Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann–Whitney test for non-normal continuous variables. Results: The median patients’ global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00¿am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann¿Whitney test for non-normal continuous variables. Results:The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00¿am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Managing Decisions Regarding Rural Expressway Routes and Associated Highway Bypasses, 2009

For several years, the Iowa Department of Transportation has constructed bypasses along rural highways. Most bypasses were constructed on the state’s Commercial Industrial Network (CIN). Now that work on the CIN has been completed and the system is open to traffic, it is possible to study the impacts of bypasses. In the past, construction of highway bypasses has led community residents and business people to raise concerns about the loss of business activity. For policy development purposes, it is essential to understand the impacts that a bypass might have on safety, the community, and economics. By researching these impacts, policies can be produced to help to alleviate any negative impacts and create a better system that is ultimately more cost-effective. This study found that the use of trade area analysis does not provide proof that a bypass can positively or negatively impact the economy of a rural community. The analysis did show that, even though the population of a community may be stable for several years and per capita income is increasing, sales leakage still occurs. The literature, site visits, and data make it is apparent that a bypass can positively affect a community. Some conditions that would need to exist in order to maximize a positive impact include the installation of signage along the bypass directing travelers to businesses and services in the community, community or regional plans that include the bypass in future land development scenarios, and businesses adjusting their business plans to attract bypass users. In addition, how proactive a community is in adapting to the bypass will determine the kinds of effects felt in the community. Results of statistical safety analysis indicate that, at least when crashes are separated by severity, bypasses with at-grade accesses appear to perform more poorly than either the bypasses with fully separated accesses or with a mix of at-grade and fully separated accesses. However, the benefit in terms of improved safety of bypasses with fully separated accesses relative to bypasses with a mixed type of accesses is not statistically conclusive.

Land use changes, landscape ecology and their socioeconomic driving forces in the Spanish Mediterranean coast (the Maresme County, 1850-2005)

[cat] Utilitzem un conjunt de mètriques del paisatge per estudiar l'evolució a llarg termini seguida en una típica zona costanera del Mediterrani des de 1850 fins a 2005, que mostren una greu deterioració del medi ambient entre 1950 i 2005. Les principals forces motores d'aquesta degradació del paisatge han estat el creixement urbà experimentat a les antigues zones agrícoles situades a les planes litorals, juntament amb l'abandonament i la reforestació dels vessants dels pujols interceptats per àrees residencials de baixa densitat, carreteres i altres infraestructures lineals. Duem a terme una anàlisi estadística de redundància (RDA) amb la finalitat d'identificar els que considerem com alguns agents rectors socioeconòmics i polítics d'última instància d'aquests impactes ambientals. Els resultats confirmen les nostres hipòtesis interpretatives, que són que: 1) els canvis en les cobertes i usos del sòl determinen canvis en les propietats dels paisatge, tant estructurals com funcionals; 2) aquests canvis no es produeixen per atzar, sinó que estan relacionats amb factors geogràfics i forces socioeconòmiques i polítiques.

Land use changes, landscape ecology and their socioeconomic driving forces in the Spanish Mediterranean coast (the Maresme County, 1850-2005)

[cat] Utilitzem un conjunt de mètriques del paisatge per estudiar l'evolució a llarg termini seguida en una típica zona costanera del Mediterrani des de 1850 fins a 2005, que mostren una greu deterioració del medi ambient entre 1950 i 2005. Les principals forces motores d'aquesta degradació del paisatge han estat el creixement urbà experimentat a les antigues zones agrícoles situades a les planes litorals, juntament amb l'abandonament i la reforestació dels vessants dels pujols interceptats per àrees residencials de baixa densitat, carreteres i altres infraestructures lineals. Duem a terme una anàlisi estadística de redundància (RDA) amb la finalitat d'identificar els que considerem com alguns agents rectors socioeconòmics i polítics d'última instància d'aquests impactes ambientals. Els resultats confirmen les nostres hipòtesis interpretatives, que són que: 1) els canvis en les cobertes i usos del sòl determinen canvis en les propietats dels paisatge, tant estructurals com funcionals; 2) aquests canvis no es produeixen per atzar, sinó que estan relacionats amb factors geogràfics i forces socioeconòmiques i polítiques.

