Literatura académica sobre el tema "Leeds Monthly Meeting"

Abstract The unavailability of civil courts to hear cases relating to Muslim family law and other related matters persuaded community leaders and religious scholars in the United Kingdom to establish several Sharīʿah councils. This article explores the role played by these councils in resolving matrimonial disputes, especially the process and procedure of issuing an Islamic divorce. Library and empirical research methods were employed. Three main uk Sharīʿah councils were visited wherein mediation and arbitration sessions, as well as monthly meetings, were observed to examine how disputes are handled and decisions made. The study leads to several findings. Mediation and arbitration are the main methods used in the process, and despite the relative success of Sharīʿah councils, they face challenges resulting from the dichotomy and overlapping jurisdictions of Islamic and English family law and the non-alignment of divorce issued by uk courts and religious divorce.

Background:Patient and public involvement (PPI) is gaining increasing recognition as important in ensuring research is relevant and acceptable to participants. Rheuma Tolerance for Cure (RTCure) is a 5 year international collaboration between academia and industry; focusing on earlier detection and prevention of rheumatoid arthritis (RA) through the use of immune-tolerising treatments.Objectives:To bring lived experience and insight into scientific discussions; and to evolve collaboration between lay representatives and academia/industry.Methods:9 Patient Research Partners (PRPs) from 5 European countries were recruited via the EULAR PARE Network and institutions within the RTCure Consortium (8 PRPs with RA and 1 ‘at risk’). They were asked to enter into a legal agreement with the Consortium. PRPs participated in teleconferences (TCs) and were invited to attend face-to-face (F2F) meetings at least annually. Requests for input/feedback were sent from researchers to PRPs via the project’s Patient Engagement Expert [SK].Results:PRP involvement has given researchers and industry partners a new perspective on patient priorities, and focused thought on the ethics of recruitment for and participation in clinical trials of people ‘at risk’ of developing RA. PRPs have helped define the target populations, given their thoughts on what types of treatments are acceptable to people ‘at risk’ and have aided the development of a survey (sent to EULAR PARE members) regarding the use of animal models in biomedical research. Positive informal feedback has been received from researchers and industry regarding the contribution of PRPs to the ongoing project (formal evaluation of PPI in RTCure will be carried out in 2020 and at the project end in 2022).Challenges:Legal agreements- Many PRPs refused to sign the Consortium’s complex PRP Agreement; feeling it unnecessary, incomprehensible and inequitable. After extensive consultation with various parties (including EULAR and the Innovative Medicines Initiative) no similar contract was found. Views for its requirement even varied between legal experts. After 2 years of intense discussion, a simple non-disclosure agreement was agreed upon. Ideally any contract, if required, should be approved prior to project onset.Meeting logistics- Other improvements identified were to locate the meeting venue and accommodation on the same site to minimise travel, and to make it easier for PRPs to take breaks when required. This also facilitates informal discussions and patient inclusivity. We now have agreed a policy to fund PRPs extra nights before and after meetings, and to bring a carer if needed.Enabling understanding– Future annual meetings will start with a F2F meeting between PRPs and Work Package Leads. Researchers will be encouraged to start presentations with a summary slide in lay language. Additionally, an RTCure Glossary is in development.Enabling participation– SK will provide monthly project updates and PRP TCs will be held in the evening (as some PRPs remain employed). PRPs will be invited to all project TCs and F2F meetings. Recruitment is underway to increase the number of ‘at risk’ PRPs as their viewpoint is vital to this study.Conclusion:Currently PPI in RTCure is an ongoing mutual learning process. Universal guidance regarding what types of contracts are needed for PPI would be useful. Communication, trust and fruitful discussions have evolved through F2F meetings (both formal and informal) between PRPs, academia and industry. It is important that all parties can be open with each other in order to make PPI more meaningful.Acknowledgments:This work has received support from the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking RTCure grant number 777357.Disclosure of Interests:Savia de Souza: None declared, Ruth Williams: None declared, Eva Johansson: None declared, Codruta Zabalan: None declared, Tom Esterine: None declared, Margôt Bakkers: None declared, Wolfgang Roth: None declared, Neil Mc Carthy: None declared, Meryll Blake: None declared, Susanne Karlfeldt: None declared, Martina Johannesson: None declared, Karim Raza Grant/research support from: KR has received research funding from AbbVie and Pfizer, Consultant of: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, Speakers bureau: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai

244 Background: The Cancer Imaging Program (CIP) at Cancer Care Ontario was established in 2009 to improve the quality of cancer imaging in Ontario. Methods: After initial selection of a Provincial clinical lead in 2009, fourteen regional clinical leads were selected to represent all geographical regions of the province. Through a stakeholder survey and a priority setting process the following four high-level areas of priority emerged to support quality improvement of cancer imaging: (1) Developing and Fostering an Imaging Community of Practice, (2) Imaging Appropriateness, (3) Timely Access to Imaging, and (4) Standardized/Synoptic Reporting. Results: (1) An Imaging Community of Practice was established with the regional clinical leads, who participate in monthly meetings to build and strengthen inter-regional relationships and share information on regional activities and priorities; (2) Best practice standards for imaging in lung and colorectal cancer have been developed by consolidating and endorsing national and international guidelines. New imaging guidelines are being developed by the Program in Evidence-Based Care. Evidence-based recommendations being developed for focal tumour ablation procedures; (3) Three Interventional Radiology procedures (CT-guided lung biopsies, peripherally inserted central catheters and portacaths) have been selected for an ongoing wait time collection that captures monthly point-in-time data. The data has initiated discussions on appropriate benchmarks and identification of factors that may contribute wait times; and (4) Synoptic Radiology Reporting enables the collection of uniform and complete data to improve the information available to referring clinicians for diagnosis and treatment planning. Work is underway in the development of: implementation roadmap, evidence-based clinical checklists, infrastructure to store and share synoptic reports, and international standards for synoptic radiology reporting. Conclusions: The establishment of the CIP as a clinical program under a provincial cancer agency has enabled the development of an Imaging Community of Practice and allowed for work on provincial-wide initiatives that enable quality improvement of cancer imaging.

Purpose – When a patient unexpectedly has to go back to the operating theatre, there is often a perceived problem with the primary operation. An IRT30 is defined as any patient returning to the operating theatre within 30 days of the index procedure. IRT30 has been suggested to be a useful quality indicator of surgical standards and surgeon performance. The purpose of this paper is to evaluate the usefulness of this validated tool, by assessing all IRT30 over a 12-month period. Learning points for individual surgeons, surgical subspecialty units and the clinical governance leads were reviewed. Design/methodology/approach – Consecutive series of general and vascular surgical patients undergoing elective and emergency procedures between July 2012 and 2013. Prospective data collection of all IRT30s classified as Types 1-5 by a single-rater and in-depth discussion of Types 3-5 cases at the clinical governance meetings. The individual case learning points were recorded and the collective data monitored monthly. Findings – There were 134 IRT30s. In total 84 cases were discussed: Type 3 (n=80), Type 4 (n=4) and Type 5 (n=0). In total 50 cases were not discussed: Type 1 (n=27), Type 2 (n=23). Originality/value – It is crucial that surgeons continue to learn throughout their surgical career by reflecting on their own and their colleague’s results, complications and surgical performance. Analysing Types 3 and 4 IRT30s within the governance meetings has identified learning points related to both surgical technique and surgical decision making. By embracing these learning points, surgical technique and individual as well as group surgeon performance can be modified and opportunities for training and focused supervision created.

