Positive Deviance A New Strategy for Improving Hand Hygiene Compliance

2010 ◽  
Vol 31 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Alexandre R. Marra ◽  
Luciana Reis Guastelli ◽  
Carla Manuela Pereira de Araújo ◽  
Jorge L. Saraiva dos Santos ◽  
Luiz Carlos R. Lamblet ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Positive Deviance ◽  
Incidence Density ◽  
Second Phase ◽  
The West ◽  
The Third ◽  
Third Phase ◽  
Significant Difference ◽  
Step Down ◽  
Hygiene Compliance

Objective.To evaluate the effectiveness of a positive deviance strategy for the improvement of hand hygiene compliance in 2 adult step-down units.Design.A 9-month, controlled trial comparing the effect of positive deviance on compliance with hand hygiene.Setting.Two 20-bed step-down units at a tertiary care private hospital.Methods.The first phase of our study was a 3-month baseline period (from April to June 2008) in which hand hygiene episodes were counted by use of electronic handwashing counters. From July to September 2008 (ie, the second phase), a positive deviance strategy was implemented in the east unit; the west unit was the control unit. During the period from October to December 2008 (ie, the third phase), positive deviance was applied in both units.Results.During the first phase, there was no statistically significant difference between the 2 step-down units in the number of episodes of hand hygiene per 1,000 patient-days or in the incidence density of healthcare-associated infections (HAIs) per 1,000 patient-days. During the second phase, there were 62,000 hand hygiene episodes per 1,000 patient-days in the east unit and 33,570 hand hygiene episodes per 1,000 patient-days in the west unit (P < .01). The incidence density of HAIs per 1,000 patient-days was 6.5 in the east unit and 12.7 in the west unit (P = .04). During the third phase, there was no statistically significant difference in hand hygiene episodes per 1,000 patient-days (P = .16) or in incidence density of HAIs per 1,000 patient-days.Conclusion.A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of HAIs.

Braille Instruction for Blind Diabetic Adults with Decreased Tactile Sensitivity

1985 ◽  
Vol 79 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Randall K. Harley ◽  
James W. Pichert ◽  
Merrie Morrison
Keyword(s):  
Daily Living ◽  
Special Educators ◽  
Tactile Sensation ◽  
Second Phase ◽  
Tactile Sensitivity ◽  
Learning To Read ◽  
Discrimination Ability ◽  
The Third ◽  
Third Phase ◽  
Significant Difference

Special educators may assume that diabetic persons who are blind and have decreased tactile sensitivity cannot be taught to read braille. This article describes a three-part study that compared the tactile sensitivity and braille-discrimination ability of blind diabetic and blind nondiabetic adults. In the first phase, the diabetic subjects required 80 percent more stimulation before reporting any tactile sensation on a modified Optacon. In the second phase, no significant difference was found in the subjects’ ability to discriminate standard and enlarged braille characters. In the third phase, four tactually impaired blind diabetic adults received training and demonstrated ability in learning to read enough braille for use in daily living.

PENERAPAN MODEL QUANTUM LEARNING UNTUK MENINGKATKAN HASIL BELAJAR AUTOCAD SISWA KELAS X TEKNIK PEMESINAN SMK NEGERI 1 STABAT

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Abdul Hasan Saragih
Keyword(s):  
Positive Response ◽  
Phase 1 ◽  
First Grade ◽  
Learning Model ◽  
Second Phase ◽  
Phase 2 ◽  
Phase 3 ◽  
The Third ◽  
Third Phase ◽  
Quantum Learning

