scholarly journals Multiperspective simulations for implementing a change in service: stroke telethrombolysis

2021 ◽  
pp. bmjstel-2020-000848
Author(s):  
Craig William Brown ◽  
Petrus Elofuke
Keyword(s):  
Patient Care ◽  
Service Providers ◽  
Stroke Care ◽  
Referral Hospital ◽  
The Other ◽  
Treatment Delivery ◽  
Hyperacute Stroke ◽  
Simulation Based ◽  
Change In Practice ◽  
Process Elements

Simulation-based training has been used in a variety of ways to demonstrate and improve process elements of patient care. One example of this is in improving door-to-needle times in hyperacute stroke care. Changes in service by one team which affect another bring difference of opinions between service providers involved and can lead to interdepartmental conflict. In this report, we use Kurt Lewin’s model for change to describe how a series of multiperspective simulation-based exercises were used in implementing a change in practice with the introduction of telethrombolysis within a large tertiary stroke referral hospital. The use of multiperspective or bidirectional simulation allowed a ‘meeting of minds’ with each service able to illustrate key themes to the other service. This was demonstrated through a series of simulation-based exercises. Following successful simulation-based exercises and subsequent interdepartmental agreement, a telethrombolysis pilot has been conducted within our centre. Ongoing audit of practice continues as this method of treatment delivery is continued. Further simulation work is planned as a national thrombectomy service is instigated.

Exploration of Product Centric Factors in Telecom Industry

2015 ◽  
Vol 8 (1) ◽  
Author(s):  
Swati Ganeti ◽  
Rajat Agarwal ◽  
Murali Krishna Medudula ◽  
Mahim Sagar
Keyword(s):  
Service Quality ◽  
Service Provider ◽  
Service Providers ◽  
Network Connectivity ◽  
Factor Loading ◽  
The Other ◽  
Relative Importance ◽  
Network Connection ◽  
Telecom Service ◽  
Telecom Industry

Telecom industry is one of those industries which has changed dramatically during the past decade. With more and more players entering in this industry, competition is ever increasing. The war between these players is slowly shifting from the price to the augmentation. This paper aims at exploring such factors which influence a customers preference of one telecom service provider (TSP) over the other. It is a descriptive research where study has been conducted among the consumers of different telecom service providers (TSPs). By reviewing the existing literature in this domain, we explored different factors which affect the consumers decision to prefer one telecom service provider over the other. A consumer targeted questionnaire was designed where consumers were asked about the factors they consider (with their relative importance quantified using Likert scale), before buying a new network connection to know the relative importance of the various factors. Factor Analysis was performed to club various variables into distinct factors. Statistical techniques then helped in identifying the relative importance. From the Factor Loading matrix the following five factors were generated:- Overall service quality, Point of Purchase Differentiator, Promotion Measures, Tariff Plans and Size of the Network. Further study in the behavioural perceptions of consumer shows that the most important factor in influencing the customer buying behavior is Service Quality. The second most important factor is cost and various plans offered by the telecom service provider. Network connectivity was considered by almost all the respondents and consumers prefer the largest network player. The study also found that promotional measures dont influence the customers as expected.

scholarly journals Exploring the behavioral drivers of review valence

2018 ◽  
Vol 30 (10) ◽  
pp. 3083-3099 ◽  
Author(s):  
Panagiotis Stamolampros ◽  
Nikolaos Korfiatis
Keyword(s):  
Information Content ◽  
Service Providers ◽  
Online Reviews ◽  
The Other ◽  
Three Dimensions ◽  
Spatial Distance ◽  
Bag Of Words ◽  
Content Type ◽  
Online Ratings ◽  
Positive Direct

Purpose Although the literature has established the effect of online reviews on customer purchase intentions, the influence of psychological factors on online ratings is overlooked. This paper aims to examine these factors under the perspective of construal level theory (CLT). Design/methodology/approach Using review data from TripAdvisor and Booking.com, the authors study three dimensions of psychological distances (temporal, spatial and social) and their direct and interaction effects on review valence, using regression analysis. The authors examine the effect of these distances on the information content of online reviews using a novel bag-of-words model to assess its concreteness. Findings Temporal distance and spatial distance have positive direct effects on review valence. Social distance, on the other hand, has a negative direct effect. However, its interaction with the other two distances has a positive effect, suggesting that consumers tend to “zoom-out” to less concrete things in their ratings. Practical implications The findings provide implications for the interpretation of review ratings by the service providers and their information content. Originality/value This study extends the CLT and electronic word-of-mouth literature by jointly exploring the effect of all three psychological distances that are applicable in post-purchase evaluations. Methodologically, it provides a novel application of the bag-of-words model in evaluating the concreteness of online reviews.

