OBJECTIVE: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the operating room (OR) - touting surgical site infections (SSIs) and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature. BACKGROUND DATA: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomy. METHODS: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented SSIs. Articles that satisfied the following criteria were included: (1) studies looking at personal items in the OR, such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, but not just OR equipment; and (2) the primary outcome measure was infection at the surgical site. RESULTS: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for SSIs. Only one article examined the correlation between a personal item near the operative site and SSI, concluding that wedding rings worn in the OR had no impact on SSIs. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to SSI in any of these studies. CONCLUSION: There is no objective evidence to suggest that personal items in the OR increase risk for SSIs.

Designing a safe and economical mining activity is the main goal of every mine design engineer. With the rise of computer modeling in mine design there is a need for a standardized method to use geologic characterization of rocks in engineering design. In this research, first a review of empirical methods will be conducted and after that a step-by-step method is presented to adequately use FLAC3D, for development pillars, in room and pillar mine in development stage. ARMPS database is used to evaluate the FLAC3D model results. ARMPS database consists of 645 case study in room and pillar mines. 170 of them are mines in development phase. In this research all 170 cases will be analyzed in FLAC3D v4.0 and the results will be compared to actual success and failure from the database. Also, the stability factor found from FLAC3D will be compared to ARMPS. Finally, it is tried to calibrate FLAC3D stability factor so it can be used in room and pillar design.

Approximately 65% of all surgeries are conducted in the outpatient surgery setting involving more than 35 million patients. Thirty-five to fifty percent of these outpatients will experience post discharge nausea and vomiting (PDNV), nausea and vomiting that occurs after discharge from the health care facility after surgery. A dearth of literature details the problems associated with nausea and vomiting experienced by patients after discharge home from outpatient surgery. The purposes of this dissertation were to (1) review the current knowledge in the area of post discharge nausea and vomiting; (2) present results of an integrative review of the research literature to determine best evidence for prevention of PDNV in adults or rescue of patients who suffer from post discharge nausea and vomiting (PDNV); (3) present a critical review and analysis of measurement of nausea and vomiting after discharge from outpatient surgery, and (4) present findings of a prospective research study. The purposes of the research study were to: 1) describe the incidence and severity of PDNV over a 7-day period in a sample of adult surgical patients undergoing outpatient surgeries under general anesthesia, 2) describe the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, 3) compare the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and 4) determine outcomes associated with PDNV. This study was part of a multi-site study that had as a primary objective development of a simplified risk model for predicting patients most likely to suffer PDNV. In this research study we described the incidence and severity of PDNV in adult outpatients after ambulatory surgery, described the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, compared the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and determined outcomes associated with PDNV.

Large opencast coal mines require a complex infrastructure to fulfill production demand and quality values. The distinct specifications required by each customer are achieved by blending adjustments. There is limited control in variability. With only partial information available, operation controllers blend coal by empirical approximation, trying to keep quality between acceptable ranges in order to avoid penalizations, shipment rejections or even contract suspensions. When a decision support system (DSS) centralized in a control room is used for blending control, crew operators visualize enhanced displays of the different sources of information, obtaining a holistic perspective of operations. Using a simulator to reproduce the blending sequence, crew operators can experiment with diverse what-if scenarios and develop blending strategies for an entire working shift, in which they also incorporate their own expertise and the knowledge obtained after interpreting the simulation results. The research focuses on the empirical analysis of the effectiveness of the DSS by studying the performance of crew users in different operating scenarios produced with a simulator. The development of a methodology for measuring this effectiveness and its impact in the quantification of controlling the variability of blending represents a significant contribution in the area of quality improvement for coal production. The effectiveness of the DSS for controlling the blending and load out processes has been numerically measured after experimenting diverse simulated scenarios, proving that the difference between estimated and actual quality delivered is narrower when using a DSS, in comparison with the BTU variability obtained from historical data. The strategies that produced better results in terms of control of coal quality variability, maximization of infrastructure utilization, time spent in making decisions and the minimization of risk for penalizations and rejections, were scored proportionally to the benefits obtained.

