Abstract 199: Hardwiring Institutional Learning Through Team-Based Problem-Solving in a Pediatric Cardiovascular Intensive Care Unit

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Eric A Williams ◽  
Lauren Ladwig ◽  
De Ann Nikolai ◽  
Gay Matthews ◽  
Jeanine M Graf
Keyword(s):  
Problem Solving ◽  
Real Time ◽  
Task Force ◽  
High Reliability ◽  
Ease Of Use ◽  
Practice Change ◽  
Frontline Staff ◽  
Pareto Chart ◽  
Exact Test ◽  
Before And After

Introduction: Our purpose was to develop a high reliability system (The SWARM) to empower frontline staff to share information regarding communication and process inefficiencies to rapidly develop solutions. Hypothesis: A systematic process for recognition, evaluation, and transparent feedback would increase the use of problem-solving. Methods: A multidisciplinary team, led by a physician and nurse, developed an email strategy to let frontline staff identify problems in real-time and solve and spread this knowledge throughout the CVICU and Heart Center. Problems submitted were outside the scope of institutional patient safety reporting. Unless immediate attention was required, the SWARM team evaluated entries weekly. Entries were categorized as: 1) Useful information to share with ICU staff; 2) More information needed to be obtained and personnel consulted; or 3) A multidisciplinary task force needed to generate consensus and evidence-based guidelines. Solutions were shared with ICU staff via direct email and a monthly newsletter. After 6 months ICU staff were surveyed with 5 questions regarding awareness, utility, and ease of use of the SWARM process. Staff were resurveyed after re-education and institution of leadership walk-rounds. Rates of SWARM entries before and after re-education were compared using Fisher’s Exact Test for proportions.*p<.05 Results: Of the total 65 SWARM entries, 9% were level 1, 86% were level 2 and 5% were level 3. Entries were categorized into problem types and are shown in the Pareto Chart as percent of total(See Chart). Pre- and post- survey results indicated that staff awareness increased from 70% to 91% and staff understanding of utility increased from 57% to 75%. After re-education, use in CVICU increased by 417% (0.7/week to 2.9/week)*. The increased rate of use of the SWARM system has been sustained for 8 weeks post education. The current rate is 1.8/week. The top two Solutions by category were Re-Education (62%) and Practice Change (17%). Conclusions: A system was developed to better manage quality through real-time awareness of our performance. The formal creation of a standardized context for information sharing has resulted in a significant increase in the performance of problem-solving. This multidisciplinary effort allows for minimizing unnecessary variation in how quality improvement efforts are identified and performed.

The Influence of Process Management: Uncovering the Impact of Real-Time Managerial Interventions via a Topic Modeling Approach

2021 ◽  
pp. 1-46
Author(s):  
Joshua Gyory ◽  
Kenneth Kotovsky ◽  
Jonathan Cagan
Keyword(s):  
Problem Solving ◽  
Real Time ◽  
Process Management ◽  
Topic Model ◽  
Design Team ◽  
Design Cognition ◽  
Team Members ◽  
Conceptual Engineering ◽  
Before And After ◽  
The Impact

Abstract Computationally studying team discourse can provide valuable, real-time insights into the state of design teams and design cognition during problem-solving. The particular experimental design, adopted from previous work by the authors, places one of the design team conditions under the guidance of a human process manager. In that work, teams under this process management outperformed the unmanaged teams in terms of their design performance. This opens the opportunity to not only model design discourse during problem solving, but more critically, to explore process manager interventions and their impact on design cognition. Utilizing this experimental framework, a topic model is trained on the discourse of human designers of both managed and unmanaged teams collaboratively solving a conceptual engineering design task. Results show that the two team conditions significantly differ in a number of the extracted topics, and in particular, those topics that most pertain to the manager interventions. A dynamic look during the design process reveals that the largest differences between the managed and unmanaged teams occur during the latter half of problem-solving. Furthermore, a before and after analysis of the topic-motivated interventions reveals that the process manager interventions significantly shift the topic mixture of the team members&#x92; discourse immediately after intervening. Taken together, these results from this work not only corroborate the effect of the process manager interventions on design team discourse and cognition but provide promise for the computational detection and facilitation of design interventions based on real-time, discourse data.

scholarly journals Effect of Taking the Liberal Arts Course ‘Creative Thinking and Problem Solving’ on the Improvement of Creative Competencies of College Students in Science and Engineering －Focusing on Comparison Before and After COVID-19

2021 ◽  
Vol 15 (5) ◽  
pp. 359-372
Author(s):  
Young-Ju Hur ◽  
Eun Sook Park
Keyword(s):  
Problem Solving ◽  
Real Time ◽  
Creative Thinking ◽  
Science And Engineering ◽  
Video System ◽  
Online Class ◽  
The Real ◽  
Face To Face ◽  
Before And After ◽  
The Face

