Thank you, Dr. Mayhew

A wonderfully written comment by Dr. Emily Mayhew, Military Medical Historian at Imperial College London, to my post below, made me curious about other things she has produced. I came upon this marvelous story about a New Zealand and a Scottish doctor who, during wartime, invented many of the practices used in plastic surgery. This is documented in her book, The Reconstruction Of Warriors, published by Greenhill Books. The story was also the subject of a BBC documentary, narrated by Dr. Mayhew.

Dynamic lighting versus delirium

A design element of the new Jeroen Bosch hospital will allow the hospital to conduct a clinical trial to test the effect of dynamic lighting on the incidence of delirium in the ICUs.

Here is a statement of the problem:

Delirium is a frequently encountered problem in ICU patients and leads to increased morbidity and mortality; Delirium in the ICU is associated with sleep deprivation which is among others caused by a disrupted circadian rhythm; Dynamic Light application aims at restoring a proper circadian rhythm by rhythmically alternating light intensity and has shown beneficial effects in sleep quality. Whether DLA improves sleep quality and reduces delirium incidence in ICU patients is not known.

The experiment is made possible because the hospital installed this kind of lighting system in its new ICUs. The lights in the ICU rooms can automatically mimic the intensity and color of light during the day at this latitude. In this experiment, some patients will experience this dynamic lighting regime, while a control group will experience the usual levels of ICU lighting. More details about the experiment are here.

Where Can I find Important Reports that determine the Stock Market?

I know I have to look for GDP, consumer spending, SEC, S & P, Moody, housing, unemployment, quarterly reports, inflation, the Federal Reserve. I do not know where to get these reports and when they leave. Where I can find these reports and other reports I look for? 
 

Nationa Bureau of Economic Research

Economic Indicators and Releases.................. http://www.nber.org/releases/

Can you Identify two Essential Skills or Cornerstones that will lead you to Success?

• Sense of hard work and common. Seriously - these things are rare in today's market. I'm taking a hard worker with good common sense in a flaky genius at any time.

• Having the courage and thinking things through. You can have both. You can have the courage to do things impossibe and think through before doing so.

• Being able to answer your questions on the application itself, and not after them all the answers.

What jobs should you look for after a course in Tourism and a IT training?

There is no correlation between these two courses! However, you can open your own tour and travel agency and can establish a good business!

however

You could try one of the many travel Web sites. They might have the need for a technician with exposure to tourism.

The field is easier to get a job with a degree in computer science or electrical engineering?

About the degree

There is a department called computer science and engineering at universities. You can get a degree in "electrical engineering, computer 'computer science and engineering" and "information science."

Could be the best field

I think the strong field at this time. That, and there are very few universities offering a major in "usability" - the specific art / science of writing software that is easy to use for the computer owner. Many programmers do not always give an idea of ​​the ease of use and that is why some software just gets you nuts. Websites must also be easy to use. That area is growing rapidly.

Do you Have to go to College to get into Nursing, Is there another Way?

• You must have a college degree to become a nurse. However, in addition to classroom work, in its third year of college is going to start doing clinical at the hospital. I shadow a nurse and get hands on training in all departments of the hospital.

• You can not become a nurse learning in the workplace - the need for formal education as well.

• Not a chance. You must go through years of rigorous college courses before he can become a nurse. The job is fine for some jobs, but not for the life of the people are at stake.

Schools for the Study of RN in Oklahoma City?

The University of Oklahoma has a huge campus health sciences center in Oklahoma City, near the capital. One school is the school of nursing.

What is a Building Society reference number to Work in UK?

That is indeed the account number (personal to you).

A number of work permit is exactly what it says: If you need a work permit to work in the UK, you must give the number of permission to confirm that you have one (you need to produce the original to your employer and make sure it is fine).

Jobs for Finance Majors?

First is the investment banking. It can be very fierce and reserved for graduates of high school like Wharton, Harvard, etc.. Investment banking is the structuring of deals, complex business models, etc.. You will be working late into the night, basically your job is your life.

However
 
There are financial services, where is the center or back office. Here's your chance to support functions more as trade support, reconciliation, reporting, accounting and so on. The schedule is much more normal.

Also
 
There is also the aspect of the sales of a financial advisor. You basically have to make cold calls to get customers to come in.

Seeing things clearly in the Netherlands

In the post below, I summarize a conference held today at Jeroen Bosch Hospital in 's-Hertogenbosch (den Bosch), in the Netherlands, entitled "Quality and Transparency in Care and Training." In addition to the conference, today was a significant day in that a new website was launched by the hospital to present quality and safety data to the public and to the hospital's staff.

As explained by Dr. Marjo Jager, patient quality specialist, Jeroen Bosch has a strong commitment to transparency as a key element of process improvement in the hospital. The leadership of the hospital views transparency as the most powerful way to reduce preventable injuries, but also as essential to successful and ethical responses to patients and to safeguard employees.

Marjo noted that preconditions for successful implementation of transparency are a culture of learning rather than blaming and judging; ownership by those who deliver care; significant participation by physicians in designing new care regimes and setting an example; and strong support from the board.

