General surgical foundation doctor: optimisation of daily practice

2020 ◽  
Vol 96 (1136) ◽  
pp. 339-342
Author(s):  
Emmanuel Feldano ◽  
Michael Clark ◽  
Benjamin Ramasubbu
Keyword(s):  
Structural Changes ◽  
Positive Impact ◽  
Daily Practice ◽  
Daily Routine ◽  
Improvement Project ◽  
Surgical Ward ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionThe role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes.MethodsThe project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed).ResultsThere was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved.ConclusionThe implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.

scholarly journals 8 General surgical foundation doctor optimisation of daily practice

2019 ◽  
Vol 95 (1130) ◽  
pp. 687.1-687
Author(s):  
Emmanuel Feldano ◽  
Ben Ramasubbu
Keyword(s):  
Structural Changes ◽  
Working Hours ◽  
Daily Practice ◽  
Task Completion ◽  
Junior Doctors ◽  
Daily Routine ◽  
European Working ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionTraditionally the role of a surgical foundation year 1 (FY1s) doctors consisted of long working hours, multiple on call shifts and little to rest however, the introduction of European working time directive now means that FY1s are constricted to 48 hours per week on average and various other regulations that junior doctors should abide by yet the same quantity of daily tasks remains the same. In this study we looked at the difficulties FY1s now face in their daily working day and if some of these issues could be resolved by implementing some structural changes.MethodsThe study was conducted in three cycles, each lasting five days (Monday to Friday). Cycle 1 included shadowing of Surgical FY1s on wards for five consecutive days observing daily routine (arrival, lunch and departure time), task completion, communication and handovers. Following this multiple interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in cycle 2 (as the new model was scaffolded into place) and cycle 3 (strictly observed).ResultsIn cycle 1 we observed that 100% of F1s arrived to work on time, there was no set times for lunch and all of the FY1s lunches were interrupted. There was no structure for handovers and 100% of F1s stayed at work beyond there contracted hours. In second cycle, 100% of F1s had lunch between the hours of 12pm-1PM on 3/5 days and 75% on the remaining two days. 75% of F1s had uninterrupted lunches on all 5 days. Morning and afternoon handovers were completed every day. In cycle 3 the results remained as high. There was no significant difference in number of tasks between week 1, 2 and 3.ConclusionThrough the implementation of daily structure and other interventions involving the multidisciplinary team we improved the quality of F1s working day and increased the efficiency of service delivered on the surgical ward.

scholarly journals AB1088 NAIL PSORIASIS: THE UNDERESTIMATED DISORDER IN PSORIASIS AND PSORIASIS ARTHRITIS. CAN ULTRASOUND AND CAPILLARY MICROSCOPY IN PATIENTS WITH NAIL PSORIASIS SPEED UP OUR DIAGNOSIS AND THERAPY?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1833.2-1833
Author(s):  
B. C. Detlef ◽  
S. El-Nawab-Becker ◽  
M. Toellner ◽  
A. Kleinheinz ◽  
T. Witte
Keyword(s):  
Psoriasis Vulgaris ◽  
Extensor Tendon ◽  
Daily Practice ◽  
Daily Routine ◽  
Nail Psoriasis ◽  
Capillary Microscopy ◽  
Nail Matrix ◽  
Significant Difference ◽  
The Us ◽  
Nail Involvement

