Case H The American Heart Institute Sofia V. Agoritsas and Ann Scheck McAlearney The Case
of Amanda Jones Presenting with chest pain, 60-year-old Amanda Jones was rushed from the
ambulance bay of the emergency department (ED) of Fast Bay University Hospital (EBUH) to
the catheterization lab. The American Heart Institute
(AHI) lab team determined that Jones was experiencing an ST-segment elcration myocardial
infarction (STFAII), the deadlicst rype of heart attack. As a result, within 30 minutes of her
arrival, Jones received a percutaneous coronary intervention (PCI), but the occluded artery could
not be opened. The cardiac catheterization lab team aceelerated the protocols to fasttrack Jones
for emergen cardiac bypass surgery with the cardiac surgeon on call. Luckily, Joseph Cusimano,
MD, the chief of cardiac surgery, was available, and Jones was taken into the operating room
(OR) within one hour. As time lost was a matter of life and death, it was a race against time.
Collaboration among the interdicciplinary teams of the divisions of cardiology and cardiac
surgery and communication among the clinical leaders throughour the AHI were critical to
Jones's survival. Fortunately for Jones, her cardiac emergency had a happy cnding. She
reconered and was released a week later without brain or heart damage. What Jones didn't know;
though, was that AHI was more of a virtual institute than an actual place. Although she had been
seen and treated at FBUH, the collahoration and communication that oecurred cronsed
departments, divivions, and organizational benundarics, And unfortunatchy. AHI's executive
director Sandra Cietty was not convinced that this structure alwayy pronided patients and their
familics with the best carc and service quality they espected and doweried. East Bay University
Hospital and the American Heart Institute Cardiac Service Line FRUH, a 700-bed teaching
hospital, is one of two tertiary care facilitics within True Care Health System (TC:HS. FBUH is
the flagship hospital for adult acute care in the health system. The other acute care hexpital. Truc
Care North. was only recently acquired by TCHS and is 20 milcs awxy from the other four main
facilitics. The Children's Hospital, a psychiatric hospital, and a cancer hespital constitute the
remaining three hempitals of TCHS. AHI is the cardiac service line that spans TCHS. AHI is
viewed as a leading prowider and piomeer in cardiac care in the region. It is led by Dr. Barry A.
Mlount, an interventional cardiologist. AHI prowides adult cardiac care throughout the state and
includes a staff of 50 full-time emplened cardiologists and cight cardiac surgeons, five of whom
primarily work out of FBUH isec Evhituis 111.8 and 111.9%. The AHI service line also includes
sis close-to-home cardike outreach clinics that are part of IC.HS's ambulatory carc network: this
network spans the suburbs around the five-hospital health system. AHI has heen listed nationally
by leading organizations such as Healt.
Case H The American Heart Institute Sofia V. Agoritsas and Ann Scheck.pdftuffail786
Case H The American Heart Institute Sofia V. Agoritsas and Ann Scheck McAlearney The Case
of Amanda Jones Presenting with chest pain, 60-year-old Amanda Jones was rushed from the
ambulance bay of the emergency department (ED) of Fast Bay University Hospital (EBUH) to
the catheterization lab. The American Heart Institute
(AHI) lab team determined that Jones was experiencing an ST-segment oferation myocardial
infarction (STFAII), the deadliest type of heart attack. As a result, within 30 minutes of her
arrival, Jones received a percutancous coronary intervention ( PCI ), but the oceluded artery
could not be opened. The cardiac catheterization lab team accelerated the protocols to fasttrack
Jones for emergency cardiac bypass surgery with the cardiac surgeon on call. L.uckily, Joseph
Cusimano, MID, the chief of candiac surgery, was available, and Jones was taken into the
operating room (OR) within one hour. As time lost was a matter of life and dearh, it was a race
against time. Collaboration among the interdisciplinary teams of the divisions of cardiology and
cardiac surgery and communication among the clinical leaders throughout the AHI were eritical
to Joner's survilal. Fortunately for Jones, her cardiac emergency had a happy ending. She
reconered and was released a week later without brain or heart damage. What Jones didn 't know,
though, was that AHI was more of a virtual institute than an actual place. Although she had been
seen and treated at FBUH, the collaloration and communication that occurred croned
departments, divisions, and organizational boundturics, And unfortumatchy, AHI sexecutive
director Sandra Cietty was not convinced that this structure alwass pronided paticnts and their
fanilics with the best carc and service quality they expected and decroed. East Bay University
Hospital and the American Heart Institute Cardiac Service Line EBUH, a 700-bed teaching
hospital, is one of two tertiary care facilitics within True Care Health System (IC.HSI. FBUH is
the flagship hospital for adult acute care in the health system. The other acute care hespital, True
Care North. was only recently acquired by TCHS and is 20 miles away from the other four main
facilitics. The Children's Hospital, a pschiatric hospital, and a cancer hospital constitute the
remaining three hespitals of TCHS. AHI is the cardiak service line that spans TCHS. AHI is
vicued as a leading provider and pioneer in cardiac care in the region. It is led by Dr. Barry A.
Mount, an interventional cardiologist. AHI prowides adult cardiac care throughout the state and
includes a staff of 50 full-time cmplored cardiologists and cight cardiac surgeons, five of whom
primarily work out of FBCH rsee Evhibits III.8 and 111.9). The AHI senice line alvo indudes six
close-to-home cartik outreach clinies that are part of ICHS's ambulatory carc network: this
network spans the suburbs anound the five-hospital health system. AHI has been listed nationally
by leading organizations stch as Health.
The Case of Amanda Jones wehulance by of the emergency depurtince.pdfINFO952279
The Case of Amanda Jones wehulance by of the emergency depurtincent +EDy of Fee lise
thinenit? time hot wa a mamor of life and dourfi, is was a rack againt time cindinileng and
cantias segry and oummurication amoog the ctinkcal leadon wort Liter wiahere brain we lucirt
itumage East Bay University Hospital and the American Heart Institute Cardiac Service Line wh
dine no hoenc caskis retrokll diniov thit ane furt of I6. Hsi amtula
The mission of AHI is to provide world-class, comprehensive cardiac care, to advance cardiac
research, and to promote medical education in a fiscally responsible manner. Its vision is to
become a premier center of excellence in cardiovascular medicine in the United States.
Cardiology and cardiac surgery are to be coordinated in an integrated and seamlesm delivery
system. The AHI's goals and guiding principles are - to foster clinical leadership and clinical
expertise in high-quality cardiac carc, - to promote a patient-centered care environment and a
culture of exectlence, - to develop and implement evidenced-based guidelines that are
measurable and outcomes driven, - to provide patients with appropriate education to empower
thern and their families to participate in their clinical decision making and self. management, and
- to create marketing initiatives that will brand the identity of AHI.
AHI Structure AHI is, in practice. a tirtual service linc, requiring ssnerghtic cooperation frum all
ICHS candiac services to realiec its mivion and achicte its gouls isec EI. hitvit 111.101, Acrom.
AHI the involved carfiac Mrtices indode gencral and intcricntional cardiologs: clectrophysiolugt:
the congestive heart failure (CHF) program: cardiac rehabilitation: and cardiac surgery, inctoding
carfiac bypus surgen, the minimallv invave vahe urgent program, molvitios surgery, the
endoravcular aortic repair eenter. and heart transiant. The mait divioions the consituse the AHIl
werike line are canticloge and canfothorade varger:- Theve divivins anc embedded within
traditiond deparmontal striturs within the depurtments of medicine ise Evhibit III 11 s and
serpery cardiothoracic vergery ane maintained throygh their depurtmunt Howere, AHI under the
AHI hirtusl ervice line sricture, deypite the depurtment of onginh
"Prrsician Aebulatory Peactices includes oulveach clinica.