Abstract P184: Effect of Acute Stroke Care Hospital Networks in Korea

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jihoon Kang ◽  
Seong Eun Kim ◽  
Hyunjoo Song ◽  
Hee-joon Bae
Keyword(s):  
Network Analysis ◽  
Acute Stroke ◽  
Stroke Care ◽  
The Other ◽  
Care Hospital ◽  
Initial Visit ◽  
Analysis Method ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Hospital Networks

Purpose: Stroke patients generally transport stroke patients either to nearest stroke hospital with secondary transfers or to hub hospitals in selective cases. This study aimed to determine the stroke community of close networks and to evaluate their role for the access the endovascular treatment (EVT). Methods: Using the nationwide acute stroke hospital (ASH) surveillance data assessed the major quality indicators of all stroke patients of South Korea, triage information both initial visit and secondary interhospital transfers were extracted according to the hospitals. Based on them, stroke community with dense linkages were partitioned using the network-based Louvain algorithm. The hierarchical model estimated the function of stroke community for the EVT. Results: For 6-month surveying period, 19113 subjects admitted to the 246 ASHs. Of them, 1831 (9.6%) were transferred from 763 adjacent facilities not ASH, while 1283 (6.7%) from the other ASHs. The algorithm determined the 113 stroke communities where composed median 7 hospitals (2 ASHs and 5 adjacent facilities) and treated about 30 subjects per month. Most of communities formed the spindle shape with higher centralization index and located within 150 Km (Figure). Stroke communities significantly affected 11% of EVT after adjustments. Conclusions: Network analysis method effectively contoured the high centralizing stroke communities and helped the functions on the EVT accessibility.

Abstract W P317: Pan-London Simulation Training for Hyperacute Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
J Birns ◽  
P Jaye ◽  
A Roots ◽  
G Reedy ◽  
Alastair Ross
Keyword(s):  
Learning Outcomes ◽  
Health Care Professionals ◽  
Simulation Training ◽  
Emergency Situation ◽  
Technical Skills ◽  
Stroke Care ◽  
Training Programme ◽  
Management Decision ◽  
Structured Interviews ◽  
Hyperacute Stroke

Background: City-wide re-organisation of stroke care in London, incorporating 8 hyperacute stroke units (HASUs), has improved thrombolysis rates and survival cost-effectively. Continued staffing of HASUs requires stroke-specialist training to develop competencies for managing neurological emergencies. Simulation training provides an education platform for health care professionals to become immersed in realistic scenarios where outcome is dependent upon technical and non-technical skills. Methods: A standardised, curriculum-mapped, high-fidelity, simulation-training programme was developed on 4 HASUs for city-wide staff to attend. Learning outcomes included technical (acute stroke assessment/management) and non-technical skills (including time management/decision-making/teamwork). A mixed-methods evaluation approach was used to evaluate data from participants before, during, and after training. Results: Over a 2 year period, 152 HASU staff (70 medical; 82 nursing) participated. Quantitative analysis showed a pre/post-course increase in candidates’ ability to manage emergency stroke situations (t=6.6, p<0.001), leadership skills (t=6.7, p<0.001) and communication skills (t=3.7, p<0.001), more so in junior compared with senior clinicians. Simulation training was enjoyable (mean (SD) rating 5.7(2) on 7 point Likert scale), with higher ratings from doctors compared with nurses (t=3; p<0.01). Enjoyment correlated positively (r=0.853; p<0.001) and previous experience of simulation correlated negatively (r=-0.228; p<0.05) with relevance to clinical practice. Thematic analysis of post-course semi-structured interviews demonstrated 5 important learning outcomes (assertiveness; calling for help; situational awareness; teamwork; verbalising thoughts) and 3 main responses for transference to practice (general enthusiasm with no particular practical change; immediate recognition of an emergency situation providing recall of the course; reflective change). Conclusion: Simulation training may be effective in helping achieve HASU-specific learning outcomes and may be delivered in a standardised manner across multiple sites.

