Cost of Implementing Complex Community Intervention for Healthier Lifestyle at Five Health Clinics in Malaysia

Mapping Intimacies ◽

10.21203/rs.3.rs-45013/v1 ◽

2020 ◽

Author(s):

NUR HIDAYATI ABDUL HALIM ◽

Nurul Salwana Abu Bakar ◽

Nur Azmiah Zainuddin

Keyword(s):

Steady State ◽

Progress Monitoring ◽

Community Intervention ◽

Behavioural Change ◽

Healthcare Personnel ◽

Anthropometric Measurement ◽

Additional Time ◽

Total Cost ◽

Behaviour Change Counselling ◽

Registration Number

Abstract BackgroundA complex community intervention for behavioural change through the use of behaviour change counselling provided by community health promoters (CHPs) and utilisation of an E-health platform was designed to address an increasing number of obese and overweight women entering pregnancy. This paper describes a cost analysis of this novel intervention.MethodsThe analysis was performed from a provider’s perspective, and calculated in Malaysian ringgit (RM). Included were costs for purchase of clients’ progress monitoring equipment, including anthropometric measurement and information technology (IT) equipment; training and education of the CHPs and other healthcare personnel; and cost of contact between the clients and the providers; excluding costs for intervention planning and resource development; and research costs.ResultsAssuming that the intervention is running at a steady state; utilising existing facilities; and does not require additional time; total cost was RM 445,725.51 and average cost per intervention per person RM 3,073.97. About 50% of the total cost was for the purchase of IT equipment, 17% for the maintenance of the system and the remainder for consumables, emoluments and utilities.ConclusionsFindings of this study suggests that implementation of the intervention requires the provider to invest heavily in IT hardware and maintenance of the E-health platform. However, this analysis is likely an under-estimate of the actual cost as it was conducted from a provider’s perspective only and the intervention was assumed to have matured and running at a steady state; which may not be the case as changes were undertaken during its implementation to allow for maximum outcome.Trial registration number: NMRR-15-2333-28679Date of registration: 22 March 2016

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Optimized Procedure to Schedule Physicians in an Intensive Care Unit: A Case Study

Mathematics ◽

10.3390/math8111976 ◽

2020 ◽

Vol 8 (11) ◽

pp. 1976

Author(s):

Lotfi Hidri ◽

Achraf Gazdar ◽

Mohammed M. Mabkhot

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cost Minimization ◽

Optimal Schedule ◽

Real Life ◽

Real Data ◽

Experimental Tests ◽

Operating Costs ◽

Healthcare Personnel ◽

Total Cost

Hospitals are facing an important financial pressure due to the increasing of the operating costs. Indeed, the growth for the hospitals’ services demand causes a rising in the number of required qualified personnel. Enlarging the personnel number increases dramatically the fixed total cost. Based on some studies, 50% of operating costs in US hospitals are allocated to healthcare personnel. Therefore, reducing these types of costs without damaging the service quality becomes a priority and an obligation. In this context, several studies focused on minimizing the total cost by producing optimal or near optimal schedules for nurses and physicians. In this paper, a real-life physicians scheduling problem with cost minimization is addressed. This problem is encountered in an Intensive Care Unit (ICU) where the current schedule is manually produced. The manual schedule is generating a highly unbalanced load within physicians in addition to a high cost overtime. The manual schedule preparation is a time consuming procedure. The main objective of this work is to propose a procedure that systematically produces an optimal schedule. This optimal schedule minimizes the total overtime within a short time and should satisfies the faced constraints. The studied problem is mathematically formulated as an integer linear program. The constraints are real, hard, and some of them are non-classical ones (compared to the existing literature). The obtained mathematical model is solved using a state-of-the-art software. Experimental tests on real data have shown the performance of the proposed procedure. Indeed, the new optimal schedules reduce the total overtime by up to 69%. In addition, a more balanced workload for physicians is obtained and several physician preferences are now satisfied.

