A Surgical Complexity Factor for Clefts of Primary and Secondary Palates.

The surgical treatment of patients with cleft lip and palate depends on the characteristics of the affected anatomical structures (palate, lip and nose). The objective of this work was to develop a quantified classification for these clefts, to represent their surgical complexity. This work was developed with the team of surgeons of the SUMA Cleft Leadership Center (CLC) Smile Train Mexico. The method of Multiple-Criteria Decision Analysis was applied using the Analytic Hierarchy Approach. A surgical complexity factor associated with each cleft was defined and it was validated in a sample of fifty patients treated at the SUMA-CLC.Clinical Relevance- A quantitative classification that represents the surgical complexity of clefts provides an objective unified criteria for planning the surgical treatment of patients, as well as having standardized procedures for the surgical treatment of patients.

Estado del Arte de la Evaluación de Tecnologías en Salud en América Latina / State of the Art of the Evaluation of Health Technologies in Latin America

Resumen El surgimiento y desarrollo de las tecnologías en salud ha hecho que se intensifique el papel de su evaluación en los últimos años, provocando un interés creciente en la Evaluación de Tecnologías en Salud (ETES) en América Latina, a través de intentos por proporcionar información útil al tomador de decisiones. Este artículo presenta una revisión del estado del arte de ETES en Latinoamérica, a partir del análisis de publicaciones en revistas y eventos especializados. Se abordaron tres aspectos: elementos de evaluación, métodos que se aplican y políticas resultantes. Se encontraron los siguientes aspectos de evaluación: seguridad, eficacia, efectividad y eficiencia, económico-financieros, clínicos y técnicos, estos últimos con mayor desarrollo. Con respecto a los métodos, se encontraron propuestas de estrategias empíricas para el análisis de la información y la toma de decisiones. La generación de políticas públicas relacionadas con la ETES en América Latina es incipiente, apenas se están identificando las problemáticas nacionales y las estrategias a seguir para su solución. Por lo tanto, se aprecia una necesidad de seguir trabajando en el desarrollo de políticas, estrategias y métodos de ETES en la región Latinoamericana que permitan responder a las problemáticas en salud de la población de cada país.

Abstract The emergence and development of health technologies have intensified the role of their evaluation in recent years, causing a growing interest in the Evaluation of Health Technologies (ETES) in Latin America, through attempts to provide useful information to the decision-maker. This article presents a review of the state of the art of ETES in Latin America, from the analysis of publications in journals and specific events. Three aspects were addressed: evaluation elements, methods that are applied, and resulting policies. The following evaluation aspects were found: safety, efficacy, effectiveness and efficiency, economic-financial, clinical and technical, the latter with more significant development. Concerning the methods, proposals for empirical strategies for the analysis of information and decision making were found. The generation of public policies related to the HTA in Latin America is under development, national problems are hardly being identified, and the strategies to be followed for their solution. Therefore, there is a need to continue working on the development of policies, and methods of HTA in the Latin American region that allow responding to the health problems of the population of each country.

An assessment strategy for proposals of engineering projects in the Bachelor of Biomedical Engineering Curriculum at Universidad Autónoma Metropolitana-Iztapalapa.

Since 1974, the Bachelor of Biomedical Engineering Program (BBME) is offered at Universidad Autónoma Metropolitana-Iztapalapa, in Mexico City. By design, it must be completed in four years (12 trimesters) and, in the latter three, the senior students work on a BME project, which is done by completing three modules: Project Seminar (PS), Project on BME I and Project on BME II. In the PS module, the student must find a problem of interest in the BME field and suggest a solution through the development of an Engineering Project Proposal (EPP). Currently, the module is being taught by two faculty members of the BBME, who instruct students on how to develop their EPPs and evaluate their progress by reviewing a number of EPPs during the trimester. This generates a huge workload for the module instructors, which makes it necessary to involve more faculty members trimester-to-trimester (i.e. every 12 weeks) and, therefore, to create a set of systematic guidelines that ease the evaluation process for new instructors. Hence, the purpose of this paper is to present an assessment strategy (in the form of an assessment matrix) for the PS module as well as some preliminary results after two trimesters of its implementation.

Improving the drug dispensing process at the National Institute of respiratory diseases by applying the six sigma methodology.

