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Article
Publication date: 27 July 2012

David Birnbaum, William Jarvis, Peter Pronovost and Roxie Zarate

This paper aims to determine whether the rank order of hospitals changes when their central line‐associated bloodstream infection (CLABSI) rate is computed using a…

Abstract

Purpose

This paper aims to determine whether the rank order of hospitals changes when their central line‐associated bloodstream infection (CLABSI) rate is computed using a traditional proxy measure for the denominator (number of patients with one or more catheter in place) versus using the actual number of catheters or catheter‐lumens.

Design/methodology/approach

The authors conducted a statewide voluntary one‐day prevalence survey among all hospitals participating in Washington State's mandatory public reporting program. Hospitals counted the number of catheters and catheter‐lumens as well as patients with catheters. Counts of patients with one or more catheter in place, of catheters, and of catheter‐lumens were extracted from each hospital's completed survey form and transformed into a ratio. Three CLABSI incidence density rates were computed for each hospital by scaling their annual CLABSI rate in the previous calendar year by the ratio of patients to catheters to catheter‐lumens. Influence of these three different denominators on rank order of the hospitals was assessed by scaling the corresponding Centers for Disease Control and Prevention's National Healthcare Safety Network incidence density rates for each participating hospital and examining position shifts with the Wilcoxon signed rank test.

Findings

Statistically significant but only modest shifts in position became evident, which did not correlate with service complexity characteristics of the hospitals affected.

Originality/value

Others have shown that the CLABSI incidence density rate in a single hospital is significantly affected by switching from a traditional proxy measure denominator to a more meaningful denominator. This is the first report on whether all hospitals' rates would be affected in a uniform or a non‐uniform manner if a different denominator were to be selected by mandatory public reporting programs.

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Book part
Publication date: 24 October 2019

Shreyas S. Limaye and Christina M. Mastrangelo

Healthcare-associated infections (HAIs) are a major cause of concern because of the high levels of associated morbidity, mortality, and cost. In addition, children and…

Abstract

Healthcare-associated infections (HAIs) are a major cause of concern because of the high levels of associated morbidity, mortality, and cost. In addition, children and intensive care unit (ICU) patients are more vulnerable to these infections due to low levels of immunity. Various medical interventions and statistical process control techniques have been suggested to counter the spread of these infections and aid early detection of an infection outbreak. Methods such as hand hygiene help in the prevention of HAIs and are well-documented in the literature. This chapter demonstrates the utilization of a systems methodology to model and validate factors that contribute to the risk of HAIs in a pediatric ICU. It proposes an approach that has three unique aspects: it studies the problem of HAIs as a whole by focusing on several HAIs instead of a single type, it projects the effects of interventions onto the general patient population using the system-level model, and it studies both medical and behavioral interventions and compares their effectiveness. This methodology uses a systems modeling framework that includes simulation, risk analysis, and statistical techniques for studying interventions to reduce the transmission likelihood of HAIs.

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Article
Publication date: 12 July 2011

Max Rolfstam, Wendy Phillips and Elmer Bakker

Public procurement has been increasingly seen as an important innovation policy tool. One neglected aspect of the public procurement of innovation is, however, diffusion…

Abstract

Purpose

Public procurement has been increasingly seen as an important innovation policy tool. One neglected aspect of the public procurement of innovation is, however, diffusion. The purpose of this paper is to counter this neglect by exploring how institutional coordination may affect the diffusion of innovations procured by a public agency.

Design/methodology/approach

A case study including semi‐structured interviews and the consulting of different documents were used to study how institutions and institutional coordination affect the adoption and diffusion of innovation.

Findings

Several endogenous institutions were identified that act as barriers to the diffusion of innovation throughout an organisation. Attempts to re‐design and negate these barriers were also identified.

Research limitations/implications

Institutional analysis of innovation has a tendency to be limited to formal and exogenous institutions. The paper underscores the importance of taking into account the endogenous institutional set‐up. The results are drawn on a single case study.

Practical implications

The understanding of public procurement of innovation needs to be expanded beyond the formal procurement process. Special attention needs to be given to diffusion processes where institutional coordination and re‐design should be considered an important component.

Originality/value

The paper considers diffusion as an important component of public procurement of innovation, and emphasises the importance of the endogenous institutional level both for understanding and for coordinating diffusion, which are two aspects commonly neglected in the literature.