This study was conducted to derive implications on how educational activities should be organized and operated for improving creative competency in online class situations by analyzing how it has changed in classes before and after COVID-19. These classes were taken by science and engineering students who took the ‘Creative Thinking and Problem Solving’ subject operated by N University. In order to achieve the goals of this study, a pre-post test related to creative competency was administered at the beginning and end of the semester to 92 students who took the face-to-face class in the second semester of 2019, and to 120 students who took the on-line class in the second semester of 2020. The research results are as follows: Creative competency was significantly improved in the face-to-face class, but not in the online class. Looking at each sub-competency of creative competency, both the challenge spirit and problem solving ability were significantly improved in the face-to-face class. Moreover, the student’s challenge spirit ability was significantly improved in the online class, but their problem solving ability was not significantly improved. These results were similar regardless of whether the instructor changed, or if the students’ grades changed. Also, the students’ gender had no bearing on these results either. Based on these research results, as well as on our educational goals and the content of the classes, the project activities involved in the ‘Creative Thinking and Problem Solving’ subject can be used in online classes in their current form. But this study suggested that strategies for improving students' problem-solving abilities need to be supplemented. Specifically, instructors should increase communication opportunities through the parallel use of the real-time remote video system, and should guide their students to become faithful to the team-based project activities through the sub-session function of the real-time remote video system. To this end, the university may consider changing two credits of two hours into two credits of three hours, or three credits of three hours. Universities also need to operate this subject in connection with extra-activities. It is also necessary for instructors to provide a support environment where students can freely meet using the real-time remote video system, and can engage in solving problems through their own initiative.

Scientific Problem Solving in a Virtual Laboratory: A Comparison Between Individuals and Pairs

2008 ◽  
Vol 67 (2) ◽  
pp. 71-83 ◽  
Author(s):  
Yolanda A. Métrailler ◽  
Ester Reijnen ◽  
Cornelia Kneser ◽  
Klaus Opwis
Keyword(s):  
Visual Search ◽  
Problem Solving ◽  
Process Data ◽  
Scientific Problem ◽  
Domain Specific ◽  
Scientific Problem Solving ◽  
Before And After ◽  
Verbal Data ◽  
Psychological Knowledge ◽  
Problem Solving Task

This study compared individuals with pairs in a scientific problem-solving task. Participants interacted with a virtual psychological laboratory called Virtue to reason about a visual search theory. To this end, they created hypotheses, designed experiments, and analyzed and interpreted the results of their experiments in order to discover which of five possible factors affected the visual search process. Before and after their interaction with Virtue, participants took a test measuring theoretical and methodological knowledge. In addition, process data reflecting participants’ experimental activities and verbal data were collected. The results showed a significant but equal increase in knowledge for both groups. We found differences between individuals and pairs in the evaluation of hypotheses in the process data, and in descriptive and explanatory statements in the verbal data. Interacting with Virtue helped all students improve their domain-specific and domain-general psychological knowledge.

scholarly journals Influence of extracorporeal membrane oxygenation on serum microRNA expression

2019 ◽  
Vol 47 (12) ◽  
pp. 6109-6119
Author(s):  
M. Scettri ◽  
H. Seeba ◽  
D. L. Staudacher ◽  
S. Robinson ◽  
D. Stallmann ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real Time ◽  
Underlying Disease ◽  
Real Time Quantitative Pcr ◽  
Membrane Oxygenation ◽  
Serum Microrna ◽  
Clinical Biomarkers ◽  
Differentially Expressed Mirnas ◽  
Before And After ◽  
Medical Intensive Care

Objective To date, no biomarkers have been established to predict haematological complications and outcomes of extracorporeal membrane oxygenation (ECMO). The aim of this study was to investigate the expression of a panel of microRNAs (miRNAs), which are promising biomarkers in many clinical fields, in patients before and after initiating ECMO. Methods Serum miRNA levels from 14 patients hospitalized for acute respiratory failure and supported with ECMO in our medical intensive care unit were analysed before and 24 hours after ECMO. In total, 179 serum-enriched miRNAs were profiled by using a real-time PCR panel. For validation, differentially expressed miRNAs were individually quantified with conventional real-time quantitative PCR at 0, 24, and 72 hours. Results Under ECMO support, platelet count significantly decreased by 65 × 103/µL (25th percentile = 154.3 × 103/µL; 75th percentile = 33 × 103/µL). Expression of the 179 miRNAs investigated in this study did not change significantly throughout the observational period. Conclusions According to our data, the expression of serum miRNAs was not altered by ECMO therapy itself. We conclude that ECMO does not limit the application of miRNAs as specific clinical biomarkers for the patients’ underlying disease.

