scholarly journals Complexity to downplay complexity: Implications of ERM logics for the Italian NHS

2020 ◽  
Vol 17 (4, Special Issue) ◽  
pp. 369-376
Author(s):  
Raffaela Casciello ◽  
Fiorenza Meucci
Keyword(s):  
Risk Management ◽  
Healthcare System ◽  
Ad Hoc ◽  
Healthcare Organizations ◽  
Top Down ◽  
Welfare Services ◽  
Holistic Analysis ◽  
The Right

The aim of the paper is to investigate COVID-19-related issues currently affecting the Italian Healthcare System and offer causes for reflection on how to deal efficiently with risk management criticalities. Through the lenses of the Quality in Extreme Adversity (QEA) action framework, such reflections benefit from a greater depth of holistic analysis on risk management opportunities and threats towards both renewing and protecting the welfare services of the Italian Healthcare System. The complexity and urgency to overcome the multitude of risks require healthcare organizations to intervene immediately with integrated top-down enterprise-wide approaches of risk management. In such conditions, the adoption of ad hoc shaped ERM models could be the right solution for facing adequately the inefficiencies in pandemic management.

scholarly journals “A debriefer must be neutral” and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Julia Carolin Seelandt ◽  
Katie Walker ◽  
Michaela Kolbe
Keyword(s):  
Interpersonal Relationships ◽  
Western Europe ◽  
Ad Hoc ◽  
Scientific Evidence ◽  
Clinical Event ◽  
Clinical Settings ◽  
Healthcare Organizations ◽  
The Usa ◽  
Open Coding ◽  
Healthcare Administrators

Abstract Background The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. Methods We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. Results In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. Conclusion The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.

Stent Graft Placement in the Top-Down Direction for Treating Traumatic Intra-Abdominal Suprahepatic Inferior Vena Cava Rupture: A Case Report

2021 ◽  
pp. 152660282110250
Author(s):  
Yun Chul Park ◽  
Hyoung Ook Kim ◽  
Nam Yeol Yim ◽  
Byung Chan Lee ◽  
Chan Park ◽  
...  
Keyword(s):  
Case Report ◽  
Inferior Vena Cava ◽  
Stent Graft ◽  
Inferior Vena ◽  
Vena Cava ◽  
Endovascular Management ◽  
Top Down ◽  
Life Threatening ◽  
The Right ◽  
Suprahepatic Inferior Vena Cava

Purpose The treatment of suprahepatic inferior vena cava (IVC) ruptures results in high mortality rates due to difficulty in performing the surgical procedure. Here, we present a case of successful endovascular management of a life-threatening suprahepatic IVC rupture with top-down placement of a stent graft. Case Report A 33-year-old woman was involved in a traffic accident and presented to our emergency department due to unstable hemodynamics after blunt abdominal wall trauma. Computed tomography (CT) revealed massive extravasation of contrast agent from the suprahepatic IVC, which suggested traumatic suprahepatic IVC rupture. To seal the IVC, to salvage major hepatic veins, and to prevent migration of the stent graft into the right side of the heart after placement, an aortic cuff with a proximal hook was introduced in a top-down direction via the right internal jugular vein. After closure of the injured IVC, the patient’s hemodynamics improved, and additional laparotomy was performed. After 3 months of trauma care, the patient recovered and was discharged. Follow-up CT after 58 months showed a patent stent graft within the IVC. Conclusion Endovascular management with top-down placement of a stent graft is a viable option for emergent damage control in patients with life-threatening hemorrhage from IVC rupture.

scholarly journals Causal modulation of right hemisphere fronto-parietal phase synchrony with Transcranial Magnetic Stimulation during a conscious visual detection task

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chloé Stengel ◽  
Marine Vernet ◽  
Julià L. Amengual ◽  
Antoni Valero-Cabré
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Visual Perception ◽  
Frequency Band ◽  
Magnetic Stimulation ◽  
Visual Detection ◽  
Detection Task ◽  
Oscillatory Activity ◽  
Top Down ◽  
The Right ◽  
High Beta

AbstractCorrelational evidence in non-human primates has reported increases of fronto-parietal high-beta (22–30 Hz) synchrony during the top-down allocation of visuo-spatial attention. But may inter-regional synchronization at this specific frequency band provide a causal mechanism by which top-down attentional processes facilitate conscious visual perception? To address this question, we analyzed electroencephalographic (EEG) signals from a group of healthy participants who performed a conscious visual detection task while we delivered brief (4 pulses) rhythmic (30 Hz) or random bursts of Transcranial Magnetic Stimulation (TMS) to the right Frontal Eye Field (FEF) prior to the onset of a lateralized target. We report increases of inter-regional synchronization in the high-beta band (25–35 Hz) between the electrode closest to the stimulated region (the right FEF) and right parietal EEG leads, and increases of local inter-trial coherence within the same frequency band over bilateral parietal EEG contacts, both driven by rhythmic but not random TMS patterns. Such increases were accompained by improvements of conscious visual sensitivity for left visual targets in the rhythmic but not the random TMS condition. These outcomes suggest that high-beta inter-regional synchrony can be modulated non-invasively and that high-beta oscillatory activity across the right dorsal fronto-parietal network may contribute to the facilitation of conscious visual perception. Our work supports future applications of non-invasive brain stimulation to restore impaired visually-guided behaviors by operating on top-down attentional modulatory mechanisms.

