OPERATIONS THROUGHPUT AS A DETERMINANT OF GOLDEN-HOUR IN MASS-GATHERING MEDICINE

BACKGROUNDGolden-hour, a time-tested concept for trauma-care, involves a systems approach encompassing healthcare, logistics, geographical, environmental and temporal variables. Golden-hour paradigm in mass-gathering-medicine such as the Hajj-pilgrimage entwines along healthcare availability, accessibility, efficiency and interoperability; expanding from the patient-centric to public-health centric approach. The realm of mass-gathering-medicine invokes an opportunity for incorporating operations-throughput as a determinant of golden-hour for overall capacity-building and interoperability.METHODSGolden-hour was evaluated during the Indian-Medical-Mission operations for Hajj-2016; which established, operated and coordinated a strategic network of round-the-clock medical operations. Throughput was evaluated as deliverables/time, against established Standard-Operating-Procedures for various clinical, investigation, drug-dispensing and patient-transfer algorithms. Patient encounter-time, waiting-time, turnaround-time were assessed throughout echeloned healthcare under a patient-centric healthcare-delivery model. Dynamic evaluation was carried out to cater for variation and heterogeneity.RESULTSMassive surge of 3,94,013 patients comprising 2,25,103 males (57.1%) and 1,68,910 females (42.9%) overwhelmed the throughput capacities of outpatient attendance, pharmacy, laboratory, imaging, ambulance, referrals and documentation. There was delay in attendance, suspicion, diagnosis and isolation of patients with communicable infections. The situational-analysis of operations-throughput highlights wasted turnaround-time due to mobilization of medical-team, diverting critical healthcare resources away from emergency situations.CONCLUSIONTime being a crucial factor in the complexity of medical-care, operations-throughput remains an important determinant towards interoperability of bottlenecks, thereby being a determinant of golden-hour in mass-gathering-medicine. Early transportation of patient to definitive-care reduces treatment initiation-time, notwithstanding logistics of communication, evacuation, terrain and weather being deterministic in outcome. Golden-hour needs to be emphasized under a population-based approach targeting the clientele towards administering first-aid and reaching out to hospital within the golden-hour.

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Mass Gathering Medicine Tabletop Game - A Systems Approach to a Major Planned Event, Health Services Planning

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17003880 ◽

2017 ◽

Vol 32 (S1) ◽

pp. S140

Author(s):

Adam Lund ◽

Sheila Turris ◽

Kerrie Lewis

Keyword(s):

Health Services ◽

Systems Approach ◽

Mass Gathering ◽

Health Services Planning ◽

Mass Gathering Medicine

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Policy for increasing feeder stock of Bali cattle (Bos javonicus domesticus) in Kupang District

Journal of Animal Science and Veterinary Medicine ◽

10.31248/jasvm2020.242 ◽

2020 ◽

Vol 5 (6) ◽

pp. 235-248

Author(s):

Maria Krova ◽

◽

M. F. Lalus ◽

Markus M. Kleden ◽

◽

...

Keyword(s):

Systems Approach ◽

Population Based ◽

Supply Management ◽

Stock Management ◽

Contributing Factors ◽

Policy Interventions ◽

Innovation And Technology ◽

Calving Rate ◽

Bali Cattle ◽

The Difference

The scarcity of feeder stock of Bali cattle (Bos javonicus domesticus) in Kupang Regency is currently increasing. One of the contributing factors is the difference in management between the fattening business that produces beef cattle and the breeding business that produces feeders and heifers. The research aims to determine: the interaction between actors to increase the supply of feeder; the behavior of feeder population based on actual stock management, and the necessary policy interventions to increase the supply of feeder. The research was conducted by applying a dynamics systems approach. This modelling used ventana systems software. Data and mental models were collected through observation, focus group discussions, and in-depth interviews with key informants. The results showed that the interaction between actors was limited to the marketing of cattle for both local and domestic markets. The actual feeders supply management shows that cattle population tends to decline due to low calving rate (70%), high calves mortality (35%), and the high slaughtering of productive females (80%). The necessary policy interventions are to implement various efforts to increase the calving rate to be 80%, reduce the mortality rate by applying 2% feed supplementation, and reduce the sales of productive females to be 50%. The actual supply management of Bali feeders needs to be engineered by increasing stakeholder services that coordinate synergistically for learning innovation and technology. It is necessary to establish a breeder cooperative to suppress the sale of productive cows as the cause of its high slaughtering

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Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj medical mission in mass-gathering medicine

Journal of Infection and Public Health ◽

10.1016/j.jiph.2017.06.004 ◽

2018 ◽

Vol 11 (2) ◽

pp. 165-170 ◽

Cited By ~ 21

Author(s):

Inam D. Khan ◽

Shahbaz A. Khan ◽

Bushra Asima ◽

Syed B. Hussaini ◽

M. Zakiuddin ◽

...

Keyword(s):

Morbidity And Mortality ◽

Mass Gathering ◽

Medical Mission ◽

Mass Gathering Medicine

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FDA oversight of NSIGHT genomic research: the need for an integrated systems approach to regulation

10.1101/19001370 ◽

2019 ◽

Author(s):

Laura V. Milko ◽

Flavia Chen ◽

Kee Chan ◽

Amy M. Brower ◽

Pankaj B. Agrawal ◽

...