EXHIBIT III.13 Summary of Statistics (Inctudes East Bay University Hospiral and Truc Cane
North Hospital)
EXHIBIT III.13 Summary of Statistics (continued)
The executive director of AHI, Sandra Getty, BSN, RN, MBA, is respomsible for service line
business development and serves as the liaison for cardicnascu. lar programs. She previously
worked as the nurw manager in the catheteriza. tion lab with 10. Mount 20 years ago and played
a major part in helping the division to become filmless, Since then. Getty has established an
clectroplryx. ologv program, including an atrial fibrillation center and a conpective heart failure
program. In her current role she is responsible f.
This case was prepared by Abeel A. Mangi, EMBA Class of GrazynaBroyles24
This document summarizes a case study about Dr. Frank Young leading a project to reduce blood transfusions during cardiac surgery at Huntington University Hospital. The hospital had high transfusion rates of 71% compared to the national average of 48.9%. Young proposed using techniques like autologous blood harvesting and retrograde autologous priming to address this issue. However, he faced challenges due to the hospital's complex organizational structure with physicians and medical teams reporting through different chains of command.
STEMI Systems of Care in New Jersey: interview with Bil Rosen of Capital Heal...David Hiltz
In this interview, Bil Rosen and I will discuss STEMI systems of care, Mission: Lifeline and efforts to improve recognition, care and outcomes for Acute Coronary Syndrome (ACS) patients in New Jersey.
Pump It Up: Inova Heart and Vascular Institute's bold new vision to save more...Jane Langille
In this cover story for INOVA Magazine, I profiled a patient with congestive heart failure who lived for many months with two ventricular assist devices (VADs) before he finally received a heart transplant. Expertise matters! INOVA is one of the few centers in the U.S. that can implant two VADs in one procedure and also performs the highest number of heart transplants in the mid-Atlantic region. Strong leadership at the Inova Heart and Vascular Insitute is setting a bold new course for the future to meet growing demand for heart failure patients, including new monitoring technologies, state-of-the-art interventional procedures and a new strategic plan that includes building a cardiac dream team of specialists.
The 2015 annual report for the Swedish Heart & Vascular Institute highlights developments in three key areas:
1) A shift to cardiologist subspecialization to provide more focused care for complex cardiac conditions.
2) Growth of the cardiac surgery program with over 50,000 surgeries performed and continued increase in patient volumes.
3) Advancements in cardiac imaging that provide critical details to guide minimally invasive procedures and improve outcomes.
The document provides information about urinary tract infections and catheter-associated urinary tract infections (CAUTIs). It discusses APIC's mission to reduce infection risks and outlines strategies to prevent CAUTIs. CAUTIs are common in long-term care facility residents with indwelling catheters. Prevention efforts can reduce CAUTI rates and associated risks like bacteremia. Guidelines for CAUTI prevention in hospitals also generally apply to long-term care facilities. A facility's infection risk assessment should identify CAUTI as a priority for intervention strategies outlined in the guide.
This study aimed to investigate the effect of a learning guideline on nurses' knowledge and performance regarding patient safety after cardiac catheterization. A quasi-experimental design was used with 51 nurses from cardiac units. Nurses' knowledge and performance were assessed before and after implementing a 4-week learning guideline program using questionnaires and checklists. The results showed that nurses had significantly higher knowledge scores after the learning guideline, with a positive correlation between qualification, experience, and post-guideline knowledge. Nurses' performance scores were satisfactory both before and after the guideline, but there was a strong positive correlation between qualification and post-guideline performance. In conclusion, the learning guideline improved nurses' knowledge regarding patient safety after cardiac catheterization.
Case H The American Heart Institute Sofia V. Agoritsas and Ann Scheck.pdftuffail786
Case H The American Heart Institute Sofia V. Agoritsas and Ann Scheck McAlearney The Case
of Amanda Jones Presenting with chest pain, 60-year-old Amanda Jones was rushed from the
ambulance bay of the emergency department (ED) of Fast Bay University Hospital (EBUH) to
the catheterization lab. The American Heart Institute
(AHI) lab team determined that Jones was experiencing an ST-segment oferation myocardial
infarction (STFAII), the deadliest type of heart attack. As a result, within 30 minutes of her
arrival, Jones received a percutancous coronary intervention ( PCI ), but the oceluded artery
could not be opened. The cardiac catheterization lab team accelerated the protocols to fasttrack
Jones for emergency cardiac bypass surgery with the cardiac surgeon on call. L.uckily, Joseph
Cusimano, MID, the chief of candiac surgery, was available, and Jones was taken into the
operating room (OR) within one hour. As time lost was a matter of life and dearh, it was a race
against time. Collaboration among the interdisciplinary teams of the divisions of cardiology and
cardiac surgery and communication among the clinical leaders throughout the AHI were eritical
to Joner's survilal. Fortunately for Jones, her cardiac emergency had a happy ending. She
reconered and was released a week later without brain or heart damage. What Jones didn 't know,
though, was that AHI was more of a virtual institute than an actual place. Although she had been
seen and treated at FBUH, the collaloration and communication that occurred croned
departments, divisions, and organizational boundturics, And unfortumatchy, AHI sexecutive
director Sandra Cietty was not convinced that this structure alwass pronided paticnts and their
fanilics with the best carc and service quality they expected and decroed. East Bay University
Hospital and the American Heart Institute Cardiac Service Line EBUH, a 700-bed teaching
hospital, is one of two tertiary care facilitics within True Care Health System (IC.HSI. FBUH is
the flagship hospital for adult acute care in the health system. The other acute care hespital, True
Care North. was only recently acquired by TCHS and is 20 miles away from the other four main
facilitics. The Children's Hospital, a pschiatric hospital, and a cancer hospital constitute the
remaining three hespitals of TCHS. AHI is the cardiak service line that spans TCHS. AHI is
vicued as a leading provider and pioneer in cardiac care in the region. It is led by Dr. Barry A.
Mount, an interventional cardiologist. AHI prowides adult cardiac care throughout the state and
includes a staff of 50 full-time cmplored cardiologists and cight cardiac surgeons, five of whom
primarily work out of FBCH rsee Evhibits III.8 and 111.9). The AHI senice line alvo indudes six
close-to-home cartik outreach clinies that are part of ICHS's ambulatory carc network: this
network spans the suburbs anound the five-hospital health system. AHI has been listed nationally
by leading organizations stch as Health.
The Case of Amanda Jones wehulance by of the emergency depurtince.pdfINFO952279
The Case of Amanda Jones wehulance by of the emergency depurtincent +EDy of Fee lise
thinenit? time hot wa a mamor of life and dourfi, is was a rack againt time cindinileng and
cantias segry and oummurication amoog the ctinkcal leadon wort Liter wiahere brain we lucirt
itumage East Bay University Hospital and the American Heart Institute Cardiac Service Line wh
dine no hoenc caskis retrokll diniov thit ane furt of I6. Hsi amtula
The mission of AHI is to provide world-class, comprehensive cardiac care, to advance cardiac
research, and to promote medical education in a fiscally responsible manner. Its vision is to
become a premier center of excellence in cardiovascular medicine in the United States.
Cardiology and cardiac surgery are to be coordinated in an integrated and seamlesm delivery
system. The AHI's goals and guiding principles are - to foster clinical leadership and clinical
expertise in high-quality cardiac carc, - to promote a patient-centered care environment and a
culture of exectlence, - to develop and implement evidenced-based guidelines that are
measurable and outcomes driven, - to provide patients with appropriate education to empower
thern and their families to participate in their clinical decision making and self. management, and
- to create marketing initiatives that will brand the identity of AHI.
AHI Structure AHI is, in practice. a tirtual service linc, requiring ssnerghtic cooperation frum all
ICHS candiac services to realiec its mivion and achicte its gouls isec EI. hitvit 111.101, Acrom.
