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LEAN quality improvement

Cong Ming-Hua, Zou Bao-Hua, Yu Lei
Anorexia cancer cachexia syndrome is prevalent in advanced cancer patients, which is featured by anorexia, decreased dietary intake, body weight loss (skeletal muscle mass loss), and unable to be reversed by routine nutritional support therapy. Up to now, the main mechanisms involved in cancer cachexia include excessive systemic inflammation, which is represented by increased plasma levels of IL-1, IL-6, TNF-alpha, tumor-induced factors, such as PIF and LMF. These factors eventually act on orexigenic and anorexigenic neurons located in hypothalamus or protein and lipid metabolism of peripheral tissues, which lead to anorexia, decreased dietary intake, enhanced basic metabolism rate and hyper catabolism...
October 18, 2016: Current Pharmaceutical Biotechnology
Carl Savage, Louise Parke, Mia von Knorring, Pamela Mazzocato
BACKGROUND: Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. METHODS: We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital...
October 19, 2016: BMC Health Services Research
Jacobo Á Rubio-Arias, Elena Marín-Cascales, Domingo J Ramos-Campo, Alejandro Martínez, Linda H Chung, Pedro E Alcaraz
OBJECTIVE: The purpose of the present systematic review and meta-analysis was to evaluate published, randomized controlled trials that investigated the effects of whole-body vibration training (WBVT) on lean mass in postmenopausal women. METHODS: The following electronic databases were searched from September to October 2015: PubMed, Web of Science, and Cochrane. Two different authors tabulated, independently, the selected indices in identical predetermined forms...
October 3, 2016: Menopause: the Journal of the North American Menopause Society
Renée J Roberts, Ashley E Wilson, Zenaide Quezado
Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign)...
October 3, 2016: Anesthesia and Analgesia
Eik Bjerre, Ditte Marie Bruun, Anders Tolver, Klaus Brasso, Peter Krustrup, Christoffer Johansen, Robin Christensen, Mikael Rørth, Julie Midtgaard
BACKGROUND: Prostate cancer is the most common non-cutaneous malignancy in men. Today most patients may expect to live years following the diagnosis and may thus experience significant morbidity due to disease progression and treatment toxicity. In order to address some of these problems exercise has been suggested and previously studies have shown improvements of disease specific quality of life and a reduction in treatment-related toxicity. Cohort studies with long term follow up have suggested that physical activity is associated with improved survival in prostate cancer patients...
October 3, 2016: BMC Cancer
Andrea Chiarini, Claudio Baccarani
Purpose This paper aims to contribute to the debate concerning total quality management (TQM)-Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls. Design/methodology/approach Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment...
October 3, 2016: Leadership in Health Services
William P Fisher, A Jackson Stenner
Huge resources are invested in metrology and standards in the natural sciences, engineering, and across a wide range of commercial technologies. Significant positive returns of human, social, environmental, and economic value on these investments have been sustained for decades. Proven methods for calibrating test and survey instruments in linear units are readily available, as are data- and theory-based methods for equating those instruments to a shared unit. Using these methods, metrological traceability is obtained in a variety of commercially available elementary and secondary English and Spanish language reading education programs in the U...
October 2016: Measurement: Journal of the International Measurement Confederation
Fonda G Robinson, Larry L Cunningham, Sharon P Turner, John Lindroth, Deborah Ray, Talib Khan, Audrey Yates
The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes...
October 2016: Journal of Dental Education
Arielle M Fisher, Michael Q Ding, Harry Hochheiser, Gerald P Douglas
BACKGROUND: Free and charitable clinics are a critical part of America's healthcare safety net. Although informatics tools have the potential to mitigate many of the organizational and service-related challenges facing these clinics, little research attention has been paid to the workflows and potential impact of electronic systems in these settings. In previous work, we performed a qualitative investigation at a free clinic dispensary to identify workflow challenges that may be alleviated through introduction of informatics interventions...
September 29, 2016: BMC Health Services Research
Rachel Flynn, Shannon D Scott, Thomas Rotter, Dawn Hartfield
AIM: A discussion of how nurses can contribute to and lead improvement science activities in health care. BACKGROUND: Quality failures in health care have led to the urgent need for healthcare quality improvement. However, commonly quality improvement interventions proceed to practice implementation without rigorous methods or sufficient empirical evidence. This lack of evidence for quality improvement has led to the development of improvement science, which embodies quality improvement research and quality improvement practice...
September 28, 2016: Journal of Advanced Nursing
Sandra G Leggat, Richard Gough, Timothy Bartram, Pauline Stanton, Greg J Bamber, Ruth Ballardie, Amrik Sohal
Purpose Hospitals have used process redesign to increase the efficiency of the emergency department (ED) to cope with increasing demand. While there are published studies suggesting a positive outcome, recent reviews have reported that it is difficult to conclude that these approaches are effective as a result of substandard research methodology. The purpose of this paper is to explore the perceptions of hospital staff on the impact of a process redesign initiative on quality of care. Design/methodology/approach A retrospective qualitative case study examining a Lean Six Sigma (LSS) initiative in a large metropolitan hospital from 2009 to 2010...
September 19, 2016: Journal of Health Organization and Management
Aikaterini A Nella, Ashwini Mallappa, Ashley F Perritt, Verena Gounden, Parag Kumar, Ninet Sinaii, Lori-Ann Daley, Alexander Ling, Chia-Ying Liu, Steven J Soldin, Deborah P Merke
CONTEXT: Classic congenital adrenal hyperplasia (CAH) management remains challenging, as supraphysiologic glucocorticoid doses are often needed to optimally suppress the ACTH-driven adrenal androgen overproduction. OBJECTIVE: To approximate physiologic cortisol secretion via continuous subcutaneous hydrocortisone infusion (CSHI) and evaluate the safety and efficacy of CSHI in difficult-to-treat CAH patients. DESIGN: Eight adult patients with classic CAH participated in a single-center open label phase I-II study comparing CSHI to conventional oral glucocorticoid treatment...