Background:Nail psoriasis is an extreme diagnostic and therapeutic challenge and represents an enormous physical and psychological burden for affected patients.50% of patients with psoriasis vulgaris develop nail involvement (NailPso)during the course of their disease. NailPso is the strongest predictor of psoriatic arthritis (PsA). Through the synovio-enthesial concept we have learned that there is an anatomical-pathophysiological relationship between DIP joint, extensor tendon and nail matrix. We have observed in daily practice that hypervascularization (HV) in ultrasound Power Doppler (US-PD)the nail matrix may be a pathognomonic element in its own right. There are no data on this in the literature.Objectives:Is there a difference in the ultrasound PD examination of the DIP joint and nail area and in the capillary microscopy of the corresponding nail fold in patients with psoriasis vulgaris and nail psoriasis versus patients with psoriasis vulgaris without nail psoriasis.Methods:Monocentric prospective study of all consecutive patients with psoriasis vulgaris who have come to a rheumatic practice to clarify a PsA. Inaddition to demographic data, assessments (PASI,DLQI,CASPAR,GEPARD, DAS28, SJ,TJ,FFBH), clinical examination, a standardized ultrasound PD examination and capillary microscopy of the affected fingertips in PsO patients suffering from nail psoriasis was performed as well as corresponding examinations of the 2nd and 3rd finger right in PsO patients without nail involvement.Results:79 patients could be included during the study period. Thereof 25 PsO patients without nail involvement and 44 PsO patients with nail involvement. Since the patients were examined consecutively, the difference results. There was no difference in age, BMI and sex in both groups (Pso and NailPso). The Caspar criteria as classification criteria for a PsA were positive in 65% of the NailPso patients and positive in 50% of all PsO patients without nail infestation. Hypervascularization in the US-PD examination in the area of the nail matrix could be seen significantly more frequently in NailPso compared to non-NagelPso patients. Such a difference did not exist in the HV of the extensor tendons.Capillary microscopy showed a significant difference in the number of torsions/twist capillaries in NailPso compared to Pso patients without NailPso.Hypervascularization of the nail matrix is seen significantly more frequently in patients with psoriasis of the nail than in patients without psoriasis of the nail. Such a difference does not exist in DIP joint -extensor tendon- enthesitis. At the same time, torsions are significantly more frequently seen in capillary microscopy in NailPso than in patients without NailPso.Conclusion:The US-PD examination is a simple and non-invasive procedure which can be performed routinely in daily practice. The hypervascularization of the nail matrix should also make one think of nail psoriasis in the early stage of PsO, in order to be able to start early an appropriate therapy for this very stigmatizing and therapeutically extremely difficult manifestation of PsO. It seems to occur independently of extensor tendon synovitis as an independent manifestation phenomenon.The occurrence of torsions in capillary microscopy >50 % also seems to be groundbreaking for a NagelPso, whereby capillary microscopy is a temporal challenge in daily routine.References:§ The present study (7734-BO-S2018 Ethics Commission of the MHH, Medical School Hannover, Germany) contains parts of the PhD thesis of M.TöllnerDisclosure of Interests:Becker-Capeller Detlef Grant/research support from: Novartis, Speakers bureau: Pfizer, Soham El-Nawab-Becker: None declared, Malo Toellner: None declared, Andreas Kleinheinz: None declared, Torsten Witte: None declared

scholarly journals Performance Assessment of University Lecturers: A Data Mining Approach

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Milkhatun Milkhatun ◽  
Alfi Ari Fakhrur Rizal ◽  
Ni Wayan Wiwin Asthiningsih ◽  
Asslia Johar Latipah
Keyword(s):  
Community Service ◽  
Teaching And Learning ◽  
Positive Impact ◽  
Learning Approaches ◽  
Teaching Materials ◽  
Study Program ◽  
Data Mining Approach ◽  
Quality Of Teaching ◽  
Significant Difference

A lecturer with a good performance has a positive impact on the quality of teaching and learning. The said quality  includes the delivery of teaching materials, learning methods, and ultimately the academic results of students. Performance of lecturers contributes significantly to the quality of research and community service which in turn improves the quality of teaching materials. It is desirable, therefore, to have a method to measure the performance of lecturers in carrying out the Tri Dharma (or the three responsibility) activities, which consist of teaching and learning process, research, and community service activities, including publications at both national and international level. This study seeks to measure the performance of lecturers and cluster them into three categories, namely "satisfactory", "good", and "poor". Data were taken from academic works of nursing study program lecturers in conducting academic activities. Clustering process is carried out using two machine learning approaches, which is K-Means and K-Medoids algorithms. Evaluation of the clustering results suggests that K-Medoids algorithm performs better compared to using K-Means. DBI score for clustering techniques using K-Means is -0.417 while the score for K-Medoids is -0.652. The significant difference in the score shows that K-Medoids algorithm works better in determining the performance of lecturers in carrying out Tri Dharma activities.

Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study

2016 ◽  
Vol 31 (3) ◽  
pp. 275-282 ◽  
Author(s):  
Alze Pereira dos Santos Tavares ◽  
Carolina Paparelli ◽  
Carolina Sassaki Kishimoto ◽  
Silvia Avo Cortizo ◽  
Karen Ebina ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
Missing Data ◽  
Outcome Measure ◽  
Symptom Control ◽  
Daily Practice ◽  
Daily Routine ◽  
Palliative Care Outcome Scale ◽  
Care Outcome

Background: Gathering clinical evidence data on patients’ palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. Aim: To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients. Design: An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly. Setting/participants: Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study. Results: Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: ‘pain’ and ‘other symptoms’ presented statistical significant differences ( p < 0.05). Conclusion: Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.

scholarly journals Quality of Life in Children with Asthma versus Healthy Children

2018 ◽  
Vol 6 (8) ◽  
pp. 1413-1418 ◽  
Author(s):  
Samaneh Kouzegaran ◽  
Parisa Samimi ◽  
Hamid Ahanchian ◽  
Maryam Khoshkhui ◽  
Fatemeh Behmanesh
Keyword(s):  
Quality Of Life ◽  
Physical Performance ◽  
Control Group ◽  
P Value ◽  
Healthy Children ◽  
Significant Difference ◽  
Children With Asthma ◽  
And Performance ◽  
Asthma Group

BACKGROUND: Asthma is the most prevalent chronic disease in the pediatric age group. The disease affects different aspects of the children's lives, such as physical, emotional, social and educational aspects. Thus, more focus has been on the quality of life in these patients rather than the duration of their illness in recent years.AIM: This study examined the different aspects of quality of life in asthmatic children for the first time in this geographic area.METHODS: The study was cross-sectional conducted in 2015-2016. The asthmatic group was 100 patients aged 8 to 12 admitted to the Asthma and Allergy Clinic of Ghaem Hospital (as) in Mashhad with the control group composed of 100 healthy children of the same age and gender. The standard questionnaire pedsQLTM was used for comparing the quality of life of children in the two groups. Statistical analysis was SPSS23 with P-value less than 0.05, which was statistically significant.RESULTS: In each group, 58 patients were boys, and 42 were girls. In a comparison of the quality of life of children, the asthma group with a mean total score of Peds QL 20.99 ± 12.54 compared to the healthy children with a mean total score of Peds QL of 8.8 ± 5.41 had a lower quality of life (P < 0.001). Moreover, regarding various aspects of quality of life asthma group had a lower quality of life in physical performance, emotional performance and performance in school (P < 0.001). Nonetheless, there was no significant difference between the two groups considering social function (P = 0.267). Examining the relationship between Peds QL score of patients with asthma with various variables was indicative of the fact that Peds QL scores were significantly correlated with the gender of the patients, showing better quality of life in the girls (P = 0.001).CONCLUSION: The results indicated that children with asthma have a significantly lower quality of life compared with healthy children of the same age. Also, in examining the different aspects of quality of life, these children had a lower quality of life in physical performance, emotional performance, and performance at school, and were at the level as that of healthy children only in social performance.

scholarly journals Índice de Governança Corporativa, Desempenho e Valor da Firma no Brasil

2005 ◽  
Vol 3 (1) ◽  
pp. 1 ◽  
Author(s):  
André Luiz Carvalhal da Silva ◽  
Ricardo Pereira Câmara Leal
Keyword(s):  
Corporate Governance ◽  
Return On Assets ◽  
Good Corporate Governance ◽  
Total Capital ◽  
Significant Difference ◽  
Governance Practices ◽  
And Performance ◽  
And Control ◽  
High Degree