AHI the involved carfiac Mrtices indode gencral and intcricntional cardiologs: clectrophysiolugt:
the congestive heart failure (CHF) program: cardiac rehabilitation: and cardiac surgery, inctoding
carfiac bypus surgen, the minimallv invave vahe urgent program, molvitios surgery, the
endoravcular aortic repair eenter. and heart transiant. The mait divioions the consituse the AHIl
werike line are canticloge and canfothorade varger:- Theve divivins anc embedded within
traditiond deparmontal striturs within the depurtments of medicine ise Evhibit III 11 s and
serpery cardiothoracic vergery ane maintained throygh their depurtmunt Howere, AHI under the
AHI hirtusl ervice line sricture, deypite the depurtment of onginh
"Prrsician Aebulatory Peactices includes oulveach clinica.
EXHIBIT III.13 Summary of Statistics (Inctudes East Bay University Hospiral and Truc Cane
North Hospital)
EXHIBIT III.13 Summary of Statistics (continued)
The executive director of AHI, Sandra Getty, BSN, RN, MBA, is respomsible for service line
business development and serves as the liaison for cardicnascu. lar programs. She previously
worked as the nurw manager in the catheteriza. tion lab with 10. Mount 20 years ago and played
a major part in helping the division to become filmless, Since then. Getty has established an
clectroplryx. ologv program, including an atrial fibrillation center and a conpective heart failure
program. In her current role she is responsible f.
This case was prepared by Abeel A. Mangi, EMBA Class of GrazynaBroyles24
This document summarizes a case study about Dr. Frank Young leading a project to reduce blood transfusions during cardiac surgery at Huntington University Hospital. The hospital had high transfusion rates of 71% compared to the national average of 48.9%. Young proposed using techniques like autologous blood harvesting and retrograde autologous priming to address this issue. However, he faced challenges due to the hospital's complex organizational structure with physicians and medical teams reporting through different chains of command.
STEMI Systems of Care in New Jersey: interview with Bil Rosen of Capital Heal...David Hiltz
In this interview, Bil Rosen and I will discuss STEMI systems of care, Mission: Lifeline and efforts to improve recognition, care and outcomes for Acute Coronary Syndrome (ACS) patients in New Jersey.
Pump It Up: Inova Heart and Vascular Institute's bold new vision to save more...Jane Langille
In this cover story for INOVA Magazine, I profiled a patient with congestive heart failure who lived for many months with two ventricular assist devices (VADs) before he finally received a heart transplant. Expertise matters! INOVA is one of the few centers in the U.S. that can implant two VADs in one procedure and also performs the highest number of heart transplants in the mid-Atlantic region. Strong leadership at the Inova Heart and Vascular Insitute is setting a bold new course for the future to meet growing demand for heart failure patients, including new monitoring technologies, state-of-the-art interventional procedures and a new strategic plan that includes building a cardiac dream team of specialists.
The 2015 annual report for the Swedish Heart & Vascular Institute highlights developments in three key areas:
1) A shift to cardiologist subspecialization to provide more focused care for complex cardiac conditions.
2) Growth of the cardiac surgery program with over 50,000 surgeries performed and continued increase in patient volumes.
3) Advancements in cardiac imaging that provide critical details to guide minimally invasive procedures and improve outcomes.
The document provides information about urinary tract infections and catheter-associated urinary tract infections (CAUTIs). It discusses APIC's mission to reduce infection risks and outlines strategies to prevent CAUTIs. CAUTIs are common in long-term care facility residents with indwelling catheters. Prevention efforts can reduce CAUTI rates and associated risks like bacteremia. Guidelines for CAUTI prevention in hospitals also generally apply to long-term care facilities. A facility's infection risk assessment should identify CAUTI as a priority for intervention strategies outlined in the guide.
This study aimed to investigate the effect of a learning guideline on nurses' knowledge and performance regarding patient safety after cardiac catheterization. A quasi-experimental design was used with 51 nurses from cardiac units. Nurses' knowledge and performance were assessed before and after implementing a 4-week learning guideline program using questionnaires and checklists. The results showed that nurses had significantly higher knowledge scores after the learning guideline, with a positive correlation between qualification, experience, and post-guideline knowledge. Nurses' performance scores were satisfactory both before and after the guideline, but there was a strong positive correlation between qualification and post-guideline performance. In conclusion, the learning guideline improved nurses' knowledge regarding patient safety after cardiac catheterization.
The Stony Brook University Heart Institute has expanded its cardiothoracic team with the addition of two new surgeons, Dr. Joanna Chikwe and Dr. Henry J. Tannous. Dr. Chikwe will serve as Co-Director of the Heart Institute and Chief of the Division of Cardiothoracic Surgery. Dr. Tannous has been appointed as a Clinical Associate Professor. They bring extensive experience from Mount Sinai Health System to Stony Brook to help serve the growing cardiac needs of Long Island.
The document discusses the new angioplasty (PCI) capabilities at Richmond University Medical Center. It describes how the program has already saved over 30 lives since beginning emergency procedures in June 2015. It also profiles the story of Dorothy Kihlstrom, who suffered a major heart attack and was able to be treated via emergency angioplasty at RUMC, saving her life due to the rapid treatment without need for transfer to another hospital. The program is seen as a vital service that is improving heart attack survival rates on Staten Island.
CHI Memorial Heart Institute provides advanced cardiac care including structural heart programs, imaging technologies, and interventional cardiology. It has received several awards for quality in areas like heart attack treatment and heart failure care. The report outlines the institute's services, volumes, and outcomes data demonstrating its leadership in cardiac care in the region. It also describes specific programs like those for atrial fibrillation ablation and heart failure management that are improving patient outcomes and quality of life.
- CVD is the leading cause of death in the US and costs over $650 billion annually. Cardiac rehabilitation (CR) improves outcomes but participation is low at around 30%.
- Wearable sensors show promise to increase CR participation, effectiveness, and reduce costs by enabling remote monitoring. Existing products have limitations but new technologies like the Intel Edison platform could help integrate multiple sensors into convenient form factors.
- For wearable sensors to enable remote CR, challenges around data standards, processing, and addressing doctors' needs for actionable data must be overcome. Widespread adoption may also require changes to the healthcare payment system to compensate doctors for remote services.
Most Trusted Healthcare Center to Watch, 2022 October 2022.pdfInsightsSuccess4
This edition features a handful of Healthcare Center across several sectors that are at the forefront of leading us .
Read More: https://insightssuccess.com/most-trusted-healthcare-center-to-watch-2022-october2022/
Ambulatory Care in the US Healthcare System, Portfolio Option #1Ricci Hayes
This document summarizes ambulatory care in the US healthcare system. It discusses how ambulatory care centers provide non-emergency care on an outpatient basis and have grown significantly since the 1970s. The Affordable Care Act has further increased demand for ambulatory care by focusing on prevention, coordinated care, and efficiency. The document outlines the historical development of ambulatory care, current models, political influences, quality and safety issues, and future challenges around continued growth and ensuring financial viability under new payment systems.
The document summarizes key changes in the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. It thanks contributors and provides an introduction. Major changes included in the guidelines are emphasized for adult and pediatric basic and advanced life support, including updated algorithms, early epinephrine administration, and post-cardiac arrest care. The guidelines are based primarily on expert opinion and limited clinical data due to challenges conducting high-quality resuscitation research.
The document summarizes key changes in the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. It thanks contributors and provides an introduction. Major changes included in the adult basic and advanced life support section are emphasized, such as enhanced algorithms, early CPR and epinephrine administration, monitoring CPR quality, and improved post-cardiac arrest care. New recommendations are highlighted regarding various resuscitation practices.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
This document discusses factors that contribute to readmissions of stroke patients and interventions to reduce readmissions. It notes that readmissions account for 20.5% of hospital admissions and reviews reasons for readmissions like medication issues, lack of follow-up care, and unhealthy lifestyles. The document outlines programs like TRACS, COMPASS and MISTT that provide post-discharge support through nurse coaching, medication management support and lifestyle counseling to reduce readmissions.
A talk to the South Australian branch of the Australian Cardiac Rehabilitation Association at their local meeting.
In particular the talk was about the cardiac rehabilitation DVD called 'what's wrong with my heart'.For more information go to www.whatswrongwithmyheart.com,and to read more visit www.dralistairbegg.com
Overview presentation of Millennium HealthCare Inc., a company providing physician practices and healthcare facilities of all sizes with practice development & management services utilizing our expertise to identify medical practice opportunities.
