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Supplemental material, sj-pdf-1-vet-10.1177_03009858231183983 for Citrobacter freundii-associated lesions in stranded loggerhead sea turtles (Caretta caretta) by Alicia Inurria, Alejandro Suárez-Pérez, Pascual Calabuig and Jorge Orós in Veterinary Pathology

Resumen Objetivo: Explorar la información existente sobre el Soporte Vital Avanzado Enfermero (SVAE) en Twitter. Metodología: Se realizó un estudio, de naturaleza documental, basado en una revisión métrica mediante una búsqueda sistemática de información sobre el SVAE en Twitter desde 31/01/10 al 7/03/20. Se analizaron tuits y usuarios empleando indicadores métricos. Resultados principales: Se analizaron 215 tuits. Año más productivo: 2019 con 83 tuits. De los 76 usuarios que publican sobre el SVAE, el 75% son hombres, mayormente de Madrid y enfermeros. Tema de más auge: Difusión del SVAE entre los profesionales de la salud (27%). Tema más divulgado y de repercusión: Intervenciones asistenciales del SVAE. Dicho recurso se observa en 12 CCAA. Conclusión principal: La red social Twitter muestra el SVAE como un recurso asistencial implantado en numerosas CCAA, del que se dispone una información creciente y complementaria a las bases de datos. Dicha información procede, principalmente, de eventos científicos, aportando valor y conocimientos sobre distintos aspectos del SVAE y permitiendo su debate entre profesionales del ámbito.

AimsThe aims of this study were: a) to describe the pathological and laboratory findings in a case series of stranding and mortality associated with ingestion of large amounts of sea urchins in loggerhead turtles (Caretta caretta), and b) to alert veterinarians and biologists involved in sea turtle conservation of this cause of stranding and/or death.MethodsThe six loggerheads studied were stranded on the coasts of Gran Canaria, Canary Islands, Spain, between 2008 and 2015. Post mortem studies included pathological, microbiological, and sea urchin species identification procedures.ResultsAll turtles showed severe intestinal impaction caused by large amounts of sea urchins, mainly affecting the colon and the caudal half of the small intestine. Histologically, severe focal fibrinonecrotic enteritis was diagnosed in two turtles. In the remaining turtles, lesions ranged from mild desquamation of the intestinal epithelium to severe congestion of the blood vessels of lamina propria, submucosa, muscular and serosa, and edema. Vibrio sp. was isolated from the spleen and intestinal mucosa of a loggerhead in which focal fibrinonecrotic enteritis had been diagnosed. In five turtles, all the remains were fragments from long-spined sea urchins (Diadema africanum); the last turtle contained a mixture of long-spined sea urchin (90%) and purple sea urchin (Sphaerechinus granularis) (10%) remains.ConclusionsAlthough the prevalence of this cause of stranding was low (< 1.6%) compared to other mortality causes, continued overfishing and anthropogenic climate change could increase its incidence. Intestinal impaction with large amounts of sea urchins should be included in the differential diagnosis of gastrointestinal diseases in sea turtles, and the possible toxic effect of some sea urchin species on sea turtles should also be investigated.

Frente al debate sobre si el impacto económico del turismo de cruceros es real o está sobreestimado, este trabajo se centra en analizar la percepción que tiene el propio sector turístico de las ciudades que acogen cruceros sobre dicho impacto. Para ello se cuenta con una muestra de 371 gerentes de establecimientos turísticos del hinterland de dos puertos españoles de cruceros. La metodología está basada en regresiones ordered logit y multinomial logit. Las conclusiones confirman la buena imagen pública que tradicionalmente ha disfrutado el tráfico de cruceros. Concretamente, muestran un sector turístico que mayoritariamente defiende el turismo de cruceros como instrumento de desarrollo económico y turístico, especialmente en el segmento de turismo cultural y gastronómico, donde los gerentes le presuponen una contribución incluso mayor a la de las aerolíneas de bajo coste (LCCs). Aunque la visión de los gerentes no es uniforme sino que depende de las características del establecimiento turístico y su propia experiencia. Los gerentes también defienden la intervención directa de las administraciones públicas, incluso con ayudas económicas, para favorecer la implantación de los cruceros en sus ciudades. Incluso las agencias de viajes, tradicionalmente críticas con las ayudas a las LCCs, muestran un apoyo claro a este tipo de ayudas.

Article-at-a-Glance Background In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement™ (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution. Methods The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement—RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems. Results The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line–associated bloodstream and ventilator-associated pneumonias decreased to essentially zero. Conclusion MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.

