Objectives:
This work aims to improve the quality of care provided to patients by equipping caregivers with comprehensive set of problem-solving tools and competencies. This is achieved through the ...development of a customized health design process that incorporates both human-centric and data-centric tools.
Background:
To meet the growing complexity of today’s clinical practice, caregivers need to be empowered with the tools and competencies necessary to address the multifaceted challenges they encounter. This has emphasized the need to broaden the traditional role of caregivers as evidence-based practitioners to include being healthcare problem-solvers and innovators who utilize their creative and critical thinking skills.
Method:
While design thinking (DT) is a popular methodology that fosters caregivers’ empathy and creativity, it does not provide tools for evaluating the quality of obtained solutions. To address this gap, a problem-solving process that combines DT and data-centric tools of the Lean Six Sigma method was developed in this work.
Results:
The evaluation of this customized design process was based on targeted competencies derived from the six aims of healthcare. The potential benefits are then highlighted through mapping the possible outputs of every phase with the targeted set of caregivers’ skills. Additionally, an implementation plan was outlined for a local hospital, showcasing the potential impact this process can have in empowering caregivers with the necessary competencies to create effective and innovative solutions for care delivery.
Conclusion:
Overall, This unique approach has the potential to contribute to the ongoing effort to transform healthcare into an efficient system that meets the needs of both patients and caregivers.
The INDRA multidetector has been used to study multifragmentation processes in central collisions for the Xe + Sn reaction at 50
A MeV. A single isotropic source formed at an excitation energy of 12
...A MeV exhausting most of the emitted charged products has been isolated in such collisions. The fragment kinetic energy spectra indicate a fast disintegration of the system with a radial collective motion of about 2
A MeV. The light charged particle characteristics within this scenario are also discussed.
The properties of fragments and light charged particles emitted in multifragmentation of single sources formed in central 36
A
MeV Gd+U collisions are reviewed. Most of the products are ...isotropically distributed in the reaction c.m. Fragment kinetic energies reveal the onset of radial collective energy. A bulk effect is experimentally evidenced from the similarity of the charge distribution with that from the lighter 32
A
MeV Xe+Sn system. Spinodal decomposition of finite nuclear matter exhibits the same property in simulated central collisions for the two systems, and appears therefore as a possible mechanism at the origin of multifragmentation in this incident energy domain.
The 4π array INDRA was used to detect nearly all charged products emitted in Ar + Ni collisions between 52 and 95 MeV/u. The charge, mass and excitation energy
E
∗
of the quasi-projectiles have been ...reconstructed event by event. Excitation energies up to 25 MeV per nucleon are reached. Apparent temperatures obtained from several double isotopic yield ratios
Tr
0 show different dependences upon
E
∗
.
T
6
Li
7
Li
3
Heα
0 yields the highest values, as well as the high energy slopes
Ts of the kinetic energy spectra. Two statistical models, sequential evaporation and gas in complete equilibrium, taking into account side feeding and discrete excited states population, show that the data can be explained by a steady increase of the initial temperature with excitation energy without evidence for a liquid-gas phase transition.
A sample of ‘single-source’ events, compatible with the multifragmentation of very heavy fused systems, are isolated among well-measured
155Gd
+
natU 36
A
MeV reactions by examining the evolution of ...the kinematics of fragments with
Z⩾5 as a function of the dissipated energy and loss of memory of the entrance channel. Single-source events are found to be the result of very central collisions. Such central collisions may also lead to multiple fragment emission due to the decay of excited projectile- and target-like nuclei and so-called ‘neck’ emission, and for this reason the isolation of single-source events is very difficult. Event-selection criteria based on centrality of collisions, or on the isotropy of the emitted fragments in each event, are found to be inefficient to separate the two mechanisms, unless they take into account the redistribution of fragments' kinetic energies into directions perpendicular to the beam axis. The selected events are good candidates to look for bulk effects in the multifragmentation process.