Bakgrund: Att arbeta i en miljö där hälsofarlig rök och risk för smitta förekommer innebär en risk för operationssjuksköterskans hälsa. På universitetssjukhuset finns riktlinjer om när mun- och andningsskydd ska användas. Syfte: Att undersöka om operationssjuksköterskorna på universitetssjukhuset har fullgoda kunskaper om sjukhusets riktlinjer angående mun- och andningsskydd. Att undersöka förutsättningarna för operationssjuksköterskorna att kunna följa riktlinjerna, deras upplevelse av riktlinjernas tillgänglighet samt vilka faktorer som avgör operationssjuksköterskornas val av mun- och andningsskydd. Metod: Studien är en deskriptiv enkätstudie med tvärsnittsdesign och kvantitativ ansats. Enkäter delades ut till operationssjuksköterskor på universitetssjukhuset vilka är verksamma på operationssal. För att bli godkänd i sin kunskap krävdes att respondenten hade 100 % rätta svar på kunskapsfrågorna. Data från enkäterna hanterades deskriptivt och analyserades med Mann Whitney u-test och Chi-två-test. Resultat: Hos 62 % fanns inte fullständiga kunskaper om universitetssjukhuset riktlinjer angående mun- och andningsskydd. Vidare upplevde 60 % att riktlinjerna inte är lättillgängliga. Resultatet visade att 24 % ansåg sig alltid kunna följa riktlinjerna. Slutsats: Resultatet visar att kunskapen gällande riktlinjerna är ofullständig vilket innebär att en stor del av operationssjuksköterskorna i studien riskerar sin hälsa i sitt arbete. För att operationssjuksköterskorna ska kunna uppdatera sina kunskaper bör universitetssjukhuset utforma tydligare riktlinjer angående mun- och andningsskydd i ett samlat dokument. / Background: OR nurses work in a place where there is hazardous smoke and contagion. This represents a risk to their health. The teaching hospital has guidelines for when to use facial protective devices. Aim: To see if the OR nurses at the teaching hospital have complete knowledge about the hospital guidelines regarding facial protective devices, and to study the OR nurses’ ability to follow the guidelines. The study will also determine the nurses’ perception of the availability of the guidelines and which factors determine the OR nurses’ choice of facial protective devices. Method: This is a descriptive questionnaire study with a cross-sectional design and a quantitative approach. The questionnaires were distributed to OR nurses who work in the operating room. In order to pass the test about the guidelines the respondent had to get 100 % correct answers. Data from the questionnaire were described and analyzed using Mann Whitney U test and Chi-square test. Result: Of the OR nurses, 62 % were lacking complete knowledge about the guidelines regarding facial protective devices. Furthermore, 60 % perceived the guidelines as not easily accessible. The result showed that 24 % always considered themselves to be able to follow the guidelines. Conclusion: The result shows a lack of knowledge regarding the guidelines. This means that a big part of the OR nurses in this study risk their health at work. To enable the OR nurses to update their knowledge, the teaching hospital should develop clearer guidelines on facial protective devices in one single document.

This practicum project investigates current emergency department waiting room models and explores how the psychology of waiting can be applied to positively influence the waiting experience. This culmination of research, coupled with concepts of evidence-based design (EBD), precedent research and regional site visits result in an understanding of emergency department waiting that challenges current emergency department design. This knowledge led to the formulation of a theoretical framework and hypothetical design proposal that aims to uncover, identify, and integrate design concepts known to influence emergency department waiting environment satisfaction. / February 2017