Abstract TP240: Simulation-Based Learning Improves Neurology Resident Training in Acute Stroke Care

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Waimei Tai ◽  
J.j. Baumann ◽  
Esther Melamed ◽  
Nirali Vora ◽  
Neil Schwartz
Keyword(s):  
Acute Stroke ◽  
Training Session ◽  
Vital Signs ◽  
Stroke Care ◽  
Resident Training ◽  
Acute Stroke Care ◽  
Simulation Based ◽  
Overall Evaluation ◽  
Simulation Center

Introduction: Acute “stroke codes” are stressful for the new neurology resident who must lead a multi-disciplinary team and quickly integrate information to make high risk time-sensitive decisions. While other disciplines have used simulation technology for years for cardiac arrest codes, neurology has just begun utilizing this resource. Objective: To improve neurology trainees’ execution of a multi-disciplinary acute stroke code using simulation experience Methods: We identified three learning objectives for the simulation experience: assess tissue plasminogen activator (tPA) eligibility, utilize appropriate order sets, and communicate effectively. Scripts for two emergent scenarios were developed: ischemic stroke requiring i.v. tPA and warfarin-associated intracranial hemorrhage requiring coagulopathy reversal. A standardized patient (SP) was trained. Neurology residents in their first week of training were the learners. Six residents attended a four-hour training session in the Simulation Center at Stanford University. Half of the trainees participated in the scenario while the others observed through live video. The SP acted the part in a fully-equipped, mock emergency room. Monitors, controlled remotely, displayed vital signs which changed to reflect interventions performed. Screens also displayed radiologic data. Trainees communicated with the stroke fellow and nursing regarding the plan of care and placed orders through an electronic medical record in training mode. Debriefing occurred after each scenario. Evaluations were completed and collected. Results: Trainees had positive experiences and felt more comfortable with the stroke code after the training. On a 1-5 scale, learners rated quality of teaching (average 4.6); learning from the scenario (4.8); overall organization (4.2); facilities (5); and overall evaluation (4.6). Conclusions: Simulation training offers a valuable opportunity to enhance neurology resident’s comfort in running stroke codes. Additional studies are required to measure long-term retention of acquired skills and training effect on systems and clinical outcomes.

Conclusion

2019 ◽  
pp. 117-119
Author(s):  
Charles F. Manski
Keyword(s):  
Patient Care ◽  
Guideline Development ◽  
Medical Knowledge ◽  
The Other ◽  
Adherence To Guidelines ◽  
Decisions Under Uncertainty

This concluding chapter provides suggestions that encourage putting the themes of the book into practice. It returns to the question from Chapter 1: “Should clinicians adhere to guidelines or exercise judgment?” The chapter cautions against universal adherence to guidelines. Motivated by some of these considerations, the chapter considers separating two tasks of guideline development that have commonly been performed in conjunction. One task is to characterize medical knowledge. The other is to make recommendations for patient care. An alternative to having guidelines make care recommendations would be to enhance the ability of clinicians to make reasonable patient care decisions under uncertainty.

To Support and Defend

2019 ◽  
pp. 152-187
Author(s):  
Juliane Hammer
Keyword(s):  
At Risk ◽  
Domestic Violence ◽  
Direct Contact ◽  
Service Providers ◽  
The Other ◽  
Community Leaders ◽  
Religious Convictions ◽  
The One ◽  
Muslim Communities

This chapter highlights Muslim service providers of many kinds and the organizations in which they work. Muslim service providers, in different ways from advocates and community leaders, not only are at the front lines of the struggle against domestic violence (DV) in Muslim communities but also most directly and persistently interact with the mainstream DV landscape/movement. Service providers are at risk themselves in more acute ways as their direct contact with victims and survivors can also become contact with perpetrators who are a threat not only to DV victims but also to anyone who supports those victims. The chapter then explores the significance of their religious convictions and identities for the work they perform and for the ways in which they relate to their clients on the one hand and to “the system” on the other. It also sketches the landscape of Muslim DV services and offers some insights into the specific challenges this work entails.

