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Rete delle malattie rare: simulazione della gestione della rete con modello parametrico
Full text linkItalian ministerial decree number 279 of May 18th, 2001, provides the establishment of a national network devoted to rare diseases, by means of which preventing action is to be developed, care is to be activated, interventions directed to diagnosis and therapy are to be improved, information and education are to be promoted.
Rare Disease Network is made up by all structures and regional system services which contribute, in an integrated way and each one related to its specific competences and functions, to develop and implement all actions provided by the up decree.
In detail, main nodes of Rare Diseases Network are accredited providers, preferably hospital ones, suitably identified by Regions among those which possess documented experience in diagnosis and cure of specific Rare Diseases or Rare Diseases groups, and are equipped with adapt support structures and complementary services.
Network providers are connected, in a diversified way on the basis of different regional health organizations, to hospital and territorial services closer to sick people residence places. These connections, even if experimented as strategic for the effective charge of people with rare diseases, currently suffer from a fulfilment diversity and still result lacking in many territorial areas.
The present paper has the objective of carrying out of a simulation model, made out by language Rockwell Arena, which permits to reproduce the Rare Diseases network actual system and to dynamically analyse its behaviour, to test management criteria, to evaluate critical situations in running queues and in efforts to which each node is called, to suggest and validate planning choices, to compare alternative solutions in short times and with very small expenses.
Moreover, data processing supplies a by-product consisting in a database which records all paths covered by every patient among centres both from a medical and simply from a geographical point of view; such paths may be influenced both by external parameters (managed as system variables) like for instance the appeal of a professional operating in a centre, or by inner parameters like the specific planning which assigns a larger or a smaller basin to a node.
Such a way we can not only observe how patients’ population is distributed on the basis of statistical laws, but also how patients’ population behaves on the basis of strategic decisions.
In the model, every newborn is inserted into the system according to a statistic which arrives at different distributions for every week of the year, with characteristics like for instance the birth zone.
If the newborn is sick, then all necessary treatments are listed with necessary resources, duration, beginning, etc. All treatments remain in a queue until they are effected: queues (time and lengths) are revealed related to every centre resources and to centre choice policy.
All of the parameters regarding each treatment is stored in a database and can be handled without accessing Arena Simulation giving to the model a great flexibility in representing actual situation and the issues concerning the Rare Diseases Network.Il decreto Ministeriale numero 279 del 19 maggio 2001, ha disposto la realizzazione di una Rete Nazionale per la gestione delle Malattie Rare, con lo scopo di promuovere la prevenzione, attivare i percorsi terapeutici, migliorare gli standard degli interventi rivolti alla diagnosi e terapia, promuovere l'informazione e l'educazione in merito a queste patologie.
La Rete delle Malattie Rare è stata costruita in Veneto utilizzando strutture mediche e servizi già esistenti in Regione integrandoli e collegandoli in un network in cui a ciascuno sono assegnate specifiche funzioni e competenze per realizzare quanto previsto dal decreto Ministeriale.
Nel dettaglio, i principali nodi delle malattie rare di rete sono Centri accreditati, normalmente assimilabili a quelli ospedalieri, opportunamente individuati dalle Regioni tra le strutture che sono in possesso di documentata esperienza nella diagnosi e cura delle malattie rare o gruppi malattie rare, e sono dotate di adattare le strutture di supporto e servizi complementari.
I Centri sono connessi, in modo diversificato in base alle diverse organizzazioni sanitarie regionali, a servizi ospedalieri territoriali il più vicino possibile al malato in modo da ridurne lo stress in termini di spostamento. Queste connessioni, anche se si sono rivelate assolutamente strategiche per la presa in carico della gestione di persone affette da malattie rare, soffrono ancora di una distribuzione di efficacia a “macchia di leopardo” e ancora risultato carente in molte aree territoriali.
Scopo della presente ricerca è la progettazione e realizzazione di un modello di simulazione implementato nel software Arena Simulation della Rockwell, con lo scopo di riprodurre il sistema di gestione della Rete delle Malattie rare e di analizzarne dinamicamente il comportamento, testarne i criteri di gestione, valutarne le situazioni critiche nella gestione di code ed impegni (in termini di tempo e risorse) dei nodi della rete, suggerire e validare scelte progettuali, confrontare soluzioni alternative in tempi brevi e con spese contenute.
Inoltre l'elaborazione dei dati nel modello di simulazione fornirà un sottoprodotto costituito in un database in grado di registrare tutti i percorsi coperti da ogni paziente che si muove tra Centri per avere accesso alle cure specifiche, sia da un punto di vista medico che semplicemente da un punto di vista geografico; tali percorsi possono essere influenzati sia da parametri esterni (gestiti come variabili di sistema) come ad esempio l’appeal di un particolare Centro per ragioni di professionalità o immagine, o da parametri interni come la pianificazione specifica che potrà assegnare un bacino di utenza più grande o più piccolo ad un singolo nodo.
In questo modo il modello consentirà l’osservazione non solo di come la popolaizone dei pazienti affetti da malattie Rare si andranno a distribuire sul territorio sulla base di regole statistiche, ma anche come attraverso decisioni strategiche sarà possibile governare distribuzioni e flussi.
