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A Multicenter Randomized Trial to Determine the Effect of an Environmental Disinfection Intervention on the Incidence of Healthcare-Associated Clostridium difficile Infection
OBJECTIVE To determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI). DESIGN A multicenter randomized trial. SETTING In total,16 acute-care hospitals in northeastern Ohio participated in the study. INTERVENTION We conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI. RESULTS Overall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI. CONCLUSIONS An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI. Infect Control Hosp Epidemiol 2017;38:777-783.
Journal Article
Project management metrics, KPIs, and dashboards
Harold Kerzner's essential strategies on measuring project management performance With the growth of complex projects, stakeholder involvement, and advancements in visual-based technology, metrics and KPIs (key performance indicators) are key factors in evaluating project performance. Dashboard reporting systems provide accessible project performance data, and sharing this vital data in a concise and consistent manner is a key communication responsibility of all project managers. This third edition of Kerzner's groundbreaking work, Project Management Metrics, KPIs, and Dashboards: A Guide to Measuring and Monitoring Project Performance, helps functional managers gain a thorough grasp of what metrics and KPIs are and how to use them. Plus, this edition includes new sections on processing dashboard information, portfolio management PMO and metrics, and BI tool flexibility. Offers comprehensive coverage of the different dashboard types, design issues, and applications Provides full-color dashboards from some of the most successful project management companies, including IBM, Microsoft, and others Aligns with PMI's PMBOK® Guide and stresses value-driven project management PPT decks are available by chapter and a test bank will be available for use in seminar presentations and courses Get ready to bolster your awareness of what good metrics management really entails today-and be armed with the knowledge to measure performance more effectively.
eBook
A One-Stage Model of Abatement Innovation in Cournot Duopoly: Emissions vs Performance Standards
This paper evaluates the comparative performance of emission and performance standards in a one-stage game of abatement R&D and Cournot duopoly, in terms of R&D propensity, output and social welfare. For each standard, firms simultaneously select R&D and output levels, given the standard’s exogenous constraint. A performance standard generates higher R&D investments and output, but lower profit, than the pollution-equivalent emissions standard. The same conclusion extends to social welfare only under high demand. We also conduct a similar comparison for each of the two instruments across the one-stage and the two-stage models. The two-stage model leads to higher levels of R&D and industry output for both standards. The same conclusion applies to the social welfare comparison for the emissions standard. However, for the performance standard, the same conclusion requires a damage parameter below a given threshhold. When the standards are chosen to maximize welfare, the performance comparison becomes highly parameter-dependent, except that social welfare is higher for the performance standard. Some policy implications are discussed.
Journal Article
Impacts of platform-based CBL on undergraduate nursing students’ academic performance, self-efficacy, clinical decision-making and critical thinking abilities: A cluster randomized controlled trial
To compare the effects of traditional and platform-based case-based learning (CBL) on undergraduate nursing students’ academic performance, self-efficacy, clinical decision-making and critical thinking abilities.
Traditional CBL can improve students’ academic performance but faces challenges in the era of “Internet + education.” It is unclear whether platform-based CBL is as effective as traditional CBL.
Cluster randomized controlled trial.
A total of 88 undergraduate nursing students from two classes were recruited using cluster sampling and separated into two groups by class. The control group (n = 45) received traditional CBL, and the experimental group (n = 43) received platform-based CBL. Academic performance, self-efficacy, clinical decision-making, critical thinking disposition and experimental group’s learning records from the online platform were evaluated.
No difference was found between the two groups in overall academic performance, but formative evaluation and final examination scores in the course differed. Compared with the control group, the experimental group presented significant differences in self-efficacy and clinical decision-making. There was no difference between the total clinical thinking disposition scores; however, truth-seeking, systematicity and self-confidence exhibited significant differences. Concerning student progression, all experimental students advanced from “Grade I” to “Grade V” or “Grade IV”. The usability questionnaire’s average score regarding the platform was 77.03 (SD 7.43) and the top dimension was teaching utility.
Compared with traditional CBL, platform-based CBL may better enhance self-efficacy and clinical decision-making abilities in nursing undergraduate students.
Journal Article
An embedded checklist in the Anesthesia Information Management System improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting
BackgroundAnaesthesiologists work in a high stress, high consequence environment in which missed steps in preparation may lead to medical errors and potential patient harm. The pre-anaesthetic induction period has been identified as a time in which medical errors can occur. The Anesthesia Patient Safety Foundation has developed a Pre-Anesthetic Induction Patient Safety (PIPS) checklist. We conducted this study to test the effectiveness of this checklist, when embedded in our institutional Anesthesia Information Management System (AIMS), on resident performance in a simulated environment.MethodsUsing a randomised, controlled, observer-blinded design, we compared performance of anaesthesiology residents in a simulated operating room under production pressure using a checklist in completing a thorough pre-anaesthetic induction evaluation and setup with that of residents with no checklist. The checklist was embedded in the simulated operating room's electronic medical record.ResultsData for 38 anaesthesiology residents shows a statistically significant difference in performance in pre-anaesthetic setup and evaluation as scored by blinded raters (maximum score 22 points), with the checklist group performing better by 7.8 points (p<0.01). The effects of gender and year of residency on total score were not significant. Simulation duration (time to anaesthetic agent administration) was increased significantly by the use of the checklist.ConclusionRequired use of a pre-induction checklist improves anaesthesiology resident performance in a simulated environment. The PIPS checklist as an integrated part of a departmental AIMS warrant further investigation as a quality measure.
