Framework Of Best Practices Research Articles

SPIRIT: Systematic Planning of Intelligent Reuse of Integrated Clinical Routine Data. A Conceptual Best-practice Framework and Procedure Model.

Secondary use of clinical routine data is receiving an increasing amount of attention in biomedicine and healthcare. However, building and analysing integrated clinical routine data repositories are nontrivial, challenging tasks. As in most evolving fields, recognized standards, well-proven methodological frameworks, or accurately described best-practice approaches for the systematic planning of solutions for secondary use of routine medical record data are missing. We propose a conceptual best-practice framework and procedure model for the systematic planning of intelligent reuse of integrated clinical routine data (SPIRIT). SPIRIT was developed based on a broad literature overview and further refined in two case studies with different kinds of clinical routine data, including process-oriented nursing data from a large hospital group and high-volume multimodal clinical data from a neurologic intensive care unit. SPIRIT aims at tailoring secondary use solutions to specific needs of single departments without losing sight of the institution as a whole. It provides a general conceptual best-practice framework consisting of three parts: First, a secondary use strategy for the whole organization is determined. Second, comprehensive analyses are conducted from two different viewpoints to define the requirements regarding a clinical routine data reuse solution at the system level from the data perspective (BOTTOM UP) and at the strategic level from the future users perspective (TOP DOWN). An obligatory clinical context analysis (IN BETWEEN) facilitates refinement, combination, and integration of the different requirements. The third part of SPIRIT is dedicated to implementation, which comprises design and realization of clinical data integration and management as well as data analysis solutions. The SPIRIT framework is intended to be used to systematically plan the intelligent reuse of clinical routine data for multiple purposes, which often was not intended when the primary clinical documentation systems were implemented. SPIRIT helps to overcome this gap. It can be applied in healthcare institutions of any size or specialization and allows a stepwise setup and evolution of holistic clinical routine data reuse solutions.

Residential Building Management System Features and Underlying Factors

Abstract For the implementation of real estate management, in accordance with the legislative framework of good practice and quality management, a system is required that helps the processes to be arranged according to their fundamental values, criteria and functions. The study sets residential property management elements and factors influencing them. The significance of the topic is set by the developing industry and the requirement for quality and sustainable management model that includes all interested parties - owners, lessees, tenants, users on the one side, housing managers on the other and the state, local government and non-governmental organisations on the third side. The development of this sector as a whole depends on the quality of residential housing management process.

What does a good RCT recruitment consultation look like? A new simple six-step model to promote information sharing and recruitment to RCTs

Objective: The mode of delivery of trial information is a key determinant of recruitment to randomised controlled trials (RCTs), which can be modified in order to encourage patients to participate. This paper presents the development and initial validation of a simple six-step model to support recruitment. Study design and setting: 92 recruitment consultations with 60 new patients were recorded and analysed during a pilot RCT comparing surgical and non-surgical interventions for hip impingement. Recordings were analysed using techniques of thematic analysis and focused conversation analysis pioneered in previous studies. Analysis of recordings continued during the full-scale trial. Results: The pilot study was successful, with 70% of patients approached across 9 centres agreeing to take part in the RCT, and the full-scale trial has achieved 75% recruitment in 19 centres. A simple six-step model providing a framework for good recruitment practice was developed at the pilot phase and then validated, and tested in the main trial. The model enabled recruiters to explain the design and conduct of the RCT and provide reassuring information for patients in the context of consultations very different from routine practice. Conclusion: The six-step model provides a useful framework for recruitment to RCTs. It encourages the implementation of good RCT recruitment practice and provides strategies to support recruiters. The model requires further testing in a wide range of RCTs and clinical contexts.

Undiagnosed Diseases Network International (UDNI): White paper for global actions to meet patient needs.

In 2008, the National Institutes of Health's (NIH) Undiagnosed Disease Program (UDP) was initiated to provide diagnoses for individuals who had long sought one without success. As a result of two international conferences (Rome 2014 and Budapest 2015), the Undiagnosed Diseases Network International (UDNI) was established, modeled in part after the NIH UDP. Undiagnosed diseases are a global health issue, calling for an international scientific and healthcare effort. To meet this demand, the UDNI has built a consensus framework of principles, best practices and governance; the Board of Directors reflects its international character, as it includes experts from Australia, Canada, Hungary, Italy, Japan and the USA. The UDNI involves centers with internationally recognized expertise, and its scientific resources and know-how aim to fill the knowledge gaps that impede diagnosis. Consequently, the UDNI fosters the translation of research into medical practice. Active patient involvement is critical; the Patient Advisory Group is expected to play an increasing role in UDNI activities. All information for physicians and patients will be available at the UDNI website.

