RESUMO
BACKGROUND: Multiple training modalities for laparoscopy have different advantages, but little research has been conducted on the benefit of a training program that includes multiple different training methods compared to one method only. This study aimed to evaluate benefits of a combined multi-modality training program for surgical residents. METHODS: Laparoscopic cholecystectomy (LC) was performed on a porcine liver as the pre-test. Randomization was stratified for experience to the multi-modality Training group (12 h of training on Virtual Reality (VR) and box trainer) or Control group (no training). The post-test consisted of a VR LC and porcine LC. Performance was rated with the Global Operative Assessment of Laparoscopic Skills (GOALS) score by blinded experts. RESULTS: Training (n = 33) and Control (n = 31) were similar in the pre-test (GOALS: 13.7 ± 3.4 vs. 14.7 ± 2.6; p = 0.198; operation time 57.0 ± 18.1 vs. 63.4 ± 17.5 min; p = 0.191). In the post-test porcine LC, Training had improved GOALS scores (+ 2.84 ± 2.85 points, p < 0.001), while Control did not (+ 0.55 ± 2.34 points, p = 0.154). Operation time in the post-test was shorter for Training vs. Control (40.0 ± 17.0 vs. 55.0 ± 22.2 min; p = 0.012). Junior residents improved GOALS scores to the level of senior residents (pre-test: 13.7 ± 2.7 vs. 18.3 ± 2.9; p = 0.010; post-test: 15.5 ± 3.4 vs. 18.8 ± 3.8; p = 0.120) but senior residents remained faster (50.1 ± 20.6 vs. 25.0 ± 1.9 min; p < 0.001). No differences were found between groups on the post-test VR trainer. CONCLUSIONS: Structured multi-modality training is beneficial for novices to improve basics and overcome the initial learning curve in laparoscopy as well as to decrease operation time for LCs in different stages of experience. Future studies should evaluate multi-modality training in comparison with single modalities. TRIAL REGISTRATION: German Clinical Trials Register DRKS00011040.
Assuntos
Colecistectomia Laparoscópica/educação , Competência Clínica , Simulação por Computador , Currículo , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Adulto , Feminino , Humanos , Curva de Aprendizado , MasculinoRESUMO
BACKGROUND: The value of virtual reality (VR) simulators for robot-assisted surgery (RAS) for skill assessment and training of surgeons has not been established. This systematic review and meta-analysis aimed to identify evidence on transferability of surgical skills acquired on robotic VR simulators to the operating room and the predictive value of robotic VR simulator performance for intraoperative performance. METHODS: MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science were searched systematically. Risk of bias was assessed using the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale for Education. Correlation coefficients were chosen as effect measure and pooled using the inverse-variance weighting approach. A random-effects model was applied to estimate the summary effect. RESULTS: A total of 14 131 potential articles were identified; there were eight studies eligible for qualitative and three for quantitative analysis. Three of four studies demonstrated transfer of surgical skills from robotic VR simulators to the operating room measured by time and technical surgical performance. Two of three studies found significant positive correlations between robotic VR simulator performance and intraoperative technical surgical performance; quantitative analysis revealed a positive combined correlation (r = 0.67, 95 per cent c.i. 0.22 to 0.88). CONCLUSION: Technical surgical skills acquired through robotic VR simulator training can be transferred to the operating room, and operating room performance seems to be predictable by robotic VR simulator performance. VR training can therefore be justified before operating on patients.