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Sedation Practices for Routine Gastrointestinal Endoscopy: A Systematic Review of Recommendations

10.21203/rs.3.rs-45992/v3 ◽

2020 ◽

Author(s):

Fahima Dossa ◽

Olivia Megetto ◽

Mafo Yakubu ◽

David D.Q. Zhang ◽

Nancy N. Baxter

Keyword(s):

English Language ◽

Gastrointestinal Endoscopy ◽

Blood Pressure Monitoring ◽

Professional Associations ◽

Healthcare Personnel ◽

Supporting Evidence ◽

Level Of Evidence ◽

Moderate Sedation ◽

Registration Number

Abstract Background: Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures. Methods: We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Results: We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations. Conclusions: Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency. Registration Number CRD42019141076

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Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia

Thorax ◽

10.1136/thoraxjnl-2019-213142 ◽

2020 ◽

Vol 75 (4) ◽

pp. 298-305

Author(s):

Catherine Ann Byrnes ◽

Adrian Trenholme ◽

Shirley Lawrence ◽

Harley Aish ◽

Julie Anne Higham ◽

...

Keyword(s):

Community Intervention ◽

Healthcare Access ◽

Respiratory Morbidity ◽

Health Issues ◽

Intervention Programme ◽

Control Intervention ◽

Registration Number ◽

Chest X Ray ◽

Randomised Controlled ◽

Wet Cough

BackgroundHospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge.MethodsThis randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to ‘intervention’ or ‘control’. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22.Findings400 children (203 intervention, 197 control) were enrolled in 2011–2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe.InterpretationWe have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years.Trial registration numberACTRN12610001095055.

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Sedation Practices for Routine Gastrointestinal Endoscopy: A Systematic Review of Recommendations

10.21203/rs.3.rs-45992/v1 ◽

2020 ◽

Author(s):

Fahima Dossa ◽

Olivia Megetto ◽

Mafo Yakubu ◽

David D.Q. Zhang ◽

Nancy N. Baxter

Keyword(s):

English Language ◽

Gastrointestinal Endoscopy ◽

Blood Pressure Monitoring ◽

Professional Associations ◽

Healthcare Personnel ◽

Supporting Evidence ◽

Level Of Evidence ◽

Moderate Sedation ◽

Registration Number

Abstract Background: Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures.Methods: We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded.We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool.Results: We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations.Conclusions: Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.Registration Number: CRD42019141076

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Sedation Practices for Routine Gastrointestinal Endoscopy: A Systematic Review of Recommendations

10.21203/rs.3.rs-45992/v2 ◽

2020 ◽

Author(s):

Fahima Dossa ◽

Olivia Megetto ◽

Mafo Yakubu ◽

David D.Q. Zhang ◽

Nancy N. Baxter

Keyword(s):

English Language ◽

Gastrointestinal Endoscopy ◽

Blood Pressure Monitoring ◽

Professional Associations ◽

Healthcare Personnel ◽

Supporting Evidence ◽

Level Of Evidence ◽

Moderate Sedation ◽

Registration Number

Abstract Background Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures. Methods We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Results We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations. Conclusions Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency. Registration Number CRD42019141076

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Generalization and Analysis of the Lisberger-Sejnowski VOR Model

Neural Computation ◽

10.1162/neco.1995.7.4.735 ◽

1995 ◽

Vol 7 (4) ◽

pp. 735-752 ◽

Cited By ~ 4

Author(s):

Ning Qian

Keyword(s):

Steady State ◽

Purkinje Cell ◽

Time Constant ◽

Transient Behavior ◽

Point Of View ◽

Additional Time ◽

Time Constants ◽

Generalized System ◽

Special Cases ◽

Physiological Tests

Lisberger and Sejnowski (1992) recently proposed a computational model for motor learning in the vestibular-ocular reflex (VOR) system. They showed that the steady-state gain of the system can be modified by changing the ratio of the two time constants along the feedforward and the feedback projections to the Purkinje cell unit in their model VOR network. Here we generalize their model by including two additional time constant variables and two synaptic weight variables, which were set to fixed values in their original model. We derive the stability conditions of the generalized system and thoroughly analyze its steady-state and transient behavior. It is found that the generalized system can display a continuum of behavior with the Lisberger-Sejnowski model and a static model proposed by Miles et al. (1980b) as special cases. Moreover, although mathematically the Lisberger-Sejnowski model requires two precise relationships among its parameters, the model is robust against small perturbations from the physiological point of view. Additional considerations on the gain of smooth pursuit eye movement, which is believed to share the positive feedback loop with the VOR network, suggest that the VOR network should operate in the parameter range favoring the behavior studied by Lisberger and Sejnowski. Under this condition, the steady-state gain of the VOR is found to depend on all four time constants in the network. The time constant of the Purkinje cell unit should be relatively small in order to achieve effective VOR learning through the modifications of the other time constants. Our analysis provides a thorough characterization of the system and could thus be useful for guiding further physiological tests of the model.

