RESUMEN
Although in the last years technology innovation in healthcare brought big improvements in care level and patient quality of life, hospital complexity and management cost became higher. For this reason, necessity of planning for medical equipment procurement within hospitals is getting more and more important in order to sustainable provide appropriate technology for both routine activity and innovative procedures. In order to support hospital decision makers for technology procurement planning, an expert model was designed as reported in the following paper. It combines the most widely used approaches for technology evaluation by taking into consideration Health Technology Assessment (HTA) and Medical Equipment Replacement Model (MERM). The designing phases include a first definition of prioritization algorithms, then the weighting process through experts' interviews and a final step for the model validation that included both statistical testing and comparison with real decisions. In conclusion, the designed model was able to provide a semi-automated tool that through the use of multidisciplinary information is able to prioritize different requests of technology acquisition in hospitals. Validation outcomes improved the model accuracy and created different "user profiles" according to the specific needs of decision makers.
Asunto(s)
Hospitales , Tecnología Biomédica , Toma de Decisiones , Atención a la Salud , Estudios de Evaluación como Asunto , Planificación en Salud , Servicios de Salud , Humanos , Invenciones , Mejoramiento de la Calidad , Calidad de Vida , Evaluación de la Tecnología BiomédicaRESUMEN
Clinical activities can be seen as results of precise and defined events' succession where every single phase is characterized by a waiting time which includes working duration and possible delay. Technology makes part of this process. For a proper business continuity management, planning the minimum number of devices according to the working load only is not enough. A risk analysis on the whole process should be carried out in order to define which interventions and extra purchase have to be made. Markov models and reliability engineering approaches can be used for evaluating the possible interventions and to protect the whole system from technology failures. The following paper reports a case study on the application of the proposed integrated model, including risk analysis approach and queuing theory model, for defining the proper number of device which are essential to guarantee medical activity and comply the business continuity management requirements in hospitals.
Asunto(s)
Comercio , Continuidad de la Atención al Paciente , Hospitales , Modelos Teóricos , Equipos y SuministrosRESUMEN
In this paper we present PHARMA 2.0 a telematics integrated system aimed at reducing Adverse Drug Events (ADEs) in the phases of drug prescription, transcription, distribution and administration. The proposed system is grounded on three sub-systems: a CPOE (Computerized Prescription Order Entry), an RFID-based drug container and dispenser and a middleware system. The visualization and management of prescription and administration data are handled through a web application designed to comply with international usability regulation.
Asunto(s)
Prescripciones de Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Integración de Sistemas , Telemedicina , Humanos , Sistemas de Entrada de Órdenes MédicasRESUMEN
Radiation patterns of 2 and 4cm square Dual Concentric Conductor (DCC) microstrip antennas were studied theoretically with Finite Difference Time Domain (FDTD) analysis and compared with experimental measurements of power deposition (SAR) in layered lossy dielectric loads. Single and array configurations were investigated with 915 MHz excitation applied across either one, two or four sides, or four corners of the square apertures. FDTD simulations were carried out for realistic models of a muscle tissue load coupled to the DCC antennas with a 5 mm thick bolus of either distilled water or low loss Silicone Oil. This study characterizes the effect on SAR of adding three additional thin dielectric layers which are necessary for clinical use of the applicator. These layers consist of a 0.1 mm thick dielectric coating on the array surface to provide electrical isolation of DCC apertures, and 0.15 mm thick plastic layers above and below the bolus to contain the liquid. Experimental measurements of SAR in a plane 1 cm deep in muscle phantom agree well with theoretical FDTD simulations in the multi-layered tissue models. These studies reveal significant changes in SAR for applicator configurations involving low dielectric constant (Er) layers on either side of a high Er water bolus layer. Prominent changes include a broadening and centring of the SAR under each aperture as well as increased SAR penetration in muscle. No significant differences are noted between the simple and complete load configurations for the low Er Silicone Oil bolus. Both theoretical and measured data demonstrate relatively uniform SAR distributions with > 50% of maximum SAR extending to the perimeter of single and multi-aperture array configurations of DCC applicators when using a thin 5 mm water or Silicone Oil bolus.
Asunto(s)
Hipertermia Inducida/instrumentación , Electricidad Estática , Modelos Teóricos , Fantasmas de ImagenRESUMEN
A water-cooled electromagnetic (EM) dipole, for intracavitary hyperthermia, embodying a metallic reflector to give directional characteristics to the SAR and then to the heating pattern in the biological tissue, is considered. The influence of the reflector on the SAR deposition has been theoretically modelled with an EM analysis which uses the method of moments (MOM). A thermal model, based on the heat transfer equation, is used to predict temperature distribution, which exhibits a directivity related to the angular extension of the reflector. Experiments have been carried out in a polyacrylamide phantom. The temperature distribution detected with a liquid crystal sheet shows fairly good agreement with theoretical predictions.
Asunto(s)
Hipertermia Inducida/instrumentación , Fenómenos Electromagnéticos/instrumentación , Humanos , Metales , Modelos Estructurales , Modelos Teóricos , TermodinámicaRESUMEN
On the basis of data reported in literature concerning the saprophytic bacterial flora of natural mineral waters bottled in glass or in PVC containers and in view of the results obtained during their own investigations, the AA. consider it impossible to establish a limit to the charge of bacterial flora in agar at 20 degrees C and believe that any possible proposal concerning rules limiting the bacterial charge at 37 degrees C requires more detailed study and preliminary controls. In any case, they propose to apply the strictest vigilance in excluding the presence of any sign whatever of fecal contamination or of potentially pathogenic bacterial types (f.i. P. aeruginosa) in all water samples; they also suggest to require that the performance of comparative tests be extended to the stages preceding bottling. Current experimental investigations reveal that the multiplying process seems to be accelerated and more protracted in time in waters bottled in PVC containers than in those kept in glass containers.