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LEAN Emergency Medicine

Marie Pigeyre, Fereshteh T Yazdi, Yuvreet Kaur, David Meyre
In high-, middle- and low-income countries, the rising prevalence of obesity is the underlying cause of numerous health complications and increased mortality. Being a complex and heritable disorder, obesity results from the interplay between genetic susceptibility, epigenetics, metagenomics and the environment. Attempts at understanding the genetic basis of obesity have identified numerous genes associated with syndromic monogenic, non-syndromic monogenic, oligogenic and polygenic obesity. The genetics of leanness are also considered relevant as it mirrors some of obesity's aetiologies...
June 1, 2016: Clinical Science (1979-)
Zhuoyuan Liang, Lijie Ren, Ting Wang, Huoyou Hu, Weiping Li, Yaping Wang, Dehong Liu, Yi Lie
The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment...
April 19, 2016: Australasian Physical & Engineering Sciences in Medicine
W Langsteger, A Rezaee, W Loidl, H S Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M Beheshti, L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W Langsteger, A Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M Hartenbach, T Beyer, K Herrmann, J Czernin, I Rausch, P Rust, M D DiFranco, M Lassen, A Stadlbauer, M E Mayerhöfer, M Hartenbach, M Hacker, T Beyer, K Binzel, R Magnussen, W Wei, M U Knopp, D C Flanigan, C Kaeding, M V Knopp, A Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A Haug, Wencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas Kluge, C L Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, M V Knopp, M Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, R P Baum, B Knäusl, D Georg, M Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O Langer, M Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, M J Koepp, M-C Asselin, E Pataraia, O Langer, M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M Mitterhauser, L Nics, B Steiner, M Hacker, M Mitterhauser, W Wadsak, A Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver Langer, S Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O Langer, D Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H Mikula, C Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-Hannes, T Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M Mitterhauser, C Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T Filip, S Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W Wadsak, T Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O Langer, P Lam, M Aistleitner, R Eichinger, C Artner, H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W Wadsak, H Kvaternik, R Müller, D Hausberger, C Zink, R M Aigner, U Cossío, M Asensio, A Montes, S Akhtar, Y Te Welscher, R van Nostrum, V Gómez-Vallejo, J Llop, F VandeVyver, T Barclay, N Lippens, M Troch, L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C Pirich, N Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-Weidinger, T Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N Talbot, S Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R Aigner, S Stanzel, F Quehenberger, R M Aigner, A Koljević Marković, Milica Janković, V Miler Jerković, M Paskaš, G Pupić, R Džodić, D Popović, M C Fornito, D Familiari, P Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M Kamínek, W H Thomson, C Lewis, W H Thomson, J O'Brien, G James, A Notghi, H Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M Gabriel, M C Fornito, G Leonardi, W H Thomson, J O'Brien, G James, J Hudzietzová, J Sabol, M Fülöp
A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CTW Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M BeheshtiA2 F18 Choline PET - CT: an accurate diagnostic tool for the detection of parathyroid adenoma?L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W LangstegerA3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinomaA Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M HartenbachA4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRIT Beyer, K Herrmann, J CzerninA5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimationI Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T BeyerA6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viabilityK Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV KnoppA7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapyA Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A HaugA8 QDOSE - comprehensive software solution for internal dose assessmentWencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas KlugeA9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolizationCL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV KnoppA10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentationM Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D GeorgA11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidarM Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O LangerA12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity...
April 2016: EJNMMI Research
Tiziana Meschi, Andrea Ticinesi, Beatrice Prati, Arianna Montali, Antonio Ventura, Antonio Nouvenne, Loris Borghi
Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients...
August 2016: Internal and Emergency Medicine
Richard Fleming, David B Seifer, John L Frattarelli, Jane Ruman
Oocyte number and quality decline with age; however, fertility varies significantly even among women of the same age. Various measures have been developed to predict response to ovarian stimulation and reproductive potential. Evaluation of ovarian reserve can identify patients who may experience poor response or hyper-response to exogenous gonadotrophins and can aid in the personalization of treatment to achieve good response and minimize risks. In recent years, two key methods, antral follicle count (AFC), an ultrasound biomarker of follicle number, and the concentration of serum anti-Müllerian hormone (AMH), a hormone biomarker of follicle number, have emerged as preferred methods for assessing ovarian reserve...
