PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Process optimization”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,585 records · Page 88Linked to original sources
PubMed1999

[ENT expert assessment for federal health insurance in North Rhine. A contribution to the internal discussion of quantitative and qualitative optimization of the expert witness process].

Contribution to an Internal Discussion on Quantitative and Qualitative Optimisation of Expertising Procedures: The medical advisory and expertising Services of the German statutory sickness insurance are according to German social legislation authorised to request supporting documents direct from the treating physicians or hospitals. The consultant medical expertiser for ENT diseases at Cologne worked out the percentage of requests that resulted in "further investigations" and the amount of work involved. A document form was used to record all such requests for a given period. 154 expertising procedures concerning ENT diseases were counted within a period of 5 weeks. 47% of the patients concerned pertained to workers' sickness insurance funds and 29% to guilds sickness insurance funds. Two thirds of all requests were channelled through the statutory sociomedical preconsultant service and one-third were sent by post. 55% of all the requested documents were considered to be "complete" and 45% "incomplete". N = 100 requests were initial and N = 54 were follow-up requests. The answers received were considered satisfactory and final in 62% of the requests, whereas "further inquiries" were considered necessary in n = 58 (38%) of the cases. 80% of the cases in which the requests resulted in satisfactory information, were approved for sickness insurance payment and approximately 20% were rejected. The average period of time that elapsed between a request for more information and the reply and the final expertising given to and passed on to the patient by the statutory insurance body was 2 weeks. In cases where "further inquiries" are considered necessary, three additional working days are usually required in the Cologne ENT diseases area. If the statutory sociomedical preconsultant service procedure could be intensified, this would result in better channelling of requests by the ENT medical and advisory service of the stautory sickness insurance bodies. A more pronounced examination by the statutory sociomedical preconsultant service could minimise the need for additional requests, follow-ups and "further inquiries" and could increase the speed of completion of approved or rejected insurance cases from 14 days to at the most one day or even 0 days. This pilot study was conducted to encourage the local bodies to optimise their work. In the long run good quality of work, patient satifaction and patients' job security will result and will be the corner-stones of modern quality assurance and quality management in North-Rhine Westphalian medical expertising and consultant services in association with the relevant statutory sickness insurance bodies.

Disability Evaluation↗
PubMed1999

Optimizing healthcare research data warehouse design through past COSTAR query analysis.

Over the past two years we have reviewed and implemented the specifications for a large relational database (a data warehouse) to find research cohorts from data similar to that contained within the clinical COSTAR database at the Massachusetts General Hospital. A review of 16 years of COSTAR research queries was conducted to determine the most common search strategies. These search strategies are relevant to the general research community, because they use the Medical Query Language (MQL) developed for the COSTAR M database which is extremely flexible (much more so than SQL) and allows searches by coded fields, text reports, and laboratory values in a completely ad hoc fashion. By reviewing these search strategies, we were able to obtain user specifications for a research oriented healthcare data warehouse that could support 90% of the queries. The data warehouse was implemented in a relational database using the star schema, allowing for highly optimized analytical processing. This allowed queries that performed slowly in the M database to be performed very rapidly in the relational database. It also allowed the data warehouse to scale effectively.

Databases as Topic↗
PubMed1999

[Rapid prototyping and bone reconstruction].

The authors describe the main techniques for rapid prototyping used in the medical field, with particular emphasis on Laser stereolithography. They describe the basics of the technique as well as the procedures they currently use to construct anatomic specimens from scanned images. For more than 10 years, the targets of researchers in the field of bone reconstruction in craniofacial surgery have been: to design a system to acquire data directly from CT-scans, to optimize modelling, processing and materials, to verify the possibility of producing prefabricated prostheses with data from preoperative models (22 cases). The target of integrating this technique into therapeutic protocols has been reached. The current trend in research is to produce prostheses from biocompatible materials directly from CT scan data by Laser stereolithography.

Computer-Aided Design↗
PubMed2000

Cochlear view: postoperative radiography for cochlear implantation.

OBJECTIVE: This study aimed to define a spatial position of the cochlea in the skull based on anatomical studies and to design an appropriate method of skull radiography for demonstration of the multichannel intracochlear electrode array and the structures of the inner ear, for use in evaluating the electrode position and its related pitch perception. BACKGROUND: The conventional skull radiograph (plain radiograph) can offer a complete and direct image of an intracochlear electrode array, if the x-ray is directed to the cochlea and parallel to the axis of the cochlea. METHODS: Measurement from computed tomography imaging and three-dimensional reconstruction were performed to define the spatial position of the cochlea in the skull. RESULTS: A radiographic projection, the cochlear view, was designed. A detailed radiographic method and radiologic interpretation of the cochlear view is described. An improved clinical method for measuring the longitudinal and angular position of the electrodes from the cochlear view is recommended. CONCLUSIONS: The application of the cochlear view has proved that it is beneficial postoperatively in documenting the results of cochlear implantation, and in evaluating the depth of insertion and position of individual electrodes. It serves as a valuable reference for managing frequency mapping, optimizing speech processing strategies, and further research purposes. The method can be widely used in cochlear implant clinics because of its simplicity, low radiation, speed, and minimal cost.

