[Improvement of quality characteristics of medical services based on patient satisfaction measurement results and QFD tools].

One of the directions to increase the effectiveness of medical organizations in the region is the development of managerial tools for improving the quality of medical services. The aim of the study is to develop an approach to improving the quality of medical services based on the results of measuring patient satisfaction with the quality of medical services, mapping satisfaction criteria to medical and technological characteristics of the quality of services, substantiation and selection of appropriate corrective measures. The method of measuring patient satisfaction with the quality of the provided medical service and the method of deploying quality functions ensuring transformation of patient needs and expectations into characteristics of service quality were used. The measurement of patients' satisfaction with the quality of medical services is carried out during medical and sociological research. The measurement results are obtained by statistical processing using a software set. To determine measures to improve the quality of cardiological services, the results of changing patient satisfaction were used in accordance with the method of deploying quality functions, which consists in implementing a number of steps that ensure the determination of a minimum set of additional requirements for medical services in order to meet the requirements of patients. This technique is supported by specialized software. Implementation of the proposed approach makes it possible to form tools aimed at creating an information model of medical services and ensure the change in the quality of such services demanded by patients.

Evaluating the academic scientific laboratories' safety by applying failure mode and effect analysis (FMEA) at the public university in Lebanon.

Workers at scientific academic laboratories are at risk of potential exposure to different types of hazards. The study's purpose was to assess the potential failure modes (FMs) of hazards facing them through the application of the Failure Mode and Effect Analysis (FMEA) method to propose corrective actions preventive actions (CAPA) to mitigate them and to improve the safety outcomes in these workplaces (WP) at the Lebanese public University (PbU). The potential FMs leading to accident occurrence in biological and chemical labs were identified and prioritized, their causes and effects were determined by applying two surveys, and the risk priority number (RPN) for each failure was calculated. A total of 24 FMs were identified. The most alarming FM having the highest RPN scores (80) was found in the workplace 'category requiring an emergency for corrective actions (CA), it is related to the unavailability of a hazard pictogram plot and the lack of labeling of chemicals and waste containers according to their categories. The FMs having RPN scores (75-60) requiring an urgent CA were assigned to other hazards of the WP, chemical, biological, and failure of the educational system. The need to program for the remaining FMs (RPN scores 20-48) is related to the safety, biological, physical, and radioactive categories 'hazards. It is recommended to apply continuously FMEA and implement the CA proposed for each detected FM in the scientific laboratories of the PbU in order to support the decision-makers to improve laboratory safety.

Examining Patterns of Persistent Listeria Contamination in Packinghouses Using Agent-Based Models.

ABSTRACT: Persistent Listeria monocytogenes contamination may occur in a packinghouse if the pathogen successfully infiltrates the facility and reaches a harborage site, where it may be difficult to remove and may contaminate produce within the facility. There is a need for simulation-based decision support tools that can predict which equipment sites are more likely to undergo persistent contamination and simulate potential corrective actions to prevent this contamination. Thus, we adapted for longer term simulation two existing applications of an agent-based model of Listeria spp. hourly contamination dynamics in produce packinghouses. Next, we developed a novel approach to identify and analyze persistent and transient Listeria contamination patterns on simulated agents representing equipment sites and employees. Testing of corrective actions showed that methods that involved targeted, facility-specific, risk-based sanitation were the most effective in reducing both the likelihood and duration of persistent contamination. Generic approaches to controlling Listeria (e.g., more concentrated sanitizers) are unlikely to be successful and suggest that use of sanitation schedules produced through facility-specific root cause analysis and hygienic design are key in reducing persistence. Hourly Listeria contamination patterns also suggest that transient contamination may be mistaken for persistent contamination, depending on the frequency of environmental sampling. Likewise, as concentrations of Listeria on most contaminated agents were predicted to be very low, there is also a possibility to mistake persistence for transient contamination of sites, or even miss it outright, due to false-negative environmental Listeria monitoring results. These findings support that agent-based models may be valuable decision support tools, aiding in the identification of contamination patterns within packinghouses and assessing the viability of specific corrective actions.