This classroom research was conducted on the autocad instructions to the first grade of mechinary class of SMK Negeri 1 Stabat aiming at : (1) improving the student’ archievementon autocad instructional to the student of mechinary architecture class of SMK Negeri 1 Stabat, (2) applying Quantum Learning Model to the students of mechinary class of SMK Negeri 1 Stabat, arising the positive response to autocad subject by applying Quantum Learning Model of the students of mechinary class of SMK Negeri 1 Stabat. The result shows that (1) by applying quantum learning model, the students’ achievement improves significantly. The improvement ofthe achievement of the 34 students is very satisfactory; on the first phase, 27 students passed (70.59%), 10 students failed (29.41%). On the second phase 27 students (79.41%) passed and 7 students (20.59%) failed. On the third phase 30 students (88.24%) passed and 4 students (11.76%) failed. The application of quantum learning model in SMK Negeri 1 Stabat proved satisfying. This was visible from the activeness of the students from phase 1 to 3. The activeness average of the students was 74.31% on phase 1,81.35% on phase 2, and 83.63% on phase 3. (3) The application of the quantum learning model on teaching autocad was very positively welcome by the students of mechinary class of SMK Negeri 1 Stabat. On phase 1 the improvement was 81.53% . It improved to 86.15% on phase 3. Therefore, The improvement ofstudent’ response can be categorized good.

Mixed-Methods Evaluation as Scaffold to the Development of a Mobile Health Application to Support the Prescription of Wheelchairs and Postural Support Devices (Preprint)

2020 ◽  
Author(s):  
Adriana Klein ◽  
Roseli de Deus Lopes ◽  
Rodrigo Suigh
Keyword(s):  
Mixed Methods ◽  
Mobile Health ◽  
Second Phase ◽  
The Third ◽  
Evaluation Approach ◽  
Mixed Methods Evaluation ◽  
Usability Tests ◽  
Third Phase ◽  
Postural Support ◽  
Support Devices

BACKGROUND EasySeating is a mobile health (mHealth) app that supports the prescription of wheelchair and postural support devices (WPSD). It can be used by occupational therapists (OT) and physiotherapists (PT) who prescribe WPSD. The app offers a standardization of the prescription procedure, showing images, metrics and details that guide the prescriber to decide on the best equipment. It was developed with an iterative mixed-methods evaluation approach. Objective: The aim of this study was to investigate the processes involved in the prescription of WPSD and to propose, develop and evaluate a mHealth to support OT and PT prescribers. OBJECTIVE The aim of this study was to investigate the processes involved in the prescription of WPSD and to propose, develop and evaluate a mHealth to support OT and PT prescribers. METHODS This study was divided into three phases and was carried out as an iterative process composed of user consulting/testing (using a mixed-methods evaluation approach), system (re)design and software development. The first phase consisted of the collection of qualitative and quantitative data to map and understand the users requirements and of the development of the first prototype (v1) of the app. This data collection was performed through semi-structured interviews with 14 OT and PT prescribers, 5 specialized technicians and 5 WPSD users. The second phase aimed at improving the overall functionality of the app and consisted in the development, test and evaluation of the prototypes v1, v2, v3 and v4. A total of 59 prescribers tested and evaluated these prototypes by means of open interviews, semi-structured questionnaires and focus groups. The third phase focused in the usability aspects of the app. It consisted in the development and test of the prototype v5. Eight technology specialists assessed its usability through heuristics evaluation. RESULTS Data collected in phase one indicated there is a lack of standardization on the prescription of postural support devices (PSD). A divergent nomenclature for the PSDs was also found and classified in eight categories. These information guided the development of the first prototype of the EasySeating app. Phase two results pointed that the prescribers value the insertion of the app into their clinical practice, as it accelerates and increases the quality of the evaluation process and improves the organization of the prescription information. Significant suggestions for the improvement of the app were given during the users tests, including the use of images to represent the PSDs. The usability tests from the third phase revealed two strong issues that must be solved: the need of greater feedback and failures in the persistence of the input data. CONCLUSIONS This study demonstrated that there is a lack of systematization of the WPSD prescription process. The evaluation of the developed EasySeating app demonstrated that there is a potential to standardize, integrate and organize the WPSD prescription information, supporting and facilitating the decision making process of the prescribers. CLINICALTRIAL This study was approved by the Research Ethics Board of the Universidade de São Paulo (registered protocol n°53929516.6.0000.0065) URL - http://plataformabrasil.saude.gov.br/login.jsf