The purpose of this work was to improve the drug dispensing process at the National Institute of Respiratory Diseases of Mexico by applying the six sigma methodology, identifying the non-value added activities as well as the areas of opportunity, in order to make proposals to ensure the supply of prescription drugs to the patient in a timely manner. Seven variables were defined and three indicators were generated, which were implemented in three clinical services of the Institute to measure the current performance of the drug distribution process. With the obtained results, a proposed set of eight improvements were subsequently implemented in a pilot program.

Learning curves of the X Ray innovated process in the imaging Department of the National Institute of Respiratory Diseases, Mexico.

The impact within a known process due to the introduction of new technology may entail many factors such as workflow modification, increase of wait time, modification in service quality, and even cultural changes. The inclusion of these factors into a process affects its performance, but the implementation of innovations may counteract the impact and could even enhance the process. The objective of this work was to evaluate the impact of the innovations implemented in the X Ray process by the estimation of the learning curves and the estimated time in which the maximum learning may be reached.

Improvement of the health technology management process of the public Health Service in Morelos using the Six Sigma methodology.

The purpose of this study was to make a proposal to improve the management process of the health technology within the Health Service at Morelos State, México, using the five stages of Six Sigma methodology: Definition, Measurement, Analysis, Improvement and Control. Up to date these five steps have been executed resulting in a set of proposals to improve the current health technology management process. This will allow the establishment of a medical equipment control program that impacts the three levels of Health Care Service in Morelos State in Mexico.

A mathematical function to evaluate surgical complexity of cleft lip and palate.

The objective of this work is to show the modeling of a similarity function adapted to the medical environment using the logical-combinatorial approach of pattern recognition theory, and its application comparing the condition of patients with congenital malformations in the lip and/or palate, which are called cleft-primary palate and/or cleft-secondary palate, respectively. The similarity function is defined by the comparison criteria determined for each variable, taking into account their type (qualitative or quantitative), their domain and their initial space representation. In all, we defined 18 variables, with their domains and six different comparison criteria (fuzzy and absolute difference type). The model includes, further, the importance of every variable as well as a weight which reflects the surgical complexity of the cleft. Likewise, the usefulness of this function is shown by calculating the similarity among three patients. This work was developed jointly with the Cleft Palate Team at the Reconstructive Surgery Service of the Pediatric Hospital of Tacubaya, which belongs to the Health Institute of the Federal District in Mexico City.

Indicators to estimate radiographic film savings due to a PACS in a Mexican health institute.

The scope of this paper is to evaluate the impact of PACS implementation in radiographic film (RF) savings at the Imaging Department at the National Institute of Respiratory Diseases in Mexico City, considering both Computed Tomography (CT) and Computed Radiography (CR) modalities. The PACS at the INER was installed in 2006, and the CT and CR have been operating entirely digitally since then. Therefore, the document evaluate three different periods, before the arriving of the PACS (2005), during the PACS installation (2006) and after PACS (2007). A set of indicators were designed to measure and visualize the impact of the PACS in the RF savings. Two templates are provided to define and to apply each one of the indicators proposed.

Lean Six Sigma applied to a process innovation in a mexican health institute's imaging department.

Delivery of services to a patient has to be given with an acceptable measure of quality that can be monitored through the patient's satisfaction. The objective of this work was to innovate processes eliminating waste and non value-added work in processes done at the Imaging Department in the National Institute of Respiratory Diseases (INER for its Spanish acronym) in Mexico City, to decrease the time a patient spends in a study and increase satisfaction. This innovation will be done using Lean Six Sigma tools and applied in a pilot program.

PACS: reengineering workflow in the Imaging Department of a National Health Institute in Mexico.

The National Institute of Respiratory Diseases (INER) recently acquired a PACS-RIS system. Its installation has caused the need to modify some processes related to the imaging department. The objective of this work was to identify all steps involved in the appointment set up process <--> image scanning <--> radiological diagnostic process as well as to detect operational problems in two imaging modalities: X-Ray and Tomography, and to propose a solution in order to get the optimal use of the PACS-RIS system.

The choice to go digital: a guideline for using PACS in countries receptive to technology.

Countries receptive to technology are those who absorb and adapt knowledge coming from developed countries. Their capability for assimilating technology depends on factors related with the availability of facilities, financial resources and even, cultural differences. In order to prevent adverse events in the usage of the technology, it is important to analyze and to evaluate these factors. The objective of this work was to identify and to analyze the elements involved in the performance and use of a PACS, and to provide a guideline for its implementation in healthcare systems of countries receptive to technology based on the use of PACS in Mexico.

Electrical safety priority index for medical equipment.