This study investigates the relationship between the quality of a firms corporate governance practices and its valuation and performance, through the construction of a broad firm-specific corporate governance index for Brazilian listed companies. The empirical results indicate a high degree of ownership and control concentration. We can also note a significant difference between the voting and total capital owned by the largest shareholders, mainly through the existence of non-voting shares. Panel data results indicate that less than 4% of Brazilian firms have good corporate governance practices, and that firms with better corporate governance have significantly higher performance (return on assets). There is also positive relationship between Tobin’s Q and better corporate governance practices although the results are not statistically significant.

scholarly journals THE IMPACT OF SUBLINGUAL ALLERGEN IMMUNOTHERAPY ON ASTHMA CONTROL AND THE QUALITY OF LIFE LEVEL IN PATIENTS WITH ALLERGIC ASTHMA AND SENSITIZATION TO TREES POLLEN

2014 ◽  
Vol 11 (4) ◽  
pp. 50-54
Author(s):  
D A NAGATKIN ◽  
A V ZHESTKOV
Keyword(s):  
Quality Of Life ◽  
Allergic Asthma ◽  
Inhaled Corticosteroids ◽  
Positive Impact ◽  
Forced Expiratory Volume ◽  
Average Dose ◽  
Allergen Specific Immunotherapy ◽  
Significant Difference ◽  
The Impact

Background. To Evaluate the effects of trees pollen sublingual products on the control and quality of life in patients with allergic asthma and proven sensitization to pollens of trees. Methods. We enrolled 56 patients in open prospective study and divided into 2 groups to assess the effectiveness of therapy with sublingual allergen. Groups were matched on estimated parameters of quality of life, level of control and forced expiratory volume in the first second. Results. Statistically significant improvement of quality of life parameters and the level of control within the group receiving sublingual immunotherapy was obtained. Significant difference in the average dose of received inhaled corticosteroids was established in the treatment group comparing to control. Conclusion. Sublingual allergen specific immunotherapy has a positive impact on quality of life and level of control in patients with allergic asthma and proven sensitization to pollens of trees, and decreasing the dose of inhaled corticosteroids.

scholarly journals What an Interventionalist Needs to Know About INOCA

2021 ◽  
Vol 16 ◽  
Author(s):  
Daniel Tze Yee Ang ◽  
Colin Berry
Keyword(s):  
Quality Of Life ◽  
Diagnostic Procedure ◽  
Positive Impact ◽  
Symptom Burden ◽  
Daily Practice ◽  
Microvascular Angina ◽  
Cardiac Symptoms ◽  
Artery Disease ◽  
Safety Considerations

Ischaemia with non-obstructed coronary artery disease (INOCA) remains a diagnostic and therapeutic challenge. An anatomical investigation-based approach to ischaemic heart disease fails to account for disorders of vasomotion. The main INOCA endotypes are microvascular angina, vasospastic angina, mixed (both) or non-cardiac symptoms. The interventional diagnostic procedure (IDP) enables differentiation between clinical endotypes, with linked stratified medical therapy leading to a reduced symptom burden and a better quality of life. Interventionists are therefore well placed to make a positive impact with more personalised care. Despite adjunctive tests of coronary function being supported by contemporary guidelines, IDP use in daily practice remains limited. More widespread adoption should be encouraged. This article reviews a stratified approach to INOCA, describes a streamlined approach to the IDP and highlights some practical and safety considerations.

