The Clinical Nursing and Midwifery Dashboard (CNMD): A State-Wide Implementation.

The clinical nursing and midwifery dashboard (CNMD) was built to provide a near real-time information and data visualisations for nurse unit managers (NUMs) and maternity unit managers (MUMs) within only a 5-15 minutes delay from when they enter data to the integrated electronic medical records (ieMR) system. The dashboard displays metrics and information about current adult inpatients in overnight wards. The aim is to support NUMs and MUMs to manage their daily workload and have continuous visibility of patients nursing risk and safety assessment documentation. A quantitative evaluation approach was conducted to measure the impact of the dashboard on key performance indicators. Statistical analysis was completed to compare risk assessment average completion times prior to and post CNMD implementation. The results of the evaluation were positive, and the statistical analysis shows significant reduction in the average time to complete different risk assessments with p-value<0.01.

Meditation music improved the quality of suturing in an experimental bypass procedure.

BACKGROUND: Neurosurgeons are vulnerable to additional noise in their natural operating environment. Noise exposure is associated with reduced cognitive function, inability to concentrate, and nervousness. Mediation music provides an opportunity to create a calmer environment which may reduce stress during surgery. METHODS: A pilot study was performed to find a suitable task, meditation music of surgeon's choice, and operation noise and to reach a certain level of training. For the main experiment, two neurosurgeons with different microsurgical experience used real operation noise and meditation music with delta waves as mediating music. Each surgeon performed 10 training bypasses (five with noise and five with music) with 16 stitches in each bypass. The total time to complete 16 stitches, a number of unachieved movements (N.U.Ms), length of thread consumed, and distribution of the stitches were quantified from the recorded videos and compared in both groups. RESULTS: A N.U.Ms were significantly reduced from 109 ± 38 with operation room (OR) noise to 38 ± 13 (p < 0.05) with meditating music in novice surgeon. Similar results were found in the experienced surgeon performing the same task [from 29 ± 6.94 to 14 ± 3.36 (p < 0.05)]. The total time utilized for the sixteen stitches was slightly improved (not significantly) in the novice surgeon and unchanged in the experienced surgeon. However, the thread length used for 16 stitches was significantly different with OR noise in comparison to meditating music in both surgeons. The distribution stitches showed a non-significant trend toward a uniform distribution with meditation music in both surgeons. CONCLUSIONS: Meditation music of surgeon's choice is a simple method that improved quality of bypass suturing in an experimental bypass procedure.

Hybrid Capability to Integrate Multiple Treatment Modalities for Managing High-Grade Intracranial Dural Arteriovenous Fistulas.

BACKGROUND: An integrated multimodality approach can be effective in treatment of high-grade dural arteriovenous fistulas. Nevertheless, this requires a high level of efficient cooperation between different departments, underlying a degree of bias in the decisional process. In comparison, hybrid capability, integrating these modalities in one hand, may allow aggregating multimodality treatment strategies by pooling their individual benefits, leading to a more holistic view of the consequences of each modality. METHODS: We retrospectively reviewed 18 cases of dural arteriovenous fistulas subjected to a hybrid treatment approach at the Diakonieklinikum Jung-Stilling, Siegen, Germany, between March 2008 and January 2017. Nine cases were excluded. We selected 4 cases that highlight different aspects of hybrid capability for illustrative purposes. RESULTS: Hybrid capability allows treatment of a dural arteriovenous fistula based on the individual clinical situation of the patient and features of the lesion, free of interdepartmental bias. The surgeon maintains a level of flexibility that enables him or her to move from a minimally invasive endovascular approach to a maximally invasive surgical access according to the specific situation. Hybrid capability can lead to a highly efficient treatment regimen with palliation of symptoms and complete obliteration of the fistula, improving performance in these complex pathologies. CONCLUSIONS: Hybrid capability has great potential in the treatment of complex neurovascular lesions. It remains to be seen if a single surgeon with hybrid capability can supersede the current multidepartmental practice and achieve better outcomes.