Maximum voluntary isometric contraction (MVIC) is a standardized method for measurement of muscle strength in patients with neuromuscular disease. Values obtained from MVIC testing are difficult to interpret at present as normative data are limited. The objective of this study was to generate reference values for MVIC. A convenience sample of 494 healthy men and women aged 20-76 years was recruited. MVIC testing was performed on nine muscle groups bilaterally: neck flexors, shoulder abductors, shoulder adductors, elbow and knee flexors and extensors, and hip and ankle flexors. MVIC was performed using the Quantitative Muscle Assessment system. Age and sex related reference values were calculated for each muscle group using quantile regression. A clinical reporting system was developed to facilitate interpretation of patient values with reference to normal percentiles. Reference values generated from this study can be used to determine the presence and extent of muscle weakness in a given population and to evaluate the effectiveness of treatment interventions.
Undergraduate training in DRE is limited. Training in DRE can no longer be reasonably considered part of the core curriculum taught in Irish medical schools.
ObjectivesTo identify and rank the most significant workplace stressors to which consultants and trainees are exposed within the publicly funded health sector in Ireland.DesignFollowing a preliminary semistructured telephone interview, a Delphi technique with 3 rounds of reiterative questionnaires was used to obtain consensus. Conducted in Spring 2014, doctors were purposively selected by their college faculty or specialty training body.SettingConsultants and higher specialist trainees who were engaged at a collegiate level with their faculty or professional training body. All were employed in the Irish publicly funded health sector by the Health Services Executive.Participants49 doctors: 30 consultants (13 male, 17 female) and 19 trainees (7 male, 12 female). Consultants and trainees were from a wide range of hospital specialties including anaesthetics, radiology and psychiatry.ResultsConsultants are most concerned with the quality of healthcare management and its impact on service. They are also concerned about the quality of care they provide. They feel undervalued within the negative sociocultural environment that they work. Trainees also feel undervalued with an uncertain future and they also perceive their sociocultural environment as negative. They echo concerns regarding the quality of care they provide. They struggle with the interface between career demands and personal life.ConclusionsThis Delphi study sought to explore the working life of doctors in Irish hospitals at a time when resources are scarce. It identified both common and distinct concerns regarding sources of stress for 2 groups of doctors. Its identification of key stressors should guide managers and clinicians towards solutions for improving the quality of patient care and the health of care providers.
Background
The Day Hospital had the potential to assist the hospital in achieving its target of reducing length of stay and early supported discharge. However the service was not providing a timely, quality service. The Day Hospital was reviewed as part of a week-long Rapid Improvement Event (RIE) to optimise the service.
Methods
Lean methodologies were utilised, including process mapping, gap analysis and A3 thinking. Data collection and analysis was gathered on the initial state prior to the RIE. Patient interviews were conducted and visual management systems were used to clarify the therapy schedules and rapid experiments of clinic flow boards. The key areas for service development were identified and changes were implemented and audited at 90 days and one year.
Results
Results at one year review showed that wait time for patients to attend an appointment was reduced by 75% (average of 270 days to 70 days) from 2017 to 2018. There was a 184% increase in new patient referrals from 2017 to 2018 and 98% of feedback from the patient surveys was positive. Five new clinic pathways were developed and added to the three existing clinics. Slots were also made available at clinics for early supported discharge from the hospital. Communication between staff was greatly improved through monthly meetings and utilizing a visual management system. Patient feedback surveys were checked monthly and streamlining the administration process improved the capacity of the service.
Conclusion
The RIE produced positive outcomes for the hospital, patients and staff. It achieved the key targets of providing a quality and timely service. The data at key time points indicate positive sustainability in these key areas.
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