Using Goals of Care Conversations to Build Ethics Competency

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 139-139
Author(s):  
Nico Nortje ◽  
◽  
◽  
Keyword(s):  
Healthcare Providers ◽  
Care Team ◽  
Competency Development ◽  
Goals Of Care ◽  
Information Preferences ◽  
Autonomous Decision ◽  
Clinical Ethicist ◽  
Acceptable Quality ◽  
Set Up

"Literature indicates that 99% of clinicians believe that timely Goals of Care (GOC) conversations are important. However, only 11% of patients report having had GOC conversations with their providers throughout the trajectory of their disease. Congruent to this, it is reported that only 41% of patients feel that they have received care consistent with their preferences. One can therefore deduct that there is a great ethical gap in how patients are approached by healthcare providers, especially respecting their autonomous decision-making. As a concept, GOC refers to discussing patients’ therapy intend, which is informed by the patients’ hope, fears, information preferences, presumed minimally acceptable quality of life, and expectations for their future. Therefore it needs to be an explicit conversation which is personalized to each patient’s context and circumstances. Within these conceptual ideas there are a myriad of ethical values which needs to be addressed. The author will explain how a Goals of Care initiative was started at the hospital where the author is a clinical ethicist and how these interactions with various members of the care team have been used to build ethics competencies of all the members of the care team. This innovative approach has been applauded by the participants for making ethics practical and applicable. The structure of the talk will focus on basic literature review, discussion on initiative (how it was set up), challenges, lessons learnt, value in ethics competency development. "

STUDY OF INACCURACY IN THE OPERATION OF THE MAIN CONTROLLER OF STB MACHINE

2019 ◽  
Keyword(s):  
Normal Distribution ◽  
Stable Process ◽  
Random Errors ◽  
Actual Length ◽  
Experimental Data Processing ◽  
Set Up ◽  
Main Regulator ◽  
Transmission Gear ◽  
Selection Of

At production of fabrics, including fabrics for agricultural purpose, an important role is played by the cor-rect adjustment of operation of machine main regulator. The quality of setup of machine main controller is determined by the proper selection of rotation angle of warp beam weaving per one filling thread. In the pro-cess of using the regulator as a result of mistakes in adjustment, wear of transmission gear and backlashes in connections of details there are random changes in threads length. The purpose of the article is the research of property of random errors of basis giving by STB machine regulator. Mistakes can be both negative, and positive. In case of emergence only negative or only positive mistakes operation of the machine becomes im-possible as there will be a consecutive accumulation of mistakes. As a result of experimental data processing for stable process of weaving and the invariable diameter of basis threads winding of threads it is revealed that the random error of giving is set up as linear function of the accidental length having normal distribution. Measurements of accidental deviations in giving of a basis by the main regulator allowed to construct a curve of normal distribution of its actual length for one pass of weft thread. The presented curve of distribution of random errors in giving of a basis is the displaced curve of normal distribution of the accidental sizes. Also we define the density of probability of normal distribution of basis giving errors connected with a margin er-ror operation of the main regulator knowing of which allows to plan ways of their decrease that is important for improvement of quality of the produced fabrics.

Quality of Information Metrics for Autonomous Decision Marking

2003 ◽  
Author(s):  
Russell Purtell ◽  
Ravi Prasanth ◽  
Joao Cabrera ◽  
Raman Mehra ◽  
Robert Smith
Keyword(s):  
Quality Of Information ◽  
Autonomous Decision ◽  
Information Metrics

The Rotterdam Initiative in Reducing Waste Discharges at Source

1991 ◽  
Vol 24 (10) ◽  
pp. 171-177
Author(s):  
T. Vellinga ◽  
J. P. J. Nijssen
Keyword(s):  
Public Relations ◽  
Action Plan ◽  
Detailed Balance ◽  
River Rhine ◽  
The North ◽  
Complementary Role ◽  
Action Programme ◽  
The North Sea ◽  
Set Up

