Preliminary Experience of a PDCA-Cycle and Quality Management Based Training Curriculum for Rat Liver Transplantation

Significance of Ongoing Training and Professional Development in Optimizing Healthcare-associated Infection Prevention and Control

The employees who work in infection prevention and control (IPC) are very important in the field of health-care because they are committed to protecting patients, staff, and visitors from the risk of acquiring infections while in the hospital. The complexity of infection control in hospitals is alwaysgrowing in tandem with the rapid developments that are being made in medical technology andpractices. IPC personnel are required to maintain vigilance and continually improve their monitoringof the entire health-care process due to the ongoing development of IPC guidelines and regulations, the fluctuating infection risks, and the emergence of new infectious diseases. As a result, individuals involved in the prevention and control of infections in health-care settings absolutely need to participate in continual training and professional development. This reviewemphasizes the need of relevant professionals to engage in ongoing training and professional development to maintain their skills in the area of healthcare-associated infection control and prevention. Personnel working in IPC may more effectively react to newly discovered health risks andmake certain that hospital infection (HI) management gets the appropriate attention if they have atimely and in-depth awareness of best practices. They are better able to maintain their composure, react correctly, and deliver the most effective infection control and prevention techniques for the health-care system, all while increasing awareness about the significance of effective HI management.

Head and neck cancer patient journey's health literacy: a multidisciplinary team perspective. VOICE study

PURPOSE

Health literacy is a current Public Health priority in Portugal. The participation of well-informed patients in their care and shared decision making are essential, especially in chronic aggressive and debilitating pathologies such as recurrent or metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC).

AIMS

This study aimed to characterize R/M HNSCC patients' and caregivers' information needs identified by healthcare professionals (HCPs).

METHODS

Two online Focus Groups, one with only medical doctors and the other with other HCPs involved in the treatment of R/M HNSCC patients, were conducted, using a modified Metaplan, Lean or adapted PDCA methodology. The discussions were audio recorded in full and content analysis was performed using ATLAS.ti qualitative data analysis software.

RESULTS

Topics addressed were diagnosis, treatment, quality of life, and global evaluation. In general, all experts agreed that only essential information should be cautiously given, according to patients' and caregivers' wishes. It was consensual that patients are given the necessary information to adhere to treatment. Two main barriers were identified: one barrier was associated with verbal communication due to the lack of health literacy of these patients, and the other barrier regarded healthcare access. It was also considered important to remind patients of the daily and social activities that they could and should maintain, as well as providing sufficient social resources and problem-solving training to caregivers.

CONCLUSIONS

This qualitative study highlights the complexity of R/M HNSCC patients' care. Immediate availability of psychologists and psychiatrists should be implemented in all centers that treat HNSCC patients. The differences found between the physicians' Focus Group and other HCPs' Focus Group in some of the addressed topics emphasize the importance of a multidisciplinary and holistic approach, in a biomedical model integrated with a biopsychosocial model.

A PDCA Model for Disinfection Supply Rooms in the Context of Artificial Intelligence to Reduce the Incidence of Adverse Events and Improve the Disinfection Compliance Rate

As an important section for controlling hospital infection, the main responsibility of the sterilization supply room is to clean, disinfect, sterilize, store, and distribute all medical devices that need to be reused in the hospital, and the quality of its work is closely related to the normal work of the hospital. Disinfection and supply department is the premise and foundation of the hospital department, mainly responsible for the recovery, cleaning, disinfection, sterilization, storage, and distribution of medical devices. The cleaning and disinfection work is characterized by strong technicality and high requirements, and the work effect is directly related to the safety of patients' lives and the occurrence of hospital infections. Therefore, there is an urgent need for a scientific and efficient management mode to be applied to the work of the supply room. The traditional management mode has some drawbacks, which affects the actual work of the hospital. Disinfection and supply rooms are an important part of hospital infection control and an important department to ensure the quality of health care. An effective management mode can not only improve the efficiency but also the overall quality of work, and PDCA (plan-do-check action cycle) as an advanced management mode can effectively improve the quality of management. This study investigates the effect of PDCA cycle management based on artificial intelligence algorithms in the nursing management of sterile supply rooms, and the experimental results show that the algorithm model can effectively reduce the incidence of adverse events and improve the rate of sterilization standards, which has certain practical significance.

