Instruction Sheet Research Articles

Pilot testing of dipsticks as point-of-care assays for rapid diagnosis of poor-quality artemisinin drugs in endemic settings.

BackgroundGood-quality artemisinin drugs are essential for malaria treatment, but increasing prevalence of poor-quality artemisinin drugs in many endemic countries hinders effective management of malaria cases.MethodsTo develop a point-of-care assay for rapid identification of counterfeit and substandard artemisinin drugs for resource-limited areas, we used specific monoclonal antibodies against artesunate and artemether, and developed prototypes of lateral flow dipstick assays. In this pilot test, we evaluated the feasibility of these dipsticks under different endemic settings and their performance in the hands of untrained personnel.ResultsThe results showed that the dipstick tests can be successfully performed by different investigators with the included instruction sheet. None of the artemether and artesunate drugs collected from public pharmacies in different endemic countries failed the test.ConclusionIt is possible that the simple dipstick assays, with future optimization of test conditions and sensitivity, can be used as a qualitative and semi-quantitative assay for rapid screening of counterfeit artemisinin drugs in endemic settings.

Pengembangan Perangkat Pembelajaran Matematika Model Kooperatif Tipe STAD dengan Media Powerpoint Ispring pada Materi Jajargenjang, Layang-Layang dan Trapesium di Kelas VII SMP

The aim of this research are: to describe the process of development and instructional instruments of cooperative learning type STAD with Microsoft Power Point Ispring on topic parallelogram, the kite and trapezium at SMP Class Seven. The Subject of this research is SMP Muhammadiyah 13 Surabaya in class seven at year 2013-2014, tow parallel class are VII A an VII B. The model of development teaching material for this research is use 4-D Thiagarajan’s development instructional model. The development process consist of four phases, those are define, design, develop, and disseminate. Instructional instruments that developed are lesson plan, students work sheet, achievement test and the microsoft power point ispring media learning. The researches instrument are used validation’s instructional instruments sheet, observational sheet of student’s activities in learning, observational sheet of teacher ability to manage the instruction, and the quotioner of students responses. The instructional instruments that has been developed by the next one will be seen whether already as instructional instruments that was good that is an equipment that could support learning process so as the aim that it was hoped could be reached and be equipment pembelajaran that was developed in accordance with the development procedure of instructional instruments and met (1) Valid that is has divalidasi by the expert and filled the minimal criterion valid. (2) was tested, by filling the criterion: (a) the teacher's capacity managed pembelajaran was classified as effective (b) the Activity of the student was classified as active (c) the positive Criterion for the student's response to pembelajaran and the completeness of studying results in a classical manner was reached (d) the results Test studied met valid, reliable and sensitive. Based on the analysis in the development stage, was received by the conclusion that instructional instruments cooperative model mathematics the STAD type with the media Microsoft PowerPoint Ispring learning to material parallelogram, the kite and the trapezium in the SMP Muhammadiyah 13 VII classes filled the good criterion was based on results of the validation of the expert and results of the test that filled conditions that were determined that is, (1) the activity of the student during pembelajaran effective; (2) the teacher's capacity in managed learning process effective; (3) the student's response to pembelajaran active and the completeness of studying results in a classical manner was reached; and (4) the results test studied that was used sensitive, valid, and reliabel.

INSTRUMEN TES KECERDASAN LOGIKA-MATEMATIKA UNTUK ANAK USIA DINI

This study aims to produce an instrument Logical-mathematical intelligence test inearly childhood are valid and reliable. This research was conducted in six kindergartens inJakarta. The method used in this research is the development method adapted from Dick-Careyinstructional models and models of development Djaali-Moeljono. There are three main stagesin the development of this instrument to obtain instruments finals, namely: (1) PhaseIntroduction namely: identify problems and conduct studies theories (2) phase of productdevelopment, including designing constructs measured variables based on the theory,development dimension, indicators and grains instruments, testing the validity by experts andpanels, a revised instrument panel based on expert input and analysis and reliability testingresults. (3) Implementation Phase includes: field trials, conducted empirical test, a revisionclause instrument, obtaining final instrument and establishing guidelines for administration andscoring. Test instruments resulting from this research is the instruction sheet, item pictures andmarking sheet. The tests showed that whole grains have a significant level of <0.05, with thevalue of reliability coefficient of 0.856. The results showed that the test instrument LogicalMathematical intelligence fit for use.