The impact of value-based payment on the referral of oncology patients to tobacco cessation services.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 116-116
Author(s):  
Louise Bedard ◽  
Jennifer J. Griggs
Keyword(s):  
Tobacco Cessation ◽  
Positive Impact ◽  
Quality Care ◽  
Improvement Project ◽  
Core Measure ◽  
And Performance ◽  
Oncology Practice ◽  
Performance Results ◽  
The Impact ◽  
The Relationship

116 Background: The purpose of this study is to investigate the relationship between the introduction of value-based payment, the initiation of a quality improvement project, and practices’ performance to refer or administer tobacco cessation counseling to patients. Methods: The Michigan Oncology Quality Consortium (MOQC) is a statewide quality collaborative sponsored by Blue Cross/Blue Shield of Michigan (BCBSM). MOQC uses ASCO's Quality Oncology Practice Initiative (QOPI) for measurement.Value-based payment (VBP) was introduced in 2017 by BCBSM. The VBP is achieved if a region reaches a target established for four QOPI measures. One of the four quality measures is QOPI's core measure 22bb: tobacco cessation counseling administered or patient referred. At the time the VBP was introduced, a subset of MOQC practices chose to initiate a quality project to improve performance on this measure. Analyses describes the performance of all MOQC practices with the introduction of the VBP, and performance of the practices who chose to revise their tobacco cessation processes to address performance. Results: The proportion of patients who were administered or referred to tobacco cessation services in participating MOQC practices was 49% (n = 793 charts) from abstracted rounds Spring 2014 - 2017. After the introduction of VBP, this proportion increased to 58% (n = 307 charts) in Fall 2017. Performance improved on this QOPI measure for both subsets of MOQC practices - those practices that chose to initiate a quality project focused on this measure (n = 19) and practices that selected another measure (n = 27). Practices that developed a quality project improved their aggregate proportion from 46% (Spring 2014-2017, n = 839 charts) to 51% (Fall 2017, n = 266 charts). Practices that focused on another quality measure improved from 51% (Spring 2014-2017, n = 789 charts) to 65% (Fall 2017, n = 265 charts). Conclusions: Our data suggest that the presence of VBP may have had a positive impact on referral patterns for tobacco cessation services for cancer patients. Additional analyses are required to determine if there is a combination or sequencing of VBP and process improvement strategies to optimize the delivery of quality care.

Improving the quality of the daily ward round in a Plastic Surgery unit by adapting the SAFE Ward Round Tool of the Royal College of Surgeons of Edinburgh

2020 ◽  
Vol 25 (6) ◽  
pp. 233-238
Author(s):  
Harry D Koumoullis ◽  
Martin Shapev ◽  
Gabriel Wong ◽  
Sophie Gerring ◽  
Goerge Patrinios ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Emergency Admission ◽  
Daily Practice ◽  
Ward Round ◽  
Surgical Tool ◽  
Surgical Ward ◽  
Ward Rounds ◽  
Surgery Department ◽  
Pro Forma

Aim Our goal was to audit the quality of the ward round documentation in our Plastic Surgery department by using the SAFE Ward Round Tool of the RCS Edinburgh’s as a reference standard, and to create an in-house pro-forma based on results and discussion. Method An initial cycle based on the SAFE Tool was undertaken with prospective audit of individual daily ward round entries. A sticker pro forma was introduced and re-audit was done using the same criteria. Based on results and discussion, the pro-forma was further improved. Re-audit was performed to assess percentage of completion of its contents. Results The first cycle showed 47% (n = 42) completion rate and re-audit after implementation of the sticker found a rise up to 70% (n = 42). The third cycle examining solely sticker completion yielded a compliance of 88% (n = 61). This improvement reflected to the enthusiastic comments received from staff working in allied specialties. Conclusions Significant lapses in daily ward round documentation were revealed by our methodology. A sticker pro-forma, which we have named the Surgical Tool for the Assessment of Rounds (STAR), was introduced and provided measurable and sustainable improvements on our daily ward round practice. That had as a result the safeguarding of patient safety in the frame of Good Medical Practice. We suggest same methodology to be followed based on the SAFE Ward Round Tool for surgical ward rounds improvement in all the surgical and interventional specialties particularly when there is a component of emergency admission in their daily practice

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