1,721,057 research outputs found
L'HTA (HEALTH TECHNOLOGY ASSESSMENT) PER IL MANAGEMENT DELLE APPARECCHIATURE BIOMEDICALI DI UN'AZIENDA OSPEDALIERA: RIALLOCAZIONE, DONAZIONE AI PAESI IN VIA DI SVILUPPO, IDEAZIONE E PROGETTAZIONE DI UNA COMUNITÀ VIRTUALE
No full textAl centro dell’analisi c’è lo studio delle possibili procedure di donazione delle apparecchiature biomediche dismesse ma ancora funzionanti via web nell’ambito del Management Sanitario. Nella prima parte dell’elaborato vengono presentati gli strumenti necessari per la classificazione delle apparecchiature biomediche e si sottolinea la necessita della realizzazione e dell’introduzione di uno strumento in grado di valutare le apparecchiature biomedicali, al fine di dichiararne l’eventuale dismissione, al fine di garantire una corretta riorganizzazione del patrimonio tecnologico di qualsivoglia struttura sanitaria. In particolare, coerentemente con una gestione razionalizzata e ottimizzata delle risorse messe a disposizione dal Governo centrale e dalle Regioni, è stato indispensabile ottenere informazioni precise su ogni singolo passo del ciclo di vita di quelle tecnologie ritenute critiche non soltanto per gli effetti che possono avere sullo stato di salute o la qualità della vita di un individuo, ma anche per le modalità con le quali si interfacciano con la struttura nella quale si trovano. Il protocollo realizzato in questo lavoro è stato il presupposto indispensabile per determinare l’eventuale dismissione delle apparecchiature biomedicali poiché, attraverso tale strumento, è stato possibile definire la situazione riguardante la convenienza o la necessità di una dismissione di una o più apparecchiature e/o eventuali nuovi acquisti e, dunque, di conoscere meglio la realtà operativa delle apparecchiature sanitarie appartenenti all’ A.O.R.N. “A. Cardarelli” ed agire di conseguenza, per evitare inutili sprechi sia di risorse che di denaro. Il valore numerico, attraverso il quale l’apparecchiatura viene classificata consente di determinare se l’oggetto in esame risulta pienamente rispondente ai criteri o si trova in Fuori Uso indifferibile o in Fuori Uso programmato: in questo caso, si potrà procedere alla riallocazione o alla donazione, che, prescindendo dall’aspetto legale, rappresentano due valide modalità attraverso le quali continuare ad utilizzare efficacemente le macchine in esame, poiché se in un caso risulta possibile applicare una ridistribuzione del patrimonio tecnologico della struttura sanitaria, nell’altro si realizza una procedura contrattuale attraverso la quale un bene, che altrimenti sarebbe non utilizzato e destinato alla distruzione, viene donato a un’altra struttura donataria. In seguito, alla luce della necessità di migliorare il processo di donazione di apparecchiature biomedicali, per il reciproco vantaggio di donatori e beneficiari, si è proceduto con la creazione di un portale web che consente ai due attori principali di questo sistema di interagire, dotando il portale degli strumenti necessari ad entrambi aumentando cosi l’efficacia delle procedure di donazione. Per sviluppare questa parte si è seguita una linea di tipo economico-gestionale, non prima però di aver fatto luce sulle tecniche di progettazione dei siti web, quali struttura motore di ricerca, interfaccia di navigazione, url e contenuti. Successivamente è stato sviluppato un classico Business Plan nel quale si è ipotizzata la creazione di una società, per la creazione di una comunità virtuale che permettesse la donazione di apparecchiature biomedicali. Il business plan è artcolato in cinque parti: - idea progetto - analisi delle opportunita’ di mercato del progetto comunita’ virtuale - piano organizzativo e produttivo - piano di marketing - piano finanziario Infine, dal punto di vista imprenditoriale, la società ipotizzata dovrebbe portare l’impresa al punto di inversione o pareggio, che nel nostro caso si verificherà durante il II anno, detto anche break even point; a partire da questo punto tutto l’investimento fatto sarà stato recuperato e, quindi, l’impresa inizierà ad avere un profitto; mentre, dal punto di vista tecnico il portale della comunità virtuale permetterà di superare quelli che sono i punti critici della donazione off-linee e di apportare i seguenti vantaggi che sono poi le caratteristiche peculiari del web: - Immediatezza delle azioni degli attori(donatori –beneficiari) - Feedback tra le varie parti del sistema - Capillarità: la capacita di raggiungere i luoghi più disparati grazie ad un semplice doppino telefonico o alla tecnologia gps
Lean Six Sigma Approach to Improve the Management of Patients Undergoing Laparoscopic Cholecystectomy