Ogni nuovo nato viene introdotto come entità nel modello sulla base di una distribuzione statistica che definisce diversi tassi di natalità nell’anno con dettaglio a livello di settimana, e a ciascuno di questi viene assegnato un set di informazioni che lo personalizzano quali ad esempio la zona di nascita in relazione al Nodo di competenza che ne gestirà il decorso se necessario.
Se il Nato verrà dichiarato malato nel modello, allora adesso verranno associate tutti i trattamenti necessari alla cura della patologia corredati delle informazioni necessarie alla gestione quali: risorse necessarie, durata, tempo di prima insorgenza...
Tutti i trattamenti rimangono nel modello e vengono gestiti fino al compimento del ciclo di vita rimanendo in sospeso fino al momento in cui dovranno effettivamente essere applicati: per ciascuno dei Centri di cui è composta la Rete vengono registrate le caratteristiche dell’esecuzione della prestazione in particolare inerenti il tempo di attesa e il tempo di somministrazione.
Tutti i parametri riguardanti i Trattamenti sono archiviati in una base dati e possono essere gestiti senza accedere ad Arena Simulation. Ne risulta un modello estremamente flessibile e capace di rappresentare la problematica della gestione della Rete delle malattie rare
Emergency department optimization by simulation: two actual applications
No full textThe Emergency Department of a hospital is devoted to provide first aid to outpatients who suffer from
an injury or an illness requiring urgent care. Emergency Department service is characterized by: a) high
variability of patient arrivals, depending on time (day, week, year intervals ) and on exceptional events
(epidemics, maxiemergencies) occurring, according to extreme randomness; b) different required assistance
type according to patient characteristics and to suffered injury or illness; c) hard requirements for quick
(sometimes immediate) response, also in case of congestion. An emergency department shall be correctly
designed and managed for what concerns: a) structures (major treatment, minor treatment rooms, waiting
rooms, short term admission rooms, beds); b) technological resources (specifical instruments); c) human
resources (doctors, nurses, engineers and related working rules, turns of duty, etc.) in order to supply a
high quality service at minimum cost. Once given the presence of randomness in patient arrival, in patient
management (due to priorities and possible preemption) and in services’ duration, an analytical model is
hard to build and anyway not suitable, as it is able to provide only mean behaviour results, while a simulation
model is able to describe system behaviour in detail, and to give results related both to mean and to extreme
conditions. A correct organization and resource dimensioning is very important both in the planning and in
the management phase and may be usefully supported by a simulation model to be applied by administrators
and operators. As an emergency department is a very complex framework, a model which simulates it requires
a large amount of time and an expert software programmer to be built and implemented. In this paper we
employ a generalized flexible model built up by us and presented in a previous paper, able to reproduce
all common structural and functional characteristics of every actual emergency room only by adjusting
functional parameters. This simulation model was adapted to two actual emergency departments requiring
reorganization as they evidenced performance problems. By an easy simulation exercise: a) present situations
were reproduced and weak organizational aspects of system behaviour analyzed; b) a new dimensioning of
employed resources and working rules were suggested and tested by means of parameters setting; c) new
dimensioning was evaluated in terms of economical and social costs
Extended Neonatal Metabolic Screening by Tandem Mass Spectrometry: Models and Simulation of Alternative Management Solutions
No full textNeonatal metabolic screening aims at identifying newborns with severe metabolic pathologies in order to promote appropriate interventions to avoid or to improve adverse outcomes. Tandem Mass Spectrometry permits, from a blood drop, collected on a blotting paper by a puncture on the heel, to measure a lot of metabolites according to their mass; this method can identify more than 30 metabolites, each of which is a potential marker of a hereditary metabolic disease. The large amount of available information and the difficulty in correctly interpreting them in a short time, compatible with the exigencies of newborns, imposes to find an optimal management of structures devoted to perform the related tests. In the paper four different solutions, based on different utilizations of a cluster of two or more test structures, are examined and evaluated. A simulation model, coded in language Arena, has been built to get numerical results; such a model may be usefully employed to compare the effects of different solutions for an actual situation and to give a correct dimensioning to the chosen solution
Emergency Department: a General Adaptable Simulation Model Implemented in Arena
No full textThe Emergency Department of a hospital is devoted to provide first aid to outpatients. A correct organization and resource dimensioning is very important both in the planning and in the management phase and may be usefully supported by a simulation model to be applied by administrators and operators. As an emergency department is a very complex framework, a model which simulates it requires a large amount of time and an expert software programmer to be built and implemented. In this paper a generalized flexible model has been built up, able to reproduce all common structural and functional characteristics of every actual emergency room. This simulation model can be easily adapted to almost all emergency departments only by defining its functional parameters without altering its structure; it is written in language SIMAN by tool Arena, widely diffused, and permits an easy readability also by non expert users
ASSISTANCE TO PALLIATIVE PEDIATRIC PATIENTS: SIMULATION MODEL
Full text linkWe discuss a simulation model describing paediatric palliative assistance network
behaviour and its use by patients. The model is absolutely general, but has been tested on Veneto
Region (Italy), currently equipped with a network including paediatric hospital departments, a
paediatric hospice and home integrated assistance. Different assistance politics were examined.
As expected, politics increasing hospice and home integrated assistance for palliative patients,
improve orderly patients assistance in hospitals and permit a remarkably reduced total cost
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
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
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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