Security Issues in Cloud Federations

2012 ◽  
pp. 176-194 ◽  
Author(s):  
Massimiliano Rak ◽  
Massimo Ficco ◽  
Jesus Luna ◽  
Hamza Ghani ◽  
Neeraj Suri ◽  
...  
Keyword(s):  
Identity Management ◽  
Service Providers ◽  
Cyber Attacks ◽  
The Other ◽  
Special Focus ◽  
Security Issues ◽  
Security Challenges ◽  
Cloud Federation ◽  
Large Effort ◽  
Computational Resources

The cloud paradigm, based on the idea of delegating to the network any kind of computational resources, is showing a considerable success. The estimated trend is that the number of different cloud-based solutions, approaches, and service providers (CSP) will continue growing. Despite the big number of different cloud solutions that currently exist, most of them are “walled gardens” unable to interoperate. On the other side, a large effort is taking place in the cloud community to develop and identify open solutions and standards. In such a context the concept of cloud federation, an architecture that combines the functionalities of different CSP, is a hot topic. This chapter presents an overview of the cloud federation topic, with special focus on its most important security challenges. Furthermore, it proposes a taxonomy of possible approaches to federation. Then it proposes a comparison of security problems in cloud and grid environment, and a detailed analysis of two relevant security problems, identity management and Cyber Attacks analysis, trying to outline how they can be applied in a federated context.

Epistemic Opacity

2019 ◽  
pp. 98-131
Author(s):  
Johannes Lenhard
Keyword(s):  
Mathematical Models ◽  
Simulation Models ◽  
Scientific Understanding ◽  
The Other ◽  
Weak Version ◽  
Simulation Based ◽  
Lower Standard ◽  
Epistemic Standards ◽  
Epistemic Opacity ◽  
Experimental Runs

This chapter shows that—and how—simulation models are epistemically opaque. Nevertheless, it is argued, simulation models can provide a means to control dynamics. Researchers can employ a series of iterated (experimental) runs of the model and can learn to orient themselves within the model—even if the dynamics of the simulation remain (at least partly) opaque. Admittedly, such an acquaintance with the model falls short of the high epistemic standards usually ascribed to mathematical models. This lower standard is still sufficient, however, when the aim is controlled intervention in technological contexts. On the other hand, opacity has to be accepted if the option for control is to remain in any way open. This chapter closes by discussing whether epistemic opacity restricts simulation-based science to a pragmatic—“weak”—version of scientific understanding.

scholarly journals Rehabilitation Therapists’ Clinical Questions in the Context of Evidence-Based Patient Care: An Exploratory Study

2013 ◽  
Author(s):  
Lorie Kloda ◽  
Joan Bartlett
Keyword(s):  
Qualitative Study ◽  
Patient Care ◽  
Exploratory Study ◽  
Occupational Therapists ◽  
Stroke Care ◽  
Evidence Based ◽  
Speech Language Pathologists ◽  
Accident Vasculaire Cérébral ◽  
Clinical Questions ◽  
Etude Qualitative

In this qualitative study, rehabilitation therapists (occupational therapists, physiotherapists, and speech-language pathologists) working in stroke care will be asked about their clinical questions. The goals of the study are: to identify common characteristics of questions, to develop a typology of questions, and to uncover reasons why certain questions are pursued.Pour cette étude qualitative, des thérapeutes en réadaptation (ergothérapeutes, physiothérapeutes et orthophonistes) œuvrant auprès de patients ayant subi un accident vasculaire cérébral sont interrogés à propos de leurs questions cliniques. Cette étude vise à déterminer les caractéristiques communes des questions, à dresser une typologie des questions et à découvrir les raisons pour lesquelles certaines questions adressées. 

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