Evaluation of Staff Satisfaction After Implementation of a Routine Work Checklist in An Oral Outpatient Department and Its Effect On Work Efficiency

Background: To evaluate the feasibility, effectiveness and sustainability of using a checklist in the routine work of a stomatological outpatient department and investigate the satisfaction of the nursing staff with the checklist.Methods: The study was divided into two stages: design and manufacture the checklist and apply the checklist. After the expert group performed stage one, an analysis of work efficiency and work omissions and a survey of staff satisfaction were carried out. The results of the groups either using the checklist (n = 30) or not (n = 30) were analysed and compared.Results: The average time of the checklist group was 15.20±1.70 min, and the average time of the nonchecklist group was 25.30±2.70 min, P < 0.001. The working efficiency of the checklist group was significantly higher than that of the nonchecklist group. The omission rate was 0% in the checklist group and 16.67% in the nonchecklist group. Staff satisfaction with the use of the checklist was high.Conclusion: The checklist can make routine work more efficient and convenient in a stomatological outpatient department. It is recommended for use in stomatological outpatient departments or hospitals.

The Role of Trait Impulsivity and Novelty-Seeking as Predisposing Factors to the Acquisition and Reinstatement of MDMA Self-Administration

<p>It has been suggested that the response to novelty and impulsivity predict the latency to acquisition and maintenance of drug self-administration, respectively. The aim of this thesis was to examine the relationship between these two traits and (1) the latency to acquisition and (2) maintenance (drug seeking) of 3,4-methylenedioxymethamphetamine (MDMA) self–administration. Impulsivity, measured as premature responding on the 5-choice serial reaction time task (5-CSRTT), and novelty seeking, measured as the locomotor response in a novel environment, were measured prior to self-administration. Due to characteristics of the rat strain and test equipment the 5-CSRTT was configurated in the first part of this study and modified from the standard version. Following training in this task animals were implanted with a siliastic catheter and were subsequently screened for their response to a novel environment prior to MDMA self-administration. Latency to acquisition was determined as the number of test sessions required to self-administer an initial criterion of 90 infusions of 1.0 mg/kg/infusion as well as an additional 150 infusions of 0.5 mg/kg/infusion MDMA. For some rats, the ability of MDMA (0, 5.0 or 10.0 mg/kg, IP) to produce drug seeking was subsequently measured and for others, impulsivity was again measured following self-administration. Novelty seeking predicted cocaine self-administration but was not significantly correlated with either the acquisition or drug-seeking measures of MDMA self-administration. Impulsivity was not significantly correlated with the latency to acquire self-administration of MDMA but was significantly and positively correlated with the magnitude of MDMA produced drug-seeking. Furthermore, MDMA self-administration produced a number of notable, but transient, deficits in the 5-CSRTT; there was an increase in omission rate and a delayed increase in premature responses in particular. These findings suggest that impulsivity, but not sensation seeking, might be a risk factor for the development of compulsive drug-seeking following withdrawal from MDMA self-administration. A surprising finding from this study was a high acquisition rate amongst rats that acquired the 5-CSRTT prior to self-administration. This difference was examined in a separate set of experiments. This effect could not be explained by an effect of handling, food restriction, or exposure to sweetened condensed milk and might possibly be due to differences in instrumental learning.</p>

The Role of Trait Impulsivity and Novelty-Seeking as Predisposing Factors to the Acquisition and Reinstatement of MDMA Self-Administration