Time for space at the table: an African American - Native American analyst-in-training's first-hand reflections. A call for the IAAP to publicly denounce (but not erase) the White supremacist writings of C.G. Jung.

This article provides an African American-Native American analyst-in-training's first-hand reflections on Jung's firm depiction of Blacks of African descent and America's First Nations People (the Red man) as inferior, through a theory of primitivity that unveils Jung's belief in and support of White supremacy. With no intended disrespect or neglect intended toward America's First Nations, this article focuses primarily on Jung's apparent disdain for Blacks (the Negro). Utilizing writings from Frederick Douglass, W.E.B. Du Bois and Na'im Akbar, this article highlights ways in which Jung's biases align with the White supremacist perspective of the Negro as a problem, detrimental to social order. The paper concludes with an Appendix which outlines a call to the International Association for Analytical Psychology (IAAP) to take corrective action and to publicly denounce those facets of Jung's writings that diverge from the core of his theory and that promote toxic attitudes of bigotry, perhaps discouraging many people of colour from enrolling in analytic training.

Cet article fournit les réflexions personnelles d'un analyste en formation et d'origine afro-américaine et amérindienne sur les représentations inflexibles de Jung concernant les non-blancs d'origine Africaine et les Peuples des Premières Nations d'Amérique (l'homme Rouge) comme inférieurs, au travers d'une théorie de ce qui est primitif, théorie qui dévoile la croyance et le soutien de Jung en la suprématie blanche. Sans vouloir manquer de respect ou d'intérêt envers les Premières Nations d'Amérique, cet article se concentre principalement sur le mépris manifeste de Jung pour les Noirs (le Nègre). Utilisant les écrits de Frederick Douglass, W.E.B. Du Bois et Na'im Akbar, cet article souligne les façons dont la partialité de Jung concorde avec la perspective de la suprématie de la race blanche qui considère le Nègre en tant que problème, préjudiciable à l'ordre social. L'article se termine par une Annexe qui présente une demande à l'AIPA de se positionner et de dénoncer publiquement ces facettes des écrits de Jung qui divergent du cœur de sa théorie et qui nourrissent des attitudes toxiques de sectarisme, décourageant peut-être un nombre important de personnes non-blanches à s'inscrire dans une formation analytique.

Este artículo ofrece reflexiones de primera-mano de un analista en formación Africano-Americano y Nativo-Americano sobre la descripción de Jung, de las personas de descendencia Africana y de los Pueblos Originarios Americanos (el hombre rojo), como inferior, a partir de una teoría sobre el primitivismo que encubre su creencia y apoyo a la supremacía del blanco. Sin ninguna falta de respeto o atención intencionada hacia los Pueblos Originarios de América, el presente artículo se focaliza principalmente en la aparente desconsideración hacia los Negros. Utilizando escritos de Frederic Douglass, W.E.B. Du Bois y Na'im Akbar, el artículo da cuenta de los modos en los cuales los prejuicios de Jung se alinean con la perspectiva de la supremacía del Blanco que considera al Negro como un problema perjudicial al orden social. El trabajo concluye con un Apéndice que esboza un llamado a la IAAP a tomar una acción correctiva y a denunciar públicamente estos aspectos de los escritos de Jung, que se apartan del centro de su teoría y promueve actitudes tóxicas de intolerancia, quizás desalentando a muchas personas no-blancas, a inscribirse en una formación analítica.

Evaluation of corrective actions of feedback from clinicians on Clinical Laboratory Services at Bamenda Regional Hospital Laboratory, Cameroon.

