Interiority of a Disconnected Mind

<p>As the population of New Zealand ages, the rate of people with dementia is also increasing, creating greater demand for specialised dementia facilities. However, few of these are located in the rural context that New Zealand is known for. In addition, as a society we have created a stigma around aged care, and tend to design un-home-like and institutional centres. The importance of creating a space that provides contextual features, appropriate wayfinding and therapeutic characteristics has been overtaken by the need to design for efficiency of staffing requirements. Current settings and the relocation to a more urban living environment increases the confusion for those rural people with dementia, as there is little to prompt their memory or make them feel at home. This thesis proposes the design of a dementia care facility that reflects the lifestyle rural people have come from. It examines how these three aspects: context, wayfinding and therapeutic design can be included to enhance the design of a dementia facility, as well as create a space that is enlivening for the residents.</p>

Interiority of a Disconnected Mind

<p>As the population of New Zealand ages, the rate of people with dementia is also increasing, creating greater demand for specialised dementia facilities. However, few of these are located in the rural context that New Zealand is known for. In addition, as a society we have created a stigma around aged care, and tend to design un-home-like and institutional centres. The importance of creating a space that provides contextual features, appropriate wayfinding and therapeutic characteristics has been overtaken by the need to design for efficiency of staffing requirements. Current settings and the relocation to a more urban living environment increases the confusion for those rural people with dementia, as there is little to prompt their memory or make them feel at home. This thesis proposes the design of a dementia care facility that reflects the lifestyle rural people have come from. It examines how these three aspects: context, wayfinding and therapeutic design can be included to enhance the design of a dementia facility, as well as create a space that is enlivening for the residents.</p>

Patient needs and resource intensity weighting in the ambulatory care unit

Across British Columbia Cancer (BC Cancer), oncology nurses work as part of an interdisciplinary team in the outpatient ambulatory care unit (ACU) and support patients across the trajectory of their cancer journey. Previous initiatives, which focused on identifying patient needs and nursing role optimization work, have enhanced role clarity, enabling nurses to articulate their scope of practice and specialty competencies required to best meet the needs of patients and families. However, while the patient needs and fundamental practice elements have been identified to optimize the ACU nursing role, a gap still exists in quantifying the staffing resources required to operationalize the current model of care. To address this gap, a quality improvement project was initiated to develop an internally validated ACU Nursing Resource Intensity Weighting (RIW) tool for projecting baseline staffing requirements. The tool can be utilized to inform strategic and operational planning discussions focused on improving the outpatient model of care in oncology.

Rapid design and implementation of an adaptive pooling workflow for SARS-CoV-2 testing in an NHS diagnostic laboratory: a proof-of-concept study

Background: Diagnostic laboratories are currently required to provide routine testing of asymptomatic staff and patients as a part of their clinical screening for SARS-CoV-2 infection. However, these cohorts display very different disease prevalence from symptomatic individuals and testing capacity for asymptomatic screening is often limited. Group testing is frequently proposed as a possible solution to address this; however, proposals neglect the technical and operational feasibility of implementation in a front-line diagnostic laboratory. Methods: Between October and December 2020, as a seven-week proof of concept, we took into account scientific, technical and operational feasibility to design and implement an adaptive pooling strategy in an NHS diagnostic laboratory in London (UK). We assessed the impact of pooling on analytical sensitivity and modelled the impact of prevalence on pooling strategy. We then considered the operational constraints to model the potential gains in capacity and the requirements for additional staff and infrastructure. Finally, we developed a LIMS-agnostic laboratory automation workflow and software solution and tested the technical feasibility of our adaptive pooling workflow. Results: First, we determined the analytical sensitivity of the implemented SARS-CoV-2 assay to be 250 copies/mL. We then determined that, in a setting with limited analyser capacity, the testing capacity could be increased by two-fold with pooling, however, in a setting with limited reagents, this could rise to a five-fold increase. These capacity increases could be realized with modest additional resource and staffing requirements whilst utilizing up to 76% fewer plastic consumables and 90% fewer reagents. Finally, we successfully implemented a plate-based pooling workflow and tested 920 patient samples using the reagents that would usually be required to process just 222 samples. Conclusions: Adaptive pooled testing is a scientifically, technically and operationally feasible solution to increase testing capacity in frontline NHS diagnostic laboratories.