AimsSt Charles is one of the largest inpatient mental health units in London with 8 wards and covers the boroughs of Kensington & Chelsea and Westminster. This project aimed was set up so that 95% of patients in St Charles Mental Health Centre would have a complete cardiometabolic health assessment by December 2020. This would include Weight, Smoking, Alcohol, Substance Use, Hypertension, Cholesterol and Diabetes assessments with necessary interventions recorded. The outcome of the intervention would improve overall physical health and life expectancy.MethodPeople with serious mental illness experience significantly worse physical health and shorter life expectancy of up to 10 to 15 years than the general population. CNWL is making Physical Health of patients in Mental Health Services a priority. Performance in this area has been challenging across the Trust because of: –Buy in from clinicians.–Staff did not feel empowered to discuss interventions with patients.–High sickness and absence as a result of COVID was found to directly correlate with reduced physical health monitoring/recording.–Lack of training in completing the SystmOne physical health templateThe following cardiometabolic risk monitoring interventions were recorded on SystemOne (electronic documentation platform) and performance reviewed using Tableau : Weight, Smoking, Alcohol, Substance Use, Hypertension, Cholesterol and Diabetes assessments with necessary interventions recorded.ResultPrior to the commencement of this project, the wards in St Charles Mental Health Centre completed physical health assessments on roughly 8% of the patients in February 2020. The QI project was implemented in June 2020. By September 2020, physical health recording across 8 wards across St Charles had increased to 89% following successful implementation of the interventions.ConclusionThe following interventions resulted in a significant improvement in physical health cardiometabolic risk monitoring at a busy inpatient mental health setting: –Monthly physical heath meetings to enable shared learning with ward doctors, nurses and healthcare assistants.–Ongoing one-to-one and group support to train staff with completing and recording physical health assessments.–Tableau Physical Health Report regularly reviewed with MDT during ward round meetings.–Physical health leads given supernumerary days to run physical health clinics on the wards.–Fortnightly Physical health monitoring meetings with the Director of Nursing and Head of Governance.

Regional surgical quality Collaboratives are improving surgical quality and cutting costs by building regional relationships that leverage information sharing to improve outcomes. The South Carolina Surgical Quality Collaborative (SCSQC) is a new regional surgical quality Collaborative focused on improving general surgery outcomes in South Carolina. It is a joint effort which brings together the skills and resources of Health Sciences South Carolina, the South Carolina Hospital Association, and the Blue Cross Blue Shield of SC Foundation to create a web-based data collection system to provide real-time outcomes data to participating surgeons, and establishing a supportive network for sharing best practices and promoting data driven quality improvement. Members of the SCSQC abstracted more than 8000 general surgery cases from eight participating hospitals in its first year. These facilities are spread across the state of South Carolina and range from large academic referral centers to small community hospitals. The resulting data should be representative of much of the surgical care provided in South Carolina. Monthly conference calls and quarterly face-to-face meetings occur with site Surgeon Leads, site Surgical Clinical Quality Reviewer, and Collaborative leaders. Each site is pursuing a quality improvement project addressing issues identified from analysis of their initial data. Early results on these efforts are encouraging. The SCSQC is a new regional surgical quality Collaborative, which leverages multiple state resources, builds on the successes of similar Collaboratives in Michigan and Tennessee, with the goal to improve the quality and value of general surgical care for South Carolinians.

Abstract Background With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop robust antimicrobial stewardship programs (ASP). Methods BJC HealthCare is a 13 hospital healthcare system serving the St. Louis, mid-Missouri, and Southern Illinois region and includes adult and pediatric academic medical centers, as well as community and critical access hospitals. In 2015, BJC system leaders engaged relevant clinical and executive stakeholders at each hospital to champion formation of a multidisciplinary system ASP Council. A comprehensive gap analysis was performed to assess current stewardship resources and activities. BJC system clinical leads facilitated the development of hospital specific leadership support statements, identification of hospital pharmacy and medical leaders, and all mandated educational components. To facilitate tracking, reporting and improvement activities, a robust antimicrobial use data dashboard was created. Each hospital has a dedicated ASP team that is supported by the system clinical leads. Hospital learnings are shared at monthly system ASP meetings allowing for broad dissemination. Results By leveraging system resources, all 13 BJC HealthCare hospitals met all Joint Commission requirements by January 2017. BJC’s model of ASP allows for the development of broad-based stewardship activities including development of education modules for patients and providers, and clinical decision support tools while allowing individual hospitals to implement activities based on local needs and resource availability. Local hospital teams have developed treatment guidelines, targeted antibiotic pharmacy review, “handshake” stewardship models, and allergy testing protocols. Central support of local hospital ASP has resulted in a 7.6% system decrease in tracked antimicrobial use, including a 16.5% reduction in quinolone usage. Additionally, the C. difficilestandardized infection ratio decreased from 1.08 to 0.622 since program initiation. Conclusion Despite significant differences in hospital resources, a system-supported ASP model focused on implementing the CDC core elements can result in significant reductions in antimicrobial use. Disclosures J. Newland, Merck: Grant Investigator, Research grant; Allergan: Grant Investigator, Research grant

