scholarly journals A novel approach to explore Safety-I and Safety-II perspectives in in situ simulations—the structured what if functional resonance analysis methodology

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Ralph James MacKinnon ◽  
Karin Pukk-Härenstam ◽  
Christopher Kennedy ◽  
Erik Hollnagel ◽  
David Slater
Keyword(s):  
Patient Safety ◽  
Patient Outcomes ◽  
Case Series ◽  
Added Value ◽  
Daily Work ◽  
Resonance Analysis ◽  
Analysis Methodology ◽  
Novel Approach ◽  
Enhance Patient Safety

Abstract Objectives With ever increasingly complex healthcare settings, technology enhanced simulation (TES) is well positioned to explore all perspectives to enhance patient safety and patient outcomes. Analysis from a Safety-II stance requires identification of human adjustments in daily work that are key to maintaining safety. The aim of this paper is to describe an approach to explore the consequences of human variability from a Safety-II perspective and describe the added value of this to TES. Methods The reader is guided through a novel application of functional resonance analysis methodology (FRAM), a method to analyse how a system or activity is affected by human variability, to explore human adaptations observed in in situ simulations (ISS). The structured applicability of this novel approach to TES is described by application to empirical data from the standardised ISS management of paediatric time critical head injuries (TCHI). Results A case series is presented to illustrate the step-wise observation of key timings during ISSs, the construction of FRAM models and the visualisation of the propagation of human adaptations through the FRAM models. The key functions/actions that ensure the propagation are visible, as are the sequelae of the adaptations. Conclusions The approach as described in this paper is a first step to illuminating how to explore, analyse and observe the consequences of positive and negative human adaptations within simulated complex systems. This provides TES with a structured methodology to visualise and reflect upon both Safety-I and Safety-II perspectives to enhance patient safety and patient outcomes.

scholarly journals MULTIDISCIPLINARY TEAM-BASED DELIBERATE PRACTICE USING IN SITU SIMULATIONS TO ENHANCE PATIENT SAFETY ON A PEDIATRIC INPATIENT UNIT

2017 ◽  
Vol 22 (suppl_1) ◽  
pp. e29-e29
Author(s):  
K Lambrinakos-Raymond ◽  
D D’Arienzo ◽  
M Dandavino ◽  
N Korah ◽  
V Ballenas ◽  
...  
Keyword(s):  
Patient Safety ◽  
Multidisciplinary Team ◽  
Deliberate Practice ◽  
Inpatient Unit ◽  
Enhance Patient Safety ◽  
Pediatric Inpatient

scholarly journals IMPROVING SYSTEM READINESS, STAFF PREPAREDNESS AND PATIENT SAFETY IN A NEW SINGLE FAMILY ROOM NICU THROUGH IN SITU SIMULATION

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e16-e16
Author(s):  
Ahmed Moussa ◽  
Audrey Larone-Juneau ◽  
Laura Fazilleau ◽  
Marie-Eve Rochon ◽  
Justine Giroux ◽  
...  
Keyword(s):  
Patient Safety ◽  
Repeated Measures ◽  
Large Scale ◽  
Multidisciplinary Teams ◽  
Single Family ◽  
In Situ Simulation ◽  
Ensure Patient Safety ◽  
System Readiness ◽  
Dependent Samples

Abstract BACKGROUND Transitions to new healthcare environments can negatively impact patient care and threaten patient safety. Immersive in situ simulation conducted in newly constructed single family room (SFR) Neonatal Intensive Care Units (NICUs) prior to occupancy, has been shown to be effective in testing new environments and identifying latent safety threats (LSTs). These simulations overlay human factors to identify LSTs as new and existing process and systems are implemented in the new environment OBJECTIVES We aimed to demonstrate that large-scale, immersive, in situ simulation prior to the transition to a new SFR NICU improves: 1) systems readiness, 2) staff preparedness, 3) patient safety, 4) staff comfort with simulation, and 5) staff attitude towards culture change. DESIGN/METHODS Multidisciplinary teams of neonatal healthcare providers (HCP) and parents of former NICU patients participated in large-scale, immersive in-situ simulations conducted in the new NICU prior to occupancy. One eighth of the NICU was outfitted with equipment and mannequins and staff performed in their native roles. Multidisciplinary debriefings, which included parents, were conducted immediately after simulations to identify LSTs. Through an iterative process issues were resolved and additional simulations conducted. Debriefings were documented and debriefing transcripts transcribed and LSTs classified using qualitative methods. To assess systems readiness and staff preparedness for transition into the new NICU, HCPs completed surveys prior to transition, post-simulation and post-transition. Systems readiness and staff preparedness were rated on a 5-point Likert scale. Average survey responses were analyzed using dependent samples t-tests and repeated measures ANOVAs. RESULTS One hundred eight HCPs and 24 parents participated in six half-day simulation sessions. A total of 75 LSTs were identified and were categorized into eight themes: 1) work organization, 2) orientation and parent wayfinding, 3) communication devices/systems, 4) nursing and resuscitation equipment, 5) ergonomics, 6) parent comfort; 7) work processes, and 8) interdepartmental interactions. Prior to the transition to the new NICU, 76% of the LSTs were resolved. Survey response rate was 31%, 16%, 7% for baseline, post-simulation and post-move surveys, respectively. System readiness at baseline was 1.3/5,. Post-simulation systems readiness was 3.5/5 (p = 0.0001) and post-transition was 3.9/5 (p = 0.02). Staff preparedness at baseline was 1.4/5. Staff preparedness post-simulation was 3.3/5 (p = 0.006) and post-transition was 3.9/5 (p = 0.03). CONCLUSION Large-scale, immersive in situ simulation is a feasible and effective methodology for identifying LSTs, improving systems readiness and staff preparedness in a new SFR NICU prior to occupancy. However, to optimize patient safety, identified LSTs must be mitigated prior to occupancy. Coordinating large-scale simulations is worth the time and cost investment necessary to optimize systems and ensure patient safety prior to transition to a new SFR NICU.