Adolescent↗
PubMed2000

[Quality management and consumer orientation: survey of referring pediatricians of a Berlin pediatric clinic].

Quality management in hospitals not only includes performance according to international medical standards but also the optimization of processes regarding internal staff as well as external customers. Total Quality Management (TQM) and the Business Excellence Model of the European Foundation of Quality Management (EFQM) require continuous evaluation of customer satisfaction. Specialists and family physician as external customers influence the patient's choice of a hospital. The aim of the present study is to evaluate the satisfaction of admitting physicians of a children's hospital with the help of a questionnaire. The results describe their needs and their level of satisfaction regarding service, information, cooperation and communication within the hospital.

Berlin↗
PubMed2000

[An analysis of the immunity indices of patients with indurative diseases of the head of the pancreas].

Based on an analysis of dynamics of immunity indices the authors have revealed differences in the character of their changes in nontumoral and tumoral diseases and in relation to the stage of the malignant process. The optimal minimum of indices of the immunity status in indurative diseases of the pancreas head is proposed which is of significance for differential diagnosis and determination of resectability of the tumor.

Adult↗
PubMed1998

Clinical pathways--the new paradigm in healthcare?

A clinical pathway defines the optimal care process, sequencing and timing of interventions by doctors, nurses and other healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals in the USA, Australia and United Kingdom. Clinical pathways are developed through collaborative efforts of clinicians, nurses, pharmacists, physiotherapists and other allied healthcare professionals with the aim towards improving the quality of patient care. Clinical pathways have been shown to reduce unnecessary variation in patient care, reduce delays in discharge through more efficient discharge planning, and improve the cost-effectiveness of clinical services. The approach and objectives of clinical pathways are consistent with those of total quality management (TQM) and continuous quality improvement (CQI) and is essentially the application of these principles to the patient's bedside. This article examines the proliferation in the use of clinical pathways, its benefits to the healthcare organisation, its application as a tool for CQI activities in direct relation to patient care and the medico-legal implications involved.

Critical Pathways↗
PubMed2000

Clinical pathways--an evaluation of its impact on the quality of care in an acute care general hospital in Singapore.

A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals and various healthcare organisations in many parts of the world. It is now slowly gaining momentum and popularity in Asia and Singapore. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimising cost to the patient. Clinical pathways have been shown to reduce unnecessary variation in patient care, reduce delays in discharge through more efficient discharge planning, and improve the cost-effectiveness of clinical services. The approach and objectives of clinical pathways are consistent with those of total quality management (TQM) and continuous clinical quality improvement (CQI), and is essentially the application of these principles at the patient's bedside. However, despite the growing popularity of pathways, their impact on clinical outcomes and their clinical effectiveness remains largely untested and unproven through rigorous clinical trials. This paper begins with an overview of the nature of clinical pathways and the analysis of variances from the pathway, their benefits to the healthcare organisation, their application as a tool for CQI activities in direct relation to patient care, and their effectiveness in a variety of healthcare settings. The paper describes an evaluation of the impact of a clinical pathway on the quality of care for patients admitted for uncomplicated acute myocardial infarction (AMI) through an analysis of variances. The author carried out a one year evaluation of a clinical pathway on uncomplicated AMI in Changi General Hospital (CGH) to determine its effectiveness and impact on a defined set of outcomes. A before and after nonrandomized study of two groups of patients admitted to the Hospital for uncomplicated AMI was done. A total of 169 patients were managed on the clinical pathway compared to 100 patients in the control (historical comparison) group. Outcomes were compared between the two groups of patients. Restriction and matching of study subjects in both groups ensured that the patients selected were comparable in terms of severity of illness. The results showed that the patients on the clinical pathway and the comparison group were similar with respect to demographic variables, prevalence of risk factors and comorbidities. There was a statistically significant reduction in the average length of stay after implementation of the clinical pathway. This was achieved without any adverse effect on short term clinical outcomes such as in-hospital mortality, complication rate and morbidity. There were no significant difference in readmission rates at 6 months after discharge. The paper concludes that clinical pathways, implemented in the context of an acute care general hospital, is able to significantly improve care processes through better collaboration among healthcare professionals and improvements in work systems.