Aineominaisuuksien mallinnustarkkuuden vaikutukset lämmönsiirtimien lämpöteknisessä simuloinnissa

Työssä on käsitelty fluidien aineominaisuuksien vaikutuksia paperikoneiden kuivatusosissa käytettävien lämmönsiirtimien lämpöteknisessä simuloinnissa. Pääkohteena selvitettiin kostean ilman ja veden fysikaalisien aineominaisuuksien mallinnustarkkuuden vaikutuksia lämpövirtaan lauhduttamattomissa ja lauhduttavissa tapauksissa. Asiaa tutkittiin tekemällä herkkyysanalyysi työssä kehitetyille termodynaamisille malleille. Perinteisen herkkyysanalyysin lisäksi herkkyyksiä tutkittiin myös Bayesiläisellä tilastoanalyysillä. Työssä käsiteltiin myös aineominaisuuksien käyttäytymistä ja mallintamista lämmönsiirtimissä. Kirjallisuudesta etsittiin aineominaisuusmallit, joilla kostean ilman ja veden fysikaalisia aineominaisuuksia voidaan kuvata riittävän tarkasti. Työssä havaittiin, että yksittäisistä aineominaisuuksista selkeästi suurimmat vaikutukset on ominaisentalpioiden mallinnuksen epätarkkuuksilla. Myös kaikkien aineominaisuuksien epätarkkuuksilla havaittiin olevan huomattavan suuret yhteisvaikutukset lämpövirran laskentatarkkuuteen. Viiden prosentin epätarkkuus kaikkien aineominaisuuksien mallinnuksessa johtaa 3 - 7 %:n epätarkkuuteen lämpövirran laskennassa. Näin ollen kaikkien aineominaisuuksien mallintamiseen tulee kiinnittää huomiota.

Työpisteiden tiedonkäyttö ja hyödyntäminen osana palveluyhtiön johtamisjärjestelmää

Tutkimuksen tavoitteena oli etsiä kohdeorganisaation taustalla olevia tekijöitä, jotka joko edesauttavat tai estävät nykyisen johtamisjärjestelmän soveltamista, tiedon käyttöä ja hyödyntämistä organisaation työpisteissä. Kohdeorganisaatio on Varenso Oy, Tekniset tuotantopalvelut. Teoriaosiossa käsitellään tietojohtamiseen liittyvää käsitteistöä sekä tiedon luomiseen, johtamiseen ja hyödyntämiseen liittyviä tekijöitä. Johtamista lähestytään myös perustehtävän, strategian ja muutosvalmiuden, valta- ja organisaatiorakenteiden sekä informaatio- ohjauksen näkökulmasta. Lopuksi käsitellään suorituskykyä, tavoitteiden asettamista, mittaamista funktionaalisissa- ja prosessijohdetuissa organisaatioissa. Empiirisessä osiossa tehtiin kyselytutkimus. Tulokset analysoitiin monimuuttujamenetelmiä soveltaen ja löydettiin faktorit, joiden avulla on mahdollista vaikuttaa kohdeorganisaation toimintaan. Kyselytutkimuksen avulla tulkittiin organisaation tämän hetkistä suorituskykyä ja asemaa suhteessa tavoitteisiin. Tuloksena syntyi myös toimenpideehdotuksia.

Classificação de cerâmicas arqueológicas da Bacia Amazônica

In order to elucidate the traditional classification of archaeological artefacts, a multielemental analytical method for characterisation of its micro and macro chemical constituents. combined with statistical multivariate analysis for classification, were used. Instrumental thermal neutron activation analysis, for elemental chemical determination, and three statistical methods: discriminant, cluster and modified cluster analysis were applied. The statistical results obtained for the samples from Iquiri, Quinari and Xapuri archaeological phases were in good agreement with the conventional archaeological classification. Iaco and Jacuru archaeological phase were not characterised as homogenous groups. Iquiri phase were the most distinct in relation to the other analysed groups. An homogeneous group for 54% collected samples at the Los Angeles site was also found, this could be characterised as a new archaeological phase.