The International Criminal Court's Provisional Authority to Coerce

2012 ◽  
Vol 26 (1) ◽  
pp. 93-101 ◽  
Author(s):  
Antonio Franceschet
Keyword(s):  
United Nations ◽  
Civil Wars ◽  
Security Council ◽  
Ad Hoc ◽  
International Criminal ◽  
World Order ◽  
Former Yugoslavia ◽  
The World ◽  
The Will ◽  
The Right

The United Nations ad hoc tribunals in the former Yugoslavia and Rwanda had primacy over national judicial agents for crimes committed in these countries during the most notorious civil wars and genocide of the 1990s. The UN Charter granted the Security Council the right to establish a tribunal for Yugoslavia in the context of ongoing civil war and against the will of recalcitrant national agents. The Council used that same right to punish individuals responsible for a genocide that it failed earlier to prevent in Rwanda. In both cases the Council delegated a portion of its coercive title to independent tribunal agents, thereby overriding the default locus of punishment in the world order: sovereign states.

A Hazard and Risk Management System for Large Rock Slope Hazards Affecting Pipelines in Mountainous Terrain

2002 ◽  
Author(s):  
Michael Porter ◽  
Alex Baumgard ◽  
K. Wayne Savigny
Keyword(s):  
Risk Management ◽  
Rock Slope ◽  
Management Program ◽  
South American ◽  
Mountainous Terrain ◽  
Hazard Exposure ◽  
Access Road ◽  
Hazard And Risk ◽  
The Right ◽  
Hazard Rating

Pipelines and other linear facilities that traverse mountainous terrain may be subject to rock fall and rock slide hazards. A system is required to determine which sites pose the greatest hazard to the facility. Once sites are ranked according to hazard exposure, a risk management program involving inspection, monitoring, contingency planning and/or mitigation can be implemented in a systematic and defensible manner. A hazard rating methodology was developed to identify and characterize rock slope hazards above a South American Concentrate Pipeline, and to provide a relative ranking of hazard exposure for the pipeline, an access road and operational personnel. The rating methodology incorporates the geometry of the right-of-way, estimated pipe depth, staff and vehicle occupancy time, failure mechanism and magnitude, and the annual probability of hazard occurrence. This information is used in a risk-based framework to assign relative hazard ratings within rock slope sections of relatively uniform hazard exposure. This paper outlines a general framework for natural hazard and risk management along linear facilities, describes the rock slope hazard rating methodology, and illustrates how the system was applied along a South American Concentrate Pipeline.

The impact of counterfeit risk management on healthcare supply chain performance: an empirical analysis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mauro Falasca ◽  
Scott Dellana ◽  
William J. Rowe ◽  
John F. Kros
Keyword(s):  
Risk Management ◽  
Supply Chain ◽  
The United States ◽  
Equation Modeling ◽  
Significant Positive Effect ◽  
Healthcare Organizations ◽  
Content Type ◽  
Overall Performance ◽  
The Impact ◽  
Positive Effect

PurposeThis study develops and tests a model exploring the relationship between supply chain (SC) counterfeit risk management and performance in the healthcare supply chain (HCSC).Design/methodology/approachIn the proposed theoretical model, HCSC counterfeit risk management is characterized by HCSC counterfeit risk orientation (HCRO), HCSC counterfeit risk mitigation (HCRM) and HCSC risk management integration (HRMI), while performance is represented by healthcare logistics performance (HLP) and healthcare organization overall performance (HOP). Partial least squares structural equation modeling (PLS-SEM) and survey data from 55 HCSC managers are used to test the research hypotheses.FindingsHCRO has a significant positive effect on HCRM, while HCRM has a positive impact on HRMI. With respect to HLP, HCRM has a nonsignificant effect, while HRMI has a significant impact, thus confirming the important mediating role of HRMI. Finally, HLP has a significant positive effect on the overall performance of healthcare organizations.Research limitations/implicationsAll study participants were from the United States, limiting the generalizability of the study findings to different countries or regions. The sample size employed in the study did not allow the authors to distinguish among the different types of healthcare organizations.Originality/valueThis study delineates between a healthcare organization's philosophy toward counterfeiting risks vs actions taken to eliminate or reduce the impact of counterfeiting on the HCSC. By offering firm-level guidance for managers, this study informs healthcare organizations about addressing the challenge of counterfeiting in the HCSC.

