The Mandated Publication of Individual Hospital Charge Description Masters Does Not Permit the Estimation of Complex Procedure Charges

Thresholding algorithms segment an image into two parts (foreground and background) by producing a binary version of our initial input. It is a complex procedure (due to the distinctive characteristics of each image) which often constitutes the initial step of other image processing or computer vision applications. Global techniques calculate a single threshold for the whole image while local techniques calculate a different threshold for each pixel based on specific attributes of its local area. In some of our previous work, we introduced some specific fuzzy inclusion and entropy measures which we efficiently managed to use on both global and local thresholding. The general method which we presented was an open and adaptable procedure, it was free of sensitivity or bias parameters and it involved image classification, mathematical functions, a fuzzy symmetrical triangular number and some criteria of choosing between two possible thresholds. Here, we continue this research and try to avoid all these by automatically connecting our measures with the wanted threshold using some Artificial Neural Network (ANN). Using an ANN in image segmentation is not uncommon especially in the domain of medical images. However, our proposition involves the use of an Adaptive Neuro-Fuzzy Inference System (ANFIS) which means that all we need is a proper database. It is a simple and immediate method which could provide researchers with an alternative approach to the thresholding problem considering that they probably have at their disposal some appropriate and specialized data.

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Alcohol septal ablation through a bare metal stent after rotative atherectomy: a complex procedure

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2012.04.001 ◽

2012 ◽

Vol 13 (4) ◽

pp. 249-252

Author(s):

Nicolas Combaret ◽

Géraud Souteyrand ◽

Pascal Motreff ◽

Jean René Lusson

Keyword(s):

Bare Metal Stent ◽

Bare Metal ◽

Metal Stent ◽

Alcohol Septal Ablation ◽

Complex Procedure

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Lung involvement in systemic sclerosis is associated with adverse hospital outcomes: insights from the National Inpatient Sample

Journal of Investigative Medicine ◽

10.1136/jim-2020-001743 ◽

2021 ◽

pp. jim-2020-001743

Author(s):

Jesse Osemudiamen Odion ◽

Armaan Guraya ◽

Chukwudi Charles Modijeje ◽

Osahon Nekpen Idolor ◽

Eseosa Jennifer Sanwo ◽

...

Keyword(s):

Systemic Sclerosis ◽

Hospital Charge ◽

Hospital Length Of Stay ◽

Lung Involvement ◽

National Inpatient Sample ◽

Inpatient Mortality ◽

Total Hospital ◽

Total Hospital Charge ◽

Icd 10 ◽

Secondary Outcomes

This study aimed to compare outcomes of systemic sclerosis (SSc) hospitalizations with and without lung involvement. The primary outcome was inpatient mortality while secondary outcomes were hospital length of stay (LOS) and total hospital charge. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. This database is the largest collection of inpatient hospitalization data in the USA. The NIS was searched for SSc hospitalizations with and without lung involvement as principal or secondary diagnosis using International Classification of Diseases 10th Revision (ICD-10) codes. SSc hospitalizations for patients aged ≥18 years from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for possible confounders for the primary and secondary outcomes, respectively. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 62,930 hospitalizations were for adult patients who had either a principal or secondary ICD-10 code for SSc. 5095 (8.10%) of these hospitalizations had lung involvement. Lung involvement group had greater inpatient mortality (9.04% vs 4.36%, adjusted OR 2.09, 95% CI 1.61 to 2.73, p<0.0001), increase in mean adjusted LOS of 1.81 days (95% CI 0.98 to 2.64, p<0.0001), and increase in mean adjusted total hospital charge of $31,807 (95% CI 14,779 to 48,834, p<0.0001), compared with those without lung involvement. Hospitalizations for SSc with lung involvement have increased inpatient mortality, LOS and total hospital charge compared with those without lung involvement. Collaboration between the pulmonologist and the rheumatologist is important in optimizing outcomes of SSc hospitalizations with lung involvement.