Theoretical and applied principles of system of personnel adaptation

In modern conditions, as development and reform of economic and socio-labor spheres, continuous technical progress and inconstant world environment, staffing requirements are constantly growing. Today, important issues for the system of employment and adaptation are their improvement with the help of modern personnel technologies, which would take into account external and internal factors, strategic orientation, could adapt to the natural response to excessive market spontaneity. Staff adaptation is the fundamental basis of any organization and further work with the employee. The adaptation measures in a complex way, are playing the role of basis for adaptation programs. That program, in turn, describes the tasks, main goals, deadlines and identifies the employees responsible for the adaptation; establishes a sequence of actions to achieve the set goals and indicates what knowledge, skills, competencies and skills a new employee should have and what results he or she should show after the end of the adaptation period. From the organizational point of view, there are several periods of adaptation. First, this is a familiarization period lasting one month. The second period is an evaluation one. In the third period, there is a gradual integration into the organization. In the article there is identifying of most common features of personnel adaptation system regardless the industry and organization in which that system operates. The goals of personnel adaptation in organization are defined. In today's labor market, the question of not only the formation of the ideal staff in the organization, but also the retention of valuable staff – this is the task can be performed by an effective system of staff adaptation.

Issues of training staff of information and library institutions in Uzbekistan

This article covers the issues of training specialists for information and library institutions, the existing problems and challenges in the Republic of Uzbekistan. It also presents the reforms, historical facts and digital data on the training of librarians with higher and secondary special education in our country. Special attention was paid to the topical issues of management of information and library institutions, staffing requirements, the introduction of innovative methods in the educational process. Also, the requirements for the bachelor’s and master’s degree programs in the training of information and library specialists with higher education, the views on the individual approach.

1569 Paediatric Upper Limb Fracture Manipulation in A Children’s Emergency Department: Practice Changes During The COVID-19 Pandemic

Background Trauma theatre time is valuable and previous studies reported cost of £24.77/minute. BSUH Children’s emergency department (CED) guidelines were implemented in December 2016, allowing reduction of forearm and distal radius (DR) fractures in CED using 70% nitrous (N2O) sedation. Due to COVID-19 pandemic and the risks associated with aerosol generating procedures as well as staffing levels, CED shifted to using 50%N2O with or without intranasal fentanyl. Method Relevant fractures presenting to CED from Feb-Dec 2020 were identified and compared to previous years. Demographics, treatment modality, timings, and outcomes were reviewed for 275 patients. Results In 2017-2018, 56% were manipulated in CED under 70%N2O (compared to only 3% in 2016). The main barrier identified was shortage of doctors trained in sedation to supervise use of 70%N20. In 2020, 101 patients were suitable for manipulation in CED. 64 had DR fractures, 37 midshaft fractures, 65 were male. Mean age: 10 years. 92 patients (91%) were manipulated in CED/fracture clinic. One was under 70%N2O; the rest used 50%N2O with or without intranasal fentanyl. 8 (9%) had manipulation under GA. Of those manipulated in CED, 3 were re-manipulated in clinic for cast problems. A typical MUA takes 30minutes indicating a saving of £743 per case; therefore, £68,356 over the study period. Conclusions Paediatric upper limb fracture manipulation in CED under N2O is effective and provides significant cost savings. Due to changes related to COVID-19 pandemic, considerably more patients in 2020 were safely treated in CED/clinic. Using 50%N2O improves uptake due to lower staffing requirements.

Contrast-enhanced Mammography: A Guide to Setting Up a New Clinical Program

Contrast-enhanced mammography (CEM) is gaining rapid traction following the U.S. Food and Drug Administration approval for diagnostic indications. Contrast-enhanced mammography is an alternative form of mammography that uses a dual-energy technique for image acquisition after the intravenous administration of iodinated contrast material. The resulting exam includes a dual set of images, one that appears similar to a routine 2D mammogram and one that highlights areas of contrast uptake. Studies have shown improved sensitivity compared to mammography and similar performance to contrast-enhanced breast MRI. As radiology groups incorporate CEM into clinical practice they must first select the indications for which CEM will be used. Many practices initially use CEM as an MRI alternative or in cases recommended for biopsy. Practices should then define the CEM clinical workflow and patient selection to include ordering, scheduling, contrast safety screening, and managing imaging on the day of the exam. The main equipment requirements for performing CEM include CEM-capable mammography equipment, a power injector for contrast administration, and imaging-viewing capability. The main staffing requirements include personnel to place the intravenous line, perform the CEM exam, and interpret the CEM. To safely and appropriately perform CEM, staff must be trained in their respective roles and to manage potential contrast-related events. Lastly, informing referring colleagues and patients of CEM through marketing campaigns is helpful for successful implementation.