BACKGROUND: Customers' satisfaction is imperative for success. Clinical laboratories continuously strive to attain very high levels of customer satisfaction to serve their clients and maintain accreditation. The concept of customer satisfaction has not yet been asserted in most clinical laboratories in Cameroon. OBJECTIVES: Our objectives were to assess the satisfaction of clinicians with the laboratory services at the Bamenda Regional Hospital Laboratory, identify important challenges, corrective actions implemented and changes in satisfaction. METHODS: This retrospective study reviewed secondary data from clinician satisfaction survey records from March 2017 and November 2017. Challenges and implemented corrective actions were identified for assessed statements of dissatisfaction (dissatisfaction rates ≥ 20%) on the March 2017 survey. Satisfaction rates in March 2017 and November 2017 were compared. RESULTS: High levels of dissatisfaction were observed for general satisfaction, waiting time, communication, duty consciousness, specimen collection and approach on the March 2017 survey. The main challenges identified were: lack of respect for the expected length of the waiting time, poor attitude, inadequate information, staff shortage and inadequate supervision. Statistically significant reductions in rates of dissatisfaction were observed for general satisfaction, waiting time, communication, response to emergencies, issuing of results, specimen collection, approach and duty consciousness. CONCLUSION: Waiting time is a major cause of clinician dissatisfaction with laboratory services. The identification of clinicians' challenges and the effective implementation of corrective actions contribute to improvements in clinician satisfaction.

Assessment of coastal ecosystems vulnerability to pollution: Algiers coast, Algeria.

Coastal areas are frequently influenced by direct and/or indirect multiple anthropogenic pressures, which impacts marine life. Those perturbations may act in a heterogeneous way with a different intensity and are related to the complexity of coastal ecosystems. To visualize all these interactions at a local scale, a methodology inspired from many researches has been implemented in order to search, identify, and classify coastal ecosystems according to their sensitivity to anthropic pressure exerted by coastal cities. Thus, producing vulnerability maps will be essential tools to local coastal managers. We have applied this methodology on five coastal municipalities in Algiers. Firstly, the environmental sensitivity of coastal ecosystems was assessed by analyzing these four sub-indices: biological sensitivity, geomorphological sensitivity, hydrodynamic characteristics, and pollution intensity. Secondly, an assessment of the anthropogenic pressures presented by each municipality was carried out. Five sub-indexes have been taken into consideration when conducting this assessment: human activities, infrastructures, vectors of pollution, urbanization, and regulatory protection. Then, vulnerability maps were produced by the overlapping of sensitivity and anthropic pressure maps. The results assessed for the environmental vulnerability indicated that most areas are moderately to highly vulnerable, especially in the municipalities of Bab El Oued, Rais Hamidou, and Ain Bénian. The analysis of the obtained results shows the potential applicability of this methodology because they accurately reflect the reality. Therefore, these results can be useful to decision-makers by providing them with a relatively rational decision-making tool to prioritize future management and planning efforts.

European follow-up of incorrect biomarker results for colorectal cancer demonstrates the importance of quality improvement projects.

Biomarker analysis for colorectal cancer has been shown to be reliable in Europe with 97% of samples tested by EQA participants to be correctly classified. This study focuses on errors during the annual EQA assessment. The aim was to explore the causes and actions related to the observed errors and to provide feedback and assess any improvement between 2016 and 2017. An electronic survey was sent to all laboratories with minimum one genotyping error or technical failure on ten tumor samples. A workshop was organized based on 2016 survey responses. Improvement of performance in 2017 was assessed for returning participants (n = 76), survey respondents (n = 13) and workshop participants (n = 4). Survey respondents and workshop participants improved in terms of (maximum) analysis score, successful participation, and genotyping errors compared to all returning participants. In 2016, mostly pre- and post-analytical errors (both 25%) were observed caused by unsuitability of the tumor tissue for molecular analysis. In 2017, most errors were due to analytical problems (50.0%) caused by methodological problems. The most common actions taken (n = 58) were protocol revisions (34.5%) and staff training (15.5%). In 24.1% of issues identified no action was performed. Corrective actions were linked to an improved performance, especially if performed by the pathologist. Although biomarker testing has improved over time, error occurrence at different phases stresses the need for quality improvement throughout the test process. Participation to quality improvement projects and a close collaboration with the pathologist can have a positive influence on performance.

[Internal audit in medical laboratory: what means of control for an effective audit process?]. / Audit interne dans un laboratoire de biologie médicale: quels moyens de maîtrise pour un processus d'audit efficace ?