Assuntos
Competência Clínica , Procedimentos Cirúrgicos Robóticos/educação , Treinamento por Simulação , Realidade Virtual , Humanos , Estudos de Validação como AssuntoRESUMO
OBJECTIVE: To evaluate the use of percutaneous electrical nerve stimulation (PENS) in the management of patients with painful diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS: A total of 50 adult patients with type 2 diabetes and peripheral neuropathic pain of >6 months duration involving the lower extremities were randomly assigned to receive active PENS (needles with electrical stimulation at an alternating frequency of 15 and 30 Hz) and sham (needles only) treatments for 3 weeks. Each series of treatments was administered for 30 min three times a week according to a standardized protocol. After a 1-week washout period, all patients were subsequently switched to the other modality. A 10-cm visual analog scale (VAS) was used to assess pain, physical activity, and quality of sleep before each session. The changes in VAS scores and daily requirements for oral analgesic medication were determined during each 3-week treatment period. Patients completed the MOS 36-Item Short-Form Health Survey (SF-36), the Beck Depression Inventory (BDI), and the Profile of Mood States (POMS) before and after completion of each treatment modality. At the end of the crossover study, a patient preference questionnaire was used to compare the effectiveness of the two modalities. RESULTS: Compared with the pain VAS scores before active (6.2 +/- 1.0) and sham (6.4 +/- 0.9) treatments, pain scores after treatment were reduced to 2.5 +/- 0.8 and 6.3 +/- 1.1, respectively. With active PENS treatment, the VAS activity and sleep scores were significantly improved from 5.2 +/- 1.0 and 5.8 +/- 1.3 to 7.9 +/- 1.0 and 8.3 +/- 0.7, respectively. The VAS scores for pain, activity, and sleep were unchanged from baseline values after the sham treatments. Patients' daily oral nonopioid analgesic requirements decreased by 49 and 14% after active and sham PENS treatments, respectively. The post-treatment physical and mental components of the SF-36, the BDI, and the POMS all showed a significantly greater improvement with active versus sham treatments. Active PENS treatment improved the neuropathic pain symptoms in all patients. CONCLUSIONS: PENS is a useful nonpharmacological therapeutic modality for treating diabetic neuropathic pain. In addition to decreasing extremity pain, PENS therapy improved physical activity, sense of well-being, and quality of sleep while reducing the need for oral nonopioid analgesic medication.
Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Neuropatias Diabéticas/fisiopatologia , Manejo da Dor , Doenças do Sistema Nervoso Periférico/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Idoso , Neuropatias Diabéticas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Dor/psicologia , Medição da Dor , Doenças do Sistema Nervoso Periférico/terapiaRESUMO
A group of 109 HIV seropositive and 51 seronegative intravenous drug users was evaluated for the presence of HIV-1-related neurologic disease using clinical, neurologic, neuropsychological, and electrophysiologic evaluations. About 80% of HIV seropositive subjects had less than two constitutional symptoms. CD4 cell counts were less than 500/mm3 among 56% of seropositive participants; three individuals were receiving zidovudine. Neurologic abnormalities were found frequently among the cohort, independently of HIV-1 serostatus; electrophysiologic abnormalities were uncommon. Participants from both serologic groups scored significantly lower on neuropsychological tests as compared with norms established for a cohort of homosexual men, and there was no clear association between HIV-1 serostatus and performance on these tests. This study suggests that HIV infection was not the dominant cause of neurologic abnormalities among the study cohort.
Assuntos
Infecções por HIV/fisiopatologia , HIV-1 , Doenças do Sistema Nervoso/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Análise de Variância , Estudos Transversais , Feminino , Infecções por HIV/etiologia , Infecções por HIV/psicologia , Humanos , Masculino , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/psicologia , Condução Nervosa/fisiologia , Testes Neuropsicológicos , Abuso de Substâncias por Via Intravenosa/fisiopatologia , Abuso de Substâncias por Via Intravenosa/psicologiaRESUMO
BACKGROUND: In the 1970s a new approach to the delivery of hormonal contraception was researched and developed. It was suggested that the addition of a progestogen to a non-medicated contraceptive device improved its contraceptive action. An advantage of these hormonally impregnated intrauterine systems (IUS) is that they are relatively maintenance free, with users having to consciously discontinue using them to become pregnant rather than taking a proactive daily decision to avoid conception. OBJECTIVES: To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY: Literature was identified through database searches, reference lists and individuals/organisations working in the field. Searches covered the period from 1972 to November 2003. SELECTION CRITERIA: All randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate. DATA COLLECTION AND ANALYSIS: The quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs <=250mm2 (i.e. Nova-T, Multiload, CuT 200 and CuT 220 IUDs) and non-medicated IUDs. MAIN RESULTS: Twenty-one RCTs comparing hormonally impregnated IUSs to a reversible contraceptive method met the inclusion criteria and it was possible to include eight of these in the meta-analyses, four comparing LNG-20 IUSs with non-hormonal IUDs, one comparing the LNG-20 IUS with Norplant-2 and three comparing Progestasert with non-hormonal IUDs. No significant difference was observed between the pregnancy rates for the LNG-20 users and those for the IUD >250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD <=250mm2. Women using the LNG-20 IUS were more likely to experience amenorrhoea and device expulsion than women using IUDs >250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant difference was noted for these two outcomes when Progestasert users were compared to IUD<=250mm2 users. The only other significant differences found in the meta-analyses were that Progestasert users were less likely to expel the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2. REVIEWERS' CONCLUSIONl the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2. REVIEWERS' CONCLUSIONS: Current evidence suggests LNG-20 IUS users are no more or less likely to have unwanted pregnancies than IUD >250mm2 and Norplant-2 users. The LNG-20 IUS was more effective in preventing either intrauterine or extrauterine pregnancies than IUDs <=250mm2. The contraceptive effectiveness of Progestasert was significantly better than non-medicated IUDs, but no difference was observed when compared to IUDs<=250mm2. Continuation of LNG-20 IUS use was similar to continuation of the non-hormonal IUDs and Norplant-2. Amenorrhoea was the main reason for the discontinuation for the LNG-20 IUS and women should be informed of this prior to starting this method.