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Medical dispatchers’ perception of the interaction with the caller during emergency calls - a qualitative study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00860-y ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Thea Palsgaard Møller ◽

Hejdi Gamst Jensen ◽

Søren Viereck ◽

Freddy Lippert ◽

Doris Østergaaard

Keyword(s):

Public Awareness ◽

Emergency Call ◽

Awareness Campaigns ◽

Emergency Calls ◽

Modifiable Factors ◽

Qualitative Interview Study ◽

Call Process ◽

Complex Procedure ◽

Call Handling ◽

Emergency Medical Dispatchers

Abstract Background Medical dispatching is a highly complex procedure and has an impact upon patient outcome. It includes call-taking and triage, prioritization of resources and the provision of guidance and instructions to callers. Whilst emergency medical dispatchers play a key role in the process, their perception of the process is rarely reported. We explored medical dispatchers’ perception of the interaction with the caller during emergency calls. Secondly, we aimed to develop a model for emergency call handling based on these findings. Methods To provide an in-depth understanding of the dispatching process, an explorative qualitative interview study was designed. A grounded theory design and thematic analysis were applied. Results A total of 5 paramedics and 6 registered nurses were interviewed. The emerging themes derived from dispatchers’ perception of the emergency call process were related to both the callers and the medical dispatchers themselves, from which four and three themes were identified, respectively. Dispatchers reported that for callers, the motive for calling, the situation, the perception and presentation of the problem was influencing factors. For the dispatchers the expertise, teamwork and organization influenced the process. Based on the medical dispatchers´ perception, a model of the workflow and interaction between the caller and the dispatcher was developed based on themes related to the caller and the dispatcher. Conclusions According to medical dispatchers, the callers seem to lack knowledge about best utilization of the emergency number and the medical dispatching process, which can be improved by public awareness campaigns and incorporating information into first aid courses. For medical dispatchers the most potent modifiable factors were based upon the continuous professional development of the medical dispatchers and the system that supports them. The model of call handling underlines the complexity of medical dispatching that embraces the context of the call beyond clinical presentation of the problem.

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Shared burdens: The General Average adjustment of the Jan Maria

International Journal of Maritime History ◽

10.1177/08438714211013585 ◽

2021 ◽

Vol 33 (2) ◽

pp. 322-343

Author(s):

Sabine C P J Go

Keyword(s):

Risk Management ◽

Business Environment ◽

Coping Mechanisms ◽

Small Scale ◽

Marine Insurance ◽

Financial Innovations ◽

Complex Procedure ◽

General Average ◽

The Baltic

The Jan Maria was a Dutch schooner that, in 1883, en route from the Baltic to its home port, was forced to jettison cargo during a fierce storm, which resulted in a General Average (GA) procedure. GA refers to a method that redistributes damages that were deliberately inflicted by the master, in order to save the ship and its cargo, among all those parties that benefited from the action. The report of this procedure of the Jan Maria has been preserved and is exceptional in its completeness. It offers a unique view on a complex procedure and also on the coping mechanisms of small-scale entrepreneurs in a volatile business environment. In this article, I will explain the principle and functioning of GA, and I will argue that, in spite of financial innovations like marine insurance, GA remained an important part of risk management.

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An update on the epidemiology, length of stay, and cost of Kawasaki disease hospitalisation in the United States

Cardiology in the Young ◽

10.1017/s1047951119000982 ◽

2019 ◽

Vol 29 (06) ◽

pp. 828-832 ◽

Cited By ~ 2

Author(s):

Laxmi V. Ghimire ◽

Fu-Sheng Chou ◽

Narayan B. Mahotra ◽

Sharan P. Sharma

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Length Of Stay ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Developed Countries ◽

