In 2017, our hospital was identified as a high outlier for postoperative Clostridium difficile infections (CDIs) in the American College of Surgeons NSQIP semi-annual report. The Department of ...Surgery initiated a CDI task force with representation from Surgery, Infectious Disease, Pharmacy, and Performance Services to analyze available data, identify opportunities for improvement, and implement strategies to reduce CDIs.
Strategies to reduce CDIs were reviewed from the literature and the following multidisciplinary strategies were initiated: antimicrobial stewardship optimization of perioperative order sets to avoid cefoxitin and fluoroquinolone use was completed; penicillin allergy assessment and skin testing were implemented concomitantly; increased use of ultraviolet disinfectant strategies for terminal cleaning of CDI patient rooms; increased hand hygiene and personal protection equipment signage, as well as monitoring in high-risk CDI areas; improved diagnostic stewardship by an electronic best practice advisory to reduce inappropriate CDI testing; education through surgical grand rounds; and routine data feedback via NSQIP and National Healthcare Safety Network CDI reports.
The observed rate of CDIs decreased from 1.27% in 2016 to 0.91% in 2017. Cefoxitin and fluoroquinolone use decreased. Clostridium difficile infection testing for patients on laxatives decreased. Terminal cleaning with ultraviolet light increased. Handwashing compliance increased. Data feedback to stakeholders was established.
Our multidisciplinary CDI reduction program has demonstrated significant reductions in CDIs. It is effective, straightforward to implement and monitor, and can be generalized to high-outlier institutions.
The development of a new, comprehensive and multicomponent treatment for social phobia is described. Initial results of a pilot study with the new treatment also are reported. The treatment was found ...to be effective with severe (generalized) social phobics, most of whom had co-occurring Axis I and/or II conditions. In addition to significant change on a host of outcome variables, a normative-based endstate functioning index was used to determine treatment efficacy. The results are discussed with respect to the implementation of the treatment and in terms of the need for a comprehensive approach to treating social phobia.
The election of President Barack Obama signaled for many the realization of a post-racial America, a nation in which racism was no longer a defining social, cultural, and political issue. While many ...Americans espouse a colorblind racial ideology and publicly endorse the broad goals of integration and equal treatment without regard to race, in actuality this attitude serves to reify and legitimize racism and protects racial privileges by denying and minimizing the effects of systematic and institutionalized racism.InThe Colorblind Screen, the contributors examine television's role as the major discursive medium in the articulation and contestation of racialized identities in the United States. While the dominant mode of televisual racialization has shifted to a colorblind ideology that foregrounds racial differences in order to celebrate multicultural assimilation, the volume investigates how this practice denies the significant social, economic, and political realities and inequalities that continue to define race relations today. Focusing on such iconic figures as President Obama, LeBron James, and Oprah Winfrey, many chapters examine the ways in which race is read by television audiences and fans. Other essays focus on how visual constructions of race in dramas like24,Sleeper Cell, andThe Wantedcontinue to conflate Arab and Muslim identities in post-9/11 television. The volume offers an important intervention in the study of the televisual representation of race, engaging with multiple aspects of the mythologies developing around notions of a post-racial America and the duplicitous discursive rationale offered by the ideology of colorblindness.
Psychology in the United States has struggled with defining and specifying competencies for the practice of psychology since the Boulder Conference of 1949 outlined the first training model for ...graduate programs in psychology. Competency was largely defined by types of experiences and “seat time” until 1986, when the first major competency model in professional psychology in the United States was proposed. By 2000, discussions about the competencies had begun in earnest, and since that time, psychology’s focus on competencies has intensified, resulting in a shift away from a model of training that involved tracking the number of hours spent learning specific knowledge or skills to a “culture of competence” that emphasizes outcome, that is, the acquisition of the essential knowledge and skills. In order to develop this culture, competence must first be defined and described. A number of efforts to do so have been completed, initially resulting in a confusing array of different models or perspectives. Over time, however, the models have become more refined and similar in their structure and framework. This article provides an overview of these efforts and discusses the next steps in the implementation of a competency model that is comprehensive enough to be useful, but simple enough to be used. The implications of the competency development process for training, practice, and regulation are discussed.
Discrepancies in Black male graduation rates at NCAA Division-I state flagship institutions have raised questions about claims of unilateral academic progress among certain revenue sport athletes. ...Researchers have identified gaps in NCAA and federal graduation rates between athletes and non-athletes based on race and type of sport participation. This exploratory study examines the degree to which graduation rates vary between football and male basketball athletes and male undergraduates at state flagship institutions. We pay particular attention to gaps in graduation rates for Black male athletes. We then seek theoretical explanations for these gaps by drawing on the athletic role-engulfment and key-player hypothesis, the mismatch education hypothesis, and the institutional isomorphism theory.
Psychology in the United States has struggled with defining and specifying competencies for the practice of psychology since the Boulder Conference of 1949 outlined the first training model for ...graduate programs in psychology. Competency was largely defined by types of experiences and "seat time" until 1986, when the first major competency model in professional psychology in the United States was proposed. By 2000, discussions about the competencies had begun in earnest, and since that time, psychology's focus on competencies has intensified, resulting in a shift away from a model of training that involved tracking the number of hours spent learning specific knowledge or skills to a "culture of competence" that emphasizes outcome, that is, the acquisition of the essential knowledge and skills. In order to develop this culture, competence must first be defined and described. A number of efforts to do so have been completed, initially resulting in a confusing array of different models or perspectives. Over time, however, the models have become more refined and similar in their structure and framework. This article provides an overview of these efforts and discusses the next steps in the implementation of a competency model that is comprehensive enough to be useful, but simple enough to be used. The implications of the competency development process for training, practice, and regulation are discussed.
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