The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery.

Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient's length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.

Impact of skull sutures, spongiform bone distribution, and aging skull conductivities on the EEG forward and inverse problems.

Objective. Source imaging is a principal objective for electroencephalography (EEG), the solutions of which require forward problem (FP) computations characterising the electric potential distribution on the scalp due to known sources. Additionally, the EEG-FP is dependent upon realistic, anatomically correct volume conductors and accurate tissue conductivities, where the skull is particularly important. Skull conductivity, however, deviates according to bone composition and the presence of adult sutures. The presented study therefore analyses the effect the presence of adult sutures and differing bone composition have on the EEG-FP and inverse problem (IP) solutions.Approach. Utilising a well-established head atlas, detailed head models were generated including compact and spongiform bone and adult sutures. The true skull conductivity was considered as inhomogeneous according to spongiform bone proportion and sutures. The EEG-FP and EEG-IP were solved and compared to results employing homogeneous skull models, with varying conductivities and omitting sutures, as well as using a hypothesised aging skull conductivity model.Main results. Significant localised FP errors, with relative error up to 85%, were revealed, particularly evident along suture lines and directly related to the proportion of spongiform bone. This remained evident at various ages. Similar EEG-IP inaccuracies were found, with the largest (maximum 4.14 cm) across suture lines.Significance. It is concluded that modelling the skull as an inhomogeneous layer that varies according to spongiform bone proportion and includes differing suture conductivity is imperative for accurate EEG-FP and source localisation calculations. Their omission can result in significant errors, relevant for EEG research and clinical diagnosis.

Training Healthcare Professionals to Work With People With Intellectual and Developmental Disabilities.

This study assessed 155 healthcare providers, from nine disciplines, who work professionally with people with intellectual and developmental disabilities (IDD). Using a national, web-based survey, respondents rated their experience, comfort, and competence in treating individuals with different disability types and preferred methods of continuing education; respondents also provided suggestions for attracting others to work with the IDD population. Findings revealed that experiences, comfort, and competence were all higher concerning persons with autism spectrum disorder (ASD) and intellectual disability (ID), lower for those with deaf-blindness. Overall, levels of experience exceeded levels of comfort, which in turn exceeded levels of competence. The most helpful venues for continued training involved day-to-day contact with persons with IDD, which also characterized open-ended responses. Research and practical implications are discussed.

Does participant's age impact on tDCS induced fields? Insights from computational simulations.

Objective: Understanding the induced current flow from transcranial direct current stimulation (tDCS) is essential for determining the optimal dose and treatment. Head tissue conductivities play a key role in the resulting electromagnetic fields. However, there exists a complicated relationship between skull conductivity and participant age, that remains unclear. We explored how variations in skull electrical conductivities, particularly as a suggested function of age, affected tDCS induced electric fields.Approach: Simulations were employed to compare tDCS outcomes for different intensities across head atlases of varying age. Three databases were chosen to demonstrate differing variability in skull conductivity with age and how this may affect induced fields. Differences in tDCS electric fields due to proposed age-dependent skull conductivity variation, as well as deviations in grey matter, white matter and scalp, were compared and the most influential tissues determined.Main results: tDCS induced peak electric fields significantly negatively correlated with age, exacerbated by employing proposed age-appropriate skull conductivity (according to all three datasets). Uncertainty in skull conductivity was the most sensitive to changes in peak fields with increasing age. These results were revealed to be directly due to changing skull conductivity, rather than head geometry alone. There was no correlation between tDCS focality and age.Significance: Accurate and individualised head anatomy andin vivoskull conductivity measurements are essential for modelling tDCS induced fields. In particular, age should be taken into account when considering stimulation dose to precisely predict outcomes.

Variation in Reported Human Head Tissue Electrical Conductivity Values.

Electromagnetic source characterisation requires accurate volume conductor models representing head geometry and the electrical conductivity field. Head tissue conductivity is often assumed from previous literature, however, despite extensive research, measurements are inconsistent. A meta-analysis of reported human head electrical conductivity values was therefore conducted to determine significant variation and subsequent influential factors. Of 3121 identified publications spanning three databases, 56 papers were included in data extraction. Conductivity values were categorised according to tissue type, and recorded alongside methodology, measurement condition, current frequency, tissue temperature, participant pathology and age. We found variation in electrical conductivity of the whole-skull, the spongiform layer of the skull, isotropic, perpendicularly- and parallelly-oriented white matter (WM) and the brain-to-skull-conductivity ratio (BSCR) could be significantly attributed to a combination of differences in methodology and demographics. This large variation should be acknowledged, and care should be taken when creating volume conductor models, ideally constructing them on an individual basis, rather than assuming them from the literature. When personalised models are unavailable, it is suggested weighted average means from the current meta-analysis are used. Assigning conductivity as: 0.41 S/m for the scalp, 0.02 S/m for the whole skull, or when better modelled as a three-layer skull 0.048 S/m for the spongiform layer, 0.007 S/m for the inner compact and 0.005 S/m for the outer compact, as well as 1.71 S/m for the CSF, 0.47 S/m for the grey matter, 0.22 S/m for WM and 50.4 for the BSCR.

High delusional ideation is associated with false pictorial memory.

BACKGROUND AND OBJECTIVES: To assess the relationship between false memories and schizotypal experiences in healthy volunteers. Previous research has examined a number of schizotypal dimensions and experiences and found a variety of results. Our aim was to determine the specificity of these associations by giving participants a schizotypy measure which tapped positive, negative and disorganised dimensions (O-LIFE) and another which focused on delusional ideation (PDI). METHODS: A new memory task was used consisting of images of everyday items, separated into categories. At test participants were presented with pictures which had been seen in the study phase, related lures (additional items from the same categories but which were new) and new items which were not from these categories. RESULTS: Positive correlations were found between scores on the positive dimension of schizotypy/delusional ideation and proportion of false memories. Moreover, these participants also had a greater tendency to respond with the highest confidence old response, regardless of the status of the item. No significant correlations were found with the other dimensions of schizotypy. LIMITATIONS: The confidence finding differs somewhat from previous research, which has found more confidence in memory errors and less confidence in correct responses in schizophrenia. It is unclear the reason(s) for this discrepancy. CONCLUSIONS: Increased false memory is associated with the positive dimension of schizotypy and delusional ideation and not the disorganised or negative dimensions. Furthermore, our results suggest that those high in positive schizotypy/delusional ideation require less evidence before they are willing to call an item old.

Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review.

BACKGROUND: Comorbid post-traumatic stress disorder (PTSD) is associated with poorer outcomes of other disorders, but is treatable. Aims To estimate the frequency of clinically undetected PTSD in secondary care. METHOD: A systematic review of studies that screened for PTSD and reported on PTSD documentation in clinical records. Frequency of undetected PTSD was estimated, and reasons for heterogeneity explored. RESULTS: The median proportion of participants with undetected PTSD (29 studies) was 28.6% (interquartile range 18.2-38.6%). There was substantial heterogeneity, with studies conducted in the USA and those with the highest proportions of in-patients and patients with psychotic disorder reporting higher frequencies of undetected PTSD. CONCLUSIONS: Undetected PTSD is common in secondary care, even if the true value is at the lower limit of the estimates reported here. Trials examining the impact of routine screening for PTSD are required to determine whether such programmes should be standard procedure for all mental health services. Declaration of interest None.

Synthesis and hydrolysis studies of a peptide containing the reactive triad of serine proteases with an associated linker to a dye on a solid phase support.

The synthesis of a Tentagel-supported peptide incorporating the reactive triad of serine, histidine and aspartic acid, found within serine protease enzymes, is described.