No full textLaparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both emergency and elective surgery. The incidence of the disease related to an increasingly elderly population coupled with the efficacy and safety of LC treatment resulted in an increase in the frequency of interventions without an increase in surgical mortality. For these reasons, managers implement strategies by which to standardize the process of patients undergoing LC. Specifically, the goal is to ensure, in accordance with the guidelines of the Italian Ministry of Health, a reduction in post-operative length of stay (LOS). In this study, a Lean Six Sigma (LSS) methodological approach was implemented to identify and subsequently investigate, through statistical analysis, the effect that corrective actions have had on the post-operative hospitalization for LC interventions performed in a University Hospital. The analysis of the process, which involved a sample of 478 patients, with an approach guided by the Define, Measure, Analyze, Improve, and Control (DMAIC) cycle, made it possible to reduce the post-operative LOS from an average of 6.67 to 4.44 days. The most significant reduction was obtained for the 60–69 age group, for whom the probability of using LC is higher than for younger people. The LSS offers a methodological rigor that has allowed us, as already known, to make significant improvements to the process, standardizing the result by limiting the variability and obtaining a total reduction of post-operative LOS of 67%
HTA (Health Technology Assessment): A means to reach governance goals and to guide health politics on the topic of clinical risk management
No full textPresent work is aimed to highlight the need of a systematic approach to guarantee global patient security, which is the final goal each organization should aim to. To reach this scope, a multidisciplinary evaluation is required for any action in health services. In consequence this represents the basic approach that steers health politics choices in the matter of clinical risk management
Application of Supply Chain Management at Drugs Flow in an Italian Hospital District
Full text linkThe globalization has pushed to change the organization of every companies, even the hospitals. The principal phenomenon in that period and fundamental today again, has been the Supply Chain Management (SCM), with which the company is no longer seen as an isolated entity but active part in an extremely complex supply network. In fact, the only way to guarantee the competitiveness of businesses in the new world economy is through the cooperation and the integration between customers and suppliers. The present work analyses the drugs flow of three Italian hospital: the Cardarelli Hospital in Campobasso, the Veneziale located in Isernia and the San Timoteo site in Termoli. The data was provided by MOLISE DATA SPA that collected the information from all ASREM with particular interest in the already mentioned hospitals. Particularly, will be highlight, using simulation model, the benefits deriving from the implementation of a new Supply Chain, creating a collaboration along the entire logistics production chain. Thanks to a more efficient management of drugs will get a reduction of business costs and an improvement of the health services offered
Fuzzy logic–based clinical decision support system for the evaluation of renal function in post-Transplant Patients
Full text linkIn the context of the gradual development of artificial intelligence in health care, the clinical decision support systems (CDSS) play an increasing crucial role in improving the quality of the therapeutic and diagnostic efficiency in health care. The fuzzy logic (FL) provides an effective means for dealing with uncertainties in the health decision-making process; therefore, FL-based CDSS becomes a very powerful tool for data and knowledge management, being able to think like an expert clinician. This work proposes an FL-based CDSS for the evaluation of renal function in posttransplant patients
An application of symbolic dynamics for FHRV assessment
No full textFetal heart rate variability is surely one of the most important parameters to monitor fetal wellbeing. Linear studies, widely employed to study fetal heart variability and its correlations with the development of the autonomous nervous system, have shown some limitations in highlight dynamics potentially relevant. During the last decades, therefore, nonlinear analysis methods have gained a growing interest to analyze the chaotic nature of cardiac activity. Techniques investigating nonlinear dynamics have been already successfully employed in adults, to analyze different physiological and pathological states. Concerning fetal monitoring, instead, a smaller number of papers is available in the literature; even if symbolic dynamics was recently employed to quantify fetal heart rate regularity, demonstrating that the use of this technique may lead to a better and more differentiated understanding of normal fetal physiological development. In this work, we applied the symbolic dynamics to analyze fetal heart rate variability in healthy fetuses at the end of a physiological pregnancy. Our results confirmed the potentiality of the technique to highlight differences between signals characterized by more or less variabilit
