Improvement Program
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2021 ◽  
Vol 50 (Supplement_1) ◽  
Irfan Khan ◽  
Raihan Noman ◽  
Nabeel Markatia ◽  
Juan Ruiz Pelaez ◽  
Pura Rodriguez de la Vega ◽  

Abstract Background There is conflicting evidence in the literature regarding whether type of anesthesia (regional vs. general) is associated with postoperative mortality in patients undergoing hip arthroplasty. The present study compares mortality between general or regional anesthesia administered to patients undergoing either total (THA) or partial hip arthroplasty (PHA). Methods A retrospective cohort was assembled using the 2015-2016 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients undergoing hip arthroplasty under general or regional anesthesia were included. Adjusted odds of 30 days all-cause postoperative mortality according to type of anesthesia were estimated by fitting multiple logistic regression models that included potential confounders and effect modifiers. Results A total of 60,897 patients were included. Given that the interaction between type of anesthesia and type of arthroplasty was statistically significant, separated models were fitted for each type of arthroplasty. There was no evidence of an association between type of anesthesia and postoperative mortality in hip arthroplasty patients regardless of whether the arthroplasty was partial (OR = 0.85; CI 0.59-1.22) or total (OR = 0.68; CI 0.43-1.08). Conclusion The overall postoperative mortality in adult hip arthroplasty patients is low. Our findings support that mortality is not different between patients receiving regional vs general anesthesia regardless of type of hip arthroplasty (total vs. partial). Key Message In patients undergoing total hip arthroplasty or partial hip arthroplasty, the use of general or regional anesthesia does not impact early postoperative mortality.

2021 ◽  
Vol 34 (3) ◽  
pp. 590-598

ABSTRACT Iron and zinc deficiency is one of the main problems affecting vulnerable populations in the Colombian Caribbean, thereby generating malnutrition from the consumption of foods with low content of essential minerals. The objective of this study was to evaluate the genotype-environment interaction for iron and zinc accumulation in grains in 10 cowpea bean genotypes by additive main effects and multiplicative interaction (AMMI) model and to select the most stable ones to stimulate their planting or as parents in the genetic improvement program. Nine promising lines and a commercial control were evaluated using the randomized complete block design with 10 treatments and four replications in 10 environments of the northern Colombia in the second semester of 2017 and first of 2018. The adaptability and stability analysis was done using AMMI model. The results showed highly significant differences at the level of environments, genotypes, and genotype-environment interaction for iron and zinc, demostrating a differential adaptability of genotypes in the test environments. Genotypes 2 and 3 expressed greater adaptability and stability for iron contents in the seed; while genotype 1, recorded it for zinc contents. These three genotypes outperformed the commercial control and, therefore, can be recommended for planting or be used as parents in the genetic improvement program.

2021 ◽  
Vol 7 (2) ◽  
pp. 91-98
Rahmalia Syahputri ◽  
Nurfiana Nurfiana ◽  
Jaka Darmawan ◽  
Ari Widiantoko

Budi Mulya 2 (BM2) orphanage is a social institution located in Bandar Lampung. To meet the operational needs of development, the day-to-day operations of the orphanage, as well as their development, BM 2 rely on donations provided by permanent and non-permanent donors, thus the cost of developing the homes and foster children is unpredictable, very small, and insufficient. For an institution to have sufficient funds for both physical and non-physical development to allow foster children can be maximized for their guidance process, it is necessary to plan and develop a focused and sustainable business. As one of the efforts is conducting a long-term three-year program to empower the economy independently through aquaculture and plantations in buckets.  By doing this action, it is hoped we can build a community service and education institution that is dynamic and capable of accommodating and fostering many neglected children through an independent economic enterprise improvement program. This paper describes the results of the service during the first  year of service activities; which are the construction and cultivation training, the first harvest, and several activities during the COVID-19 pandemic had been held. In addition, the skills of the caregiver and foster children improve in cultivating fish and plants in buckets.   Abstrak: Panti asuhan Budi Mulya 2 (BM 2) adalah satu satu lembaga sosial yang berlokasi di Bandar Lampung. Dalam memenuhi kebutuhan operasional pembangunan, operasional sehari-hari panti dan anak asuh, serta pengembangannya, BM 2 mengandalkan donasi yang diberikan oleh Donatur tetap dan tidak tetap, sehingga biaya pengembangan panti dan anak asuh tidak stabil, sangat kecil, dan tidak mencukupi. Agar lembaga dapat memiliki dana yang cukup untuk pengembangan baik fisik dan non fisik, sehingga anak asuh dapat termaksimalkan proses pem­binaan­nya, maka Perlu direncanakan dan dikembangkannya usaha yang terarah dan berkesi­nam­­bungan. Sebagai salah satu upaya, untuk itu, telah dicanangkan program jangka panjang tiga tahun pemberdayaan ekonomi mandiri melalui budidaya perikanan dan perkebun­an dalam ember. Melalui kegiatan ini diharapkan terbentuknya sebuah lembaga pengabdian dan pendidikan masyarakat yang dinamis dan mampu menampung dan membina banyak anak-anak terlantar melalui program peningkatan usaha ekonomi mandiri. Tulisan ini memaparkan hasil pengabdian selama tahun pertama kegiatan pengabdian; antara lain telah diselenggarakannya pembangunan dan pelatihan budidaya, panen pertama, dan beberapa kegiatan pada masa pandemic COVID-19. Selain itu, bertambahnya keterampilan Pengasuh dan Anak asuh dalam membudidayakan ikan dan tanaman dalam ember.

2021 ◽  
Vol 21 (1) ◽  
Sherry L. Ball ◽  
Saul J. Weiner ◽  
Alan Schwartz ◽  
Lisa Altman ◽  
Amy Binns-Calvey ◽  

Abstract Background Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians. Methods Patients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study. Results There were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p = .008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p = .02), and at a time that is convenient (p = .04). Patients who volunteered sometimes expressed concerns they were “spying” on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources. Conclusions A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.

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