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Using the theoretical domains framework and the behavioural change wheel in an overarching synthesis of systematic reviews

BMJ Open ◽

10.1136/bmjopen-2018-024950 ◽

2019 ◽

Vol 9 (6) ◽

pp. e024950 ◽

Cited By ~ 8

Author(s):

Michelle Richardson ◽

Claire Louise Khouja ◽

Katy Sutcliffe ◽

James Thomas

Keyword(s):

Behaviour Change ◽

Systematic Reviews ◽

Behavioural Change ◽

Self Care ◽

Theoretical Domains Framework ◽

Intervention Strategies ◽

Multiple Sources ◽

Minor Ailments ◽

Registration Number ◽

Motivation Model

ObjectiveSynthesis that can filter the evidence from multiple sources to inform the choice of intervention components is highly desirable yet, at present, there are few examples of systematic reviews that explicitly define this type of synthesis using behaviour change frameworks. Here, we demonstrate how using the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW) made it possible to bring together the findings from a series of three interconnected systematic reviews on the self-care of minor ailments (MAs) to inform the choice of intervention components.MethodThe TDF and the capability, opportunity, motivation model of behaviour at the hub of the BCW were used to synthesise the findings from the three reviews, including syntheses of service-user views in interviews (review 1, 20 studies) and surveys (review 2, 13 studies), and evaluations of a range of interventions and services (review 3, 21 studies).ResultsThe TDF and BCW approach provided a systematic, structured and replicable methodology for retrospectively integrating different types of evidence within a series of systematic reviews. Several intervention strategies, grounded in theory and discussed with key stakeholders, were suggested, which can be implemented and tested.ConclusionsThis novel application of the TDF/BCW approach illustrates how it can be used to bring together quantitative and qualitative evidence to better understand self-care behaviour for MAs within a systematic review context. The TDF/BCW approach facilitated exploration of the contradictions and gaps between the separate review syntheses, and supported the identification of possible intervention strategies, grounded in theory. The ongoing development and refinement of this method is supported.PROSPERO registration numberCRD42017071515

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Studies on Water in the Hydration Chamber of a Modified Electron Microscope

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100069715 ◽

1970 ◽

Vol 28 ◽

pp. 544-545

Author(s):

R. C. Moretz ◽

G. G. Hausner ◽

D. F. Parsons

Keyword(s):

Thin Film ◽

Thin Films ◽

Electron Microscope ◽

Steady State ◽

Room Temperature ◽

Small Mass ◽

Equilibrium Pressure ◽

Biological Objects ◽

Mechanical Pump ◽

Differential Pumping

Use of the electron microscope to examine wet objects is possible due to the small mass thickness of the equilibrium pressure of water vapor at room temperature. Previous attempts to examine hydrated biological objects and water itself used a chamber consisting of two small apertures sealed by two thin films. Extensive work in our laboratory showed that such films have an 80% failure rate when wet. Using the principle of differential pumping of the microscope column, we can use open apertures in place of thin film windows.Fig. 1 shows the modified Siemens la specimen chamber with the connections to the water supply and the auxiliary pumping station. A mechanical pump is connected to the vapor supply via a 100μ aperture to maintain steady-state conditions.

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Continuous hydrogenolysis of acetal-stabilized lignin in flow

Green Chemistry ◽

10.1039/d0gc02928a ◽

2021 ◽

Author(s):

Wu Lan ◽

Yuan Peng Du ◽

Songlan Sun ◽

Jean Behaghel de Bueren ◽

Florent Héroguel ◽

...

Keyword(s):

Steady State ◽

Challenges And Opportunities

We performed a steady state high-yielding depolymerization of soluble acetal-stabilized lignin in flow, which offered a window into challenges and opportunities that will be faced when continuously processing this feedstock.

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