Metodologías y herramientas para la mejora continua y la resolución de problemas

Se describen metodologías y herramientas desarrolladas en Japón para la mejora continua y la resolución de problemas dentro de las organizaciones

PLAST OF EMIGRATION AS PART OF UKRAINIAN YOUTH MOVEMENT OF THE INTERWAR EUROPE

Reasons of foundation and the main kinds of activity of Ukrainian scout organizations abroad and the Union of Ukrainian Plast-Emigrants are described in the article. The author points out the importance of presentation Ukrainian nation by the Union of Ukrainian Plast-Emigrants in the international sphere. Also it is briefly touched upon history of the scout movement in the world and explained interconnection between scout and Plast organizational structure and the peculiarities of their educational system. The author finds out, that Plast was national branch of scout movement.Particular attention is paid to the role of sport for the Plast. Physical training was an important element of scouts’ activity. Participating in the international sports competitions of Plast delegations gave an opportunity to inform the foreign community about the Ukrainian affairs. The network of the Ukrainian scout organizations in Europe in 1920–1939 was analysed and found out, that in view of the favorable conditions (economic and political) in the countries of Central-Eastern Europe, the largest and most active Plast centers were concentrated. Especially we should admit Plsat units in the Czechoslovak Republic. In this country numerous Plast organizations were founded and worked. Besides, in 1930 the Union of Ukrainian Plast-Emigrants was created in Prague. During the interwar period the mentioned Union presented Ukrainian youth emigrants

Use of a “Fascial-Sock” Technique to Manage the Stump and Stoma After Insertion of an Osseointegrated Implant in Transfemoral Amputees

Introduction:. We describe a new surgical technique to improve the stability of the peristomal skin around an osseointegrated implant in transfemoral amputees. As a secondary effect, the technique makes it easier to shape the residual limb into a cone and reduces the need for more complex revision surgery in the years after surgery. Methods:. We compared outcomes in 2 groups of unilateral, transfemoral amputees by 18 months after insertion of an osseointegrated prosthetic limb implant. In Group 1, the soft tissues were managed using a standard muscle-platform technique. In Group 2, the soft tissues were managed using a fascial-sock technique. Rates of peristomal infection requiring treatment with oral antibiotics, rates of peristomal enthesopathy pain, surgical revision rates, and effectiveness of peristomal skin adhesion to the underlying bone were assessed. Results:. Rates of peristomal skin infection were 50% lower in Group 2. Rates of treatment for enthesopathy pain were 50% lower in Group 2. Surgical revision rates were the same in both groups. However, the need to revise the stoma specifically was 50% lower in Group 2 and the nature of the revision procedures in Group 2 were less complicated (mainly for soft-tissue overhangs). By contrast, the need for bony debridement as part of the revision procedure was 4 X greater in Group 1 compared with Group 2. Finally, we were 1.8 X more likely to achieve a dry and stable stoma by 18 months using a fascial sock approach. Conclusion:. Use of a fascial sock approach appears to be associated with improved rates of stability of the peristomal soft tissues, leading to decreased morbidity from this area at 18 months after treatment with an OI implant. Level of Evidence:. Level III. See Instructions for Authors for a complete description of levels of evidence

Earfold Implantable Clip System for Correction of Prominent Ears: Analysis of Safety in 403 Patients

Background:. The Earfold system, a new treatment for the correction of prominent ears, consists of 3 components: the Earfold implant, the Earfold introducer, and the Prefold positioner. Methods:. This is an interim report based on an ongoing analysis of safety in a series of patients treated for prominent ears with the Earfold implant between February 2013 and September 2014. Safety was assessed based on adverse event reports and the need for implant revision; follow-up is ongoing. Results:. Seven surgeons used 1,200 Earfold implants to treat 403 patients (ages, 7–70 years; 63% male); the time since the initial implant procedure now ranges from 30 to 48 months. To date, 145 patients (36%) have returned for a follow-up visit (mean, 7.7 months [range, 1–34 months]). Adverse events requiring intervention have affected 39 of 403 (9.7%) patients; these include implant revisions (n = 17 [4.2%], most often due to implant visibility), skin erosion over the implant (n = 15 [3.7%]), and infection (n = 7 [1.7%]). Bleeding, recurrence of prominence, hematoma, deformity, or adverse scarring did not occur. Conclusions:. This interim analysis has shown that Earfold prominent ear correction system is associated with relatively few adverse events that require intervention; a small number of patients experienced infection, implant extrusion, or implant visibility that required revision. Most adverse events were related to either patient selection or technical errors at implantation. It is expected that with continued use of Earfold by surgeons experienced in otoplasty, the adverse event incidence will decrease

625 The Impact of COVID-19 on Burn Care at a Regional Burn Center

Abstract Introduction The COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care. Methods A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years. Results Selected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours). Table 1. Selected burn center data comparing 2020 with 2019 and 2018. Conclusions This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist. </jats:sec