Lupus nephritis (LN) is a severe and frequent complication of systemic lupus erythematosus. For decades, cyclophosphamide-based regimens have been the gold standard in treating patients with LN. ...However, cyclophosphamide use is associated with increased morbidity and mortality, and thus alternative treatments are needed. We report 3 cases of severe class IV LN successfully treated with rituximab as an induction, as well as a long-term maintenance, treatment. Complete remission of LN, documented by means of a control kidney biopsy, occurred in all patients and was maintained during follow-up using rituximab as sole maintenance treatment. No severe infectious complications were observed during treatment with rituximab. Our data suggest that rituximab may prove to be an optimal maintenance treatment in patients with severe LN.
Les infections nosocomiales à germes multirésistants sont fréquentes en réanimation néonatale et engagent le pronostic vital. Les traitements antibiotiques classiques sont souvent inefficaces. De ...janvier à décembre 1994, 15 nouveau-nés ont présenté une infection nosocomiale à germes multirésistants. Tous ont reçu un traitement antibiotique conventionnel initial. Neufs étaient intubés, ventilés, depuis plus de 8 jours. Toutes ces infections nosocomiales ont été documentées :
Klebsiella pneumoniae (n = 9),
Enterobacter (n = 4),
Acinetobacter (n = 1),
Xanthomonas maltophilia (n = 1). Un traitement par ciprofloxacine à la dose moyenne de 20 mg/kg/j a été entrepris. Les enfants survivants (n = 14) sont suivis régulièrement depuis leur sortie du service. La durée du traitement par la ciprofloxacine est de 11 ± 3 jours. L'efficacité clinique et bactériologique est bonne puisque 14 nouveau-nés ont évolué favorablement. La stérilisation des hémocultures a été obtenue au bout de 4 jours en moyenne. Un seul décès a été noté, imputable plutôt aux complications de l'asphyxie périnatale. Un cas de rash cutané et un cas de thrombopénie ont été observés respectivement au 3e et au 6e jour du traitement. Aucun enfant ayant reçu la ciprofloxacine n'a développé de complications articulaires pendant les 12 à 15 mois qui ont suivi le traitement. La ciprofloxacine paraît une bonne alternative thérapeutique chez les nouveau-nés pour traiter les infections nosocomiales à germes multirésistants. Les effets secondaires liés aux fluoroquinolones sont rares, modérés et réversibles.
Nosocomial infections are very frequent in neonatal intensive care units. They are usually very severe and associed with high mortality despite antibiotic therapy. From January to December 1994, fifteen newborns presented nosocomial infections due to multiresistant bacteria. All these patients received an initial antibiotic treatment. Nine of these newborns presented respiratory distress leading to tracheal intubation and ventilation. The bacteria responsible for these infections were
Klebsiella pneumoniae (n = 9),
Enterobacter (n = 4),
Acinetobacter (n = 1),
Xanthomonas maltophilia (n = 1). Ciprofloxacin therapy dosed at 20 mg/Kg/d was used. The newborns who survived from the infection were regularly followed up. The duration of therapy was 11 ± 3 days. Bacteriological and clinical efficacy was excellent in 14 newborns. The hemocultures were sterilized in about 4 days. The only death was due to respiratory asphyxia. A case of skin rash and another of thrombopenia were noted, respectively on the 3rd and 6th day of therapy. No articular complication was observed following ciprofloxacin treatment after a 12–15 month follow-up. Ciprofloxacin seems to be a good therapeutic tool for the treatment of severe nosocomial infection. Side effects are rare, mild, and reversible.
Charged product multiplicities and
Z distributions were measured for single multifragmenting sources produced in collisions between
129
Xe+
nat
Sn
and
155
Gd+
238
U
at the same available energy per ...nucleon.
Z distributions are found identical for both reactions while fragment multiplicities scale as the charge of the total systems. A complete dynamical simulation, in which multifragmentation originates in the spinodal decomposition of a finite piece of nuclear matter resulting from an incomplete fusion of projectile and target, well accounts for this experimental observation.
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