Prevalence of psychosomatic symptoms among school going children

Psychosomatic symptoms are the physical symptoms that are exhibited by the child or exacerbated by psychological factors; the underlying cause may be stressors in the environment that may be of emotional or social origin. The main objectives of the study is to assess the prevalence of psychosomatic symptoms among school going children in the age group of 6 to 10 Yrs and to find an association between the psychosomatic symptoms and selected background variables A non-experimental explorative descriptive research design was used. The 100 subject were selected by Non- probability convenient sampling technique from selected homes of community areas of western Pune. Modified Rutter’s scale B was used for the psychosomatic symptoms. Maximum students (76%) showed symptoms of irritability and one percent of subject had constipation, soiling of clothes, hearing and vision problems. The mean value was 5.42 and the standard deviation was 2.226. On association of psycho somatic symptoms with selected demographic variables, significant relation was seen with the education of parents with p-value 0.015. Correlation between the psychosomatic symptoms and its coping strategies showed a correlation (0.48) using Kruskal Wallis H test. Based on these findings an instructional sheet was prepared for the parents, which mainly dealt with the concept of spending valuable time with children.

The Eudora Welty Collection: Mississippi Department of Archives and History

The Eudora Welty CollectionMississippi Department of Archives and History Forrest Galey, Special Projects Officer The materials transferred to the Archives and Records Services Division (A&RS) from the Museum Division since March 2011, along with those transferred to the Mississippi Department of Archives and History (MDAH) upon the settlement of Eudora Welty’s estate, continue to be incorporated into the Eudora Welty Collection. Currently, no series are closed for reprocessing but some series are undergoing substantial revisions. There are also new series being added. We suggest researchers contact MDAH, refdesk@mdah.state.ms.us, to verify the [End Page 149] availability of series that are of particular interest to them prior to visiting the archives. Readers are invited to visit the MDAH website where the home page mdah.state.ms.us/new/ features Welty information with some regularity and provides a portal to the online catalog where new series and series revisions may be posted. The A&RS division continues to use Koha, an open source system, for its online catalog. An instruction sheet, The Eudora Welty Collection: Collection Research and Access via the Online Catalog, has been prepared to aid researchers in readily locating catalog records for the Eudora Welty Collection and other Welty-related materials in the division’s holdings. The document concludes with a current series list. Researchers interested in obtaining publication rights for, and/or reproductions of, material in the Eudora Welty Collection may benefit from information provided in The Eudora Welty Collection: Contacts for Use Permission and Reprographic Services. The 2016 Eudora Welty Research Fellowship, co-sponsored by the Eudora Welty Foundation and the Mississippi Department of Archives and History, has been awarded to Boosung Kim, a PhD candidate in English at Texas A&M University. On-site research at the William F. Winter Archives and History Building, supported by the $2,000 stipend, will be conducted during the summer. The Eudora Welty Collection Mississippi Department of Archives and History Archives and Records Services Division Reviewing the Mississippi Department of Archives and History (MDAH) website, www.mdah.state.ms.us/new/, and links within the Research menu may help you learn about our operations and become accustomed to the online catalog before you visit the William F. Winter Archives and History Building in Jackson, Mississippi. When you are visiting the archives or at home using our online catalog you may go directly to the Eudora Welty Collection, Manuscript Number Z/0301.000/S. This is our principal collection of Welty papers, photographs, manuscripts, etc. donated or bequeathed to MDAH by Eudora Welty. [End Page 150] Off-site review of the Eudora Welty Collection catalog record and finding aid • From http://mdah.state.ms.us/new/ select “Online Catalog” • Method 1: On the Online Catalog opening page screen, under “Search”: select “Call number as phrase” in the drop down menu; type “Z/0301” in the adjacent blank box; and click the “Go” button. This method will take you to the catalog records for the Welty (Eudora) Collection directly. • Method 2: On the Online Catalog opening page screen select the tab marked “Advanced Search.” On the “Advanced Search” screen, under “Search for”: select “Keyword” and select “Title” in the drop down menu; type “Eudora Welty” in the adjacent blank box; scroll down the screen to “Limit to any of the following:” and check the box for “Manuscript Collection”; and click the “Search” button. This method may be used to search for the Welty (Eudora) Collection as well as *other resources. • On the “Catalog Record” screen for the Eudora Welty Collection there is a link to “Online Resources: Collection description”: click this link to see the Series list. (If clicking the “Search” button in the previous step yielded a list of multiple titles instead of going directly to the Eudora Welty Collection catalog record, then look for “Welty (Eudora) Collection” on the results page and click the title to open the “Catalog Record.”) • On the Series list: click any of the Series’ titles to see the respective Series descriptions. (Box and folder numbers appear in Series descriptions. Make a note of the box and folder number(s) for reference...

