Waiting Time Screening in Diagnostic Medical Imaging - A Case-Based View

Due to the high standards expected from diagnostic medical imaging, the analysis of information regarding waiting lists via different information systems is of utmost importance. Such analysis, on the one hand, may improve the diagnostic quality and, on the other hand, may lead to the reduction of waiting times, with the concomitant increase of the quality of services and the reduction of the inherent financial costs. Hence, the purpose of this study is to assess the waiting time in the delivery of diagnostic medical imaging services, like computed tomography and magnetic resonance imaging. Thereby, this work is focused on the development of a decision support system to assess waiting times in diagnostic medical imaging with recourse to operational data of selected attributes extracted from distinct information systems. The computational framework is built on top of a Logic Programming Case-base Reasoning approach to Knowledge Representation and Reasoning that caters for the handling of in-complete, unknown, or even self-contradictory information.

A Case Based approach to assess Waiting Time Prediction at an Intensive Care Unity

Waiting time at an intensive care unity stands for a key feature in the assessment of healthcare quality. Nevertheless, its estimation is a difficult task, not only due to the different factors with intricate relations among them, but also with respect to the available data, which may be incomplete, self-contradictory or even unknown. However, its prediction not only improves the patients’ satisfaction but also enhance the quality of the healthcare being provided. To fulfill this goal, this work aims at the development of a decision support system that allows one to predict how long a patient should remain at an emergency unit, having into consideration all the remarks that were just stated above. It is built on top of a Logic Programming approach to knowledge representation and reasoning, complemented with a Case Base approach to computing.

The Pine Wood Nematode: a personal view

The first report of the disease (“pine wilt disease”) associated with the pinewood nematode, goes back to 1905, when Yano reported an unusual decline of pines from Nagasaki. For a long time thereafter, the cause of he disease was sought, but without success. Because of the large number of insect species that were usually seen around and on infected trees, it had always been assumed that the causal agent would prove to be one of these. However, in 1971, Kiyohara and Tokushike found a nematode of the genus Bursaphelenchus in infected trees. The nematode found was multiplied on fungal culture, inoculated into healthy trees and then re-isolated from the resulting wilted trees. The subsequent published reports were impressive: this Bursaphelenchus species could kill fully-grown trees within a few months in the warmer areas of Japan, and could destroy complete forests of susceptible pine species within a few years. Pinus densiflora, P. thunbergii und P. luchuensis were particularly affected. In 1972, Mamiya and Kiyohara described the new species of nematode extracted from the wood of diseased pines; it was a named Bursaphelenchus lignicolus. Since 1975, the species has spread to the north of Japan, with the exception of the most northerly prefectures. In 1977, the loss of wood in the west of the country reached 80%. Probably as a result of unusually high summer temperatures and reduced rainfall in the years 1978 and 1979, the losses were more than 2 million m3 per year. From the beginning, B. lignicolus was always considered by Japanese scientists to be an exotic pest. But where did it come from? That this nematode could also cause damage in the USA became clear in 1979 when B. lignicolus was isolated in great numbers from wood of a 39 year-old pine tree (Pinus nigra) in Missouri which had suddenly died after the colour of its needles changed to a reddish-brown colour (Dropkin und Foudin, 2 1979). In 1981, B. lignicolus was synonymised by Nickle et al. with B. xylophilus which had been found for the first time in the USA as far back as 1929, and reported by Steiner and Buhrer in 1934. It had originally been named Aphelenchoides xylophilus, the wood-inhabiting Aphelenchoides but was recognised by Nickle, in 1970,to belong in the genus Bursaphelenchus. Its common name in the USA was the "pine wood nematode" (PWN. After its detection in Missouri, it became known that B. xylophilus was widespread throughout the USA and Canada. It occurred there on native species of conifers where, as a rule, it did not show the symptoms of pine wilt disease unless susceptible species were stressed eg., by high temperature. This fact was an illuminating piece of evidence that North America could be the homeland of PWN. Dwinell (1993) later reported the presence of B. xylophilus in Mexico. The main vector of the PWN in Japan was shown to be the long-horned beetle Monochamus alternatus, belonging to the family Cerambycidae. This beetle lays its eggs in dead or dying trees where the developing larvae then feed in the cambium layer. It was already known in Japan in the 19th century but in the 1930s, it was said to be present in most areas of Japan, but was generally uncommon. However, with the spread of the pine wilt disease, and the resulting increase of weakened trees that could act as breeding sites for beetles, the populations of Monochamus spp. increased significantly In North America, other Monochamus species transmit PWN, and the main vector is M. carolinensis. In Japan, there are also other, less efficient vectors in the genus Monochamus. Possibly, all Monochamus species that breed in conifers can transmit the PWN. The occasional transmission by less efficient species of Monochamus or by some of the many other beetle genera in the bark or wood is of little significance. In Europe, M. galloprovincialis and M. sutor transmits the closely related species B. mucronatus. Some speculate that these two insect species are “standing by” and waiting for the arrival of B. xylophilus. In 1982, the nematode was detected and China. It was first found in dead pines near the Zhongshan Monument of Nanjing (CHENG et. al. 1983); 265 trees were then killed by pine wilt disease. Despite great efforts at eradication in China, the nematode spread further and pine wilt disease has been 3 reported from parts of the provinces of Jiangsu, Anhui, Guangdong, Shandong, Zhejiang and Hubei (YANG, 2003). In 1986, the spread of the PWN to Taiwan was discovered and in 1989, the nematode was reported to be present in the Republic of Korea where it had first been detected in Pinus thunbergii and P. densiflora. It was though to have been introduced with packing material from Japan. PWN was advancing. In 1984, B. xylophilus was found in wood chips imported into Finland from the USA and Canada, and this was the impetus to establish phytosanitary measures to prevent any possible spread into Europe. Finland prohibited the import of coniferous wood chips from these sources, and the other Nordic countries soon followed suit. EPPO (the European and Mediterranean Plant Protection Organization) made a recommendation to its member countries in 1986 to refuse wood imports from infested countries. With its Directive of 1989 (77/93 EEC), the European Community (later called the European Union or EU) recognised the potential danger of B. xylophilus for European forests and imposed restrictions on imports into the Europe. PWN was placed on the quarantine list of the EU and also of other European countries. Later, in 1991, a dispensation was allowed by the Commission of the EU(92/13 EEC) for coniferous wood from North America provided that certain specified requirements were fulfilled that would prevent introduction.