To core, or not to core: the impact of coring on tree health and a best-practice framework for collecting dendrochronological information from living trees.

Trees are natural repositories of valuable environmental information that is preserved in the growth and structure of their stems, branches and roots. Dendrochronological analyses, based on the counting, crossdating and characterisation of incrementally formed wood rings, offer powerful insights for diverse fields including ecology, climatology and archaeology. The application of this toolset is likely to increase in popularity over coming decades due to advances in the field and a reduction in the cost of analyses. In research settings where the continued value of living trees subject to dendrochronological investigation is important, the use of an increment bore corer to extract trunk tissue is considered the best option to minimise negative impacts on tree health (e.g. stress and fitness). A small and fragmented body of literature, however, reports significant after-effects, and in some cases fatal outcomes, from this sampling technique. As it stands, the literature documenting increment bore coring (IBC) impacts lacks experimental consistency and is poorly replicated, making it difficult for prospective users of the method to assess likely tree responses to coring. This paucity of information has the potential to lead to destructive misuse of the method and also limits its safe implementation in circumstances where the risk of impacts may be appropriate. If IBC is to fulfil its potential as a method of choice across research fields, then we must first address our limited understanding of IBC impacts and provide a framework for its appropriate future use. Firstly, we review the historical context of studies examining the impacts of IBC on trees to identify known patterns, focal issues and biases in existing knowledge. IBC wound responses, particularly those that impact on lumber quality, have been the primary focus of prior studies. No universal treatment was identified that conclusively improved wound healing and few studies have linked wound responses to tree health impacts. Secondly, we build on literature insights using a theoretical approach to identify the most important factors to guide future research involving implementation of IBC, including innate tree characteristics and environmental factors. Thirdly, we synthesise and interrogate the quantitative data available through meta-analysis to identify risk factors for wound reactions. Although poor reporting standards, restricted scopes and a bias towards temperate ecosystems limited quantitative insight, we found that complete cambial wound closure could still harbour high rates of internal trunk decay, and that conditions favouring faster growth generally correlated with reduced indices of internal and external damage in broadleaved taxa. Finally, we propose a framework for guiding best-practice application of IBC to address knowledge gaps and maximise the utility of this method, including standardised reporting indices for identifying and minimising negative impacts on tree health. While IBC is an underutilised tool of ecological enquiry with broad applicability, the method will always incur some risk of negative impacts on the cored tree. We caution that the decision to core, or not to core, must be given careful consideration on a case-by-case basis. In time, we are confident that this choice will be better informed by evidence-based insight.

Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool.

Fracture Liaison Services are the best model to prevent secondary fractures. The International Osteoporosis Foundation developed a Best Practice Framework to provide a quality benchmark. After a year of implementation, we confirmed that a single framework with set criteria is able to benchmark services across healthcare systems worldwide. Despite evidence for the clinical effectiveness of secondary fracture prevention, translation in the real-world setting remains disappointing. Where implemented, a wide variety of service models are used to deliver effective secondary fracture prevention. To support use of effective models of care across the globe, the International Osteoporosis Foundation's Capture the Fracture® programme developed a Best Practice Framework (BPF) tool of criteria and standards to provide a quality benchmark. We now report findings after the first 12 months of implementation. A questionnaire for the BPF was created and made available to institutions on the Capture the Fracture website. Responses from institutions were used to assign gold, silver, bronze or black (insufficient) level of achievements mapped across five domains. Through an interactive process with the institution, a final score was determined and published on the Capture the Fracture website Fracture Liaison Service (FLS) map. Sixty hospitals across six continents submitted their questionnaires. The hospitals served populations from 20,000 to 15 million and were a mix of private and publicly funded. Each FLS managed 146 to 6200 fragility fracture patients per year with a total of 55,160 patients across all sites. Overall, 27 hospitals scored gold, 23 silver and 10 bronze. The pathway for the hip fracture patients had the highest proportion of gold grading while vertebral fracture the lowest. In the first 12 months, we have successfully tested the BPF tool in a range of health settings across the globe. Initial findings confirm a significant heterogeneity in service provision and highlight the importance of a global approach to ensure high quality secondary fracture prevention services.