Usefulness of a stepwise training program for laparoscopic gastrectomy

INTRODUCTION

Laparoscopic gastrectomy (LG) is a complicated procedure with a long learning curve. This study was performed to investigate the usefulness of our stepwise training program for LG for improving the quality of the surgery.

METHODS

The stepwise training method comprised the following four steps: (1) basic training using a dry box and checking by mentors; (2) advanced training, including the use of animals and cadavers; (3) clinical experience, including standardization and preoperative three-dimensional simulation; and (4) self-assessment and feedback. In total, 153 patients who underwent curative gastrectomy for gastric cancer were included in this study.

RESULTS

The operative time gradually decreased for both laparoscopic distal gastrectomy (LDG) (2013, 395 minutes; 2017, 278 minutes; P < .001; ρ = -0.68) and laparoscopic total gastrectomy (LTG) (2013, 476 minutes; 2017, 319 minutes; P < .001; ρ = -0.56). The blood loss volume gradually decreased for both LDG (2013, 43.0 mL; 2017, 18.6 mL; P < .005; ρ = -0.30) and LTG (2013, 143.8 mL; 2017, 13.5 mL; P < .005; ρ = -0.41).

CONCLUSIONS

Our stepwise training program contributes to reduce operation time and blood loss in LG.

Human Resource Abilities and Skills in TQM for Sustainable Enterprises

Total quality management (TQM) is a lean manufacturing tool that focuses on ensuring the production of goods that meet design specifications and give customer satisfaction, both attractive benefits highly appreciated by managers. However, there are several factors involved in the success of TQM programs, many of which are cultural aspects associated with human resources (HR). This article presents a structural equation model that integrates three latent variables related to internal HR: “managerial commitment,” “employee integration,” and “training and education,” which are linked to the operational benefits of a manufacturing system. The variables are connected through six hypotheses that have been validated with information obtained from 398 responses of a questionnaire applied to manufacturing industry professionals. In addition, a sensitivity analysis was carried out to describe the probabilities of occurrence for the variables at low and high levels. The hypotheses were statistically validated with the partial least squared technique, where the results showed that human factors play an essential role in the success of TQM, since the direct, indirect, and total effects of managerial commitment, employee integration and training, and education processes on the benefits obtained from the implementation of TQM were statistically significant at 95% confidence.

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. To better understand the mechanism behind these surgical procedures, a rat partial liver transplantation (PLTx) model was established for relevant surgical studies. Because of the complexity of the rat PLTx model, a protocol with detailed descriptions is required. An article published previously reported a protocol in which ex vivo hepatectomy was used to achieve 50% rat PLTx. In contrast to this protocol, we introduced a re-arterialized PLTx with an in vivo 70% hepatectomy. An updated vessel-oriented hepatectomy was incorporated into the rat PLTx to refine the microsurgical procedure. The portal veins and hepatic arteries of the left lateral lobe and the median lobe were individually dissected and ligated before removal of the liver parenchyma, thereby decreasing the probability of bleeding in the remnant liver stump. Furthermore, an end-to-side vessel anastomosis between the common hepatic artery and the enlarged proper hepatic artery was introduced to re-arterialize the hepatic artery. By using this end-to-side vessel anastomosis technique, the diameter of the anastomosis was enlarged, thereby decreasing the difficulty of hand suture and maintaining a high rate of anastomotic patency. Moreover, the cuff anastomosis of the infrahepatic vena cava was slightly modified. A section of circumferential liver parenchyma around the vena cava of a recipient was preserved during cuff anastomosis to maintain the three-dimensional shape of the vascular lumen. This section of liver parenchyma was removed after completing the anastomosis. With this modification, the step involving placement of stay sutures was omitted, thereby further shortening the cuff anastomosis time. By using this protocol of rat PLTx, a low liver enzyme level, an intact liver lobular architecture and a high survival rate were achieved after microsurgery.

