Departmental Change Research Articles

High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes.

To examine the long-term outcomes of high dose rate brachytherapy boost (HDR-BT) combined with external beam radiotherapy (EBRT) for intermediate and high-risk prostate cancer patients. Data from 95 patients who underwent combined EBRT (50.4Gy) and HDR-BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan-Meier method. Regression analysis was conducted to identify important predictors of outcomes. A total of 24 patients received an initial HDR-BT dose of 18Gy in three fractions, with the remaining 71 patients receiving 16Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow-up was 58months. The 5-year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P>0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. The combined HDR-BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre-emptive TURP and/or HS insertion.

Green, Yellow, Red: Implementing a New Workflow for Collection Management at College of Charleston Libraries

This article summarizes the North Carolina Serials Conference presentation “Green, Yellow, Red: Implementing a New Workflow for Collection Management at College of Charleston Libraries,” a case study evaluating a new workflow created by the Collection and Content Services Department at the College of Charleston Libraries to streamline the renewals process after significant departmental and staff changes. The librarians involved in creating the workflow found that they could not only use it to organize their renewals processes, but also to open communication with faculty regarding underutilized resources.

Frequency and Severity of Acute Allergic-Like Reactions to Intravenously Administered Gadolinium-Based Contrast Media in Children.

The purpose of this study is to determine the frequency and severity of acute allergic-like reactions to gadolinium-based contrast media (GBCM) in children before, during, and after the transition from gadopentetate dimeglumine to gadoterate meglumine as our primary clinical GBCM. Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective investigation. Allergic-like reactions to GBCM in pediatric patients were retrospectively assessed from January 2009 to January 2017, which included a departmental change of GBCM from gadopentetate dimeglumine to gadoterate meglumine. Allergic-like reactions were identified from departmental and hospital databases. The number of doses of GBCM was obtained from billing data. Allergic-like reaction frequencies for each GBCM were calculated and compared using the chi-squared test. A total of 32,365 administrations of GBCM occurred during the study period (327 for gadofosveset trisodium; 672 for gadoxetate disodium; 12,012 for gadoterate meglumine; and 19,354 for gadopentetate dimeglumine). Allergic-like reactions occurred after 21 (0.06%) administrations. Reaction frequencies were not significantly different among the GBCM (0.3% gadofosveset trisodium; 0% gadoxetate disodium, 0.06% gadoterate meglumine, 0.08% gadopentetate dimeglumine; P > 0.05). Ten (47.6%) reactions were mild, 10 (47.6%) were moderate, and 1 (4.8%) was severe. The overall reaction frequency peaked during the 6-month transition period from gadopentetate dimeglumine to gadoterate meglumine (0.20%), compared with 0.07% pretransition (P = 0.048) and 0.04% posttransition (P = 0.0095). Allergic-like reactions to GBCM in children are rare. Gadoterate meglumine has a reaction frequency that does not significantly differ from other GBCMs. During the transition from gadopentetate dimeglumine to gadoterate meglumine, an increase in the frequency of reported allergic-like reactions was observed, likely reflective of the Weber effect.

Review: Partnership for Undergraduate Life Sciences Education (PULSE)

Partnership for Undergraduate Life Sciences Education (PULSE) (Higher Education Resources; http://pulse-community.org) The impact from the 2011 Vision and Change in Undergraduate Biology Education report led by the American Association for the Advancement of Science has rippled across the country, sparking curricular and institutional change. Part of this dissemination of ideas in and approaches to biology education took place thanks to the Partnership for Undergraduate Life Science Education (PULSE). This community of undergraduate life science instructors actively supports its members in efforts to bring about authentic, grassroots, departmental change at institutions of higher education. Program officers from the Howard Hughes Medical Institute, the National Science Foundation, and the National Institute for General Medical Sciences initiated PULSE in 2012 …

Effects of the work limitations on the career path of a cohort of health workers.

