scholarly journals REDUCING ANTIPSYCHOTIC PRESCRIBING IN NURSING HOMES: FACILITATORS AND BARRIERS FOR HIGH-IMPACT STATE INITIATIVES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S160
Author(s):  
Stephen Crystal ◽  
Richard Hermida ◽  
Olga F Jarrín ◽  
Sheree Neese-Todd ◽  
Beth Angell ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Case Studies ◽  
Large Scale ◽  
Technical Assistance ◽  
Monitoring Program ◽  
Clinical Practices ◽  
State Initiatives ◽  
Key Factor ◽  
Antipsychotic Prescribing ◽  
National Partnership

Abstract In conjunction with the National Partnership to Improve Dementia Care in Nursing Homes initiated in 2012, states implemented initiatives to reduce antipsychotic use. All achieved substantial reductions, but improvement varied across states. By 2018, several states had achieved reductions of more than 45%, including several of the largest states. These reductions are noteworthy given the challenging nature of behavioral symptoms of dementia, and difficulties encountered historically and internationally in changing strongly-rooted clinical practices. How were these successful interventions achieved in high-performing state initiatives? What were the barriers encountered and facilitators that helped overcome these barriers? What does this experience suggest for sustainability of change? To address these questions, we draw on a mixed-methods study of antipsychotic prescribing in nursing homes incorporating analyses of prescribing data, state policy case studies, and facility case studies. Successful states integrated large-scale educational initiatives with strong regulatory action, often focusing especially on laggard facilities. Texas’ initiative was particularly noteworthy, achieving a 56.5% reduction across its far-flung network of nearly 100,000 residents and 1,200 facilities. Texas used metrics to identify facilities that achieved notable reductions in antipsychotic prescribing, and encouraged them to share their strategies with “late adopters”. The state deployed a designated Quality Monitoring Program (QMP), distinct from the survey process, to provide on-site technical assistance to laggard facilities, and provided education for all levels of staff and assistance in implementing data-driven improvement strategies. Successful state initiatives achieved considerable buy-in on the need to reduce antipsychotic use, a key factor in achieving successful system change.

scholarly journals Causal and Corrective Organisational Culture: A Systematic Review of Case Studies of Institutional Failure

2020 ◽  
Author(s):  
E. Julie Hald ◽  
Alex Gillespie ◽  
Tom W. Reader
Keyword(s):  
Case Studies ◽  
Safety Culture ◽  
Large Scale ◽  
Human Life ◽  
Organisational Culture ◽  
Cultural Factors ◽  
Ethical Culture ◽  
Institutional Failure ◽  
Key Factor

Abstract Organisational culture is assumed to be a key factor in large-scale and avoidable institutional failures (e.g. accidents, corruption). Whilst models such as “ethical culture” and “safety culture” have been used to explain such failures, minimal research has investigated their ability to do so, and a single and unified model of the role of culture in institutional failures is lacking. To address this, we systematically identified case study articles investigating the relationship between culture and institutional failures relating to ethics and risk management (n = 74). A content analysis of the cultural factors leading to failures found 23 common factors and a common sequential pattern. First, culture is described as causing practices that develop into institutional failure (e.g. poor prioritisation, ineffective management, inadequate training). Second, and usually sequentially related to causal culture, culture is also used to describe the problems of correction: how people, in most cases, had the opportunity to correct a problem and avert failure, but did not take appropriate action (e.g. listening and responding to employee concerns). It was established that most of the cultural factors identified in the case studies were consistent with survey-based models of safety culture and ethical culture. Failures of safety and ethics also largely involve the same causal and corrective factors of culture, although some aspects of culture more frequently precede certain outcome types (e.g. management not listening to warnings more commonly precedes a loss of human life). We propose that the distinction between causal and corrective culture can form the basis of a unified (combining both ethical and safety culture literatures) and generalisable model of organisational failure.

