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LEAN Emergency Medicine

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https://www.readbyqxmd.com/read/28959780/restructuring-hospitalist-work-schedules-to-improve-care-timeliness-and-efficiency
#1
Monika Wells, Evan Coates, Barbara Williams, Craig Blackmore
Background In 2014, we recognised that the pace of admissions frequently exceeded our ability to assign a hospitalist. Long patient wait times occurred at admission, especially for patients arriving in the late afternoon when hospitalist day shifts were ending. Our purpose was to redesign hospitalist schedules, duties and method of distributing admissions to match demand. Design We used administrative data to tabulate Hospital Medicine admission requests by time of day and identified mismatch between volume and capacity with the current staffing model...
2017: BMJ Open Qual
https://www.readbyqxmd.com/read/28913934/the-incidence-of-sarcopenia-among-hospitalized-older-patients-results-from-the-glisten-study
#2
Anna Maria Martone, Lara Bianchi, Pasquale Abete, Giuseppe Bellelli, Mario Bo, Antonio Cherubini, Francesco Corica, Mauro Di Bari, Marcello Maggio, Giovanna Maria Manca, Emanuele Marzetti, Maria Rosaria Rizzo, Andrea Rossi, Stefano Volpato, Francesco Landi
BACKGROUND: New evidence is emerging on the importance of lean body mass during periods of illness and recovery. The preservation of lean body mass during such periods of intense stress impacts both patient and treatment outcomes. However, data concerning the incidence of sarcopenia among older people during hospitalization are scarce. The objective of this study was to evaluate the development of sarcopenia in a sample of hospitalized older subjects. METHODS: We used data of 394 participants from the multicentre Italian Study conducted by the Gruppo Lavoro Italiano Sarcopenia-Trattamento e Nutrizione (GLISTEN) in 12 Acute Care Wards (Internal Medicine and Geriatrics) of University Hospitals across Italy...
September 14, 2017: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/28829007/how-do-doctors-and-nurses-in-emergency-departments-in-hong-kong-view-their-disaster-preparedness-a-cross-sectional-territory-wide-online-survey
#3
Rex P K Lam, Satchit Balsari, Kevin K C Hung, Kai-Hsun Hsiao, L P Leung, Jennifer Leaning
OBJECTIVES: To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness. DESIGN: This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015. Participants The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing...
August 22, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/28375955/using-lean-management-to-reduce-emergency-department-length-of-stay-for-medicine-admissions
#4
Nazima Allaudeen, Anita Vashi, Julia S Breckenridge, Farnoosh Haji-Sheikhi, Sarah Wagner, Keith A Posley, Steven M Asch
BACKGROUND: The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. OBJECTIVE: To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. DESIGN, SETTING, PATIENTS: Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016...
April 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28152741/quality-improvement-strategies-in-medical-oncology-a-qualitative-analysis-from-a-scoping-review
#5
Laavanya Dharmakulaseelan, Simron Singh, Adam E Haynes, Brian M Wong, Matthew C Cheung
203 Background: In 2001, the Institute of Medicine (IOM) outlined imperatives to improve quality of care. Quality improvement (QI) has since become essential to cancer care but barriers still exist to the publication of and participation in QI initiatives, including limited recognition for QI and uncertainty with methodologies. We sought to identify strategies used in QI in scholarly medical oncology literature to provide practical guidance for QI. METHODS: We conducted a scoping review using Arksey and O'Malley's framework...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28065392/mapping-the-process-of-emergency-care-at-a-teaching-hospital-in-ghana
#6
Emily Aaronson, Elizabeth Mort, Samara Soghoian
Emergency Department (ED) overcrowding has become a global concern as the number of countries with formalized emergency care systems has expanded, and the burden of trauma and non-communicable diseases in low and middle-income countries increased. In light of this, the international Emergency Medicine literature has outlined the need for operational projects in low and middle income countries which focus on the process of care. Despite this, there is limited published literature describing these types of projects...
January 3, 2017: Healthcare
https://www.readbyqxmd.com/read/28047234/tu-fg-bra-03-systems-engineering-and-treatment-planning-process-control-in-radiation-medicine
#7
A Kapur
Optimizing Radiation Therapy Process The radiotherapy (RT) process has evolved over the years with innovations in CT and MR simulations, treatment planning, and treatment delivery. Image-Guided Radiotherapy (IGRT) has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body Radiotherapy (SBRT) and Stereotactic Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the simulation/plan/treatment even if the number of treatments per day remains the same...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/27857987/the-comparison-of-the-efficiency-of-traditional-lectures-to-video-supported-lectures-within-the-training-of-the-emergency-medicine-residents
#8
Aydın Sarıhan, Neşe Colak Oray, Birdal Güllüpınar, Sedat Yanturali, Ridvan Atilla, Berna Musal
OBJECTIVES: Recent developments in computer and video technology, multimedia resources enter quickest way possible into medical education and have started to gain popularity. The aim of this study is to evaluate the impact of video-supported lectures on leaning, with comparison to traditional lectures. METHODS: According to lecture techniques, two separate groups; one is the traditional lectures group (TLG) and the other is video-supported lectures group (VSLG), are formed...
September 2016: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27154742/recent-progress-in-genetics-epigenetics-and-metagenomics-unveils-the-pathophysiology-of-human-obesity
#9
REVIEW
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-)
https://www.readbyqxmd.com/read/27094731/effective-management-of-patients-with-acute-ischemic-stroke-based-on-lean-production-on-thrombolytic-flow-optimization
#10
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...
December 2016: Australasian Physical & Engineering Sciences in Medicine
https://www.readbyqxmd.com/read/27090254/32nd-international-austrian-winter-symposium-zell-am-see-the-netherlands-20-23-january-2016
#11
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
https://www.readbyqxmd.com/read/26846233/a-novel-organizational-model-to-face-the-challenge-of-multimorbid-elderly-patients-in-an-internal-medicine-setting-a-case-study-from-parma-hospital-italy
#12
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
https://www.readbyqxmd.com/read/26283017/assessing-ovarian-response-antral-follicle-count-versus-anti-m%C3%A3-llerian-hormone
#13
REVIEW
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
https://www.readbyqxmd.com/read/26128606/mo-b-brb-03-systems-engineering-tools-for-treatment-planning-process-optimization-in-radiation-medicine
#14
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
https://www.readbyqxmd.com/read/25726627/clinical-characteristics-of-obese-patients-with-hypertension-and-chronic-ischemic-heart-disease
#15
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/25661553/obesity-and-coronary-artery-disease-evaluation-and-treatment
#16
REVIEW
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
https://www.readbyqxmd.com/read/25483409/redesigning-an-inpatient-pediatric-service-using-lean-to-improve-throughput-efficiency
#17
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
https://www.readbyqxmd.com/read/25065114/complexity-complicates-lean-lessons-from-seven-emergency-services
#18
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/25065111/implementing-lean-methods-in-the-emergency-department-the-role-of-professions-and-professional-status
#19
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
https://www.readbyqxmd.com/read/24411657/entropy-a-conceptual-approach-to-measuring-situation-level-workload-within-emergency-care-and-its-relationship-to-emergency-department-crowding
#20
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
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