Designed for workarounds: a qualitative study of the causes of operational failures in hospitals.

Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level-rather than department-level-performance measures; 2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries.

RDA and RDH retention surveys. CDA's Council on Education and Professional Relations.

This article presents the results of a survey of dental auxiliaries conducted by the California Dental Association's Council on Education and Professional Relations. The survey found that a surprisingly high number of dental assistants (56 percent) and hygienists (42 percent) are considering whether to remain in the dental health care field, stated reasons for this include lack of paid benefits and little opportunity for career growth. The results also suggest, however, that if the perceived deficiencies in these areas were addressed, RDAs and RDHs might remain in the profession.

Asymptomatic myositis ossificans of the medial pterygoid muscles: a case report.

Traumatic myositis ossificans, also known as myositis ossificans circumscripta or fibrodysplasia ossificans circumscripta, is a form of dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue. This is usually due to a single severe injury or repeated minor injuries to muscle, although cases without a history of injury have been reported. Heterotopic ossification is rare in the orofacial region, especially in the medial pterygoid muscles. A case of medial pterygoid myositis ossificans with unique computed tomography findings is described.

Accuracy and bond strength of reversible with irreversible hydrocolloid impression systems: a comparative study.

Combinations of three reversible hydrocolloids with five irreversible hydrocolloids were evaluated for dimensional accuracy and bond strength. A stainless steel model representing two teeth prepared for a fixed partial denture was designed for an accuracy study. The recordings were made with a measuring microscope, and the tensile bond strength was determined with an Instron Universal Testing instrument. The accuracy of these materials was clinically acceptable, and the resulting models were suitable. The materials distributed by a common supplier exhibited better tensile strength, although one irreversible hydrocolloid, Jeltrate, performed well in the noncompanion combination groups. This reversible with irreversible hydrocolloid combination impression has an advantage compared with the traditional reversible hydrocolloid impression, because it does not require elaborate, expensive conditioning equipment and water cooled trays.

Dimensional accuracy and bond strength of addition silicones.

A cross-matching study was conducted to evaluate the effect on dimensional accuracy and tensile bond strength between the materials when intermixing brands of addition silicone impression materials in a putty-wash impression. Three brands of putty-wash systems (Reprosil, Permagum, and Express), which formed nine possible combinations, were involved in this study. The dimensional accuracy was estimated from stone casts recovered from impressions of a standardized stainless steel master model. Findings indicated no adverse effect on the bond between putty and light-bodied materials of different brands. Statistical analysis indicated significant differences. However, because the actual differences in percent deviations between the intermixed groups and their respective reference groups are very small, they are presumed to be insignificant clinically.