Nursing professionals’ attitudes toward use of physical restraints in Styrian nursing homes Austria

Pflege ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 57-63
Author(s):  
Hannes Mayerl ◽  
Tanja Trummer ◽  
Erwin Stolz ◽  
Éva Rásky ◽  
Wolfgang Freidl
Keyword(s):  
Nursing Homes ◽  
Large Scale ◽  
Critical Role ◽  
Physical Restraint ◽  
Care Practice ◽  
Physical Restraints ◽  
Convenience Sample ◽  
Restraint Use ◽  
Positive Attitudes ◽  
Nursing Professionals

Abstract. Background: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals’ attitudes toward this practice. Aim: Since nursing professionals’ views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals’ attitudes concerning use of physical restraints in nursing homes of Styria (Austria). Method: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. Results: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny “good reasons” for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals’ views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. Conclusions: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

Going the Distance

2020 ◽  
Author(s):  
Ron Harris
Keyword(s):  
Large Scale ◽  
Western Europe ◽  
Family Firms ◽  
Global Trade ◽  
Long Distance ◽  
Business Corporation ◽  
Modern Economy ◽  
Key Factor ◽  
Silk Route ◽  
Passive Investors

Before the seventeenth century, trade across Eurasia was mostly conducted in short segments along the Silk Route and Indian Ocean. Business was organized in family firms, merchant networks, and state-owned enterprises, and dominated by Chinese, Indian, and Arabic traders. However, around 1600 the first two joint-stock corporations, the English and Dutch East India Companies, were established. This book tells the story of overland and maritime trade without Europeans, of European Cape Route trade without corporations, and of how new, large-scale, and impersonal organizations arose in Europe to control long-distance trade for more than three centuries. It shows that by 1700, the scene and methods for global trade had dramatically changed: Dutch and English merchants shepherded goods directly from China and India to northwestern Europe. To understand this transformation, the book compares the organizational forms used in four major regions: China, India, the Middle East, and Western Europe. The English and Dutch were the last to leap into Eurasian trade, and they innovated in order to compete. They raised capital from passive investors through impersonal stock markets and their joint-stock corporations deployed more capital, ships, and agents to deliver goods from their origins to consumers. The book explores the history behind a cornerstone of the modern economy, and how this organizational revolution contributed to the formation of global trade and the creation of the business corporation as a key factor in Europe's economic rise.

Mapping global water projects: improving access to donor investment information on the web

Water Policy ◽  
2003 ◽  
Vol 5 (3) ◽  
pp. 203-212
Author(s):  
J. Lisa Jorgensona
Keyword(s):  
Water Resources ◽  
Web Sites ◽  
Large Scale ◽  
Technical Assistance ◽  
Water Withdrawal ◽  
Small Scale ◽  
Water Projects ◽  
Essential Information ◽  
Water Project ◽  
The Web

This paper discusses a series of discusses how web sites now report international water project information, and maps the combined donor investment in more than 6000 water projects, active since 1995. The maps show donor investment:  • has addressed water scarcity,  • has improved access to improvised water resources,  • correlates with growth in GDP,  • appears to show a correlation with growth in net private capital flow,  • does NOT appear to correlate with growth in GNI. Evaluation indicates problems in the combined water project portfolios for major donor organizations: •difficulties in grouping projects over differing Sector classifications, food security, or agriculture/irrigation is the most difficult.  • inability to map donor projects at the country or river basin level because 60% of the donor projects include no location data (town, province, watershed) in the title or abstracts available on the web sites.  • no means to identify donor projects with utilization of water resources from training or technical assistance.  • no information of the source of water (river, aquifer, rainwater catchment).  • an identifiable quantity of water (withdrawal amounts, or increased water efficiency) is not provided.  • differentiation between large scale verses small scale projects. Recommendation: Major donors need to look at how the web harvests and combines their information, and look at ways to agree on a standard template for project titles to include more essential information. The Japanese (JICA) and the Asian Development Bank provide good models.

scholarly journals Modeling regional impacts and resilience to water service disruptions in urban economies

2021 ◽  
pp. 239980832199870
Author(s):  
Sheree A Pagsuyoin ◽  
Joost R Santos
Keyword(s):  
Case Studies ◽  
Large Scale ◽  
Urban Region ◽  
Economic Losses ◽  
Drought Severity ◽  
Severe Drought ◽  
Time Varying ◽  
National Capital Region ◽  
Economic Sectors ◽  
The Impact