Technology in Counselor Education: HIPAA and HITECH as Best Practice

The use of technology in counseling is expanding. Ethical use of technology in counseling practice is now a stand-alone section in the 2014 American Counseling Association Code of Ethics. The Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act provide a framework for best practices that counselor educators can utilize when incorporating the use of technology into counselor education programs. This article discusses recommended guidelines, standards, and regulations of HIPAA and HITECH that can provide a framework through which counselor educators can work to design policies and procedures to guide the ethical use of technology in programs that prepare and train future counselors.Keywords: counselor education, technology, best practice, HIPAA, HITECHThe enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) brought forth a variety of standards addressing the privacy, security and transaction of individual protected health (PHI; Wheeler & Bertram, 2012). According to the language of HIPAA (2013, §160.103), PHI is defined as individually identifiable health information (p. 983) that is transmitted by or maintained in electronic media or any other medium, with the exception of educational or employment records. identifiable health information is specified as follows:Information, including demographic data, that relates to:* the individual's past, present or future physical or mental health or condition,* the provision of health care to the individual, or* the past, present, or future payment for the provision of health care to the individual, and that identifies the individual for which there is a reasonable basis to believe can be used to identify the individual. Individually identifiable health includes many common identifiers. (U.S. Department of Health and Human Services [HHS], n.d.-b, p. 4)The HIPAA standards identify 18 different elements that are considered to be part of one's PHI. These include basic demographic data such as names, street addresses, elements of dates (e.g., birth dates, admission dates, discharge dates) and phone numbers. It also includes such as vehicle identifiers, Internet protocol address numbers, biometric identifiers and photographic images (HIPAA, 2013, § 164.514, b.2.i).According to language in HIPAA, the applicability of its standards, requirements and implementation only apply to entities, which are (1) a health plan (2) a health care clearinghouse (3) a health care provider who transmits any health in electronic form in connection with [HIPAA standards and policies] (HIPAA, 2013, § 160.102). Covered entities have an array of required and suggested privacy and security measures that they must take into consideration in order to protect individuals' PHI; failure to protect individuals' could result in serious fines. For example, one recent ruling found a university medical training clinic to be in violation of HIPAA statutes when network firewall protection had been disabled. The oversight resulted in a $400,000 penalty (Yu, 2013). Moreover, the recent implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 increased the fines resulting from failure to comply with HIPAA, including fines for individuals claiming they did not know that can range from $100-$50,000 (Modifications to the HIPAA Privacy, 2013, p. 5583). The final omnibus ruling of HIPAA-HITECH, enforcing these violations, went into effect on March 26, 2013 (Modifications to the HIPAA Privacy, 2013; Ostrowski, 2014). Enforcement of the changes from the HITECH Act on HIPAA standards began on September 23, 2013, for covered entities (Modifications to the HIPAA Privacy, 2013).Academic departments and universities must understand the importance of HIPAA and HITECH regulations in order to determine whether the department or university is considered a covered entity. …

International framework for examination of the cervical region for potential of cervical arterial dysfunction prior to orthopaedic manual therapy intervention

A consensus clinical reasoning framework for best practice for the examination of the cervical spine region has been developed through an iterative consultative process with experts and manual physical therapy organisations. The framework was approved by the 22 member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (October 2012). The purpose of the framework is to provide guidance to clinicians for the assessment of the cervical region for potential of Cervical Arterial Dysfunction in advance of planned management (inclusive of manual therapy and exercise interventions). The best, most recent scientific evidence is combined with international expert opinion, and is presented with the intention to be informative, but not prescriptive; and therefore as an aid to the clinician's clinical reasoning. Important underlying principles of the framework are that 1] although presentations and adverse events of Cervical Arterial Dysfunction are rare, it is a potentially serious condition and needs to be considered in musculoskeletal assessment; 2] manual therapists cannot rely on the results of one clinical test to draw conclusions as to the presence or risk of Cervical Arterial Dysfunction; and 3] a clinically reasoned understanding of the patient's presentation, including a risk:benefit analysis, following an informed, planned and individualised assessment, is essential for recognition of this condition and for safe manual therapy practice in the cervical region. Clinicians should also be cognisant of jurisdictionally specific requirements and obligations, particularly related to patient informed consent, when intending to use manual therapy in the cervical region.