Defining Standards in Experimental Microsurgical Training: Recommendations of the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM)

Background: Expectations towards surgeons in modern surgical practice are extremely high with minimal complication rates and maximal patient safety as paramount objectives. Both of these aims are highly dependent on individual technical skills that require sustained, focused, and efficient training outside the clinical environment. At the same time, there is an increasing moral and ethical pressure to reduce the use of animals in research and training, which has fundamentally changed the practice of microsurgical training and research. Various animal models were introduced and widely used during the mid-20th century, the pioneering era of experimental microsurgery. Since then, high numbers of ex vivo training concepts and quality control measures have been proposed, all aiming to reduce the number of animals without compromising quality and outcome of training. Summary: Numerous microsurgical training courses are available worldwide, but there is no general agreement concerning the standardization of microsurgical training. The major aim of this literature review and recommendation is to give an overview of various aspects of microsurgical training. We introduce here the findings of a previous survey-based analysis of microsurgical courses within our network. Basic principles behind microsurgical training (3Rs, good laboratory practice, 3Cs), considerations around various microsurgical training models, as well as several skill assessment tools are discussed. Recommendations are formulated following intense discussions within the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM), based on scientific literature as well as on several decades of experience in the field of experimental (micro)surgery and preclinical research, represented by the contributing authors. Key Messages: Although ex vivo models are crucial for the replacement and reduction of live animal use, living animals are still indispensable at every level of training which aims at more than just a basic introduction to microsurgical techniques. Modern, competency-based microsurgical training is multi-level, implementing different objective assessment tools as outcome measures. A clear consensus on fundamental principles of microsurgical training and more active international collaboration for the sake of standardization are urgently needed.

Proposing a two-criterion quality loss function using critical process capability indices

Purpose

Average quadratic quality loss function (QQLF) measures quality of a given process using mean shift from its target value and variance. While it has a target parameter for the mean, it lacks a target for the variance revisable for counting any progress of the process across different quality levels, above/below the standard level; thus, it appears too general. Hence, in this research, it was initially supposed that all processes are located at two possible quality spaces, above/below the standard level. The purpose of this paper is to propose a two-criterion QQLF, in which each criterion is specifically proper to one of the quality spaces.

Design/methodology/approach

Since 1.33 is a literarily standard or satisfactory value for two most important process capability indicesCpandCpk, its upper/lower spaces are assumed as high-/low-quality spaces. Then the indices are integrated into traditional QQLF, of type nominal the best (NTB), to develop a two-criterion QQLF, in which each criterion is more suitable for each quality space. These two criteria have also been innovatively embedded in the plan-do-check-act (PDCA) cycle to help continuous improvement. Finally, the proposed function has been examined in comparison with the traditional one in Feiz Hospital in the province of Isfahan, Iran.

Findings

Results indicate that the internal process of the studied case is placed on the lower quality space. So the first criterion of revised QQLF gives a more relevant evaluation for that process, compared with the traditional function. Moreover, this study has embedded both proposed criteria in the PDCA cycle as well.

Research limitations/implications

Formulating the two-criterion QQLF only for observations of normal and symmetric distributions, and offering it solely for NTB characteristics are limitations of this study.

Practical implications

Two more relevant quality loss criteria have been formulated for each process (service or manufacturing). However, in order to show the comprehensiveness of the proposed method even in service institutes, emergency function of Feiz Hospital has been examined.

Originality/value

The traditional loss function of type NTB merely and implicitly targets zero defect for variance. In fact, it calculates quality loss of all processes placed on different quality spaces using a same measure. This study, however, provides a practitioner with opportunity of targeting excellent or satisfactory targets.