The median age of the workforce, and of healthcare workers in particular, is increasing, resulting in a reduced work capacity. This may prompt the occupational physician to issue fitness for work limitations. To examine the health surveillance data collected over 20 years on the employees of a large healthcare institution to identify the effects of the limitations imposed on their career paths. The database of health surveillance records gathered over the years was analysed using the same dedicated software. Fourteen types of limitations were classified via a "text mining" treatment. 3,653 subjects were selected, divided in two groups (A: with a limitation and B: without limitation) comprised of 655 and 2,998 subjects, respectively. The subjects were then ranked on the basis of departments and tasks involved. We also evaluated the number of departmental changes for each worker and the corresponding rate of change for the three groups A, B and B post-limitation. Limitations have been increasing in parallel with the aging of workers, in particular those relating to Manual Load Handling/Posture (MLH/P). The limitations due to Allergy/Latex lasted longer, and in a greater proportion than MLH/P, particularly when compared to the limitation for Shift Work and those for "Other Limitations" that were shrinking faster. There is a clear relationship between certain types of limitations/prescriptions and workers' ages. It is necessary to carry out an assessment of the association with the work performed in order to implement age management strategies aimed at maintaining work capacity in aging workers.

The Roles of STEM Faculty Communities of Practice in Institutional and Departmental Reform in Higher Education

This study examines how involvement in four cross-institutional STEM faculty communities of practice is associated with local departmental and institutional change for faculty members belonging to these communities. It is informed by the communities of practice and change in higher education literature and utilizes data gathered through a survey of community members (n = 2,503). The findings reveal engagement experiences and aspects of community design associated with departmental and institutional change related to STEM reform. These findings contribute to recommendations for designing future STEM reform initiatives.

Skills to pay the bills?

Education Circular and pedagogical reform is often occurring in undergraduate science, technology, engineering, and math (STEM) departments. How can institutions measure whether these curriculum changes are successful? The Survey of Teaching Beliefs and Practices for Undergraduates (STEP-U) developed by Marbach-Ad et al. measures the value that students attribute to skills needed for the workplace (e.g., the ability to work in groups) and teaching practices intended to promote these skills (e.g., group assignments). Specifically, STEP-U is able to simultaneously assess student experiences and teaching practices, ultimately allowing departments to design curricula that better prepare students for the STEM workforce. STEP-U's potential for driving both departmental and institutional change is high, because it can be used to illustrate student experiences between cohorts, within subdisciplines, or between majors. CBE Life Sci. Educ. 10.1187/cbe.16-05-0164 (2016).

The PULSE Vision & Change Rubrics, Version 1.0: A Valid and Equitable Tool to Measure Transformation of Life Sciences Departments at All Institution Types.

The PULSE Vision & Change Rubrics, version 1.0, assess life sciences departments' progress toward implementation of the principles of the Vision and Change report. This paper reports on the development of the rubrics, their validation, and their reliability in measuring departmental change aligned with the Vision and Change recommendations. The rubrics assess 66 different criteria across five areas: Curriculum Alignment, Assessment, Faculty Practice/Faculty Support, Infrastructure, and Climate for Change. The results from this work demonstrate the rubrics can be used to evaluate departmental transformation equitably across institution types and represent baseline data about the adoption of the Vision and Change recommendations by life sciences programs across the United States. While all institution types have made progress, liberal arts institutions are farther along in implementing these recommendations. Generally, institutions earned the highest scores on the Curriculum Alignment rubric and the lowest scores on the Assessment rubric. The results of this study clearly indicate that the Vision & Change Rubrics, version 1.0, are valid and equitable and can track long-term progress of the transformation of life sciences departments. In addition, four of the five rubrics have broad applicability and can be used to evaluate departmental transformation by other science, technology, engineering, and mathematics disciplines.

Anything can happen in the Zone: Library and Departmental Change Driven by Migration to a Cloud-based Library Management System

Butler University Libraries had already made progressive changes in public services areas, but Technical Services remained unchanged and bound to legacy practices from decades past. For us, the best catalyst for change was a system migration to a cloud-based type of management system. This system migration was tied to organizational restructuring and a new strategic plan, each of which intertwined with the details of the migration project and was underpinned by thoughtful analysis of how to help employees through change. Details of the migration are discussed in relation to how they inspired departmental and organizational change through updated technology.