Background Systems for measuring the performance of general practices are extremely limited. Objectives The aim was to develop, pilot test and evaluate a measure of productivity that can be applied across all typical general practices in England, and that may result in improvements in practice, thereby leading to better patient outcomes. Methods Stage 1 – the approach used was based on the Productivity Measurement and Enhancement System (ProMES). Through 16 workshops with 80 general practice staff and 72 patient representatives, the objectives of general practices were identified, as were indicators that could measure these objectives and systems to convert the indicators into an effectiveness score and a productivity index. This was followed by a consensus exercise involving a face-to-face meeting with 16 stakeholders and an online survey with 27 respondents. An online version of the tool [termed the General Practice Effectiveness Tool (GPET)] and detailed guidance were created. Stage 2 – 51 practices were trained to use the GPET for up to 6 months, entering data on each indicator monthly and getting automated feedback on changes in effectiveness over time. The feasibility and acceptability of the GPET were examined via 38 telephone interviews with practice representatives, an online survey of practice managers and two focus groups with patient representatives. Results The workshops resulted in 11 objectives across four performance areas: (1) clinical care, (2) practice management, (3) patient focus and (4) external focus. These were measured by 52 indicators, gathered from clinical information systems, practice records, checklists, a short patient questionnaire and a short staff questionnaire. The consensus exercise suggested that this model was appropriate, but that the tool would be of more benefit in tracking productivity within practices than in performance management. Thirty-eight out of 51 practices provided monthly data, but only 28 practices did so for the full period. Limited time and personnel changes made participation difficult for some. Over the pilot period, practice effectiveness increased significantly. Perceptions of the GPET were varied. Usefulness was given an average rating of 4.5 out of 10.0. Ease of use was more positive, scoring 5.6 out of 10.0. Five indicators were highlighted as problematic to gather, and 27% of practices had difficulties entering data. Feedback from interviews suggested difficulties using the online system and finding time to make use of feedback. Most practices could not provide sufficient monthly financial data to calculate a conventional productivity index. Limitations It was not possible to create a measure that provides comparability between all practices, and most practices could not provide sufficient financial data to create a productivity index, leaving an effectiveness measure instead. Having a relatively small number of practices, with no control group, limited this study, and there was a limited timescale for the testing and evaluation. Implications The GPET has demonstrated some viability as a tool to aid practice improvement. The model devised could serve as a basis for measuring effectiveness in general practice more widely. Future work Some additional research is needed to refine the GPET. Enhanced testing with a control sample would evaluate whether or not it is the use of the GPET that leads to improved performance. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Objective – This paper describes the experiences of four prominent North American research libraries as they implemented Balanced Scorecards as part of a one-year initiative facilitated by the Association of Research Libraries (ARL). The Balanced Scorecard is a widely accepted organizational performance model that ties strategy to performance in four areas: finance, learning and growth, customers, and internal processes. Methods – Four universities participated in the initiative: Johns Hopkins University, McMaster University, the University of Virginia, and the University of Washington. Each university sent a small group of librarians to develop their Scorecard initiatives and identified a lead member. The four teams met with a consultant and the ARL lead twice for face-to-face training in using the Scorecard. Participants came together during monthly phone calls to review progress and discuss next steps. Additional face-to-face meetings were held throughout the year in conjunction with major library conferences. Results – The process of developing the Scorecards included the following steps: defining a purpose statement, identifying strategic objectives, creating a strategy map, identifying measures, selecting appropriate measures, and setting targets. Many commonalities were evident in the four libraries’ slates of strategic objectives. There were also many commonalities among measures, although the number chosen by each institution varied significantly, from 26 to 48. Conclusion – The yearlong ARL initiative met its initial objectives. The four local implementations are still a work in progress, but the leads are fully trained and infrastructure is in place. Data is being collected, and the leadership teams are starting to see their first deliverables from the process. The high level of commonality between measures proposed at the four sites suggests that a standardized slate of measures is viable.