Keyword(s):

Clinical Research ◽

Systems Approach ◽

Genomic Sequence ◽

Clinical Investigation ◽

Risk Assessments ◽

Genomic Research ◽

Institutional Review Boards ◽

Sequence Information ◽

Genomic Technologies ◽

Challenges And Opportunities

ABSTRACTThe National Institutes of Health (NIH) funded the Newborn Sequencing In Genomic medicine and public HealTh (NSIGHT) Consortium to investigate the implications, challenges and opportunities associated with the possible use of genomic sequence information in the newborn period. Following announcement of the NSIGHT awardees in 2013, the Food and Drug Administration (FDA) contacted investigators and requested that pre-submissions to investigational device exemptions (IDE) be submitted for the use of genomic sequencing under Title 21 of the Code of Federal Regulations (21 CFR) part 812. IDE regulation permits clinical investigation of medical devices that have not been approved by the FDA. To our knowledge, this marked the first time the FDA determined that NIH-funded clinical genomic research projects are subject to IDE regulation. Here we review the history of and rationale behind FDA oversight of clinical research and the NSIGHT Consortium’s experiences in navigating the IDE process. Overall, NSIGHT investigators found that FDA’s application of existing IDE regulations and medical device definitions aligned imprecisely with the aims of publicly funded exploratory clinical research protocols. IDE risk assessments by the FDA were similar to, but distinct from, protocol risk assessments conducted by local Institutional Review Boards (IRBs), and had the potential to reflect novel oversight of emerging genomic technologies. However, the pre-IDE and IDE process delayed the start of NSIGHT research studies by an average of 10 months, and significantly limited the scope of investigation in two of the four NIH approved projects. Based on the experience of the NSIGHT Consortium, we conclude that policies and practices governing the development and use of novel genomic technologies in clinical research urgently need clarification in order to mitigate potentially conflicting or redundant oversight by IRBs, NIH, FDA, and state authorities.

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Embracing Healthcare Delivery Challenges during a Pandemic. Review from a nodal designated COVID-19 center in Qatar

Avicenna ◽

10.5339/avi.2021.8 ◽

2021 ◽

Vol 2021 (2) ◽

Author(s):

Manish Barman ◽

Tanweer Hussain ◽

Hatem Abuswiril ◽

Memon Noor Illahi ◽

Muhammad Sharif ◽

...

Keyword(s):

Economies Of Scale ◽

Patient Flow ◽

Healthcare Delivery ◽

Developed Countries ◽

Population Based ◽

System Capacity ◽

Complex Situation ◽

Healthcare Waste ◽

Work Arrangements ◽

Trade Offs

Hospitals and healthcare systems are instrumental in the formulation and delivery of a coordinated response to disaster management especially epidemics. In healthcare policy and strategy formation, there are only trade-offs, which with uncertainty are akin to gambles. National organizations play a key role in pandemics through the expression of physician motivation. Effective strategies can facilitate physician action through economies of scale that lower the costs for physicians to meet both community and patients' needs. Moreover, no matter how well clinicians are motivated and positioned to act, their collective actions are likely to fall short without complementary systems for population-based care that require the operational support of an organization. This review of institutional policy implementation and frameworks intends to highlight how a nodal-designated COVID-19 center in Qatar managed to control the menace by altering its procedural sets and work arrangements to augment an integrated, intrinsic response to a briskly emerging, conceivably complex situation. This outcome was achieved under the guidance of a national leadership team, effectively adapted to its specific challenges by building on current medical evidence, management routines, proficiencies, and health system capacity. This ambitious drive started with the cohesion of services and implementation of evidence-based protocols by assigning a physician-led team to research, strategize and organize improved patient flow and information by arranging analytical compliance and preparedness. Through these service approaches and ongoing efforts, HMGH has realized significant outcome improvements, such as increasing capacity building, reducing healthcare waste, and increasing patient satisfaction rates whilst successfully achieving significantly lower COVID-19 mortality both in terms of absolute numbers and as percent population compared to many developed countries in the world. The strategies outlined in this article might not be all-inclusive or fit other healthcare system models, but they generate a veritable interest to pursue and be subjected to further rigorous study.

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Ambient Intelligence for Patient-Centric Healthcare Delivery: Technologies, Framework, and Applications

Lecture Notes in Networks and Systems - Design Frameworks for Wireless Networks ◽

10.1007/978-981-13-9574-1_10 ◽

2019 ◽

pp. 223-254

Author(s):

G. S. Karthick ◽

P. B. Pankajavalli

Keyword(s):

Ambient Intelligence ◽

Healthcare Delivery ◽

Patient Centric

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An Automated Method for Differential Blood Counting Using Microscope Color Image of Isolated WBC

International Journal of E-Health and Medical Communications ◽

10.4018/jehmc.2010100103 ◽

2010 ◽

Vol 1 (4) ◽

pp. 35-48

Author(s):

Anant R. Koppar ◽

Venugopalachar Sridhar

Keyword(s):

Blood Cells ◽

Human Error ◽

Color Image ◽

White Blood Cells ◽

Healthcare Delivery ◽

Cost Effective ◽

Turnaround Time ◽

Differential Count ◽

Flow Process ◽

Automated Method

Healthcare Delivery Systems are becoming overloaded in developed and developing countries. It is imperative that more efficient and cost effective processes be employed by innovative applications of technology in the delivery system. One such process in Haematology that needs attention is “Generation of report on the Differential Count of Blood”. Most rural centers in India still employ traditional, manual processes to identify and count White Blood Cells under a microscope. This traditional method of manually counting the white blood cells is prone to human error and time consuming. Medical Imaging with innovative application of algorithms can be used for recognizing and analyzing the images from blood smears to provide an efficient alternative for differential counting and reporting. In this regard, the objective of this paper is to provide a simple and pragmatic software system built on innovative yet simple imaging algorithms for achieving better efficiency and accuracy of results. The resulting work-flow process has enabled truly practical tele-pathology by enabling e-collaboration between lesser skilled technicians and more skilled experts, which cuts down the total turnaround time for differential count reporting from days to minutes. The system can be extended to detect malarial parasites in blood and also cancerous cells.

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