Staff Changes Research Articles

Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial

BackgroundWe previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice.MethodsWe conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework.ResultsThe questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers.ConclusionsWe found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation.Trial registrationClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

THE IMPACT OF CLOUD-BASED MANAGEMENT INFORMATION SYSTEMS ON HRM EFFICIENCY: AN ANALYSIS OF SMALL AND MEDIUM-SIZED ENTERPRISES (SMEs)

Cloud-based management information systems (MIS) are becoming integral to the operational success of small and medium-sized enterprises (SMEs), particularly in enhancing the efficiency of human resource management (HRM) processes. This article, based on a comprehensive review of 75 peer-reviewed studies, investigates how the adoption of cloud-based MIS positively impacts critical HRM functions such as employee management, recruitment, training, and performance monitoring. The findings indicate that cloud-based systems significantly streamline these HR tasks by reducing time, costs, and the administrative burdens traditionally associated with manual or localized HR operations. Moreover, the integration of real-time data analytics through cloud-based platforms enhances decision-making capabilities, enabling HR professionals to make data-driven and timely decisions that improve overall workforce management. The reviewed studies also emphasize that cloud-based MIS are essential for improving strategic HR planning. These systems allow SMEs to access advanced tools for workforce analytics, employee engagement, and performance tracking, which were previously only accessible to larger corporations. The flexibility and scalability offered by cloud-based MIS enable SMEs to quickly adapt to changes in staffing needs, business growth, and external market conditions without the need for costly infrastructure. Furthermore, the review highlights the role of cloud technology in fostering innovation within HR departments by supporting predictive analytics and AI-driven decision-making, which can further enhance operational efficiency. In addition to operational benefits, cloud-based MIS facilitate a more seamless integration of HR functions across geographically dispersed teams, allowing for enhanced collaboration and communication. This capability is especially critical as SMEs continue to adopt remote and hybrid work models.

The Influence of Hospital Physician Integration on Culture of Patient Safety.

Medical errors are responsible for a large number of deaths every year in the Unites States. Hospitals use various strategies including leadership, staffing, and structural changes to deal with this concerning issue. Hospital physician integration is a structural strategy to possibly improve patient safety. Using the conceptual lens of Donabedian's Structure Process Outcome model, this study aims to investigate how hospital physician integration affects organizational, management, and communication attributes of patient safety culture. A pooled cross sectional study design using the Hospital Survey on Patient Safety Culture, the American Hospital Association data, and Area Health Resource File was used to analyze the relationship between hospital physician integration and organizational and management patient safety culture attributes. The dataset comprised of hospital level data from 2021 and 2022 for patient safety culture and hospital characteristics and contained a final sample of 205 observations. The independent variable was levels of integration across five levels. Three attributes of safety culture were chosen-positive perceptions of communication openness, organizational learning, and hospital management support for patient safety. The control variables were organizational characteristics. Multivariable linear regression was used as the analytic method. Findings demonstrated a statistically significant correlation between higher level of hospital physician integration and positive perceptions of hospital management support for patient safety. There are 0.063 higher positive perceptions of hospital management support for patient safety for higher levels of integration compared with lower levels of integration (P < 0.05). Perceptions of communication openness and organizational learning did not demonstrate a statistically significant correlation with any level of hospital physician integration. Hospital physician integration and hospital management support for patient safety were moderately but significantly related. Hospital physician integration allows resources to become available for physician. As physicians take on management roles management of resources and eventually performance can improve, there is a need for future research in this area to examine if integration is a step in the right direction to overcome the challenges of patient safety and if investments in resources and training can be beneficial to safety culture.

Effective Communication Strategies for Business Analysts to Bridge the Gap between IT and Finance

