Coming Soon to John Dempsey Hospital: Schwartz Center Rounds®

SCHWARTZ CENTER ROUNDS® at John Dempsey Hospital Schwartz Center Rounds were created to provide a multidisciplinary forum where clinical caregivers have the opportunity to discuss their experiences, thoughts and feelings. The Rounds, which differ from medical or ethics Rounds, offer caregivers a safe, open and relaxed place where they can share their concerns and fears, both for their patients and themselves. The premise is that caregivers are better able to make personal connections with patients when they have greater awareness of, and insight into, their own responses and feelings. The Rounds provide a scheduled time and place where caregivers focus on the social, emotional and personal aspects of patient care.

A relação da motivação para o trabalho com as metas do trabalhador: um estudo de caso em uma operadora de call center

Having as basic purpose, that the work motivational strategies are more efficient when elaborated directly from the worker¿s personal goals and values, the study line of this dissertation searched to identify the worker¿s motivational employee¿s profile from call center industry. The knowledge of this motivational profile makes possible the development of differentiated programs of motivation inside the organization, aiming to attend goals of diverse groups of workers. In order to achieve the considered objective, the present dissertation analyzed one of the biggest companies in call center¿s inside Brazilian market, the BrasilCenter Communications Ltda. In such a way, in the first stage of the study, a bibliographical research was carried out, with the objective to collect contributions from diverse authors on the motivation subject, and also a modern theory of values was presented, verified empirically in more than 60 countries, which identifies the people¿s motivational structure. Having as base the results of these studies, the worker¿s concept profile motivational and argued its way of evaluation in the organizations it was boarded. In the second stage, a field research was carried out, with the application of the Inventory of Values of Schwartz theory (IVS), in order to identify the employee¿s motivational profile crowded in the Center of Attendance and Services (call center) company, located in Juiz de Fora city. The analysis of the results from the field research, based on the bibliographical data, identified that the values prioritized for the call center¿s employees are the ones that serves the collective and mixing goals. This motivational profile offers some perspectives of employee¿s valuation that correspond to their goals and interests. The displayed results point respect to the centrality of the types of values benevolence, conformity, security and universalism among the participants in the sample. As the accented was more among the employees it was the search of collective results it, is concluded that the more appropriate valuation strategies are those related to the tolerance for the ideas and opinion of the others, to harmonic a organizational enviroment, the concern with the quality of life at work and the social aspects of the work.

Tuning the valence of the cerium center in (Na)phthalocyaninato and porphyrinato cerium double-deckers by changing the nature of the tetrapyrrole ligands

A series of 7 cerium double-decker complexes with various tetrapyrrole ligands including porphyrinates, phthalocyaninates, and 2,3-naphthalocyaninates have been prepared by previously described methodologies and characterized with elemental analysis and a range of spectroscopic methods. The molecular structures of two heteroleptic \[(na)phthalocyaninato](porphyrinato) complexes have also been determined by X-ray diffraction analysis which exhibit a slightly distorted square antiprismatic geometry with two domed ligands. Having a range of tetrapyrrole ligands with very different electronic properties, these compounds have been systematically investigated for the effects of ligands on the valence of the cerium center. On the basis of the spectroscopic (UV−vis, near-IR, IR, and Raman), electrochemical, and structural data of these compounds and compared with those of the other rare earth(III) counterparts reported earlier, it has been found that the cerium center adopts an intermediate valence in these complexes. It assumes a virtually trivalent state in cerium bis(tetra-tert-butylnaphthalocyaninate) as a result of the two electron rich naphthalocyaninato ligands, which facilitate the delocalization of electron from the ligands to the metal center. For the rest of the cerium double-deckers, the cerium center is predominantly tetravalent. The valences (3.59−3.68) have been quantified according to their LIII-edge X-ray absorption near-edge structure (XANES) profiles.

Measuring the effect of patient comfort rounds on practice environment and patient satisfaction : A pilot study

Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction and safety, and improve the nursing practice environment, but the innovation has not been adequately tested. A quasiexperimental pretest post-test non-randomized parallel group trial design was used to test the effect of hourly patient comfort rounds on patient satisfaction and nursing perceptions of the practice environment, and to evaluate research processes and instruments for a proposed larger study. A Patient Satisfaction Survey instrument was developed and used in conjunction with the Practice Environment Scale of the Nursing Work Index. Results on patient satisfaction showed no significant changes. Significant changes were found for three of the five practice environment subscales. Consistent with the aim of a pilot study, this research has provided important information related to design, instruments and process that will inform a larger sufficiently powered study.

The influence of travel time and size of shopping center towards the frequencies of visiting customers in shopping centers in surabaya

Visiting a modern shopping center is becoming vital in our society nowadays. The fast growth of shopping center, transportation system, and modern vehicles has given more choices for consumers in shopping. Although there are many reasons for the consumers in visiting the shopping center, the influence of travel time and size of shopping center are important things to be considered towards the frequencies of visiting customers in shopping centers. A survey to the customers of three major shopping centers in Surabaya has been conducted to evaluate the Ellwood’s model and Huff’s model. A new exponent value N of 0.48 and n of 0.50 has been found from the Ellwood’s model, while a coefficient of 0.267 and an add value of 0.245 have been found from the Huff’s model.