In 2010 Memorial Hermann Health System (MHHS) implemented the Joint Commission Center for Transforming Healthcare's (the Center's) Web-based Targeted Solutions Tool ®(TST ®) for improving hand hygiene through-out its 12 hospitals after participating in the Center's first project on hand hygiene, pilot testing the TST, and achieving significant improvement for each pilot unit. Because hand hygiene is a key contributing factor in health care-associated infections (HAIs), this project was an important part of MHHS's strategy to eliminate HAIs.MHHS implemented the TST for hand hygiene in 150 inpatient units in 12 hospitals and conducted a system wide process improvement project from October 2010 through December 2014. The TST enabled MHHS to measure compliance rates, identify reasons for noncompliance, implement tested interventions provided by the TST, and sustain the improvements. Data on rates of ICU central line- associated bloodstream infections (CLABSIs) and ventilator- associated pneumonia (VAP) were also collected and analyzed.Based on 31,600 observations (October 2010- May 2011), MHHS's system wide hand hygiene compliance baseline rate averaged 58.1%. Compliance averaged 84.4% during the "improve" phase (June 2011-November 2012), 94.7% in the first 13 months of the "control phase" (December 2012-December 2014) and 95.6% in the final 12 months (p0.0001 for all comparisons to baseline). Con comitantly, adult ICU CLABSI and VAP rates decreased by 49% (p = 0.024) and 45% (p = 0.045), respectively.MHHS substantially improved hand hygiene compliance in its hospitals and sustained high levels of compliance for 25 months following implementation. Adult ICU CLABSI and VAP rates decreased in association with the hand hygiene compliance improvements.

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but did not receive mupirocin, 35 (31%) developed SSI’s, the majority of which were caused by SA. LESSON LEARNED: SA positive patients not treated with mupirocin have an increased risk of developing an SSI. Compliance with elements of a bundle must be monitored. Notification to staff of positive nasal swab Results is key for timely treating of positive swab. Standardization of post-operative care is more difficult if patients recover on > 1 unit. Patients cleared for OR by PCP or who consented to OR via phone did not get nasal swabs.

En la actualidad, las empresas tienen la necesidad de gestionar sus recursos y datos de una forma eficiente para permitir un mayor rendimiento de los mismos. Por ello, la necesidad de incorporar herramientas que realicen esta gestión de la mejor forma posible. En concreto, la empresa, consultora tecnológica donde se ha desarrollado e implantado esta herramienta software de gestión de RRHH, asignación de perfiles y peticiones de ofertas laborales, no disponía de ninguna herramienta de gestión que permitiera aumentar el rendimiento y la organización de los datos. Esta herramienta será capaz de almacenar, modificar, consultar datos y generar informes sobre diferentes ámbitos necesarios en el trabajo diario del departamento de selección y RRHH. La información que almacenará esta herramienta será en referencia a la creación de una base de datos de candidatos con sus datos personales, permitirá su asignación a perfiles tecnológicos y guardará información relevante de su seguimiento en los procesos de selección en los que se encuentra involucrado el candidato. Por último, se podrán realizar búsquedas por cualquier criterio relacionado con los datos almacenados sobre el mismo. Respecto a la gestión de RRHH, almacenará información sobre los empleados de la empresa (datos personales, CVs, contrato laboral, condiciones laborales, etc.) y permitirá guardar un historial individual de los proyectos en los que ha estado asignado el recurso para su mejor seguimiento. Finalmente, respecto a las peticiones de ofertas laborales, almacenará la información necesaria para su correcta gestión y atención a los clientes que envían sus ofertas para mejorar la atención a las mismas. Se podrá realizar un seguimiento más exhaustivo de cada petición y de los recursos asignados a la misma. Al igual que en las secciones anteriores de candidato y plantilla, será posible realizar búsquedas por cualquier criterio relacionado con cada petición. Como módulo adicional, se ha implementado una serie de plantillas sobre las que los usuarios de la herramienta podrán generar informes estadísticos y detallados sobre estas peticiones para un mejor análisis y atención a clientes personalizado., At present, companies have a need to manage their resources and data in an efficient manner to enable higher performance thereof. Therefore, the need to incorporate management tools that make this the best possible way. Specifically, the company, technological consultancy which has developed and implemented this tool of HR management software, profile assignment requests and job offers, did not have any management tool that would increase performance and data organization. This tool will be able to store, edit, query data and generate reports on different areas necessary in the daily work of selection and HR department. The information stored this tool will be in reference to the creation of a database of candidates with their personal data, will allow assignment to technology profiles and keep relevant information from your monitoring selection processes in which is involved the candidate . Finally, they will be searchable by any criteria related to the data stored on it. Regarding HR management, store information on company employees (personal data, CVs, employment contracts, working conditions, etc.) and allow you to save an individual record of projects in which the resource has been assigned to his best tracing. Finally, with respect to requests for job offers, will store the information necessary for proper management and attention to customers who send their bids to improve care for them. You can perform a more thorough each request and the resources assigned to the same track. As in the previous sections of candidate and template, it will be possible to search by any criteria associated with each request. As an additional module has implemented a series of templates on which users can generate statistical tool and detailed reports on these requests for better analysis and personalized attention to customers.