Generating Real‐Time, Actionable Outcome Measures at Blythedale Children's Hospital

Hoping to leverage the data they collect into meaningful information that will guide strategy, large health care systems have been among the first to embrace predictive analytics. Smaller facilities, however, generally do not have the information technology (IT) infrastructure needed to invest significantly in the development of predictive analytic tools. Blythedale Children's Hospital, a small, independent, freestanding institution in Valhalla, New York, established an Outcomes Committee composed of health care and IT professionals to find creative ways to use static electronic medical record and administrative data to create mechanisms for real‐time actionable outcomes. The goal was to present data as information to the frontline clinicians when they needed it most, so they could take swift and appropriate action at bedside. A Wound Rounding Tool, which ensured proper identification, assessment, and follow‐up of patients with wounds, provided a framework of best practices for the development of many other initiatives to improve an array of processes. ©2015 Wiley Periodicals, Inc.

The Project and the Surprise: Invisible, ‘Sensitive Space’ and Meanings in Writing and Reading Stories

This collection of empirical observations argues for a more flexible and receptive approach to the dynamics of production and participation in fiction and literary texts. Sketching out both the actors in and the stages of these activities from a bird's eye view, this paper explores their relationships, plunging into the multi-layered nature of texts. Additionally, its ecological orientation takes up a new challenge, that is, to grasp the inescapable role played by the Invisible in the devising and creation of stories. Outlined within a framework of practical tests and best practices, the hypothesis of a sensitive space together with its features, summarised by the triad simultaneity-compresence-multiplicity, allows sensing, in the symbolic guise of stop-motion frames or watermarks, the intense activity of the meanings that filter through the gestures of writing and reading stories.

A Framework of Best Practices in Managing Business Reengineering for Islamic

The progressive globalization of financial markets requires financial institutions to upgrade their operational processes beyond local to global standards. As a result, many banks in developing countries strive to improve customer service quality and reduce operating costs to enhance their profitability performances. In achieving these remarkable performances, many financial institutions have reengineered their operational processes to become more competitive in the market. A study on Islamic banks in relation to business process reengineering (BPR) is limited. In fact, a study of the best practices of BRP for these banks has yet to be investigated even though the operations of these banks are admittedly different among financial institutions and scholars. Hence, this paper is trying to fill this gap by discussing the best practices of BPR for Islamic banks. We propose eight practices, namely change management, project management, management competence, customer focus, IT infrastructure, process redesign, financial resources, and less bureaucratic structure to be considered as the best practices. 

Issues of Governance : Transparency and Accountability of Sovereign Wealth Funds in Muslim Countries

Sovereign Wealth Funds (SWFs) have been growing in number and size over the years, in both Muslim and non-Muslim countries. Their importance in terms of potential impact on the economic, social and political fronts of both the home countries (managing the SWFs) and the host countries (receiving the investments of SWFs) has drawn increasing attention to the operations of these funds. The basic concerns about these funds are the issues of governance, transparency and accountability at a global level. This paper aims to highlight these issues with a specific focus on SWFs sponsored by the members of the Organisation of Islāmic Cooperation (OIC), or Muslim countries in short. It discusses the gaps arising in the governance, transparency and accountability of SWFs in Muslim Countries (SWF-MC) and proposes some recommendations to improve their practices with a view to enhance their impact on social and economic developments in Muslim countries. It also discusses the Santiago Principles which have been developed as a comprehensive set of voluntary codes to serve as a framework of international best practices in the area of governance for SWFs. It is found that SWF-MC such as Libya, Qatar, Sudan, Nigeria, Oman, Brunei and others are the least compliant funds with regard to the Santiago Principles based on the Truman scoreboard. Moreover, the overall level of transparency of SWF-MC, based on the Linaburg–Maduell Transparency Index (LMTI) is also very low. Based on these findings, it is deemed crucial that SWF-MC should be properly set up and governed by international best practices.