Emory University Hospital is a 573-bed tertiary care facility in Atlanta, Georgia established in 1915. It is part of the extensive Emory Healthcare system and is renowned for its research, receiving numerous awards and accolades. Emory provides a vast array of medical services and has 38 specialties available through its alliance of partners. It addresses economic challenges through expansion of ambulatory services and initiatives to contain costs.
Richard Chazal, representing the American College of Cardiology (ACC), spoke at the opening ceremony of the conference. He emphasized that the US and China face common challenges in healthcare, such as an aging population increasing demand and a shortage of physicians. However, China has more experience treating many patients with fewer physicians. The ACC aims to learn from China's experience and expand training opportunities for Chinese physicians to improve patient care globally. Both countries would benefit from sharing experiences and resources to address issues like rising costs and access to quality care.
Impact of a designed nursing intervention protocol on myocardial infarction p...Alexander Decker
This study examined the impact of a designed nursing intervention protocol on myocardial infarction patients' outcomes at a university hospital in Egypt. Forty adult myocardial infarction patients were included. The study found that after exposure to the nursing intervention protocol, patients had significantly higher total mean knowledge scores and total mean practice scores. It also found that patients had medium to high levels of compliance to lifelong instructions. The results support the hypotheses that the nursing intervention protocol improved patients' knowledge, practices, and compliance. The study concluded that a nursing intervention protocol can have a positive impact on myocardial infarction patient outcomes.
North West General Hospital and Research CenterOsama Yousaf
North West General Hospital is a 200-bed state-of-the-art private hospital in Peshawar, Pakistan. It was established as a joint venture between Alliance Healthcare and 8 former physicians of Rehman Medical Institute. The hospital has over 30 medical specialties and provides services including emergency care, surgery, imaging, and a cancer center. It also plans to build a new medical school and research facilities. The hospital aims to provide high-quality compassionate care and promote health through prevention and innovative practices. It faces challenges in attracting patients, high employee turnover, and ensuring quality materials and supplies.
7th Middle East Cardiovascular Disease and Intervention ConferenceCheryl Prior
The 7th Middle East Cardiovascular Disease and Intervention Conference aims to provide delegates the opportunity to learn the complexity of the disease, discuss the various interventional procedures, their efficiency and effectiveness in treatment of various cases, and understanding of local realities and practical constraints in improving patient care in the Middle East.
International and regional experts will discuss challenging coronary cases, paediatric interventional cases, cardiac surgery, arrhythmia, heart failures and guidelines to practice.
Key themes
Coronary intervention
Endovascular intervention
Non-cardiac intervention
Paediatric intervention
Cardiac surgery
Arrhythmia
Heart failure
Cardiac rehabilitation
Preventive cardiology
General cardiology
Echocardiography
Managing dyslipidemia
Scientific committee
Local Chair: Dr Omar K. Hallak, Chief of Interventional Cardiology Department, American Hospital Dubai, Dubai, UAE
Activity Director: Dr Ravi Nair, Associate Director, Cardiac Cath Lab, Cleveland Clinic, Professor of Medicine, Lerner College of Medicine, Cleveland, Ohio, USA
Krish Sankaranarayanan has over 24 years of experience in healthcare and holds multiple degrees including an MS in Patient Safety Leadership. He discussed the historical context of patient safety including figures like Florence Nightingale and Dr. Codman who helped establish standards. High reliability organizations have zero tolerance for errors, unlike healthcare which has error rates comparable to less safe industries. Common causes of medical errors include miscommunication and lack of standardized processes. The presentation provided tools and techniques to improve safety including accreditation, checklists, and focusing on system design rather than individual blame.
HealthCursor Consulting Group India- Mobile Health is going to be a 3000 crore market in India by 2017. (Source PwC). M-health (use of mobile phones) and E-health are all set to make an entry into India's primary health centres (PHCs) and sub-centres as the health ministry plans to go hi-tech. Healthcare industry is expected to show a strong growth of 23% per annum to become a US$ 77 billion industry by 2012. One of the largest sector in terms of revenue and employment has grown at 9.3% per annum between 2000-2009 with a current size at par with fastest growing developing country like China, Brazil and Mexico.Driven by various catalysts such as increasing population, rising income levels, changing demographics and illness profile with a shift from chronic to life style diseases, healthcare industry is expected to move to levels of US$ 77 billion in next 3 years. (Source: ASSOCHAM).
Empowering rural India is of utmost importance and the government needs to do so by provisioning for broadband penetration and financial inclusion. Access to quality health care is another key to achieving rural empowerment. The budget for this segment was raised marginally last year and it would be good to have an allocation for rural health care programs with provisions for technology that would help modernize this sector to expand its reach through remote healthcare solutions and telemedicine.
Furthermore, the government announced a big budget campaign 'Swabhimaan' in the budget last year to promote banking and provide services to about 20,000 villages. In order to meet this goal, the budget this year too would need to make provisions accordingly. The steering committee on health said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data. Disease surveillance will be put on a GIS platform.
Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.India will also put in place a Citizen Health Information System (CHIS) - a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children andwomen, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of the CHIS.
Economies of Indian states can grow 1.08 per cent faster with every 10 per cent increase in Internet and broadband connections.
Week 1 Case Study Foundations of U.S. Health Care Delivery nicolleszkyj
Week 1 Case Study: Foundations of U.S. Health Care Delivery
The coordination of care through integrated delivery systems is at the foundation of health care delivery in the United States. Often a primary goal of government officials, public health professionals, and health care administrators, measuring care coordination is a key performance indicator that directly correlates with the overall success of the health system (Johnson & Stokopf, 2010).
Northwestern Hospital first opened its doors back 1882 in Minneapolis, Minnesota. Early hospitals were small, often with fewer than 50 beds, unsanitary, and nonscientific compared to their modern counterparts (Allina Health). Moreover, they mainly served the poorest members of the community or patients who were mentally ill or facing life-threating illnesses. Northwestern Hospital was an early pioneer in the establishment of what would eventually become an evidence-based medicine (EBM) practice and featured one of the first schools of nursing in the United States (Allina Health).
Introduction
For over a century Northwestern Hospital’s use of EBM has enabled clinicians and practitioners to incorporate best treatment practices at the point of patient care in both their hospital and ambulatory organizations. For example, Northwestern’s goal to enhance quality delivery and overall patient care hastened the formation of a new entity, Minneapolis Medical Center Incorporated (MMCI). In 1966, Northwestern Hospital, along with other health care facilities in the Minneapolis area, formed the nucleus of an organization that would significantly master care coordination and delivery in the ensuing decades. Ultimately, an EBM environment created a standard of patient care that enabled MMCI to advance care delivery and medical education and lay the foundations of a modern health care delivery system.
Case Report
MMCI established a culture of continuous quality improvement (CQI). Wenke, Jongwha, LaClair, and Paz (2013) have linked CQI to better clinical quality and improved patient satisfaction. The best practice in EBM methodology is to ensure that patient care is coordinated and of high quality through the use of objective clinical data from credible sources and references. By the 1980s, a desire to add resources and support services for the coordinated care of patients such as physical rehabilitation helped lead an evolution from Northwestern Hospital to MMCI and then formation of Abbott Northwestern Hospital. Since that time, the hospital’s health services offerings have grown into a primary health system, supporting cardiovascular care, medical education, and health plans.
Conclusion
MMCI recently went through a merger and is now part of a larger health system called Allina Health that serves patients in locations across the Midwest. It has significantly expanded its portfolio of EBM to include mental health services, neuroscience, orthopedic care, and cancer treatment. Additionally, decision makers ...
Pharoah Company has four operating divisions. During the first quarte.pdftuffail786
Petromax Enterprises uses a continuous review inventory control system for one of its SKUs.