As organizations depend more on technology to stay ahead of the competition, their information technology (IT) and business departments must work together closely. However, cultural differences and understanding between the specialized fields often make it hard for them to work together effectively. If these issues are fixed, they could make it easier to finish projects, stick to budgets, and agree on the company's goals. Many companies use business analysts to help people talk to each other by acting as liaisons knowledgeable in technology and finances. However, there is limited information in the literature about how analysts can connect the tasks. This study fills that gap by looking into the problems when IT and finance work together and suggesting specific steps analysts can take to improve strategic alignment. Looking at past studies shows that common differences make it hard for people to work together. IT and finance use different vocabularies for technical terms and project-based versus financial terms, leading to misunderstandings. They also set other priorities. It emphasizes speed of innovation and technical practicality, while finance emphasizes reducing risk, accuracy, and returns. There are also differences in the amount of knowledge and skill that people in IT and finance have regarding technical solution details and financial effects. They also use different ways to make decisions. IT bases judgments on technological factors, while finance assesses business impact. Besides, cultural norms diverge between the flexible and creative IT culture and the rigorous and methodical finance culture. Business analysts should utilize several focused communication strategies to close these gaps. Creating a shared vocabulary helps terms from diverse fields fit. Regular mapping and stakeholder conversations help you grasp other perspectives. Actively listening, repeating, asking questions, and summarizing shows you comprehend. Educating on decision-making variables and expertise broadens perspectives. Discussing cultural meanings and making sure individuals understand questions improves discussion. Using shared goals like increasing sales or lowering costs is another way to unite people around similar goals. By using these specific methods, business experts can help IT and finance work together despite cultural differences. Mapping and teaching regularly help keep relationships strong even as needs and staff change. By focusing on active listening, aligning vocabulary, and highlighting shared interests, you can build good working relationships necessary to get strategic benefits from technology investments.

Ensure new coaches adhere to pre‐existing medical restrictions for student‐athletes

A recent lawsuit filed by a collegiate football player who claimed that he received substandard medical care and was pressured to participate in excess of his medical restrictions highlights the potential liability concerns that can arise after a staffing change.

Supporting kindergarten staff’s agency in inclusion through long-term in-service training

ABSTRACT Supporting teachers’ agency is essential for implementing inclusive education, as agentic teachers tend to take more responsibility for making a change and focus more on activities that benefit the children they teach. Lack of teacher agency might be one of the reasons why inclusive education has not been applied successfully in kindergartens. In our study, we focused on supporting teacher agency for inclusive education according to the ecological model of agency. Our approach to inclusive education was drawn from the holistic model of inclusive education. We developed an in-service training program to support the three dimensions of agency across different levels outlined in the model of the implementation of inclusive education. The aim of this study was to explore the improvement in participants’ agency during the in-service training program. We applied pre- and post-questionnaires to explore the agency of kindergarten staff members who attended the in-service training program. The results showed statistically significant changes in kindergarten staff’s agency in the iterational and projective dimensions of agency in implementing inclusion. Therefore, we can conclude that a long-term team-based in-service course is effective in supporting teacher agency related to inclusion.

Evaluating and identifying changes in the rate of unplanned discharge among Department of Veterans Affairs (VA) facilities providing substance use disorder residential care

IntroductionQuality improvement (QI) methods play a critical role in ensuring that patients receive high-quality and timely care. Healthcare systems should use valid and reliable measures to inform QI efforts. Mental health settings including substance use disorder (SUD) residential programs have been slow to develop and incorporate quality measurement into routine practice. Unplanned discharge is of particular concern because this event is associated with harm including suicide. Healthcare systems require criteria that they can use to operationalize unplanned discharge as a quality measure in SUD residential programs. MethodsThe study included all discharges from the Department of Veterans Affairs (VA) residential SUD programs between 2018 and 2022. The study calculated crude and adjusted rates of irregular discharge. The study used the first two years of observation (2018–2019) in a logistic regression model to determine the parameter estimates for three important covariates, age, risk for homelessness, and principal diagnosis. The study tested permutations of bin size (N) and days (D) per bin to identify a single set of parameters to enable small and large facilities to have sufficient power to detect out-of-control processes (i.e., significant worsening or improvement in rates). Aligned with standard nomenclature, the study calculated the control limits based on three standard deviations (SD). Values that fell above or below three SD were statistically significant. ResultsThe cohort included 56 facilities (26,361 discharges). Irregular discharge was associated with younger age (18–40 years) and a principal diagnosis of a drug use disorder. Testing parameter values of 100 discharges (N) over 120 days (D) would yield enough power to detect modest relative changes to the irregular discharge rate for small and large facilities while testing frequently enough to make the evaluations temporally relevant. Because secular trends such as staff changes over time will impact results, the quality control method should allow for real-time feedback to those most proximal to the event. ConclusionsThe study created a set of parameters and a methodology that residential SUD programs can use to operationalize unplanned discharge locally. These data could assist programs in conducting QI work to address unplanned discharge and related harms.