Sjuksköterskor som arbetar på akutmottagningar utsätts regelbundet för stress. Det medför psykiska och fysiska besvär för sjuksköterskor och försämrad omvårdnad för patienten. Studien avser att utifrån vetenskaplig litteratur sammanställa de faktorer som leder till stress för sjuksköterskor som arbetar på akutmottagningar och hur vården påverkas av stressade sjuksköteskor. Syfte Syftet med litteraturstudien var att beskriva vilka faktorer på akutmottagningen som upplevdes bidra till stress för sjuksköterskor som arbetar på en akutmottagning och hur stressen påverkar sjuksköterskors möjligheter att erbjuda en god vård för patienter på akutmottagningen. Metod Studien har genomförts som en litteraturstudie. I studien användes 15 artiklar som bestod av både kvalitativ och kvantitativ ansats. Materialet hämtades i databaserna CINAHL och PubMed. Resultat Resultatet visar att det finns flera olika faktorer som bidrar till stress för sjuksköterskor på akutmottagningen. Stressande faktorer visade sig utifrån studierna i resultatet vara; hög arbetsbelastning och låg bemanning, avsaknad av tid för reflektion för sjuksköterskan, att vårda barn i stressade situationer, hot och våld på akutmottagningen, kommunikation samt smärta och lidande. Hur vården påverkas av sjuksköterskors stress på akutmottagningen var utifrån studierna att patientsäkerheten blev försämrad och att vårdrelationen påverkades. Slutsats Författarna drar slutsatsen att stress påverkar sjuksköteskors arbetsuppgifter på akutmottagningen. Patienters möjlighet till patientsäker och god vård på akutmottagningen påverkas negativt av stressade sjuksköterskor. För att komma till rätta med sjuksköterskebristen på akutmottagningar så är det av betydelse för sjukhusledningen att arbeta preventivt mot stressade sjuksköterskor. / Nurses working in emergency rooms are exposed to stress on a regular basis. This may affect them with physical and psychological problems which consecutively can be seen as one of the reasons of a lowered quality within patient's care. This thesis, based on scientific literature, shall collect facts that lead nurses into stress as well as its consequences within caretaking. Purpose The purpose of this study was to describe the factors in the emergency department experienced contribute to stress for nurses working in an emergency department and how stress affects nurses' ability to provide quality care for patients in the emergency department. Method The study was conducted as a literature review. The study used 15 articles that consisted of both qualitative and quantitative approach. The material was downloaded from the databases CINAHL and PubMed. Results The results show that there are several factors which contribute to a high(er) stress level for nurses working in emergency rooms. The thesis shows that stress factors such as: high work intensity, understaffing , too little time for the nurses to reflect their on work, caretaking of children in stress filled times, threats and violence in the emergency area, insufficient communication as well as pain and suffering in general. Based on the studies, it could be concluded that this stress, influencing the nurses, is also causing effects on the actual caretaking by the means of a substandard patient safety and an affected nurse-patient-relation. Conclusion The authors conclude that stress affects the nurse's work in the emergency department. Patient’s opportunity for patient safety and good care in the emergency department is adversely affected by stressed nurses. In order to deal with the nursing shortage in emergency departments, it is important for the hospital management to prevent stress among nurses

Time series forecasting and modeling are challenging problems during the past decades, because of its plenty of properties and underlying correlated relationships. As a result, researchers proposed a lot of models to deal with the time series. However, the proposed models such as Autoregressive integrated moving average (ARIMA) and artificial neural networks (ANNs) only describe part of the properties of time series. In this thesis, we introduce a new hybrid model integrated filter structure to improve the prediction accuracy. Case studies with real data from University of Kentucky HealthCare are carried out to examine the superiority of our model. Also, we applied our model to operating room (OR) to reduce the inefficiency cost. The experiment results indicate that our model always outperforms compared with other models in different conditions.

M.Cur. (Nursing Science) / Please refer to full text to view abstract

Selten wird Software nur an einem Standort entwickelt. Teams oder Teammitglieder können auf der ganzen Welt verstreut sein, um gemeinsam an einem Produkt oder einer Aufgabe zu arbeiten. Gleichzeitig werden agile Vorgehen bei der Entwicklung neuer Software zunehmend populär, die aber einen hohen Kommunikationsaufwand zwischen allen Beteiligten erfordern. Wo anfänglich ein Widerspruch zu vermuten ist, zeigen die Erfahrungen der Saxonia Systems AG, dass die agilen Werte und Prinzipien die verteilte Entwicklung positiv beeinflussen können. Mit der Zeit haben die Teams Erfahrungen gesammelt und Best Practices definiert. Daraus entstand das Konzept „Ein Team Ein Office“ (ETEO), welches heute einen virtuellen Projektraum, ausgewählte Kollaborationswerkzeuge, angepasste Prozesse und Rollen und ein motiviertes Team umfasst. In diesem Artikel werden wir anhand des VIST-Modells zeigen, dass agile und verteilte Arbeit kein Widerspruch ist und wie wir mit ETEO die agile und verteilte Softwareentwicklung unterstützen.