THE DEVELOPMENT OF SCIENTIFIC-APPROACH-BASED LEARNING INSTRUMENTSINTEGRATED WITH RED ONION FARMING POTENCY IN BREBES INDONESIA

This study aimed to describe the eligibility category of science learning instrument based on scientific approach integrated with onion farming potency. Also, this study aimed to analyze the effectiveness of the application of the science learning instrument in terms ofscience process skills development and the cognitive learning outcomes in the student of class VII SMPN 1 Bulakamba.This study used thedevelopment research methods by adapting the 4D model that includes define, design, develop, and disseminate. The learning instruments developed in this research were the learning implementation plan (RPP) and the student worksheet (LKS). The data collection was done by using non-test technique using interview guides, product validation sheet, students’ response sheet to the readability of LKS and the instructional observation sheets; as well as using theworksheet of process skills and cognitive learning outcomes. The results showed that the eligibility of the science learning instruments integrated with onion farming potency was categorized as excellent. The application of scientific-approach-based learning instruments was effective to improve the process skills and the students’ cognitive learning outcomes in class VII SMPN 1 Bulakamba.

OP‐5 INTEROBSERVER VALIDITY OF THE REFLUX FINDING SCORE FOR INFANTS (RFS‐I) IN FLEXIBLE VERSUS RIGID LARYNGOSCOPY.

Background:The Reflux Finding Score for Infants (RFS‐I) was developed to objectively assess signs of laryngopharyngeal reflux (LPR). Based on review of flexible laryngoscopic videos, only moderate inter‐ and highly variable intraobserver reliability was found. We hypothesized that examination of the infant larynx with rigid laryngoscopy would provide better agreement. AIM: to assess the validity of the RFS‐I in the detection of LPR‐related findings using flexible versus rigid laryngoscopy.Methods:Thirty consecutive infants underwent flexible and rigid laryngoscopy. Based on the recorded videos, RFS‐I was scored by 4 otorhinolaryngologists, 2 otorhinolaryngology fellows, and 2 inexperienced observers. Videos were presented in a randomized order, blinded for clinical profile and findings during initial examination. Observers were provided an instruction sheet prior to evaluation. For categorical data, agreement was calculated using Cohen's kappa (2 observers) and Fleiss’ kappa (>2 observers). For ordinal data the intraclass correlation coefficient (ICC) was used.Results:Of 30 included patients (17 M; median age 7.5 (0–19.8) months), main reasons for referral were: stridor (n = 15,50%), ALTE/apneas (n = 7,23.3%), follow‐up of laryngeal abnormalities (n = 6,20%), aspiration (n = 5,16.7%), and other indications (n = 7,23.3%). Overall interobserver agreement of the RFS‐I was moderate for both flexible (ICC = 0.60, [95%CI 0.44–0.76]) and rigid (ICC = 0.42, [95%CI 0.26–0.62] laryngoscopy. There were no significant differences in agreement on overall RFS‐I scores and individual RFS‐I items for flexible versus rigid laryngoscopy. We did observe higher overall agreement amongst the 2 inexperienced observers for rigid (ICC = 0.40, [95%CI 0.03–0.67]), compared to flexible (ICC = 0.11, [95%CI 0.17–0.41]) laryngoscopy, albeit not significant. Comparing RFS‐I results for flexible versus rigid laryngoscopy per observer, agreement ranged from no to substantial agreement (k = ‐0.16–0.63, mean k = 0.22) and the observed agreement (not adjusted for chance) was 0.08–0.35%.Conclusions:Interobserver agreement of the RFS‐I was only moderate and did not differ between flexible and rigid laryngoscopy. This indicates that the RFS‐I should not be used with flexible, nor rigid laryngoscopy to detect signs of LPR.