A novel approach for preparing in-situ nitrogen doped carbon via pyrolysis of bean pulp for supercapacitors

Energy ◽  
2021 ◽  
Vol 216 ◽  
pp. 119227
Author(s):  
Yan Ding ◽  
Yunchao Li ◽  
Yujie Dai ◽  
Xinhong Han ◽  
Bo Xing ◽  
...  
Keyword(s):  
Nitrogen Doped ◽  
Novel Approach ◽  
Nitrogen Doped Carbon

scholarly journals Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK

2021 ◽  
Vol 10 (11) ◽  
pp. 2478
Author(s):  
Majid Moshirfar ◽  
David G. West ◽  
Chase M Miller ◽  
William B. West ◽  
Shannon E. McCabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
High Myopia ◽  
Case Series ◽  
Retrospective Case ◽  
Visual Outcomes ◽  
Uncorrected Distance Visual Acuity ◽  
Incidence Risk ◽  
Mechanical Devices

Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.

scholarly journals In Situ Generation of Green Hybrid Nanofibrillar Polymer-Polymer Composites—A Novel Approach to the Triple Shape Memory Polymer Formation

Polymers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 1900
Author(s):  
Ramin Hosseinnezhad ◽  
Iurii Vozniak ◽  
Fahmi Zaïri
Keyword(s):  
Polymer Blends ◽  
Shape Memory ◽  
Shape Memory Polymer ◽  
Cellulose Nanofibers ◽  
Polymeric Materials ◽  
Novel Approach ◽  
Phase Transition Temperatures ◽  
Triple Shape Memory

The paper discusses the possibility of using in situ generated hybrid polymer-polymer nanocomposites as polymeric materials with triple shape memory, which, unlike conventional polymer blends with triple shape memory, are characterized by fully separated phase transition temperatures and strongest bonding between the polymer blends phase interfaces which are critical to the shape fixing and recovery. This was demonstrated using the three-component system polylactide/polybutylene adipateterephthalate/cellulose nanofibers (PLA/PBAT/CNFs). The role of in situ generated PBAT nanofibers and CNFs in the formation of efficient physical crosslinks at PLA-PBAT, PLA-CNF and PBAT-CNF interfaces and the effect of CNFs on the PBAT fibrillation and crystallization processes were elucidated. The in situ generated composites showed drastically higher values of strain recovery ratios, strain fixity ratios, faster recovery rate and better mechanical properties compared to the blend.

scholarly journals A Novel Cobalt Metallopolymer with Redox-Matched Conjugated Organic Backbone via Electropolymerization of a Readily Available N4 Cobalt Complex

Polymers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 1667
Author(s):  
Mikhail Karushev
Keyword(s):  
Redox Reactions ◽  
Repeat Unit ◽  
Cobalt Complex ◽  
Radical Cations ◽  
Electrochemical Quartz Crystal Microbalance ◽  
Practical Applications ◽  
Sensing Applications ◽  
Novel Approach ◽  
Redox Switching

Fast and reversible cobalt-centered redox reactions in metallopolymers are the key to using these materials in energy storage, electrocatalytic, and sensing applications. Metal-centered electrochemical activity can be enhanced via redox matching of the conjugated organic backbone and cobalt centers. In this study, we present a novel approach to redox matching via modification of the cobalt coordination site: a conductive electrochemically active polymer was electro-synthesized from [Co(Amben)] complex (Amben = N,N′-bis(o-aminobenzylidene)ethylenediamine) for the first time. The poly-[Co(Amben)] films were investigated by cyclic voltammetry, electrochemical quartz crystal microbalance (EQCM), in situ UV‑vis-NIR spectroelectrochemistry, and in situ conductance measurements between −0.9 and 1.3 V vs. Ag/Ag+. The polymer displayed multistep redox processes involving reversible transfer of the total of 1.25 electrons per repeat unit. The findings indicate consecutive formation of three redox states during reversible electrochemical oxidation of the polymer film, which were identified as benzidine radical cations, Co(III) ions, and benzidine di-cations. The Co(II)/Co(III) redox switching is retained in the thick polymer films because it occurs at potentials of high polymer conductivity due to the optimum redox matching of the Co(II)/Co(III) redox pair with the organic conjugated backbone. It makes poly-[Co(Amben)] suitable for various practical applications based on cobalt-mediated redox reactions.

Sign in / Sign up

Export Citation Format

Share Document