scholarly journals Bedside clinicians retain nurses through turnover analysis and best practices

2019 ◽  
Vol 9 (12) ◽  
pp. 27
Author(s):  
Nina Hawthorne-Spears ◽  
Mary Shepherd
Keyword(s):  
Best Practices ◽  
Shared Governance ◽  
Health Care Organizations ◽  
Medical Center ◽  
Nurse Leaders ◽  
Change Model ◽  
Quality Outcomes ◽  
Texas Medical ◽  
Strategic Initiatives

The nursing shortage is projected to grow to well over 500,000 by 2020. Health care organizations are faced with increasing vacancies, mandating that strategic initiatives be developed to address the imperative of retaining their registered nurses (RNs). The implications for reducing RN turnover include improved safety and quality outcomes for patients. RN turnover also has financial implications. The average annual hospital cost of RN turnover is between $5.2 and $8.1 million dollars. Houston Methodist Hospital in the Texas Medical Center is a large, 1,200-bed metropolitan facility that employs over 3,000 nurses. By using shared governance to engage bedside clinicians and the ADKAR change model, nurse leaders were able to reduce organizational RN turnover from 16.39% to 10.57%, outperforming the national average and the American Nurses Credentialing Center’s benchmark for Magnet facilities with greater than or equal to 700 beds. This article will discuss the role of nurse leaders in creating a culture of retention, methods that were implemented at Houston Methodist Hospital to engage and empower beside clinicians to assume a lead role in reducing RN turnover, and the best practices discovered and implemented by bedside clinicians to improve RN turnover.

scholarly journals Mindset First, Strategy Second: Finding the Savings and Performance in Changing Culture

2020 ◽  
Vol 185 (Supplement_3) ◽  
pp. 17-24
Author(s):  
David R Gibson
Keyword(s):  
Military Service ◽  
Health Care Organizations ◽  
Medical Center ◽  
Army Medical ◽  
Organizational Challenges ◽  
Fort Hood ◽  
Strategic Initiatives ◽  
And Performance ◽  
The Impact ◽  
And Training

ABSTRACT Resolving major challenges for health care organizations is a constant challenge. Each military service provides its leaders with superb education and training to lead the constant needs and changes of the mission requirements. The primary trap we leaders may fall into, though, is when we mistake our own expertise and perspectives as the solutions to our organizational challenges. To fully unleash the potential of our people and organizations, we must be deliberate in setting a culture that leverages all the diversity within our organization. At the Carl R. Darnall Army Medical Center, Fort Hood, TX, our leadership team initiated an effort to shift the organizational mindset to create this cultural soil. The seeds of our education, training and strategic initiatives then were able to flourish and address our organizational challenges, but only after we addressed our own leadership mindset gap. By establishing and modeling a foundational outward mindset to ensure our team focused on the impact of our actions, we nurtured a culture that was inquisitive, collaborative, and without blame. In doing so, we eliminated negative financial and safety outcomes that threatened our institution and transformed it into a leading Army Medical Center.

The Science of Wisdom in a Polarized World: Knowns and Unknowns

2020 ◽  
Author(s):  
Igor Grossmann ◽  
Nic M. Weststrate ◽  
Monika Ardelt ◽  
Justin Peter Brienza ◽  
Mengxi Dong ◽  
...  
Keyword(s):  
Individual Differences ◽  
Problem Solving ◽  
Best Practices ◽  
Cognitive Sciences ◽  
Methodological Challenges ◽  
The Common ◽  
Empirical Approaches ◽  
And Training ◽  
Contextual Differences

Interest in wisdom in the cognitive sciences, psychology, and education has been paralleled by conceptual confusions about its nature and assessment. To clarify these issues and promote consensus in the field, wisdom researchers met in Toronto in July of 2019, resolving disputes through discussion. Guided by a survey of scientists who study wisdom-related constructs, we established a common wisdom model, observing that empirical approaches to wisdom converge on the morally-grounded application of metacognition to reasoning and problem-solving. After outlining the function of relevant metacognitive and moral processes, we critically evaluate existing empirical approaches to measurement and offer recommendations for best practices. In the subsequent sections, we use the common wisdom model to selectively review evidence about the role of individual differences for development and manifestation of wisdom, approaches to wisdom development and training, as well as cultural, subcultural, and social-contextual differences. We conclude by discussing wisdom’s conceptual overlap with a host of other constructs and outline unresolved conceptual and methodological challenges.

