Enhancing Teamwork with CliftonStrengths

Abstract Problem: Poor teamwork has a negative impact on patient safety, patient outcomes, patient satisfaction, healthcare work environments, and staff satisfaction. Effective teamwork is therefore critical but can be challenging. Context: At a large, non-profit, academic healthcare system in San Francisco, all staff members working in the clinical research services (CRS) department identified teamwork as an area of concern. Teamwork survey results also indicated that teamwork could be improved. Interventions: A literature review provided evidence that many types of team training are effective in multiple settings. Team training for all CRS staff included three interventions: a CliftonStrengths assessment, a one-on-one coaching session with a nurse consultant, and a team workshop. Measures: The Nursing Teamwork Survey (NTS) was administered before any interventions to establish a baseline score. The NTS is a reliable and psychometrically validated teamwork measurement tool. The survey was re-administered two weeks after all interventions were complete. Results: Following the three interventions, the overall teamwork score improved 14.7% from baseline. Conclusions: The strengths-based approach used in this initiative proved successful in improving teamwork. This project has great potential for spread and can serve as a guide for others seeking to enhance teamwork in their microsystems

Manipulation of the follicular phase: Uterodomes and pregnancy - is there a correlation?

BACKGROUND: Manipulation of the follicular phase uterine epithelium in women undergoing infertility treatment, has not generally shown differing morphological effects on uterine epithelial characteristics using Scanning Electron Microscopy (SEM) and resultant pregnancy rates have remained suboptimal utilising these manipulations. The present study observed manipulation of the proliferative epithelium, with either 7 or 14 days of sequential oestrogen (E) therapy followed by progesterone (P) and assessed the appearance of pinopods (now called uterodomes) for their usefulness as potential implantation markers in seven women who subsequently became pregnant. Three endometrial biopsies per patient were taken during consecutive cycles: day 19 of a natural cycle - (group 1), days 11/12 of a second cycle after 7 days E then P - (group 2), and days 19/22 of a third cycle after 14 days E then P - (group 3). Embryo transfer (ET) was performed in a subsequent long treatment cycle (as per Group 3). RESULTS: Seven pregnancies resulted in seven viable births including one twins and one miscarriage. Analysis of the individual regimes showed 5 days of P treatment to have a higher correlation for uterodomes in all 3 cycles observed individually. It was also observed that all 7 women demonstrated the appearance of uterodomes in at least one of their cycles. CONCLUSIONS: We conclude that manipulation of the follicular phase by shortening the period of E exposure to 7 days, does not compromise uterine epithelial morphology and we add weight to the conclusion that uterodomes indicate a receptive endometrium for implantation

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Caractérisation de semi-conducteurs organiques par microscopie à effet tunnel et par spectroscopie optique

Les propriétés électroniques et d'autoassemblage de deux composés organiques, le DHTAP et le bis-pyrène, ont été étudiées par microscopie à effet tunnel (STM), sous ultra-vide et à basse température. Les propriétés optiques ont été étudiées par spectroscopie en cavité résonnante (CRD), également sous ultravide.La croissance du DHTAP a été étudiée sur différents métaux nobles. La croissance du bis-pyrène a été étudiée sur Au(111). Dans chaque cas, les conditions de température idéales pour la formation d’une première couche organisée ont été déterminées. Différents modèles sont proposés pour les structures observées en première couche. La formation de la seconde couche moléculaire à également été étudiée.L'évolution des propriétés optiques, étudié par CRD, du bis-pyrène déposé sur du verre borosilicate combinée aux informations obtenues par STM ont permit d’associer ces modifications aux interactions des moments dipolaires de transition des molécules de la première et de la seconde couche et on également permit de déterminer le mode de croissance.Finalement, la possibilité d’induire des modifications chimique de la molécule de DHTAP, intégrée dans une couche auto-assemblée, en utilisant le courant tunnel du STM a été observé. Il s’avère que la molécule de DHTAP intégrée en première couche peut subir une double déshydrogénation pour conduire à la formation d’un composé identifié comme étant le 5,7,12,14-tetraazapentacene (TAP). En seconde couche, la formation de deux radicaux, en plus du TAP, a été observé. La molécule de TAP présente un certain intérêt du fait qu’elle n’est pas synthétisable pas les méthodes conventionnelle de chimie organique.Electronic and self-assembling properties of two organic compound, the DHTAP and the bis-pyrene, have been studied by the means of low temperature scanning tunnelling microscopy (STM) under ultrahigh vacuum conditions. Optical properties have been studied by cavity ring-down (CRD) spectroscopy, also under ultrahigh vacuum conditions.The growth of DHTAP has been studied on different metallic substrate. The growth of bis-pyrene has been studied on Au(111). In each case, the optimal temperature conditions for the formation of a well-ordered first monolayer have been determined. The formation of second monolayers has also been studied. The evolution of the optical properties, studied by CRD, of bis-pyrene deposited on borosilicate glass combined with information obtained from STM allow us to identify these modifications as interactions between transition dipole moments of molecules in the first and in the second layer, and also determine the growth mode.Finally, the possibility to induce chemical modification of DHTAP molecules embedded in an ordered monolayer using the tunnelling current of the STM has been studied. It appears that the molecule embedded in the first ML can be doubly dehydrogenated which leads to the formation of a compound identified as 5,7,12,14-tetraazapentacene (TAP). In the second layer, the formation of two radicals in addition to the TAP has been observed. The TAP molecule is interesting because of that it cannot be synthesized using common organic chemical methods

O-017 Appeased embryo transfer with hypnosis

Abstract text Objective , We report in this presentation the use for couples undergoing infertility treatment of a new way of accompaniment. Hypnosis associated with learning of self-hypnosis is a solid support to valid an appeased uptake of an infertility program and lower the emotional charge associated with such treatments. Main enhance emotional comfort in couples undergoing infertility treatment. Secondary patients feelings after results of the attempt (whether failure or success), pregnancy rates. Contains During a first meeting family and historical back ground is analyzed as well as medical file and causes for infertility. Then a first specific session is proposed in relation with underlying problems using ericksonian hypnosis. For example sessions using amnesia can be used in patients having had traumatic experiences. Comfort and wellbeing suggestions are used after each hypnosis session. Two other sessions can be proposed at office, one called “the two chests” first one to pack all past failures and second to collect present or past successes regarding all fields. These successes will be resourceful to refer to. The second session will be to enhance self-confidence using contes. In order to enhance autonomy patients are given 4 audio sessions prerecorded to home practice. Three of them are specific to intra uterine insemination or embryo transfer. One is called FIVETE to listen the day before medical procedure, one is called SIMPLE INDUCTION to start just before and throughout the procedure. One to do after procedure at home called DO NOTHING. Patients are called few weeks after the attempt for debrief and results. </jats:sec