Transition between flow charts and Jackson Structured Program (JSP)

Abstract Background While multidisciplinary teams (MDTs) are now considered an essential part of cancer care decision-making, how they perform varies widely. The authors hypothesised that a comprehensive, multipronged improvement program, and associated annual member survey, could strengthen MDT performance across a whole cancer service. Methods The study comprised the introduction of a structured program, the Tumour Program Strengthening Initiative (TPSI) linked with an annual survey of member’s perceptions of their performance. Three iterations of the survey have been completed (2017, 2018 and 2019). Generalised estimating equations (GEEs) were used to test for a difference in the proportion of positive survey responses between 2017 and 2019 adjusted for team clustering. Results Twelve teams participated in TPSI. One hundred twenty-nine, 118 and 146 members completed the survey in 2017, 2018 and 2019, respectively. Of the 17 questions that were asked in all three years, nine showed significant improvement and, of these, five were highly significant. Documenting consensus, developing Terms of Reference (TORs), establishing referral criteria and referring to clinical practice guidelines showed most improvement. Questions related to patient considerations, professional development and quality improvement (QI) activities showed no significant change. Conclusions TPSI resulted in sustained and significant improvement. The MDT survey not only allowed MDT members to identify their strengths and weaknesses but also provided insights for management to flag priority areas for further support. Overall program improvement reflected the strengthening of the weakest teams as well as further improvement in highly performing MDTs. Importantly, the initiative has the potential to achieve behaviour change amongst clinicians.

Download Full-text

Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship

American Journal of Perinatology Reports ◽

10.1055/s-0038-1675344 ◽

2018 ◽

Vol 08 (04) ◽

pp. e251-e260 ◽

Cited By ~ 1

Author(s):

Kathleen Antony ◽

Nauman Khurshid ◽

Barbara Trampe ◽

Vivek Gupta ◽

J. Iruretagoyena ◽

...

Keyword(s):

Phase Iii ◽

Independent Practice ◽

American Institute ◽

Maternal Fetal Medicine ◽

Fetal Medicine ◽

Diagnostic Skills ◽

Qualitative Feedback ◽

Average Total Number ◽

Structured Program ◽

Structured Approach

Objective The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging. Study Design We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training. Results This curriculum was implemented in 2006. Of the eight maternal-fetal medicine fellows who completed this program, 100% were capable of following this curriculum and 100% felt comfortable performing and interpreting detailed sonograms including sonograms with significant and uncommon anomalies. Qualitative feedback was also positive. Finally, this structured approach resulted in an increase in the average total number of sonograms interpreted. Conclusion Our curriculum, by following the explicit guidelines and expectations set out by the American Institute of Ultrasound in Medicine and the American Board of Obstetrics and Gynecology for practicing maternal-fetal medicine fellowship graduates, provides an opportunity to explore national standardization for this component of training.

Download Full-text

Design and Development of Weatherproof Seals for Prefabricated Construction: A Methodological Approach

Buildings ◽

10.3390/buildings8090117 ◽

2018 ◽

Vol 8 (9) ◽

pp. 117 ◽

Cited By ~ 5

Author(s):

Kristopher Orlowski ◽

Kasun Shanaka ◽

Priyan Mendis

Keyword(s):

Development Process ◽

Methodological Approach ◽

Building Industry ◽

Practical Application ◽

Design And Development ◽

Modular Systems ◽

Design Life ◽

Flow Charts ◽

And Performance ◽

Careful Design

Satisfactory weatherproofing of buildings is vital to maximise their design life and performance which requires the careful design of external sealing technologies. Systems commonly available have served well in conventional construction however with many prefabricated systems emerging in the building industry new and novel means of weatherproofing between panels and modules need to be developed purpose specific to this application. This paper presents a holistic and fundamental methodological approach to Design and Development of waterproof seals and has been applied specific for prefabricated panelised and modular systems. Two purpose specific weatherproof seals are finally presented. Flow charts of the overview of the suggested methodological approach and the processes within which include DfMA that have been incorporated into understanding and developing seals for this practical application. These strategies have enabled a resourceful and holistic set of processes that can be adapted and used for similar forms of product research in new and developing areas of construction such as prefabrication. The design and development process is thoroughly investigated and has resulted in an exploration of the technical challenges and potential solutions which take into consideration factors from installation limitations to building tolerances.

Download Full-text

Study of Direct Measuring of Lubricant Condition in Rolling Element Bearings With Microcomputer Technique

Journal of Tribology ◽

10.1115/1.2920236 ◽

1990 ◽

Vol 112 (1) ◽

pp. 92-97 ◽

Cited By ~ 2

Author(s):

Dongchu Zhao

Keyword(s):

Film Thickness ◽

Strain Gage ◽

Lubricant Film ◽

Rolling Element Bearings ◽

Main Program ◽

Test Apparatus ◽

Lubricant Film Thickness ◽

Rolling Element ◽

Lubricant Films ◽

Flow Charts

A method for measuring the lubricant condition with strain gage in rolling element bearings and the instrument used are introduced. In order to illustrate the method and the instrument, the theory of measuring lubricant films in rolling element bearings using strain technique, test apparatus, microcomputer hardware as well as software, flow charts for the main program and subprograms, are first described in detail. In addition, the lubricant film thickness is measured for several different lubricants and results are compared with theoretical ones. It is demonstrated that using the method and the instrument introduced in this paper, one can measure the lubricant condition inside bearings very accurately.

Download Full-text