Integrated Multidisciplinary Approach to Advance Care Planning for Vulnerable Older Adults

Advance Care Planning (ACP) is increasingly recognized as a crucial step to ensure patients receive medical care that consistent with their overall goals and values; however it remains suboptimal among vulnerable older adults. The objective was to determine whether a nurse navigator led ACP pathway plus a provider-facing EMR documentation program called ACPSmart improves ACP documentation within the EMR within an Accountable Care Organization (ACO) for vulnerable older adults. This was a randomized, pragmatic, effectiveness clinical trial was conducted from November 1, 2018 to November 1, 2019, at 8 primary care practices. Patients 65 years or older within an affiliated ACO with multimorbidity plus physical impairments, cognitive impairments, and/or frailty were included. Participants were randomized to either a nurse navigator led ACP pathway (NN) or usual care (UC). The primary outcome was documentation of new ACP discussion within the EMR at 12 months along with the quality of ACP discussions. Among 759 randomized patients (379 NN / 380 UC, mean age 77.7 years), compared to usual care, the NN led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, p<0.001). There was also higher completion rates of ACP legal forms (24.3% vs 10.0%, p<0.001), MOST forms (10.3% vs 1.1%, p<0.001), along with documentation of medical decision maker (64% vs 35%, p<0.001). The nurse navigator led ACP pathway plus ACPSmart documentation program increased documentation of ACP within the EMR. This may mitigate prior barriers to ACP and could substantially improve ACP documentation within the EMR.

Electronic system for documentation of the grape gene pool for assessing the ecological potential of varieties and their use in breeding

The need to create a multifunctional electronic system for documentation of the grape gene pool, focused on the characteristics of its ecological potential, has been updated. The step-by-step development of the system architecture of the grape gene pool documentation program, including the program interface, is presented. As the characteristics that most fully describe the economically valuable characteristics of grape varieties, 85 indicators were selected, and they were grouped according to functional characteristics into 9 groups. The logical structure was created and the physical design of the database was carried out. An electronic information Database has been formed, the development of which is focused on the characteristics of the obtained potential of genotypes carrying breeding significant traits, their classification, certification and areas of use. In the process of research, the screening of the grape gene pool by environmental parameters was carried out, which are based on analytical methods grouped that make it possible to obtain a complex of physiological and biochemical indicators characterizing the resistance of plants to extreme stress factors of the environment. To implement the task of varieties selection according to specified criterions, three algorithms are implemented depending on the type and user requirements for the selected varieties. In view of the environment stress full increasing and the need to focus on the ecological characteristics of varieties, the algorithms for their assessment have been developed with a focus on weather and climatic peculiarity. In order to rank variety forms according to the degree of resistance to dehydration and extreme low and high temperatures, a scale of tester varieties (standards) from low to highly resistant has been developed. The original own scale is proposed to assess every type of resistance.

Model Program Khutbah Jumat Di Masjid Al-Ikhlash Surabaya: Perspektif Manajemen Operasi

ABSTRACTThis research is intended to describe the program management sermon Friday at the Al-Ikhlash mosque, Tanjung Perak in Surabaya in Ecstasy. The goal in this study was describe the idea in search management program comes in Mosque Al-Ikhlash Tanjung Perak Surabaya in Ecstasy, described the selection process khatib, describes the design introduction, describes the implementation of the trial and described the shape of the design eventually. This study uses qualitative methods with the descriptive approach. This research uses data collection techniques in the form of in-depth interviews, observation and documentation. Program management ' preaching Friday at Mosque Al-Ikhlash of Tanjung Perak Surabaya Aware include: the Groove, the duration of the sermon, the criteria of khatib, theme, schedule khatib, SOP appearance khatib and infrastructure repair facility that supports the sermon Friday. Advice for all administrators that are in Al-Ikhlash mosque in Surabaya, to always provide service properly to the jama'ah, through the care facilities in Mosque Al-Ikhlash, choose a quality khatib-khatib, to performing at home and feel comfortable when the worship in the Mosque of Al-Ikhlash. ABSTRAKPenelitian ini dimaksudkan untuk menggambarkan manajemen program khutbah Jum’at di Masjid Al-Ikhlash Tanjung Sadari Perak Surabaya. Tujuan dalam penelitian ini adalah menggambarkan pencarian gagasan dalam manajemen program khutbah di Masjid Al-Ikhlash Tanjung Sadari Perak Surabaya, menggambarkan proses seleksi khatib, menggambarkan design pendahuluan, menggambarkan pelaksanaan uji coba dan menggambarkan bentuk design akhirnya. Penelitian ini menggunakan metode kualitatif dengan pendekatan deskriptif. Penelitian ini menggunakan teknik pengumpulan data berupa wawancara mendalam, observasi dan dokumentasi. Manajemen Program khutbah Jum’at di Masjid Al-Ikhlash Tanjung Sadari Perak Surabaya meliputi: alur, durasi khutbah, kriteria khatib, tema, jadwal khatib, SOP penampilan khatib dan sarana prasana yang mendukung khutbah Jum’at. Saran bagi segenap pengurus yang ada di Masjid Al-Ikhlash Surabaya, agar selalu memberikan pelayanan dengan baik kepada para jama’ah, melalui perawatan fasilitas yang ada di Masjid Al-Ikhlash, memilih khatib-khatib yang berkualitas, agar jama’ah betah dan merasa nyaman ketika beribadah di Masjid Al-Ikhlash.