September 28, 2016: Journal of Clinical Endocrinology and Metabolism
Khalil Al-Hyari, Sewar Abu Hammour, Mohammad Khair Saleem Abu Zaid, Mohamed Haffar
Purpose The purpose of this paper is to study the effect of the implementation of Lean bundles on hospital performance in private hospitals in Jordan and evaluate how much the size of organization can affect the relationship between Lean bundles implementation and hospital performance. Design/methodology/approach The research is considered as quantitative method (descriptive and hypothesis testing). Three statistical techniques were adopted to analyse the data. Structural equation modeling techniques and multi-group analysis were used to examine the research's hypothesis, and to perform the required statistical analysis of the data from the survey...
October 10, 2016: International Journal of Health Care Quality Assurance
James B Haddow, Maria Walshe, Dinesh Aggarwal, Ankur Thapar, John Hardman, Jonathan Wilson, Ayo Oshowo, Chetan Bhan, Hasan Mukhtar
We aimed to improve the lead-time and the patient experience of the diagnostic stage of the suspected colorectal cancer pathway. This project worked within the constraints of limited resources and an austere environment. The core team included a project manager trained in quality improvement methodologies. Senior and Fleming's planned change model was used as the overall framework. Baseline data supported the case for change and highlighted targets for improvement. A stakeholder workshop employed social movement theory, lean thinking, experience-based design and patient stories to engage influential leaders and secure support and commitment...
September 2016: Healthcare
Timothy J Schultz, Peter Roupas, Richard Wiechula, Debra Krause, Susan Gravier, Anthony Tuckett, Sonia Hines, Alison Kitson
BACKGROUND: Optimizing body composition for healthy aging in the community is a significant challenge. There are a number of potential interventions available for older people to support both weight gain (for those who are underweight) and weight loss (for overweight or obese people). While the benefits of weight gain for underweight people are generally clearly defined, the value of weight loss in overweight or obese people is less clear, particularly for older people. OBJECTIVES: This umbrella review aimed to measure the effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community and to explore theirqualitative perceptions...
August 2016: JBI Database of Systematic Reviews and Implementation Reports
Kris Beattie, Brian P Carson, Mark Lyons, Ian C Kenny
Cycling economy (CE), power at maximal oxygen uptake (WV̇O2max) and anaerobic function (i.e. sprinting ability) are considered to be the best physiological performance indicators in elite road cyclists. In addition to cardiovascular function, these physiological indicators are partly dictated by neuromuscular factors. One technique to improve neuromuscular function in athletes is through strength training. The aim of this study was to investigate the effect of a 20 week maximal- and explosive-strength training intervention on strength (maximal- , explosive-strength & bike-specific explosive-strength), WV̇O2max, CE and body composition (body mass, fat & lean mass) in cyclists...
September 6, 2016: International Journal of Sports Physiology and Performance
I Castres, C Tourny, F Lemaitre, J Coquart
PURPOSE: The aim of this pilot study was to assess the impact of a physical activity program of walking 10,000 steps per day along with monthly dietary counseling on the body composition, biological parameters, resting energy expenditure (REE) and health-related quality of life (HRQoL) of obese individuals. METHODS: Thirty-five obese adults (26 women; age: 39.2 ± 13.4 years, body mass, BM: 104.1 ± 18.7 kg and body mass index, BMI: 38.3 ± 6.6 kg m(-2)) followed a walking program (instructions were provided so that the participants increase their walking distance by 1000 steps each week, until to perform at least 10,000 steps per day) and received qualitative dietary advice (cookbook presenting numerous recipes with low calories and dietary advices was provided) for 6 months...
September 6, 2016: Journal of Endocrinological Investigation
Jennifer L Hefner, Ravi S Tripathi, Erik E Abel, Michelle Farneman, Jason Galloway, Susan D Moffatt-Bruce
BACKGROUND: In 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%. OBJECTIVES: To use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time. METHODS: A multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record...
September 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Mubin I Syed, Kamal Morar, Azim Shaikh, Paul Craig, Omar Khan, Sumeet Patel, Hooman Khabiri
PURPOSE: To report 6-month safety and efficacy results of a pilot study of left gastric artery (LGA) embolization for the treatment of morbid obesity (ie, body mass index [BMI] > 40 kg/m(2)). MATERIALS AND METHODS: Four white patients (three women; average age, 41 y [range, 30-54 y]; mean weight, 259.3 lbs [range, 199-296 lbs]; mean BMI, 42.4 kg/m(2) [range, 40.2-44.9 kg/m(2)]) underwent an LGA embolization procedure with 300-500-µm Bead Block particles via right common femoral or left radial artery approach...
October 2016: Journal of Vascular and Interventional Radiology: JVIR
Patricia A Gabow
The goal of U.S. health care should be good health for every American. This daunting goal will require closing the health care gap in communities with a particular focus on the most vulnerable populations and the safety net institutions that disproportionately serve these communities. This Commentary describes Denver Health's (DH's) two-pronged approach to achieving this goal: (1) creating an integrated system that focuses on the needs of vulnerable populations, and (2) creating an approach for financial viability, quality of care, and employee engagement...
October 2016: Academic Medicine: Journal of the Association of American Medical Colleges
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