Foucault as Superauthor

2019 ◽  
Vol 29 (2) ◽  
pp. 104-125
Keyword(s):  
Free Speech ◽  
Second Phase ◽  
Contemporary Society ◽  
Sovereign Power ◽  
Ancient Greek ◽  
Main Motivation ◽  
Critical Attitude ◽  
The Third ◽  
Third Phase ◽  
Lecture Courses

Three phases in Foucault’s examination of authorship and free speech were essential to him throughout his life. They can be linked to such texts as the three lectures “What is an Author?” (first phase), “What is Critique?,” and “What is Revolution?” (second phase), and the two lecture courses, “Fearless Speech,” and “The Courage of Truth” (third phase). Initially, Foucault merely describes the founders of discursivity (hence, “superauthors”), among whom he reckoned only Marx and Freud, as the sole alternative to his own conceptualization of the author function, which is exhibited en masse in contemporary society. He then modifies his views on superauthorship by making Kant the paradigm and by linking his own concept of free speech to a Kan-tian critical attitude. However, Foucault claims only the half of Kant’s philosophical legacy that is related to the study of the ontology of the self.The article advances the hypothesis that the sovereign power of speech, which can be found in Marx and Heidegger and in generally in the concept of “superauthorship,” becomes unacceptable for Foucault. During the third phase, the danger of a tyrannical use of free speech compels Foucault to make a number of fruitful but questionable choices in his work. He focuses on a single aspect of free speech in which a speaker is in a weaker position and therefore has to overcome his fear in order to tell the truth. Foucault associates this kind of free speech with the ancient Greek notion of parrhesia, which according to his interpretation means “fearless speech”; however, this reading is not always supported by the ancient Greek sources. Foucault’s deliberations bring him to the radical conclusion that free speech transforms into performative “aesthetics of existence.” Foucault’s main motivation for pursuing this line of thought all through his life was to investigate his own abilities and powers as an author

scholarly journals A Decade in Trying to Increase Hand Hygiene—Finally Success

2020 ◽  
Vol 41 (S1) ◽  
pp. s93-s94
Author(s):  
Linda Huddleston ◽  
Sheila Bennett ◽  
Christopher Hermann
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Bloodstream Infections ◽  
Central Line ◽  
Second Phase ◽  
Two Phase ◽  
Hygiene Compliance ◽  
Tract Infections ◽  
The Voice

Background: Over the past 10 years, a rural health system has tried 10 different interventions to reduce hospital-associated infections (HAIs), and only 1 intervention has led to a reduction in HAIs. Reducing HAIs is a goal of nearly all hospitals, and improper hand hygiene is widely accepted as the main cause of HAIs. Even so, improving hand hygiene compliance is a challenge. Methods: Our facility implemented a two-phase longitudinal study to utilize an electronic hand hygiene reminder system to reduce HAIs. In the first phase, we implemented an intervention in 2 high-risk clinical units. The second phase of the study consisted of expanding the system to 3 additional clinical areas that had a lower incidence of HAIs. The hand hygiene baseline was established at 45% for these units prior to the voice reminder being turned on. Results: The system gathered baseline data prior to being turned on, and our average hand hygiene compliance rate was 49%. Once the voice reminder was turned on, hand hygiene improved nearly 35% within 6 months. During the first phase, there was a statistically significant 62% reduction in the average number of HAIs (catheter associated urinary tract infections (CAUTI), central-line–acquired bloodstream infections (CLABSIs), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant organisms (MDROs), and Clostridiodes difficile experienced in the preliminary units, comparing 12 months prior to 12 months after turning on the voice reminder. In the second phase, hand hygiene compliance increased to >65% in the following 6 months. During the second phase, all HAIs fell by a statistically significant 60%. This was determined by comparing the HAI rates 6 months prior to the voice reminder being turned on to 6 months after the voice reminder was turned on. Conclusions: The HAI data from both phases were aggregated, and there was a statistically significant reduction in MDROs by 90%, CAUTIs by 60%, and C. difficile by 64%. This resulted in annual savings >$1 million in direct costs of nonreimbursed HAIs.Funding: NoneDisclosures: None

