Lean management has proved to be the preferred way of managers who strive for achieving performances comparable to that of the Toyota Company that firstly applied the “no wastes” philosophy. In... Show More

Lean management has proved to be the preferred way of managers who strive for achieving performances comparable to that of the Toyota Company that firstly applied the “no wastes” philosophy. In healthcare, managers look at reducing the patients' waiting times and management costs, increasing productivity and optimizing the resources allocation. In order to build consensus about the effectiveness of lean practices, two simulation models representing the two costliest departments of a public healthcare facility in Southern Italy (an Elective Surgery Department and the Intensive Care and Resuscitation Unit) have been developed. The simulation models have been equipped with built-in functions capable of implementing different lean policies (e.g. 5S method, visual management, kanban method, pull system) which supports planning and patients' scheduling activities. Simulated results ensure managerial advantages (e.g. resources' utilization levels), savings (e.g. overtime costs) and improved customer satisfaction (e.g. patients' waiting times and waiting lists' lengths).

This paper describes the modelling and analysis of the processes and activities used in the Blood Transfusion Centre of Hospital Brotzu (Cagliari – Italy), via FMECA (Failure Modes Effects and... Show More

This paper describes the modelling and analysis of the processes and activities used in the Blood Transfusion Centre of Hospital Brotzu (Cagliari – Italy), via FMECA (Failure Modes Effects and Criticalities Analysis) method, in order to enhance patient safety and improve clinical risk management. The first part of the study consists on an analysis of the present blood transfusion chain processes (AS-IS), obtained by reverse engineering. Then a concise description of the FMECA methodology is presented. After the introduction of the reengineered process (TO-BE), developed via introduction of RFID technology, the results of simulation will be presented. For each activity of the two configurations studied (AS-IS and TO-BE) some performance indicators were evaluated, then a sensitivity analysis has been carried out to investigate the consistency of FMECA analysis. Finally follows the comparison of results between the simulation of actual process and the reengineered one.

The extracorporeal membrane oxygenation (ECMO) is a common procedure of extracorporeal circulation (ECC) used in case of cardiopulmonary diseases. The major clinical complications are related to... Show More

The extracorporeal membrane oxygenation (ECMO) is a common procedure of extracorporeal circulation (ECC) used in case of cardiopulmonary diseases. The major clinical complications are related to hemodynamic changes and to the mechanical shear stress. The aim of this study is to evaluate the effects of the modality of perfusion during ECMO, comparing the hemodynamic behavior generated by constant flow (normal modality) with the one obtained by pulsed perfusion induced by the intra-aortic balloon pump (IABP). To carry out the study, the computational fluid dynamic (CFD) approach was chosen, realizing a multi-scale model. The numerical results have highlighted that the IABP-induced pulsed perfusion increases both flow and pressure in the supraaortic vessels, even if the balloon makes the wall shear stress (WSS) pattern and the hemolysis index worse.

Classification-based segmentation is an approach to establish generic analysis of medical image data. Significant feature sets covering different characteristics of regions to segment allow for... Show More

Classification-based segmentation is an approach to establish generic analysis of medical image data. Significant feature sets covering different characteristics of regions to segment allow for robust discrimination of topologically defined classes. In this work a method for automated domain-specific feature selection to achieve a higher level of predictability is presented, incorporating multivariate feature analysis. For calculation of the probability density function, different approaches, like histogram analysis, enumeration of the entire feature space or umbrella Monte Carlo Integration are investigated. Furthermore, meta features calculated on entire classification results rather than on particular regions are introduced. Predictability of both, single local and meta features, is evaluated for different medical datasets as well for simulated intensity volumes, allowing testing and evaluating specific classification problems. The automated feature selection proofs to be accurate for classification-based segmentation utilizing well-known machine learning approaches.