Qualidade e triagem de Manchester : Estudo de caso Hospital CUF Descobertas

A saúde em Portugal encontra-se no caminho da mudança, rumo à excelência, pois questiona-se o sistema, a sua estrutura, os seus processos e os resultados. Uma das condições que mais influencia a competitividade entre instituições da saúde é a qualidade. Sendo a sociedade cada vez mais exigente, medi-la e avalia-la é um imperativo da época actual. O presente estudo teve como objectivo, contribuir para a realização de um diagnóstico de um processo de melhoria implementado num hospital privado de Lisboa - Hospital CUF Descobertas (HCD), no Serviço de Atendimento Permanente (SAP), à luz dos princípios da qualidade total. O procedimento da Triagem de Manchester é um processo que tem como principal objectivo o estabelecimento de prioridades, ou seja, identificar critérios de gravidade, de forma objectiva e sistematizada, que indicam a prioridade clínica com que o cliente deve ser atendido e o respectivo tempo de espera alvo recomendado até observação médica. Não se trata de estabelecer diagnósticos. Para o efeito, utilizou-se uma abordagem metodológica, suportada pelo modelo de auto-avaliação, designado Modelo Common Assessment Framework (CAF). Neste sentido, privilegiando-se a utilização dos critérios de meios deste modelo. Foi aplicado um questionário aos colaboradores do Serviço de Atendimento Permanente do Hospital CUF Descobertas. O Tratamento de dados estatísticos foi realizado com o apoio do SPSS, versão 16.0 e do Microsoft Excel. Os resultados deste estudo culminam com a identificação de pontos fortes, pontos fracos e sugestões de melhorias para o serviço em estudo. Neste sentido, este trabalho serviu de diagnóstico para se poder identificar em que ponto se situa e que rumo se deve seguir para se atingir um patamar de excelência relativamente à qualidade. Abstract: Health in Portugal finds itself on the path toward change, trying to find excellence while challenging the system and its structure, processes, and results. One of the conditions that most influences the competitiveness between the institutes of health is quality because society is becoming more demanding. Measuring and evaluating this change is happening in this current time. The present study has the objective of contributing and establishing a diagnostic tool relative to the process of improvement. This tool was used in a private hospital in Lisbon, Hospital CUF Descobertas, in the Emergency Room, in looking at the principles of total quality. This process designed through the Manchester Triage System has the main objective of the establishment of priorities through which we want to identify criteria of seriousness in an objective and systematic way that indicate a clinical priority with which the client is attended to in respect to the waiting time, giving a recommended time until medical observation. ln this sense, we do not diagnose patients in triage. For this effect, we used a methodological overview supported by the model of self-evaluation, the Common Assessment Framework (CAF}, in which we used the criteria: Leadership, Planning and Strategy, People, Resources and Processes. To arrive at this, a questionnaire was used by the collaborators of the emergency room of Hospital CUF Descobertas. The statistical analysis of the data was performed using SPSS version 16.0 and Microsoft Excel. The results of this study culminated with the identification of strong points, weak points, and suggestions for improvements for the work in study. ln this way, with this study, we can identify in where an organization finds itself and the path it should take in order to achieve a high level of quality excellence.