October 2015: Reproductive Biomedicine Online
A Kapur
The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same...
June 2015: Medical Physics
Camelia C Diaconu, Bianca Paraschiv
UNLABELLED: Obesity is a risk factor for arterial hypertension, type 2 diabetes and cardiovascular diseases. Some studies reported an obesity paradox: obese patients with cardiovascular diseases have better prognosis than patients with body mass index BMI <25 kg/m2. The objective of the study was to identify the differences between the clinical characteristics of obese hypertensive patients with chronic ischemic heart disease in comparison with lean hypertensive patients with chronic ischemic heart disease...
October 2014: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
David Garcia-Labbé, Emmeline Ruka, Olivier F Bertrand, Pierre Voisine, Olivier Costerousse, Paul Poirier
With the increasing prevalence of obesity, clinicians are now facing a growing population of patients with specific features of clinical presentation, diagnostic challenges, and interventional, medical, and surgical management. After briefly discussing the effect of obesity on atherosclerotic burden in this review, we will focus on strategies clinicians might use to ensure better outcomes when performing revascularization in obese and severely obese patients. These patients tend to present comorbidities at a younger age, and their anthropometric features might limit the use of traditional cardiovascular risk stratification approaches for ischemic disease...
February 2015: Canadian Journal of Cardiology
Michael J Beck, Kirk Gosik
BACKGROUND: Data suggest that delays in discharges from inpatient units affect hospital throughput and contribute to emergency department crowding. Lean/Six Sigma (LSS) has been shown to improve inefficiencies in other industries. There are no published data on what impact LSS can have on advancing and sustaining earlier patient discharges. OBJECTIVE: Determine the impact LSS has on advancing times of placement of discharge order and patient discharge compared to control...
April 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Pamela Mazzocato, Johan Thor, Ulrika Bäckman, Mats Brommels, Jan Carlsson, Fredrik Jonsson, Magnus Hagmar, Carl Savage
PURPOSE: The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data. DESIGN/METHODOLOGY/APPROACH: A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services' capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery...
2014: Journal of Health Organization and Management
Stephen Timmons, Frank Coffey, Paraskevas Vezyridis
PURPOSE: The purpose of this paper is to examine the implementation of lean methods in an Emergency Department (ED) and the role of the professions in this process. DESIGN/METHODOLOGY/APPROACH: Qualitative, semi-structured interviews with ED staff in a UK NHS hospital. FINDINGS: Lean was met with more engagement and enthusiasm by the professionals than is usually reported in the literature. The main reasons for this were a combination of a national policy, the unique clinical environment and the status of the professional project for doctors in emergency medicine...
2014: Journal of Health Organization and Management
Peter W Crane, Yuan Zhou, Yifan Sun, Li Lin, Sandra M Schneider
BACKGROUND: Emergency department (ED) crowding correlates with patient safety. Difficulties quantifying crowding and providing solutions were highlighted in the recent Institute of Medicine (IOM) report calling for the application of advanced industrial engineering (IE) research techniques to evaluate ED crowding. ED personnel workload is a related concept, with potential reciprocal effects between the two. Collaboration between emergency medicine and IE is needed to address crowding and ED personnel workload...
April 2014: Journal of Emergency Medicine
N W Solomons, M Mazariegos
The observation that disease has an effect on the tissues of the human body is as old as medicine, itself, and was not lost on preliterate and pre-technological societies. Primary changes in the amount, proportions or quality of total body mass, specific organs and specific tissues constitute pathologies; conversely, changes in body composition secondary to and conditioned by diseases are myriad. The classification of most of the associations has been roughly addressed. Nutritional and dietetic therapeutics allows us to intervene to change proportions of fat and lean, while surgery provides some leverage to modify and reconstruct organs and appendages and also to remove excess fat...