Building a culture of safety in Australian residential aged care facilities: protocol for a longitudinal mixed methods research programme

IntroductionThe quality and safety of care within residential aged care facilities (RACFs) have been linked to their organisational culture. However, evidence for understanding and improving culture in this setting is...

One small state university library’s transformation through rightsizing

PurposeAcademic libraries are having to reconsider personnel, collections, space, and budget. This paper provides examples of how rightsizing opportunities in those areas can be approached in a positive way.Design/methodology/approachLibrarians at a small, rural, public university library approached rightsizing as an opportunity to shape the library in positive ways. This paper provides a reflection on those efforts in personnel, collections, space, and budget that have taken place over the past decade at this university, and highlights how the library’s role as the driver of these changes helped foster a positive culture.FindingsThis paper explains the ways the library is viewed both internally and externally as a more student-focused service and location. Examples in this paper may provide ideas for other libraries to utilize in their rightsizing efforts.Originality/valueHistorically, this library encountered forced cuts due to lower than anticipated enrollments and reduced funding from the state. This contributed to low morale and understandably defensive attitudes; however, these did not serve the library well. Post 2013, the library transitioned to a self-initiated approach to making changes. Some of these changes came about due to stagnation in budgets while others can be attributed to changes in staff due to retirements and new hires. Through this shift to proactive rightsizing, our library team has recognized we are adaptable and nimble. This has benefitted morale and helped the library grow a positive reputation on campus.

Evolving through multiple, co-existing pressures to change: a case study of self-organization in primary care during the COVID-19 pandemic in Canada

BackgroundPrimary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time.MethodologyWe completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic.FindingsRe-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period.ConclusionsThrough insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.

Probation practice and attention-deficit hyperactivity disorder.

Twenty-one Community Rehabilitation Companies were set up following the division of the National Probation Services during 'Transforming Rehabilitation' in England and Wales, under a 2013 Ministry of Justice initiative. Reunification commenced in 2018. A study completed prior to these changes suggested that probation officers had had little training in recognising attention-deficit hyperactivity disorder (ADHD) and may have been underestimating its prevalence among their clientele. Given the substantial changes in probation staffing and organisation since 2018, a new study seems warranted. The aim of the study was to understand experiences of people under a community sentence who reported having ADHD and of probation staff working with them. Using a qualitative research design, one-to-one semi-structured interviews were conducted with client facing probation staff recruited from one Community Rehabilitation Company. Service users undertaking a community sentence who had been diagnosed with or self-identified as having ADHD were then identified and recruited by these staff; those who consented were also interviewed. Transcripts were analysed using a thematic analytic approach. Thirteen probation staff and six male offenders under community sentences, agreed to participate and completed interviews. The overarching themes emerging from the two groups were similar, both reflecting on descriptions of ADHD; treatment of ADHD; experiences of having or working with ADHD in the wider community and in the criminal justice system specifically and visions of future support needs tied to the order. In addition, probation officers specifically raised the matter of payment by results. Both service users and probation staff identified gaps in knowledge, experience and services, but areas of good practice were also identified. The findings highlight the continuing under-acknowledgement of tailored clinical support for people serving a community sentence who have ADHD together with a lack of support and training about ADHD for probation staff. Return to the national organisation of probation services and recognition of need for a range of relevant skills offers a great opportunity for re-evaluating supervision and management of offenders under community sentences who have ADHD. These findings provide the basis for a template for developing knowledge and support provision for probation staff to recognise ADHD, or its likelihood, and their capacity to follow through with appropriately informed personalised supervision plans and access to specialist service advice and support.