To present the University of Genoa Advanced Simulation Center (SimAv) and the project of a trainer (eLap4D) that would achieve the equivalent goals of the fundamentals of laparoscopic surgery... Show More

To present the University of Genoa Advanced Simulation Center (SimAv) and the project of a trainer (eLap4D) that would achieve the equivalent goals of the fundamentals of laparoscopic surgery trainer at an economical cost. The validation process is going to be shown too. METHODS. The laparoscopic trainer is a physical low-cost laparoscopic training platform that reproduces the tactile feedback (eLaparo4d) integrated with a software for virtual anatomical realistic scenarios (Unity3D V 4.1). A sample of 20 students was selected, divided into 2 homogeneous groups with respect to the level of confidence with the use of video games, consoles, smartphones (this has been possible thanks to the use of a questionnaire, administered before the practical phase of training). The groups participated in a training program based on 5 basic laparoscopic skills (laparoscopic focusing and navigation, hand – eye – coordination and grasp coordination). So, a second and a third study sample was chosen, consisting of 20 post graduate students (intermediate group) and 20 experienced surgeons; for these groups a training program was provided, identical to the previous group as well as their subdivision into 2 group. The face validity was used for an ergonomic analysis of the simulator, the construct to test the system's ability to differentiate potential expert users (experienced surgeons) from non-experts (student without experience in laparoscopic surgery). The authors analyzed the results of the three samples obtained by comparing variables such as score, % of fulfillment, panality and time. At the same time, the students' improvements have been monitored, developing a customized learning curve for each user. To evaluate the structural characteristics of the simulator a specific questionnaire has been used. The results were encouraging. The simulator is ergonomically satisfactory and its structural features are adapted to the training. The system was able to differentiate the level of experience and also has therefore met the requirements of “construct validity”. laparoscopic simulators can be constructed at an economical cost.

This paper intends to simplify challenging concepts through role-play demonstrations and serve as a foundation for understanding the basis of securing healthcare data. Disparity exists between the... Show More

This paper intends to simplify challenging concepts through role-play demonstrations and serve as a foundation for understanding the basis of securing healthcare data. Disparity exists between the rising need for security of electronic healthcare information and the number of healthcare leaders who understand the concepts behind ensuring privacy and accuracy of such data. Healthcare managers with a basic understanding of data encryption and how it safeguards health information are vital to the success of Electronic Health Records. They often are responsible for proper oversight of such systems and should instill confidence in medical providers and patients that electronic medical data is safe and accurate. However, data security and privacy are complex concepts and remain foreign to many healthcare managers. This paper reviews the benefits of simulation learning and outlines a workshop and simulation game developed in response to difficulties teaching the technology of encryption. The results are validated with anecdotal and indirect statistical evidence.

When an individual is seen or treated by a healthcare professional, a series of alphanumeric codes are used to describe the medical diagnoses and services provided. This designated classification... Show More

When an individual is seen or treated by a healthcare professional, a series of alphanumeric codes are used to describe the medical diagnoses and services provided. This designated classification structure, the ninth iteration of ICD (International Classification of Diseases), implements the use of coding for healthcare management, public health and medical informatics, and insurance purposes. ICD-9 has been the coding standard in the healthcare industry for 30 years. On October 1st, 2015, the tenth revision ICD-10 was formally implemented in the United States. This paper explores the validity of predictions from domain professionals regarding fraud detection and the implementation of the ICD-10 code set. The notion that fraud detection systems using supervised learning algorithms will encounter an initial decline in performance due to ICD-10 is fairly unsupported at the moment. The authors claim that the results from their study will provide evidence that will support this notion of a preliminary negative transitional impact.

Information and knowledge are the basis of all organizational processes and activities. But these two resources are not sufficient to organizational competitiveness or allocation of resources... Show More

Information and knowledge are the basis of all organizational processes and activities. But these two resources are not sufficient to organizational competitiveness or allocation of resources efficiency, or commercial activities effectiveness. Organizations should develop reaction and response mechanisms to established economic dynamics. The concept of intelligence corresponds to the value creation process by signal capture capability (information), their interpretation, understanding and reaction aiming at taking measures and decisions in the form, content and the appropriate time to identified situations. In this study the authors' propose a reference model with some dimensions, in order to establish a possible evaluation of the organizational intelligence level in hospital organizations.