scholarly journals Real-Time High-Level Acute Pain Detection Using a Smartphone and a Wrist-Worn Electrodermal Activity Sensor

Sensors ◽  
2021 ◽  
Vol 21 (12) ◽  
pp. 3956
Author(s):  
Youngsun Kong ◽  
Hugo F. Posada-Quintero ◽  
Ki H. Chon
Keyword(s):  
Real Time ◽  
Electrodermal Activity ◽  
Smartphone Application ◽  
Real Time Processing ◽  
Pain Stimulation ◽  
Significant Difference ◽  
Before And After ◽  
Electrical Pulses ◽  
Pain Detection ◽  
High Level

The subjectiveness of pain can lead to inaccurate prescribing of pain medication, which can exacerbate drug addiction and overdose. Given that pain is often experienced in patients’ homes, there is an urgent need for ambulatory devices that can quantify pain in real-time. We implemented three time- and frequency-domain electrodermal activity (EDA) indices in our smartphone application that collects EDA signals using a wrist-worn device. We then evaluated our computational algorithms using thermal grill data from ten subjects. The thermal grill delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). Furthermore, we simulated the real-time processing of the smartphone application using a dataset pre-collected from another group of fifteen subjects who underwent pain stimulation using electrical pulses, which elicited a VAS pain score level 7 out of 10. All EDA features showed significant difference between painless and pain segments, termed for the 5-s segments before and after each pain stimulus. Random forest showed the highest accuracy in detecting pain, 81.5%, with 78.9% sensitivity and 84.2% specificity with leave-one-subject-out cross-validation approach. Our results show the potential of a smartphone application to provide near real-time objective pain detection.

scholarly journals SURG-03. IMMERSIVE VIRTUAL REALITY APPLICATIONS IN NEUROSURGICAL ONCOLOGY

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii461-iii461
Author(s):  
Andrea Carai ◽  
Angela Mastronuzzi ◽  
Giovanna Stefania Colafati ◽  
Paul Voicu ◽  
Nicola Onorini ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Real Time ◽  
New Technologies ◽  
Young Patients ◽  
Spatial Relationship ◽  
3D Models ◽  
Immersive Virtual Reality ◽  
Global Improvement ◽  
3D Rendering ◽  
Before And After

Abstract Tridimensional (3D) rendering of volumetric neuroimaging is increasingly been used to assist surgical management of brain tumors. New technologies allowing immersive virtual reality (VR) visualization of obtained models offer the opportunity to appreciate neuroanatomical details and spatial relationship between the tumor and normal neuroanatomical structures to a level never seen before. We present our preliminary experience with the Surgical Theatre, a commercially available 3D VR system, in 60 consecutive neurosurgical oncology cases. 3D models were developed from volumetric CT scans and MR standard and advanced sequences. The system allows the loading of 6 different layers at the same time, with the possibility to modulate opacity and threshold in real time. Use of the 3D VR was used during preoperative planning allowing a better definition of surgical strategy. A tailored craniotomy and brain dissection can be simulated in advanced and precisely performed in the OR, connecting the system to intraoperative neuronavigation. Smaller blood vessels are generally not included in the 3D rendering, however, real-time intraoperative threshold modulation of the 3D model assisted in their identification improving surgical confidence and safety during the procedure. VR was also used offline, both before and after surgery, in the setting of case discussion within the neurosurgical team and during MDT discussion. Finally, 3D VR was used during informed consent, improving communication with families and young patients. 3D VR allows to tailor surgical strategies to the single patient, contributing to procedural safety and efficacy and to the global improvement of neurosurgical oncology care.

Changing trends in quality of media reporting of suicide in the community following a celebrity suicide in India

2021 ◽  
pp. 000486742110096
Author(s):  
Vikas Menon ◽  
Sujita Kumar Kar ◽  
Ramdas Ransing ◽  
Ginni Sharma ◽  
Jigyansa Ipsita Pattnaik ◽  
...  
Keyword(s):  
Online News ◽  
Significant Rise ◽  
Warning Signs ◽  
World Health ◽  
Media Reporting ◽  
Exact Test ◽  
Reporting Practices ◽  
Before And After ◽  
Celebrity Suicide

Objective: Little is known about changes in quality of media reporting of suicide in the community following a celebrity suicide. Our objective was to compare trends in quality of media reporting of suicide, before and after the suicide of an Indian entertainment celebrity, against the World Health Organization suicide reporting guidelines. Method: Online news portals of English and local language newspapers, as well as television channels, were searched to identify relevant suicide-related news articles. Comparison of reporting characteristics before and after the celebrity suicide was performed using chi-square test or Fisher’s exact test. Results: A total of 3867 eligible news reports were retrieved. There was a significant increase in harmful reporting characteristics, such as reporting the name, age and gender of the deceased ( p < 0.001 for all comparisons), mentioning the location ( p < 0.001) and reason for suicide ( p = 0.04) and including photos of the deceased ( p = 0.002) following the celebrity suicide. Helpful reporting practices were less affected; there was a significant rise in inclusion of expert opinion ( p = 0.04) and mention of suicide-related warning signs ( p = 0.02). Conclusion: Following a celebrity suicide, significant changes in the quality of media reporting of suicide were noted with an increase in several potentially harmful reporting characteristics.