P-723 Egg-conomized frozen embryo transfer

Abstract Study question Is home-based monitoring of ovulation cost effective compared with hospital-controlled ovulation in women undergoing frozen embryo transfer in the natural cycle? Summary answer Home-based monitoring to time frozen-embryo-transfer is cost-effective compared to hospital-controlled ovulation, as it results in lower cost with no difference in ongoing pregnancy rates. What is known already Women undergoing frozen embryo transfer treated by home-based monitoring of ovulation or hospital-controlled ovulation have comparable ongoing pregnancy rates. We found no differences in secondary outcomes, including the risk of undetected ovulation. Complete home-based monitoring of ovulation with LH hormone kits is feasible and requires no hospital visits at lower costs since ultrasound monitoring and hCG injection are no longer needed. Both consequences imply potentially lower costs after home-based monitoring of ovulation. Study design, size, duration We performed an economic evaluation of home-based monitoring of ovulation compared with hospital-controlled ovulation in a national multicentre randomised controlled trial in women undergoing frozen embryo transfer (ANTARCTICA-2 RCT Dutch TrialRegister Trial NL6414). 1464 women were randomly assigned between April 10, 2018, and April 13, 2022, with 732 allocated to home-based monitoring and 732 to hospital-controlled monitoring. All randomized patients were included according to the intention-to-treat principle. Participants/materials, setting, methods We performed a cost-effectiveness analysis from a hospital and societal perspective. We compared the direct medical costs of home-based monitoring of ovulation and hospital-controlled ovulation during one cycle until an ongoing pregnancy occurred. Direct medical costs included digital ovulation tests, transvaginal ultrasound monitoring of the dominant follicle followed by hCG trigger, hormone measurements in blood, treatment for miscarriage or ectopic pregnancy. Nonparametric bootstrapping was used to calculate cost estimates and differences with 95% confidence intervals. Main results and the role of chance Ongoing pregnancy rates were 20·8% in the home-based monitoring group and 20·9% in the hospital-controlled group (risk ratio [RR] 0·99 [90% CI 0·81 to 1·22]; risk difference [RD] -0·14 [90% CI -3·63 to 3·36]). No differences in ectopic pregnancies or miscarriages were found. Home-based monitoring required less travelling to the hospital, less ultrasounds by doctors or nurses, less hormone measurements in blood, and less medication (hCG injections). Mean direct medical costs per woman in the home-based monitoring of ovulation group and in the hospital-controlled ovulation group were €752 versus €991, respectively, with a mean difference of €239. The ICER consistently showed home-based monitoring to be less costly with no difference in effectiveness. Consequently, the cost difference from a societal perspective was larger. The mean costs per woman in the home-based monitoring of ovulation group and in the hospital-controlled ovulation group were €787 versus €1395, respectively, with a mean difference of €607 in favour of home-based monitoring. Limitations, reasons for caution We report on one cycle per women. Women usually undergomultiple frozen-embryo-cycles. This is of importance for clinical decision making aboutimplementation of home-based monitoring, since the cumulative benefit of multiple cycles perwoman should be taken into account. Wider implications of the findings The results of our trial show that home-based monitoring time frozen embryo transfer is equally effective but less costly compared with hospital-controlled ovulation. In this era of climate change and shortages of hospital staff and waiting lists, any process that takes less human labour is important. Trial registration number Dutch Trial Register (Trial NL6414)

846 Implant Waste and Associated Costs in Trauma and Orthopaedic Surgery: A Systematic Review

Abstract Aim Trauma and orthopaedic (T&amp;O) surgery relies heavily on medical devices of different unrecyclable materials. This specialty generates significant metalwork wastage through implants, screws, nails and plates, placing a large economical strain on healthcare. Finding sustainable solutions is vital given globally increasing life expectancies and heavier dependency on invasive interventions, such a knee or hip arthroplasties. Our primary outcome is to quantify implant wastage across the literature, and secondarily investigate the associated costs. Method PRISMA guidelines were followed in the design, conduct and reporting. We searched through three databases (Scopus, PubMed and Embase) using MeSh terms including “implant waste” and “trauma and orthopaedic surgery”. We included observational and randomised controlled trials reporting patients undergoing T&amp;O surgery, where the wastage or associated costs was provided. Results Our final analysis included 15 articles, screened from a total of 2,145 articles. 25,025 procedures were included, but there was limited and unmatched data. Implant waste ranged, occurring in 0.8%-25.1% procedures and costing on average $167,139.13. Screws and nails were amongst the most wasted material (up to 91% and 48% respectively), however intramedullary nails were the greatest cost contributor, making up to 47.6% of total wastage cost. Up to 95% of waste was attributable to human error. Conclusions Balancing implant wastage and hospital costs with patient safety is a challenge for many T&amp;O subspecialties. The largest factors contributing to waste were human factors, such as surgeon or staff error, miscommunication and changing decision. We hope this review will inform future guidelines in encouraging implant waste mindfulness.