Details

International Journal of Public Sector Management, vol. 24 no. 5
Type: Research Article
ISSN: 0951-3558

Keywords

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Article
Publication date: 4 December 2020

Fei Qi, Bai Chen, Shigang She and Shuyuan Gao

This paper aims to present a shape sensing method and feedback control strategy based on fiber Bragg grating (FBG) sensor to improve the control accuracy of the robot and…

Abstract

Purpose

This paper aims to present a shape sensing method and feedback control strategy based on fiber Bragg grating (FBG) sensor to improve the control accuracy of the robot and ensure the safety of the cardiac interventional surgery.

Design/methodology/approach

To theoretically describe the shape of the catheter robot, the kinematic model is established by the geometric analysis method. And to obtain the actual shape, a large curvature assemble sensor based on FBG is adopted and a novel simple shape reconstruction model is proposed, which can provide the shape curve and distal position. In addition, the influence of external load on the bending deformation is investigated by experiments. To improve the shape accuracy of the robot, a shape feedback control method is presented to control the catheter robot, which can control the robot to bend into the pre-given desired shape.

Findings

Experiment results verify the effectiveness of the shape sensing method and the reconstruction model, and the correlation coefficients of three sets of curve in different coordinate directions are 0.9986, 0.9992 and 0.9999. Results of the shape feedback experiment show that the curvature error and direction angle error are 1.42% and 10.3%, respectively. The continuum catheter robot can be controlled to achieve the desired bending shape.

Originality/value

The shape reconstruction method and feedback control strategy proposed in this paper can improve the control accuracy of the robot to avoid the risk of the collision with the surrounding blood vessels, the tissues and organs.

Details

Industrial Robot: the international journal of robotics research and application, vol. 48 no. 2
Type: Research Article
ISSN: 0143-991X

Keywords

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Article
Publication date: 10 July 2009

Zsolt Badics and Doron Harlev

The purpose of this paper is to describe a numerical inversion technology developed to reconstruct endocardial electric potential maps on the internal surface of heart…

Abstract

Purpose

The purpose of this paper is to describe a numerical inversion technology developed to reconstruct endocardial electric potential maps on the internal surface of heart chambers utilizing intracavitary multi‐electrode catheter measurements. The objective is to perform the reconstruction real time with high accuracy, thereby allowing the incorporation of the technology into medical imaging systems.

Design/methodology/approach

Electrode potential points from several beats are merged in order to maximize the information extracted from the catheter measurements. To solve the ill‐posed inverse problem fast, numerically stable solution algorithms based on generalized Tikhonov regularization and bidiagonalization are developed. The latter algorithm also provides an efficient framework for choosing the regularization parameter optimally.

Findings

Results of three examples are presented to thoroughly illustrate the performance of the algorithm: one with synthetic data generated in a computational electromagnetics (virtual lab) environment, thereby allowing exact error analysis; another with measured data from a phantom‐bench human heart model where the effect of measurement errors can be investigated in a controlled environment; and a third example that illustrates how the algorithm performs when the catheter data are collected in vivo in a swine heart.

Practical implications

The speed and accuracy in the three examples successfully prove that the inversion technology can be a key component of medical imaging systems.

Originality/value

While some elements of these computational models and techniques presented have been used for decades, the authors achieve speed and accuracy that have not been reported before by combining multi‐beat catheter measurements, the generalized Tikhonov regularization technique, a bidiagonalization algorithm and other top‐notch linear algebra techniques.

Details

COMPEL - The international journal for computation and mathematics in electrical and electronic engineering, vol. 28 no. 4
Type: Research Article
ISSN: 0332-1649

Keywords

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Article
Publication date: 19 October 2010

Criona M. Walshe, Kevin S. Boner, Jane Bourke, Rosemary Hone, Maureen Lynch, Liam Delaney and Dermot Phelan

Catheter related blood stream infection (CRBSI) remains an important complication of central venous catheters(CVCs). Educational programmes have been associated with CRBSI…

Abstract

Purpose

Catheter related blood stream infection (CRBSI) remains an important complication of central venous catheters(CVCs). Educational programmes have been associated with CRBSI reduction but evidence in total parenteral nutrition (TPN) patients is limited, despite an increased risk of CRBSI. The effect of educational processes were evaluated and the value of different methods of expression of CRBSI incidence were assessed.

