Guidance on In Line Inspection First Run Success

Author(s):  
Stephen R. Gower ◽  
David Whitman

First run success is a key performance measure used in the BP Global In Line Inspection (ILI) Contract [1]. This drives effectiveness and efficiency in the processes supporting ILI and it is a key commercial performance indicator for ILI Suppliers. Although run success rates are often referred to across the industry there has been little standardisation in the terminology, or the factors that lead to a successful run. Three definitions have been established for run success: Technical; Commercial and Operational. Each has a place although it is Operational run success that drives improvements between operators and suppliers. The introduction of a performance measure for first run success increases the focus on getting things right the first time. The financial cost of ILI run failure has probably been underestimated by the industry; although it is estimated that it could be as high as 30% of total contracted costs for ILI. For some projects the costs associated with a failed run can be far greater than the original project costs (e.g. additional vessel support costs for deployment or recovery during offshore operations). A failed run can also result in a delayed inspection and an associated increased risk as well as potentially compromising compliance with regulatory requirements. The consequences of run failure vary in severity and can be presented in a pyramid similar to the typical representation of safety statistics. A stuck tool requiring intervention or a pipeline failure, as a result of an incorrect inspection report, would be at the top of the pyramid. The lower tiers would capture technical failures and the effectiveness of cleaning. Understanding the consequence of failures can help drive performance improvements across the industry. As part of the BP continuous improvement process, ILI Suppliers and internal stakeholders were brought together for a facilitated workshop to understand the factors affecting first run success rates. The workshop identified a number of common themes which were consistent across all of the Suppliers addressing; both operational issues and tool performance. A Guidance Note was then developed with the ILI Suppliers to drive improvements in first run success rates. This was shared with the Pipeline Operators Forum (POF) in October 2011 and has been further developed as a POF Guidance Document. A separate guidance note has been developed to address recommended practices for collecting and verifying field data. Successful ILI requires good communication between all parties. As the industry starts to inspect more difficult and challenging lines it will be important to improve ILI run success rates. Across the industry we probably know how to do it, but doing it consistently is the challenge. The development of industry Guidance Notes represent a small step towards achieving this objective. As ILI operations improve the focus will increasingly turn to the reliability of tools. There is much that can be learnt from other industry sectors, such as the motor or aviation industry, on improving reliability of components and systems. This will require an increased use of preventative maintenance practices. There is also a need to create a common basis for reporting reliability of inspection tools and for this to be taken into account when operators make their selection of ILI tools. The Global ILI Contract has brought an increased focus to the performance of the overall inspection process which is driving improvements in first run success rates. It has facilitated the development of guidelines on best practice and is starting to set standards for reliability. The high level of cooperation between suppliers and operators to drive improvements in this area is a measure of the importance of first run success rates to all parts of our industry. Achieving ILI first run success requires both the operator and ILI supplier to work together. Whilst each has a key part to play effective communication from an early stage is essential.

2019 ◽  
Vol 9 (2) ◽  
pp. 200-210 ◽  
Author(s):  
Ann Minton ◽  
Jane Lowe

Purpose The purpose of this paper is to review a range of mechanisms used by universities to support employers to facilitate effective “on the job learning” for apprentices. It reflects on how these mechanisms can be used to address some of the challenges, reported in the literature that employers face to in supporting apprentices in the workplace. Design/methodology/approach A short questionnaire administered to colleagues prior to attendance at a workshop, identified a range of activities, at various stages of engagement with employers that were used by universities to facilitate effective workplace learning and also to address some of the challenges faced by employers. These activities were then discussed and explored within the workshop to identify areas of best practice from the HEI sector to promote effective workplace learning. Findings Engagement with employers needs to occur from the outset of the development of the apprenticeship. Embedding the on the job learning within the design of the academic programme, with explicit links between the theoretical learning (knowledge element of the apprenticeship standard) and practical application of learning (skills and behaviours within the apprenticeship standard). Regular interactions with a range of staff within the employer ensure that there is a clear understanding throughout the apprentice’s journey, of how to promote an effective learning environment for the apprentice within the context of the organisation. The role of the workplace facilitator/mentor key. A range of approaches to providing training and ongoing support for facilitators/mentors was identified. Research limitations/implications The study was limited to the participants within the workshop at the conference, a self-selecting group from a relatively small number of HE providers. The HEIs represented provided apprenticeships in a range of subject areas, working with both public sector and private sector providers. Further studies are required to encompass a broader range of providers, including drawing on best practice from the FE and independent sector, and applying principles used there in the context of HE. Practical implications Engagement with employers from an early stage of the development of the apprenticeship is imperative, viewing the apprenticeship holistically, rather than as an academic programme with some work-based activities. Resources need to be devoted to regular and frequent contact with a range of personnel within the employer organisation, so that a partnership approach to supporting learning is developed. Training and ongoing support for work-based mentors/facilitators continues to be a key success factor. This needs to be managed to balance the learning needs of the mentors with the potential impact on workplace productivity. Social implications The paper identifies a range of approaches that will enhance the effectiveness of learning in the workplace. This will both enhance the apprentice’s learning experience and ensure that higher and degree apprenticeships are developed holistically, meeting the academic requirements of the university and the workplace needs of the employer. This, in turn, will enhance success rates and reduce attrition rates from apprenticeships, which, in turn, may encourage more employers to engage with higher and degree apprenticeships. Originality/value The paper collates a range of best practice from the sector to promote effective workplace learning.