Innovation in clinical learning for the acute hospital environment : nursing grand rounds

The literature reports that workload factors affect nurses' ability to fully engage in continuing professional development. Hence the work environment in acute care calls for innovative approaches to achieve continuous development of nursing practice and work satisfaction. This study employs a one group pre-test post-test design to test the effectiveness of nursing grand rounds on nursing worklife satisfaction and work environment in an acute surgical ward. The effect of nursing grand rounds was measured using the Nursing Worklife Satisfaction Scale and the Practice Environment Scale. There was no change between pre- and post-test on these measures but trends were evident in some component scores. Statistical results were inconclusive but observational data indicated that nursing grand rounds was found to be feasible, well attended with tested processes for implementation in an acute care environment.

Applying six-sigma in the service industry: a review and case study in call center services

This paper presents an extensive review on the services, six-sigma, and application of six-sigma in services. In order to improve service quality focus on service process is necessary. Six-sigma is a philosophy which also concentrates on the improvement of process. So, six-sigma if properly applied can be useful for services. This study focuses on the application aspect of six-sigma to wider range of services. The wider applicability of six-sigma depends on identification of key performance indicators(KPIs) for different types of service processes. A case study is conducted in call center services to identify, analyze and compare critical to quality characteristics (CTQs) and KPIs with other types of services available in literature. This study will be helpful to both practitioners and researchers.

Classification of the Johnson Space Center stratospheric dust collection

A review of 291 catalogued particles on the bases of particle size, shape, bulk chemistry, and texture is used to establish a reliable taxonomy. Extraterrestrial materials occur in three defined categories: spheres, aggregates and fragments. Approximately 76% of aggregates are of probable extraterrestrial origin, whereas spheres contain the smallest amount of extraterrestrial material (approx 43%). -B.M.

Utilizing Wide-Area Signals for off-center SVCs to damp interarea oscillations

Wide-Area Measurement Systems (WAMS) provide the opportunity of utilizing remote signals from different locations for the enhancement of power system stability. This paper focuses on the implementation of remote measurements as supplementary signals for off-center Static Var Compensators (SVCs) to damp inter-area oscillations. Combination of participation factor and residue method is used for the selection of most effective stabilizing signal. Speed difference of two generators from separate areas is identified as the best stabilizing signal and used as a supplementary signal for lead-lag controller of SVCs. Time delays of remote measurements and control signals is considered. Wide-Area Damping Controller (WADC) is deployed in Matlab Simulink framework and is tested under different operating conditions. Simulation results reveal that the proposed WADC improve the dynamic characteristic of the system significantly.

Evolving progress in oncologic and operative outcomes for esophageal and junctional cancer : lessons from the experience of a high-volume center

Objective: Modern series from high-volume esophageal centers report an approximate 40% 5-year survival in patients treated with curative intent and postoperative mortality rates of less than 4%. An objective analysis of factors that underpin current benchmarks within high-volume centers has not been performed. Methods: Three time periods were studied, 1990 to 1998 (period 1), 1999 to 2003 (period 2), and 2004 to 2008 (period 3), in which 471, 254, and 342 patients, respectively, with esophageal cancer were treated with curative intent. All data were prospectively recorded, and staging, pathology, treatment, operative, and oncologic outcomes were compared. Results: Five-year disease-specific survival was 28%, 35%, and 44%, and in-hospital postoperative mortality was 6.7%, 4.4%, and 1.7% for periods 1 to 3, respectively (P < .001). Period 3, compared with periods 1 and 2, respectively, was associated with significantly (P < .001) more early tumors (17% vs 4% and 6%), higher nodal yields (median 22 vs 11 and 18), and a higher R0 rate in surgically treated patients (81% vs 73% and 75%). The use of multimodal therapy increased (P < .05) across time periods. By multivariate analysis, age, T stage, N stage, vascular invasion, R status, and time period were significantly (P < .0001) associated with outcome. Conclusions: Improved survival with localized esophageal cancer in the modern era may reflect an increase of early tumors and optimized staging. Important surgical and pathologic standards, including a higher R0 resection rate and nodal yields, and lower postoperative mortality, were also observed. Copyright © 2012 by The American Association for Thoracic Surgery.

A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center

Purpose The use of intravascular devices is associated with a number of potential complications. Despite a number of evidence-based clinical guidelines in this area, there continues to be nursing practice discrepancies. This study aims to examine nursing practice in a cancer care setting to identify nursing practice and areas for improvement respective to best available evidence. Methods A point prevalence survey was undertaken in a tertiary cancer care centre in Queensland, Australia. On a randomly selected day, four nurses assessed intravascular device related nursing practices and collected data using a standardized survey tool. Results 58 inpatients (100%) were assessed. Forty-eight (83%) had a device in situ, comprising 14 Peripheral Intravenous Catheters (29.2%), 14 Peripherally Inserted Central Catheters (29.2%), 14 Hickman catheters (29.2%) and six Port-a-Caths (12.4%). Suboptimal outcomes such as incidences of local site complications, incorrect/inadequate documentation, lack of flushing orders, and unclean/non intact dressings were observed. Conclusions This study has highlighted a number of intravascular device related nursing practice discrepancies compared with current hospital policy. Education and other implementation strategies can be applied to improve nursing practice. Following education strategies, it will be valuable to repeat this survey on a regular basis to provide feedback to nursing staff and implement strategies to improve practice. More research is required to provide evidence to clinical practice with regards to intravascular device related consumables, flushing technique and protocols.

Prevention of surgical site infection in total joint arthroplasty : an international tertiary care center survery

Background Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population. Questions/Purposes What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA? Patients and Methods A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared. Results Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention. Conclusion Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.