Water is a critical natural resource that sustains the productivity of many economic sectors, whether directly or indirectly. Climate change alongside rapid growth and development are a threat to water sustainability and regional productivity. In this paper, we develop an extension to the economic input-output model to assess the impact of water supply disruptions to regional economies. The model utilizes the inoperability variable, which measures the extent to which an infrastructure system or economic sector is unable to deliver its intended output. While the inoperability concept has been utilized in previous applications, this paper offers extensions that capture the time-varying nature of inoperability as the sectors recover from a disruptive event, such as drought. The model extension is capable of inserting inoperability adjustments within the drought timeline to capture time-varying likelihoods and severities, as well as the dependencies of various economic sectors on water. The model was applied to case studies of severe drought in two regions: (1) the state of Massachusetts (MA) and (2) the US National Capital Region (NCR). These regions were selected to contrast drought resilience between a mixed urban–rural region (MA) and a highly urban region (NCR). These regions also have comparable overall gross domestic products despite significant differences in the distribution and share of the economic sectors comprising each region. The results of the case studies indicate that in both regions, the utility and real estate sectors suffer the largest economic loss; nonetheless, results also identify region-specific sectors that incur significant losses. For the NCR, three sectors in the top 10 ranking of highest economic losses are government-related, whereas in the MA, four sectors in the top 10 are manufacturing sectors. Furthermore, the accommodation sector has also been included in the NCR case intuitively because of the high concentration of museums and famous landmarks. In contrast, the Wholesale Trade sector was among the sectors with the highest economic losses in the MA case study because of its large geographic size conducive for warehouses used as nodes for large-scale supply chain networks. Future modeling extensions could potentially include analysis of water demand and supply management strategies that can enhance regional resilience against droughts. Other regional case studies can also be pursued in future efforts to analyze various categories of drought severity beyond the case studies featured in this paper.

scholarly journals Interventions to optimize medication use in nursing homes: a narrative review

2021 ◽  
Author(s):  
Anne Spinewine ◽  
Perrine Evrard ◽  
Carmel Hughes
Keyword(s):  
Nursing Homes ◽  
Large Scale ◽  
Adverse Drug Events ◽  
Experimental Studies ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Qualitative Studies ◽  
Patient Centered ◽  
Barriers And Enablers ◽  
Specific Medication

Abstract Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

scholarly journals Trace element catalyses mineral replacement reactions and facilitates ore formation

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Yanlu Xing ◽  
Joël Brugger ◽  
Barbara Etschmann ◽  
Andrew G. Tomkins ◽  
Andrew J. Frierdich ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Trace Elements ◽  
Fluid Flow ◽  
Large Scale ◽  
Metal Accumulation ◽  
Nucleation And Growth ◽  
Reaction Interface ◽  
Ore Formation ◽  
Key Factor ◽  
Mineral Replacement

AbstractReaction-induced porosity is a key factor enabling protracted fluid-rock interactions in the Earth’s crust, promoting large-scale mineralogical changes during diagenesis, metamorphism, and ore formation. Here, we show experimentally that the presence of trace amounts of dissolved cerium increases the porosity of hematite (Fe2O3) formed via fluid-induced, redox-independent replacement of magnetite (Fe3O4), thereby increasing the efficiency of coupled magnetite replacement, fluid flow, and element mass transfer. Cerium acts as a catalyst affecting the nucleation and growth of hematite by modifying the Fe2+(aq)/Fe3+(aq) ratio at the reaction interface. Our results demonstrate that trace elements can enhance fluid-mediated mineral replacement reactions, ultimately controlling the kinetics, texture, and composition of fluid-mineral systems. Applied to some of the world’s most valuable orebodies, these results provide new insights into how early formation of extensive magnetite alteration may have preconditioned these ore systems for later enhanced metal accumulation, contributing to their sizes and metal endowment.

scholarly journals Exploiting Proximity-Based Mobile Apps for Large-Scale Location Privacy Probing