Much of the material dredged from the port of Rotterdam is contaminated to such a degree that it must be placed in specially constructed sites. The aim of Rotterdam is to ensure that the dredged material will once again be clean. This will entail the thorough cleansing of the sources of the contamination of the sediment in the harbours and in the River Rhine. The Rotterdam Rhine Research Project (RRP) is one of the means to achieve this based on: technical research, legal research, public relations and dialogues with dischargers. The programme for five selected heavy metals is almost complete. For many heavy metal discharge points between Rotterdam and Rheinfelden, a specially devised independent load assessment has been carried out four times. Balance studies were used to determine the relative contributions of the point discharges to the total. Currently the results are being used in an attempt to negotiate agreements with a selected number of the major dischargers. At present, more detailed balance studies are being set up and exploratory measurements carried out for organic micropollutants. It may be concluded that the research is progressing successfully and methods and techniques developed seem satisfactory and broadly applicable. The Rhine Action Programme encompasses an international effort to improve the quality of the Rhine water. Although the RRP plays a modest complementary role to the Rhine Action Plan, there is no doubt of the value of this Rotterdam initiative. The mode of work followed in the RRP contains elements that can be of use in combatting the contamination of the North Sea by rivers other than the Rhine.

What Advantages Can Be Expected from the Acceptance of Variable Quality Standards for Sewage Treatment Effluents?

1988 ◽  
Vol 20 (4-5) ◽  
pp. 249-251
Author(s):  
Jacques Bernard
Keyword(s):  
Water Quality ◽  
Sewage Treatment ◽  
Quality Standards ◽  
Quality Level ◽  
Environment Protection ◽  
Economical Benefit ◽  
Quality Objective ◽  
Set Up ◽  
Variable Quality

The flow and the water quality of the rivers vary throughout the year. Very frequently the environment protection authorities set up a quality objective for the river water and this mini mum quality level is constant. So, it wou1d seem possible to accept variable quality standards for plant effluents. A first approach of the problem,by a small French task group,based on three actual cases leads to the provisory conclusion that such a regulation is suitable and presents economical benefit only in some very limit ed cases.

Women's healthcare providers: Work factors, personality, and stress

2019 ◽  
Vol 47 (7) ◽  
pp. 1-11
Author(s):  
Victoria A. Farrow ◽  
Anthony Ahrens ◽  
Kathleen C. Gunthert ◽  
Jay Schulkin
Keyword(s):  
Cultural Differences ◽  
Perceived Stress ◽  
Healthcare Providers ◽  
Descriptive Statistics ◽  
Related Factors ◽  
Work Related ◽  
Work Factors ◽  
Physician Stress ◽  
Linear Regressions

We assessed neuroticism, perceived stress, and work-related factors among obstetrician-gynecologists (ob-gyns), and examined the relationships between these variables. Surveys were sent to 500 physician members of the American College of Obstetricians and Gynecologists and we received 287 (57.4%) completed responses. Analyses included descriptive statistics and linear regressions. Ob-gyns reported high levels of perceived stress. After controlling for neuroticism, variables that significantly predicted stress levels included average hours worked, perception of working too many hours, colleague support for work–home balance, isolation due to gender/cultural differences, and perception of workplace control. Because these work-related factors are linked to stress even when controlling for neuroticism, administrators and physicians may consider whether any of these factors are modifiable to mitigate physician stress. This in turn may affect physicians' own health and the quality of care patients receive.

DRUG REGULATORY PROCEDURES IN TANZANIA: A GLIMPSE

2015 ◽  
Vol 3 (2) ◽  
pp. 1-7 ◽  
Author(s):  
Achin Jain ◽  
M P Venkatesh M P ◽  
Pramod T.M. Kumar
Keyword(s):  
Quality Control ◽  
Medical Devices ◽  
Emerging Market ◽  
Well Being ◽  
New Drugs ◽  
Regulatory Body ◽  
Herbal Drugs ◽  
Drug Products ◽  
Set Up