Parental Experiences of Medication Administration to Children at Home and Understanding of Adverse Drug Events.

Medication administration errors are the most common type of error in pediatric medicine. Preventing medication errors is an important part of ensuring safe and quality patient care for pediatric patients. Few studies have described this issue from the perspective of the parents of pediatric patients. This study describes parents' administration of medication to their children at home and the understanding of these parents of adverse drug events (ADEs). A cross-sectional survey design was used to gather data from 179 parents of pediatric patients at two pediatric units at a hospital and three children's daycare centers in Korea. Data were collected from July to August 2012 using a self-reported questionnaire. Participants reported administering antipyretics (94.4%), decongestants (89.4%), and antibiotics (77.7%) to their children at home. The major source of medication information was instruction sheets. Parents more commonly used dosing cups (43.6%) and droppers (32.9%) when administering liquid medication to children. Furthermore, 12.3% of the children experienced ADEs. Only 48% of the participants were provided information on ADEs, 15.1% were unsure about the recommended dosage, and 11.2% were unsure of the recommended method for administering the medication. Analysis of variance and post hoc tests showed that level of parental education and monthly income each had a significant impact on participant understanding of ADEs. This study suggests that parents should be educated about ways to avoid common medication errors in children. In addition, in the case of low-income families, home visits should be carried out to understand how to reduce home medication errors and provide drug-related information to parents. Strategies are needed to reduce pediatric home medication errors and minimize ADEs and to provide medication information to parents.

Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.

BackgroundStudies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education.ObjectiveTo investigate women’s acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India.DesignSecondary outcome of a randomised, controlled, non-inferiority trial.SettingOutpatient primary health care clinics in rural and urban Rajasthan, India.PopulationWomen were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years.MethodsAbortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible.Main Outcome MeasuresWomen’s acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups.Results731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001).ConclusionHome-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women’s preference should be offered to foster women’s reproductive autonomy.Trial RegistrationClinicalTrials.gov NCT01827995

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India: a randomised, controlled, non-inferiority trial.

The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2·2%, 95% CI -5·9 to 1·6). One case of haemorrhage occurred in each group (rate of adverse events 0·3% in each group); no other adverse events were noted. Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Effect of multifaceted interventions on reducing return visits within 72 h after non-traumatic emergency department visits.