2018 ◽  
Vol 2018 ◽  
pp. 1-22 ◽  
Author(s):  
Shuang Zhao ◽  
Xiapu Luo ◽  
Xiaobo Ma ◽  
Bo Bai ◽  
Yankang Zhao ◽  
...  
Keyword(s):  
Social Networks ◽  
Case Studies ◽  
Real World ◽  
Emission Reduction ◽  
Large Scale ◽  
Location Privacy ◽  
Mobile Apps ◽  
Physical World ◽  
Typical Type ◽  
Location Spoofing

Proximity-based apps have been changing the way people interact with each other in the physical world. To help people extend their social networks, proximity-based nearby-stranger (NS) apps that encourage people to make friends with nearby strangers have gained popularity recently. As another typical type of proximity-based apps, some ridesharing (RS) apps allowing drivers to search nearby passengers and get their ridesharing requests also become popular due to their contribution to economy and emission reduction. In this paper, we concentrate on the location privacy of proximity-based mobile apps. By analyzing the communication mechanism, we find that many apps of this type are vulnerable to large-scale location spoofing attack (LLSA). We accordingly propose three approaches to performing LLSA. To evaluate the threat of LLSA posed to proximity-based mobile apps, we perform real-world case studies against an NS app named Weibo and an RS app called Didi. The results show that our approaches can effectively and automatically collect a huge volume of users’ locations or travel records, thereby demonstrating the severity of LLSA. We apply the LLSA approaches against nine popular proximity-based apps with millions of installations to evaluate the defense strength. We finally suggest possible countermeasures for the proposed attacks.

Drama and Environment: Joining Forces to Engage Children and Young People in Environmental Education

2013 ◽  
Vol 29 (2) ◽  
pp. 182-201 ◽  
Author(s):  
David J. Curtis ◽  
Mark Howden ◽  
Fran Curtis ◽  
Ian McColm ◽  
Juliet Scrine ◽  
...  
Keyword(s):  
Environmental Education ◽  
Case Studies ◽  
Large Scale ◽  
Environmental Issues ◽  
Contemporary Society ◽  
Children And Young People ◽  
School Based ◽  
Qualitative Evidence ◽  
Theatre Company ◽  
Theatre In Education

AbstractEngaging and exciting students about the environment remains a challenge in contemporary society, even while objective measures show the rapid state of the world's environment declining. To illuminate the integration of drama and environmental education as a means of engaging students in environmental issues, the work of performance companies Evergreen Theatre, Leapfish and Eaton Gorge Theatre Company, the ecological oratorio Plague and the Moonflower, and a school-based trial of play-building were examined through survey data and participant observations. These case studies employed drama in different ways — theatre-in-education, play-building, and large-scale performance event. The four case studies provide quantitative and qualitative evidence for drama-based activities leading to an improvement in knowledge about the environment and understandings about the consequences of one's actions. In observing and participating in these case studies, we reflect that drama is a means of synthesising and presenting scientific research in ways that are creative and multi-layered, and which excite students, helping maintain their attention and facilitating their engagement.

Toolkit for Epidemiologic Response to an Acute Chemical Release

2016 ◽  
Vol 10 (4) ◽  
pp. 631-632 ◽  
Author(s):  
Mary Anne Duncan ◽  
Maureen F. Orr
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Technical Assistance ◽  
Local Health ◽  
Toxic Substances ◽  
Public Health Action ◽  
Public Health Agencies ◽  
Chemical Release ◽  
State And Local ◽  
The Many

AbstractWhen a large chemical incident occurs and people are injured, public health agencies need to be able to provide guidance and respond to questions from the public, the media, and public officials. Because of this urgent need for information to support appropriate public health action, the Agency for Toxic Substances and Disease Registry (ATSDR) of the US Department of Health and Human Services has developed the Assessment of Chemical Exposures (ACE) Toolkit. The ACE Toolkit, available on the ATSDR website, offers materials including surveys, consent forms, databases, and training materials that state and local health personnel can use to rapidly conduct an epidemiologic investigation after a large-scale acute chemical release. All materials are readily adaptable to the many different chemical incident scenarios that may occur and the data needs of the responding agency. An expert ACE team is available to provide technical assistance on site or remotely. (Disaster Med Public Health Preparedness. 2016;10:631–632)

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