1,720,961 research outputs found
Technology and Service Assessment Tools in Healthcare
No full textThe role of clinical engineers is rapidly changing and the economic constraints have pulled them towards new responsibilities to manage. Particularly, the assessment of health technologies has covered one of the most important areas among clinical engineers’ duties. Different techniques and methodologies for technology assessment and improvement are available in the literature and they are currently in use within hospitals and healthcare facilities. However, scientific research and practical needs seem to be misaligned, causing misuse of scientific results due to the lack of tools easy-to-use from practical perspective.
This thesis aims at integrating methodologies, even derived from different sectors, for providing standardized and versatile tools that overcome the current issues, providing healthcare facility with a path to follow for choosing the best methodology to be used in diverse situations.
Different case studies are presented, in order to cover the wide range of possibilities within health technology assessment (HTA). Particularly, technology assessment was performed on medical devices using both Hospital-Based HTA for an existing technology and horizon scanning for designing an innovative solution. Then the assessment was extended to hospital services, with particular attention to clinical engineering services, using Multi-Criteria Decision Analysis. Process improvement methodologies were also considered and applied to sterilization service that was also studied and assessed integrating the classical HTA approach with Multi-Criteria Decision Analysis.
These studies allowed to identify a path useful from practical perspective and based on scientific approach aimed at helping healthcare professionals and clinical engineers to choose the best methodology in accordance to specific constraints and needs of particular situations
Multi-criteria decision analysis for the assessment of non-clinical hospital services: Methodology and case study
Full text linkNon-clinical hospital services to support clinical activities, such as the sterilization service and clinical engineering, are an important technology asset in healthcare, and require constant improvement aimed to reduce
economic burden and increase quality. The selection of the most effective healthcare service to adopt in a healthcare facility is a multi-criteria decision problem that classical Health Technology Assessment, being mostly
focused on medicines, vaccines and medical devices, cannot easily address.
Here we present a methodology based on Multi-Criteria Decision Analysis allowing a full assessment of non-clinical hospital services and supporting the selection of the most suitable solution in a certain environment.
The methodology involves two different panels of experts: the first one includes international professionals and is aimed at selecting the assessment criteria that are relevant to the target service; the second one is a
local panel whose members know the needs and peculiarities of the specific healthcare facility. This approach allows the final decision makers to take into account changes and constraints of their environment, but examining
criteria that are internationally recognized as of interest. The proposed methodology, tested in a real context of an Italian Local Health Authority, is versatile and can be applied in any context, even out of the healthcare
domain, especially if data in the literature are not sufficient to allow comparisons with similar services in different settings.
Abbreviations: HTA, Health Technology Assessment; NCHS, Non-Clinical Hospital Services; CSSD, Central Sterile Services Department; MCDA, Multi-Criteria Decision Analysis; ASM, Local Healt
An Innovative Method for Standardizing Lean Management Approach in Hospitals
No full textLean management constitutes an emerging approach in the healthcare context, in order to increase quality of care and reduce costs. Nevertheless, literature shows the lack of a standardized method, especially in healthcare, due to the complexity of the involved processes. This paper proposes an innovative method for standardizing the lean management approach in Healthcare, in order to reduce wastes particularly in Hospitals. The integration of different techniques, such as IDEF0, and GQM, used in the process management is proposed, in order to let the overall method reproducible and repeatable. The application and feasibility of the method has been studied in an Italian Hospital
Multi-criteria decision analysis to redesign an Italian Clinical Engineering Service under specific needs and regulation requirement
No full textThe aim of this study is to fulfill the need of reengineering the Clinical Engineering Service in an Italian ASL (Local Health Authority) located in Sardinia, in accordance with the Italian regulations for healthcare.
Even if methods for processes redesigning in healthcare organizations are available in the literature, there are no recent evidences of their application in Clinical Engineering Services.
Among the multi-criteria techniques, in this work PAPRIKA was used, since it is an easy-to-use and intuitive method for multi- criteria decision making, based on decision-makers’ preferences.
We identified the decision makers’ criteria to be fulfilled and four different preference levels for each criterion, as inputs of the method. Moreover four different scenarios were identified and, for each scenario and criterion, the decision makers selected the most suitable level. In order to reduce the number of pairwise comparisons among the preference levels associated to the identified criteria, the online software 1000minds, implementing the PAPRIKA method, was used.
After 460 steps, the software allowed to rank the four possible scenarios. The application of the method allowed choosing the best solution for the ASL and it represents a good way for decision making, even though the number of questions is still high
Planning of Maintenance for Medical Devices through a Workload Redistribution in a Clinical Engineering Service
No full textThe common practice of Clinical Engineering Services (CESs) is to manage separately Electric Safety Checks (ESCs), Quality Controls (QCs) and Preventive Maintenance (PM). However, protocols related to these activities are partially overlapped. This results in a redundancy of maintenance
steps producing a waste of time. Furthermore, outsourced CESs are in charge of managing activities in hospitals located in different areas with the same team. Thus the distance to be covered by technicians from an area to another one in order to reach the equipment represents a waste of time.
This problem can be solved by merging ESC, QC and PM into a unique operative protocol we call Single Planned Activity (SPA). This implies the development of new maintenance plans and the human resources redistribution, and clinical engineers are in charge of this task. In order to assess its feasibility, we developed a comprehensive method that consists of the analysis of technician’s workload and of the algorithm able to generate a monthly maintenance plan. The method reprograms the previous planned activities through the available human resources redistribution in a more efficient way, according to their actual workload. The method has been tested in an Italian CES and proved to be useful for clinical engineers
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Personalized support for chronic conditions. A novel approach for enhancing self-management and improving lifestyle.
No full textObjective: Solutions for improving management of chronic conditions are under the attention of healthcare systems, due to the increasing prevalence caused by demographic change and better survival, and the relevant impact on healthcare expenditures. The objective of this study was to propose a comprehensive architecture of a mHealth system aimed at boosting the active and informed participation of patients in their care process, while at the same time overcoming the current technical and psychological/clinical issues highlighted by the existing literature.
Methods: After having studied the current challenges outlined in the literature, both in terms of technological and human requirements, we focused our attention on some specific psychological aspects with a view to providing patients with a comprehensive and personalized solution. Our approach has been reinforced through the results of a preliminary assessment we conducted on 22 patients with chronic conditions. The main goal of such an assessment was to provide a preliminary understanding of their needs in a real context, both in terms of self-awareness and of their predisposition toward the use of IT solutions.
Results: According to the specific needs and features, such as mindfulness and gamification, which were identified through the literature and the preliminary assessment, we designed a comprehensive open architecture able to provide a tailor-made solution linked to specific individuals’ needs.
Conclusion: The present study represents the preliminary step towards the development of a solution aimed at enhancing patients’ actual perception and encouraging self-management and self-awareness for a better lifestyle. Future work regards further identification of pathology-related needs and requirements through focus groups including all stakeholders in order to describe the architecture and functionality in greater detail
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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