Above you see an action shot of the moment of truth, as staffers Miriam Casarotto and Bart Deijkers prepare to push the "activate" button on the new website.

Beyond the website, the hospital is also posting clinical data on patient care floors for all to see. They are experimenting with locations and topics, and this is all bound to change with experience, but the commitment to openness is evident, even when the numbers indicate a need for improvement.

Here, for example, is the current scoresheet with regard to pain management on one of the floors. The hospital clearly indicates a result less favorable than they would like, accompanied visually with a cartoon face that is not smiling.


In contrast, note this one with regard to avoiding decubitis ulcers (bedsores), which indicates performance at the hoped-for standard of care.

Congratulations to the administrative and clinical leadership of the hospital, and for the support provided by its board, for these significant steps in improving the quality and safety of patient care.

Borrowing safety ideas in the Netherlands

I just attended and presented at a conference at Jeroen Bosch Hospital in 's-Hertogenbosch (den Bosch), in the Netherlands, entitled "Quality and Transparency in Care and Training." It was held on the occasion of the opening of an entirely new hospital, following a merger with two other hospitals in the city (Bosch Medicentrum and the Carolus Hospitals). Hospital administrators and clinicians from throughout the country attended.

Our MC for the day was Jozein Bensing, professor of health psychology at the University of Utrecht. Relative to today's topic, she is most known for a paper she published a few years ago documenting that 1700 people per year unnecessarily die in Dutch health care facilities. This report gave substantial impetus to improvements in patient safety in the country's hospitals.

Jozein chairs the quality and safety committee of Jeroen Bosch's supervisory board (the equivalent of the board of trustees of a US hospital.) She said that the hospital has a goal of being the safest hospital in the Netherlands and plans to do so by "practicing what you preach" and learning as much as possible from others, in the health care field and beyond.

So it was appropriate that the chair of the symposium committee, Marck Haerkens (CEO of Wings of Care), and his colleagues decided to bring in the lessons of quality and safety from other fields. They see parallels with airline safety, and so we heard from Pieter van Vollenhoven Chair of the national Safety Board; Jos Nijhuis, CEO of Amsterdam's Schiphol Airport, and Tames Oud, head of training for Transavia Airlines.

Tames suggested that, while aviation and medicine are two different worlds, there some striking similarities, such as highly motivated professionals and critical processes. In both worlds safety and quality depend on effective cooperation between different disciplines. Like Captain Sullenberger back in the US, Tames asserted that the medical community could benefit from Crew Resource Management (CRM). Its objective is to reduce incidents (and worse) due to lack of situational awareness and team cooperation. He noted that CRM training makes people aware of the relevance of the human factor in team performance, and aids in creating a blame-free environment for people to work in.

In addition, Scott Higginbotham, mission manager at NASA's Kennedy Space Center, presented on "Safety and Mission Assurance." (He is seen here on the right with Willy Spaan, the hospital's CEO.) Scott's primary responsibility is to lead the multi-disciplinary team of engineers and technicians that assemble and test the experiments and satellites that fly aboard the Space Shuttle and the International Space Station. A summary: Manned spaceflight is an incredibly complex and inherently risky human endeavor. As the result of the lessons learned through years of triumph and tragedy, NASA has embraced a comprehensive and integrated approach to the challenge of ensuring safety and mission success. His presentation provided an overview of some of the techniques employed in this effort.

Regular readers of this blog will know my topic: I presented the experience of my former hospital with regard to its goal to eliminate preventable harm for its patients. I explored the hospital’s success in improving quality and safety for patients, endorsing public transparency of clinical outcomes, and engaging in process improvement driven by front-line staff.

As I have noted before, there are often misconceptions as people talk about “transparency” in the health care field. They say the main societal value is to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. As for hospitals, people believe the main strategic value of transparency is to create a competitive advantage vis-à-vis other hospitals in the same city or region. Both these impressions are misguided.

Transparency’s major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

Many thanks to the symposium's major organizers, Marian de Bont and Dr. Kees Smulders, secretary and manager, respectively, of Jeroen Bosch's quality section (seen here) for their invitation and for planning a day of interesting and insightful talks.

In the post above, I include recent activities of Dr. Smulders and his staff with regard to new approaches to transparency in their hospital.

I wonder What are the Requirements to Work as a Medical Assistant?

For the most part, the successful completion of a Medical Assistance program. Most community colleges and non-profit vocational schools have master's programs, usually lasts about 9-12 months, although some associate degree programs.  

About the practice 

Of physician work occasionally has a pair of MA ORA they were really patient care in the obstetrics unit to work, but because doctors knew about these clinical PCT skills, professionalism and knowledge in the workplace at Work / delivery, had no problem with them "running the patients' office. The other MAs  in the entire practice / graduate programs MA.

Consider this 
 
The CNA (Certified Nursing Assistant) and a physician assistant (certified, registered, or just MA) are not the same job and have the same duties. You'd be surprised how much people think they are one and the same.

How to choose the Maintenance Influence of Programming Languages?

Let's take a scenario, a company wants to create software for other major company. It is a web-based software. By poppularity, PHP is going strong as a web programming language. However, Java is another strong competitor.