scholarly journals PROFESSIONAL IDENTITY QUESTIONNAIRE FOR PSYCHOLOGICAL HELP PROVIDERS: DEVELOPMENT AND VALIDATION

2021 ◽  
Vol 7 ◽  
pp. 13-23
Author(s):  
Elīna Akmane ◽  
Kristīne Mārtinsone ◽  
Zane Krieķe ◽  
Viktorija Perepjolkina ◽  
Agnese Drunka ◽  
...  
Keyword(s):  
Focus Group ◽  
Professional Identity ◽  
Psychometric Properties ◽  
Social Workers ◽  
Group Discussion ◽  
Psychological Help ◽  
Second Phase ◽  
The Third ◽  
Third Phase ◽  
Development And Validation

The aim of this research was to develop multiscale questionnaire of professional identity (PI) and to test its psychometric properties. This research was conducted in 3 phases. During the first phase a scoping review, a focus group discussion, and a rapid literature review were conducted to identify the criteria of PI. Survey items were constructed and assessed in the second phase. The data were collected, and the psychometric properties were examined in the third phase. The survey was completed by 239 psychological help providers in Latvia (psychiatrists (n = 13), nurses (n = 37), psychotherapists (n = 8), art therapists (n = 45), psychologists (n = 55), psychotherapy specialists (n = 28) and social workers (n = 53)) aged between 22 and 80 years (M = 45.8; SD = 10.6) of which 95% women (n = 227) and 5% men (n = 12). As a result, 8 factors structure was confirmed (k = 38). Overall, it can be concluded that the survey examines a unified phenomenon, and the items are internally consistent on all scales (α = .715 - .873). The development of this questionnaire is an important step towards the research of PI.   

scholarly journals Competency Matrix for Medical Residency Programmes in Endocrinology and Metabolism

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 195-206
Author(s):  
Ana Augusta Motta Oliveira Valente ◽  
Milena Coelho Fernandes Caldato
Keyword(s):  
Data Analysis ◽  
Core Competencies ◽  
Second Phase ◽  
Medical Residency ◽  
Fundamental Field ◽  
Delphi Methodology ◽  
Residency Programs ◽  
The Third ◽  
Third Phase ◽  
Structured Matrix

ABSTRACT Introduction Medical competencies have become the focus of Medical Education at all levels around the world. In this context the Medical Residency Programs (MRP) in Brazil have begun to seek a competency-based curriculum to improve the specialist training. Objective To develop a proposed Competency Matrix for Medical Residency Programs in Endocrinology and Metabolism (MREM). Methodology The study was divided into four phases. The first phase consisted of a bibliographical review and construction of the Pilot Matrix. In the second phase the Pilot Matrix was applied to endocrinologists from Belém, with subsequent data analysis and construction of the Structured Matrix. The third phase started with the implementation of the Structured Matrix at the Brazilian Congress of Endocrinology and Metabolism – CBEM 2016 with a total of 49 responses. Based on the Delphi methodology, the 230 competencies of each one of the matrices were analyzed and a questionnaire containing competences with a discrepancy level greater than 10% was created, including some suggestions from the experts. In the fourth and last phase, also using Delphi methodology, the questionnaire was sent by email and data analysis and construction of the MREM proposal was performed. Results In the second, third and fourth phases, the response rate of Endocrinologists was 73.3%, 51% and 76.4%, respectively. With the Southeast region of Brazil presenting the largest number of participants. There are 219 competencies in the Pilot Matrix, 230 in the Structured Matrix and 244 in the final MREM proposal. The competency areas of Diabetes and Obesity, Metabolic Syndrome and Alterations of Appetite were those which showed major change and suggestions. In all phases, only 2 competencies were excluded. The suggestions made in the third phase were unanimously accepted. Conclusion The MREM proposal was concluded with 21 areas and 244 competencies, 33 classified as prerequisites, 157 as essential competencies, 36 as desirable and 18 as advanced. The competencies were distributed as follows in the MCPRMEM: “Fundamental” field with 100 competencies, with 15 prerequisites, 65 core competencies, 14 desirable and 6 advanced ones; “Specific Knowledge” field with 132 competences, with 18 prerequisites, 87 essential competences, 19 desirable and 8 advanced; and “Complementary Training” field with 12 skills, no prerequisites, 5 core competencies, 3 desirable and 4 advanced skills.