Standardizing the Handling of Surgical Specimens

To standardize the handling of surgical specimens, the OR clinical educators in a community hospital setting devised a series of departmental changes as a quality improvement project. A newly created skill validation was reviewed in an hour-long educational meeting with all OR staff members. In addition to creating a new annual skill validation, discussions about specimens were included in the hand over, the time out, and a newly instituted debriefing tool to be used toward the end of a procedure. This interdisciplinary group devised interventions to improve the process of handling specimens such as standardizing the labeling process and changing the transparency of the specimen container. The goal was to assure standardization of specimen handling, specifically to assist novice staff members, and to harmonize inconsistencies between specialties within the practice of existing staff members. These combined methods helped to ensure accurate communication and procurement of specimens for all procedures.

Where's the Geography department? The changing administrative place of Geography in UK higher education

This paper considers recent patterns of departmental change in the management of Geography in UK universities. It notes the increasingly multidisciplinary management of Geography since the mid‐1990s. Various measures of this trend are explored and discussed. The paper also considers the problematic accommodation of Geography within the faculty structures of institutions. These findings speak of a problematic identity for the discipline within this institutional context. The paper goes on to consider some of the impacts of these trends for the practice of Geography in UK higher education.

Changing the Departmental Learning Culture to Enable Student-Centred Learning in Large Classes

The fast changing workplace requires lifelong learners that can adapt and function effectively in a variety of circumstances. To equip students with the necessary knowledge and skills to be marketable and survive in the workplace is not easy, especially in the context of very large classes. In this mixed method study current practices and challenges related to teaching, learning and assessment were investigated at a South African university with classes of up to 800 students. Only the qualitative component of the study, which involved in-depth interviews with lecturers of these classes, is used for this article. We found that transfer of knowledge by lecturing and electronic assessments by means of multiple-choice questions (MCQs) were the dominant practices in these classes. Individual efforts by lecturers to use student-centred methods were met with resistance by both colleagues and students. We argue that this situation will not change unless the departmental learning culture changes to incorporate student-centred teaching, learning and assessment as classroom practice. Some examples are presented of viable ways to use peer- and self-assessment in these large classes which could be adopted as standard departmental teaching and learning practice. DOI: 10.5901/mjss.2014.v5n8p386

Leading Departmental Change to Advance Perioperative Quality

Leading Departmental Change to Advance Perioperative Quality

Blueprint for Health Service Psychology Education and Training: A brief consideration of departmental resources and cultural changes necessary for implementation.

Blueprint for Health Service Psychology Education and Training: A brief consideration of departmental resources and cultural changes necessary for implementation.

Scholar Quest: A Residency Research Program Aligned With Faculty Goals

Introduction: The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development.Methods: A research program, Scholar Quest (SQ), was developed as a part of an Information Mastery program. The goal of SQ is for residents to gain understanding of scholarly activity through a mentor-directed experience in original research. This curriculum is facilitated by providing residents protected time for didactics, seed grants and statistical/staff support. We evaluated total scholarly activity and resident/faculty involvement before and after implementation (PRE-SQ; 2003–2005 and POST-SQ; 2007–2009).Results: Scholarly activity was greater POST-SQ versus PRE-SQ (123 versus 27) (p<0.05) with an incidence rate ratio (IRR)=2.35. Resident and faculty involvement in scholarly activity also increased PRE-SQ to POST-SQ (22 to 98 residents; 10 to 39 faculty, p<0.05) with an IRR=2.87 and 2.69, respectively.Conclusion: Implementation of a program using department environmental change promoting a resident longitudinal research curriculum yielded increased resident and faculty scholarly involvement, as well as an increase in total scholarly activity.

Understanding corporate governance in the Australian public sector

Purpose – The purpose of this paper is to identify factors that affect corporate governance in Australian state government departments. Design/methodology/approach – A qualitative analysis of semi-structured interviews with 65 executives and middle managers from 25 departments across Australia is used. The interviews identified managers ' perceptions of the structures and practices of governance in four nominated areas: strategic planning, auditing, risk management and capacity building. A social capital model is utilised to analyse the data along structural, relational and cognitive dimensions. Findings – Aligned with the structural dimension, frequent departmental and leadership changes and the size and complexity of departments are reported as major barriers to good governance, while well-structured committees are perceived to strengthen governance. Aligned with the relational dimension, a culture of good working relationships between staff and strong leadership are recognised as critical for strong go...

