Optimisation of maintenance in delivery systems for cytostatic medicines

Background The real-world application of maintenance in organisations brings together a number of maintenance policies in order to achieve the desired availability, efficiency and profitability. However, the literature mostly chooses a single maintenance policy, and so the decision process is not suited to the real conditions in the company to which it is applied. Our study takes a combination of maintenance policies as alternatives, and so conforms to the actual practice of maintenance in organisations. Furthermore, it introduces the possibility of including extra spare parts, or outsourcing maintenance policies. Although the selection of maintenance policies has been applied to many kinds of business and of machine, there is almost no instance of its application to hospitals, and it has never been applied to delivery systems for cytostatic drugs. Methods The model uses the fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), which is recognised as being highly suitable for solving group decision-making problems in a fuzzy environment. Fuzzy set theory is also considered to be more proficient than crisp numbers for handling the ambiguity, imprecisions, data scarcity, and uncertainty inherent in decisions made by human beings. The judgements required were obtained from a decision group comprising the heads of facilities maintenance, maintenance of medical equipment, health and safety at work, environment, and programming-admission. The group also included care staff; specifically, the heads of the main clinical services, and the medical supervisors. The model includes original criteria, such as Quality of health care, which measures impact on care as a function of mean availability of each alternative. It also considers Impact on hospital management via the criteria: Working environment in the organisation and Impact on health care; the former criterion measures equality among care services in the hospital, while the latter assesses the effect on regional health cover. The model was built using real data obtained from a state hospital in Spain. The model can also be easily applied to other national and international healthcare organisations, providing weights specific to the criteria. These are produced by a decision group from each healthcare organisation and the alternatives are updated in accordance with what is considered important in each hospital. Results The results obtained from the model recommend changing the alternative that is currently in use, Corrective and Preventive Maintenance, to Corrective and Preventive Maintenance plus two spare hoods. This alternative would lead to an availability of 1 (the highest possible) in the systems for preparing personalised cytotoxic drugs, and so the quality of service is therefore very high. Additionally, it could offer services to all the users of the hospital, and also offer cover in the preparation of cytotoxic medicines to other hospitals in the catchment area. Conclusions The results suggest the possibility that improvements to the support and logistical systems, which include maintenance, traditionally held to have no effect on quality of care, may be key to improving care quality, but also in reducing risk to patients, care and non-care staff, and the environment.

Proposal for a new therapeutic high dosage of Pidotimod in children with Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome: a randomized controlled study.

Background. Despite to PFAPA syndrome is considered a benign and self-limited condition in childhood its impact on patients and families can be remarkable in many cases. Currently, the therapeutic options for managing are non-specific and no consensus exists about the best treatment to use. Pidotimod has been suggested as a new potential treatment in PFAPA syndrome for its immunodulatory effects. We conducted a preliminary, prospective, controlled, open, cross-over trial to assess the efficacy and the safety of Pidotimod in the treatment of children with PFAPA syndrome. Methods. 22 children with PFAPA syndrome were randomly allocated to treatment with pidotimod (with 2 vials of 400mg daily) in combination with betamethasone 0.5-1 mg on need, based on parents/caregivers' decision (group A) or betamethasone 0.5-1mg on need, based on parents/caregivers' decision (group B). Each treatment period was for 3 months (Phase 1), after that patients were switched to the other arm for other 3 months (Phase 2). Efficacy was expressed in terms of number of episodes of fever, pharyngitis, or aphthous stomatitis, as well as the additional use of betamethasone on need. Safety and tolerability of the Pidotimod were evaluated on the basis of the number and type of adverse events (AEs) recorded during the treatment.Results. Patients receiving Pidotimod and use betametasone showed a significant decrease in frequency of fevers (p=0.002); number of episodes of pharyngitis (p=0.049); aphthous stomatitis (p=0.036) as well as the betamethasone use on need (p=0.007). Overall, 19/22 (86.4%) showed benefits from Pidotimod administration. The safety profile of Pidotimod was excellent as no serious adverse events have been reported in the treated groups.Conclusions. We firstly showed that high dosage of Pidotimod could be an effective and safe to reduce the PFAPA attacks in children.

Proposal for a new therapeutic high dosage of Pidotimod in children with Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome: an interventional study.