Analysis of Variance↗
PubMed2000

Optimal reporting of health care process measures: inferential statistics as help or hindrance?

In this paper we discuss the appropriate application of inferential statistics to practice profiles and other measures of care. To accomplish our objectives, we first describe the relative merits of measuring three well-recognized domains of medical quality: structure, process, and outcome. Next, we discuss inferential statistics as used in quality improvement. We then describe several common circumstances that arise in the measurement of medical care, giving attention to the application of inferential statistics to each situation. We end with a brief discussion of statistical techniques commonly used in the measurement of quality and challenges that arise with their use.

Health Services Research↗
PubMed2001

Immunocytochemical analysis of basket cells in rat piriform cortex.

Basket cells, defined by axons that preferentially contact cell bodies, were studied in rat piriform (olfactory) cortex with antisera to gamma-aminobutyric acid (GABA)ergic markers (GABA, glutamate decarboxylase) and to peptides and calcium binding proteins that are expressed by basket cells. Detailed visualization of dendritic and axonal arbors was obtained by silver-gold enhancement of staining for vasoactive intestinal peptide (VIP), cholecystokinin (CCK), parvalbumin, and calbindin. Neuronal features were placed into five categories: soma-dendritic and axonal morphologies, laminar distributions of dendritic and axonal processes, and molecular phenotype. Although comparatively few forms were distinguished within each category, a highly varied co-expression of features from different categories produced a "combinatorial explosion" in the characteristics of individual neurons. Findings of particular functional interest include: dendritic distributions suggesting that somatic inhibition is mediated by feedforward as well as feedback pathways, axonal variations suggesting a differential shaping of the temporal aspects of somatic inhibition from different basket cells, evidence that different principal cell populations receive input from different combinations of basket cells, and a close association between axonal morphology and molecular phenotype. A finding of practical importance is that light microscopic measurements of boutons were diagnostic for the molecular phenotype and certain morphological attributes of basket cells. It is argued that the diversity in basket cell form in the piriform cortex, as in other areas of the cerebral cortex, reflects requirements for large numbers of specifically tailored inhibitory processes for optimal operation that cannot be met by a small number of rigidly defined neuronal populations.

Animals↗
PubMed2001

[Extraction technology of Fructus Psoraleae with orthogonal test].

The extraction conditions of Fructus Psoraleae were studied with orthogonal test, taking the contents of psoralen and isopsoralen as indexes and smesh degree, alcohol concentration, alcohol volume, immersion time and immersion times as factors. The results showed the optimal extraction process is pulverizing the herbs into 20 meshes powder, 6 times volume of 55% alcohol immersed three times and two days every time.

Chemistry, Pharmaceutical↗
PubMed2002

Optimize APC revenue with process-oriented assessments.

To maintain or improve revenue streams under the Medicare outpatient prospective payment system (PPS), healthcare financial managers should use a process-oriented approach to assess the effectiveness of revenue capture in departments most affected by the PPS's use of ambulatory patient classifications, which typically include the radiology, cardiology, and emergency departments. Such an assessment should be conducted by a multidisciplinary team with senior management support. The team ideally should include the CFO, COO, and leaders from the departments to be assessed. Such an assessment process should consist of five basic phases: chargemaster/charge-capture analysis, revenue-capture process assessment, claims review, development of implementation strategies, and monitoring.

Ambulatory Care↗
PubMed2002

Anaerobic digestion of olive oil mill effluents together with swine manure in UASB reactors.

Combined anaerobic digestion of olive oil mill effluent (OME) with swine manure, was investigated. In batch experiments was shown that for anaerobic degradation of OME alone nitrogen addition was needed. A COD:N ratio in the range of 65:1 to 126:1 was necessary for the optimal degradation process. Furthermore, it was found that methane productions rates during digestion of either swine manure alone or OME alone were much lower than the rates achieved when OME and manure were digested together. Admixing OME with manure at a concentration of 5 to 10% OME resulted in the highest methane production rates. Using upflow anaerobic sludge blanket (UASB) reactors, it was shown that codigestion of OME with swine manure (up to 50% OME) was successful with a COD reduction up to 75%. The process was adapted for degradation of OME with stepwise increase of the OME load to the UASB reactor. The results showed that the high content of ammonia in swine manure, together with content of other nutrients, make it possible to degrade OME without addition of external alkalinity and without addition of external nitrogen source. Anaerobic treatment of OME in UASB reactors resulted in reduction of simple phenolic compounds such as mequinol, phenyl ethyl alcohol and ethyl methyl phenol. After anaerobic treatment the concentration of these compounds was reduced between 75 and 100%. However, the concentration of some degradation products such as methyl phenol and ethyl phenol were detected in significantly higher concentrations after treatment, indicating that the process has to be further optimised to achieve satisfactory removal of all xenobiotic compounds.

