The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip

In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken

Bayesian optimization for materials design

We introduce Bayesian optimization, a technique developed for optimizing time-consuming engineering simulations and for fitting machine learning models on large datasets. Bayesian optimization guides the choice of experiments during materials design and discovery to find good material designs in as few experiments as possible. We focus on the case when materials designs are parameterized by a low-dimensional vector. Bayesian optimization is built on a statistical technique called Gaussian process regression, which allows predicting the performance of a new design based on previously tested designs. After providing a detailed introduction to Gaussian process regression, we introduce two Bayesian optimization methods: expected improvement, for design problems with noise-free evaluations; and the knowledge-gradient method, which generalizes expected improvement and may be used in design problems with noisy evaluations. Both methods are derived using a value-of-information analysis, and enjoy one-step Bayes-optimality

Discomfort experienced at the daily life of relatives of people admitted at ICU

This is a qualitative research that aimed to get to know the discomforts experienced at the daily life of relatives of people admitted at the intensive care unit (ICU). It happened on a general ICU at a public hospital, in Salvador-BA, by the second half of 2009. Nine relatives of people admitted were interviewed. The technique used was the analysis from the Grounded Theory. The results showed that the interaction of the families with the reality of life threat from the relative admitted, had as main discomfort, the discontinuity in their daily life, which was characterized by four categories: Living the distress of a possible loss, difficulties to take care of themselves, facing a separation in the family, suffering with changes in their social and professional lives. These discomforts can be minimized by the healthcare team’s effectiveness to the demands of the family and the support of its social network

Leadership Requirements for Successful Implementation of Lean Management in Health Care: A Systematic Review of the Literature

Lean is a management philosophy aimed at increasing value for end users by controlling waste. As such, it is a promising approach for health-care organizations to improve quality and control costs. Yet the transition to Lean management often fails in health-care organizations, commonly due to a lack of specific Lean leadership skills. This research addresses a gap in the knowledge about leadership requirements for successful Lean implementation in health-care organizations. A systematic literature search was performed using the MEDLINE, EMBASE and Emerald databases, resulting in the selection of 23 articles. Analysis of these articles confirmed the five Lean leadership principles identified in the manufacturing literature—improvement culture, self-development, employee training, going to the gemba, and hoshin kanri—and identified specific leadership behaviors, skills, characteristics, and attitudes for each principle. A sixth leadership principle, that of customer value, was also identified. This research contributes to existing Lean literature by providing new insights into leadership requirements for Lean transitions in health care. A new leadership framework is suggested for Lean leadership requirements during Lean implementation. In practice, this research provides health-care leaders with a practical framework and guidance with which to successfully implement Lean in a health-care institution

Comfort from the perspective of families of people hospitalized in the intensive care unit

This study aimed at understanding the meaning of comfort to the families of people in intensive care units. It consists of a qualitative study carried out in the intensive care unit of a hospital in Salvador-Bahia. Fourteen family members were interviewed. The authors utilized the theoretical principles of symbolic interactionism and the technique of qualitative data analysis. Results indicated that the categories Safety, Receptiveness, Information, Proximity, Social and Spiritual Support, Convenience and Integration expressed the meaning of comfort, which was comprised of reliability in terms of technical-scientific competence and a supportive and sensitive attitude of the team, chance of recovery, access to information and the opportunity to be close to the patient, support of people in their social life, spiritual sources and the environmental structure of the hospital, preservation of self-care and routine activities. It was concluded that the family is important as objects and subjects of the actions in healthcare and must be the focus in public health policies and programs in Brazil

Lean leadership:Towards continuous improvement capability in healthcare

This research focuses on the role of leadership styles during Lean Management (LM) initiatives in healthcare environments. Specifically, this study examined the role of leadership styles in the development of Continuous Improvement (CI) capability of teams. The empirical evidence was collected by applying a multiple-case design, and consisted of interviews, observations, and documentation. These data sources were used to develop case studies, and to identify leadership behaviours supportive of LM. Through qualitative case analysis, the influence of leadership styles on CI capability was determined. The results show that a hybrid leadership style is associated with higher levels of CI capability, and that the duration of a LM program in itself does not dictate maturity. A mix of both transactional and transformational leadership styles seems a necessary condition for teams to reach higher levels of CI capability. Based on these findings, this paper provides a framework to structure thinking on LM and leadership styles, and concludes with supporting propositions. The current outcomes imply that leaders should be sensitive towards their adopted leadership style, and should adopt a leadership style that combines both transformational as well as transactional elements, when leading LM teams