Background. Despite to PFAPA syndrome is considered a benign and self-limited condition in childhood its impact on patients and families can be remarkable in many cases. Currently, the therapeutic options for managing are non-specific and no consensus exists about the best treatment to use. Pidotimod has been suggested as a new potential treatment in PFAPA syndrome for its immunodulatory effects. We conducted a preliminary, prospective, controlled, open, cross-over trial to assess the efficacy and the safety of Pidotimod in the treatment of children with PFAPA syndrome. Methods. 22 children with PFAPA syndrome were randomly allocated to treatment with pidotimod (with 2 vials of 400mg daily) in combination with betamethasone 0.5-1 mg on need, based on parents/caregivers' decision (group A) or betamethasone 0.5-1mg on need, based on parents/caregivers' decision (group B). Each treatment period was for 3 months (Phase 1), after that patients were switched to the other arm for other 3 months (Phase 2). Efficacy was expressed in terms of number of episodes of fever, pharyngitis, or aphthous stomatitis, as well as the additional use of betamethasone on need. Safety and tolerability of the Pidotimod were evaluated on the basis of the number and type of adverse events (AEs) recorded during the treatment.Results. Patients receiving Pidotimod and use betametasone showed a significant decrease in frequency of fevers (p=0.002); number of episodes of pharyngitis (p=0.049); aphthous stomatitis (p=0.036) as well as the betamethasone use on need (p=0.007). Overall, 19/22 (86.4%) showed benefits from Pidotimod administration. The safety profile of Pidotimod was excellent as no serious adverse events have been reported in the treated groups.Conclusions. We firstly showed that high dosage of Pidotimod could be an effective and safe to reduce the PFAPA attacks in children.

Aplikasi Berpikir Kritis dalam Asuhan Keperawatan

ABSTRACTLatar belakang : berfikir merupakan suatu proses yang berjalan secara berkesinambungan mencakup interaksi dari suatu rangkaian pikiran dan persepsi. Berfikir kritis dalam keperawatan merupakan komponen dasar dalam pertanggunggugatan profesional dan kualitas asuhan keperawatan Tujuan : untuk mengetahui cara aplikasi berfikir kris dalam asuhan berfikir kritis Metode : debate, individual decision, group discussion, persuasi, propaganda, coercio, kombinasi beberapa metode. Hasil : berfikir kritis dalam pengkajian,berfikir kritis dalam perumusan diagnostik keperawatan, berfikir kritis dalam merancang intervensi keperawatan, keterampilan berfikir kritis dalam implementasi keperawatan. Pembahasan : berfikir kritis memiliki enam sub-skill yang terdiri dari interpretasi, analisis, kesimpulan, penjelasan, dan regulasi diri. Penutup : berfikir kritis adalah suatu proses berfikir secara sistematik yang penting bagi berfikir kritis adalah berfikir dengan tujuan dan mengarah kesasaran yang membantu individu membuat penilaian berdasarkan kata bukan pikiran. Kata kunci : Berfikir kritis, aplikasi berfikir kritis, asuhan keperawatan.

Do Democracies Possess the Wisdom of Crowds? Decision Group Size, Regime Type, and Strategic Effectiveness

What is it about democracies—if anything—that enables them to avoid war with each other while navigating conflictual international politics in pursuit of their own interests? Recent research in International Studies Quarterly by Brad LeVeck and Neil Narang (2017) provides an elegant new answer to this longstanding question. Drawing on “wisdom of crowds” logic—the insight that a large-enough group of inexpert judges is more likely to average towards an accurate estimate of a continuous variable than a smaller group, even when the smaller group contains relevant experts—supported by experimental evidence, they suggest that democracies’ strategic advantages lie in their large, diverse decision-making communities. If such crowd wisdom equips democracies to accurately assess others’ capabilities and intentions, so the argument goes, then they should be better than alternative regime types at maximizing their own interests while still avoiding the bargaining failure that is resort to war. Unfortunately, however, the politics of democratic foreign policy-making compromise the crowd-wisdom mechanism. This response article thus elucidates key flaws in the argument that crowd wisdom underpins democratic peace, before progressing to explain how the crowd-wisdom insight nonetheless carries important implications—irrespective of regime type—for strategic effectiveness.