Prognostic decision support using symbolic dynamics in CTG monitoring
No full textFoetal heart rate variability is one of the most important parameters to monitor foetal wellbeing. Linear parameters, widely employed to study foetal heart variability, have shown some limitations in highlight dynamics potentially relevant. During the last decades, therefore, nonlinear analysis methods have gained a growing interest to analyze the chaotic nature of cardiac activity. Parameters derived by techniques investigating nonlinear can be included in computerised systems of cardiotocographic monitoring. In this work, we described an application of symbolic dynamics to analyze foetal heart rate variability in healthy foetuses and a concise index, introduced for its classification in antepartum CTG monitoring. The introduced index demonstrated to be capable to highlight differences in heart rate variability and resulted correlated with the Apgar score at birth, in particular, higher variability indexes values are associated to early greater vitality at birth. These preliminary results confirm that SD can be a helpful tool in CTG monitoring, supporting medical decisions in order to assure the maximum well-being of newborn
Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study
Full text linkBackground: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring—in a very short time—of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods: This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d’Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results: The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions: This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration
Classification and regression model to manage the hospitalization for laparoscopic cholecystectomy
Full text linkAbstract Gallstone disease (GD) is one of the most common morbidities in the world. Laparoscopic Cholecystectomy (LC) is currently the gold standard, performed in about 96% of cases. The most affected groups are the elderly, who generally have higher pre- and post-operative morbidity and mortality rates and longer Length of Stay (LOS). For this reason, several indicators have been defined to improve quality and efficiency and contain costs. In this study, data from patients who underwent LC at the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno in the years 2010–2020 were processed using a Multiple Linear Regression (MLR) model and Classification algorithms in order to identify the variables that most influence LOS. The results of the 2352 patients analyzed showed that pre-operative LOS and Age were the independent variables that most affected LOS. In particular, MLR model had a R2 value equal to 0.537 and the best classification algorithm, Decision Tree, had an accuracy greater than 83%. In conclusion, both the MLR model and the classification algorithms produced significant results that could provide important support in the management of this healthcare process
The classification algorithms to support the management of the patient with femur fracture
Full text linkAbstract Effectiveness in health care is a specific characteristic of each intervention and outcome evaluated. Especially with regard to surgical interventions, organization, structure and processes play a key role in determining this parameter. In addition, health care services by definition operate in a context of limited resources, so rationalization of service organization becomes the primary goal for health care management. This aspect becomes even more relevant for those surgical services for which there are high volumes. Therefore, in order to support and optimize the management of patients undergoing surgical procedures, the data analysis could play a significant role. To this end, in this study used different classification algorithms for characterizing the process of patients undergoing surgery for a femoral neck fracture. The models showed significant accuracy with values of 81%, and parameters such as Anaemia and Gender proved to be determined risk factors for the patient’s length of stay. The predictive power of the implemented model is assessed and discussed in view of its capability to support the management and optimisation of the hospitalisation process for femoral neck fracture, and is compared with different model in order to identify the most promising algorithms. In the end, the support of artificial intelligence algorithms laying the basis for building more accurate decision-support tools for healthcare practitioners
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