Tilastollisia perusmenetelmiä yleistajuisesti

Kirjallisuusarvostelu

Configuring Health Care Services - Service Control Improvement

The costs of health care are increasing, and at the same time, population is aging. This leads health care organizations to focus more on home based care services. This thesis focuses on the home care organization of the South Karelian District of Social and Health Services (Eksote), which was established in 2010; how its operation is organized and managed, and which problem types are faced in the daily operation of home care. This thesis examines home care services through an extensive interview study, process mapping and statistical data analysis. To be able to understand the nature of services and special environment theory models, such as service management and performance measurement, service processes and service design are introduced. This study is conducted from an external researcher‟s point of view and should be used as a discussion opener. The outcome of this thesis is an upper level development path for Eksote home care. The organization should evaluate and build a service offering, then productize home care services and modularize the products and identify similarities. Service processes should be mapped to generate efficiency for repeating tasks. Units should be reasonably sized and geographically located to facilitate management and operation. All this can be done by recognizing the different types of service products: runners repeaters and strangers. Furthermore, the organization should not hide behind medical issues and should understand the legislative, medical and operational frameworks in health care.

Comparación: injerto libre o cierre primario más lente de contacto, en resección de tumores de conjuntiva limbar

INTRODUCCION: Existe controversia en cuanto a la técnica quirúrgica para el manejo de tumores del limbo conjuntival. El uso de cierre primario con uso de lente de contacto puede ofrecer una mejor cicatrización y tener ventajas adicionales sobre la técnica tradicional con el uso de plastia. OBJETIVOS: Comparar los resultados en cuanto a grado de dolor, picadas, prurito, porcentaje de epitelización y cicatrización, comodidad del paciente, grado de quemosis y tiempo de retorno a actividades diarias en ambas técnicas quirúrgicas. MATERIALES Y METODOS: Experimento clínico controlado aleatorizado en dos grupos: Al primer grupo se le realizó cirugía de resección de la lesión más plastia. Al segundo grupo se le practicó la resección de la lesión cierre primario y lente de contacto. El seguimiento se realizó al primer y cuarto día, y cada semana durante el primer mes de postoperatorio. Se utilizó el SPSS 20.0 ® para análisis estadístico de datos y se utilizó estadística no paramétrica. RESULTADOS: Se conto con 10 pacientes por grupo. El dolor y porcentaje de cicatrización al primer día postoperatorio fueron mayores en el grupo usando lente de contacto (p=0.048). Al cuarto día postquirúrgico se encontró un mayor porcentaje de cicatrización en el grupo usando lente de contacto. (p=0.075). CONCLUSIONES: El cierre por afrontamiento con uso de lente de contacto mostró dolor y picadas mayores al primer y cuarto día postoperatorio. Pero la epitelización y cicatrización fueron tempranas con un retorno corto a actividades cotidianas.

Nitrogen flows from European watersheds to coastal marine waters

Nitrogen flows from European watersheds to coastal marine waters Executive summary Nature of the problem • Most regional watersheds in Europe constitute managed human territories importing large amounts of new reactive nitrogen. • As a consequence, groundwater, surface freshwater and coastal seawater are undergoing severe nitrogen contamination and/or eutrophication problems. Approaches • A comprehensive evaluation of net anthropogenic inputs of reactive nitrogen (NANI) through atmospheric deposition, crop N fixation,fertiliser use and import of food and feed has been carried out for all European watersheds. A database on N, P and Si fluxes delivered at the basin outlets has been assembled. • A number of modelling approaches based on either statistical regression analysis or mechanistic description of the processes involved in nitrogen transfer and transformations have been developed for relating N inputs to watersheds to outputs into coastal marine ecosystems. Key findings/state of knowledge • Throughout Europe, NANI represents 3700 kgN/km2/yr (range, 0–8400 depending on the watershed), i.e. five times the background rate of natural N2 fixation. • A mean of approximately 78% of NANI does not reach the basin outlet, but instead is stored (in soils, sediments or ground water) or eliminated to the atmosphere as reactive N forms or as N2. • N delivery to the European marine coastal zone totals 810 kgN/km2/yr (range, 200–4000 depending on the watershed), about four times the natural background. In areas of limited availability of silica, these inputs cause harmful algal blooms. Major uncertainties/challenges • The exact dimension of anthropogenic N inputs to watersheds is still imperfectly known and requires pursuing monitoring programmes and data integration at the international level. • The exact nature of ‘retention’ processes, which potentially represent a major management lever for reducing N contamination of water resources, is still poorly understood. • Coastal marine eutrophication depends to a large degree on local morphological and hydrographic conditions as well as on estuarine processes, which are also imperfectly known. Recommendations • Better control and management of the nitrogen cascade at the watershed scale is required to reduce N contamination of ground- and surface water, as well as coastal eutrophication. • In spite of the potential of these management measures, there is no choice at the European scale but to reduce the primary inputs of reactive nitrogen to watersheds, through changes in agriculture, human diet and other N flows related to human activity.