Improving Research Practice in Rat Orthotopic and Partial Orthotopic Liver Transplantation: A Review, Recommendation, and Publication Guide

Background: Due to a worldwide shortage of donor organs for liver transplantation, alternative approaches, such as split and living donor liver transplantations, were introduced to increase the donor pool and reduce mortality on liver transplant waiting lists. Numerous details concerning the mechanisms and pathophysiology of liver regeneration, small-for-size syndrome, rejection, and tolerance in partial liver transplantation facilitated the development of various animal models. The high number of preclinical animal studies contributed enormously to our understanding of many clinical aspects of living donor and partial liver transplantations. Summary: Microsurgical rat models of partial orthotopic liver transplantation are well established and widely used. Nevertheless, several issues regarding this procedure are controversial, not clarified, or not yet properly standardized (graft rearterialization, size reduction techniques, etc.). The major aim of this literature review is to give the reader a current overview of rat orthotopic liver transplantation models with a special focus on partial liver transplantation. The aspects of model evolution, microsurgical training, and different technical problems are analyzed and discussed in detail. Our further aim in this paper is to elaborate a detailed publication guide in order to improve the quality of reporting in the field of rat liver transplantation according to the ARRIVE guidelines and the 3R principle. Key Messages: Partial orthotopic liver transplantation in rats is an indispensable, reliable, and cost-efficient model for transplantation research. A certain consensus on different technical issues and a significant improvement in scientific reporting are essential to improve transparency and comparability in this field as well as to foster refinement.

[Video-based self-control in surgical teaching. A new tool in a new concept]

BACKGROUND

Image and video-based results and process control are essential tools of a new teaching concept for conveying surgical skills. The new teaching concept integrates approved teaching principles and new media.

METHOD

Every performance of exercises is videotaped and the result photographically recorded. The quality of the process and result becomes accessible for an analysis by the teacher and the student/learner. The learner is instructed to perform a criteria-based self-analysis of the video and image material by themselves.

RESULTS

The new learning concept has so far been successfully applied in seven rounds within the newly designed modular class "Intensivkurs Chirurgische Techniken" (Intensive training of surgical techniques). Result documentation and analysis via digital picture was completed by almost every student. The quality of the results was high. Interestingly the result quality did not correlate with the time needed for the exercise. The training success had a lasting effect.

CONCLUSION

The new and elaborate concept improves the quality of teaching. In the long run resources for patient care should be saved when training students according to this concept prior to performing tasks in the operating theater. These resources should be allocated for further refining innovative teaching concepts.

Appropriateness of administration of nasogastric medication and preliminary intervention

A utilization study was performed in a 2200-bed tertiary care teaching hospital. Data mining was performed on all nasogastric medication prescriptions for patients hospitalized in 2011. Nurses were interviewed by questionnaire. A PDCA (Plan-Do-Check-Act) cycle was used for continuous quality improvement. The proportion of patients with nasogastric tubes (NGT) was 3.2%. A large number of medical orders (n = 6261) involved nasogastric medications with a package insert particularly noting that they should not be crushed or opened (group 1) or medications without a specific formulation recommendation in the package insert but having evidence discouraging NGT dosing (group 2). Of the nasogastrically administered sustained-release or controlled-release formulations, a sustained-release sodium valproate tablet formulation was the most prescribed drug and a sustained-release 2.5 mg felodipine tablet was prescribed with the highest proportion of NGT dosing [NGT/(NGT + oral) = 12.3%]. Among the nasogastrically administered enteric-coated formulations, a myrtol-standardized enteric-coated capsule formulation was the most prescribed drug and a pantoprazole tablet formulation was prescribed with the highest proportion of NGT dosing [NGT/(NGT + oral) = 19.3%]. Proportions of NGT dosing for amiodarone and carbamazepine (group 2) were 4.8% and 6.3%, respectively. The percentage of nurses with adequate knowledge about pharmaceutical dosage formulations was 60%. The rate of answering correctly as to whether medications in group 1 could be crushed or opened was only 30%. Awareness of evidence discouraging NGT dosing of medications in group 2 was zero. Most nurses (90%) left physicians and pharmacists with the entire responsibility for knowledge and decision-making concerning route of drug administration. After a 3-month preliminary intervention, irrational medical orders involving nasogastric administration of medications in group 1 were successfully abolished. The rate of answering correctly as to whether medications in group 1 could be crushed or opened increased to 100%. This utilization study indicates poor awareness concerning nasogastric administration of medication on the part of physicians and nurses, and preliminary intervention measures were efficient in improving knowledge through team cooperation and effort.