The United States ◽

Hospital Charge ◽

Acquired Heart Disease ◽

The Developed Countries

AbstractBackground:Kawasaki disease is an acute vasculitis of childhood and is the leading cause of acquired heart disease in the developed countries.Methods:Data from hospital discharge records were obtained from the National Kids Inpatient Database for years 2009 and 2012. Hospitalisations by months, hospital regions, timing of admission, insurance types, and ethnicity were analysed. Length of stay and total charges were also analysed.Results:There were 10,486 cases of Kawasaki disease from 12,678,005 children hospitalisation. Kawasaki disease was more common between 0 and 5 years old, in male, and in Asian. The January–March quarter had the highest rate compared to the lowest in the July–September quarter (OR=1.62, p < 0.001). Admissions on the weekend had longer length of stay [4.1 days (95 % CI: 3.97–4.31)] as compared to admissions on a weekday [3.72 days (95 % CI: 3.64–3.80), p < 0.001]. Blacks had the longest length of stay and whites had the shortest [4.33 days (95 % CI: 4.12–4.54 days) versus 3.60 days (95 % CI: 3.48–3.72 days), p < 0.001]. Coronary artery aneurysm was identified in 2.7 % of all patients with Kawasaki disease. Children with coronary artery aneurysm were hospitalised longer and had higher hospital charge. Age, admission during weekend, and the presence of coronary artery aneurysm had significant effect on the length of stay.Conclusions:This report provides the most updated epidemiological information on Kawasaki disease hospitalisation. Age, admissions during weekend, and the presence of coronary artery aneurysm are significant contributors to the length of stay.

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Abstract TP252: Using Hospital Door-to-Needle Times to Individualize Hospital Bypass Times in Order to Minimize Regional Onset-to-Needle Times

Stroke ◽

10.1161/str.47.suppl_1.tp252 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Jin-Moo Lee ◽

Andria Ford ◽

Jo-Ann Burns ◽

Peter Panagos

Keyword(s):

Patient Outcomes ◽

Treatment Options ◽

Stroke Care ◽

Smartphone Application ◽

System Level ◽

Acute Stroke Care ◽

Web Based ◽

Arrival Times ◽

Get With The Guidelines ◽

Individual Hospital

Introduction: With enhanced treatment options but limited resources, acute stroke care is becoming regionalized. Regional pre-hospital triage plans are being developed to permit bypass of certain hospitals in order to deliver patients to hospitals with higher-level resources for advanced treatment options. One of the most contentious issues in these plans is the “bypass time”_time allowed for EMS to bypass one hospital in order to transport to a hospital with presumed higher level stroke care. Hypothesis: Incorporating transport times and individual hospital door-to-needle times (DNTs) into regional pre-hospital triage bypass plans will expedite regional treatment times which may lead to improved patient outcomes at the system level. Methods: To minimize onset-to-needle times (ONTs), it is essential not only to find the fastest route to the nearest capable hospital, but to find the nearest capable hospital with the shortest DNTs. We examined specific time components comprising ONT, including Onset-to-Arrival times (OATs) and DNTs using Get-with-the-Guidelines data (GWTG), comparing the hospital with fastest DTN times (Hospital A) with that of the average in the St. Louis metropolitan area. Results: Hospital A had a mean DNT that was 20 min faster than the average St. Louis DNT (31 min vs. 51 min, p<.0.001), while OATs were not different. This 20 min advantage might be translated into a longer bypass time specifically for hospital A, to provide equivalent or faster ONTs for patients in the region. Conclusion: The incorporation of hospital DNTs into regional pre-hospital triage plans can individualize bypass times for each hospital. This practice may accelerate treatment times throughout a region, and could be trialed with the aid of web-based smartphone application that could provide EMS with important information that could minimize both transport times and DNTs.

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Lithography-Based Ceramic Manufacturing (LCM) for Dental Applications

Materials Science Forum ◽

10.4028/www.scientific.net/msf.939.95 ◽

2018 ◽

Vol 939 ◽

pp. 95-103 ◽

Cited By ~ 1

Author(s):

Malte Hartmann ◽

Markus Pfaffinger ◽

Jürgen Stampfl

Keyword(s):

Light Exposure ◽

Biaxial Bending ◽

Bending Tests ◽

Manufacturing Method ◽

Processing Step ◽

Complex Procedure ◽

Ceramic Manufacturing ◽

Dental Applications ◽

Ceramic Restorations

Dental applications like crowns, veneers or bridges require high accuracy to be fitted on the patient’s stump. Stereolithography is an additive manufacturing method, which offers high precision by using light exposure as the layer generating mechanism. In the LCM process, this precision is combined with a thermal post-processing step to achieve full ceramic restorations. The overall production of such ceramic parts in a reproducible way is a highly complex procedure. The first requirement is to find a slurry formulation, which is stable against sedimentation and segregation, that is also processable in a stereolithographic system. Such a formulation has been found by us, which could be shown by rheology measurements. During experiments with this formulation, it could be observed that there is a correlation between wet film thickness and resolution. Several adjustments to the machine have been made, to fully control this parameter. Namely, changes to the vat, the doctor blade and the building platform have been made. The improvement of the process and the quality of the final parts are validated by fabricating Siemens stars and by biaxial bending tests.

