Adopting Lean Management in Quality of Services, Cost Containment, and Time Management.

OBJECTIVES: This study aims to identify the role of adopting lean management in the quality of service, cost containment, and time management and to identify factors affecting lean management adoption, quality of service, cost containment, and time management in oncology settings. METHODS: A cross-sectional design was adopted in this study at the King Hussein Cancer Center (KHCC), a private institution in Amman, Jordan. A convenience sampling technique was used to select 360 participants. A self-administered questionnaire (58 items) was used to collect the data.  Results: The mean value for the quality of services was 3.84±0.56. These values for adoption of lean, time management, and cost containment were 3.82±0.74, 3.73±0.75, and 3.40±0.76 respectively. The results showed that the impacts of lean management adoption on the quality of service, cost containment, and time management were significant (p-value<0.001). The results showed substantial effects of all factors (organizational, departmental, and individual factors) on lean adoption, quality of service, cost containment, and time management (p value<.001). CONCLUSION: Lean management adoption had a significant impact on quality of service, cost containment, and time management in oncology settings.

Laparoscopic Partial Nephrectomy: Off-Clamp Versus on Clamp.

PURPOSE: The aim of this study is to describe our experience in laparoscopic partial nephrectomy and to compare the differences between off-clamp and on-clamp techniques in terms of clinical characteristics and outcomes. METHODS: A retrospective study was utilized. A purposeful sampling method was used to select the patients. The inclusion criteria for kidney tumors were as follows: exophytic, maximum diameter 3 cm, RENAL score 4 or more, solid or cystic, and suspected of malignancy. Around 32 participants were selected. The data were collected from patient files. RESULTS: There were no statistically significant differences between the mean of the off-clamp group and the on-clamp group in terms of tumor size, size of the kidney, and the position of the tumor. The average expected blood loss in the off-clamp group was 150.15 +/- 60.25 mL and in the on-clamp group was 75.25+/- 40.11 mL, with a p-value of less than 0.001. There was no statistically significant difference between the two groups in terms of the most common surgical complications, postoperative drainage, overall operation time, renorrhaphy time, and postoperative bedtime. CONCLUSION: The off-clamp group was shown to have a higher tumor resection duration as well as a higher rate of expected blood loss. The functional result of alterations in the estimated glomerular filtration rate seemed to be better in the off-clamp group. We expect to understand its long-term safety and oncological efficacy better as we continue to use this method.

Urinary bladder pheochromocytoma managed with TURBT. Case report and review of literature.

Bladder pheochromocytomas are rare catecholamine-secreting tumours of chromaffin cells. Sympathetic system stimulation due to Catecholamine over secretion during micturation is the most common presentation. Unsuspected bladder pheochromocytoma can result in hypertensive crisis during transurethral resection of bladder tumor (TURBT). In contrast to the urothelial tumours, bladder pheochromocytomas are hypervascular on enhanced CT scan. In this article we report a case of pheochromocytoma managed successfully by TURBT and followed up for 1 year.