Aspects of Prevention of Urinary Tract Infections Associated with Urinary Bladder Catheterisation and Their Implementation in Nursing Practice

In the case of the prevention of catheter-associated urinary tract infections (CAUTI) related to healthcare provision, high-quality and comprehensively provided nursing care is essential. Implementation of preventive strategies is based on recommended procedures, and the introduction of whole sets of measures has been shown to be effective. The objective of this research is to find out whether the providers of acute bed care have implemented the steps of CAUTI prevention, and specifically which measures leading to improved quality of care in the area of urinary infections are already in place. To determine this, we carried out quantitative research. Data were collected using a questionnaire-based investigation; we used two non-standardised and one standardised questionnaire, and the respondents were general nurses in management positions (n = 186). The results revealed that result-related CAUTI indicators are monitored by only one-third of the respondents, and records of catheterisation indication are not kept by 17.3% of general nurses. The results of the research showed deficiencies in the monitoring of CAUTI outcome and process indicators, and a weakness of the implemented preventive measures is the maintenance of catheterisation documentation. Periodic CAUTI prevention training is not implemented as recommended. It is positive that there are well-working teams of HAI prevention experts in hospitals.

Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology

Objective To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. Methods The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. Results The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). Conclusion A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

Implementation of Evidence-Based Patient Safety Practices: 4-Years’ Follow-up of a Nationwide Regulatory Intervention in Brazilian Hospitals

Background: Regulatory interventions are widely recommended to improve the quality of health services, but there are few studies on the possible models and their effects. The aim of this study is to describe the implementation process and analyse the results of a nationwide regulatory intervention for the implementation of patient safety practices.Methods: Four nationwide annual cross-sectional assessments were conducted in Brazilian hospitals with Intensive Care Unit beds. The participants involved all facilities operating during 2016-2019 (average N=1,989). The regulatory intervention theory aimed to increase adherence to safe evidence-based practices through national annual assessment involving a set of 21 validated structure and process indicators related to patient safety practices. At moment 1(Risk assessment), data were collected to classify hospitals according to the risk. In the sequence, the Sanitary Surveillance Centers (VISAS) carried out the analysis of the information sent by the hospitals. VISAS classified services into three groups according to compliance with the composite adherence indicator: High (67-100%); Medium (34-66%); and Low Compliance (0-33%). Moment 2 (Risk management) used responsive actions according to the hospital’s classification. Results: The intervention resulted in six annual cyclic stages and, between 2016-2019, 782 (40.1%), 980 (49.0%), 1,093 (54.3%) and 1,255 (61.8%) hospitals participated, respectively. 17 of the 20 indicators with at least two measurements had a significant improvement after national interventions (p<0.05). The overall percentage of compliance increased from 70.7 to 84.1 (p<0.001) and the percentage of hospitals with high compliance increased from 59.1 to 83.0 (p<0.001).Conclusion: The regulatory intervention used was a good tool to strengthen the information system and government actions to promote patient safety. The set of low-cost interventions seems to be useful to prioritise hospitals at higher risk and to induce responsive measures to implement patient safety practices in the evaluated context, promoting the efficiency of the regulatory process.

A public health value-based healthcare paradigm for HIV

Background HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework. Results Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities). Conclusions This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.

Improving Organizational Commitment to Diversity, Equity, Inclusion, and Belonging

This chapter aims to provide useful information about the implementation of diversity equity, inclusion, and belonging (DEIB) to improve organizational performance. This chapter provides a conceptual framework for organizational leaders who desire additional awareness and knowledge regarding the nature, extent, and impact of diverse employees' barriers. Further, the purpose of this endeavor is to demonstrate that the persistent lack of recruitment, promotion, and retention of diverse employees is due to systemic, structural, organizational, institutional, cultural, and societal obstacles. Further, the theory of generative interactions (TGI) supports how obstacles must be acknowledged and eliminated through increased awareness of the issues linked to evidence-based, data-driven approaches leading to measurable key process indicators (KPIs) and outcomes. To support DEIB initiatives, many organizations have developed the Chief Diversity Officer (CDO) position to manage the process, eliminate barriers, and proactively strengthen organizational culture.

INTERNATIONALISATION OF HIGHER EDUCATION BASED ON LEAN MANAGEMENT PRINCIPLES: CASE STUDY OF JAGIELLONIAN UNIVERSITY

The paper deals with the phenomenon of lean management in higher education analyzed within the context of internationalisation process in Polish higher education as a means of ensuring inclusive global higher education space. Lean management is looked upon as one of the 21st century models of university management transplanted from the sphere of private enterprises and business companies’ management. The empirical analysis has been conducted with the use of statistical data provided by the official website of Jagiellonian University, Krakow, Republic of Poland. The data have been collected in accordance with the following internationalisation process indicators: amount of bilateral Memoranda of Understanding; Inbound Mobility: number of foreign students who have completed the full cycle bachelor's / master's degree; Inbound Mobility: number of foreign students who have completed the full cycle PhD’s degree; Inbound Mobility: participation in Quin Jadwiga Fund granting schemes; Inbound Mobility: participation in Erasmus / Erasmus+ Programme; Outbound Mobility: participation in Erasmus / Erasmus+ Programme; number of outbound mobile students in accordance with bilateral agreements; number of inbound mobile students in accordance with bilateral agreements; number of outbound mobile staff in accordance with bilateral agreements; number of inbound mobile staff in accordance with bilateral agreements. The collected data have shown gradual increase of internationalisation process indicators and allowed concluding that the introduction and support of lean management principles in higher education promotes the intensification of the internationalisation process.