Assuntos
Anticoncepcionais Femininos/administração & dosagem , Dispositivos Intrauterinos Medicados , Feminino , Humanos , Dispositivos Intrauterinos Medicados/efeitos adversos , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY: Literature was identified through database searches, reference lists and individuals/organisations working in the field. SELECTION CRITERIA: All randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate. DATA COLLECTION AND ANALYSIS: The quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs <=250mm2 (i.e. Nova-T, Multiload, CuT 200 and CuT 220 IUDs) and non-medicated IUDs. MAIN RESULTS: Nineteen RCTs comparing hormonally impregnated IUSs to a reversible contraceptive method met the inclusion criteria and it was possible to include eight of these in the meta-analyses, four comparing LNG-20 IUSs with non-hormonal IUDs, one comparing the LNG-20 IUS with Norplant-2 and three comparing Progestasert with non-hormonal IUDs. No significant difference was observed between the pregnancy rates for the LNG-20 users and those for the IUD >250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD <=250mm2. Women using the LNG-20 IUS were more likely to experience amenorrhoea and device expulsion than women using IUDs >250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant differences was noted for these two outcomes when Progestasert users were compared to IUD<=250mm2 users. The only other significant differences found in the meta-analyses were that Progestasert users were less likely to expel the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2. REVIEWER'S CONCLUSIONS: Current evidence suggests LNG-20 IUS users are no more or less likely to have unwanted pregnancies than IUD >250mm2 and Norplant-2 users. The LNG-20 IUS was more effective in preventing either intrauterine or extrauterine pregnancies than IUDs <=250mm2. The contraceptive effectiveness of Progestasert was significantly better than non-medicated IUDs, but no difference was observed when compared to IUDs<=250mm2. Continuation of LNG-20 IUS use was similar to continuation of the non-hormonal IUDs and Norplant-2. Amenorrhoea was the main reason for the discontinuation for the LNG-20 IUS and women should be informed of this prior to starting this method.
Assuntos
Anticoncepcionais Femininos/administração & dosagem , Dispositivos Intrauterinos Medicados , Feminino , Humanos , Dispositivos Intrauterinos Medicados/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: To describe strategies used by tutors teaching adults with learning disabilities to use desktop virtual environments and to investigate their effectiveness by examining changes over time in tutor and learner behaviour. METHOD: Twenty adults with learning disabilities spent 12 sessions with one of four non-disabled tutors learning to use desktop virtual environments designed to teach independent living skills. Sessions were recorded on videotape, categories of behaviour were described and tapes analysed for frequency of tutor behaviours and goals achieved by learners. RESULTS: Tutor strategies were described in terms of whether they aimed to help the learner master the interaction devices or to navigate and achieve goals in the virtual environments and how directive they were. There were some differences between tutors but this did not relate to whether tutors were experienced users themselves of the environments or were initially unfamiliar with them. Goal achievement was maintained at a constant level while help with the interaction devices and specific information about the environment decreased over repeated sessions. Rates of non-specific information did not change. CONCLUSIONS: Pretraining with the interaction devices would free both tutor and learner to concentrate on achieving goals in the environments. Much of the specific help given by the tutor could be incorporated into the software.