Design/methodology/approach

Study was performed in a 525‐bed tertiary university hospital over 12 years. A multidisciplinary TPN committee was created to examine CRBSI episodes and a parallel education programme was set up and maintained. Prospectively collected data were analysed from 1,392 patients in whom 2,565 CVCs were used over 15,397 CVC days. CRBSI incidence was expressed as CRBSI episodes per 1,000 CVC days, percentage patients or percentage CVCs infected.

Findings

CRBSI incidence fell from 33 to 7 episodes per 1,000 CVC days (p<0.01). Percentage of infected CVCs fell from 17 per cent to 5 per cent(p <0.05) and proportion of patients affected fell from 27 per cent to 7 per cent(p <0.01). The corresponding slopes of the lines expressing fall in CRBSI rate were −1.3‐0.63 and −1.4 respectively.

Research limitations/implications

A sustained educational programme was associated with a significant fall in CRBSI in TPN patients. An incidence of 5‐7 episodes per 1,000 CVC days, a figure comparable with non‐TPN CVCs, was achievable.

Practical implications

Each method of expression of CRBSI incidence proved valid in this setting and contributed to the educational programme.

Originality/value

The value of this study is that it demonstrates how implementing and sustaining an education programme can achieve reduced rates of infection. No published study utilising all methods of expressing CRBSI incidence could be found.

Details

Clinical Governance: An International Journal, vol. 15 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 26 September 2019

Marcello Iasiello, Assunta Andreozzi, Nicola Bianco and Kambiz Vafai

Recently, the porous media theory has been successively proposed for many bioengineering applications. The purpose of this paper is to analyze if the porous media theory…

Abstract

Purpose

Recently, the porous media theory has been successively proposed for many bioengineering applications. The purpose of this paper is to analyze if the porous media theory can be applied to model radiofrequency (RF) cardiac ablation.

Design/methodology/approach

Blood flow, catheter and tissue are modeled. The latter is further divided into a fluid and a solid phase, and porous media equations are used to model them. The heat source term is modeled using the Laplace equation, and the finite element method is used to solve the governing equations under the appropriate boundary conditions and closure coefficients.

Findings

After validation with available literature data, results are shown for different velocities and applied voltages to understand how these parameters affect temperature fields (and necrotic regions).

Research limitations/implications

The model might require further validation with experiments under different conditions after comparisons with available literature. However, this might not be possible due to the experimental complexity.

Practical implications

The improvement in predictions from the model might help the final user, i.e. the surgeon, who uses cardiac ablation to treat arrhythmia.

Originality/value

This is the first time that the porous media theory is applied to RF cardiac ablation. The robustness of the model, in which many variables are taken into account, makes it suitable to better predict temperature fields, and damaged regions, during RF cardiac ablation treatments.

Details

International Journal of Numerical Methods for Heat & Fluid Flow, vol. 30 no. 5
Type: Research Article
ISSN: 0961-5539

Keywords

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Book part
Publication date: 7 October 2019

Jonathan Tummons

Bruno Latour, one of the architects of actor-network theory, has now enfolded this approach within a larger project, An Inquiry into Modes of Existence – AIME. Framed as…

Abstract

Bruno Latour, one of the architects of actor-network theory, has now enfolded this approach within a larger project, An Inquiry into Modes of Existence – AIME. Framed as an empirical inquiry into the ontological and epistemological conditions of modernity, Latour argues for a radical shift in how “objective truth,” “scientific fact,” and “meaning” are established within the world. In this chapter, I draw on several elements of AIME to illustrate how Latour’s ontology, building on, augmenting and responding to criticisms of actor-network theory, can be used to explore higher education, focussing on one episode derived from a larger ethnography of medical education.

Details

Theory and Method in Higher Education Research
Type: Book
ISBN: 978-1-83867-842-5

Keywords

Abstract

Details

Clinical Governance: An International Journal, vol. 13 no. 3
Type: Research Article
ISSN: 1477-7274

Abstract

Details

Clinical Governance: An International Journal, vol. 19 no. 1
Type: Research Article
ISSN: 1477-7274

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