Now the software that require large

• 1. huge maintenance.
• 2. good security
• 3. good structure for the feasibility and ease of use.

All this can not be provided by PHP. The reasons are

1.--- It is not strictly written language compared to Java
2.--- It looks more like one today can do without much hassle. Even non-programmers. However, Java requires a good knowledge of programming constructs.
3.--- Java provides better security. This class has devoted the same.

So overall  

You can see a company would choose java whether to use a large software. But if you're going to create websites or for occasional use software that does not require a huge maintenance, then certainly, PHP would be the way forward. Since it is slightly faster than java and a lot less code compared to java .. Therefore the maintenance dictate what programming language you choose.

Computer Networking Jobs in London?

For those with careers in computer networking and are looking for a job for this type of work..... You can search on indeed.com Hope you will find lots of jobs out there

What are the websites/online magazines that use real estate professionals to upgrade?

LoopNet is the # 1......others are out there

It is important

do not bother with what is happening, but what's for sale? what sells...... have to be licensed...... be a buyer's agent or realtor? You can no longer be both safe

How to Sue a Customer for Defamation in a Business?

I would add one step before its application

1.-Start to make copies of each review / post that makes
2.-Contact an attorney to discuss your case
3.-(this is the step I'm adding) to your lawyer write a letter on your behalf, informing him that have gathered evidence against him and intends to sue for defamation if not stop immediately.
4.-Wait for the reaction of the respondent. otherwise proceed

Consider this

Usually people do this because they are only listed or they are working for your competitor. When they see that you are serious about legal action against them, usually stop, so a letter from a lawyer is a very useful tool.

Are you Looking for a general Liability Insurance for a Business in South Central MO?

• You get it from a local agent, independent, who can figure out exactly what you mean by "preservation of property." Contractor to fix the old buildings? Or someone who takes food and preserved for later consumption?

• You can find a local agent near you independent in www.iiaba.net

Option to sell Life Insurance from several companies under the same license?

Consider the best

• No, you can not sell two life insurance agent's license may sell life and general insurance for your license. If you need to sell two or more life insurance then request broker license.

• Yes, although not independently. You have to work with the insurance broker.

Are there any dental insurance that covers dental implants?

• No individual plans that cover dental implants, even partially.

• There is no such thing. If you want, you'll pay out of pocket. Sorry.

• I do not believe as they are considered safe cosmetics and choose cheaper options such as prostheses.

I am looking for a list of Insurance Headquarters in Minneapolis, MN?

• You may want to check out the MN Department of Insurance for a list. However, to verify if they have their headquarters there or license can only say you should go to each website to see if they are based there or in another state.

• Well, going to the website of MN department of insurance, for a list of all insurance companies licensed to operate in the state - but it will be a long long long list - and not all have offices in Minneapolis, not talk Minnesota

The new Jeroen Bosch Hospital

I am in the Netherlands to present at a conference tomorrow at Jeroen Bosch Hospital in 's-Hertogenbosch (Den Bosch), entitled "Quality and Transparency in Care and Training." It is being held on the occasion of the opening of an entirely new hospital, following a merger with two other hospitals in the city (Bosch Medicentrum and the Carolus Hospitals).

Today, I had a chance to view the new hospital, some 110,000 square meters. (That's roughly 1.2 million square feet.) It is not often that a hospital gets to reinvent itself this way. M0st of us are happy with renovations or incremental expansions.

Here are some nice features of what I saw, in addition to the airy design of the public spaces, as above.

The outpatient clinics are all equipped with this kind of kiosk. You waive your preprinted, encoded entrance ticket in front of the scanner, and it tells you if you are in the right place for your appointment. If you are, a display screen tells you when the time for your appointment has arrived and directs you to the appropriate room. If you are in the wrong place, it gives you directions to the right place.

I am hard-pressed to know why more hospitals and clinics don't do this. We certainly have gotten used to it in other settings, from airline terminals to the registry of motor vehicles. Sure there is an upfront cost, but the savings in personnel costs would seem to offset that. In addition, it seems to me to empower patients to take charge of their logistics. (There is always a live person present in the event someone needs individualized attention.)

At the other end of the spectrum, check out this almost unheard of phenomenon: A pathologist working in an office with windows! I thought it was a Joint Commission requirement that pathologists be locked in dungeons. (Joke.)

This does, however, raise important concerns about productivity and accuracy. After all, if pathologists actually get to see outside scenes and real people, how will they stay focused? (Another joke.) (Oy, I can already imagine the comments I am going to get.)

But, more seriously, the place has an enviable microbiology laboratory, with an automated camera gizmo that transfers the pattern of microbes from thousands of petri dishes into digital format for analysis on the computer. This results in an incredible increase in the capacity of the lab to produce and review bacterial culture results.

And then, the pièce de résistance for my pathologist friends: A sample preparation table (below) that can be manipulated to rise and fall to correspond to the best working height for the laboratory person. A simple control button (see left) moves it up or down, showing the height in centimeters above the floor, so you can remember what setting works best for you ergonomically. The contractor who built the furnishings invented this approach on his own. Seems like a good product design for some entrepreneur.