Guidelines for the Reporting of Nongynecologic Cytopathology Specimens

2009 ◽  
Vol 133 (11) ◽  
pp. 1743-1756
Author(s):  
Barbara A. Crothers ◽  
William D. Tench ◽  
Mary R. Schwartz ◽  
Joel S. Bentz ◽  
Ann T. Moriarty ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Ad Hoc ◽  
Clinical Laboratory ◽  
Needle Aspiration ◽  
Health Care Team ◽  
Major Elements ◽  
Pathology Report ◽  
Care Providers ◽  
Healthcare Organizations

Abstract Context.—Gynecologic cytology terminology and report formatting have been nationally standardized since the implementation of The Bethesda System of 1988, but standard reporting for nongynecologic cytology has never been formally addressed on the same scale. Objectives.—To promote patient safety through uniform reporting in nongynecologic cytology (including fine-needle aspiration cytology) and to improve communication between laboratories and health care providers. Data Sources.—Sources include the College of American Pathologists Cytopathology Resource Committee; the College of American Pathologists Council on Scientific Affairs Ad Hoc Committee on Pathology Report Standardization; the College of American Pathologists Laboratory Accreditation Program inspection checklists; the Joint Commission for Accreditation of Healthcare Organizations; and the Clinical Laboratory Improvement Amendments of 1988. Conclusions.—We describe the major elements of quality nongynecologic cytology reporting and discuss areas of controversy in cytology reporting. Standardized nongynecologic specimen reporting will expand the concept of common report elements already widely implemented in gynecologic cytology reporting. The intent is to improve communication with the health care team while remaining in compliance with federal mandates and accreditation guidelines.

scholarly journals Wheelchair users, access and exclusion in South African higher education

2017 ◽  
Vol 6 ◽  
Author(s):  
Desire Chiwandire ◽  
Louise Vincent
Keyword(s):  
Higher Education ◽  
Students With Disabilities ◽  
South African ◽  
Ad Hoc ◽  
Persons With Disabilities ◽  
Wheelchair Users ◽  
Staff Members ◽  
Leading Role ◽  
South African Universities ◽  
The Right

Background: South Africa’s Constitution guarantees everyone, including persons with disabilities, the right to education. A variety of laws are in place obliging higher education institutions to provide appropriate physical access to education sites for all. In practice, however, many buildings remain inaccessible to people with physical disabilities.Objectives: To describe what measures South African universities are taking to make their built environments more accessible to students with diverse types of disabilities, and to assess the adequacy of such measures.Method: We conducted semi-structured in-depth face-to-face interviews with disability unit staff members (DUSMs) based at 10 different public universities in South Africa.Results: Challenges with promoting higher education accessibility for wheelchair users include the preservation and heritage justification for failing to modify older buildings, ad hoc approaches to creating accessible environments and failure to address access to toilets, libraries and transport facilities for wheelchair users.Conclusion: South African universities are still not places where all students are equally able to integrate socially. DUSMs know what ought to be done to make campuses more accessible and welcoming to students with disabilities and should be empowered to play a leading role in sensitising non-disabled members of universities, to create greater awareness of, and appreciation for, the multiple ways in which wheelchair user students continue to be excluded from full participation in university life. South African universities need to adopt a systemic approach to inclusion, which fosters an understanding of inclusion as a fundamental right rather than as a luxury.

scholarly journals Warranty of Misinforming as an Option in Product Utilization Process

10.28945/3501 ◽  
2016 ◽  
Author(s):  
Dimitar Grozdanov Christozov ◽  
Stefanka Chukova ◽  
Plamen S. Mateev
Keyword(s):  
Risk Management ◽  
Smart Phones ◽  
Fixed Cost ◽  
Strike Price ◽  
Underlying Asset ◽  
Learning Function ◽  
Time To Learn ◽  
Definition Of ◽  
The Right

The following definition of “option” is given in Wikipedia - “In finance, an option is a contract which gives the buyer (the owner or holder) the right, but not the obligation, to buy or sell an underlying asset or instrument at a specified strike price on or before a specified date, depending on the form of the option.”. Option as a risk management (mitigation) tool is broadly used in finance and trades. At the same time it introduces asymmetry in the sense that, probabilistically, it limits the level of loses (i.e., the price of option) and allows for unlimited gains. In the market of sophisticate devices (as smart phones, tablets, etc.), where technologies are rapidly advancing, customers usually do not have the experience to use all features of the device at the time of purchasing. Due to the lack of appropriate expertise, the risk of misinforming leading to not purchasing the "right" device is high, but given enough time to learn the capabilities of the device and map them to the problems faced could provide the client with substantial long term benefits. Warranty of misinforming is the mechanism to provide the client with the opportunity to explore the device and master its features with a limited risk of loses. Thus, the warranty of misinforming could be considered as an option - the customers buys it (at a fixed cost) and may gain (theoretically) unlimited benefit by realizing (within the warranty) that the device can be used to solve variety of problems not considered at the purchase time. The paper investigates the learning function of warranty of misinforming, when used as an option.

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