<p>It has been suggested that the response to novelty and impulsivity predict the latency to acquisition and maintenance of drug self-administration, respectively. The aim of this thesis was to examine the relationship between these two traits and (1) the latency to acquisition and (2) maintenance (drug seeking) of 3,4-methylenedioxymethamphetamine (MDMA) self–administration. Impulsivity, measured as premature responding on the 5-choice serial reaction time task (5-CSRTT), and novelty seeking, measured as the locomotor response in a novel environment, were measured prior to self-administration. Due to characteristics of the rat strain and test equipment the 5-CSRTT was configurated in the first part of this study and modified from the standard version. Following training in this task animals were implanted with a siliastic catheter and were subsequently screened for their response to a novel environment prior to MDMA self-administration. Latency to acquisition was determined as the number of test sessions required to self-administer an initial criterion of 90 infusions of 1.0 mg/kg/infusion as well as an additional 150 infusions of 0.5 mg/kg/infusion MDMA. For some rats, the ability of MDMA (0, 5.0 or 10.0 mg/kg, IP) to produce drug seeking was subsequently measured and for others, impulsivity was again measured following self-administration. Novelty seeking predicted cocaine self-administration but was not significantly correlated with either the acquisition or drug-seeking measures of MDMA self-administration. Impulsivity was not significantly correlated with the latency to acquire self-administration of MDMA but was significantly and positively correlated with the magnitude of MDMA produced drug-seeking. Furthermore, MDMA self-administration produced a number of notable, but transient, deficits in the 5-CSRTT; there was an increase in omission rate and a delayed increase in premature responses in particular. These findings suggest that impulsivity, but not sensation seeking, might be a risk factor for the development of compulsive drug-seeking following withdrawal from MDMA self-administration. A surprising finding from this study was a high acquisition rate amongst rats that acquired the 5-CSRTT prior to self-administration. This difference was examined in a separate set of experiments. This effect could not be explained by an effect of handling, food restriction, or exposure to sweetened condensed milk and might possibly be due to differences in instrumental learning.</p>

Automated Detection and Removal of Cardiac and Pulse Interferences from Neonatal EEG Signals

Electrical cardiac and pulsatile interference is very difficult to remove from electroencephalographic (EEG) signals, especially if recorded in neonates, for which a small number of EEG channels is used. Several methods were proposed, including Blind Source Separation (BSS) methods that required the use of artificial cardiac-related signals to improve the separation of artefactual components. To optimize the separation of cardiac-related artefactual components, we propose a method based on Independent Component Analysis (ICA) that exploits specific features of the real electrocardiographic (ECG) signals that were simultaneously recorded with the neonatal EEG. A total of forty EEG segments from 19-channel neonatal EEG recordings with and without seizures were used to test and validate the performance of our method. We observed a significant reduction in the number of independent components (ICs) containing cardiac-related interferences, with a consequent improvement in the automated classification of the separated ICs. The comparison with the expert labeling of the ICs separately containing electrical cardiac and pulsatile interference led to an accuracy = 0.99, a false omission rate = 0.01 and a sensitivity = 0.93, outperforming existing methods. Furthermore, we verified that true brain activity was preserved in neonatal EEG signals reconstructed after the removal of artefactual ICs, demonstrating the effectiveness of our method and its safe applicability in a clinical context.

Evaluation of Staff Satisfaction After Implementation of a Routine Work Checklist in an Oral Outpatient Department and its Effect on Work Efficiency

Background: To evaluate the feasibility, effectiveness and sustainability of using a checklist in the routine work of a stomatological outpatient department and investigate the satisfaction of the nursing staff with the checklist.Methods: The study was divided into two stages: design and manufacture the checklist and apply the checklist. After the expert group performed stage one, an analysis of work efficiency and work omissions and a survey of staff satisfaction were carried out. The results of the groups either using the checklist (n = 30) or not (n = 30) were analysed and compared. Results: The average time of the checklist group was 15.20±1.70 min, and the average time of the nonchecklist group was 25.30±2.70 min, P < 0.001. The working efficiency of the checklist group was significantly higher than that of the nonchecklist group. The omission rate was 0% in the checklist group and 16.67% in the nonchecklist group. Staff satisfaction with the use of the checklist was high. Conclusion: The checklist can make routine work more efficient and convenient in a stomatological outpatient department. It is recommended for use in stomatological outpatient departments or hospitals.