2020 ◽  
Vol 25 (12) ◽  
pp. 610-614
Author(s):  
Garry Cooper-Stanton

There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.


2021 ◽  
pp. ijgc-2020-002217
Author(s):  
Elizabeth B Jeans ◽  
William G Breen ◽  
Trey C Mullikin ◽  
Brittany A Looker ◽  
Andrea Mariani ◽  
...  

ObjectivesOptimal adjuvant treatment for early-stage clear cell and serous endometrial cancer remains unclear. We report outcomes for women with surgically staged International Federation of Gynecology and Obstetrics (FIGO) stage I clear cell, serous, and mixed endometrial cancers following adjuvant vaginal cuff brachytherapy with or without chemotherapy.MethodsFrom April 1998 to January 2020, women with FIGO stage IA–IB clear cell, serous, and mixed endometrial cancer underwent surgery and adjuvant vaginal cuff brachytherapy. Seventy-six patients received chemotherapy. High-dose rate vaginal cuff brachytherapy was planned to a total dose of 21 gray in three fractions using a multichannel vaginal cylinder. The primary objective was to determine the effectiveness of adjuvant vaginal cuff brachytherapy and to identify surgicopathological risk factors that could portend towards worse oncological outcomes.ResultsA total of 182 patients were included in the analysis. Median follow-up was 5.3 years (2.3–12.2). Ten-year survival was 73.3%. Five-year cumulative incidence (CI) of vaginal, pelvic, and para-aortic relapse was 1.4%, 2.1%, and 0.9%, respectively. Five-year locoregional failure, any recurrence, peritoneal relapse, and other distant recurrence was 4.4%, 11.6%, 5.3%, and 6.7%, respectively. On univariate analysis, locoregional failure was worse for larger tumors (per 1 cm) (HR 1.9, 95% CI 1.2 to 3.0, p≤0.01). Any recurrence was worse for tumors of at least 3.5 cm (HR 3.8, 95% CI 1.3 to 11.7, p=0.02) and patients with positive/suspicious cytology (HR 4.4, 95% CI 1.5 to 12.4, p≤0.01). Ten-year survival for tumors of at least 3.5 cm was 56.9% versus 86.6% for those with smaller tumors (HR 2.9, 95% CI 1.4 to 5.8, p≤0.01). Ten-year survival for positive/suspicious cytology was 50.9% versus 77.4% (HR 2.2, 95% CI 0.9 to 5.4, p=0.09). Multivariate modeling demonstrated worse locoregional failure, any recurrence, and survival with larger tumors, as well as any recurrence with positive/suspicious cytology. Subgroup analysis demonstrated improved outcomes with the use of adjuvant chemotherapy in patients with large tumors or positive/suspicious cytology.ConclusionAdjuvant vaginal cuff brachytherapy alone without chemotherapy is an appropriate treatment for women with negative peritoneal cytology and small, early-stage clear cell, serous, and mixed endometrial cancer. Larger tumors or positive/suspicious cytology are at increased risk for relapse and worse survival, and should be considered for additional upfront adjuvant treatments, such as platinum-based chemotherapy.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jose G. Bazan ◽  
Sachin R. Jhawar ◽  
Daniel Stover ◽  
Ko Un Park ◽  
Sasha Beyer ◽  
...  

AbstractIn the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors treated with lumpectomy. To evaluate existing data on radiation omission, we used the National Cancer Database (NCDB) to test the hypothesis that RT omission results in equivalent overall survival (OS) in stage 1 (T1N0) HER2+ breast cancer. We excluded patients that received neoadjuvant systemic therapy. We stratified the cohort by receipt of adjuvant radiation. We identified 6897 patients (6388 RT; 509 no RT). Patients that did not receive radiation tended to be ≥70 years-old (odds ratio [OR] = 3.69, 95% CI: 3.02–4.51, p < 0.0001), to have ≥1 comorbidity (OR = 1.33, 95% CI: 1.06–1.68, p = 0.0154), to be Hispanic (OR = 1.49, 95% CI: 1.00–2.22, p = 0.049), and to live in lower income areas (OR = 1.32, 95% CI: 1.07–1.64, p = 0.0266). Radiation omission was associated with a 3.67-fold (95% CI: 2.23–6.02, p < 0.0001) increased risk of death. While other selection biases that influence radiation omission likely persist, these data should give caution to radiation omission in T1N0 HER2+ breast cancer.


Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 29
Author(s):  
Kristina Marie Kokorelias ◽  
Einat Danieli ◽  
Sheila Dunn ◽  
Sid Feldman ◽  
David Patrick Ryan ◽  
...  