Beyond Bias

2020 ◽  
pp. 736-753
Author(s):  
Chelsea Barabas
Keyword(s):  
Best Practices ◽  
Criminal Law ◽  
Criminal Justice Reform ◽  
Trade Offs ◽  
System P ◽  
Accuracy Measures ◽  
Criminal Legal System ◽  
And Function ◽  
Role And Function

This chapter discusses contemporary debates regarding the use of artificial intelligence as a vehicle for criminal justice reform. It closely examines two general approaches to what has been widely branded as “algorithmic fairness” in criminal law: the development of formal fairness criteria and accuracy measures that illustrate the trade-offs of different algorithmic interventions; and the development of “best practices” and managerialist standards for maintaining a baseline of accuracy, transparency, and validity in these systems. Attempts to render AI-branded tools more accurate by addressing narrow notions of bias miss the deeper methodological and epistemological issues regarding the fairness of these tools. The key question is whether predictive tools reflect and reinforce punitive practices that drive disparate outcomes, and how data regimes interact with the penal ideology to naturalize these practices. The chapter then calls for a radically different understanding of the role and function of the carceral state, as a starting place for re-imagining the role of “AI” as a transformative force in the criminal legal system.

542 Objective Sleep Duration, Sleep Timing and Completion of In Vitro Fertilization Cycles; a Prospective Cohort Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A214-A214
Author(s):  
Chawanont Pimolsri ◽  
Xiru Lyu ◽  
Cathy Goldstein ◽  
Chelsea Fortin ◽  
Sunni Mumford ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Sleep Duration ◽  
Medical Center ◽  
Working Women ◽  
Vitro Fertilization ◽  
Circadian Misalignment ◽  
Logistic Regression Models ◽  
Sleep Timing

Abstract Introduction Sleep duration and circadian misalignment have been linked to fertility and fecundability. However, sleep in women undergoing IVF has rarely been examined. This study investigated the role of sleep duration and timing with completion of an IVF cycle. Methods Prospective study of women undergoing IVF at a tertiary medical center between 2015 and 2017. Sleep was assessed by wrist-worn actigraphy 1–2 weeks prior to the initiation of their IVF cycle. Reproductive profile, IVF cycle details, demographic and health information were obtained from medical charts. Sleep duration, midpoint and bedtime were examined in relation to IVF cycle completion using logistic regression models, adjusted for age and anti-Müllerian hormone levels. A sub-analysis excluded women who worked non-day shifts to control for circadian misalignment. Results A total of 48 women were studied. Median age was 33y (range 25–42), with 29% of women older than 35 years. Ten women had an IVF cycle cancellation prior to embryo transfer. These women had shorter sleep duration, more nocturnal awakenings, lower sleep efficiency, and later sleep timing in comparison to those who completed their cycle. Twenty-minute increases in sleep duration were associated with lower odds of an uncompleted IVF cycle (OR = 0.88; 95% CI 0.78, 1.00). Women with later sleep midpoints and later bedtime had higher odds of an uncompleted cycle relative to those with earlier midpoints and earlier bedtime; OR=1.24; 95% CI 1.09, 1.40 and OR=1.33; 95% CI 1.17, 1.53 respectively, per 20-minute increments. These results were independent of age, levels of anti-Müllerian hormone, or sleep duration, and remained unchanged after exclusion of shift-working women. Conclusion This study demonstrated the influence of sleep duration and sleep timing on the odds of an uncompleted IVF cycle prior to embryo transfer. Sleep is a modifiable behavior that may contribute to IVF cycle success. Support (if any):

Extrapulmonary Small Cell Cancer: A New Insight into a Rare Disease

Oncology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Leora Brazg Ferro ◽  
Ido Wolf ◽  
Shira Peleg Hasson ◽  
Inbal Golomb ◽  
Ester Osher ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Response Rate ◽  
Medical Center ◽  
Cell Cancer ◽  
Small Cell ◽  
Ki 67 ◽  
Small Cell Cancer ◽  
Pathological Characteristics ◽  
Results Of Treatment

<b><i>Introduction:</i></b> Extrapulmonary small-cell cancer (EPSCC) is a relatively rare malignancy. The management of EPSCC is usually extrapolated from small-cell lung cancer (SCLC). In spite of the morphological similarity of the 2 malignancies, there are many differences in clinical features, prognosis, and recommendations of treatment of these disorders. The data on the correlation of clinical-pathological characteristics of EPSCC and treatment results is scarce. <b><i>Materials and Methods:</i></b> This retrospective analysis of 41 consecutively treated patients diagnosed with EPSCC in 2015–2018 was performed in a tertiary medical center. The correlation between the clinical and pathological characteristics and the treatment outcome (response rate, disease-free interval, and overall medial survival) was done using the standard statistics, Kaplan-Meier method, and multivariate analyses. The stratification was done on the stage of the disease, Ki-67 proliferative index, the location of the tumor, and smoking. <b><i>Results:</i></b> Forty-one patients were included with a median age of 66.3 years. The most common primary site was the gastrointestinal tract (28, 68.3%) including the pancreas. The most common distant metastasis site was the liver (23, 56.1%). Only 2 patients (4.9%) had brain metastases. Unlike in SCLC, most patients did not have any history of smoking (23, 56.1%). Nineteen patients with metastatic disease received systemic treatment, mostly cisplatin-based chemotherapy, with a response rate of 57.9%. The results of treatment were significantly better in patients with disseminated EPSCC with Ki-67 &#x3c;55%, while its role in limited disease was nonsignificant. <b><i>Discussion:</i></b> The results of our study show the unique entity of EPSCC. The rarity of brain metastases proves that prophylactic brain irradiation should not be recommended in practice. The provocative idea of prophylactic liver irradiation in limited-stage EPSCC of gastrointestinal origin can be evaluated in future studies. The predictive role of Ki-67 is important in metastatic EPSCC. There is probably no role of smoking in developing EPSCC.