Assuntos
Deficiências da Aprendizagem/reabilitação , Ensino/métodos , Interface Usuário-Computador , Adulto , Idoso , Estudos de Coortes , Instrução por Computador , Avaliação Educacional , Meio Ambiente , Feminino , Humanos , Deficiências da Aprendizagem/diagnóstico , Masculino , Mentores , Pessoa de Meia-Idade , Estudos de Amostragem , Sensibilidade e EspecificidadeRESUMO
To ascertain the extent of impacts from CCA-treated wood bulkheads, we sampled sediments along 10-m transects from these bulkheads and from reference sites (either bulkheads made of other materials or unbulkheaded areas nearby) and analyzed the fine fraction for metals. We ascertained metal content in resident biota, and analyzed species richness, Shannon-Wiener diversity index, and biomass of the benthic community. We found accumulation of metals in the fine-grained portion of nearby sediments and reduction in the biotic community nearby (generally at 0 and 1 m); such gradients were generally not seen in reference transects. At two of the sites there was evidence for secondary reduction of the community out further to 3 or 10 m, where the metals in the fines were lower but the percent fines was greatly increased. At all the other sites, impacts were generally limited to 0 and 1 m. The lack of reduction at further distances at the other sites is attributed to factors such as the age of the bulkheads, high energy of the environment, or nature of the sediments at those sites.
RESUMO
The purpose of this study was to examine the relationship between trait anxiety and patients' evaluation of information they received during hospitalization post-myocardial infarction (MI), and to test the extent to which state anxiety and gender moderate this relationship. At the time of discharge from the hospital, 68 adult men and women who had had an MI responded to a demographic data sheet and to instruments measuring state anxiety, trait anxiety, and the quality of information they received during hospitalization. Data analysis indicated that the higher their trait anxiety, the less positively patients rated the quality of information they received during hospitalization post-MI. A series of regression analysis procedures designed to test for moderation indicated that neither state anxiety nor gender had a moderator effect on the relationship between trait anxiety and the quality of information received. The findings are interpreted within the theoretical perspectives that guided the study. Clinical implications of the findings are discussed.
Assuntos
Ansiedade/prevenção & controle , Ansiedade/psicologia , Infarto do Miocárdio/psicologia , Educação de Pacientes como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e QuestionáriosRESUMO
This study examined the hospital process variables of nursing care, medical care, information, and hospital environment, as evaluated by patients, in relation to their outcome post-myocardial infarction (MI). The sample included 68 hospitalized men and women, aged 29-92, who were diagnosed with an MI. At the time of discharge, they responded to four subscales of the Patient Judgment of Hospital Quality Questionnaire, which measured the hospital process variables, and the Revised Haussman and Hegyvary Outcome Criteria Instrument for Acute Myocardial Infarction, which measured patient outcome post-MI. Data also were collected from patient charts and nurses. Correlational analyses revealed statistically significant relationships between nursing care and patient outcome, and between hospital environment and patient outcome; neither medical care nor information correlated appreciably with patient outcome post-MI. Regression analysis indicated that nursing care was the only significant predictor of patient outcome post-MI.
Assuntos
Infarto do Miocárdio/enfermagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Ambiente de Instituições de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Relações Médico-Paciente , Competência Profissional , Análise de Regressão , Estados UnidosRESUMO
For years low sodium diets have been recommended in the treatment of Ménière's syndrome. Elevated levels of insulin play an important role in sodium retention in renal tubules. Insulin production is stimulated by high carbohydrate diets. Adrenaline, cortisone, and glucagon levels may be increased by stress or food or inhalant allergies, further elevating insulin levels. The end result of prolonged hyperinsulinemia includes vasoconstriction and eventually arterial smooth muscle hypertrophy. Individual susceptibility to Ménière's syndrome may occur as a result of inflammatory changes in the endolymphatic sac or cochlear aqueduct secondary to primary or latent viral infections, thus predisposing to fluid retention. Long term medical treatment of Ménière's should be directed towards preventing sodium retention through sodium restriction and carbohydrate management. Other factors including stress and allergy should also be considered.
Assuntos
Carboidratos da Dieta/administração & dosagem , Edema/dietoterapia , Edema/etiologia , Doença de Meniere/complicações , Edema/sangue , Feminino , Humanos , Masculino , Doença de Meniere/sangue , Pessoa de Meia-IdadeRESUMO
The needs of the chronically sick are not acknowledged under the Income Support system introduced by the Department of Social Security in April '88. A year has now passed and the difficulties and shortfalls of the new system have become clear.
RESUMO
Ovarian hormones, including progesterone, are known to have immunomodulatory and neuroprotective effects which may alter the disease course of experimental autoimmune encephalomyelitis (EAE). In the current study, we examined the treatment potential of progesterone beginning at the onset of EAE symptoms. Progesterone treated animals showed reduced peak disease scores and cumulative disease indices, and decreased inflammatory cytokine secretion (IL-2 and IL-17). In addition, increased production of IL-10 was accompanied by increased numbers of CD19+ cells and an increase in CD8+ cells. Decreased chemokine and chemokine receptor expression in the spinal cord also contributed to decreased lesions in the spinal cord.