The objective of the present study is to develop new multifaceted interventions to reduce return visits (RVs) based on identified risk factors related to RVs in the ED and to compare the RV rate before and after the implementation of the intervention. The present study was a controlled before and after study that was conducted in the ED of a 900-bed tertiary hospital in an urban area. The primary outcome was the rate of unplanned RVs to the ED and hospital admission after RV. The risk and predictive factors of RVs were identified by a retrospective study of all unscheduled RVs to the ED within 72 h in 2011. We developed five new multifaceted interventions based on the results: (i) daily RV feedback; (ii) prescription set of drugs; (iii) creation of a discharge instruction sheet; (iv) early follow-up appointments of outpatient department (OPD); and (v) enhancement of referral system. A prospective interventional study in which the interventions were implemented was then conducted over 10 months, from 1 June 2012 to 31 March 2013. The five new multifaceted interventions significantly reduced the mean early RV rate and RV admission rate after ED discharge by an average of approximately 25%, with a maximum of approximately 55% and 47%, respectively, compared with the pre-intervention period (RV rate: P < 0.001, RV admission rate: P < 0.001). Multifaceted interventions based on identified risk factors for early RV after ED discharge had a positive effect on reducing RVs and the admission rate after RVs for adult patients within 72 h of non-traumatic ED visits.

Comparing balance and inverse methods on learning conceptual and procedural knowledge in equation solving: a cognitive load perspective

We examined the use of balance and inverse methods in equation solving. The main difference between the balance and inverse methods lies in the operational line (e.g. +2 on both sides vs −2 becomes +2). Differential element interactivity favours the inverse method because the interaction between elements occurs on both sides of the equation for the balance method but only on one side of the equation for the inverse method. In an experimental study, 63 students (mean age = 13) were randomly allocated to either balance or inverse group to undertake a pre-test, study an instruction sheet, complete acquisition equations, sit for a post-test and a concept test. Procedural knowledge was assessed on performance on practice equations and post-test, whereas conceptual knowledge was assessed on performance on the concept test. The inverse group outperformed the balance group on practice equations but not the post-test. Both the balance and inverse groups scored higher on the inverse concept test than the balance concept test. Positive association between performance on procedural knowledge and performance on conceptual knowledge was found for the inverse group but not the balance group. Overall, the evidence obtained indicates a number of educational implications for implementation.

A Project to Reduce the Occlusion Rate in Hemodialysis Arteriovenous Access

Vascular occlusions in patients frequently necessitate that duty nurses work overtime to manage related vascular problems. For patients, vascular occlusions require invasive treatments that are painful, take time to heal, and increase anxiety. Furthermore, vascular occlusions seriously influence the effectiveness of hemodialysis. This project worked to reduce the rates of occlusion from 18.6% to < 15% for hemodialysis arteriovenous grafts (AVGs) and from 5.2% to < 2.6% for arteriovenous fistulas (AVFs). This project was conducted between September 1st, 2012 and July 31th, 2013. Our approach used a retrospective study, literature review, meeting discussions, and data compilation. The four main problems identified as associated with occlusion were: (1) low blood pressure during hemodialysis; (2) successive fistula puncture sites were located too close to one another; (3) abnormal blood flow; and (4) poor moisture control. Our solutions included: 1) adjusting and creating forms; 2) adjusting related nursing procedures; and 3) organizing a related lecture for our department. The occlusion rates of AVG and AVF decreased from 18.6% to 7.4% and 5.2% to 0.9%, respectively. We significantly reduced AVG and AVF occlusion rates by using simple methods such as using a tourniquet ruler, designing big-print, illustrated patient instruction sheets on preventing low blood pressure, creating a simplified fistula puncture site series chart, creating a moisture control card, and scheduling follow-up visits for patients with abnormal blood flow at the OPD. This project provides a reference for other hemodialysis departments.