Evaluation of Staff Satisfaction After Implementation of a Routine Work Checklist in an Oral Outpatient Department and Its Effect on Work Efficiency

Objective: To evaluate the feasibility, effectiveness and sustainability of using a checklist in the routine work of a stomatological outpatient department and investigate the satisfaction of the nursing staff with the checklist.Methods: The study was divided into two stages: design and manufacture the checklist and apply the checklist. After the expert group performed stage one, an analysis of work efficiency and work omissions and a survey of staff satisfaction were carried out. The results of the groups either using the checklist (n = 14) or not (n = 14) were analysed and compared. Results: The average time of the checklist group was 14.14±0.81 min, and the average time of the nonchecklist group was 26.07±2.37 min, P < 0.001. The working efficiency of the checklist group was significantly higher than that of the nonchecklist group. The omission rate was 0% in the checklist group and 21.43% in the nonchecklist group. Staff satisfaction with the use of the checklist was high. Conclusion: The checklist can make routine work more efficient and convenient in a stomatological outpatient department. It is recommended for use in stomatological outpatient departments or hospitals.

The impact of a structured handover checklist for intraoperative staff shift changes on effective communication, OR team satisfaction, and patient safety: a pilot study

Objective Handover without a structured format is prone to the omission of information and could be a potential risk to patient safety. We sought to determine the effect of a structured checklist on the quality of intraoperative change of shift handover between scrubs and circulars. Methods We conducted a control intervention study on operating room wards of two teaching hospitals from 20 Feb to 21 Nov 2020. This research was conducted in three stages as follows: assessing the current situation (as a group before the intervention), performing the intervention and evaluating the effect of using a checklist on handover quality after the intervention in two groups: with and without checklist. We examined the quality of handover between scrub and circular personnel in terms of handover duration and quality, omission of information and improvement in OR staff satisfaction. Results A total of 120 handovers were observed and evaluated. After intervention in the group using the checklist, the percentage of information omission in surgical report was decreased from 19.5 to 12.1% between scrubs (P < 0.00) and from 16.8 to 14.1% between circulars (P < 0.03). Also, in the role of scrub, the mean overall score of handover process quality was significantly higher after the intervention (x̄ = 7 ± 1.5) than before it (x̄ = 6.5 ± 0.9) (p < 0.02). In the role of circulating, despite the positive effect of overall score checklist, no significant difference was observed (p < 0.08). The use of checklist significantly increased the handover duration between scrubs (p < 0.03) and circulars (p < 0.00). The overall mean percentage of handover satisfaction increased from 67.5% before the intervention to 85.5% after the intervention (p < 0.00). Conclusion The implementation of a new structured handover checklist had a positive impact on improving the quality of communication between the surgical team, reducing the information omission rate and increasing the satisfaction.

Machine learning-enabled cancer diagnostics with widefield polarimetric second-harmonic generation microscopy

The extracellular matrix (ECM) collagen undergoes major remodeling during tumorigenesis. However, alterations to the ECM are not widely considered in cancer diagnostics, due to mostly uniform appearance of collagen fibers in white light images of hematoxylin and eosin-stained tissue sections. Polarimetric second-harmonic generation (P-SHG) microscopy enables label-free visualization and ultrastructural investigation of non-centrosymmetric molecules, which, when combined with texture analysis, provides multiparameter characterization of tissue collagen. This paper demonstrates whole slide imaging of breast tissue microarrays using high-throughput widefield P-SHG microscopy. The resulting P-SHG parameters are used in classification to differentiate tumor tissue from normal with 94.2% accuracy and F1-score, and 6.3% false discovery rate. Subsequently, the trained classifier is employed to predict tumor tissue with 91.3% accuracy, 90.7% F1-score, and 13.8% false omission rate. As such, we show that widefield P-SHG microscopy reveals collagen ultrastructure over large tissue regions and can be utilized as a sensitive biomarker for cancer diagnostics and prognostics studies.