Abstract Background National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP). Methods We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression. Results Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36). Conclusion A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates. Disclosures All authors: No reported disclosures.

This chapter chronicles the surprising post-trial revelations by Alvaro Saravia, who comes out of hiding to give an interview to a Miami newspaper. Saravia then contacts the legal team, starting a months-long dialogue that eventually leads to a sit-down meeting with two members of the team in Honduras. The legal team refuses to negotiate with Saravia unless he reveals everything he knows about those responsible for the Romero assassination and the financing of Roberto D’Aubuisson’s death squad, and although the meeting ends without an agreement, Saravia does make some interesting disclosures.

Sitting in the same rain forest where Darwin penned these words more than a century earlier, E. O. Wilson shares the identical “cathedral feeling,” the identical sense of the biological sublime evoked by the diversity of the biosphere: “Hold[ing] still for long intervals to study a few centimeters of tree trunk or ground, [and] finding some new organism at each shift in focus.” It is a feeling for his fellow creatures exhibited in every aspect of E. O. Wilson’s life: his efforts to understand ant society, his discovery of sociobiology as means of understanding all societies, and, finally, his efforts to preserve the diversity of the biosphere in which all societies must find their place. For Wilson, environmental ethics flows naturally from the cathedral feeling he shares with Darwin, their sense of the biological sublime. It is 1969 and there is a knock on Wilson’s office door. It signals the arrival a talented German entomologist, Bert Hölldobler, invited to Harvard for an extended stay. The two hit it off almost immediately; eventually, Hölldobler returns to Harvard as a full professor. While his command of English improves, his German accent never entirely disappears, an accent, Wilson feels, that lends weight to his lectures: his is the authentic voice of German science. Friends and collaborators, the two produce a stream of science that culminates in the publication of The Ants. The award of the Pulitzer for this book is Wilson’s opportunity simultaneously to signal and make light of his achievements. The book “weighed 7.5 pounds, fulfilling my criterion of a magnum opus—a book when dropped from a three-story building is big enough to kill a man.” The award is also an opportunity to express his gratitude to the institution that continued to nurture his talent. At the monthly college meeting, he recalls, “I stood and basked in the applause of the Harvard faculty. Bless my soul, the Harvard faculty. Where could I go from here but down.” By this time, however, his co-author has left Harvard. The daily drudgery of turning out grant proposals has taken its toll.

<i>Abstract</i>.—The Gulf of Maine Council on the Marine Environment, established in 1989 as a regional entity to manage environmental quality in the Gulf of Maine, recently recognized the importance of state-of-the-environment reporting as a management tool. Although participating members are individually taking steps to catalogue the collective understanding of the Gulf of Maine, until recently there has been no gulf-wide synthesis of pressures on the environment, biophysical and socioeconomic status and trends, and responses to identified issues. After a 9-month process to develop a scope for the project, in December 2009, the council approved the compilation of the “State of the Gulf of Maine Report,” to be launched in June 2010. The main objective of the “State of the Gulf of Maine Report” will be to provide information on the issues affecting the gulf in a form that is easily accessible and readable without compromising scientific validity. The reporting framework to be used will be the driving forces-pressure-state-impacts-response framework. This framework lends itself most easily to reporting on an issue-by-issue basis, so that the pressures, state, impacts, and responses are described for each issue in turn. The “State of the Gulf of Maine Report” will be a modular document that comprises an upfront section or “context document” that provides the background and context to the Gulf of Maine and a series of issue or theme papers that focus on priority areas of the council. It is also envisaged that a wiki site would be useful for informal reporting by interested parties. The main challenges to developing a state-of-the-environment reporting system for the Gulf of Maine are meeting target audience’s expectations, providing the correct level of detail, providing adequate facts in an understandable manner, processing and management of information, development and use of indicators, and funding and human resource capacity.