BIOLOGICAL INVASIONS: THE EUROPEAN SMELT OSMERUS EPERLANUS (L.) AND THE MICROSPORIDIAN GLUGEA HERTWIGI WEISSENBERG, 1911

2021 ◽  
Vol 14 (4) ◽  
pp. 2-14
Author(s):  
L. V. Anikieva ◽  
E. P. Ieshko ◽  
O. P. Sterligova ◽  
Yu. S. Reshetnikov
Keyword(s):  
Dominant Species ◽  
Fish Community ◽  
Second Phase ◽  
Invasion History ◽  
Coregonus Albula ◽  
The Third ◽  
Third Phase ◽  
Population Outbreak ◽  
Osmerus Eperlanus ◽  
Latent Phase

The paper presents the phenomenology of the smelt Osmerus eperlanus and the microsporidian Glugea hertwigi invasion into a new habitat - Lake Syamozero (Karelia), where neither of the species occurred before. The invasion history falls into 4 phases. The first, latent phase started with a spontaneous invasion of the lake by smelt and lasted until the first fish showed up in catches (1968-1970). The second phase (1971 to 1980) was the invader number outbreak. The smelt became the dominant species in the fish community, while the native plankton-feeder, the vendace Coregonus albula, became an endangered species. The third phase (1980 to 1991) was the population outbreak of the microsporidian Glugea hertwigi, and development of an epizootic. The fourth phase (since 1991 until present) is the decreasing of the number of the invasive species - the smelt and the microsporidian Glugea hertwigi and the recovery of the native vendace population.

Harvest of Briars

2019 ◽  
pp. 121-158
Author(s):  
A. Wess Mitchell
Keyword(s):  
Eighteenth Century ◽  
Ottoman Empire ◽  
Cost Effective ◽  
Balkan Peninsula ◽  
The Black Sea ◽  
Second Phase ◽  
Habsburg Monarchy ◽  
The West ◽  
The North ◽  
Third Phase

This chapter examines the competition with the Ottoman Empire and Russia, from the reconquest of Hungary to Joseph II’s final Turkish war. On its southern and eastern frontiers, the Habsburg Monarchy contended with two large land empires: a decaying Ottoman Empire, and a rising Russia determined to extend its influence on the Black Sea littorals and Balkan Peninsula. In balancing these forces, Austria faced two interrelated dangers: the possibility of Russia filling Ottoman power vacuums that Austria itself could not fill, and the potential for crises here, if improperly managed, to fetter Austria’s options for handling graver threats in the west. In dealing with these challenges, Austria deployed a range of tools over the course of the eighteenth century. In the first phase (1690s–1730s), it deployed mobile field armies to alleviate Turkish pressure on the Habsburg heartland before the arrival of significant Russian influence. In the second phase (1740s–70s), Austria used appeasement and militarized borders to ensure quiet in the south while focusing on the life-or-death struggles with Frederick the Great. In the third phase (1770s–90s), it used alliances of restraint to check and keep pace with Russian expansion, and recruit its help in comanaging problems to the north. Together, these techniques provided for a slow but largely effective recessional, in which the House of Austria used cost-effective methods to manage Turkish decline and avoid collisions that would have complicated its more important western struggles.

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