The 2015 Paris Climate Agreement: Design Options and Incentives to Increase Participation and Ambition

In 2011 in Durban, South Africa, Parties to the United Nations Framework Convention on Climate Change agreed to establish a process - the Ad Hoc Working Group on the Durban Platform for Enhanced Action - to negotiate and agree by 2015 a global outcome with legal force that is to become operative by 2020 ('ADP Agreement'). Parties also agreed that the ADP Agreement is to have the broadest possible participation (membership) and to increase ambition by the Parties (emissions reduction activities). This working paper is based on a research report produce by the author in 2013 that synthesised extensive peer-reviewed and other research on actual and theoretical elements of climate and environmental agreements and applied the findings to create a high-level best-practice framework of elements for consideration in the 2015 ADP Agreement. The paper: (1) Demonstrates how the the ADP Agreement design, character and content (paths of evolution, climate effectiveness, attributes) will fundamentally influence the outcome of future negotiations and the likelihood of success;(2) Identifies the drivers that will influence the success of climate change negotiations, the ability to reach meaningful agreement on model design and efforts to increase participation and ambition, regardless of the eventual outcome; (3) Analyses in detail a range of model options, including possible form, character and design elements and shows how the various permutations will have differing impact on participation and ambition; (4) Describes incentives to increase and maximize the possibility of universal participation (financial and technological support, low costs, penalties) without which meaningful global action on climate change could be stifled; and(5) Describes incentives to increase ambition (early action rewards, allocation rules, access to carbon markets) that are necessary to accelerate the decline of global emissions as required by science to avoid dangerous climate change. The working paper seeks to inform academics, negotiators and decision-makers in domestic and international public, private and third sectors.

Subcutaneous injection technique: an evidence-based approach.

Injections are routinely administered by nurses in acute care settings and in the community. Nurses require a thorough understanding of anatomy and physiology, pharmacological principles and equipment, and potential risks to the patient of injections. Nurses should also take an active approach to patient assessment before injecting medicines. This article, the first of two, provides an evidence-based review of injection administration, with particular reference to subcutaneous injections, and suggests a framework for best practice.

Optimization of nucleophilic ¹⁸F radiofluorinations using a microfluidic reaction approach.

Microfluidic techniques are increasingly being used to synthesize positron-emitting radiopharmaceuticals. Several reports demonstrate higher incorporation yields, with shorter reaction times and reduced amounts of reagents compared with traditional vessel-based techniques. Microfluidic techniques, therefore, have tremendous potential for allowing rapid and cost-effective optimization of new radiotracers. This protocol describes the implementation of a suitable microfluidic process to optimize classical (18)F radiofluorination reactions by rationalizing the time and reagents used. Reaction optimization varies depending on the systems used, and it typically involves 5-10 experimental days of up to 4 h of sample collection and analysis. In particular, the protocol allows optimization of the key fluidic parameters in the first tier of experiments: reaction temperature, residence time and reagent ratio. Other parameters, such as solvent, activating agent and precursor concentration need to be stated before the experimental runs. Once the optimal set of parameters is found, repeatability and scalability are also tested in the second tier of experiments. This protocol allows the standardization of a microfluidic methodology that could be applied in any radiochemistry laboratory, in order to enable rapid and efficient radiosynthesis of new and existing [(18)F]-radiotracers. Here we show how this method can be applied to the radiofluorination optimization of [(18)F]-MEL050, a melanoma tumor imaging agent. This approach, if integrated into a good manufacturing practice (GMP) framework, could result in the reduction of materials and the time required to bring new radiotracers toward preclinical and clinical applications.

An Assessment of IT Outsourcing Practices in the North-West Provincial Government: South Africa