The following information is available on the item. The firm operates 52 weeks in a year. Refer
to the standard normal table for z-values Demand =78,000 units/year > Ordering cost =$30.00
order > Holding cost =$2.50 unitlyear > Average lead time =9 weeks > Standard deviation of
weekly demand =175 units a. The economic order quantity for this item is units. (Enter your
response rounded to the nearest whole number.).
Pharoah Company has a balance in its Accounts Payable control account.pdftuffail786
Petroleum pollution in oceans stimulates the growth of certain bacteria. An assessment of this
growth has been made by counting the bacteria in each of 5 randomly chosen specimens of ocean
water (of a fixed size). The 5 counts obtained were as follows. 42,66,57,67,53 Find the of this
sample of numbers. Round your answer to two decimal places. (If necessary, consult a.
Pettijohn Inc. The balance sheet and income statement shown below a.pdftuffail786
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squared test stathtic for this data set? (4.2 pts) Select a concluslon statement from a lith of
doloes.
Ferform a chi-aquared test for homogeneity and anower the followinet (a.4 pts) What is the chl-
squared test atatistic for this data set? (b.2 pts) What is the appropriate degrees of freedom value
for this teit? (c.2 pts) What is the criticai value that you would use to deternine if there is a
difference in the distributions of fish sizes across the different lakes? (a, 2 pti) Select a
conclasion statement from a list of cholce:.
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Case Report
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Pharoah Company has four operating divisions. During the first quarte.pdftuffail786
Petromax Enterprises uses a continuous review inventory control system for one of its SKUs.
The following information is available on the item. The firm operates 52 weeks in a year. Refer
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order > Holding cost =$2.50 unitlyear > Average lead time =9 weeks > Standard deviation of
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Pharoah Company has a balance in its Accounts Payable control account.pdftuffail786
Petroleum pollution in oceans stimulates the growth of certain bacteria. An assessment of this
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Pettijohn Inc. The balance sheet and income statement shown below a.pdftuffail786
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Ferform a chi-aquared test for homogeneity and anower the followinet (a.4 pts) What is the chl-
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Person or People Write a single print statement that prints 1 person.pdftuffail786
Periodic Inventory by Three Methods; Cost of Merchandise Sold The units of an item available
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cost of merchandise sold by three methods. found interim caiculations to one decimal and final
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payments for the frst quater of 2004 Cash Anceipta trem Cuktomers Acc.pdftuffail786
payments for the frst quater of 2004 Cash Anceipta trem Cuktomers Acceunts Recwhabie
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for the thit ouaner of Navi
Largey Coenasy his provided the tollowne tudpel Aabitonal ath iniated to the fent quase of Rert
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Bhtyd indsmation for the first ouater ol zogu Aor limyley Comchimty (Clek that ioon fo view the
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ase4 information for the firat ouacior of 2024 for Largley Compary ICles the kon to whw the
dats.) Read the reavinwients More info 1. Coped expenstires incude 534.000for nem
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feat quale d. Dirtid labor, manidactering ovethesd and arilnt and adminitrative catit am paid in
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Pe fumtinace Porformance revicu may be done for p.pdftuffail786
Pe fumtinace Porformance revicu may be done for purposes. Rater bias and unciew pertormance
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known as evaluasion. Review focusing on tour related aspects of finance, customer, process and
leaming is lunown as approsich Abiufy, motivation and environment are factors that affect
employee
Fill in the missing words Performance Pertormance review may be done for purposes. Rater bias
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performance review is also known as evaluation. Review focusing on four related aspects of
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Part V - Living with SEDC and Future Prospects When Janet was searching the Internet for
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genetic counseling and other follow-up care. Alexander was twelve years old at the time and
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parte 3
SR es una mujer de 65 aos que acude al servicio de urgencias quejndose de dificultad para
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Qu informacin subjetiva debe obtener la enfermera?
La enfermera est evaluando los pulsos del paciente. Qu lugares debe revisar la enfermera?
La enfermera debe evaluar la idoneidad de la circulacin colateral antes de obtener una muestra
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Cul es la causa ms probable de la dificultad para respirar, la tos productiva y la hinchazn en
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parte 3
SR es una mujer de 65 aos que acude al servicio de urgencias quejndose de dificultad para
respirar, tos productiva e hinchazn en ambas piernas. El paciente tiene antecedentes mdicos de
insuficiencia cardaca congestiva (CHF), hipertensin y diabetes. Los signos vitales son T 97.5, P
85, R 16 y BP 160/90. Al examen fsico revela edema +2 bilateral en extremidades inferiores,
frecuencia y ritmo cardiaco regulares, y pulmones con roncos en las bases. El paciente comienza
un tratamiento con nebulizador y se ha ordenado un electrocardiograma.
Qu informacin subjetiva debe obtener la enfermera?
La enfermera est evaluando los pulsos del paciente. Qu lugares debe revisar la enfermera?
La enfermera debe evaluar la idoneidad de la circulacin colateral antes de obtener una muestra
de gases en sangre arterial (ABG). Cmo debe proceder la enfermera?
Cul es la causa ms probable de la dificultad para respirar, la tos productiva y la hinchazn en
ambas piernas de este paciente?.
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Caminata por el cementerio Steven caminaba por el cementerio todos los das en su camino a
casa desde la escuela. Era un atajo conveniente y, a plena luz del da, las lpidas y los cipreses
oscuros parecan apacibles e inofensivos. Las cosas eran diferentes esta noche. Steven atraves las
puertas lo ms rpido posible, temeroso de que lo estuvieran observando. Corri hacia las profundas
sombras de un mausoleo y contuvo el aliento, con el corazn desbocado. Trat de escuchar ruidos
siniestros, pero no pudo or nada por encima de la sangre que corra por sus odos. Presion el botn
para iluminar su reloj: 11:30 pm Debe permanecer aqu una hora completa para ganar la apuesta.
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luego gir con lentitud subacutica. Para su horror, pudo ver que la puerta del mausoleo se abra.
Steven quera correr, pero no poda. No poda sentir sus piernas; luch por respirar. Una luz amarilla
brillaba desde el interior del mausoleo. Las sombras se deslizaron y bailaron sobre las lpidas
cuando alguien o algo que sostena la luz empuj la puerta. Emita un sonido terrible y gutural,
como los gemidos de un moribundo. La puerta se abri por completo. En el umbral del mausoleo
haba un anciano con una camisa a cuadros, una linterna en la mano y un cigarrillo en la boca.
Volvi a toser, escupi y cerr la puerta. Era solo el jardinero del cementerio, terminando un largo
da de trabajo. El jardinero se dirigi hacia el cobertizo de mquinas. Tan pronto como el hombre le
dio la espalda, Steven dej su escondite y corri. Su amigo David podra quedarse con esa apuesta
de $5. Una hora en este lugar no vala la pena.
1.) Cul de las siguientes oraciones, tal como se usa en el pasaje, indica una "estructura de texto
de comparacin y contraste"?
R. Una hora en este lugar simplemente no vali la pena.
B. Las cosas fueron diferentes esta noche
C. Debe permanecer aqu la hora completa para ganar la apuesta
D. Escuch un raspado bajo detrs de l.
2.) Cul de las siguientes definiciones coincide con el significado de la palabra umbral tal como
se usa en este pasaje?
A. Un nivel en el que uno comienza a sentir o reaccionar ante algo.
B. Una tira de madera o piedra que forma la base de una puerta
C. Un punto de lanzamiento del comienzo, como en una nueva etapa de fase.
D. Un nivel, tasa o cantidad en la que algo entra en vigor.
3.) Cul de las siguientes es una conclusin lgica que se podra hacer con base en el pasaje?
A. El jardinero del cementerio es una persona muy aterradora.
B. Steven se asusta ms por la atmsfera del cementerio por la noche.
C. Steven y David a menudo hacen apuestas entre ellos.
D. Los nios que viven cerca a menudo se desafan a visitar el cementerio por la noche.
1.) Cul de las siguientes oraciones, tal como se usa en el pasaje, indica una "estructura de texto
de comparacin y contraste"?