Scalable Options for Extended Skill Building Following Didactic Training in Cognitive-Behavioral Therapy for Anxious Youth: A Pilot Randomized Trial

A sizable gap exists between the availability of evidence-based psychological treatments and the number of community therapists capable of delivering such treatments. Limited time, resources, and access to experts prompt the need for easily disseminable, lower cost options for therapist training and continued support beyond initial training. A pilot randomized trial tested scalable extended support models for therapists following initial training. Thirty-five postdegree professionals (43%) or graduate trainees (57%) from diverse disciplines viewed an initial web-based training in cognitive-behavioral therapy (CBT) for youth anxiety and then were randomly assigned to 10 weeks of expert streaming (ES; viewing weekly online supervision sessions of an expert providing consultation), peer consultation (PC; non-expert-led group discussions of CBT), or fact sheet self-study (FS; weekly review of instructional fact sheets). In initial expectations, trainees rated PC as more appropriate and useful to meet its goals than either ES or FS. At post, all support programs were rated as equally satisfactory and useful for therapists’ work, and comparable in increasing self-reported use of CBT strategies (b = .19, p = .02). In contrast, negative linear trends were found on a knowledge quiz (b = −1.23, p = .01) and self-reported beliefs about knowledge (b = −1.50, p < .001) and skill (b = −1.15, p < .001). Attrition and poor attendance presented a moderate concern for PC, and ES was rated as having the lowest implementation potential. Preliminary findings encourage further development of low-cost, scalable options for continued support of evidence-based training.

Periprocedural management of aspirin during colonoscopy: a survey of practice patterns in the United States

The risk of postpolypectomy bleeding for patients taking aspirin is low, and gastroenterology society guidelines state that aspirin is likely safe to continue; however, many practices recommend aspirin discontinuation. To characterize practice patterns of periprocedural aspirin use with colonoscopy in the United States. Survey study. Endoscopy units in the United States. We reviewed colonoscopy preparation instruction sheets available online to characterize recommendations regarding periprocedural aspirin use. The endoscopy units that recommended discontinuation of aspirin before colonoscopy were contacted to determine their reasons for doing so. We also determined which endoscopy units were recognized by the American Society for Gastrointestinal Endoscopy (ASGE) quality recognition program. Endoscopy unit recommendations regarding aspirin use before colonoscopy. We reviewed colonoscopy preparation instructions from 317 endoscopy units, of which 138 (43.5%) recommended continuing aspirin, 103 (32.5%) recommended stopping aspirin, and 76 (24%) requested patients to contact a physician. The most common reasons for recommending aspirin discontinuation were concern about bleeding after polypectomy (62%), perceived minimal downside to stopping aspirin (38%), inertia to changing old policies (20%), and concern about medicolegal implications of postpolypectomy bleeding (15%). There was no significant association between endoscopy unit recommendations about periprocedural aspirin use and ASGE quality certification (P= .17) or type of endoscopy facility (ambulatory surgical center vs hospital affiliated) (P= .55). Non-response bias. Less than half of the endoscopy units surveyed in the United States routinely continue aspirin before screening colonoscopies despite evidence that benefits outweigh the risks. It is important for gastroenterology and cardiology societies to make a firm statement, educate their members, and give them confidence and support to continue aspirin periprocedurally.

Reducing Cancelations on the Day of Scheduled Surgery at a Children’s Hospital

Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation. Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and text-message reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods. Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites. By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization.

エルロチニブおよびゲフィチニブ服薬患者の理解度向上のための患者教育体制の構築とその評価

Erlotinib and gefitinib are oral molecular target drugs for treating non-small cell lung cancer. To provide effective treatment and prevent severe toxicities, it is crucial to educate patients regarding the proper usage and adverse reactions of these drugs. Pharmacists play a key role in this respect. As there are no established patient education tools or tests for measuring patient understanding of molecular target drugs, each pharmacist evaluates the depth of patient understanding depending on their experience. In the present study, we developed various support tools such as understanding check sheet, medicine instruction sheet, leaflet of drug interaction with citrus fruits, and rash management manuals to standardize the patient education method. Each patient was tested twice with the understanding check sheet. Firstly, just after the physician/nurse explained the treatment; secondly, immediately before discharge. After the first test, we explained to the patients the questions they had answered incorrectly, with the help of the tools described above. To evaluate the usefulness of these tools, the percentage answered correctly in the understanding check sheet before and after the education was compared in 39 patients treated with erlotinib or gefitinib. The percentage answered correctly increased significantly after the education. These results suggest that the patient education system using education support tools is useful to improve patient understanding regarding erlotinib and gefitinib.