This study investigated practices that are followed when outsourcing Information Technology (IT) services in the North-West Provincial Government (NWPG) of South Africa. NWPG is a tier two level in the South African government structure and lies in between the national and the local governments. As a departure point, the research study identified the best practices in IT outsourcing, the most important benefits of this process as well as the shortcomings of IT outsourcing. The study is a culmination of requests from the provincial government stakeholders to have a framework of IT outsourcing best practices which is currently not available. The study used quantitative approach and a questionnaire as a research instrument. Findings revealed that the decision to outsource can sometimes be difficult to make and is risky. However, it also identified some benefits of IT outsourcing such as access to highly experienced IT specialists, access to advanced technologies, as well as improvement in customer service quality. Some risks associated with outsourcing such as hidden costs and loss of control on outsourced activities was also revealed. In addition, outsourcing may lead to increased unemployment and may negatively affect employees’ morale. It is recommended that NWPG should adopt an outsourcing plan that will guide its outsourcing process as well as establishing a clear understanding of its requirements, performing due diligence as well as carrying out of risk assessment during this process. Efficient and open communication channels between staff and management levels should also be developed. DOI: 10.5901/mjss.2014.v5n14p25

Strategic Integration of IT and Business Service Management

INTRODUCTION IT Industry Background The computer software development industry is comprised of businesses that design, develop, and market support systems and application software used in personal computers, servers, embedded systems, and mobile devices. The software industry started during the personal computer revolution in the mid 1970s and includes software services such as training and consulting. Proprietary or commercial software and open source software are the predominant types of businesses in the software industry. The software industry segment includes IT giants such as Microsoft, IBM, Hewlett-Packard (HP), Oracle, and SAP. The domestic software market is expected to grow at an annual rate of 5.7% from 2007 to 2012 with combined revenue of about $180 billion involving approximately 50,000 companies (Hoovers.com, 2009). The IT management industry consists of information technology and management which focuses on the management of a collection of systems, infrastructure and information that originated from the practice of IT Portfolio Management. IT management focuses on the management of information technologies as a business function that originated from the formation of the IT Infrastructure Library (ITIL) (http://www.itil.co.uk/). ITIL is a customizable framework of best practices for managing IT infrastructure, development, and operations. ITIL is an industry best practice for Business Service Management (Lindquist, Madduri, Paul, & Rajaraman, 2007). Business Service Management (BSM) (http://www.best-management-practice.com/) is a method created to automate and simplify the management of the various business processes, based on a service-oriented architecture. The IT management technology vendors who dominate the market are BMC Software, CA, IBM, and HP whose combined market share grew from 34 % in 2005 to 40% in 2006 and will reach approximately 45% in 2007 (Garbani & Mendal, 2007). There is little academic research in BSM (and ITIL) in the information systems, as well as the management and marketing literature (Cater-Steel & Toleman, 2007). Only a handful of journal articles (e.g. Davern & Wilkin, 2008; Fisher, 2006; Lindquist, Madduri, Paul, & Rajaraman, 2007) have researched the implications of BSM (and ITIL). Moreover, the literature does little to investigate the strategic and marketing-related impacts, reflecting the unique contribution of this current research case study. This paper is also written from an applied research viewpoint to emphasize the pragmatic aspects of the technologies. Therefore, the study adds the practitioner's perspective, since one of the co-authors is a Lead Software Quality Assurance Engineer at BMC Software. Not to mention, there is an increasing interest in the adoption of these technologies and solutions (e.g. ITIL) in corporate America today to enhance service delivery, support, and overall business efficiency (Cannon & Raisinghani, 2007; Fisher, 2006). Consequently, college business programs should train students in these emerging new technologies to stay competitive in the job market and apply classroom concepts in a hands-on approach (Beachboard & Beard, 2005; Cater-Steel & Toleman, 2007). Description of the Company's Business Pioneering the concept of Business Service Management, BMC Software, Inc. is a leading global provider of enterprise management solutions (systems, applications, databases, and service management) that empower companies to automate Information Technology (IT) and align it to the needs of the business. BMC Software is the 8th largest independent software vendor with 26 years of leadership and holds 94 software technology patents. BMC Software has international headquarters located in Amsterdam, The Netherlands and Singapore, Singapore. It also operates international offices in countries such as the Australia, England, Germany, China, France, India, Israel, Japan, and the Philippines. …

A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention.