A useful diagnostic method to reduce the in-hospital time delay for mechanical thrombectomy: volume perfusion computed tomography with added vessel reconstruction

OBJECTIVEVolume perfusion CT (VPCT) with added CT angiography (CTA)–like reconstruction from VPCT source data (VPCTA) can reveal multiple intracranial parameters. The authors examined the usefulness of VPCTA in terms of reducing the in-hospital time delay for mechanical thrombectomy.METHODSA total of 180 patients who underwent mechanical thrombectomy at the authors’ institution between January 2014 and March 2017 were divided into 2 groups: a CTA-based thrombectomy decision group (group 1: CTA) and a VPCTA-based decision group (group 2: VPCTA). Multiple time interval categories (from symptom onset to groin puncture, from hospital arrival to groin puncture, procedure time, from symptom onset to reperfusion, and from hospital arrival to reperfusion) were reviewed. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale score and the modified Rankin Scale, and radiological results were evaluated by the Thrombolysis in Cerebral Infarction score.RESULTSIn all of the time interval categories except for procedure time, the VPCTA group showed a significantly shorter in-hospital time delay during the prethrombectomy period than did the CTA group. The 3-month modified Rankin Scale score was significantly lower in the VPCTA group (2.8) compared with the CTA group (3.5) (p = 0.003). However, there were no statistically significant differences between the 2 groups in the other clinical and radiological outcomes.CONCLUSIONSCompared with CTA, VPCTA significantly reduced the in-hospital time delay during the prethrombectomy period.

AN INTEGRATED INTELLIGENT SYSTEM FOR CONSTRUCTION INDUSTRY: A CASE STUDY OF RAISED FLOOR MATERIAL

This paper aims to introduce a quantitative method to builders for the most appropriate material selections based on multiple attributes and integrate decision group member opinions throughout bidding process. In this respect, a new model used together with the Analytic Hierarchy Process (AHP) and fuzzy Multi-Objective Optimization on the Basis of Ratio Analysis (MOORA), multi-criteria decision methods are proposed. In a real decision process, there are many uncertainties and ambiguities. In fact decision makers cannot always provide practical guidelines and especially precise judgments due to time limitations. The intelligent model proposed demonstrates that the AHP and fuzzy MOORA approach can not only be used easily to imitate the decision duration in the material selection but also the results obtained from this work provide contractors valuable insight into the material selection problem. At the same time, the quantitative analysis method based on the appropriately raised floor materials along the bidding process enables the builders to use their restricted resources more expeditiously and enhances considerably the possibility of winning agreement, as one of the most striking points deduced from the present study. In short, the model with AHP and fuzzy MOORA approaches can assist the builders to improve resolutions for the bidding.

A Knowledge Discovery Education Framework Targeting the Effective Budget Use and Opinion Explorations in Designing Specific High Cost Product

For an R&D institution to design a specific high investment cost product, the budget is usually ‘large but limited’. To allocate such budget on the directions with key potential benefits (e.g., core technologies) requires, at first and at least, a priority over the involved design criteria, as to discover the relevant decision knowledge for a suitable budgeting plan. Such a problem becomes crucial when the designed product is relevant to the security and military sustainability of a nation, e.g., a next generation fighter. This study presents a science education framework that helps to obtain such knowledge and close the opinion gaps. It involves several main tutorial phases to construct and confirm the set of design criteria, to establish a decision hierarchy, to assess the preferential structures of the decision makers (DMs) (individually or on a group basis), and to perform some decision analyses that are designed to identify the homogeneity and heterogeneity of the opinions in the decision group. The entire framework has been applied in a training course hold in a large R&D institution, while after learning the staff successfully applied these knowledge discovery processes (for planning the budget for the fighter design works and for closing the opinion gaps present). With the staffs’ practical exercises, several empirical findings except for the budgeting priority (e.g., the discrimination between ‘more important criteria’ against the less important ones) are also interesting. For some examples (but not limited to these), it is found that the results from using two measures (statistical correlation vs. geometrical cosine similarity) to identify the opinion gaps are almost identical. It is found that DMs’ considerations under various constructs are sometimes consistent, but often hard to be consistent. It is also found that the two methods (degree of divergence (DoD) vs. number of observed subgroups (NSgs)) that are used to understand the opinions’ diversity under the constructs are different. The proposed education framework meets the recent trend of data-driven decision-making, and the teaching materials are also some updates to science education.