Reducing Culture Reporting Errors in the Microbiology Laboratory

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S131-S132
Author(s):  
Kathryn Hogan ◽  
Beena Umar ◽  
Mohamed Alhamar ◽  
Kathleen Callahan ◽  
Linoj Samuel
Keyword(s):  
Real Time ◽  
Error Rate ◽  
Reporting System ◽  
Error Rates ◽  
Tracking Errors ◽  
Corrective Measures ◽  
Safety Awareness ◽  
Before And After ◽  
Set Up ◽  
System Errors

Abstract Objectives There are few papers that characterize types of errors in microbiology laboratories and scant research demonstrating the effects of interventions on microbiology lab errors. This study aims to categorize types of culture reporting errors found in microbiology labs and to document the error rates before and after interventions designed to reduce errors and improve overall laboratory quality. Methods To improve documentation of error incidence, a self-reporting system was changed to an automatic reporting system. Errors were categorized into five types Gram stain (misinterpretations), identification (incorrect analysis), set up labeling (incorrect patient labels), procedures (not followed), and miscellaneous. Error rates were tracked according to technologist, and technologists were given real-time feedback by a manager. Error rates were also monitored in the daily quality meeting and frequently detected errors were discussed at staff meetings. Technologists attended a year-end review with a manager to improve their performance. To maintain these changes, policies were developed to monitor technologist error rate and to define corrective measures. If a certain number of errors per month was reached, technologists were required to undergo retraining by a manager. If a technologist failed to correct any error according to protocol, they were also potentially subject to corrective measures. Results In 2013, we recorded 0.5 errors per 1,000 tests. By 2018, we recorded only 0.1 errors per 1,000 tests, an 80% decrease. The yearly culture volume from 2013 to 2018 increased by 32%, while the yearly error rate went from 0.05% per year to 0.01% per year, a statistically significant decrease (P = .0007). Conclusion This study supports the effectiveness of the changes implemented to decrease errors in culture reporting. By tracking errors in real time and using a standardized process that involved timely follow-up, technologists were educated on error prevention. This practice increased safety awareness in our micro lab.

Reproducibility of velocity-dependent power: before and after lengthening contractions

2011 ◽  
Vol 36 (5) ◽  
pp. 626-633 ◽  
Author(s):  
Geoffrey A. Power ◽  
Brian H. Dalton ◽  
Charles L. Rice ◽  
Anthony A. Vandervoort
Keyword(s):  
Peak Power ◽  
High Reliability ◽  
Similar Amount ◽  
Shortening Velocity ◽  
Lengthening Contractions ◽  
Isokinetic Testing ◽  
Typical Error ◽  
Before And After ◽  
Absolute Reliability ◽  
Ankle Dorsiflexors

The determination of power using isokinetic testing has been shown to be highly reliable. However, isotonic and isokinetic testing involve specific mechanical constraints that likely necessitate different neuromuscular strategies. Therefore, the purpose here was to establish test–retest intrarater reliability (separated by 7 days) of loaded maximal shortening velocity and velocity-dependent power of the ankle dorsiflexors using the isotonic mode of the Biodex dynamometer (i) at baseline and (ii) throughout recovery following 150 high-intensity lengthening contractions. Intraclass correlation coefficients (ICC)2,1 with 95% CIs were used to determine relative reliability, whereas absolute reliability included typical error (TEM) and typical error expressed as a coefficient of variation (TEMCV). Twenty-four young men and women volunteered for the study. Maximal shortening velocity and power were determined with a fixed resistance set at 20% of maximal voluntary isometric contraction across 2 testing sessions separated by 7 days. ICCs were 0.93 and 0.98 for maximal shortening velocity and peak power, respectively. Following the lengthening contractions, ICCs indicated high reliability for maximal shortening velocity and peak power, 0.86 and 0.94, respectively, suggesting that a similar amount of fatigue was incurred on both days. Measures of absolute reliability for maximal shortening velocity and peak power also yielded high reliability. The isotonic mode is highly reliable when testing velocity-dependent power of the ankle dorsiflexors at baseline and following fatiguing lengthening contractions. The high reliability of this measure is encouraging and suggests that the isotonic mode can be used in various settings to track group changes before and after training and following fatigue and lengthening contractions.

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