R. Una hora en este lugar simplemente no vali la pena.
B. Las cosas fueron diferentes esta no.
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subsidizing basic research B. building lighthouses C. toll charges on congested roads D. cost-
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Cul de los siguientes es cierto para los transposones de ADN? seleccione todas las que
correspondan.
Son elementos transponibles.
Requieren transposasa para moverse.
Requieren transcriptasa inversa para moverse
Requieren integrasa para moverse.
Se mueven a travs de un mecanismo de cortar y pegar.
Se mueven a travs de un mecanismo de copiar y pegar. A.
Son elementos transponibles. B.
Requieren transposasa para moverse. C.
Requieren transcriptasa inversa para moverse D.
Requieren integrasa para moverse. MI.
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Se mueven a travs de un mecanismo de copiar y pegar..
�Cu�l de los siguientes es cierto de los vendedores a. Desempe�an .pdftuffail786
Cul de los siguientes es cierto de los vendedores? a. Desempean un papel en la produccin de
ingresos para sus empresas. b. Reciben retroalimentacin retrasada sobre su desempeo laboral. C.
Disfrutan de la comodidad de una rutina bien establecida. d. A menudo son una fuente terciaria
de informacin para los consumidores que probablemente sean los primeros en adoptar una
innovacin. mi. Dificultan la difusin de la innovacin..
�Cu�l de los siguientes es cierto con respecto a los dividendos Opc.pdftuffail786
Cul de los siguientes es cierto con respecto a los dividendos? Opcin multiple
-El sistema para eliminar la doble imposicin supone que la tasa del impuesto de sociedades es
del 27,5% cuando los dividendos computables se extrapolan para incluir el 138% del dividendo.
-Los dividendos recibidos de los ingresos comerciales de una CCPC que no estn sujetos a la
deduccin de pequeas empresas generalmente se incrementan para incluir el 115% del dividendo.
-Los dividendos recibidos de los ingresos comerciales de una CCPC que estn sujetos a la
deduccin de pequeas empresas generalmente se elevan al bruto para incluir el 138% del
dividendo..
�Cu�l de los siguientes describe mejor la ruta de una RFP 1- Un c.pdftuffail786
Cul de los siguientes describe mejor la ruta de una RFP?
1- Un consultor de inversiones solicita a varios administradores de fondos que presenten una
RFP. Luego, los administradores de fondos preparan y presentan sus RFP al consultor y/o al
propietario de los activos, quienes luego decidirn qu administrador seleccionar.
2- Un administrador de fondos presenta una RFP a un consultor de inversiones. Luego, el
consultor de inversiones lo compara con diferentes clientes que buscan hacer una pareja.
3- Un gestor de fondos busca inversores institucionales como compaas de seguros y planes de
pensiones ofrecindoles una serie de RFP. El consultor de inversiones ayuda al cliente a decidir en
qu invertir
4- Un propietario de activos/cliente institucional con fondos para invertir presenta una RFP a un
consultor de inversiones y administrador de fondos. El consultor de inversiones y el
administrador de fondos trabajan juntos para cumplir con los objetivos del cliente..
�Cu�l de los siguientes describe correctamente el tratamiento contab.pdftuffail786
Cul de los siguientes describe correctamente el tratamiento contable de los intereses por pagar?
A. Se muestra en el balance general como un pasivo corriente.
B. Se muestra en el balance general como un pasivo a largo plazo.
C. Se muestra en el estado de resultados como un gasto de operacin.
D. Se muestra en el balance general como un activo circulante..
�Cu�l de los siguientes cuatro elementos es fundamental para la ejec.pdftuffail786
Cul de los siguientes cuatro elementos es fundamental para la ejecucin en el modelo de
congruencia?
a. Habilidades, competencias, cultura, organizacin
b. Competencias, cultura, liderazgo, habilidades
C. Habilidades y competencias, tareas crticas, cultura, organizacin formal
d. Habilidades y competencias, cultura, organizacin formal, liderazgo.
�Cu�l de los siguientes debe hacer un gerente de proyecto para crear.pdftuffail786
Cul de los siguientes debe hacer un gerente de proyecto para crear una EDT?
Delegue la creacin de la WBS a los miembros del equipo del proyecto
Usar las expectativas de las partes interesadas para secuenciar las actividades
Obtener la aprobacin para cada seccin de la EDT del patrocinador del proyecto
Colaborar con personas experimentadas y bien informadas.
�Cu�l de los siguientes describe mejor el programa de respaldo utili.pdftuffail786
Cul de los siguientes describe mejor el programa de respaldo utilizado en un modelo financiero?
Muestra proporciones histricas que impulsan el pronstico.
Resume las prdidas y ganancias de la empresa.
Reporta el efectivo generado y gastado por una empresa.
Desglosa clculos ms largos, como PP&E y programa de deuda..
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Create a More Engaging and Human Online Learning Experience
Case H The American Heart Institute Sofia V. Agoritsas and Ann Sc.pdf
1. Case H The American Heart Institute Sofia V. Agoritsas and Ann Scheck McAlearney The Case
of Amanda Jones Presenting with chest pain, 60-year-old Amanda Jones was rushed from the
ambulance bay of the emergency department (ED) of Fast Bay University Hospital (EBUH) to
the catheterization lab. The American Heart Institute
(AHI) lab team determined that Jones was experiencing an ST-segment elcration myocardial
infarction (STFAII), the deadlicst rype of heart attack. As a result, within 30 minutes of her
arrival, Jones received a percutaneous coronary intervention (PCI), but the occluded artery could
not be opened. The cardiac catheterization lab team aceelerated the protocols to fasttrack Jones
for emergen cardiac bypass surgery with the cardiac surgeon on call. Luckily, Joseph Cusimano,
MD, the chief of cardiac surgery, was available, and Jones was taken into the operating room
(OR) within one hour. As time lost was a matter of life and death, it was a race against time.
Collaboration among the interdicciplinary teams of the divisions of cardiology and cardiac
surgery and communication among the clinical leaders throughour the AHI were critical to
Jones's survival. Fortunately for Jones, her cardiac emergency had a happy cnding. She
reconered and was released a week later without brain or heart damage. What Jones didn't know;
though, was that AHI was more of a virtual institute than an actual place. Although she had been
seen and treated at FBUH, the collahoration and communication that oecurred cronsed
departments, divivions, and organizational benundarics, And unfortunatchy. AHI's executive
director Sandra Cietty was not convinced that this structure alwayy pronided patients and their
familics with the best carc and service quality they espected and doweried. East Bay University
Hospital and the American Heart Institute Cardiac Service Line FRUH, a 700-bed teaching
hospital, is one of two tertiary care facilitics within True Care Health System (TC:HS. FBUH is
the flagship hospital for adult acute care in the health system. The other acute care hexpital. Truc
Care North. was only recently acquired by TCHS and is 20 milcs awxy from the other four main
facilitics. The Children's Hospital, a psychiatric hospital, and a cancer hespital constitute the
remaining three hempitals of TCHS. AHI is the cardiac service line that spans TCHS. AHI is
viewed as a leading prowider and piomeer in cardiac care in the region. It is led by Dr. Barry A.
Mlount, an interventional cardiologist. AHI prowides adult cardiac care throughout the state and
includes a staff of 50 full-time emplened cardiologists and cight cardiac surgeons, five of whom
primarily work out of FBUH isec Evhituis 111.8 and 111.9%. The AHI service line also includes
sis close-to-home cardike outreach clinics that are part of IC.HS's ambulatory carc network: this
network spans the suburbs around the five-hospital health system. AHI has heen listed nationally
by leading organizations such as Healthgrades as a top-ranking cardixc program in the United
2. States, lut it has not yer been ranked as a top progeram in L:S. Nims of Ilorld Report.
The mission of AHI is to provide world-class, comprehensive eardiac care, to advance cardiac
research, and to promote medical education in a fiscally responsible manner. Its vision is to
become a premier center of excellence in cardiovascular medicine in the United States.