To prepare the French Accreditation Committee (COFRAC) visit for initial certification of our medical laboratory, our direction evaluated its quality management system (QMS) and all its technical activities. This evaluation was performed owing an internal audit. This audit was outsourced. Auditors had an expertise in audit, a whole knowledge of biological standards and were independent. Several nonconformities were identified at that time, including a lack of control of several steps of the internal audit process. Hence, necessary corrective actions were taken in order to meet the requirements of standards, in particular, the formalization of all stages, from the audit program, to the implementation, review and follow-up of the corrective actions taken, and also the implementation of the resources needed to carry out audits in a pre-established timing. To ensure an optimum control of each step, the main concepts of risk management were applied: process approach, root cause analysis, effects and criticality analysis (FMECA). After a critical analysis of our practices, this methodology allowed us to define our "internal audit" process, then to formalize it and to follow it up, with a whole documentary system.

Aspectos bioéticos relacionados con la basura espacial y sus efectos sobre la vida en la tierra y la exploración aeroespacial / Bioethical aspects of space debris and its effects on life on earth and aerospace exploration / Aspectos bioéticos relacionados com o detrito espacial e seus efeitos sobre a vida na terra e a exploração espacial

Resumen El siglo XX fue una centuria de grandes descubrimientos científicos y desarrollos tecnológicos en todas las áreas, pero en particular en lo relativo a la conquista del espacio. Durante anos, la bioética fue pensada en estrecha relación con la ética médica y el ámbito de problemas específicamente humanos, pero en los últimos tiempos su sentido se ha ido ampliando. El presente trabajo busca relacionar esta preocupación por una ciencia de la supervivencia con la existencia de la llamada basura espacial o chatarra espacial que orbita la Tierra, y que en un tiempo no conocido afectara pequeñas o grandes áreas de nuestro planeta. La basura espacial se ha convertido en una preocupación cada vez mayor, especialmente en los últimos anos, puesto que las colisiones a velocidades orbitales pueden producir aún más basura espacial en el proceso llamado síndrome de Kessler, o cascada de ablación, lo que perjudicaría el funcionamiento de los satélites, afectaría las misiones espaciales o pondría en riesgo la vida de los astronautas. También es probable que dicha basura se precipite sobre la Tierra, con efectos no claramente evaluados sobre la población humana. Aunque el problema suele aparecer tanto en textos científicos como en obras de ciencia-ficción, no ha sido considerado con la seriedad exigida para un riesgo real y no alejado de la vida cotidiana.

Abstract The twentieth century was a century of great scientific discoveries and technological developments in all areas, but particularly with regard to the conquest of space. The last stretch of the millennium also witnessed two world wars and the development of atomic weapons with enormous destructive power, which made doubt many of the possibilities for the future of life on earth. At the end of his life, Albert Einstein said: "The unleashed power of the atom has changed everything except our way of thinking. So we go to a catastrophe unparalleled". It is in this context of concern about the future of life on earth, Van Rensselaer Potter coined the term bioethics, understood as Global Bioethics, a science of survival should combine biological knowledge and human values. For years, bioethics was thought closely related to medical ethics and scope of specifically human problems, but in recent years its meaning has expanded in line with the foundational approach Potter of ethics as a bridge to survival life in general. This paper seeks to relate this concern for a science of survival with the existence of the so-called space debris or space junk orbiting Earth and that once unknown, affect small or large areas of our planet. The waste consists of things as varied as large remnants of old rockets and satellites, remnants of explosions, debris or rocket components such as dust and small particles of paint. Space debris, has become a growing concern, especially in recent years, since collisions at orbital velocities can be highly damaging to functioning satellites, produce even more space debris in the process called Kessler Syndrome or waterfall ablation, but the worst would be that such wastes rush to land with not clearly evaluated effects on the human population. To illustrate a recent case of their impact on astronauts and equipment, it is the fact that the International Space Station had to be reinforced to mitigate the damage from this danger. Although the problem usually occurs both in scientific texts and works of science fiction, however it has not been considered with the seriousness required for a real risk and not away from everyday life.