Abstract TP327: Are We Really That Noncompliant? Identifying Barriers to Documenting Patient Education

Background/Purpose: Patient education impacts stroke recovery and prevention. Certification as a Joint Commission Primary Stroke Center (JC PSC) requires consistent performance in patient education. Prior to instituting a new electronic medical record (EMR) in March 2011 our hospital maintained compliance with this measure at or above 93%. We have experienced difficulty returning to this level for unclear reasons. We sought to identify factors contributing to a decrease in performance. Methods: The institution’s Get with the Guidelines Stroke database was reviewed from July 2010 to June 2012. Institutional and departmental changes occurring during months of low compliance were explored. A Project RN was hired to focus on data abstraction and patient education. Results: Prior to March 2011 compliance was 93-100%, at which time it dropped to 68%. April 2011 to June 2012 the range was 76-100% with 9 months less than 90%. Only three months during that time were 93% or better. The initial decrease in compliance was clearly attributable to the EMR which lacks previously available “hard stops” for education. Continued compliance of less than 90% was multifactorial. An average census increase of 16.8% per month from 2010 to 2012 was identified. In addition, there were staffing changes within the stroke center during months of low performance. Absence of a nurse practitioner on the inpatient unit had a negative impact. Patients in the stroke unit had better documentation of education than those on other units. Improved compliance coincided with preparation for a JC PSC site visit and completion of the Project RN’s orientation. Conclusions: Consistent achievement of stroke education at 93% or better can be reached, but is challenging in a frequently changing environment. We believe our patients are getting stroke-specific education, but documentation has declined due to the EMR, changes in staff, and growing census. Identifying these barriers has allowed the development of a PI plan with a goal of consistent compliance of 93% or better. This plan includes revision of the Project RN responsibilities and scheduling patient education sessions more frequently. Another NP is being recruited, and investigation into better use of the available features of the EMR is underway.

Axillary “Exclusion”—A Successful Technique for Reducing Seroma Formation after Mastectomy and Axillary Dissection

Introduction: A seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound breakdown. Infection developing within seroma increases morbidity and often results in the need for re-admission, re-imaging, drainage and antibiotic usage. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: 24 consecutive patients undergoing mastectomy and axillary clearance were recruited before and after a departmental change in practice. At the point of skin closure, patients either underwent “axillary exclusion” or not. Total drain outputs were recorded by community district nursing staff for all patients. At the first post-operative visit, the presence and severity of seroma was recorded. Results: 24 patients were included (study group 14, control group 10). Age, size of tumour, and number of positive lymph nodes and laterality were comparable between groups. Mean drain output for the entire group was 471 ml (3 - 1030 ml) over 5.21 days. The control group had a drain output of 763.5 ml (95%CI 674.2 - 852.8) while the study group had a mean drainage of 262.2 ml (95%CI 161.9 - 362.5), a reduction of over 65%, p < 0.001. 15 (62.5%) out of 24 patients developed seroma. 42.9% of the study group and 90% of the control group developed seroma, p < 0.01. Conclusion: Seromas are a common complication following mastectomy and axillary clearance. Our technique of axillary exclusion has resulted in significantly reduced drainage volumes and fewer seromas.

Departmental changes see Truss and early years take junior roles

Departmental changes see Truss and early years take junior roles

STAT—How to Make Every Minute Count

Several years ago, our community teaching hospital identified a need to improve patient care by streamlining the study performance workflow and hastening communication of critical study results to clinicians. "STAT" studies are a carefully selected subset of imaging studies that are prioritized due to their utility in assessing for emergent conditions including cerebrovascular accidents, pneumoperitoneum, and cardiac arrest. We describe the multiyear process of data collection, analysis, and departmental and hospital-wide system changes that significantly improved result times. Relatively simple policy changes, such as the distribution of STAT beepers to the team members and creating color-coded worklists, drastically reduced delays.