Influence of NaHCO(3) Powder on Translucency of Microfilled Composite Resin Immersed in Different Mouthrinses

The regular use of mouthrinses, particularly when combined with the use of air-powder polishing, could affect the appearance of tooth-colored restorations. The current study sought to evaluate the effect of NaHCO(3) powder on translucency of a microfilled composite resin immersed in different mouthrinses, at distinct evaluation periods. Eighty disk-shaped specimens of composite resin (Durafill VS, Heraeus Kulzer GmbH & Co. KG, Hanau, Germany) were prepared. The composite specimens were then randomly allocated into two groups according to the surface treatment: exposure to NaHCO(3) powder (10 seconds) or nonexposure, and they were randomly assigned into four subgroups, according to the mouthrinses employed (N = 10): Periogard (Colgate/Palmolive, Sao Bernardo do Campo, SP, Brazil), Cepacol (Aventis Pharma, Sao Paulo, SP, Brazil), Plax (Colgate/Palmolive), and distilled water (control group). The samples were immersed for 2 minutes daily, 5 days per week, over a 4-month test period. Translucency was measured with a transmission densitometer at seven evaluation periods. Statistical analyses (analysis of variance and Tukey`s test) revealed that: distilled water presented higher translucency values (86.72%); Periogard demonstrated the lowest translucency values (72.70%); and Plax (74.05%) and Cepacol (73.32%) showed intermediate translucency values, which were statistically similar between them (p > 0.01). NaHCO(3) air-powder polishing increased the changes in translucency associated with the mouthrinses. Air-powder polishing alone had no effect on material translucency. Translucency percent was gradually decreased from 1 week of immersion up to 4 months. It may be concluded that the NaHCO(3) powder and the tested mouthrinses have affected the translucency of microfilled composite resin, according to the tested time. CLINICAL SIGNIFICANCE During the last decade, the demand for composite resin restorations has grown considerably, however, controversy persists regarding the effect of surface roughness on color stability.

Site-directed mutagenesis and structural modeling of Coq10p indicate the presence of a tunnel for coenzyme Q6 binding

Coq10p is a protein required for coenzyme Q function, but its specific role is still unknown. It is a member of the START domain superfamily that contains a hydrophobic tunnel implicated in the binding of lipophilic molecules. We used site-directed mutagenesis, statistical coupling analysis and molecular modeling to probe structural determinants in the Coq10p putative tunnel. Four point mutations were generated (coq10-K50E, coq10-L96S, coq10-E105K and coq10-K162D) and their biochemical properties analysed, as well as structural consequences. Our results show that all mutations impaired Coq10p function and together with molecular modeling indicate an important role for the Coq10p putative tunnel. (C) 2010 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

Observational constraints on the dark energy and dark matter mutual coupling

We examine different phenomenological interaction models for Dark Energy and Dark Matter by performing statistical joint analysis with observational data arising from the 182 Gold type la supernova samples, the shift parameter of the Cosmic Microwave Background given by the three-year Wilkinson Microwave Anisotropy Probe observations, the baryon acoustic oscillation measurement from the Sloan Digital Sky Survey and age estimates of 35 galaxies. Including the time-dependent observable, we add sensitivity of measurement and give complementary results for the fitting. The compatibility among three different data sets seem to imply that the coupling between dark energy and dark matter is a small positive value, which satisfies the requirement to solve the coincidence problem and the second law of thermodynamics, being compatible with previous estimates. (c) 2008 Elsevier B.V. All rights reserved.