PROCESS IMPROVEMENT BY IMPLEMENTATION OF KAIZEN AS A QUALITY TOOL WITHIN DEFINED CONSTRAINTS: A CASE STUDY IN MANUFACTURING INDUSTRY

Kaizen is a concept that focuses on improving a work area or an organization in incremental steps. The first well-known and most frequently cited proponent of kaizen was Imai, who wrote KAIZEN – The Key to Japan’s Competitive Success (1986. This paper illustrates about kaizen case study in Small Medium Industries (SMI) Company that is ABC Company, which produce non woven fabrics. This case study is focused on reducing material wastage. Kaizen steps are used as guidelines and PDCA Cycle is choosing as problem solving approach to conduct the case study. The properly tools and techniques such as why, Work Instruction Sheet, Pareto diagram, Process Mapping, PDCA Cycle and brainstorming were used. The kaizen implementation has reduced the of time losses More than that, sales order processing lead time and production lead time was also reduced. These results have proved the effectiveness of kaizen methodology. Article DOI: https://dx.doi.org/10.20319/mijst.2016.s11.182194 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

Street Signs and Ikea Instruction Sheets: Pragmatics and Pictorial Communication

A classical objection to pictorial communication is that pictures are intrinsically ambiguous and a picture, per se, can communicate an indeterminate number of different contents. The standard interpretation of this objection is that pictures are subordinate to language and that pictorial communication is parasitic on verbal communication. We argue that in many cases verbal communication presents a similar indeterminacy, which is resolved by resorting to pragmatic mechanisms. In this spirit, we propose a pragmatic approach which explains pictorial communication in terms of implicatures in a wide sense.

Improve optimal treatment in head and neck cancer patients (HNCA).

227 Background: Since 2011, 50% of HNCA patients receiving concurrent chemoradiation with Cisplatin (CIS/XRT) have not been able to complete their therapy per protocol (dose over time interval) leading to suboptimal therapy. Based on historical data, the non-completion rate for patients HNCA receiving radiation/ high dose Cisplatin was 15%. We aim to improve this in our patients. Methods: A chart review of patients on CIS/XRT conducted and, using a Pareto Chart, the data indicated Acute Kidney Iinjury as the major cause for failure of completion. Using methodology from ASCO’s Quality Training Program, a process map for patients on treatment was created and an Ishikawa diagram (cause and effect) assisted in pinpointing breaks in processes. A telephone survey of surviving patients further clarified inadequacies. Using the Plan, Do, Study, Act (PDSA) improvement cycle, inadequacies were identified. Results: Chart review showed that significant side effects from treatment began around the 2nd cycle of Cisplatin in spite of adequate IV hydration following chemotherapy. Inadequate documentation of dietary and speech pathology consultations, patient weight and serum creatinine levels during treatment were noted. Patients reported minimal PEG tube education and infrequent use of PEG tube for hydration. Analysis of post treatment weight and creatinine level revealed a significant change in creatinine clearance. Checking daily weights, speech pathology and dietary consult prior to initiation of therapy, added hydration instructions to EPIC PEG tube instruction sheet, and nurse practitioner education and follow-up in symptom management clinic were part of the PDSA cycle interventions. If 2lb. weight loss, patients were brought in for repeat lab and IV hydration. Conclusions: Patients with advanced head and neck cancer are frail and subject to acute toxicity from chemotherapy. Change in Creatinine Clearance is a sensitive measure of renal damage/likely predictor of non-completion. Post-intervention patients had fewer unplanned admissions leading to lower costs. PDSA helped identify inadequacies in our education and monitoring processes. More post intervention data are needed to determine if true improvement in patient outcomes exist.