Changes in Antibiotic Use and Disruptions to Antimicrobial Resistance Detection in South Africa and Uganda, 2019 – 2020

Background: The COVID-19 pandemic disrupted routine health services worldwide, including systems to detect antimicrobial resistance (AR). AR is a mounting global health threat with some studies showing the highest mortality rate from AR infection is in Sub-Saharan Africa (SSA). Antibiotic use is a major contributor to AR. We sought to characterize COVID-19-related changes to antibiotic use and AR detection capacity in two countries in SSA from 2019 to 2020. Methods: Health facilities (HF) in South Africa and Uganda were surveyed as part of a larger study assessing disruptions to essential health services in SSA in the context of COVID-19. Modified stratified random sampling of HF by facility level was conducted in regions with high COVID-19 cumulative prevalence. Hospital pharmacists were surveyed to identify perceived changes in antibiotic use. Among facilities with the capacity to detect AR, surveys were conducted with AR laboratory managers to identify perceived changes in staff, equipment, training, and supplies. Descriptive data analysis was conducted using frequencies and proportions. Results: A total of 39 HFs in South Africa and 45 HFs in Uganda responded to the antibiotic use survey. Increases in total antibiotic use from 2019 to 2020 were reported by 82% (23/28) of HF in South Africa and 68% (27/40) in Uganda. Increased use of antibiotics for multi-drug resistant bacteria (per World Health Organization Reserve classification) was reported by 36% (9/25) and 38% (8/21) of HFs in South Africa and Uganda, respectively. 19 HFs in South Africa and 12 HFs in Uganda responded to the AR detection capacity survey. HFs in both countries reported decreases in laboratory staff responsible for AR (33% [13/40] in South Africa and 31% [11/35] in Uganda). Decreased availability of reagents and consumables for bacteriology and antimicrobial susceptibility testing was reported by 50% (8/16) and 33% (4/12) of HFs, and decreased availability of specimen collection supplies for bacterial cultures was reported by 41% (7/17) and 42% (5/12) of HFs in South Africa and Uganda, respectively. Diversion of laboratory supplies was reported in both countries (32% [6/19] in South Africa and 25% [3/12] of HF in Uganda). Conclusions: HFs in South Africa and Uganda reported increases in antibiotic prescribing, a risk factor for increased AR, concurrently with disruptions in AR detection capacity during the early phases of the COVID-19 pandemic. These findings emphasize the importance of investing in bacteriology and AR testing in SSA and maintaining support during infectious disease pandemics.

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes.

The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences. To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications. We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice. From 96 included patients, seven didn't receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic-related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies. Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.

Surgical Intraoperative Handoff Initiative: Standardizing Operating Room Communication Using SHRIMPS.

Operating room (OR) handoffs are not universally standardized, although standardized sign outs have been proven to provide effective communication in other aspects of healthcare. We hypothesize that creating a standardized handoff will improve communication between OR staff. A frontline stakeholder approached our quality improvement team with concern regarding inadequate quality surgical technician handoffs during staff changes. An audit tool was created for a pilot cohort of 23 cases to evaluate surgical technician handoffs from May 2022 to November 2022. Handoffs occurred in 82.6% of cases. Elements of handoff varied significantly, with an average of 34.4% completion of critical handoff elements. Audits were reviewed with stakeholders to develop a standardized communication checklist, including domains regarding sponges, sharps, hidden items, replaced items, instruments, implants, medications, procedure overview, and specimens. An acronym of these domains, SHRIMPS, was affixed to each OR wall. In the initial Plan-Do-Study-Act cycle, piloted in urology, general surgery, and neurosurgery, 100% of the 15 observed cases included handoff, averaging 76 seconds per handoff. Additionally, 100% of cases announced a handoff to the surgeon, and all elements were addressed 99.6% of the time. Plan-Do-Study-Act cycle 2 involved implementation to all service lines. Of the 68 cases observed, 100% included handoff, averaging 69.4 seconds per handoff, with 98.2% of elements addressed, though only 97.1% of handoffs were announced. Little communication standardization exists within the OR, especially regarding intraoperative staff changes. Implementation of a standardized handoff between surgical technicians resulted in substantial improvement in critical communication during staff changes.