Resumo O século XX foi um período de grandes descobertas científicas e desenvolvimentos tecnológicos em todas as áreas, mas em particular no tocante à conquista do espaço. Durante anos, a bioética foi pensada em estreita relação com a ética médica e com o âmbito de problemas especificamente humanos. Porém, nos últimos tempos, seu sentido tem sido ampliado. O presente trabalho busca relacionar essa preocupação por uma ciência da sobrevivência com a existência do chamado "detrito espacial" (ou "lixo espacial") que orbita a Terra e que, em algum momento desconhecido, afetará pequenas ou grandes áreas do nosso planeta. Os detritos espaciais se converteram em uma preocupação cada vez maior, especialmente nos últimos anos, visto que as colisões em velocidades orbitais podem produzir ainda mais detritos espaciais no processo denominado "síndrome de Kessler", o que prejudicaria o funcionamento dos satélites, afetaria as missões espaciais ou colocaria em risco a vida dos astronautas. Também é provável que tais detritos se precipitem sobre a Terra com efeitos não claramente avaliados sobre a população humana. Ainda que o problema costume aparecer tanto em textos científicos quanto em obras de ficção científica, o tema não foi considerado com a seriedade exigida para um risco real e próximo da vida cotidiana.

Enfoque basado en riesgo desde la etapa de desarrollo del producto succinilcolina infantil 100 mg / Risk-based approach from the development phase of 100mg infant succinylcoline product

Introducción: en la actualidad las guías emitidas por la Agencia de Medicamentos y Alimentos, de los EU considera que los procesos fallan porque las fuentes no son debidamente identificadas, eliminadas o controladas y plantean un nuevo enfoque de Buenas Prácticas de Producción basado en riesgos. Objetivo: aplicar un enfoque basado en riesgos en el aseguramiento de la calidad desde la etapa de desarrollo del producto succinilcolina 100 mg. Métodos: se realizó una breve descripción del proceso mediante un diagrama de bloque, se empleó el Árbol de Fallas como herramienta para identificar las posibles fuentes de falla; la valoración de riesgos partiendo de la identificación de las posibles fuentes de fallos se ejecutó a través de un método matricial. Se identificó un orden de prioridad en la toma de acciones correctivas para eliminar o mitigar el riesgo de ocurrencia. Resultados: el diagrama de bloque permitió tener un conocimiento sobre el proceso, lo que contribuyó de forma decisiva a un mejor ejercicio de la gestión de riesgos. El Árbol de Fallas resultó útil al revelar de forma gráfica las diferentes combinaciones de fallos e interrelaciones entre causa y efecto que pudieran dar lugar al evento tope indeseado. El método empleado para la valoración de riesgos permitió determinar las prioridades, siendo el tiempo extensivo de llenado (fuera de 2-8 °C) el componente crítico a considerar con especial atención; si se tiene en cuenta que la estabilidad de este producto se puede afectar a temperaturas superiores a estas, por lo que disponer de un plan de acciones correctivas acorde a los riesgos identificados permitirá la eliminación o mitigación de las mismas. Conclusiones: la herramienta de gestión de riesgos permitió identificar desde la etapa de desarrollo del producto succinilcolina 100 mg, las principales fuentes de fallas relacionadas con este proceso(AU)

Introduction: the guidelines presently issued by the Food and Drug Agency of the United States considers that processes fail because the sources are not duly identified, eliminated or controlled and submit a new approach of Good Manufacture Practice based on risks. Objective: to apply a risk-based approach to the quality assurance from the development phase of the 100 mg succinylcoline product. Methods: the process was briefly described through a block diagram with Failure Tree as a tool for identification of possible sources of failures; the risk assessment based on the detection of the possible sources of failures was made with the matrix method. An order of priority was given in the implementation of corrective actions to eliminate or mitigate the risk of occurrence. Results: the block diagram allowed knowing the process, which contributed in a decisive way to a better application of risk management. The Failure Tree proved to be useful when showing in a graphical way the different failure combinations and interrelations between cause and effect that might give rise to the unwanted top event. The method for the risk assessment made it possible to determine priorities, being the long time of filling (not within 2 to 8oC) the critical component to be specially considered if one takes into account that stability of the product may be affected by higher temperatures, therefore, a plan of corrective actions according to the identified risks will allow their elimination or mitigation. Conclusions: the risk management tool allowed identifying the main process-related sources of failures from the very development phase of the 100 mg succinylcoline product.