Due to the wide variety of equipment existing in clinical areas, there is an important question: which and how often electrical safety tests most be applied to the medical equipment. There are important differences about the electrical safety, such as the electrical insulation or the hazard considering the connection between patient and electrical instrumentation. The objective of this work was to develop an Electrical Safety Priority Index for Medical Equipment(ESPIME) involving different classifications related with electrical safety, in order to provide a numeric code indicating the priority and frequency for applying the electrical safety tests to medical equipment. The index were applied to the medical equipment in critical care locations and the result,were used to defined which set of medical equipment would be the first for developing and applying electrical safety tests in a private hospital in Mexico City.

A similarity function to evaluate the orthodontic condition in patients with cleft lip and palate.

The objective of this work is the modeling of a similarity function adapted to the medical environment using the logical-combinatorial approach of pattern recognition theory, and its application to compare the orthodontic conditions of patients with cleft-primary palate and/or cleft-secondary palate congenital malformations. The variables in domains with no a priori algebraic or topological structure are objects whose similarity or difference is evaluated by comparison criteria functions. The range of these functions is an ordered set normalized into the unit interval, and they are designed to allow differentiation and non-uniform treatment of the object-variables. The analogy between objects is formalized as a similarity function that stresses the relations among the comparison criteria and evaluates the partial descriptions (partial similarity/difference) or total descriptions (total similarity/difference) of the objects. For the orthodontic problem we defined a set of 12 variables featuring the unilateral/bilateral fissures, the conditions of maxilla, premaxilla, mandible and patient's bite. The comparison criteria (logical for malocclusion, fuzzy for maxillary collapse unilateral/anteroposterior and for overbite, and Boolean for protrusive/retrusive premaxilla conditions) were assigned a relevance factor based on the orthodontist accumulated knowledge and experience. The modeling of the similarity function and its effectiveness in comparing orthodontic conditions in patients are illustrated by the study of four clinical cases with different clefts. The results through similarity are close to the expected ones. Moreover evaluated at different moments it allows to assess the effect of treatment in a single patient, hence providing valuable auxiliary criteria for medical decision making as to the patient's rehabilitation. We include the potential extension of the methodology to other medical disciplines such as speech therapy and reconstructive surgery.

Una estrategia de evaluación para equipo de laboratorio basada en indicadores / An evaluation strategy for laboratory equipment based on indicators

The objective of this work was to develop an evaluation strategy for laboratory equipment on 18 indicators classified into four evaluation levels. 1) Equipment functionality. 2) Biomedical engineering department. 3) Equipment impact at the service and 4) Associated costs with the equipment...

A new approach to classify cleft lip and palate.

OBJECTIVE: To propose a new method, which allows for a complete description of primary and secondary cleft palates, incorporating elements that are related to the palate, lip, and nose that will also reflect the complexity of this problem. METHOD: To describe the type of cleft, two embryonic structures were considered: (1) the primary palate, formed by the prolabium, premaxilla, and columella and (2) the secondary palate, which begins at the incisive foramen and is formed by a horizontal portion of the maxilla, the horizontal portion of the palatine bones, and the soft palate. Anatomical characteristics to be considered were defined, and a new method is proposed to more fully describe any cleft. RESULTS: A description of five cases was made using the method proposed in this work and compared with other published methods for the classification and description of clefts. CONCLUSIONS: A mathematical expression was developed to characterize clefts of the primary palate, including the magnitude of palatal segment separation and the added complexity of bilateral clefts, yielding a numerical score that reflects overall complexity of the cleft. Clefts of the secondary palate are also considered in a separate score. Using this method, it is possible to incorporate elements that are not considered in other approaches and to describe all possible clefts that may exist.

A new approach to differential diagnosis of diseases.

The main goal of this paper is to show the usefulness of the logic-combinatory approach in pattern recognition theory for developing auxiliary criteria for differential medical diagnosis, based on the methodology presented by Heathfield et al. (J Biomed Eng 13 (1991) 51-57). Firstly, we propose a change in the characterization base, from disease characterization to patient characterization then, we suggest a k-valued treatment for variables which allows us to assign them values in a wider range in order to represent different degrees in symptom manifestations. Secondly, the methodology proposed is based on Testor Theory. This theory allows us to obtain the minimum combination of features (symptoms) and the set of features combination equally discriminant (typical testors) among the diseases considered. Then, applying some classification algorithm that uses typical testors, physicians will have more making differential flexibility diagnosis.