Assuntos
Encefalomielite Autoimune Experimental/tratamento farmacológico , Encefalomielite Autoimune Experimental/imunologia , Interleucina-10/metabolismo , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/imunologia , Progesterona/farmacologia , Animais , Antígenos CD19/imunologia , Biomarcadores/análise , Biomarcadores/sangue , Antígenos CD8/imunologia , Proliferação de Células/efeitos dos fármacos , Quimiocinas/efeitos dos fármacos , Quimiocinas/metabolismo , Modelos Animais de Doenças , Encefalomielite Autoimune Experimental/sangue , Feminino , Fatores Imunológicos/farmacologia , Fatores Imunológicos/uso terapêutico , Interleucina-10/sangue , Interleucina-17/sangue , Interleucina-17/metabolismo , Interleucina-2/sangue , Interleucina-2/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Esclerose Múltipla/sangue , Progesterona/uso terapêutico , Progestinas/farmacologia , Progestinas/uso terapêutico , Receptores de Quimiocinas/efeitos dos fármacos , Receptores de Quimiocinas/metabolismo , Medula Espinal/efeitos dos fármacos , Medula Espinal/imunologia , Medula Espinal/patologia , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Resultado do Tratamento , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/imunologiaAssuntos
Transtornos do Crescimento/etiologia , Seio Maxilar/crescimento & desenvolvimento , Sinusite Maxilar/complicações , Antibacterianos/uso terapêutico , Pré-Escolar , Doença Crônica , Terapia Combinada , Transtornos do Crescimento/diagnóstico por imagem , Humanos , Masculino , Sinusite Maxilar/cirurgia , Tomografia Computadorizada por Raios X , Falha de TratamentoRESUMO
Surgical treatment can be planned well in advance or arrive in a near emergency. If careful control is not exercised there is always the possibility that patients may suffer as a result. Discrete event simulation is an effective tool which can be used to find the most efficient ways of managing such a service's timetable. Examines the application of a desktop computer simulation package to model the work of a cardiac diagnosis and treatment system. The simulation package suggests how efficiency might be improved by moderating times taken to complete activities and staff and other resources required to perform the activities. Suggests the principles outlined can be readily expanded into a more complex model.
Assuntos
Serviço Hospitalar de Cardiologia/organização & administração , Simulação por Computador , Doença das Coronárias/terapia , Doença Aguda , Cardiologia , Doença das Coronárias/cirurgia , Recursos em Saúde/organização & administração , Humanos , Microcomputadores , Software/normas , Design de Software , Terapia Assistida por Computador , Fatores de Tempo , Reino Unido , Recursos HumanosRESUMO
Health care costs continue to rise because increased demand for services and limited budgets put pressure on resources, however efficiently they may be used. Proposes discrete event simulation as an effective tool in the search for more efficient health care systems. Looks at the application of a desktop computer simulation package to model part of a hospital subsystem. The simulation package shows how efficiency might be improved by moderating available resources and times taken to complete tasks. Maintains that the principles expounded here are applicable to many different aspects of health care management.
Assuntos
Simulação por Computador , Administração Hospitalar , Eficiência Organizacional , Software , Reino UnidoRESUMO
Organisations operate within a three-tiered environment--internal, micro and macro. The environment is a powerful force acting upon the effectiveness of strategic decision making. Failure to take cognisance of the influence of the three-tiered environment can have disastrous consequences. The cross-impact matrix and the TOWS matrix are two strategic decision-making aids that improve effective decision making. When used in conjunction with creative problem solving methods they can provide the basis of a powerful management tool.
Assuntos
Tomada de Decisões Gerenciais , Marketing de Serviços de Saúde/organização & administração , Técnicas de Planejamento , Setor de Assistência à Saúde/organização & administração , Inovação Organizacional , Objetivos Organizacionais , Resolução de Problemas , Avaliação de Programas e Projetos de Saúde/métodos , Medicina Estatal/organização & administração , Reino UnidoRESUMO
This study involved elderly patients with Meniere's disease with incapacitating vertigo. Several of these patients underwent surgery for relief of symptoms that was tailored to the individual's general health and degree of physical activity. Factors that might affect postoperative rehabilitation and recovery were considered, including vision, vertebrobasilar ischemia, proprioception (such as neuropathy resulting from diabetes), and basal ganglia disease. The postoperative results of this tailored approach have been completely satisfactory.