December 1996: Asia Pacific Journal of Clinical Nutrition
Asma Javed, Peter J Tebben, Philip R Fischer, Aida N Lteif
As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad as first described in 1992 by the American College of Sports Medicine consisted of disordered eating, amenorrhea, and osteoporosis; the definition was updated in 2007 to include a spectrum of dysfunction related to energy availability, menstrual function, and bone mineral density...
September 2013: Mayo Clinic Proceedings
Lazare Benaroyo
Since the mid 20th century progress in biomedical science has been punctuated by the emergence of bioethics which has fashioned the moral framework of its application to both research and clinical practice. Can we, however, consider the advent of bioethics as a form of progress marking the advances made in biomedical science with an adequate ethical stamp? The argument put forward in this chapter is based on the observation that, far from being a mark of progess, the development of bioethics runs the risk of favouring, like modern science, a dissolution of the links that unite ethics and medicine, and so of depriving the latter of the humanist dimensions that underlie the responsibilities that fall to it...
June 2013: Journal International de Bioéthique, International Journal of Bioethics
Ming-Ling Wu, Jou-Fang Deng, Yi Chen, Wei-Lan Chu, Dong-Zong Hung, Chen-Chang Yang
INTRODUCTION: Ractopamine is a leanness-enhancing agent approved in the United States and 26 other countries to reduce body fat content, increase muscle mass, and improve growth rate of certain food-producing animals. Other β-agonists with stronger pharmacologic effects, especially clenbuterol, had been illegally used as leanness-enhancing agents in the United States, China, and the European Union, and foodborne poisonings related to clenbuterol residue in meat or liver were rarely reported in the European Union and China...
October 2013: American Journal of Emergency Medicine
Nicola Burgess, Zoe Radnor
PURPOSE: The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. DESIGN/METHODOLOGY/APPROACH: Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. FINDINGS: The article identifies divergent approaches to Lean implementation in English hospitals...
2013: International Journal of Health Care Quality Assurance
Georges Bediang, Beat Stoll, Antoine Geissbuhler, Axel M Klohn, Astrid Stuckelberger, Samuel Nko'o, Philippe Chastonay
BACKGROUND: Health science education faces numerous challenges: assimilation of knowledge, management of increasing numbers of learners or changes in educational models and methodologies. With the emergence of e-learning, the use of information and communication technologies (ICT) and Internet to improve teaching and learning in health science training institutions has become a crucial issue for low and middle income countries, including sub-Saharan Africa. In this perspective, the Faculty of Medicine and Biomedical Sciences (FMBS) of Yaoundé has played a pioneering role in Cameroon in making significant efforts to improve students' and lecturers' access to computers and to Internet on its campus...
2013: BMC Medical Education
G Caldwell
Proponents of Lean Philosophy believe that successful businesses must reduce waste in working time and resources to a minimum, and maximise their use in productive work. The productive work of the Acute Medical Unit is to provide effective clinical management to a daily cohort of acutely ill patients. Many Clinicians are cynical about Lean. In this article, Dr Caldwell discusses how many clinicians complain of too much crap in the workplace, which gets in the way of swift, safe high quality clinical care. He argues that "Cutting the Crap" in the Acute Medical Unit is entirely consistent with Lean approaches to management of complex systems...
2012: Acute Medicine
Olga Kostopoulou, J Edward Russo, Greg Keenan, Brendan C Delaney, Abdel Douiri
BACKGROUND: Information distortion suggests that people change the evaluation of new information to support an emerging belief. The present study was designed to measure the extent to which physicians distort incoming medical information to support an emerging diagnosis. DESIGN: Data were collected via an anonymous questionnaire. The experimental group (102 physicians) read 3 patient scenarios, each with 2 competing diagnoses. Physicians first read information that favored 1 of the 2 diagnoses (the "steer")...
November 2012: Medical Decision Making: An International Journal of the Society for Medical Decision Making
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