Agriculture↗
PubMed2002

Synthetic vascular prostheses.

Polyethyleneterephthalate (PET), and to a lesser extent Teflon have become the major synthetic grafting material. Unlike nylon, Ivalon, and Vinyon-N which lose their tensile strength after implantation, PET and Teflon remain essentially unchanged even after long periods. TRICOMED S.A. produces the family of the knitted vascular implants Dallon made from PET fibres including: Dallon, Dallon H, Tricogel. Both Dallon and Dallon H are manufactured in a form of double (external and internal) velour surface using multifilament yarn and having optimal graft design (a variety of sizes and lengths). The velour surface gives the surface a velvety, plush texture, which improves tissue in--growth. Moreover, Dallon H is a unique vascular prostheses showing the increase in the blood susceptibility that is useful for 4 times less blood demand during preclotting as compared with standard prosthesis. Tricogel graft is made of thin-wall prostheses sealed with the porcine gelatin that provides intraoperative tightness (without preclotting) and the optimal healing process. Hydrophilic behavior of the graft is observed as an instant moistening of the surface with patient's blood and as sweating. The blood stream does not dissolve nor washes away the gelatin but causes the gelatin film to swell, which makes a better tightness. The work will describe the properties of manmade vascular grafts as well as their applications in the vascular surgery.

Biocompatible Materials↗
PubMed2002

Antiarrhythmic therapy in heart failure.

Heart failure is the term used for a cardiovascular syndrome whose definition lacks uniform criteria. It is associated with a very high mortality rate. Approximately 50% of deaths in patients with heart failure are sudden, mostly due to ventricular tachycardia (VT). In severe heart failure, death may also occur due to bradyarrhythmias. Other arrhythmias complicating heart failure include atrial and ventricular extrasystoles, atrial fibrillation, and sustained or non-sustained VT. Depending on the etiology of heart failure, different preconditions, including ischemia or structural alterations (such as fibrosis) may be prominent. Re-entrant mechanisms around scar tissue, afterdepolarizations, and triggered activity due to changes in calcium metabolism significantly contribute to arrhythmogenesis. The treatment of the underlying disease process and optimal management of heart failure is of major importance. Revascularization, beta-blocker therapy, and angiotensin converting enzyme inhibitors are all essential to appropriate therapy. Treatment of arrhythmias is performed either because patients are symptomatic or to reduce the risk of sudden cardiac death. The implantable cardioverter-defibrillator (ICD) is the best available therapy to prevent sudden cardiac death from VT. Devices with back-up pacing also offer protection against bradyarrhythmias. There is evidence that patients with sustained VT or a history of resuscitation have the best outcome with ICD therapy regardless of the degree of heart failure. Many of these patients require additional antiarrhythmic therapy (e.g. amiodarone) because of atrial fibrillation or non-sustained VT that may activate the device.

Algorithms↗
PubMed2003

A fast-conducting, stochastic integrative mode for neocortical neurons in vivo.

During activated states, neocortical neurons receive intense synaptic background activity that induces large-amplitude membrane potential fluctuations and a strong conductance in the membrane. However, little is known about the integrative properties of neurons during such high-conductance states. Here we investigated the integrative properties of neocortical pyramidal neurons under in vivo conditions simulated by computational models. We show that the presence of high-conductance fluctuations induces a stochastic state in which active dendrites are fast conducting and have a different dynamics of initiation and forward-propagation of Na+-dependent spikes. Synaptic efficacy, quantified as the probability that a synaptic input specifically evokes a somatic spike, was approximately independent of the dendritic location of the synapse. Synaptic inputs evoked precisely timed responses (milliseconds), which also showed a reduced location dependence. This scheme was found to apply to a broad range of kinetics and density distributions of voltage-dependent conductances, as well as to different dendritic morphologies. Synaptic efficacies were, however, modulable by the balance of excitation and inhibition in background activity, for all synapses at once. Thus, models predict that the intense synaptic activity in vivo can confer advantageous computational properties to neocortical neurons: they can be set to an integrative mode that is stochastic, fast conducting, and optimized to process synaptic inputs at high temporal resolution independently of their position in the dendrites. Some of these predictions can be tested experimentally.

Action Potentials↗