and, presence of a stroke unit.ConclusionsThe triangulation of literature, clinician experience and the Québec context enriched the evaluation process. Furthermore, this facilitated the development of a framework that was broadly applicable across regions to the real-world setting of decision-making in a complex system of care.

scholarly journals Public trust doctrine, research and responsible wildlife management in South Africa

Bothalia ◽  
2017 ◽  
Vol 47 (2) ◽  
Author(s):  
Andrew C. Blackmore
Keyword(s):  
Decision Making ◽  
Wildlife Management ◽  
Environmental Law ◽  
Sustainable Use ◽  
Significant Proportion ◽  
Public Trust ◽  
Evidence Based ◽  
The Public ◽  
Public Trust Doctrine

A significant proportion of South African biodiversity occurs in extensive private wildlife areas. As such, the continuance of these private reserves is paramount to conservation of the country’s biodiversity. The areas are, however, vulnerable to being divided into smaller camps as landowners enter into the new and rapidly growing industry of selective breeding and intensive management of antelope and predators. Concerns are being raised as to the long-term consequences of the products and impacts of this industry on, inter alia, integrity and conservation of the country’s wildlife, and the landscapes these facilities are located in, as well as the country’s reputation as a free ranging and fair chase hunting destination. Using the public trust doctrine as a foundation, this article characterises the relationship between the country’s environmental law and the roles played by government as the regulator, the wildlife industry, research and the public in achieving responsible wildlife management and the long-term conservation of this resource. These relationships are seen to be finely balanced between the provision of robust science, and evidence-based and cautious or risk-averse decision-making. It is concluded that the public trust doctrine is a powerful tool to limit the impacts of unsustainable and parochial use of wildlife on the conservation of biodiversity. It is also concluded that an improved understanding of the doctrine by researchers, public and the wildlife industry would lead to a greater relevance of research, and in turn sound evidence-based decision-making and ultimately sustainable use of wildlife.

scholarly journals Desenvolvimento e Avaliação de uma Plataforma Colaborativa Digital para Educação e Tomada de Decisão Médica Baseada em Evidências

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based ◽  
Life Problems

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

Implementation of Case Costing with Ontario Case Costing Initiative (OCCI)

2013 ◽  
pp. 79-88
Author(s):  
Thuy Thi Thanh Hoang
Keyword(s):  
Decision Making ◽  
Health Care Professionals ◽  
Long Term Care ◽  
Statistical Data ◽  
Evidence Based ◽  
Term Care ◽  
Patient Level ◽  
Evidence Based Decision Making ◽  
Gain Access

Over the past decade there has been a tremendous spread of computerized systems in hospitals. The advancement provided an opportunity for hospitals to gain access to computerized clinical, financial, and statistical data. Case costing information is the integration of clinical, financial, and statistical data to provide costing information at the patient level. Ontario Case Costing Initiative (OCCI) is an undertaking of the Ontario Ministry of Health and Long-Term Care (MOHLTC). This chapter focuses on the implementation of case costing using OCCI as a guideline for a hospital. It addresses the process of implementation by discussing proposals for planning, implementing, transitioning, and evaluation of case costing. The adoption of the OCCI allows health care professionals to analyze integrated health information and further enables evidence-based decision making.

scholarly journals Properly Accounting for Domestic Violence in Child Custody Cases: An Evidence-Based Analysis and Reform Proposal

2019 ◽  
pp. 1
Author(s):  
Debra Stark ◽  
Jessica Choplin ◽  
Sarah Wellard
Keyword(s):  
Decision Making ◽  
Domestic Violence ◽  
Literature Review ◽  
Best Practices ◽  
Family Law ◽  
The Other ◽  
Evidence Based ◽  
Abusive Parent ◽  
Domestic Violence Survivors