Indicators of Infertility and Fertility Care: A Systematic Scoping Review

Background: The identification of appropriate, relevant and valid indicators of infertility and fertility care is critical to effective monitoring of progress in fertility care access, equity, utilization and impact globally. The aim of the review was to map existing literature on indicators of infertility and fertility care and summarize these indicators by typology and dimensions.Methods: This review followed the framework of Arksey and O’Malley. Bibliographic databases of published studies (MEDLINE, PubMed, JSTOR, CINAHL, Web of Science and Scopus) were searched from inception to June 2021. We also searched unpublished datasets and hand-searched reference lists of relevant articles. Two reviewers independently screened reports and extracted data onto a data charting table before collating and summarizing results.Results: We included 46 reports from 88 countries. The reporting of data was either voluntary in 63 countries (72%) and compulsory in 25 countries (28%). The reporting of data was partial in 63 countries (72%) and complete in 25 countries (28%). Reporting for cycles or deliveries were based on individual cycles in 56 countries (64%) and on cumulative cycles in 32 countries (36%). In types of overall typology, most of the indicators were outcome indicators (70%) with fewer being process indicators (16%) or structural indicators (14%). In terms of dimension, of most indicators were effectiveness and efficiency indicators. Indicators on safety, patient-centeredness, equity, and timeliness were under-reported.Conclusion: A wide range of indicators of infertility and fertility care exist in literature; however, most are outcomes indicators of effectiveness and efficiency dimensions, while those on safety, patient-centeredness, equity, and timeliness and non-clinical aspects are limited. These findings provide a basis for selection and prioritization of a core set of indicators to monitor progress in fertility care.Systematic review registration: Open Science Framework (osf.io/78wrg)

Geometrical Influence on Particle Transport in Cross-Flow Ultrafiltration: Cylindrical and Flat Sheet Membranes

Cross-flow membrane ultrafiltration (UF) is used for the enrichment and purification of small colloidal particles and proteins. We explore the influence of different membrane geometries on the particle transport in, and the efficiency of, inside-out cross-flow UF. For this purpose, we generalize the accurate and numerically efficient modified boundary layer approximation (mBLA) method, developed in recent work by us for a hollow cylindrical membrane, to parallel flat sheet geometries with one or two solvent-permeable membrane sheets. Considering a reference dispersion of Brownian hard spheres where accurate expressions for its transport properties are available, the generalized mBLA method is used to analyze how particle transport and global UF process indicators are affected by varying operating parameters and the membrane geometry. We show that global process indicators including the mean permeate flux, the solvent recovery indicator, and the concentration factor are strongly dependent on the membrane geometry. A key finding is that irrespective of the many input parameters characterizing an UF experiment and its membrane geometry, the process indicators are determined by three independent dimensionless variables only. This finding can be very useful in the design, optimization, and scale-up of UF processes.

Measuring health science research and development in Africa: mapping the available data

Background In recent years there have been calls to strengthen health sciences research capacity in African countries. This capacity can contribute to improvements in health, social welfare and poverty reduction through domestic application of research findings; it is increasingly seen as critical to pandemic preparedness and response. Developing research infrastructure and performance may reduce national economies’ reliance on primary commodity and agricultural production, as countries strive to develop knowledge-based economies to help drive macroeconomic growth. Yet efforts to date to understand health sciences research capacity are limited to output metrics of journal citations and publications, failing to reflect the complexity of the health sciences research landscape in many settings. Methods We map and assess current capacity for health sciences research across all 54 countries of Africa by collecting a range of available data. This included structural indicators (research institutions and research funding), process indicators (clinical trial infrastructures, intellectual property rights and regulatory capacities) and output indicators (publications and citations). Results While there are some countries which perform well across the range of indicators used, for most countries the results are varied—suggesting high relative performance in some indicators, but lower in others. Missing data for key measures of capacity or performance is also a key concern. Taken as a whole, existing data suggest a nuanced view of the current health sciences research landscape on the African continent. Conclusion Mapping existing data may enable governments and international organizations to identify where gaps in health sciences research capacity lie, particularly in comparison to other countries in the region. It also highlights gaps where more data are needed. These data can help to inform investment priorities and future system needs.