The number of family caregivers to individuals with dementia is increasing. Family physicians are often the first point of access to the health care system for individuals with dementia and their caregivers. Caregivers are at an increased risk of developing negative physical, cognitive and affective health problems themselves. Caregivers also describe having unmet needs to help them sustain care in the community. Family physicians are in a unique position to help support caregivers and individuals with dementia, but often struggle with keeping up with best practice dementia service knowledge. The Dementia Wellness Questionnaire was designed to serve as a starting point for discussions between caregivers and family physicians by empowering caregivers to communicate their needs and concerns and to enhance family physicians’ access to specific dementia support information. The DWQ aims to alert physicians of caregiver and patient needs. This pilot study aimed to explore the experiences of physicians and caregivers of people using the Questionnaire in two family medicine clinics in Ontario, Canada. Interviews with physicians and caregivers collected data on their experiences using the DWQ following a 10-month data gathering period. Data was analyzed using content analysis. Results indicated that family physicians may have an improved efficacy in managing dementia by having dementia care case specific guidelines integrated within electronic medical records. By having time-efficient access to tailored supports, family physicians can better address the needs of the caregiver–patient dyad and help support family caregivers in their caregiving role. Caregivers expressed that the Questionnaire helped them remember concerns to bring up with physicians, in order to receive help in a more efficient manner.


2021 ◽  
pp. 239496432110105
Author(s):  
Bruno Pereira ◽  
Gui Lohmann ◽  
Luke Houghton

Collaboration plays a critical role in fostering innovation and value creation in the aviation sector. However, how factors and connections relate to the achievement of innovative outcomes in aviation require further investigation. This study investigates the key factors that create a conceptual framework by conducting a literature review and an archival analysis of news articles. The model proposed involves factors such as strategic decision-making; networking and partner choice; cultural context, values, behaviour and compatibilities; collaboration configuration; issues and risks shared; skills, capacities and experience; infrastructure and resources available; engagement activities; knowledge transfer, absorption and appropriation; collaboration management; communication flows; external environment and demand; and expectations and outcomes. Promising collaborations are also indicated in areas where the framework could be adopted to increase partnerships and outcomes. Also, we highlight best practice examples from leading organizations, such as International Airlines Group (IAG), Emirates Airline, Singapore Airlines, Boeing and JetBlue, to provide insights into existing collaborations that have led to innovation and value creation in this sector.


2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.


Author(s):  
Anne Hendricks ◽  
Christina Lenschow ◽  
Matthias Kroiss ◽  
Andreas Buck ◽  
Ralph Kickuth ◽  
...  

Abstract Purpose Repeat surgery in patients with primary hyperparathyroidism (pHPT) is associated with an increased risk of complications and failure. This stresses the need for optimized strategies to accurately localize a parathyroid adenoma before repeat surgery is performed. However, evidence on the extent of required diagnostics for a structured approach is sparse. Methods A retrospective single-center evaluation of 28 patients with an indication for surgery due to pHPT and previous thyroid or parathyroid surgery was performed. Diagnostic workup, surgical approach, and outcome in terms of complications and successful removement of parathyroid adenoma with biochemical cure were evaluated. Results Neck ultrasound, sestamibi scintigraphy, C11-methionine PET-CT, and selective parathyroid hormone venous sampling, but not MRI imaging, effectively detected the presence of a parathyroid adenoma with high positive predictive values. Biochemical cure was revealed by normalization of calcium and parathormone levels 24–48h after surgery and was achieved in 26/28 patients (92.9%) with an overall low rate of complications. Concordant localization by at least two diagnostic modalities enabled focused surgery with success rates of 100%, whereas inconclusive localization significantly increased the rate of bilateral explorations and significantly reduced the rate of biochemical cure to 80%. Conclusion These findings suggest that two concordant diagnostic modalities are sufficient to accurately localize parathyroid adenoma before repeat surgery for pHPT. In cases of poor localization, extended diagnostic procedures are warranted to enhance surgical success rates. We suggest an algorithm for better orientation when repeat surgery is intended in patients with pHPT.


2020 ◽  
Vol 32 (S1) ◽  
pp. 103-103
Author(s):  
Rose-Marie Dröes ◽  
Yvette Vermeer ◽  
Sébastien Libert ◽  
Sophie Gaber ◽  
Sarah Wallcook ◽  
...  

The Interdisciplinary Network for Dementia Using Current Technology, INDUCT, is a Marie Sklodowska Curie funded International Training Network that aims to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia. Within INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support every day life; technology to promote meaningful activities; and health care technology.Three transversal objectives were adopted by INDUCT: 1) To determine the practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; and 3) To trace facilitators and barriers for implementation of technology in dementia care.The main recommendations resulting from the research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which will be presented at the congress. The recommendations are meant to be helpful for different target groups, i.e. people with dementia, their formal and informal carers, policy makers, designers and researchers, who can easily select the for them relevant recommendations in the Best Practice Guidance by means of a selection tool. The main aim of the Best Practice Guidance is to improve the development, usage and implementation of technology for people with dementia in the three mentioned technology areas.This Best Practice Guidance is the result of the intensive collaborative partnership of INDUCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the INDUCT project.Acknowledgements: The research presented was carried out within the Marie Sklodowska Curie International Training Network (ITN) action, H2020-MSCA-ITN-2015, grant agreement number 676265.


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