Promoting the best interests of children and protecting their safety and well-being in the context of a divorce or parentage case where domestic violence has been alleged has become highly politicized and highly gendered. There are claims by fathers’ rights groups that mothers often falsely accuse fathers of domestic violence to alienate the fathers from their children and to improve their financial position. They also claim that children do better when fathers are equally involved in their children’s lives, but that judges favor mothers over fathers in custody cases. As a consequence, fathers’ rights groups have engaged in a nationwide effort to reform the custody laws to create a presumption of equal parenting time, with no exception when one of the parents has engaged in domestic violence. Domestic violence survivors and their advocates, however, claim that the needs of survivors of domestic violence and their children to be safe and free from further abuse are not being met in custody cases, that their claims of abuse are not being believed, and that the harm when a parent commits domestic violence against the other parent is not being recognized and addressed by judges and the family law professional upon whom they rely. This Article first presents a literature review, with articulated scientific standards applied to each of the pieces of research cited in this review, on what is happening outside of court and in court relating to domestic violence and best practices for taking domestic violence into account in these child custody cases. Among the key findings from this literature review are: (1) when a parent commits domestic violence against the other parent, this can cause serious long-term harm to children, (2) custody judgments tend to favor fathers over mothers because greater weight is placed on claims of alienation than on domestic violence claims, (3) long-term harms can be mitigated by evidence-based best practices, most notably, supporting non-abusive parents in their efforts to protect themselves and their children from further domestic violence, (4) family law judges and professionals must be trained on domestic violence and its nuances, as well as how to screen for domestic violence, to adequately support them, and (5) a component of this training is learning how to distinguish mutual “situational couple violence” for which “parallel parenting” custody arrangements might be feasible, from a pattern of “coercive abuse,” where sole decision-making and primary parenting time should be ordered to the non-abusive parent, and protective restrictions on parenting time should be ordered to the abusive parent. The Article then reports on a fifty-state review of custody-related laws (laws determining which parent makes major decisions relating to the child, who is allocated primary parenting time, and whether protective restrictions shall be placed on the parenting time of a parent who has engaged in domestic violence). This review found serious gaps between what evidence-based best practices suggest, and what is currently required by law in many states. These gaps in the law, including the failure of the law to require domestic violence screening and training for judges and other family law professionals, contribute to poor custody decision-making by them that compromises the safety and welfare of domestic violence survivors and their children. The Article then proposes nuanced law reforms that would align custody-related laws with evidence-based best practices for taking domestic violence into account in custody cases, including creating rebuttable presumptions, burdens of proof, and definitions of domestic violence that conform with these evidence-based best practices.

scholarly journals Coercive Measures in Psychiatry: A Review of Ethical Arguments

2021 ◽  
Vol 12 ◽  
Author(s):  
Marie Chieze ◽  
Christine Clavien ◽  
Stefan Kaiser ◽  
Samia Hurst
Keyword(s):  
Decision Making ◽  
Evaluation Process ◽  
Well Being ◽  
Fundamental Rights ◽  
Involuntary Hospitalization ◽  
Coercive Measures ◽  
Freedom Of Movement ◽  
Procedural Values ◽  
Further Development

Introduction: Coercion is frequent in clinical practice, particularly in psychiatry. Since it overrides some fundamental rights of patients (notably their liberty of movement and decision-making), adequate use of coercion requires legal and ethical justifications. In this article, we map out the ethical elements used in the literature to justify or reject the use of coercive measures limiting freedom of movement (seclusion, restraint, involuntary hospitalization) and highlight some important issues.Methods: We conducted a narrative review of the literature by searching the PubMed, Embase, PsycINFO, Google Scholar and Cairn.info databases with the keywords “coercive/compulsory measures/care/treatment, coercion, seclusion, restraint, mental health, psychiatry, involuntary/compulsory hospitalization/admission, ethics, legitimacy.” We collected all ethically relevant elements used in the author's justifications for or against coercive measures limiting freedom of movement (e.g., values, rights, practical considerations, relevant feelings, expected attitudes, risks of side effects), and coded, and ordered them into categories.Results: Some reasons provided in the literature are presented as justifying an absolute prohibition on coercion; they rely on the view that some fundamental rights, such as autonomy, are non-negotiable. Most ethically relevant elements, however, can be used in a balanced weighting of reasons to favor or reject coercive measures in certain circumstances. Professionals mostly agree that coercion is only legitimate in exceptional circumstances, when the infringement of some values (e.g., freedom of movement, short-term autonomy) is the only means to fulfill other, more important values and goals (e.g., patient's safety, the long-term rebuilding of patient's identity and autonomy). The results of evaluations vary according to which moral elements are prioritized over others. Moreover, we found numerous considerations (e.g., conditions, procedural values) for how to ensure that clinicians apply fair decision-making procedures related to coercion. Based on this analysis, we highlight vital topics that need further development.Conclusion: Before using coercive measures limiting freedom of movement, clinicians should consider and weigh all ethically pertinent elements in the situation and actively search for alternatives that are more respectful of patient's well-being and rights. Coercive measures decided upon after a transparent, carefully balanced evaluation process are more likely to be adequate, understood, and accepted by patients and caregivers.

