Houston Methodist’s policies designed to avoid the spread of severe acute respiratory syndrome coronavirus 2 during hospital-based surgeries or procedures led to a postintervention nosocomial ...Covid-19 infection rate of 0.1% during the first 19 months of the pandemic. Preoperative polymerase chain reaction testing was found to be particularly effective.
During the initial onset of the Covid-19 pandemic, there was little information regarding how to deliver surgical care safely. Houston Methodist, an eight-hospital system with a flagship academic medical center (Texas Medical Center), adopted and implemented policies that were driven by science and expert opinion, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction preoperative testing to decrease patient risk of Covid-19 diagnosis postintervention. In examining outcomes of the policies during the first 19 months of the pandemic, the authors discovered from a retrospective cohort study of 141,439 patients that the policies — especially SARS-CoV-2 preoperative testing — were effective in reducing postintervention Covid-19 disease, with an overall rate of 0.6%. Analysis of patients who had Covid-19 after intervention found that most had contracted the disease from community sources, which led to a nosocomial Covid-19 rate of 0.1%. Effective policy implementation was associated with successful delivery of safe surgical care during the pandemic.
Delirium is an acute confusional state due to physical illness and is a frequent cause of hospital admission. In this article, we describe the development and outcomes for a community delirium ...toolkit pilot across Greater Manchester during the COVID-19 pandemic. We conclude that delirium can be safely managed in the community by using a toolkit that incorporates structured assessment and management. Carers and patients benefited from the use of a co-designed information leaflet.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and is significantly underdiagnosed in the community. Respiratory impairment is a key risk factor for ...perioperative morbidity and mortality. The National Institute for Health and Care Excellence (NICE) does not recommend routine spirometry before major surgery. However, in this article, we present the potential benefits of targeted spirometry in high-risk patient groups. Of 183 patients who underwent targeted preoperative spirometry, 25/70 (35.7%) of those with airflow obstruction had no previously known respiratory diagnosis. Of patients with known COPD, 20/46 (43.5%) were not prescribed optimum inhaled therapies for their degree of lung function deficit. Knowledge of lung function in respiratory disease helps to optimise patients perioperatively and facilitate shared decision making regarding the benefits and risk of surgeries. We propose that targeted spirometry should be used as part of the perioperative multidisciplinary team assessment of selected patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The lessons learned during the development of PennOpen Pass — an early warning system to detect symptoms and exposures concerning for Covid-19 — will help advance innovations in health care long ...after the pandemic.
To open campuses safely, the University of Pennsylvania (Penn) and its health system (UPHS), with six hospitals and hundreds of outpatient practices, needed to develop an early warning system to identify the infected and exposed among Penn and UPHS campus members — 70,000 faculty, staff, and students who were at risk of transmitting severe acute respiratory syndrome coronavirus 2, or Covid-19. This warning system would help to minimize future spread by preventing individuals with concerning symptoms or recent exposures from coming into contact with others and, when necessary, streamline access to testing, self-isolation guidance, contact tracing, and medical care. The authors describe the challenges in designing, implementing, and continuously improving PennOpen Pass and the Red Pass Management System, a part-digital, part-human screening system. The lessons learned while developing and implementing PennOpen Pass provide key insights for the future of innovations in health care as we move toward improving the health of communities long after the pandemic.
A multidisciplinary team of physicians, physicists, and optical engineers conceived, deployed, and scaled up an operational, financial, and educational solution to address the limited supply of a ...critical component of safety during the Covid-19 pandemic at 21 hospitals in low- and middle-income countries.
The Covid-19 pandemic has caused worldwide shortages in N95 respirators, surgical masks, and other respiratory personal protective equipment, particularly for hospitals in low-income settings. Treatment with ultraviolet-C (UV-C) light is an affordable technology for the decontamination and reuse of N95 respirators in times of critical shortage. Optical engineers, physicists, and clinicians collaborated to develop an affordable, enclosed cabinet to decontaminate N95 respirators with UV-C irradiation in hospital sterile processing areas; units were constructed and implemented locally at 21 hospitals in low- and middle-income countries. Along with this practical grassroots approach to deliver a simple and locally accessible technology, the team’s experience in developing relevant clinical workflows resulted in a rapid and effective implementation of a decontamination process that provided hundreds of thousands of additional N95 respirators for health care provider protection.
The teaching case discusses a number of organizational challenges faced by a German vegetable producer. Two business consultants were hired to assist and to explore the situation in the new ...production facility at Peppers & More. While the CEO assumed the employees were not motivated, the consultants uncovered that various employees’ behavior, as well as a structural problem contributed to the tense situation in the production facility. During the period of analysis, it becomes apparent that there is a communication problem between the production manager and the foremen. The setup of the job rotation system and conflicts between two foremen caused further irritation at the facility. At the end of each consulting day, the consultants and the readers have to link the challenges to motivation theory and provide recommendations how Peppers & More can cope with these challenges.
Primary spinal cord glioblastoma multiforme (GBM) is a rare clinical condition and is often associated with a dismal prognosis. The standard treatment is maximal safe surgery followed by adjuvant ...radiotherapy and chemotherapy. Despite such aggressive treatments, the median survival is estimated to be around 15 months in several studies. We report three patients with primary spinal GBM who received treatment in our institute from 2012 to 2019. Among the three, one patient is on long-term follow-up with no evidence of disease, another patient succumbed to the illness and the third patient is having stable disease.
Although primary spinal GBM is usually associated with a dismal prognosis, our case series shows a subset of patients will have a favorable outcome with the protocol treatment.
We present a case of a 22-year-old male diagnosed with B-cell acute lymphoblastic leukemia who received intrathecal (IT) methotrexate (MTX) in addition to his systemic chemotherapy regime. During ...induction treatment, he presented with a rapidly progressive bilateral paresis, anarthria, and respiratory insufficiency requiring intubation. The brain magnetic resonance imaging showed bilateral lesions with diffusion restriction of the corona radiata/centrum semi-ovale without other abnormalities. He recovered spontaneously without neurological sequelae. The clinical course combined with the radiological findings is suspect for an IT-MTX-induced leukoencephalopathy.
Although neurological deficits after IT-MTX are rare and in most cases self-limiting, it should be recognized as a cause for rapid neurological decline after excluding other causes.
To achieve positive economic, environmental, and social benefits, many incumbent manufacturing firms attempt to apply circular economy principles to their business practices. However, these firms ...often struggle to change their existing linear business models to circular models because the steps required for successful transformation are still poorly understood. Based on a multiple case study of eight business model transformation journeys, this article proposes a roadmap for circular business model transformation. It provides a step-by-step process to enable circular transition, allowing companies to meet environmental, social, and financial objectives and proactively address sustainability.
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IZUM, KILJ, NUK, OILJ, PILJ, SAZU, UKNU, UL, UM, UPUK
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