Journal Article
A Database for a Changing Economy
Information about the characteristics of jobs and the individuals who fill them is valuable for career guidance, reemployment counseling, workforce development, human resource management, and other purposes. To meet these needs, the U.S. Department of Labor (DOL) in 1998 launched the Occupational Information Network (O*NET), which consists of a content model-a framework for organizing occupational data-and an electronic database. The O*NET content model includes hundreds of descriptors of work and workers organized into domains, such as skills, knowledge, and work activities. Data are collected using a classification system that organizes job titles into 1,102 occupations.
The National Center for O*NET Development (the O*NET Center) continually collects data related to these occupations. In 2008, DOL requested the National Academies to review O*NET and consider its future directions. In response, the present volume inventories and evaluates the uses of O*NET; explores the linkage of O*NET with the Standard Occupational Classification System and other data sets; and identifies ways to improve O*NET, particularly in the areas of cost-effectiveness, efficiency, and currency.
eBook
Factorial structure of Individual Work Performance Questionnaire
The objective of this study is to evaluate the factorial structure of the Spanish version of the Individual Work Performance Questionnaire (Version 1.0) and to estimate the impact that acquiescence has on it as response bias. Exactly 500 workers from organizations from different industries, primarily located in Ecuador, participated in this study. The comparison of different models using Confirmatory Factor Analysis proved that when acquiescence is not controlled, evidence leads to the rejection of a one-dimensional-or essentially one-dimensional-structure (bifactor model), thus questioning the initial conceptualization of the construct. But when this response bias is controlled, both the one-dimensional model (X.sup.2 = 429.608 [223], p < .001; CFI = .974; TLI = .982; RMSEA = .043; SRMR = .063) and the bifactor model (X.sup.2 = 270.730 [205], p = .001; CFI = .992; TLI = .994; RMSEA = .026; SRMR = .047) show relevant improvement in terms of goodness of fit over the three-correlated-factors model (X.sup.2 = 537.038 [132], p < .001; CFI = .950; TLI = .942; RMSEA = .079; SRMR = .070). However, the low reliability of the substantive factors of the bifactor model makes the one-dimensional model preferable in applied studies. Finally, the results show how mistakes could be made when concluding on the possible relationships between work performance and other relevant variables, in case acquiescence is not controlled.
Journal Article
On Environmental Regulation of Oligopoly Markets: Emission versus Performance Standards
By specializing Montero’s (J Environ Econ Manag 44:23–44, 2002) model of environmental regulation under Cournot competition to an oligopoly with linear demand and quadratic abatement costs, we extend his comparison of firms incentives to invest in R&D under emission and performance standards by solving for a closed form solution of the underlying two-stage game. This allows for a full comparison of the two instruments in terms of their resulting propensity for R&D and equilibrium industry output. In addition, we incorporate an equilibrium welfare analysis. Finally, we investigate a three-stage game wherein a welfare-maximizing regulator sets a socially optimal emission cap under each policy instrument. For the latter game, while closed-form solutions for the subgame-perfect equilibrium are not possible, we establish numerically that the resulting welfare is always larger under a performance standard.
Journal Article
GHG policy impacts for Seattle’s buildings: targets, timing, and scope
Many US cities are addressing climate change by setting goals to reduce their greenhouse gas (GHG) emissions by a specified amount within a specified time period. In order to achieve these goals, reducing emissions from existing buildings is crucial. Many cities are passing legislation to target existing buildings through benchmarking, auditing, retuning, or energy or emissions performance standards. As cities design legislation, they must consider the timing of the policies, how to prioritize building types and sizes, and how these design decisions will impact the city’s emissions. This paper addresses these questions for one particular US city: Seattle, Washington. A model of Seattle’s building stock was created with benchmarking and tax assessor data. It was then used to predict GHG emissions reductions due to different policy implementations for existing commercial and multifamily buildings. Key findings are: (1) the proposed emissions policy is expected to reduce cumulative emissions from buildings by 19% between 2020 and 2050; (2) delaying the implementation of the policy by five years could limit savings to 12%; and (3) including smaller buildings in the policy could increase savings to 34%. The lessons learned and how this can be used by other cities are discussed.Policy relevanceAs cities design legislation for energy performance standards, they must consider the impact that the timing of policies, prioritization of building types and sizes, and electrification will have on the city’s GHG emissions. A new process is presented that can assist policymakers to understand the impacts of policy decisions on decarbonizing the building stock. A model of Seattle’s building stock was created to predict emissions reductions due to different policy implementation scenarios. This model shows the impact of Seattle’s proposed emissions policy. The current policy is expected to reduce cumulative emissions from buildings by 19% between 2020 and 2050. If the implementation of the policy is delayed by five years, then cumulative emissions savings would be reduced to 12%. The inclusion of smaller buildings in the policy could increase cumulative emissions savings to 34%. Other cities can use this process to better understand their proposed policies for their building stock.
Journal Article