Benchmarking knowledge management practices in small and medium enterprises

2017 ◽  
Vol 24 (5) ◽  
pp. 1215-1233 ◽  
Author(s):  
Santoso Wibowo ◽  
Srimannarayana Grandhi
Keyword(s):  
Decision Making ◽  
Group Decision Making ◽  
Group Decision ◽  
Small And Medium Enterprises ◽  
Evaluation Criteria ◽  
Evaluation Process ◽  
Decision Makers ◽  
Content Type ◽  
Multicriteria Group Decision Making ◽  
Medium Enterprises

Purpose The purpose of this paper is to formulate the process of measuring and benchmarking the performance of knowledge management (KM) practices as a multicriteria group decision-making problem and present a new multicriteria group decision-making approach for effectively evaluating the performance of KM practices to meet the interests of various stakeholders in small and medium enterprises (SMEs). Design/methodology/approach A new multicriteria group decision-making approach is developed for evaluating the performance of KM practices of individual SMEs. Intuitionistic fuzzy numbers are used for representing the subjective assessments of decision makers in evaluating the relative importance of the evaluation criteria and the performance of individual KM practices with respect to specific evaluation criteria. A fuzzy multicriteria group decision-making algorithm is developed for measuring and benchmarking the performance of alternative KM practices. Findings The proposed multicriteria group decision-making approach is capable of effectively evaluating the performance of KM practices through adequately considering the presence of multiple decision makers, the multi-dimensional nature of the evaluation problem, and appropriately modeling the subjectiveness and imprecision of the evaluation process. The presentation of an example shows that the proposed fuzzy multicriteria group decision-making algorithm is simple to use and efficient in computation. Research limitations/implications The outcome of the multicriteria group decision-making approach is highly dependent on the inputs provided by the decision maker. Practical implications The novelty from this research lies in the utilization of a multicriteria group decision-making approach for evaluating the performance of KM practices in an organization. The outcome from the performance evaluation process allows the enterprise to adopt appropriate KM practices for achieving competitive advantages. Social implications The proposed multicriteria group decision-making approach has a significant social implication as it can be used as a decision-making tool for providing various decision makers in SMEs with useful and strategic information concerning the performance of KM practices in a given situation. Originality/value The originality of this paper lies in the development of the multicriteria group decision-making approach for effectively measuring and benchmarking the performance of KM practices of individual SMEs.

ControllingLegionellain Hospital Drinking Water: An Evidence-Based Review of Disinfection Methods

2011 ◽  
Vol 32 (2) ◽  
pp. 166-173 ◽  
Author(s):  
Yusen E. Lin ◽  
Janet E. Stout ◽  
Victor L. Yu
Keyword(s):  
Drinking Water ◽  
Water System ◽  
Preventive Measure ◽  
Laboratory Assessment ◽  
Disinfection Methods ◽  
Point Of Use ◽  
Drinking Water System ◽  
Infection Control Practitioner ◽  
Legionnaires Disease ◽  
Hospital Acquired

Hospital-acquired Legionnaires' disease is directly linked to the presence ofLegionellain hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time. In this review, we evaluate systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfection methods in outbreak situations (superheat-and-flush with or without hyperchlorination). The infection control practitioner should take the lead in selection of the disinfection system and the vendor. Formal appraisals by other hospitals with experience of the system under consideration is indicated. Routine performance of surveillance cultures of drinking water to detectLegionellaand monitoring of disinfectant concentrations are necessary to ensure long-term efficacy.

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