scholarly journals Systemic Innovation Areas for Heritage-Led Rural Regeneration: A Multilevel Repository of Best Practices

2021 ◽  
Vol 13 (9) ◽  
pp. 5069
Author(s):  
Aitziber Egusquiza ◽  
Mikel Zubiaga ◽  
Alessandra Gandini ◽  
Claudia de Luca ◽  
Simona Tondelli
Keyword(s):  
Best Practices ◽  
Environmental Sustainability ◽  
Rural Areas ◽  
Role Models ◽  
Social Inclusion ◽  
Work Support ◽  
Community Capitals ◽  
Community Capitals Framework ◽  
Systemic Innovation

This paper presents the result of the analysis of the data gathered from 20 Role Models (RM) case studies regarding their successful heritage-led rural regeneration models. For the study and comparison of the narratives of these Role Models two tools were used: the Community Capitals Framework, which studied the transference of capitals in each process and the identification of six Systemic Innovation Areas that allow this capital transference. A multilevel repository of best practices has been developed allowing the identification of common features, mechanisms for mobilisation of capitals and required resources that will facilitate the replication in other rural areas. The results of this work support the acknowledgement of the contribution of culture, together with cultural and natural heritage, to economic growth, social inclusion and environmental sustainability in rural areas reinforcing the role of culture as the fourth pillar of sustainable development.

Role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center

2017 ◽  
Vol 74 (6) ◽  
pp. 417-423 ◽  
Author(s):  
Justin Siegfried ◽  
Cristian Merchan ◽  
Marco R. Scipione ◽  
John Papadopoulos ◽  
Arash Dabestani ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

Role of Research in Best Practices

2015 ◽  
Vol 50 (1) ◽  
pp. 19-32 ◽  
Author(s):  
Maria A. Revell
Keyword(s):  
Best Practices

Standardization of Diagnostic Immunohistochemistry: Literature Review and Geisinger Experience

2014 ◽  
Vol 138 (12) ◽  
pp. 1564-1577 ◽  
Author(s):  
Fan Lin ◽  
Zongming Chen
Keyword(s):  
Quality Management ◽  
Literature Review ◽  
Best Practices ◽  
Critical Points ◽  
Medical Center ◽  
Management Program ◽  
Review Article ◽  
Data Sources ◽  
Test Results ◽  
Antibody Validation

Context Immunohistochemistry has become an indispensable ancillary technique in anatomic pathology laboratories. Standardization of every step in preanalytic, analytic, and postanalytic phases is crucial to achieve reproducible and reliable immunohistochemistry test results. Objective To standardize immunohistochemistry tests from preanalytic, analytic, to postanalytic phases. Data Sources Literature review and Geisinger (Geisinger Medical Center, Danville, Pennsylvania) experience. Conclusions This review article delineates some critical points in preanalytic, analytic, and postanalytic phases; reiterates some important questions, which may or may not have a consensus at this time; and updates the newly proposed guidelines on antibody validation from the College of American Pathologists Pathology and Laboratory Quality Center. Additionally, the article intends to share Geisinger's experience with (1) testing/optimizing a new antibody and troubleshooting; (2) interpreting and reporting immunohistochemistry assay results; (3) improving and implementing a total immunohistochemistry quality management program; and (4) developing best practices in immunohistochemistry.

The Role of Clostridium septicum in Paraneoplastic Sepsis

2000 ◽  
Vol 124 (3) ◽  
pp. 353-356
Author(s):  
J. Peter R. Pelletier ◽  
Julie A. Plumbley ◽  
Elizabeth A. Rouse ◽  
Stephen J. Cina
Keyword(s):  
Medical Center ◽  
Case Series ◽  
Teaching Hospitals ◽  
Clostridium Septicum ◽  
Medical Problems ◽  
Exclusion Criteria ◽  
Cyclic Neutropenia ◽  
The Past ◽  
Associated Conditions

Abstract Context.—Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours. Objectives.—To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions. Design.—Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years. Setting.—Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. Patients.—All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria. Main Outcome Measure.—Mortality associated with C septicum infection. Results.—In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%–70%). Conclusion.—Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.

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