MO682TAILORING AI-BASED REFERRAL TO INTENSIFIED INTERVENTION PROGRAMS FOR PERITONITIS PREVENTION WITH COST-EFFECTIVENESS SIMULATION

Background and Aims Peritonitis is a common and potentially severe complication for peritoneal dialysis (PD) patients. It is associated with mortality and technique failure risk and contributes significantly to their healthcare cost. Despite several peritonitis prevention programs based on education and training have been implemented worldwide, it has been reported a large variability of efficacy across patients groups and healthcare settings. In order to avoid unnecessary treatment of low risk patients, healthcare prevention programs should be personalized based on accurate patients’ risk profiling, so that high risk patients may be addressed with intensified prevention programs. However, referral strategy (i.e. defining when risk is too much and deserves special attention) depends the availability, efficacy and cost of medical interventions. In this study, we demonstrate through a program implementation simulator, how different referral strategies to inform peritonitis prevention program among PD patients informed by AI-based risk stratification tools, produce different healthcare and health economics outcomes. In particular, the simulation considers a prevention program characterized by standard of care, which affects all patients as well as an intensive intervention for a subset of high-risk patients (e.g. special training or medical treatment). Method The Peritonitis Risk Score model was trained and validated among 9325 PD patients treated in FMC network (Model accuracy, AUC=0.86). The pharmaco-economic model simulation was performed considering a cohort of 22,900 adult PD patients, treated in Fresenius Medical Care dialysis network between January 1, 2011 and December 31, 2018, for which the Peritonitis Risk Score was computed at a given date. The occurrence of an acute peritonitis in the month after prediction has been registered. We simulated the program outcomes in terms of proportion of referrals to the intensified prevention program, false omission rate, peritonitis risk reduction, overall cost-savings, number needed to treat. We considered the following scenario based on previous cost-effectiveness analysis on peritonitis risk prevention: Results Given the action threshold selected, 5.3% of patients entered the intensified intervention program (PPV=9.5%); the false omission rate was 2.2%. Cost savings for the intensified healthcare where generated when the effect size of the intensified intervention exceeded 1.4 (figure 1A). For that effect size the number needed to treat for each prevented peritonitis was NNT=23.4. Overall, 162 peritonitis/month could be prevented in the whole network (peritonitis with no intervention=592; Peritonitis after intervention=430). When a less conservative threshold was selected, 12.2% of patients entered the intensified prevention program (PPV=7.3%), generating a false omission rate=1.9%. Cost savings were never generated (i.e. the intensified program needed investment to be sustained) but with the same effect size of 1.4 additional 24 peritonitis/months could be saved in the whole network (peritonitis with no intervention=592; Peritonitis after intervention=406). The number needed to treat for the intensified program was NTT=30.4 (figure 1B). Conclusion Cost-effectiveness simulating tool provides a rational evaluation framework for AI-based referral to peritonitis preventive programs. This tool can be easily adapted for any healthcare program based on patient risk score.

Effect of a Structured Checklist on Quality of Intraoperative Change-of-shift Handoffs: A pre-post control study

Objective: Handoff without a structured format is prone to the omission of information and could be a potential risk to patient safety. We sought to determine the effect of a structured checklist on the quality of intraoperative change of shift handoff between scrubs and circulating.Methods: We conducted a pre-post control intervention study on operating room wards of two teaching hospitals from February to November 2020. This research was conducted in three stages as follows: assessing the current situation (as a group before the intervention), performing the intervention and evaluating the effect of using a checklist on handoff quality after the intervention in two groups: with and without checklist. We examined the quality of handoff between scrub and circular personnel in terms of handoff duration and quality, omission of information as well as changes in personnel satisfaction. Data were analyzed using SPSS software version 26.Results: A total of 120 handoffs were observed and evaluated. After intervention in the group using the checklist, the percentage of information omission in surgical report was decreased from 19.5 to 12.1% between scrubs (P<0.00) and from 16.8 to 14.1% between circulating (P <0.03). Also, in the role of scrub, the mean overall score of handoff process quality was significantly higher after the intervention (x̄=7±1.5) than before it (x̄=6.5±0.9) (p<0.02). In the role of circulating, despite the positive effect of overall score checklist, no significant difference was observed (p<0.08). The use of checklist significantly increased the handoff duration between scrubs (p<0.03) and circulating (p<0.00).Conclusion: Structured checklist has a positive impact on improving the quality of communication between the surgical team, reducing the information omission rate and increasing the satisfaction.