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A review of the complexity adjustment in the Korean Diagnosis-Related Group (KDRG)

Health Information Management Journal ◽

10.1177/1833358318795804 ◽

2018 ◽

Vol 49 (1) ◽

pp. 62-68 ◽

Cited By ~ 1

Author(s):

Sujeong Kim ◽

Chaiyoung Jung ◽

Junheum Yon ◽

Hyeonseon Park ◽

Hunsik Yang ◽

...

Keyword(s):

Diagnosis Related Groups ◽

Claim Data ◽

Hospital Charge ◽

Diagnosis Related Group ◽

Cost Data ◽

Hospital Charges ◽

Average Charge ◽

Average Hospital ◽

Adjustment Mechanism ◽

Related Group

Background: The Korean Diagnosis-Related Groups (KDRG) was revised in 2003, modifying the complexity adjustment mechanism of the Australian Refined Diagnosis-Related Groups (AR-DRGs). In 2014, the Complication and Comorbidity Level (CCL) of the existing AR-DRG system was found to have very little correlation with cost. Objective: Based on the Australian experience, the CCL for KDRG version 3.4 was reviewed. Method: Inpatient claim data for 2011 were used in this study. About 5,731,551 episodes, which had one or no complication and comorbidity (CC) and met the inclusion criteria, were selected. The differences of average hospital charges by the CCL were analysed in each Adjacent Diagnosis-Related Group (ADRG) using analysis of variance followed by Duncan’s test. The patterns of differences were presented with R 2 in three patterns: The CCL reflected the complexity well (VALID); the average charge of CCL 2, 3, 4 was greater than CCL 0 (PARTIALLY VALID); the CCL did not reflect the complexity (NOT VALID). Results: A total of 114 (19.03%), 190 (31.72%) and 295 (49.25%) ADRGs were included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R 2 for hospital charge of CCL was 4.94%. The average R 2 in VALID, PARTIALLY VALID and NOT VALID was 4.54%, 5.21%, and 4.93%, respectively. Conclusion: The CCL, the first step of complexity adjustment using secondary diagnoses, exhibited low performance. If highly accurate coding data and cost data become available, the performance of secondary diagnosis as a variable to reflect the case complexity should be re-evaluated. Implications: Lack of reviewing the complexity adjustment mechanism of the KDRG since 2003 has resulted in outdated CC lists and levels that no longer reflect the current Korean healthcare system. Reliable cost data (vs. charge) and accurate coding are essential for accuracy of reimbursement.

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The Role and Place of Accounting Information in the Decision-Making System

International conference KNOWLEDGE-BASED ORGANIZATION ◽

10.2478/kbo-2019-0055 ◽

2019 ◽

Vol 25 (2) ◽

pp. 46-51

Author(s):

Sebastian Floştoiu

Keyword(s):

Decision Making ◽

Information System ◽

Accounting Information ◽

Accurate Information ◽

Important Place ◽

Complex Procedure ◽

Decision Making System ◽

Degree Of Certainty ◽

The Subject ◽

And Performance

Abstract The results and performance of an enterprise are the result of the decisions taken by the management of the entity, decisions which are the result of a complex procedure of processing and analyzing the relevant data and information provided by the information system available. In other words, appropriate and correct decisions that lead to the achievement of the objectives and attainment of higher performances are dependent on the quality and quantity of the information. Consequently, accurate information generates correct decisions. Due to of its qualities (relevance, intelligibility, credibility and comparability), accounting information occupies a very important place in the architecture of the economic information system, having the highest degree of certainty and providing the possibility of an accurate representation of economic phenomena and processes, both at micro, as well as at macroeconomic levels. Hence, we can say that the “final outcome of accounting”, namely accounting information, is one of the most important pillars of the elaboration, substantiation and decision-making process. Starting from this premise, this article aims to capture the main features of accounting information, which qualifies it as the object and the subject of the management system.

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