To enhance the learner's competence with knowledge about a framework of quality improvement (QI) interventions to implement evidence-based practices for pressure ulcer (PrU) prevention. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize the process of creating and initiating the best-practice framework of QI for PrU prevention.2. Identify the domains and QI interventions for the best-practice framework of QI for PrU prevention. Pressure ulcer (PrU) prevention is a priority issue in US hospitals. The National Pressure Ulcer Advisory Panel endorses an evidence-based practice (EBP) protocol to help prevent PrUs. Effective implementation of EBPs requires systematic change of existing care units. Quality improvement interventions offer a mechanism of change to existing structures in order to effectively implement EBPs for PrU prevention. The best-practice framework developed by Nelson et al is a useful model of quality improvement interventions that targets process improvement in 4 domains: leadership, staff, information and information technology, and performance and improvement. At 2 academic medical centers, the best-practice framework was shown to physicians, nurses, and health services researchers. Their insight was used to modify the best-practice framework as a reference tool for quality improvement interventions in PrU prevention. The revised framework includes 25 elements across 4 domains. Many of these elements support EBPs for PrU prevention, such as updates in PrU staging and risk assessment. The best-practice framework offers a reference point to initiating a bundle of quality improvement interventions in support of EBPs. Hospitals and clinicians tasked with quality improvement efforts can use this framework to problem-solve PrU prevention and other critical issues.

Oil Spill Preparedness Response Capability and Capacity: Do we know what we want and how do we get what we need?

ABSTRACT The oil industry has relied on the tiered response structure for over forty years to meet its oil spill response and preparedness needs. Over this time there have been significant changes in the oil spill threat potential and the expectations of stakeholders and regulators in respect of what represents acceptable levels of response preparedness and planning. Many of the existing Tier 2 and Tier 3 response equipment bases were developed based on the perceived threat from oil tanker spills, however the following decade saw rapid expansion of offshore exploration and production and the advent of using FPSOs and FSOs to enable rapid development of oil production facilities with limited shore support & infrastructure. The recent offshore incidents in Australia, UK and United States have altered perspectives on spill response and preparedness requirements, in particular in response to offshore operations. Many OSROs have changed little since their inception and the response arrangements have remained fixed to the original design criteria, in spite of changes in their operating and risk environment. Through the OGP-IPIECA Joint Industry Project on Oil Spill Response, an OSRO capability assessment tool has been developed based on the assessment protocols commonly used in military and defence operations, known as “Capability Management” frameworks. In a Capability Management framework, the interlinking functions and activities of an enterprise may be defined under several best-practice paradigms or frameworks, such as the Balanced Scorecard (BSC), the US Department of Defence Architecture Framework (DoDAF), the Ministry of Defence Architecture Framework (MODAF), and many other similar systems. The UK Ministry of Defence uses a similar breakdown of Defence Lines of Development (DLoDs) encompassing Training, Equipment, Personnel, Information, Concepts and Doctrine, Organisation, Infrastructure, and Logistics, known by the acronym “Tepidoil”. The assessment protocol described in this paper uses the “Tepidoil” methodology, modified for use in an oil spill response context with the addition of a safety component to enable assessment of Tier 2 (and possibly Tier 3) facilities. The purpose of this work was to develop a comprehensive and objective tool that can be used by industry members to ensure that OSRO facilities have the resources and infrastructure to address their current risk profile. In addition, it can potentially be modified for use as an OSRO “self-assessment” tool. The assessment criteria include:TrainingEquipmentPersonnelInfrastructureDoctrine – translates into Response PhilosophyOrganizationInformationLogisticsSafety

Best practices for autonomous measurement of seawater pH with the Honeywell Durafet

Performance of autonomous pH sensors is evaluated by comparing in situ data to independent bench-top measurements of pH and to co-located pH, O2, and pCO2 sensors. While the best practice is always to deploy a properly calibrated sensor, the lengthy time period required for sensor conditioning and calibration often results in sensor deployment without comprehensive calibration. Quality control (QC) procedures are examined to determine the errors associated with different in situ calibration approaches and lay a framework for best practices. Sensor packages employing the Honeywell Durafet remained stable across multiple deployments for over nine months. However, sensor performance was often limited by biofouling. Regional empirical relationships for estimating carbonate system parameters are shown to enable identification of otherwise indistinguishable sensor offset and drift when multiple sensor types are co-located. Uncertainty is determined by calibration approach and must be quantified on a case-by-case basis. Our results indicate that the Durafet is capable of accuracy, relative to a chosen reference, of better than 0.03 pH units over multiple months. Accuracy is improved when a robust shore-side calibration is performed, an independent means of QC is available throughout a deployment, and effective biofouling prevention measures are taken.