Managing healthcare quality in project management framework

Healthcare professionals routinely deploy various quality management tools and techniques in order to improve performance of healthcare delivery. However, they are characterised by fragmented approach i.e., they are not linked with the strategic intent of the organisation. This study introduces a holistic quality improvement method, which integrates all quality improvement projects with the strategic intent of the healthcare organisations. It first identifies a healthcare system and its environment. The Strengths, Weaknesses, Opportunities and Threats (SWOT) of the system are then derived with the involvement of the concerned stakeholders. This leads to developing the strategies in order to satisfy customers in line with the organisation's competitive position. These strategies help identify a few projects, the implementation of which ensures achievement of desired quality. The projects are then prioritised with the involvement of the concerned stakeholders and implemented in order to improve the system performance. The effectiveness of the method has been demonstrated using a case study of an intensive care unit at the Eric Williams Medical Sciences Complex Hospital in Trinidad. Copyright © 2007 Inderscience Enterprises Ltd.

Fiber-type transitions and satellite cell activation in low-frequency-stimulated muscles of young and aging rats

We examined satellite cell content and the activity of satellite cell progeny in tibialis anterior muscles of young (15 weeks) and aging (101 weeks) Brown Norway (BN) rats, after they were exposed for 50 days to a standardized and highly reproducible regime of chronic low-frequency electrical stimulation. Chronic low-frequency electrical stimulation was successful in inducing fast-to-slow fiber-type transformation, characterized by a 2.3-fold increase in the proportion of IIA fibers and fourfold and sevenfold decreases in the proportion of IID/X and IIB fibers in both young and aging BN rats. These changes were accompanied by a twofold increase in the satellite cell content in both the young and aging groups; satellite cell content reached a level that was significantly higher in the young group (p < .04). The total muscle precursor cell content (i.e., satellite cells plus progeny), however, did not differ between groups, because there was a greater number of satellite cell progeny passing through the proliferative and differentiative compartments of the aging group. The resulting 1.5-fold increase in myonuclear content was similar in the young and aging groups. We conclude that satellite cells and satellite cell progeny of aging BN rats possess an unaltered capacity to contribute to the adaptive response.

Receptor for activated C Kinase 1 protein binds to and activates the human estrogen receptor α

The classical concept of estrogen receptor (ER) activation is that steroid passes the cell membrane, binds to its specific protein receptor in the cell's cytoplasm and the steroid-receptor complex travels to the nucleus where it activates responsive genes. This basic idea has been challenged by results of experiments demonstrating insulin-like growth factor 1 (IGF-1) activation of the ER in the complete absence of estrogen suggesting at least one other mechanism of ER activation not involving steroid. One explanation is that activation of the cell surface IGF-1 receptor leads to synthesis of an intracellular protein(s) able to bind to and stimulate the ER. Based on results using the two-hybrid system, coimmunoprecipitation and transfection-luciferase assays, we herein show that one of these proteins could well be receptor for activated C kinase 1 (RACK-1). Using the human ER type α (ER-α) as bait, a cloned complementary deoxyribonucleic acid (cDNA) library from IGF-1 treated human breast cancer MCF-7 cells was screened for ER-α - protein interactions. Many positive clones were obtained which contained the RACK-1 cDNA sequence. Coimmunoprecipitation of in-vitro translation products of the ER-α and RACK-1 confirmed the interaction between the two proteins. Transfection studies using the estrogen response element spliced to a luciferase reporter gene revealed that constitutive RACK-1 expression was able to powerfully stimulate ER-α activity under estrogen-free conditions. This effect could be enhanced by 17β-estradiol (E2) and blocked by tamoxifen, an E2 antagonist. These results show that RACK-1 is able to activate the ER-α in the absence of E2, although together with the latter, enhanced effects occur. Since RACK-1 gene expression is stimulated by IGF-1, it is distinctly possible that RACK-1 is the mediator of the stimulatory effects of IGF-1 on ER-α. © 2014 JMS.

Using an Infra-red sensor to measure the dynamic behaviour of N2O gas escaping through different sized holes

An anastomosis is a surgical procedure that consists of the connection of two parts of an organ and is commonly required in cases of colorectal cancer. About 80% of the patients diagnosed with this problem require surgery. The malignant tissue located on the gastrointestinal track must be resected and the most common procedure adopted is the anastomosis. Therefore, an anastomotic leak represents a significant problem and increases the duration of hospital stay, which is associated with remedial treatment and recovery, causing, as a result, a negative financial impact. A number of techniques to treat, prevent and even detect an anastomotic leakage are under investigation. However, studies show that these techniques are not always able to prevent an anastomotic leak from occurring. This paper discusses the monitoring of leakage through differently sized and differently positioned leak holes in phantom colons, using physical experiments and a Computational Fluid Dynamics package called FloWorks. © 2011 Taylor & Francis Group.