In Tanzania, Tanzania Food and Drugs Authority (TFDA), is a regulatory body responsible for controlling the quality,safety and effectiveness of food, drugs, herbal drugs, cosmetics and medical devices. The Authority has been ensuringsafety, efficacy and quality of medicines by quality control tests; in addition to other quality assessment mechanisms.The guidelines laid by TFDA have also emanated from commitment to democracy and gives strong emphasis to thefulfilment of the needs of the less privileged rural population.Tanzania is an emerging market; the pharmaceutical market is valued at over US$250 million, and is growing at anannual rate of around 16.5% and is expected to reach approximately US$550 billion in 2020. Currently, the market ishighly dependent on imports, which account for around 75% of the total pharmaceutical market.The procedures and approval requirements of new drugs, variations, import, export and disposal have been set up bythe TFDA, which help in maintaining quality of the drug products that are imported as well being produced locally 

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

Success Drivers of Urban Haats Selling Craft Products

2020 ◽  
pp. 097300522096468
Author(s):  
Rajesh Gupta ◽  
Piyush Kumar Sinha ◽  
Akash Sahu ◽  
Vandana Sood
Keyword(s):  
Mixed Method ◽  
Rural Economy ◽  
Mediating Role ◽  
Role Based ◽  
Craft Industry ◽  
Set Up ◽  
Market Separations ◽  
Method Approach

Craft industry is as much the mainstay of the rural economy after agriculture. It provides occupation to a large section of population. However, it is characterised by fragmented individual artisans on one side and dispersed customers on the other. It also suffers from market separations. Urban haats were set up with the objective to present artisans and buyer on one platform and reduce these separations. In this study urban haats have been conceptualised as marketplaces that bring artisans and customers at one place to optimise their respective values. They also serve as a tool for disintermediation and a social distribution initiative and represent a retailing initiative in the inclusive entrepreneurship domain. This study focusses on identifying drivers of success of urban haats. Using a mixed method approach, data was collected from Haat officials and NGO members through personal interviews. The data from artisans and customers was collected through a survey using a structured response format. The study was conducted at 18 haats in 10 states. The study highlights the factors that drive satisfaction of artisans and customers and the role of administrators in making the marketplace a success. Customer consider diversity of the products, quality of the products, behaviour of the salesperson, price parity with other markets, buying experience, parking space and aesthetics of the stalls as major influencing factors for the recommendation of the haats to other customers. Most important attributes of the haats in driving artisan satisfaction were stall allotment system, haat location, advertisements, product promotion and monitoring. It is also found that while the infrastructure is necessary, it is not sufficient in enhancing the performance and sustainability of haats. Administration of these haats plays a defining mediating role. Based on these findings, an approach is proposed for success of urban haats.

scholarly journals Manufacturing and development of a bolted GFRP flange joint for oil and gas applications

2021 ◽  
pp. 095440542198951
Author(s):  
Muhsin Aljuboury ◽  
Md Jahir Rizvi ◽  
Stephen Grove ◽  
Richard Cullen
Keyword(s):  
Pressure Vessel ◽  
Oil And Gas ◽  
Polyester Resin ◽  
High Strength ◽  
Adhesively Bonded ◽  
Acceptable Quality ◽  
Composite Pipe ◽  
And Performance ◽  
Composite Pipes

The goal of this experimental study is to manufacture a bolted GFRP flange connection for composite pipes with high strength and performance. A mould was designed and manufactured, which ensures the quality of the composite materials and controls its surface grade. Based on the ASME Boiler and Pressure Vessel Code, Section X, this GFRP flange was fabricated using biaxial glass fibre braid and polyester resin in a vacuum infusion process. In addition, many experiments were carried out using another mould made of glass to solve process-related issues. Moreover, an investigation was conducted to compare the drilling of the GFRP flange using two types of tools; an Erbauer diamond tile drill bit and a Brad & Spur K10 drill. Six GFRP flanges were manufactured to reach the final product with acceptable quality and performance. The flange was adhesively bonded to a composite pipe after chamfering the end of the pipe. Another type of commercially-available composite flange was used to close the other end of the pipe. Finally, blind flanges were used to close both ends, making the pressure vessel that will be tested under the range of the bolt load and internal pressure.

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