Cardiology and cardiac surgery are to be coordinated in an integrated and seamless delivery
system. The AHI's goals and guiding principles are - to foster clinical leadership and clinical
expertise in high-quality cardiac care, - to promote a patient-centered care environment and a
culture of excellence, - to develop and implement evidenced-based guidelines that are
measurable and outcomes driven, - to provide patients with appropriate education to empower
them and their families to participate in their clinical decision making and selfmanagement, and -
to create marketing initiatives that will brand the identity of AHI.
AHI Structure AHI is, in practice, a virtual service line, requiring synergistic cooperation from
all TCHS cardiac services to realize its mission and achieve its goals (sec Fxhibit III.101. Across.
AHI the involved cardiac services include general and interventional cardiology:
clectrophyiology: the congestive heart failure (C.HF, program; cardiac rehabilitation; and cardiac
surgery; including cardiac bypass surgery, the minimally invasive valve surgery program.
robotics surgery, the endowasular aortic repair center, and heart transplant. The muin divisions
that constitute the AHI service line are cardiology and cardiothoracic surger:. These divisions are
embedded within traditional departmental structures within the depurtments of medicine (se
Evhibit III.11) and surgery F tee Exhibit 111.12 . As a result, budectary control of the dinisions
of cardiology and cardiothoracic surgery are maintained through their department. Howeerr, AHI
wervice line profit and loss statements and summary of statistics neports isee Fixhilht III.13) are
reviewed monthly by an . Al cardiac axtisory boand. Furthermore, marketing activitics
incomporate advertiving for cardiology and cardiothoracic surgery under the AHI virtual service
line structure, despite the department of onigin.
"Physician Ambulatory Practices includes celtreach clinics.
XHIBIT III.13 Summary of Statistics (Includes East Bay University Hospital and True Care
North Hospital)
EXHIBIT III.13 Summary of Statistics (continued)
Leadership Challenges for the AHI Service Line The executive director of AHI, Sandra Getty,
3. BSN, RN, MIBA, is responsible for service line business development and serves as the liaison
for cardionascular programs. She previously worked as the nurse manager in the catheterization
lab with Dr. Mount 20 years ago and played a major part in helping the division to become
filmless. Since then, Getty has established an electrophysiology program, including an atrial
fibrillation center and a congestive heart failure program. In her current role she is responsible
for operational leadership and review of compliance activities, coordination of operations and
budget formation for all cost centers (except for cardiothoracic surgery), capital improvements,
and expansion planning, including transition details. Getty has also been responsible for the
acquisition and derelopment of the community outreach centers through a serics of purchases of
group practices; as a result, multiple physicians are fully employed by the healtheare system.
Now, she is leading on-boarding efforts for the new community physician practices, hoping to
facilitate seamless transitions and maintain efficiencies in processes and care coordination. Cictty
has a key responsibility to make sure that all of the programs within the cardiovascular service
line are collectively marketed under the AHI brand. In addition, all the nurse managers and
practice administrators in the cardiothoracic intensive care unit (CTICL?), cardiac intensive care
unit (C.CU), and step-down and telemetry units report to her. Recently, she led the
implementation of an electronic health record system, including computerized physician order
entry capability for the divisions of cardiology and cardiothoracic surgery, in both the outpatient
and inpatient settings. She was also responsible for implementing the American College of
(ardiology (ACC) National Cardiosascular Data Registry, and the Society of Thoracic Surgeons-
approxed electronic databases that had been recommended to track patient outcomes. Gietty is
very eager to use the new health information techologics ( HIT) and systems to cnable tracking
of patient outcomes across the AHI service line. By far Cietty's biggest challenge is managing
relationships with phsician leadership and AHI faculty: The lack of cooperation among
physicians. partially attributable to the currently virtual organizational structure for the AHI
scrvice line, limits her cfforts to improve standardization and coordinate care across FBLH and
the TCHS-despite her success implementing HIT and data registrics.
Quality Improvement Challenges for the AHI Service Line Dr. Cusimano, chief of cardiothoracic
surgery, is considered a national leader in the area of cardiovascular quality improvement. He
was recruited two years ago from the northeast, in part because of his reputation for quality
improvement. Dr. Cusimano has been part of a consortium that includes cardiothoracic surgeons,
interventional cardiologists, administrators, perfusionists, anesthesiologists, and operating room
and cardiac ICU nurses; this consortium has been actively reviewing the management of cardiac
disease in the region to identify quality improvement opportunities. For more than 20 years, the
consortium has established and maintained registries and collectively developed ways to
4. continuously improve the quality, effectiveness, and costs of care in delivering interventions for
patients with cardiac disease. Dr. Cusimano has also played a national role in the Society of
Thoracic Surgeons (STS), the national organization for cardiothoracic surgeons; with the STS, he
has served as a key member of multiple executive committees. Since coming to EBUH, Dr.
Cusimano has tried to establish several multidisciplinary teams and process improvement
initiatives. He strongly believes in improving patient outcomes, not just as a necessary response
to increased scrutiny of programs by the state department of health but because it can also
address the current AHI problems associated with outmigration of patients and decreases in
patient volume. AHI is proud of its recent statepublished outcomes, including 2 percent mortality
in coronary artery bypass graft (CABG) surgery and a higher than 99.5 percent cath/PCI survival
rate in the catheterization lab. The improvements in CABG surgery, in particular, have been
particularly evident since the arrival of Dr. Cusimano. However, AHI still needs to focus on
reducing mortality rates associated with valve surgeries. Despite Dr. Cusimano's national
prestige and experience with quality improvement, the current cardiothoracic surgery faculty at
EBUH have not embraced the changes he has made. In fact, because all of the other EBUH
surgeons were formerly trainees mentored by the current chair of surgery, Dr. Craftman, many
are leery of the "new guy." Interestingly, several surgeons had noted that they believed there
were already too many cardiae surgeons on staff at EBUH, so they were predictably
unenthusiastic about bringing Dr. Cusimano into their group. For the past two years, Dr.
Cusimano has attempted to organize the group of cardiac surgeons. He has established multiple
teaching and quality forums-including enhancing the structure, participation, and transparency
of the morbidity and mortality conference meetings, and increasing clinic and didactic
involvement with residents and on multidisciplinary rounds. The performance improvement
meetings that review patient complications are now more structured, and processes to address
opportunities for systematic solutions on the basis of root-cause analyses have been developed.
In general, the tone of care quality review meetings has changed from a focus on faultfinding and
berating individuals for mistakes to one of collective efforts to find opportunities for
improvement. Dr. Cusimano has also worked with Dr. Mount to develop a daily conference
session for faculty from cardiology and cardiothoracic surgery during which faculty meet in the
catheterization lab to review all the operative cases against recommendations from the
ACC/American Heart Association guidelines prior to performing any surgeries. The objective of
this multidisciplinary forum is to enhance the physicians' abilities to assess risk and determine
appropriate treatments for patients in a collaborative environment. However, many of the
cardiothoracic surgeons do not consistently attend the conferences, often sending a resident
physician or phyysician assistant as their representative to present the surgical case under
5. consideration. In the area of HIT-facilitated clinical decision making, Getty and Dr. Cusimano
recently implemented a serics of inpatient order sets and evidence-based guidelines in the
CTICU, step-down, and telemetry units. As a result of this process, they also decided to
incorporate the division's monthly quality indicators into the AHI service line dashboand (see
Exhibit III.14). Unfortunately, this level of transparency in reporting quality data has not helped
improve Dr. Cusimano's reputation with his colleagues. Dr. Cusimano's lack of history with the
existing faculty and weak relationships within EBUH have limited his ability to build rolume and
a strong referral base, thereby minimizing his own clinical productivit. As a result, the surgeons
who operate the most use the newly arailable patient data to tout their own performance, further
discounting the value of Dr. Cusimano's contributions to EBUH. Overall, Dr. (isimano strives to
unite, motivate, and hold each of the independent cardiac surgeons accountable, but he has yet to
be successful in this endeavor. One issuc he has encountered is that the employment contracts of
the surgeons are not uniform in structure. Dr. Cusimano has proposed to the executive
administration that each physician receive a base salary and then be given an augmentation-or
bonus-hased on certain metrics (see Exhibit III.151. The measures would he reconciled through
the department of finance on a quarterly basis. In response to this proposal, the candiac surgeons
recently met privately with the executive administration of EBUH and the chair of surgery and
threatened to leave the organization. The administration's
reaction was to increase the salaries of these surgeons because they were afraid that a large
volume of surgical referrals and cases would be diverted to hospital competitors if this group of
surgeons left EBUH - but this reaction clearly undermined Dr. Cusimano's individual authority
within the group. Moreover, looking ahead, physicians have no direct incentive to align
themselves with EBUH's or TCHS's long-term goals, and this does not bode well for future
collaboration efforts.