Decoding the Cloud Giants: A Comparison of AWS, Azure and GCP

The adoption of cloud services by companies and organizations is increasingly becoming essential for enhancing competitive performance in today's business environment. Cloud services represent a relatively new technological advancement. However, selecting the optimal cloud service to meet specific requirements remains one of the most significant challenges. Major commercial entities, including Amazon AWS, Microsoft Azure, and Google Cloud, provide a variety of cloud services through dedicated, reliable, and cost-effective web applications. These cloud services attract a diverse range of users and organizations across various sectors, such as healthcare, business, and education. This article aims to introduce cloud customers to the most prominent cloud services. Additionally, we explore the concept of cloud computing, defined as the delivery of computing resources over the Internet. Leading cloud service providers such as Microsoft Azure, Amazon Web Services (AWS), and Google Cloud Platform (GCP) offer on-demand cloud solutions, including processing power, memory, and databases, alleviating the need for users to invest in, operate, and maintain physical computers, hardware, and servers. This study compares the performance and services of three major cloud platforms—Google Cloud Platform, Amazon AWS, and Microsoft Azure—as well as their architectures and types of cloud services. Cloud technology allows resources to be dynamically scaled without the need for significant changes in infrastructure, additional staffing, or new software development.

Digitalization and care relationships of people living alone in old age: acritical analysis of policy documents

Digitalization is transforming social life and relationships. New cultural ideas of care, cooperation and reciprocity are emerging that can create challenges for older people. These are particularly poignant for older people living alone, who use digital devices less frequently and rely on support to manage the increasing number of digital tasks (appointments, bookings, financial matters). This article explores the relationship between digitalization and care relationships among older people living alone using acritical document analysis approach according to Bacchi. This approach makes it possible to look at the understanding behind the terms living alone, care relationships, and digitalization, each in relation to older people and in interaction as well as to render gaps visible. The analysis of laws and social policies as well as of political and civil society orientated documents leads to two key findings: Firstly, an individual responsibility to deal with needs arising from gaining access to and handling of digitalization is expected of older people and their social networks. This is striking as digitalization is presented as ameans of dealing with the large-scale social challenges, such as demographic change and shortage of care staff. Secondly, the analysis shows that legal documents that set out the structure for policies do not focus on digitalization in later life. With older people not being atarget group of policy of digitalization, fewer strategies are put into practice.

История и перспективы развития специальной психологии: к 100-летию со дня рождения В.И.Лубовского

&lt;p&gt;The article presents a historical overview of the formation of special psychology as a special direction of psychological science, in which Vladimir I. Lubovsky played a key role. V.I. Lubovsky headed for a long time at the Research Institute of Defectology and became the organizer and first head of the Department of Special Psychology at Moscow State University of Psychology and Education. The article describes the stages of development of the department, changes in the teaching staff, changes in various educational programs and areas implemented as part of the training of specialists for psychological and pedagogical support of children with developmental disorders. The Faculty of Clinical and Special Psychology of Moscow State University of Psychology and Education continues to develop, preserving the traditions laid down by V.I. Lubovsky. The article examines the current state of special psychology and its prospects, notes current problems of special psychology, once formulated by V.I. Lubovsky: the development of early special psychological services, the study of the possibilities and conditions for the integration of children with developmental disabilities into educational institutions, the development of a unified approach to the use terminology. All the identified problems are of current importance to this day; they are being reviewed in the context of the development of inclusive education in our country.&lt;/p&gt;

Первый выпуск возрожденной Саратовской духовной семинарии 1947–1951 годов: начальствующие, учащие и учащиеся

This article is devoted to the study of the revival process of theological education in the conditions of pressure on the Russian Orthodox Church of the atheistic Soviet state, using the example of the first graduates of the Saratov Theological Seminary, revived in 1947. The article shows the traditions and problems inherited from the pre-revolutionary Saratov Theological Seminary, and new challenges dictated by the godless atheistic state. Changes in the teaching staff of the seminary during the period under study and their impact on the process of education and upbringing of seminarians are considered. The results of teaching the seminarians are illustrated by the memories of colleagues and parishioners, reviews of the clergy, and archival documents of the authorized of the Council for the Affairs of the Russian Orthodox Church (hereinafter referred to as the Council). Based on the analysis of the first seminary graduates’ destiny, a conclusion was made about the effectiveness of the educational process at the Saratov Theological Seminary in 1947–1951.