EXHIBIT III.15 Cardiac Surgeon Compensation Model Division of Cardiothoracic Surgery
Compensation Model Surgeon: Augmentation Schedule Above Base Salary:
Additional Challenges for the AHI Service Line Dr. Mount and the other members of the cardiac
advisory board recognize that procedures have become less profitable in recent years. Increases
in costs combined with high utilization of costly devices, such as drug-eluting stents and
implantable cardioverter defibrillators, have contributed to this problem. Service line growth is a
perpetual struggle and is influenced by a variety of factors, including shifts in patient volume
from inpatient to outpatient treatments; competition across disciplines, such as cardiology,
vascular surgery, and interventional radiology; and the incorporation of novel technologies, such
6. as drug-eluting stents, that led to severe reductions in cardiac surgery volume. In addition, these
cost and growth challenges are exacerbated by additional operational and clinical issues. For
instance, AHI does not have a single budget because of its design as a virtual service line.
Similarly, because of the considerable variability in the particular conditions of each physician's
employment contract, expectations and the level of commitment between surgeons and AHI also
vary; only some of the cardiac surgeons are fully employed by the health system, and many of
the contracted surgeons feel lower levels of loyalty to AHI and the health system than AHI
would like to have. Finally, as is the case in most healthcare settings, internists and cardiologists
follow referral patterns based on their long-lasting relationships; because many of these
individuals trained as resident physicians together, they are inclined to refer to the colleagues
they know rather than follow AHI criteria for ordering consults or following the on-call
schedule. Geographic limitations also pose challenges to the coordination of patients for AHI.
Because the building infrastructure was built to accommodate traditional hospital departmental
structures, the cardiac surgery practices, CTICU, and operating rooms are contiguous with the
department of surgery and division of general surgery. However, these areas are distant (i.e.,
floors away) from the cardiology suites that include echocardiography, electrophysiology, the
CCU, and the catheterization labs. Without centralization of services, communication between
and among the various entities is complicated; this physical structure thus reinforces independent
silos of activities rather than fostering collaboration throughout AHI. In addition, many of the
cardiology group practices are located on different sites around campus. Way-finding for patients
is confusing, and the need to improve coordination of care is further compounded. Despite these
challenges, though, the cardiac advisory board believes that a comprehensive and highly
specialized heart institute that includes advanced programs will lead to profits down the road.
For instance, both Drs. Mount and Cusimano believe that the division of cardiothoracic
surgery needs to develop its minimally invasive valve surgery program. This need has become
especially pressing as the volume of CABG surgeries performed through AHI has plateaued; it
appears that many patients are being referred by community-based physicians to the comperitor
teaching hospital in the city rather than being sent to AHI surgeons. In comparison with the risks
associated with traditional surgery; patients benefit from minimally invasive valve surgery
because the breastbone is not split, the risk of infection and bleeding is lower, hospital length of
stay is shorter, recovery time is accelerated, and the cosmetic result of the surgery is better. A
strong minimally invasive valse surgery program at AHI would allow AHI to differentiate its
product from other hospital competitors that do not offer this surgical alternative. Strategic
Planning for AHI D)uring the spring of 2010, the executive administration of TCHS requested
that AHI conduct a strategic plan assessment for 2011-2015. Considering the market share
7. parameters that were analyzed-including population growth, total population size, inpatient and
outpaticnt market share, phsician supply and demand. parer mix, and the Ilerfindhal-Hirschman
Index (a measure of market concentration-capacity for growth and market prioritization were
identificd as primary arcas for strategic focus. Additional prioritics include the following: -
Establishing a discasc-bascd organization - Creating an outreach team - Building programmatic
infrastructure in the congestive heart failure and clectrophyisiology departments - Fxpanding the
AHI outreach clinic nctwork - Fxpanding the cardiac rehab program - 1Developing partnerships
with targeted local and regional community cardiology practices - Increasing Truc Care
Ambulatory Network referrals to AHI phyisicians - Establishing a one-stop communications
office - L'sing paticnt naxigators and outreach coordinaton to serie as the connectors between
AHII physicians, referring community-hased physicians, and paticnts Results of the strategic
planning process also highlighted the branding problem of the AHI and noted that much of the
problem could be
attributed to the virtual nature of the service line. Another problem the process identified was the
cannibalization of AHI market share that was occurring in certain practices and regions because
of redundancies in services offered and the substitutability of certain treatments. In some
instances the planning process suggested excessive outmigration from the outreach clinics, even
though they were part of the TCHS Ambulatory Network. It appeared that while the community-
based cardiologists were using their affiliation with AHI to promote their own practices, they
also reportedly felt disconnected from AHI and were afraid they would lose their own patients to
the main AHI campus cardiologists. Realizing the Strategic Vision: Moving from a Virtual
Service Line to Bricks and Mortar? The strategic planning process also introduced the possibility
of building a freestanding cardiac hospital. The case was made that the cardiac services division
was and would continue to be a pillar of revenue and contribution profits, and AHI might be able
to solve some of its current problems by moving into a freestanding center. Such a center would
be designed to support a comprehensive cardiac service line that included prevention, early
detection, disease management, and postprocedure follow-up care. The driving forces supporting
the case for developing the freestanding heart hospital included: (1) enhancing the academic
stature and branding image of the cardiac service line, (2) facilitating the implementation of a
more efficient clinical model, and (3) maximizing the ability of AHI to realize the value of the
cardiac service line. If this path were pursued, the freestanding facility would be expected to
epitomize the image and brand of the AHI, aligning AHI with its vision and helping to promote
identification of AHI as the destination center of excellence for cardiac tertiary and specialty
care. As a result, community-based AHI practices would be able to focus more on general
cardiac care. Centralizing specialized services in a single physical location would enable AHI to
8. (1) design care around patient needs, (2) integrate services and knowledge, and (3) create
efficiencies for disease coordination and systems processes. Costs would also be able to be
managed by leveraging economies of scale and scope. It was argued that patients would be better
served because all services would be centralized, and multidisciplinary advanced programs
would be available in one facility. The ultimate goal was that the physical infrastructure could
support programmatic development and internal physician alignment across the cardiac service
line-but at a cost of $100 million.
At present, AHI leadership must sort out the service line situation and the alternatives ahead.
Fortunately the clear consensus is that patients like Amanda Jones cannot sufter from poor
service or poor care quality because of issues related to problems with misaligned incentives,
poor collaboration, or inadequate coordination. 1.eadership realizes that it must continue to
provide both clinical and nonclinical staff with the resources and education tools ther need to be
able to provide the hest care possible. let introducing some of these resources and tools has
proved difficult in many circumstances. Neither the employees nor the staff should get caught up
in the challenges affecting the service line, but even under the most optimistic of circumstances,
a new building for the AHI would not be wailable until 2015. Case Questions 1. What problems
and issues result from the way AIH is currently organized: 2. How are design issues exacerbated
by power conflicts between and among physicians? 3. What are the issues that a new building for
AHI might be able to solve: What isstes might still plague AIII? 4. What would you recommend
that AHI lcadership do now? Who would you inole in making decisions about the future for
AHI?